HomeMy WebLinkAboutPermit Building 2003-12-4 (2)
.
Status
Issued
*
.~CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2003-01135
ISSUED: 12/04/2003
APPLIED: 11/12/2003
EXPIRES: 06/04/2004
VALUE: $ 78,700.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2458 MAlA LP
ASSESSOR'S PARCEL NO.: 1703251404400
Springfield TYPE OF WORK: . Manuf Home w
Garage/Carport Private
TYPE OF USE: lIelY Residential
PROJECT DESCRIPTION: MH wlgarage
Owner: RON BOTTOM
Address: 8777 OAK ISLAND VENETA OR 97487
I CONTRACTOR INFORMATION ,
Contractor Type
Electrical
Manuf Home Inst
Contractor
CHRISTENSON ELECTRIC INC '
RAY SHARP CONSTRUCTION INC
License
458
60926
Expiration Date
05/0112007
0711212005
Phone
541-688-612 I
541-345-2279
BUILDING INFORMATION'
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
1
R-3
U-I
VN
2
# of Stories: 1
Height of Structure
Type of Heat: Forced Air Elect
Water Type: Electric
Range Type: Electric
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Impervious Surface Area:
5,585
1,587
SETBACKS
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
18.00
22.00
5.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
1
Total:
Handicapped:
Compact:
2
Rearyard Setback:
Solar Setbacks:
% of Lot Coverage:
Yes
37.30
10..00
. /';.-11>-_ 5..00
.0 vO~i;OIz.. ;'1'>,C. I PUBLIC IMPROVEMENTS I
0" 0"'1.. ~t,. ~~ "
Street Improvements:b JS>.9 '0.1) ;so ~ . '-<_
C'- .. J.<. ;S~ 0. 0'0 c,
Storm Sewer Avliilatile: O~ 'Or. ~.I)1. :O/~ ~l~:
......A "l /: v.. ~... 0' ".,
Special Instruction:~ ~ t.PHvate'Inffastrueture....
~rF, '/~ 'Yo ~Ul'. '''0 j 00 'c.
0. Or0,C'~.I)t,~~1001J ;so~" "'0>""
~.I)1. ~ ~r "" 0", ~-0 '~ ",
~r' 0" .. flU <b. ~~ ;so q> q? Jvv
/Q' J: ~.90 01& I~u' 0-1, 1'& G:;,!t,
'6'0 ,) ~ :"0, Ol'[ JS> 95',./'iv
:? ~ ~t,. (:! I. 'les> ;)02 "0
lo. :~M :1.-- A J &~ r(//~ ~Lb' 0~
,'~. VO.r.;O.., ...." ,:t
'-'1. '11,;' 0,,' 6
~ 0.,0 :;
. ....4:
(;;,
Sidewalk Type:
DownspoutslDrains:
Notes:
NOTICE:
THIS PERMIT SHA
AUTHORIZED UND~~ ~XP'RE IF THE WORK
COMMENCED OR IS AB~~;ERMIT /S NOT
ANY 180 DAY PER/OD, ONED FOR
Pal!e 1 of3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.';
Description
Tvpe of Construction
Foundation Onlv
Garal!e
Manuf Home
Use Bid Amount
Garal!e
Manufactured Home
'.
Fee Description
Plan Review Residential
+ 10% Administrative Fee
+ 70/0 State Surcharge
Add, Alter, Extend Circ Ea Add
Addressing Assignment
Annexed 1979 or Before
Building Permit
Manuf Home State Issuance
Manufactured Home Connection
Mauufactured Home Feeder
Manufactured Home Placement
Manufactured Home Service
Plan Review - Planning
Sanitary Sewer - 1 st 50 Feet
Sanitary Sewer -Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC SanitarylStorm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Storm Drainage Impervious Area
Storm Sewer - 1st 50 Feet
Water Line - 1st 50 Feet
Willamalane Manuf Home Private
,
Total Amount Paid
.
.
