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Home My WebLink AboutPermit Building 2004-10-12 .. CITY OF .srKll~ljt<lJ!,LD Building/Combination Permit PERMIT NO: cOM2004-01132 ISSUED: 10/12/2004 APPLIED: 09/1312004 EXPIRES: 04/12/2005 VALUE: $ 77,295.00 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2533 MAlA LP ASSESSOR'S PARCEL NO.: 1703251407900 Springfield TYPE OF WORK: Manuf Home w Garage/Carport Private TYPE OF USE: Nelv Residential REQUIRED PARKING lrotal: 2 Handicapped: Compact: :-!- 30.00 ~;~\j<rl- ~ _\QY \~ ~~~ \<il ~\j I PUBLIC IMPROVEMENTS I . ~~\..\.. \.~~\<il \l't.~~\) ~\.lt' ..\ lJ\ \ v~~\'!S1tt~Ii)lt.t~e:;~~\)\J \' ~<;," 1\'\) Q.. \'5 "\ ~ :\'0Cl"'\11Or'8~b*~oins: ~\\ ~\l\'t.~\.o ~'{ \l~ c,Cl :\ \<0<;) \) ~~ PROJECT DESCRIPlrION: MH with detached garage Owner: PAUL ROCCAFORlrE Address: 450 N TERRY #65 EUGENE OR 97402 I CONTRACTOR INFORMAlrION I Contractor Type General Electrical Manuf Home Inst Contractor HARRISONJACOBSONINC ROBS ELEClrRIC INC HARRISONJACOBSONINC License 66447 156678 .\\~~ _,,\\>.~'(j6447. _~ A~ _. /~(\ ....... I BUIbJ,.. ,\,:llvro!iM>\<FION1 16/1. ", "1 " , ....." [0"'.. ell ~-, ".."~ ",\ .L1:" \lO ~\\l - ill \',"t>'" "~'6 \). t\'O""U"'\~\li~~#~I~"~"_~c,~ tI"l,,~ 1 JW;..~ ~'. b'!lht-~!A\ryc'i'ur~q'~~':~\S\ tPSJ;!~ .ry.l1~~~~0'.) <;,0\'0\ ~ ,Ii;!fctric ~~~~~~~oIl)P~&OQ~ g,),l1~E1ectric fA 106 i90 '0'" -se~Ii~~~iJ:~"ffi010 .,~ Electric .\r13 ~eS9 ~ ~~: Path 1 '~^r\\P~~ ed Building: nla I"J'Po" . .....'" '. "~ ~u:.. c:I\~'DEVELOPMENT INFORMAlrION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: J Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: ' 17.00 6.00 25.00 13.00 5.00 Overlay D1st: # Street lrrees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Impro'vements: Storm Sewer Available: Special Instruction: Yes Drainage to private storm sewer Notes: '. Paee 1 of4 Phone Number: 541-688-8207 Expiration Date 05/07/2005 08/14/2005 05/07/2005 Phone . 541-689-7762 541-686-5444 541-689-7762 Lot Size: Sq Ft Ist Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 8,277 1,620 864 To Storm Sewer 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 Garaee ManufHome . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-01132 ISSUED: 10/12/2004 APPLIED: 09/13/2004 EXPIRES: 04/12/2005 VALUE: $ 77,295.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 $24.30 $1.00 Use Bid Amount Garaee Manufactured Home Fee Description Plan Review Residential + 10% Administrative Fee + 100.10 Administrative Fee + 7% State Surcharge + 7% State Surcharge Add, Alter, Extend Circ Ea Add Addressing Assignment Annexed 1979 or Before Building Permit Fixture Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Feeder Manufactured Home Placement Manufactured Home Service Perm ServlFdr 200 amps or less Plan Review Major - Planning Sanitary Sewer - 1st 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 - Ist 50 Feet Storm Sewer Each Addtl 100' Water Line - Ist 50 Feet Water Line - Each Addtll00' Willamalane ManufHome Private Square Footage or Bid Amount 6,300.00 864.00 50,000.00 Value Date Calculated $6,300.00 $20,995.20 $50,000.00 $77,295.20 09/13/2004 09/13/2004 09/13/2004 Total Value of Project Fpp" tiiILI Amount Paid $157.27 $17.20 $62.40 $12.04 $43.68 $9.00 $31.00 $-174.93 $241.95 $14.00 $30.00 $45.00 $50.00 $160.00 $50.00 $63.00 $103.00 $45.00 $420.44 $552.92 $10.00 $865.31 $82.03 $124.76 $60.10 $772.49 $175.13 $993.86 $45.00 $14.00 $45.00 $14.00 $1,000.00 Date Paid Receipt Number 1200400000000001341 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468' 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 1200400000000001468 9/13/04 . 