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Home My WebLink AboutPermit Building 2004-5-3 -. . CITY VI< ~l"Kl1'\iuI<1~LU Building/Combination Permit PERMIT NO: COM2003-00953 ISSUED: 05/03/2004 APPLIED: 09/24/2003 EXPIRES: 11/03/2004 VALUE: $ 26,801.20 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726~3769 Inspection Line SITE ADDRESS: 2532 GRAND VISTA DR ASSESSOR'S PARCEL NO.: 1703243101400 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition PROJECT DESCRIPTION: Add new bedroom; Install windows in existing B.R.;modify Library door Residential Owner: HEAD EDWIN 0 & DARLENE L Address: 2532 GRAND VISTA DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor PAUL S ALEXANDER CONSTRUCTION OWNER OWNER OWNER License 122227 Expiration Date 03/17/2005 Phone 541-746-0923 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 U-I VN I BUILDING INFORMAnON.lulres you to Al lei".."'.... w'".o- ~Utlllty tolld1/OfSlililiMoPted by \tie 188 !set t\AASize: NotifMmntl~il&J\!0S8N ~~~t 1st Floor: In OJ.\OOOOff.tOltOO10 ~\!i11KJia\ul~il,y~ .2nd Floor: ~'1\s!i 'fu311:Qbt81n eopIes ~'Ft Basement: ~B'\I{itiRJl.lnter. (Note:.~~", ' Ft Garage/Carport nJi'R&!lYI81"thll Oregon UtiIl'lI'li1 q Ft Other: Center Is 1-8Q00332-2344). Impervious Surface Area: I DEVELOPMENT INFORMATION I 263 SETBACKS REQUIRED PARKING Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 7.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: 11.90 0.00 Street Improvements: Storm Sewer Available: Special Instruction: NOl'C~.PUBLIC IMPROVE~,El'Q:S.INORK ," lHIS PERM~6 ~~;~R 1HIS 'PER Mil IS NCSldewalk Type: AU~H~~\lr~o OR IS ABANOONEO FOR Downspoutsffirains: StormwatWU\MlS~lI'g: ERIOO AN'l 180 OA'l P . Notes: Page 1 of4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspection Line Description Tvpe of Constructiop Use Bid Amount V Wood Frame Bid Amount Dwellines Fee Description Plan Review Resideptial -Mechanical Issuance Fee- + 10% Administrative Fee + 70/0 State Surcharge Add, Alter, Extend Circ Building Permit MinimumlAdjustment Electrical Miscellaneous Mechanical Plan Review - Plapning Plan Review Residential Plan Review/Residential Hourly SDC SanitarylStorm Admin Storm Drainage Impervious Area Storm Sewer - 1st 50 Feet Total Amount Paid . . CITY U1< ~l"tOl'\jlJ1<l1i,LlJ ' Building/Combination Permit PERMIT NO: COM2003-00953 ISSUED: 05/03/2004 APPLIED: 09/24/2003 EXPIRES: 11/03/2004 VALUE: $ 26,801.20 I Valuation Deseriotion I $ Per Sq Ft ,or multiplier $1.00 $92.40 Square Footage or Bid Amount 2,500.00 263.00 Total Value of Project Fppo. PaiIIJ Amount Paid Date Paid $176.28 $10.00 $37.11 $25.98 $43.00 $236.10 $2.00 $45.00 $59.00 $263.74 $180.00 $3.57 $71.49 $45.00 9/24/03 5/3104 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 5/3/04 $1,198.27 I Plan Reviews , 09/25/2003 0912612003 APP LLH 04/1412004 04/23/2004 APP TAJ 09/26/2003 10/1412003 APP TAJ 03/02/2004 03/02/2004 APP TAJ 02/18/2004 0211812004 DON VRJ Initial Review Plan nine Review Plan nine Review Plan nine Review Public Works Review Paee 2 of4 Value Date Calculated $2,500.00 $24,301.20 $26,801.20 05/02/2004 05/02/2004 Receipt Number 1200200000000002202 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 1200400000000000607 Second revision to the complete set of plans. Rechecked revised site plan. Revised site plao submitted. Applicaot does not plan to build part of original addition. SDC impervious sq ft changed from 672 sqft to 348.75 sq ft. Changed SDC fees. . . Ul1' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00953 ISSUED: 05/03/2004 APPLIED: 09/24/2003 EXPIRES: 11/03/2004 VALUE: $ 26,801.20 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Public Works Review 09/26/2003 09/30/2003 APP MS 9/3012003 - Contractor called back and stated that storm water will go te existing. -MS Public Works Review Structural Review 04114/2004 04114/2004 04/20/2004 05/02/2004 10 APP VRJ DLM 