CITY OF Sr KIl mFIELD
Building/Combination Permit
PERMIT NO: cOM2003-01135
ISSUED: 12/04/2003
APPLIED: 11/12/2003
EXPIRES: 06/04/2004
VALUE: $ 14,700.00
I Valuation Descrintion I
$ Per Sq Ft
or multiplier
$1.00
$23.80
$1.00
Square Footage
or Bid Amount
2,800,00
500,00
64,000,00
Value
Date Calculated
Total Value of Project
$2,800,00
$11,900..00
$64,000.00
$78,700.00
ll/1212003
ll/1212003
11113/2003
}?pp< P"iilIJ
Amount Paid
Date Paid
Receipt Number
$95.16
$58.94
$41.26
$3.00
$8.00
$-156.63
$146.40
$30.00
$45.00
$50.00
$160.00
$50,00
$59,00
$45,00
$326,99
$430,16
$10,00
$214,23
$314,63
$96,89
$51.23
$727,42
$164,89
$930,61
$45,00
$45..00
$1,000,00
ll/12/03
12/4/03
12/4/03
12/4/03
12/4/03
12/4/03
12/4/03
12/4/03
1214/03
12/4/03
1214103
12/4/03
12/4/03
12/4/03
1214/03
12/4/03
12/4/03
12/4103
12/4/03
1214/03
12/4/03
12/4/03
12/4/03
12/4/03
1214/03
1214/03
1214/03
1200200000000002454
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
1200200000000002549
$4,992,18
I Plan Reviews I
Pa~e 2 of3
.
.
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: cOM2003-01135
ISSUED: 12/04/2003
APPLIED: 11/12/2003
EXPIRES: 06/04/2004
VALUE: $ 14,700.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Initial Review
ll/1212003
11/14/2003 APP LLH Application states residence is 1512
square feet. Floor plan provided
states 1587 Square feet. 1 used the
floor plan square footage because 1
could not read the dimensions on the
plan provided.
11/26/2003 APP TAJ
ll/17I2003 APP VRJ
11/20/2003 APP TCM
Planninl! Review
Public Works Review
Structural Review
ll/1412003
ll/14/2003
11114/2003
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.
I Relluired Insnections I
1 Ufer Electrical Ground: Install ground rod at footing and call for inspection ,in conjunction with footing and/or
foundation inspection.
2 Footing: After trenches are excavated.
3 Foundation: After forms are erected but prior to concrete placement.
4 Shear Wall Nailing: Before covering sheathing with finish materials,
5 Framing Inspection: Prior to cover and after all rough in inspections have been approved..
6 Manuf Home Set Up: When installation of all piers or stands is complete..
7 Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc.. have been installed..
8 Final Building: After all required inspections have been requested and approved and the huilding is complete.
9 Underfloor Drain: Prior to cover or placemeut of concrete.
10 Water Line: Prior to filling trench and including required testing.
11 Sanitary Sewer Line: Prior to filling trench and including required testing.
12 Storm Sewer Line: Prior to filling trench,
13 Manuf Home Plumbing: After home has been connected to water and sewer..
14 Rough Electric: Prior to Cover
15 Electric Service: Approval required prior to utility company energizing service.
16 Final Electric: When all electrical work is complete.
By signature, 1 state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon Is true and correct, and 1 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 eacb 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
~"':~~';) /i4a 3
Ow,.", Co.,,,ct,.. "..~ D..
Pal!e 3 of3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-0 1135
COM2003-0 1135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-01135
COM2003-0 1135
Payments:
Type of Payment
Check
i'
-w.'~.~!I!~',~""',.'-,','~,",
-',:"";' . '".. :
,
---'-..- ."."..' .
,p'
Receipt #: 1200200000000002549
Description
Addressing Assignment
Willamalane ManufHome Private
Manufactured Home Feeder
Manufactured Home Service
Add, Alter, Extend Circ Ea Add
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
Annexed 1979 or Before
Building Permit
Manufactured Home Placement
Manuf Home State Issuance
Sanitary Sewer - 1 st 50 Feet
Water Line - 1st 50 Feet
Storm Sewer - 1st 50 Feet
Manufactured Home Connection
+ 7% State Surcharge
+ 10% Administrative Fee
Plan Review - Planning
Paid By
RAY SHARP CONSTR
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Officiill Receipt
Development Services Department:..
Public Works Department . .
'.\
Date: 12/04/2003 1:14:30PM
A.mount Paid
8.00
1,000.00
50.00
50.00
3..00
930.61
430.16
326.99
164.89
727.42
314.63
214.23
JO.OO
96.89
5L23
(156.63)
146.40
160.00
30.00
45..00
45.00
45.00
45.00
4L26
58.94
59.00
$4,897..02
.
.
Item Total:
How Received
In Person
Payment Total:
Amount Paid
$4,897.02 .
$4,897.02
. .