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10112/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10112/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10/12/04 10112/04 10/12/04 10/12/04 Paee 2 of 4 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-01132 ISSUED: 10/12/2004 APPLIED: 09/13/2004 EXPIRES: 04/1212005 VALUE: $ 77,295.00 Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Amount Paid $6,134.65 I Plan Reviews I Initial Review Plannine Review 09/14/2004 09/14/2004 09/1412004 10/06/2004 APP APP SKG TAJ east side Is considered front for setback purposes. 9/29/2004 - Hookup to lnfrastructurl Is private. - MS See documents for plan review comments Public Works Review 09/14/2004 09/29/2004 APP MS Structural Review 09/14/2004 09/29/2004 APP DLM 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 Reonire'Un!'ilnectinns I Ufer Electrical Ground: Instail 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. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all' required inspections have been requested and approved and the building is complete. Undernoor Drain: Prior to cover or placement of concrete. Underslab Plumbing: Prior to filling the trench 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. Manuf Home Plumbing: After home has been connected to water and sewer. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to ~~~ . MH Service: Approval required prior to utility company energizing service. Paee 3 of 4 . . UJ f OF ~rj{jNGFIELD Status Issued Building/Combination Permit PERMIT NO: cOM2004-01132 ISSUED: 10/12/2004 APPLIED: 09/1312004 EXPIRES: 04/12/2005 VALUE: $ 77,295.00 225 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 e permitttrd is I cated at the front of the property, and the approved set of plans will remain on the site at all times dur' g)c~nfrcf _ . '- ~ .~ (O-Il..-()<-f- - - Owner or Contractors Signature Date Paee 4 of 4 225'Fifth Street Spl'ingfieid, Oregon 97477 . 541-726-3759 Phone . .~"'~"'." ~ ~. ...ty of Springfield Official Receipt W!Velopment Services Department Public Works Department Job/Journal Number eOM2004-01132 COM2004-01132 eOM2004-0ll32 COM2004-01132 COM2004-01132 eOM2004-01132 COM2004-01132 COM2004-01132 COM2004-01132 . eOM2004-0ll32 COM2004-01132 eOM2004-01132 " COM2004-0 1132 COM2004-01132 COM2004-0 1132 eOM2004-01l32 COM2004-01132 COM2004-01132 COM2004-0 1132 COM2004-0 1132 eOM2004-01132 COM2004-01132 eOM2004-01132 eOM2004-01132 eOM2004-01132 COM2004-01132 eOM2004-01132 COM2004-01132 eOM2004-0l132 :; COM2004-0 1132 COM2004-0 1132 eOM2004-01132 Payments: Type of Paymcnt eheck :; 10/12/2004 RECEIPT #: 1200400000000001468 Date: 10/12/2004 Description Manufactured Home Placement Manuf Home State Issuance Addressing Assignment Willamalane ManufHome Private Sanitary Sewer - 1st 50 Feet Water Line - 1st 50 Feet Storm Sewer - 1st 50 Feet Manufactured Home Conn - Plmb Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMe Reimbursement SDC MWMe Improvement SDC MWMe Administration SDC Sanilliry/Storm Admin SDC Transpo Admin Annexed 1979 or Before Building Permit Fixture Water Line - Each Addtl 100' Storm Sewer Each Addtl 100' Plan Review Major - Planning + 7% State Surcharge + 10% Administrative Fee + 7% State Surcharge + 10% Administrative Fee Manufactured Home Feeder Manufactured Home Service Perm ServlFdr 200 amps or less Add, Alter, Extend eirc Ea Add Paid By GOODEN HARRISON Item Total: Check Number Authorization Received By Batch Number Number How Received djb 9138 In Person Payment Total: Palle I of I 2:05:4IPM Amount Due 160.00 30.00 31.00 1,000.00 45.00 45.00 45.00 45.00 993.86 552.92 420.44 175.13 772.49 82.03 865.31 10.00 124.76 60.10 (174.93) 241.95 14.00 14.00 14.00 103.00 43.68 62.40 12.D4 17.20 50.00 50.00 63.00 9.00 $5,977.38 Amount Paid $5,977.38 $5,977.38 . 