HomeMy WebLinkAboutPermit Building 2002-11-5
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11/05/2002
APPLIED: 12/19/2001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1920 Henderson Ave A
ASSESSOR'S PARCEL NO.: 1803032002800
Eug
TYPE OF Office
TYPE OF USE: New
Public
PROJECT DESCRIPTION: Land Use: Govt & Public Admin, Zoning: LMI, Office bldg A. Plans submitted as
6853 square feet. Application states 5400 square feet. Information entered as
indicated on plans.
Owner: Oregon Department of Transportation
Address: 885 Airport Rd SE bldg X Salem OR 97310
Phone Number: (503) 986-4338
ICONTRACfOR INFORMATION I
Contractor Type
Architect
General
Electrical
Mechanical
Owner
Plumbing
Contractor License
BBT Architects
John Hyland Construction
CASCADE COMMUNICATIONS SERVICES 1128011
Wescold Inc
Oregon Department of Transportation
Jones Contractors Inc
Expiration Date Phone
(541) 382-5535
(541) 726-8081
03/30/2004 541-736-0664
(503) 235-3193
(503) 986-4338
(541) 607-6163
SETBACKS
, BUILDING INFO~TION'
:iOv.",{I.'l
#ofSto~~? ~V>~....\O~~, I Lot Size:
He~l.ft~~\0Q,0\e ",e af'r::i '0'\ Sq Ft 1st Floor:
o~'('Yp~1/f1~f: !?-f?J'5 ~0'" Sq Ft 2nd Floor:
0\0($ ~tere;rY~l\D~ ~e ~ o~0 ~ Sq Ft Basement:
\O~. oo~'l.eRa.og'i ~1Pe: O\~ ~0~V:: #0 Sq Ft Garage/Carport
,,_~ ,,"'~ ,,'l.0'E~efgj ~afh'l~e'l.~\O~'\V Sq Ft Other:
A't> .~'" 00'" ,,<;)'v. C;, '.'" \~ ". I' S rf
~ ;,,-lI\~,,~ ,,"'V'>.....'I.'lP~,~o'l.~\.;$:.{I.\"'f>l>.1 mpervlOus u ace Area:
~~~,\,C~1IjjE~OrMBNiiNFORMATION I .
\~O~<;):,\J ....>is''' >is'0~ vU- REQJJ.lB.tDPARKING
f:l<1l "$..\~'" \0\ ,,( ,,,, ~'NU'':~
(:l C~ ~e\ ~~erlay Dist: ~~ \~ ~~~
~-v~ (# Street Trees. u.. ~~ ~~~~ ~pped:
Paved Driv\\t\'\l\C~' ~\, 1iI"~ ~? ,,,\1iI ~\)~~ ct:
% of Lot c"'(~i~~\tt.\) \}~~ \1iI t>.Ylt>.~
t>.~:~~k{:~C~~I~{:?\\)\)'
IpUBLIC IMPROVE~l:;~~ \.I"
Sidewalk Type:
B
6,853
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Downspouts/Drains
Notes:
I of 9
.
. CITY VI' M'ldNGFIELD
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11/05/2002
APPLIED: 12/1912001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
Desc ription
Type of Construction
$ Per Sq Ft
Square Footage
Value
Date Calculated
Total Value of Project
Fees Paid I
Fee Description Amount Paid Date Receipt Number Received By
Commercial Plan Check $885.24 12/19/01 7567 djb
MWMC Administrative Fee $10.00 3/28/02 8438 djb
Transportation SDC Reimburseme $1,160.32 3/28/02 8438 djb
Sanitary Sewer SDC Improvement $1,185.52 3/28/02 8438 djb
Government Building - MWMC $1,439.84 3/28/02 8438 djb
Sanitary Sewer SDC Reimburseme $1,560.01 3/28/02 8438 djb
SDC Administrative Fee $2,977.35 3/28/02 8438 djb
Transportation SDC Improvement $5,120.10 3/28/02 8438 djb
Impervious Surface Area - Stor $49,071.20 3/28/02 8438 djb
Each Additional Outlet $2.00 6/27/02 9762 djb
One to Four Outlets $4.00 6/27/02 9762 djb
Mechanical Issuance $10.00 6/27/02 9762 djb
State Surcharge - Mechanical $13.44 6/27/02 9762 djb
8% Administrative Fee - Mechan $15.36 6/27/02 9762 djb
Vent Fan to One Duct $42.00 6/27/02 9762 djb
State Surcharge - Plumbing $66.29 6/27/02 9762 djb
Less than 100,000 BTU $72.00 6/27/02 9762 djb
8% Administrative Fee - Plumbi $75.76 6/27/02 9762 djb
Encroachment Permit $85.00 6/27/02 9762 djb
Final Site Plan Insp for Occy $100.00 6127/02 9762 djb
