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Home My WebLink AboutPermit Building 2004-9-21 I: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line . * .- CITY OF SPRINGFIELD' , Building/Combination Permit PERMIT NO: COM2004-00984 ISSUED: 09/21/2004 APPLIED: 08/10/2004 EXPIRES: 03/21/2005 VALUE: $ 151,698.00 SITE ADDRESS: 3846 Long Ridge Dr ASSESSOR'S PARCEL NO,: 1802061310006 Springfield TYPE OF WORK: Single Family Residence .,.......... TYPE OF USE: New Residential PROJECT DESCRIPTION: Single Family Residence Owner: KIDDER THOMAS V Address: 827 SPYGLASS DR EUGENE OR 97401 '(17178(;-(;88-008-l S! J81U8:) UO!IB::>!II)ON AI!I!ln u06aJO a~l JOI J8qwnu . _ ._. ...........^. ....., n 0,-::a"'''1' 'J~lIJa:::> aUI 5U1l1e:::> Contractor Type General Electrical Mechanical Plumbing - - - - ',' -:,. - -"lido::> ulBlqo ABW no" '0600 , CONTRACTOR 1~~t.':n'110J416l00-l00-ZS61:l'1fO U! 4l.101Ia~EIi!'el\~bnJ as<tW,..:J8Itl8:J jf!\B::>!l!~~one NlIlln U008JO 841 Atj'~\~pl!q"fll\ ~Oll r' .. ~ S8llnh8l Mel U068JO :NOIIN311V o~ nO'ItiU50lr 07/lJ112lJl)j) 541-434-6491 25790 12/23/2005 541-747-7445 147744 05/14/2005 541-935-1081 Contractor OWNER BURGHARDT & ZHUN INC MARSHALLS INC BARON PLUMBING INC # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: 1 R-3 U-l VN 3 20.00 17,80 7.00 23,30 10,00 BUILDING INFORMATION I .: '1 # of Stories:,r." 1 Lot Size: I'C I)' ""- Height of Stnicture 17,00 Sq Ft 1st Floor: Type 6iH~a't:':R'oi'ce~' Air, 'Flffi~ Sq Ft 2nd Floor: Wateh'YI";:'HILtU iJ E1.fctricRE IlSqljtB'IU~t: ' Rang;it~i:it;ENCED ol~ut~I,~c,tric [JtF~!Ii~~9~~rf:f/Carport Encr.gylfaf~:Q. nA IS fP.ath"llJONS", FtOtlier: Sprinkled Bu"din~ PERJOD,n/a b~cWli'nt Load: 1,520 463 I DEVELOPMENT INFORMATION' REQUIRED PARKING Total: 2 Handicapped: Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 2 Yes 29,60 I PUBLIC IMPROVEMENTS' Sidewalk Type: DownspoutsfDrains: Fully Improved Yes Storm drainage to weephole to curb Notes: Curbside 5' Curb and Gutter Paee 1 of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspedion Line Description Tvpe of Construction Dwellin!!s Gara!!e V Wood Frame Gara!!e . I Valuation Descrintinn , $ Per Sq Ft or multiplier $92,40 $24,30 Square Footage or Bid Amount 1,520,00 463,00 Total Value of Project )?pp<. PiWLI . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00984 ISSUED: 09/21/2004 APPLIED: 08/10/2004 EXPIRES: 03/21/2005 VALUE: $ 151,698.00 Value Date Calculated $140,448.00 $11,250,90 $151,698,90 08/10/2004 08/10/2004 Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $477,52 8/9/04 1200400000000001199 -Mechanicallssuance Fe..... $10,00 9/21/04 3200400000000000257 + 10% Administrative Fee $14,40 9/21104 3200400000000000257 + 100/0 Administrative Fee $106.57 9/21/04 3200400000000000257 + 7% State Surcharge $10,08 9/21/04 3200400000000000257 + 7% State Surcharge $74,60 9/21/04 3200400000000000257 2 Baths One or Two Family $254.00 9/21104 3200400000000000257 Addressing Assignment $31.00 9/21104 3200400000000000257 Building Permil $734.65 9/21/04 3200400000000000257 Curbcut Permit $75,00 9/21104 3200400000000000257 Dryer Vent $6,00 9/21104 3200400000000000257 Exhaust Hoods $9,00 9/21104 3200400000000000257 Furnace - up to 