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 MANUFACTURED HOME LAND USE AGREEMENT As required by the eity of Springfield Development Code, I agree that with the approval of the attached permits, one of the following manufactured homes will be placed at 2-~:t~, /vtMA Lp . Springfield, Oregon, eity Job Number L.J1!!.f~-~II~2- ~ Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has peen certified by the manufacturer to have an exterior thermal envelope meeting performance standards which reduce heat loss to levels equivalent to the performance standards required of single family dwellings constructed under the State Specialty eodes. _ Type II Manufactured Home. A unit of not less than 12 feet in width with an enclosed ,floor area of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width and that has no bare metal siding or roof mg. The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of the enclosing material exposed above grade. I further agree to meet all land use and eity eode requirements of the above mentioned parcel within 60 days of the date of Issuance of the manufactured home set up permit. These requirements may include, but are not limited to the items listed below. . Specific land use requirements regarding your parcel are noted on your approved set up plans and/or permit and your partition approval if applicable: . Street Trees . Paving Driveway . Minimum 32 square foot storage structure . eompletion of partition approval . Removal of any existing structures as noted on your partition approval . Signing and recording of any required partition, easement, improvement agreements, etc. . Final lot grading . City Sidewalk and curbcut installation . Any outside agency approval as required i.e., Division of State Land approval. By my signature below, I agree to complete the above mentioned land use requirements. )c ownerr2~ /) , ' 't ... . -- V ~ l.~~ /' - eontractor Sign~ture Date {'Il-(t.-04 Date . CITY ~F alNGFIELD SYSTEMS DEVELOPMEAoRKSHEET JOURNAL OR JOB NUMBER: eOM2004-01132 NAME OR eOMPANY: Roccaforte LOeATION: 2533 Maja LooE. TAX LOT NUMBER: 17032514 TL 07900 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF' 0 LOT SIZE (SF): ri 18 Ie>:: 8280 I ~ -'m C3 ~ 1 STORM ORAINAGE DIRECT RUNOFF TO elTY STORM SYSTEM I IMPERVIOUS S.F. x I eOST PER S.F. CHARGE I 3206.00 $0.310 I = I $993.86 I RUNOFF ROUTED TO DRYWELL DESIGNED AND eONSTRUeTED TO elTY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISeOUNT RATE I I I 0.00 $0.310 I 50"10 I ~ ITEM I TOTAL- STORM DRAINAGE SDC '$993.86 2. SANITARY SEWER - CITY DIseOUNT $0.00 $993.86 1070 A REIMBURSEMENT eOST: I NUMBER OF DFU's I x I 23 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 23 I eOST PER DFU I $24.04 I $552.92 1091 $18.28 $420.44 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDe =, $973.36 J TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FAeTORI I 9.57 I I I $18.30 I 100 $175.13 I 1093 B. IMPROVEMENT COST: I I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRlPFACTORI 9.57 I I I $80.72 I 1.00 I $772.49 I 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = , $947.62 I 4 SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I I I $82.03 = $82.03 11054 B. IMPROVEMENT eaST: I INUMBER OF FEU's I x ICOST PER FEU I I $865.31 = $865.31 1055 I MWMe eREDIT IF APPLIeABLE (SEE REVERSE) ($174.93) I 1054 MWMe ADMINISTRATIVE FEE $10.00 11056 ITEM 4 TOTAL - MWMC SANIT ARV SEWER SDC = , $782.41 J SUBTOTAL (ADD ITEMS I, 2, 3, & 4) = , $3,697.25 ~ 5 AOMINISTRATIVE FEE' I SUBTOTAL x I ADM. FEE RATE I~ eHARGE I $3.697.25 I 5% $184.86 TOTAL SANITARY ADMINISTRATION FEE: 124.76 1079 TOTAL TRANSPORTATION ADMINISTRATIOl'l FEE: $60.10 11078 ! Matt Stouder 9/29/2004 TOTAL SDC CHARGES = , $3,882.11 PREPARED BY DATE - . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION .!ABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTIJRE UNITS I (NOTE: FOR REMODELS. CALCULATE ONLY THE NIIT ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EOUIV ALENT UNITS BATHTUB 2 0 3 = 6 DRINKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETe. 0 0 3 = 0 INTEReEPTORS FOR SAND I AUTO WASH 1 ETe. 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 eLOTHESW ASHER 1 MOP SINK 1 0 3 = 3 eLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 REeEPTOR FOR REFRIG I WATER STATION 1 ETe. 0 0 1 = 0 REeEPTOR FOR COM. SINK I DISHWASHER I ETe. 0 0 3 = 0 ISHOWER. SINGLE STALL 1 0 2 = 2 I SHOWER. GANG (NUMBER OF HEADSl. 0 0 2 = 0 I SINK: eOMMERClAURESIDENTIAL K1TeHEN 1 0 3 = 3 I SINK: eOMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1 IURINAL. STALL I WALL 0 0 5 = 0 ITOILET. PUBLIe INSTALLATION 0 0 6 = 0 ITOILET. PRIVATE INST ALLA TION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDO'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 23 $EDU (Equivalent Dwelling Unit) is 8 discharge equivalent to.~.~!.~~ family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ~ eREDIT RATEI$I,OOO~I IS LAND ELGIBLE FOR ANNEXATION eREDIT? I ANNEXED ASSESSED VALUE BEFORE 1979 $5.29 (Enter I for Yes, 2 for No) I 1979 $5.29 IS IMPROVEMENT ELGlBLE FOR ANNEX. eREDIT? 0 1980 $5.19 (Enter I for Yes, 2 for No) I 1981 $5.12 BASE YEAR 1979 1982 $4:98 I 1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) \984 $4.63 VALUE 11000 CREDIT RATE 1985 $4.40 $33.07 x $5.29 ~ , $174.93 I I \986 $4.07 I I 1987 $3.67 eREDIT FOR IMPROVEMENT (IF AITER ANNEXATION) I 1988 $3.22 VALUE 11000 eREDIT RATE I 1989 $2.73 $0.00 x $5.29 0 I \990 $2.25 I I 199\ $1.80 I 1992 $1.59 TOTAL MWMe CREDIT = $174.93 I I 1993 $1.45 I 199' $1.25 I 1995 $1.09 I 1996 $0.92 ~ 1997 $0.72 1998 $0.48 I 1999 $0.28 I 2000 $0.09 ,I 2001 $0.05 . SP.CO"ELD fl"~Mt1:Jlfibi;:lnl{(tjiL;rG{j~;[if,j71Jj~~ ,., ,'~ DEV;:WPMENTSERVlc:ESD~PARTMENT ',' '~'~ 225 FIFTH STREET SPRINGFIELD, OR 97477 , , (541)726-3753 FAX (541) 726-3689 www.ci.springfield.or.us MANUFAeTURED HOME SET-UP AGREEMENT As required by the eity of Springfield Development Code;! understand and agree that with the approval of , the attached permits, one of the following manufactured homes will be placed at :2. '5 ~? jV\.~ ~ , Springfield, Oregon, eity Job Number C&vouo 4 - C J \ 3.1. ' Type I Manufactured Home: A multi sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch 00 feet in height for each 12 feet in width, that has no bare metal siding or roofmg, and that has been certified by the manufacturer to have an~xteri ermal envelOP, e meeting performance standards which reduce heat loss to levels equivalent to th rmance standards required for single family dwellings at the time of construction. initials, / Type II ManufaciHome: ' " . ' A unit of not less t1ian 12 feet in width enclosing a minimum floor area of 500 square feet, that has a nominal roof pitch of 2 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has _~encertified by the manufacturer to have an exterior thermal envelope