Water Service Footage $129.00 6/27/02 9762 djb
Sanitary Sewer Footage $185.00 6/27/02 9762 djb
Storm Sewer Footage $255.00 6/27/02 9762 djb
State Surcharge For Building P $320.10 6/27/02 9762 djb
8% Building Administrative Fee $365.83 6/27/02 9762 djb
Number of Fixtures $378.00 6127/02 9762 djb
Paving $2,080.15 6/27/02 9762 djb
Fire & Life Safety Plan Review $2,563.66 6/27/02 9762 djb
Adjusted Public Plan Review $3,280.71 6/27/02 9762 djb
Building Permit $4,572.90 6/27/02 9762 djb
State Surcharge - Electrical $3.50 7/26/02 10053 djb
8% Admin Fee - Electrical $4.00 7/26/02 10053 djb
Temporary: 200 Amps or Less $50.00 7/26/02 10053 djb
Low VoUage - Commercial Indus $45.00 11/4/02 1200200000000000186 djb
+ 7% State Surcharge $45.29 11/4102 1200200000000000186 djb
+ 8% Administrative Fee $51.76 11/4/02 1200200000000000186 djb
Perm ServlFdr 401 to 600 amps $125.00 11/4/02 1200200000000000186 djb
Add, Alter, Extend Circ Ea Add $225.00 11/4/02 1200200000000000186 djb
2 of 9
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 8% Administrative Fee
Low Voltage - Commercial Indus
Total Amount
Paving
Commercial Plan Check
Fire & Life Safety Plan Review
8% Admin Fee - Electrical
Number of Fixtures
Sanitary Sewer Footage
Storm Sewer Footage
8% Administrative Fee - Plumbi
Building Permit
State Surcharge For Building P
8% Building Administrative Fee
Temporary: 200 Amps or Less
State Surcharge - Electrical
Water Service Footage
State Surcharge - Plumbing
3hp -- 100,000 BTU
V cnt Fan to One Duct
8% Administrative Fee - Mechan
Mechanical Issuance
Government Building - MWMC
Impervious Surface Area - Stor
Adjusted Public Plan Review
Encroachment Permit
Less than 100,000 BTU
One to Four Outlets
Each Additional Outlet
State Surcharge - Mechanical
Sanitary Sewer SDC Reimburseme
Sanitary Sewer SDC Improvement
Transportation SDC Reimburseme
Transportation SDC Improvement
SDC Administrative Fee
MWMC Administrative Fee
Final Site Plan Insp for Occy
Total Fees Paid Prior to 9/30102
En~ineerin~-CIIIP
.
$252.00
$3.15
$3.60
$45.00
$78,879.08
$2,080.15
$885.24
$2,563.66
$4.00
$378.00
$185.00
$255.00
$75.76
$4,572.90
$320.10
$365.83
$50.00
$3.50
$129.00
$66.29
$72.00
$42.00
$15.36
$10.00
$1,439.84
$49,071.20
$3,280.71
$85.00
$72.00
$4.00
$2.00
$13.44
$1,560.01
$1,185.52
$1,160.32
$5,120.10
$2,977.35
$10.00
$100.00
$78,155.28
11/4/02
11/5/02
11/5/02
11/5/02
06/27/2002
12/19/2001
06127/2002
07/26/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
07/26/2002
07/26/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
06127/2002
06/27/2002
03/28/2002
03/28/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
06/27/2002
03/28/2002
03/28/2002
03/28/2002
03/28/2002
03/28/2002
03/28/2002
06/27/2002
I Plan Reviews I
02104/2002
3 of 9
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11105/2002
APPLIED: 12/19/2001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
1200200000000000186
1200200000000000192
1200200000000000192
1200200000000000192
djb
djb
djb
djb
9762
7567
9762
10053
9762
9762
9762
9762
9762
9762
9762
10053
10053
9762
9762
9762
9762
9762
9762
8438
8438
9762
9762
9762
9762
9762
9762
8438
8438
8438
8438
8438
8438
9762
Appr PO
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fire Department Review
Fire Marshal-CIIIP
.