100,000 btu $12,00 9/21/04 3200400000000000257 Plan Review Major - Planning $103,00 9/21/04 3200400000000000257 PW Muil Disc - 2nd Permit , $-30,00 9/21/04 3200400000000000257 Residence Wiring 1000 Sq Ft $106.00 9/21104 3200400000000000257 Residence Wiring Ea Addtl 500 $38,00 9/21/04 3200400000000000257 Sanitary Sewer - Improvement $365,60 9/21/04 3200400000000000257 Sanitary Sewer - Reimbursement $480.80 9/21/04 3200400000000000257 SDC MWMC Administration $10.00 9/21/04 3200400000000000257 SDC MWMC Improvement $865,31 9/21104 3200400000000000257 SDC MWMC Reimbursement $82.03 9/21/04 3200400000000000257 SDC Sanitary/Storm Admin $123,21 9/21/04 3200400000000000257 SDC Transpo Admin $63,69 9/21/04 3200400000000000257 SDC Transpo Improvement $772.49 9/21/04 3200400000000000257 SDC Transpo Reimbursement $175,13 9/21/04 3200400000000000257 Sidewalk Permit $75,00 . 9/21/04 3200400000000000257 Storm Drainage Impervious Area $986,73 9/21/04 3200400000000000257 Temp Power 200 amps or less $50,00 9/21/04 3200400000000000257 Willamalane Single Family $1,000,00 9/21/04 3200400000000000257 Total Amount Paid $7,081.81 Pa!!e 2 of4 . . CITY OF ~rK11'\iuFIELD Buildhig/Combination Permit PERMIT NO: COM2004-00984 ISSUED: 09/21/2004 APPLIED: 08/10/2004 EXPIRES: 03/21/2005 VALUE: $ 151,698.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I Plan Reviews . Initial Review 08/10/2004 08/10/2004 APP LLH Plannine Review 08/1 0/2004 08/19/2004 APP TAJ Public Works Review 08/1012004 08/11/2004 APP MS Storm drainage shall be directed to weep hole in curb, - MS Structural Review 08/10/2004 08/31/2004 OK RJB To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. U.enuire'Unsnections I Curbcut - Standard: After forms are erected but prior to placement of concrete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete, Erosion/Grading Inspection: After all erosion measures are in place. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection, Footing: After trenches are excavated, Foundation: After forms are erected but prior to concrete placement, Post and Beam: Prior to Ooor insulation or decking, Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials, Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping, Hold Downs Installed: Special Inspection performed prior to placement of concrete, Provide report to City Building Inspector, Final Building: After all required inspections have been requested and approved and the building is complete, UnderOoor Plumbing: Prior to insulation or decking, UnderOoor Drain: Prior to cover or placement of concrete, Rough Plumhing: Prior to cover and including required testing, Water Line: Prior to filling trench and including required testing, Sanitary Sewer Line: Prior to filling trench and including required testing, Storm Sewer Line: Prior to filling trench, Final Plumbing: When all plumbing work is complete, UnderOoor Mechanical, Prior to insulation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete, Temporary Electric: Approval required prior to Utility Company energizing pole, Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete, Paee30f4 . . CITY OF SPRINGFIELD Status , Issued Building/Combination Permit PERMIT NO: COM2004-00984 ISSUED: 09/21/2004 APPLIED: 08/10/2004 ' EXPIRES: 03/21/2005 VALUE: $ 151,698.