meeting performance standards which reduce heat loss to levels equivalent to the performance standards required for single , family d*ellfugs at the time of construction., initials I . I further state, by my signature below, that! have been provided with the following information: Manufactured Home Blocking, Water Line eonnection, Street Tree Standards, Sanitary Sewer eonnection, Electrical eonnection, and Minimum requirements for permanent steps. I also understand that the manufactured home shall be placed on an excavated and backfilled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure, enclosed at the perimeter with stone, brick or other concrete or masonry materials approved by the Building Official and with no more than 24 inches of the enclosing material exposed above grade. ' ' ' ~t ~ Signature -~ , ---- (~ -( 1..-0'-1 Date . . Sep-30-04 03:14P P_02 . . .. . -<>;. ... .)."U\.~";~l_I..D '0 225FlFTH STREET. SPRINGFIELD, OR 97477 . I'H:(541)726.J753 . FAX: (S411?J6.J6&.;>/,,;".94J::<" ......~.' .~' ELECTRICAL PERMIT APPUCA110N ".;>,& <': "OJ,/&c/^" "'J4lI' City Job Number COM 'Z--60Y - 0 ( 1""3, 2. Date /0 Atf;r.L'-.:::- m"t{ "0/~~~"6 . . . .. "".\ 'j .:.0 '_" ',' ..... _...._~lSlO' .... . 9"".i:'?;/~@. 1~~O~~~iOFMTNS~~:4TI02P 3. C01l-fPLl:,TEFEESCHEI?~/,,, 0 &~.o&:::~/~.. c.- lSl 4: '),', , '"0''' " g"uniL 't....,' I"J "' (c. ,\r o Sen>ice included LEGAL DESCIUPTION 1703, Z rJl L{ J:~+cmfl: / 07'700 A. . !".c~,"..R.~.s!.~~n~iu!. -.5ing~~ or "Multl.FHI (~r: IOOO~. ft. or less. Eaeh additional 500 sq. ft, or portion thereof Ench t-I.tlnufo.ct'd :-Iorr:e ;x Modular Dwelling Service or F:eder z..... S~O.oo IOC) Permid :Jrc non.llnsrc:rable and expire jf work iJ ,. not slarted within 180 d:J)'s oriuuancf or if work h Suspended for 180 days. ,." . ~, ;: .,', ", . . . ." c. . , . . . :'l~:::~:~~~~~: \~~~\- nQ D. 20:~~:::~o::e::'ders ~ .[nst..II.tio~ Alt~.:~::.: ReI~~a~~ 3 \\ n _ 'if'-> 201 AmpSlO 4iXl Amps S75.00 Address \./{) \~-x. L..r"":>2J 401 AmP~IO 6 i$~to $12~.00 . I CYAmtrlr~~N: Oreg0l\1.~ Orf1StllilY _ __ $16J.00 clty~~:-cn~hone ~~adoptlUd~Y~d~: ~~t()l\t\ $375.00 \J Notification Center. =~9hOAR 952.(101- $ 50,00 " Super.,."or LIcense Number 4 '1 ~~~:2~~~~~talili~=~"ders':;;:~X(:;.;,,;,; ':~ hpiration Date \ D \ () \ \D ~\\Ing the cen~~tUt\lit\JtNoti1l~locatlo. lIumo611-tthe lf~~ Conslt. ConlJ. Number -L~ Lo I C)LB_~n18r 1820 I Amp' 10 400 Amps . Expiration Date S) I \ Li I ()5 ~~le;~S~:;o~::: Volt~ see "B"~bo:. .",.. _Si2narure ofS~Deryising EI~c~cian __" D. ~:,Bru.~.c.n.:Ci~rcuit5 ..; ,:':" . . $ 50.00 S 69.00 SIOO.oo 'fIiew Alteration or Enenslon Per rand Olle Circuil S 43.00 I n I ) I _ Each Additionnl Circuit or ",ith -;> '/ (f\.>- \ \Loc..C.,4i-wt--~ OISer.vic~ or Feeder Perr.:il -'? $ 3.00 Owners N~~e ~ N !li'~~~'I1: <;HA\L EXPIRE.IF THE w.O.RK.. ., Addres.. ., S--ZS---;'(~ r efl-/l-., ....,-b~ TfES li\.ll.icHlll!1"eoU5 (Serie~~~~If!mq.4@~~ij)~E.cb Installation. City f::V.--&-- _ _ Phone 68i -<?:Zt::n AcUo1~J1~~~~.%~:~; A;ANDONEO FOR $ 50:00 I1V,,_I"U~ AN '11"~'(p\?I\O{4li!!i\t\eO. __ - S 50 00 OWNER INST ALLATlO:" ["roiled Energy.'RcSldemial S 25.00 The installation is being m<lde on proper.)' (own which limited EnergyiCcmrnercial S 45.00 is not intended for ~alc, 1c3:S': or rent. .!\1tnlmum Eltctric Permil Inspection Fee is $45.00 + Sll.rthar~ts Owners Signature: ., ..,., 4. ,SUllTOTAL OF ABO~'E - ',..~; .;.~ ;. ~ "~ . . 7% State Surcharge 1 0% Adminislraliv:: Fe: /7Z (20'1. 172.0 2010- Inspection Request: 726-3769 TOTAL Sha.'"'Cd Driv-:(T:):Bui:ding Fomu/Electi;;Al pt:r.l:li\ .\pplic:tion \ -OJ.doc