10/28/2002
10/2112002
01/17/2002
OK
. CITY OJ< M'KINGFIELD.
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 1lI0512002
APPLIED: 12/1912001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
AG
Plan review - Alarm System plan
review - This is an optional alarm
system. That is, the alarm system is
not required by the Building or Fire
Codes. This fire alarm system is
required to be designed and installed
in accordance with NFP A 72.
t. Provide a pull station at the
exterior door (Hall A108) as shown
on the plans sunbmitted.
2. Provide fire alarm certification at
the time of acceptance testing.
3. Acceptance testing will require Ac
power shut off 24 hours prior to
acceptance testing to verify
secondary power adequacy.
4. Contact Springfield Fire
Marshal's Office for acceptance test
726-2293.
Plan review Maintenance facility, 3
buildings total square footage is
30,053. Building A 6853 sq ft, B
occupancy, Type VN Construction.
Electric gates will be required to be
equipped with Knox keyed switches
for fire department access. Obtain
Knox application from deputy fire
marshal AI Gerard at 726-2294.
All hydrants and underground
firelines shall be pressure tested,
flushed and flow tested in the
presence of the Deputy Fire Marshal
prior to beginning of combustible
construction.
A 2A-IOB:C fire extinguisher shall
be provided for every 75' of travel in
all buildings.
Provide alarm system submittal to
Fire Marshals office for review and
approval. System shall comply with
the provisions set forth in NFP A 72
1996 edition.
Building shall be marked with the
letter A in 12" or larger letters
contrasting in color with its
background, visible from
Henderson.
Appr AG
4 of 9
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review-CIIIP
Plannin2-CIIIP
Plannin2-CIIIP
Plannin2-C/I1P
.
01/02/2002
06/04/2002
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11/05/2002
APPLIED: 12/19/2001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
Appr LH
Delay in initial review because of the
submittal. All plans for this project
were submitted as one "roll" of
plans and needed to be separated
and placed into individual
submittals. Additional time charged
for extra staff time charged under
job number 01-01400-01
Needs to submit LDAp per condition
13 of Site Plan Review conditions of
approval. Submit copies of DSL and
US Corps of Engineer permits prior
to construction per conditon 9 of Sit.
Plan Review Journal no.
2000-10-0199. If temporary
occupancy is required separately for
any building on the site bonding will
be necessary. Left second message
for Rich Scanlan on 2/20/02
Received copies of the DSL and US
Corp of Engeineer letters regarding
permits. Waiting on submittal of
LDAP.
LDAP Complete, received letters
from DSL and Army Corp. See note
below regarding temp. occupancy.
Wait LM
Wait LM
Appr LM
5 of 9
':'""1I&t--.uqo~!:I,3} ..- ..'- t.
~ t ~ ....
t" ~
,
. "C. ,
.I.~' "4 ~
. .
'v' ... ~'1f
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Structural-CIIIP
.
01/18/2002
. CITY OF SPRINGNJ'.LJJ
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11/05/2002
APPLIED: 12/19/2001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
Wait TR
6 of 9
Fed Ex'd to Tom Rogers 1/3/02.
Faxed letter to Barber Barrett
Turner Arch for comments on
preliminary plan review. General
comments for all buildings are:
requested copy of geotechnical
report, that all details in spec book
need to be stamped and signed by
arch or eng responsible for that
portion of work, special inspection
form needs to be completed and
returned to city.
Specific questions/comments for this
project:
I. Draft stops are requried in the
attic so that the maximum area is
3,000 square feet with a maximum
horizontal distance of 60 feet. Please
clairy where this is shown on the
plans. OSSC 708.3 2.
Door schedule sheet DS-I indicates
door A08 is not used, whereas sheet
A2.1 shows door A08 in room AI06
TIM. Please revise.
3. Door type D specifies safety
glazing for the sidelight, but does n01
indicate a fire rating as required by
OSSC Section 1004.3.4.3.2.2 and
713.9. Provide supplemental
information or specifications
demonstrating compliance.