9/2912003 - Storm drainage is not shown on plans. Contacted contractor - awaiting return pbone call to determine where storm drainage will go. -MS 3rd plan set. Recalculated SDC's. Second revision to the complete set of plans. Structural Review' Structural Review 09/26/2003 02/02/2004 10/14/2003 03/02/2004 APP WE DLM DLM Plan revisions 020204 Need add'l info. for roof framing, floor beam & supports at garage. Sent letter to applicant 3/212004 dim 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. L...Bsflllir1p.1rllnsnections I I Footing: After trenches are excavated, 2 Foundation: After forms are erected but prior to concrete placement. 3 Post and Beam: Prior to floor insulation or decking. 4 Floor Insulation: Prior to decking. 5 Shear Wall Nailing: Before covering sheathing with finish materials. 6 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 7 Wall Insulation: Prior to cover. S Ceiling Insulation: Prior to cover. 9 Drywall: Prior to taping. 10 Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. II Final Building: After all required inspections have been requested and approved and the building is complete. 12 Rough Mechanical: Prior to Cover 13 Final Mechanical: When all mechanical work is complete, 14 Rough Electric: Prior to Cover 15 Final Electric: When all electrical work is complete. Page 3 of 4 . . CITY OF SrKli'lld'lJ'.LIJ Building/Combination Permit PERMIT NO: COM2003-00953 ISSUED: 05/0312004 APPLIED: 09/24/2003 EXPIRES: 11/0312004 VALUE: $ 26,801.20 Status Issued 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. "?- J2~ Q- 3-0'-1 Owner or Contractors Signature Date Paee40f4 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ~ av of Springfield Official Receipt .elopment Services Department Public Works Department Job/Journal Number COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 COM2003-00953 Payments: Type of Payment CreditCard 5/3/2004 RECEIPT #: 1200400000000000607 Date: 05/03/2004 Description -Mechanical Issuance Fee- Plan Review - Planning Miscellaneous Mechanical Add, Alter, Extend Circ Storm Sewer - 1st 50 Feet Plan Review Residential Storm Drainage Impervious Area SDC SanitarylStorm Admin Minimum/Adjustment Electrical Building Permit Plan Review/Residential Hourly + 7% State Surcharge + 10% Administrative Fee Paid By EDWIN HEAD Item Total: Check Number Authorization ReceIved By Batch Number Number How ReceIved djb 000371 182643 In Person Payment Total: Page I of I 9:19:39AM Amount Due 10.00 59.00 45.00 43.00 45.00 263.74 71.49 3.57 2.00 236.10 180.00 25.98 37.11 $1,021.99 Amount Paid $1,021.99 $1,021.99 , CITY OF S!NGFIELD SYSTEMS DEVELOPMEAoRKSHEET JOURNAL OR JOB NUMBER: COM2003-00953- 3rd set of clans NAME OR COMPANY: Ed Head LOCATION: 2532 Grand Vista TAX LOT NUMBER: 17032431 t11400 DEVELOPMENT TYPE: ADDITION TO SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF' 0 LOT SIZE (SF): I. STORM DRAINAGE . DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x, COST PER S.F. 'I CHARGE I 246.50 I $0.290 I = $71.49 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 $0.290 I 50% I ~ I $0.00 ITEM I TOTAL - STORM DRAINAGE SDC , 571.49 I 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I , 0 I B. IMPROVEMENT COST: , NUMBER OF DFU's' x , 0 , COST PER DFU $22.64 COST PER DFU $17.21 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =, 50.00 3, TRANSPORT~TlON A. REIMBURSEMENT COST: , ADT TRIP RATE , x I NUMBER OF UNITS I I 9.57 'I 0 B. IMPROVEMENT COST: I ADT TRIP RATE I x 'NUMBER OF UNITS I I 9.57 'I 0 ITEM 3 TOTAL - TRANSPORTATION SDC o 571.49 50.00 50,00 [ I~ ell ~ o ~ 1070 1109\ I 11092 x , COST PER TRIP x INEWTRlP FACTORI I $17.23 . 1.00 x I COST PER TRIP x INEWTRlP FACTORI $76.01 , 1.00 = , 50.00 ~ 4, SANITARY SEWER - MWMC A. REIMBURSEMENT COST: IN UMBER OF FEU's I x ICOST PER FEU I 0 I' $332.86 B. IMPROVEMENT COST: 'NUMBER OF FEU's , x , 0 , ICOST PER FEU I 534.83 'SUBTOTAL , x I ADM. FEE RATE 1= I 571.49 I I 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Matt Stouder 4/20/2004 PREPARED BY DATE 50,00 50.00 = 50.00 11093 1094 I 1054 . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE, FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 0 0 3 = 0 IDRlNKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 ILAUNDRYTUB 0 0 2 = 0 ICLOTHESWASHER I MOP SINK 0 0 3 = 0 ICLOTHESWASHER - 3 OR MORE (EAt 0 0 6 = 0 IMOBILE HOME PARK TRAP P PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRlG I WATER STATION I ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER I ETC. 0 0 3 = 0 ISHOWER, SINGLE STALL 0 0 2 = 0 ISHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 ISINK: COMMERCiAURESlDENTIAL KITCHEN 0 0 3 = 0 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0 I,SINK: SINGLE LAVATORYIRESlDENTIAL BAR 0 0 1 = 0 IURINAL. STALL I WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 I .EDU (Equivalent Dwclliml Unit) is a disc~ eQuivalent to a sinlde familv dwellioll: unit (20 DI-1J's) set at 167 gallons per day ..J MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE L YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 CREDIT RA TE/SI,OOO ASSESSED V AWE $4.92 $4.92 $4,83 $4.77 $4.64 $4.47 $4.30 $4,09 $3.78 S3.41 $2,98 $2.52 S2.06 SI.64 SI.45 SUI SI.13 $0,97 SO.82 $0.63 $0.41 $0.22 $0.04 r--::D ELGlBLE FOR ANNEXATION CREDIT? :lo II II 'OLfm (Enter I for Yes, 2 for No) I IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? I (Enter I for Yes, 2 for No) BASE YEAR 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE /1000 CREDIT RATE $0.00 x $4.92 = I SO.OO CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE /1000 CREDIT RATE $0.00 x $4.92 0 TOTAL MWMC CREDIT = $0.00 r/ -. . . . . \, 1 '. ." '. " . .. " . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: COUlZCO~ 9''>3 Address: Z532. G,Ao--d. V.~4 Issued by: ':J:>6' Date: br 5/yo~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the "pp.vp.;ate blanks and initial boxes I and 2, and either box 3A or 3B: ~ 1. ,s I own, reside in, or will reside in the completed structure, 2, I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion, w- 3A. My general contractor is ~ I 5 A/exAv-dCiL ~ rlR_ (Name) /22227 (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board, OR D 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board, If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. 2CI?~ (' S-3-0'-( (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 03/11/03 .' J.' , . ", Acting ~s X o1.lrOwn General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ~ NOTE: This Information NDtice tD Property Owners about Construction Responsibilities was developed by the CDnstruction ContractDrs Board in accDrdance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor il} constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold incDme taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For a State Business ill number, call the Business Information Center at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes. on the wages of all employees. For more information, call the Oregon' Employment Department at 503-947-1488. Worke~s',Comp<ens.ation Insurance: As an employer, you are subject to th~ Oregon Workers' Compensation Law, and must obtain workers' compensation irlsurance' for your employees. If you fail to obtain workers' compensation. insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Reveuue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. . . . . Other Responsibilities and Areas of Con~erns Code Compliance: As the permit holder for this project, you are responsible for-resolving any failure to meet code requirements that may be brought to your' attention through in,q,ections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water daniage from pipe punctures, fire or work that must be redone, Time: Make sure you have.sufficient time to supervise your el11]>loyees. , . Expertise: Make sure you have the skills to i1ct as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building offiCials as the appropnate times' so they can. perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-462]) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property- owner.doc 03/11/03 ,.?:.',., :;~;?'