~ CJr.f OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
, JOURNAL OR JOB NUMBER: Com2003-01135
NAME OR COMPANY: Ron Bottom
LOCATION: 2458 Mai. Looy
TAX LOT NUMBER: 17032514114400
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF: 1587 LOT SIZE (SF):
!.STORM DRAINAGE
5585
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I '
I 3209.00 I $0.290 = I $930.61 I
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 DISCOUNT
I 0.00 I I $0.290 I 50% I = $0.00
ITEM I TOTAL - STORM DRAINAGE SDC '$930..61 I
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x r COST PER DFU
I 19 I I $22.64
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x COST PER DFU
I 19 I $17.21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =,
$930,6 I
$430.. I 6
$326..99
$757.15
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I
I 9.57 I I I
B. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I
I 9.57 I I 1
ITEM 3 TOTAL - TRANSPORT A nON SDC
x I COST PER TRIP x INEWTRIP FACTOR I
I $17.23 1.00 I
x I COST PER TRiP x INEWTRIP FACTOR I
I $76.01 1.00 I
= , $892..3 I
$164..89
$727,42
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $314.63
B. IMPROVEMENT COST:
INUMBER OF FEU's I x
I I I
=
$314,63
I COST PER FEU
I $214.23
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARV SEWER SO( = ,
SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ ,
5, ADMINISTRATIVE FEE:
ISUBTOTAL I x ADM. FEE RATE I~
I $2,962.30 I 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
$382,23
$2,962..30
CHARGE
$148,12
Virginia Jurasevich
PREPARED BY
11/17/2003
TOTAL SDC CHARGES
DATE
~f
~
~
l~
1070
1091
1092
1093
1094
1054
. .
....
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE, FOR REMODELS. CAlCULATE ONLY THE NET ADDmONAL AXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EOUIV ALENT UNITS
I BATHTUB 1 0 3 = 3
IDRINKING FOUNTAIN 0 0 1 = 0
IFLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL I SOLIDS I ETC 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH I ETC 0 0 6 = 0
!LAUNDRY TUB 0 0 2 = 0
I CLOTH ESWASH ER / MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EAl 0 0 6 = 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRIG/ WATER STATION / ETC 0 0 1 = 0
IRECEPTOR FOR COM. SINK I DISHWASHER / ETC 0 0 3 = 0
ISHOWER. SINGLE STALL 1 0 2 = 2
ISHOWER, GANG (NUMBER OF HEADSl. 0 0 2 = 0
ISINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
ISINK, SINGLE LAVATORYIRESIDENTIAL BAR 2 0 1 = 2
IURINAL, STALL! WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 19
-I
1
I
I
.1
I
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single fanl;~~Y dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
I YEAR CREDIT RA TE/$ 1,000 l
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT?
I BEFORE 1979 55.04 (Enter I for Yes, 2 for No) I
1979 S5,04 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 0
1980 $4.95 (Enter I for Yes, 2 for No) I
1981 54,88 BASE YEAR 1979
1982 $4.75
1983 54.58 CREDIT FOR LAND (IF APPLICABLE)
1984 54AI VALUE/IOOO CREDIT RATE
1985 $4.20 $31.08 x $5.04 - , $156.63
1986 13.88
1987 5350 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 53.07 VALUE / 1000 CREDIT RATE
1989 52.60 $0.00 x $5.04 0
1990 12.14 .
1991 $1.71
1992 $1.52 TOTAL MWMC CREDIT = $156.63
1993 5U8
1994 $1.19
1995 51.03
1996 SO,87
1997 10,68
1998 SO,46
1999 $0.27
2000 10,09
2001 50,04
,\,\a5 \,\,\e lV'~Sa
\lll",i\\ed '\iC land
,ass -paC\
1\09 ?{o\e~o\ {eqUife ~
does
225 FlFl'H STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICALt\~~f..flR!TION
City Job Number ~S Date
1. ~EOCATIONtOF:LNST'~~kf.~~'IJ
J..~~~~ff\Mf7('~' ,
L\~3Q.~~N (J\t\{)D ,
JOB DESCRIPTION'
~~~~~~~
not started within 180 days of issuance or if work is
Suspended for 180 days,'
~~".~"'j1"",",J,l.~~~"""*~K~~':'::'''''='~~-'~-",, .
r!cC::ONTR:A6FORiINSl'AEEitTIONfONli '
2. ~i".;;,r~"'~m~~';'~~:.A>.w~.t'.r.~~"~"\a;"'r.::l\lt~
Electrical Contractor 9rris tenson ElectriC
Address
1 ?qR fl"thgLJ)rivp
City Eugene
Phone 541-688-6121
Supervisor License Number
3759 S
Expiration Date 10/01/04
Constr.. Contr.. Number 26-34C
Expiration Date 10/01/04
Sign:me of SUjrviSing E1ectricia ) ,
, ~:J
, ~ ~ T ~~:~ ?mllM
Owners Name ~
Address ~ -r'1lln ,tln
City \\Dl\e-l'tL Phone
...~.
OWNER INSTALLATION
The installation is being made on e" "eO'" 1 own which
is not intended for sale, lease or rent..