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety, I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction, . ~~ ---- / /' ""'-... ) ~ - Owner or Contractors Signature 9ft/Icy Date { d. J!. ,.1./<0 f"t?t., Pa!!e 4 of 4 ~25 Rirth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 COM2004-00984 LDP2004-00056 Payments: Type of Payment CreditCard 9/2112004 . a~ Ilk.; aity of Springfield Official Receipt .evelopment Services Department Public Works Department RECEIPT #: 3200400000000000257 Date: 09/21/2004 Description Addressing Assignment Willamalane Single Family Temp Power 200 amps or less Sidewalk Permit Curbcut Permit PW Mult Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin . SDC Transpo Admin Plan Review Major - Planning Building Permit 2 Baths One or Two Family Furnace - up to 100,000 btu Exhaust Hoods Dryer Vent -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee + 7% State Surcharge + 10% Administrative Fee Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 LDAP Short Form Paid By THOMAS V. KJDDER Item Total: Check Number Authorization Received By Batch Number Number How Received njm 011271 In Person Payment Total: Page I of! 2:17:09PM Amount Due 31.00 1,000.00 50.00 75.00 75.00 (30.00) 986.73 480.80 365.60 175.13 772.49 82.03 865.31 10.00 123.21 63.69 103.00 734.65 254.00 12.00 9.00 6.00 10.00 74.60 106.57 10.08 14.40 106.00 38.00 300.00 $6,904.29 Amount Paid $6,904.29 $6,904.29 CITY OF alNGFIELD SYSTEMS DEVELOPME&ORKSHEET --.----- JOURNAL OR JOB NUMBER: COM2004-00984 NAME OR COMPANY: Thomas Kidder LOCATION: 3846 lonll.Ridge TAX LOT NUMBER: 18020613 Tax lot 10006 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF' 0 LOT SIZE (SF): 1. STORM DRAINAGF, DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I CHARGE I I 3183.00 I $0.310 = I $986.73 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS . I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I 0.00 I I $0.310 I 50"10 = I ITEM I TOTAL - STORM DRAINAGE SDC $986. 73 ~ DISCOUNT $0.00 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x 20 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x 20 I $18.28 ITEM 2 TOTAL - CITY SANITARY SEWER SDC COST PER DFU $24.04 = , $846.40 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADTTRlPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI 9.57 I I I I $18.30 I 1.00 I B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI 9.57 I I I I $80.72 I 1.00 I ITEM 3 TOTAL - TRANSPORTATION SDC = , 5947.62 4. SANITARY SEWER - MWMC A REIMBURSEMENT COST: INUMBER OF FEU's I x I I ICOST PER FEU I $82.03 B. IMPROVEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I I I $865.31 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , 5 ADMINISTRATIVE FEE: I SUBTOTAL x I ADM. FEE RATE 1~ I $3.738.09 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: 5957.34 $3,738.09 6534 $986.73 5480.80 $365.60 5175.13 11093 I 5772.49 11094 'i = :l I = 5865.31 50.00 510.00 I 1056 ~ I CHARGE $186.90 Matt Stouder TOTAL SDC CHARGES 8/11/2004 PREPARED BY DATE ~ 123.21 563.69 ..J 1078 , = '$3,924.99 V1 ~ Cl o U ~ ~ V1 6 ~ 1070 1091 1092 1054 