~:...,..'c'~..itY OF"S {J:NGEIELD~~OREG'0N>' ,. ,,:...,.. , ~~l:" \:'J','t:.."'::: ',' .h. ~,'~'l ,...,' ~:f..-,~l<.~ J"-~"~...~ :"">..~'..:-:r :'~"~"~'l.r:';~.~ ._,:.\L~~~_~,:'~ SPRINGFIELD ~~ m ' , . ~.""~~ . F ~e,\!l~~I"I~iP.!'~t 8S s~&~~!1;~t~as l'h~owlng a~b~ta7.r\a does not re'!.~II~~~9\!i:.lilDliIlflsil"'iil Zoning ~ [_...._....".""""',..Q~l~~. ,'...~_, T " , ,,?_,"I~o-i:. ..,_.,.~""" 'COMPLETE.F '. CH UEE'BELo'Wr~. ~t t;)\'t.;;;i!, ' ,"-............~.,..~;,;tl~vf.]'li~rll~Bgnaturo.....Jo:.,'~..~-.;j~::;; ........~~, 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 , ELECTRICAL PERMIT APPLICATION City Job Number Ct2J!12dJ-?, -~)3Date 1. ~,p,'lYciTION7JFJNST'AELtftiON{f(ii'J;;;:'<il'\li, " ,-~~~..;>#C ~'?"k<>n~,..~i:<:;::.:~~lqr~~~- 3. Z,:{,l c:;~) 7l/5~ ~ , LEGAL DESCRIPTION I7tQ~ ~31 ~f)L.~D JOB DESCRIPTION A. ~~R.~,-~i~,~1m~r~~i~f[t~,'lJ~4rmil~frp~~~fli~~,i~ fJ.ao.!;l.='~~';~~L~~~~":1IW~';~C,i.tI<' "~"'~~-~' Service Included ~~J 1000 sq. ft. or less Each additional 500 sq. ft. or . portion thereof $106.00 $19.00 Permits are non-transferable and expire if work is Each Manufac!" d Home or not started within 180 days of issuance or ifwor[<. is Modular Dwelling Service or Suspended for 180 days. Feeder ~"'"' "",~...~..~ li."l1I....~~~"'l_~.",~\>_'0>....".....~'F""?'-~ eI~~~..l-.>.l,J,;~~~itii?:~jJf~.?'~.,.'*+i:~"'''r<>1:''~a\.l:r~1'':~ ,eoNT~c;!1,c;l,l!.il,fffflDtLI.:ATION_ONIfy:\'l ~r ~S&y~ces'or,Fe...de~.~Installatioil:Alterations or Relocation:~ 2, .' . '. " :ll~~MIT~S"ff~tt*EXfllR~ IF 1n o.w\:H:\~_"r,"""",-""",...~r.~...." -, '''Ku"a~''''''~'''''_~''_'u'1 Electrical Contractor 1I-\lS 'r"\~rg IIMnFR 1HIS PERM\iib~ ~ps or less $ 63.00 IWfl'iME'icEO .OR IS ~P.NDONED f&!f).".ps to 400 Amps $ 75.00 Address C~~ 1&{J C{\'( o~~{) 401 Amps to 600 Amps $125.00 A , 7 601 Amps to 1000 Amps $163.00 City Phone Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 $50.00 Expiration Date ~t..~..,.~,... ....~ ....."~~.,...'Ir..~j_\!lI!i~. ~ r "n" '"y, req~ 'lIfary;Seivices 'or. FeeiIers:,: ~..~~ '!l:"",",,' . "'T1ENI\U;~' 3!:~ db~;'eO!egOn 1l\Y~' ,. ~ ....,,--_. ","". folloW ru\es,ad?P. e Thnee rules iIliitlift1m~flteration or Relocation Notilicatlon ~~1':~~10 thrO~gh om~: Wess $ 50.00 in 0"1". 952 ..' {lh.,,;n COpieS o1!\}t' ~'f 400 Amps $ 69.00 009U. .'uu ~'-~enter, (Note:.t~e4%~~J!lBfdi\600 Amps $100.00 calling t e nrpnQn Utility Non moel ;v. ir.: - "32.-2~~00 Amps or I~OO Volts see "B" above. . .. nu C teris1-800..., D <B"*"~h'r.,')o'J.1O!':"'~ii~~.&J.l!~~-I'~"j}t"!\5\~':.,~j#l SIgnature ofSupefVIsmg Electnclan en ' . ~.&,,~.\f~.!!!.!-~..Iir~~~D'i~~ 'l'~~ Expiration Date / Constr. Contr. Number /" I I Owners Name bEl 4/90 Address CS32 GRAMn VISTA Dl<.. City 5IlfI/JGfJa...iJ Phone 7'1'1-3707 f<Y.)f1k 7J.f7-c;897 11>4 (New Alteration or Extension Per Panel 'One Circuit' 1 ' Each Additional Circuit or with ' Service or Feeder Permit $ 43.00 $ 3.00 '13.00 E. fBirc~1r;;~~l~(S~~~~ii~~~1~~t~;lilliEd)~E~~~tillttiri~~ .~ ,....s~...___""'~ ~'.:>k "'"'"'-""-"'''''>~~u':;=''''':>-~"''''' ~~;;.c,,,,__......._,,., c...'~ ~;'l , Pump or irrigation Sign/Outline Lighting , Limited Energy~esidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45,00 + Surcharges r\'i":*1~~'<'... "tW;~.*~"'l':ff-4';;.r'~(";~~'j:r::~:' 4. ~'SUBTO"FAJj.OFABOVEj:" ",,,, '" _, ",-c... - ,.. ";,o..~.~'.'" ..- ~lit,..~l:;;,$'>~~<,~..,>~,.,~ " 45~ ----. ~~b / 4. fib 5i!Il1,6S .1=~'?~O 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building FonnslElectrical Pennit Application 1-Q3.doc