Owners Signature:
Inspection Request: 726-3769
~~'(.e.~",,~,,~~':~~':;~"'~~~i.'tl ;.;:4'::_,,;....~~~..,.Ji.t\~}.,itt:~ev-af~l!.~
3. ~;eOMEI::ETE:FEE.SCHED,ULE'BELOW,':R~~f'1!'f.'!'''''';1ME
~~.a.~-'1..,;;.f~..fiili\:-:::-lilol1;..-...~"&17::"~1~..-,...':"~...".::'='..~R.~~~.tb
~~...-:"~~-.;,IiC"i"_~<!'"~...~~1;ijr.l..;~;;w;--..""!~"'(;"i\4.."..,,:.,.,r,I'.!l.;:J{~~"l'll:M.:.--fi.-~
A ~N- ~i:;...~-":R:-pJ!i( .'fd..~::~.,: 1..;il:S:'''':<'nl~'T}~~~I,t:'I'ti.~~l-F:;;'J~:, '''-:is''';v';?::d''' >':~I:';' 1';.<<tllR\~~~~ :ri,,:,,) !;t
..~, eW~ eSI enna ',;.;:.~ mg..e;oT-.hl' U ..; ,00JlW\" per.:. we mfT'"umt:"". .,
~~""'-':..'..".s;"""'''~-''''~'-''''' ......._.,....,-,~.,.,....,,-,,~~... .....-::""---~:;,;iC.:...oh"'..~*'i.
Service Included'
1 000 sq. ft.. orless
Each additional 500 sq. ft or .
portion thereof .
$106..00
$ 19..00
Each Manufact' d Home or
Modular Dwelling Service or
Feeder '
'2-
$50..00 \ to pO
~~i-!~~~~~~;:\te..~~~e-"'{';~~~r~~:~~x''"'''~":I'I.~~
B. ~~t~!t~~W!m~~~g~!~.t~~J,!~~1Jt~=-~~.
200 Amps or less $ 63.00
201 Amps to 400 Amps__~ \.SJl?\OO
\aW\"''1~''-- 1
401 hAmI'S,lOj600.Aii)ps,gon ~.._ _nn$ 1'25,00
60{'~p~l;:' 1;~~O~;"nrp~gd by thbr. .;:~-;re S~63..0~~
10Ilu.... ......- ',- _'", Th05-e - -- ,...
O.rff,i\99QlAP1PSlVolts r.. hroU:;h nAR ,$3'75\00
Reconnect.0nIy001-0010 \ .. __ n' the$'50:00 \
nun. . ~_. in ('OPI-..-
_ _~,.J..'{n" maV obta ; ....n ,plpohone
c. 3[@1J1.0~Sr~~~!f!~~EB_~
'r1umber\Ortheu:"';~~~s;~-2344). '
Installation, A1teratioIi'or'Relocation
200 Amps or less $ 50.00
201 Amps to 400 AIDps $ 69.00
401 Amps to 600 Amps $100..00
Over 600 Amps or 1000 Volts see "E" above.. ,
~~$I;.~;"'1ril'I;;y. ""J;I.liM' 1lC;!'~,~~,~~f"',;.,..Io\\l~~,' .'
D. ~~r.a.~Clf€,lrc~L~ ~~5:': ~Q\,~~~~~~~~
Ne"b~tt\lt,~ or Extension Per PE~~ 1HE WORK' . '
One:CircuihERM\1 SHAll EXPIR - --, "1 ~L4i,ll9r -
EaCh\RcIili~'lWlt~C@.l~r[WltiIH\b 1'1: ",;. 1" D (J.J
serviWd~Mfde~E~f\ IS ABA lED liOBloo ~ .
!!l~Wt;~~~~~~~l"""'!f!.'''''W''':~"ro!J'';:~~i~",;,-m;,1
E. '2' . Jan~$.ei;Yij;ii!r~e!;llobUlcluded),-,Eaclllnstallation:i:
tIf...,.. ........-.~_-"'....~~!'\\..~.."!),<<o.~ttt.;,c,~"";::;O'''-'_.,''~'.''~_v''',,,.......~~,.J..i::::~
Pump or irrigation
Sign/Outline Lighting
Limited, EnergylResidential
Limited Energy/Commercial
$ 50..00
$ 50..00
$ 25..00
$ 45.00
Minim, um E" lectric P, erIDJ, 't Imp, e, c,tion Fee is $45.00 + Surcharges cJ
4.~Stm,-XO,~T~OEWO".~~: " · \M 0
~~~~.03;.~~~~11ii1':!{ l);) I
fl,~l
tU~
\'L().(~I.
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FonnslElectricnl Permit ApplicOltion 1..Q3.doc