1055 1054 11079 '. . ., ., DRAiNAGE F~TURE UNIT (DFU) CALCULATION TABLE NUMBER DF NEW FIXTURES x UNIT EQUIVALENT' DRAINAGE FIXTURE UNITS (NDTE, FOR REMODELS. CALCULATE DNL Y THE NET ADDmDNAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EOUIV ALENT UNITS I BATHTUB 1 0 3 = 3 IDRlNKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN" 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 il LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 " ICLOTHESWASHER - 3 OR MORE (EAl 0 0 6 = 0 I IMOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 II IRECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0 IRECEPTOR FOR COM. SINK / DISHWASHER I ETC. 0 0 3 = 0 I ISHOWER. SINGLE STALL 1 0 2 = 2 I ISHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0 1 I SINK: COMMERCiAiJRESiDENTIAL KITCHEN 1 0 3 = 3 I ISINK: COMMERCIAL BAR 0 0 2 = 0 1 ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 I ISINK: SINGLE LAVATORY/RESiDENTIAL BAR 1 0 1 = 1 I IURlNAL, STALL I WALL 0 0 5 = 0 I ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 I ITOILET, PRIVATE INSTALLATION 2 0 3 = 6 I MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 20 .EDU (Equivalent Dwelling Unit) is a discharge cqui~enl to 8 sinl'de family dwellin~ unit (20 DFU's) set at 167 J:[allons per day [ MWMC CREDIT CALCULA TlON TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ~ ANNEXED I I f BEFORE 1979 1979 1980 1981 1982 1983 \984 1985 \986 1987 1988 1989 \990 \99\ 1992 \993 \994 1995 \996 \997 1998 1999 2000 2001 CREDIT RA TE/$I ,06Oli ASSESSED V ALUE ~ IS LAND ELGlBLE FOR ANNEXATION CREDIT? $5.29 (Enter I for Yes, 2 for No) $5.29 IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? $5.19 (Enter I for Yes, 2 for No) $5.12 BASE YEAR $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 II I I I I I o 1998 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x 50.48 = , 50.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $0.48 o TOTAL MWMC CREDIT = $0.00 . . . I .. . SPRINGFIELD ~ '(}IJ~ ";." 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (gt.l)726-~89 0'0" ;r"'!~~t, A!. \,~~; ELECTRICALPERMITAPPLICATION ~Io .. oJ), 0/.,,,, ~ 4",~ ~'(} ~9",,, ~..,& City Job Number tbMZc::ro'( - fJO?r'l Date r, i. oLf oJ)~"O' "'" "SIJ"O''>"s , 8i ~ """ / .... C'/q,. /~'(J. 1. I LOCATIONOFINSTALLATION I 3. I COMPLETEFEESCHED~iThQw~r.::';;J)O',;~",~ '3 gtj b La",- e, B/J, e- 'l\<L. .. '.. "'" "Z-.q~ A. I New Residentia",,-Single or MuIti-Famil~ dw~ I / ODD b Service Included ~I'/ 1000 sq. ft. or less 1 $1 06.00 ~ 0 b Each additional 500 sq. ft. or " ~.~ r;7,uirp.s yOU to " portion the\epfYT\C'N: Or "".:\1 \. c.:..,. J,I ~.OOly '3 t) h .. 'df'lr1f.."'{~ rJ' ...v..... ..J rth Each MainifaCt'd Hom~lor~1 "'\ 11038 rules are set to Modular:gWellirig:Seivi-cg'gl- 1 0 through OAP$~<<.~oOOI- Feeder in OAR 952.001,00 . res 01 ,he rlHes t'\' ._<iI^....~ln"oD . 'S I nm-lU wu .', .' Unt' thP tell:lIJ"U" B. ~1;;erviets.p~;lili~flIi~n;-\!1~t%\ll!~""j ~s.IBfation: v .'h~r for the Oregon .4\ 200 Amps llI-lmlr Center Is 1_600-3a2-2~6J.'\)0 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 LEGAL DESCRIPTION I?;D z.Obr J JOB DESCRIPTION SFL Permits are non-transferable and expire if work is not started within 180 days oflssuaoce or if work Is Suspended for 180 days. 2. I CONTRACTOR INSTALLATIOJll,Q1'fLY I GO-de! ~n t",cfion S Electrical Contractor"-./ eh.crr ,'c. ea",/><r,,,! st. ~~ Address...2.J() /.JJa./ I, 's: City 6ct q e.n e.- Phone 1J3 f./- C:, '-I q / Supervisor License Number 309/5 /()- /- o.r/ / {nO C;-eJi 7- j- 0 C:, Expiration Date Constr. Contr. Number Expiration Date Owners Name lh~;, \L,d~ ICM.- <. f2,~ J~ l!.- Address -s'IN b ~?rb Phone City OWNER INST ALLA TlON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 c. I Temporary Services or Feeders .:\ lostallation"AlteratioD or Relocation iWI,I;I:; 200 Amps or less $ 50.00 201 AJ,~ffu~~~k1J,~sSHALL EXPIRE IFT$~.'llSlJRI( 401 A~~srt~~oo~rhpJJNDER THIS PERMHq<SOMlT . Over ~:~~~~~~gi#f~li~~JQbW~D FOR D. I Branch Cir,cuilS L.nluu. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. I Miscellaneous (Service/feeder not included) -Each Installation' I Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.1 SUBTOTAL9F,'ABOVE # . I /I.{L/ 100'i!: 1l{40 Ib~'!!- 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FormsIElectrical Permit Application I-03.doc . . ~ '?o"O~NO~ EE~~~~;;~~ :;~;;~t;:;:;n~,,~,!~ , I 0',0."'.. "-_L 9".", I. I LOCATION OF INSTALLATION I 3. I COMPLETE FEE SCHEDULE J%.O)tc ~.-I-:.-,)S7" J ~~A"~ \'it\oV"\, """3~' ~"~:'''1>/, LEGAL DESCRIPTION \ A. I New ResidentiaI- Single or Multi-Family p~~ it. ~v:....;. _l ~011J.ol ~ \COO 6 Service 10cIuded 0 ";p JOB DESCRIPTION 10i~.n.,orllCSl;J' Oregon law requires YOul$ll~<.oo ~ "t.1 , ~.. \IllY ---r:. ~ '"' ~ ' Eac addJ.li?Oal SOO'sgdl>drby the urt:lyuIO h \Jl.-\ \ '-LJ ()\ (').Q..-(' po i6W/ijerteof'C~~t;r 0 Those rules are se'st'jl~oo \. Notllica Ion . IlOAH \/02-06'1- Permits are non~ransferable and expire if work Is E'\TIt~l'\lOOI,dlIOm't-'b1-O throUg h rules by not started within 180 days of Issuance or If work is M'l\\l!!JIb Dro&~''''1c,.~.le.\ft caples at t e h<S5GlOO Suspended for 180 days. Fecl"J'er ,'I'ng the center. (Note: .ho ,..1"0 '. ca I . 'otility-NOti!lCa110n 2. I CONTRACTOR INSTALLATION ONLY I /B.I SellOlE\lpg>,re~~~~tl!ii~~.~fFtp.tions or Relocation: Ele trical Contractor ' / 200 Amps or less $ 63.00 / 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps, $125.00 601 Amps to 1000 Amps $163.00 City Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 i :..','.....:: Owners Name \~~ J::::\ Address City W~ Pho e OWNER INSTALLATION c. , Tempor.rY;Services'or'cF~OderSf iI. 'I tit "~Ohl\. AUTHORIZED UNDER THIS PERMIT IS /ilL) r In~~wll~Ib~~j~D'~qy PS l\~P,~'ti'I.l\~1ill fUH ~f).tXJ 209\j'\l1'~&tlIO~\Y PERIOD. \' $ 50.00 ..J 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "8" above. D. I Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. I Miscellaneous (Service/feeder not included) -Each Installation I The installation is being made on property 1 own which is not intended for sale, lease or rent. Pump or inigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee Is 545.00 + Surcbarges Owners Signature: 4.1 SUBTOTAL OF ABOVE 7% State Surcharge 10% Administrative Fee I f)O.OO , :,>.So t6~:~ Inspection Request: 726-3769 TOTAL Shared Drive(T:)lBuilding FormslElectrical Pennit Application 1-03.doc