4. Calculation page I indicates the
1994 UBC 1996 OSSC was used.
The current code is the 1997 UBC
1998 OSSC, please revise.
5. The wind load analysis appears to
use method 2 projected area method,
for the walls and modifies the force
on the roof according to the slope. It
method 2, normal force method, is
intended, provide specific
calculations for the windward and
leeward loads. Note the roof pitch in
the plans is 4:12, not 3:12 as used int
he calculations.
6. The siesmic calcuations on page 7
are for the 1996 OSSc. Please
provide calculations based on the
1998 OSSc.
7. Detail 21A4.1 specifies (2) layers
5/8" gyp. bd. at the bottom chord of
Status:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Structural-CIIIP
.
02/19/2002
7 of 9
. CITY OF SPRINlJl'l~LU
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11/05/2002
APPLIED: 12/19/2001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
Info LH
the truss at the rated corridor,
whereas detail AD-43 specifies top
and bottom of the truss. Please
clarify.
8. Detail ADI9 as referenced on
section 1/A4.1 has apparently been
omitted. Please provide a copy of
the detail.
9. Provide installation specifications
and detailes for the suspended
ceiling demonstrating compliance
with UBC standard 25-2.
Fed Ex'd comments on plan review
notes from Todd Turner, Barber
Barrett Turner Architects to Tom
Rogers. Letter identified Building
A, Band C. See job file for specific
comments. Very large packet. Too
large to list. I hopper
~ii~c-.- . . .
, CITY OF SPRINGFIELD
" .
~._'" " Building/Combination Permit
t. \';
.-
Status: Issued PERMIT NO: 01-01398-01
225 Fifth Street, Springfield, OR ISSUED: 11/05/2002
541-726-3753 Phone APPLIED: 12/19/2001
541-726-3676 Fax EXPIRES: 05/05/2003
541-726-3769 Inspection Line VALUE: $ 1,897,237.00
Structural-CII/P 03/19/2002 Info LH Fed Exed information to Tom
Rogers from ODOT from Barber
Barrett Turner Architects, Todd
Turner Information included I)
Accessible Stall drawing 2)
Accessible ramp 3) Van Sign Detail
4) Sidewalk joints 5) Typical curbs
6) Truck wash trench 7) Catch basin
and grate 8) Type 2 grate and frame
9) Slab edge garage door 10)Bollard
II) Retaining wall12)Dumpster
ramp I3)Pavement Edge 14) slab
edge 15) CMU sill at wall 16)
Fascia/eave detail 17) exterior soffit
detail 18) Rake flashing 19) Ridge
flashing 20) Wall system 21)
Louvered Vent - Head 22) Louver
Sill 23) Threshold 24) Jamb at
exterior door 25) Head at Exterior
door 26) Jamb typical interior door
27) base, interior relite 28) jamb
typical interior relite 29) alum
window at cmu sill 30) sill, exterior
window 31) jamb, exterior window
32) head, exterior window 33) jamb
34) head/sill 35) base cabinet single
drawer unit 35) typical cabinet
upper 36) base cabinet wtih sink 37)
counter 38) bench at shower 39)
bench at locker room 40) locker base
41) Ihr non bearing partition 42)
non bearing partition 43) one hour
wall 44) non bearing wall 45)
overhead door 46) head exterior
door jamb, similar 47) Ihr wall at
steel col, maintenance building b 48)
Ihr wall at roof beam maintennace
building b.
Structural-CII/P 04/17/2002 Appr TM Approved for ODOT office only.
Additional required plans needed
for other buildings covered under
other job numbers still under
review. Building A (this job
number) is approved.
SUB - CommlInd 01/24/2002 Wait JF Requesting form 3a, 3b and
applicable worksheets. Requesting
form 4a. Faxed request to BBT
Archtect requesting forms 1-28-02 L
Hopper
SUB - CommlInd 03/26/2002 Appr JF Pass Energy Code Review
8 of 9
.
. L.111' OF ~rKH~GFIELD
Building/Combination Permit
PERMIT NO: 01-01398-01
ISSUED: 11105/2002
APPLIED: 12/19/2001
EXPIRES: 05/05/2003
VALUE: $ 1,897,237.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone _
541-726-3676 Fax
541-726-3769 Inspection Line
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.
~rvlljJi~
I Underground Electric: Prior to cover
2 Rough Electric: Prior to Cover
3 Electric Service: Approval required prior to utility company energizing service.
4 Final Electric: When all electrical work is complete.
5 Low Voltage: Prior to cover.
6 Low Voltage: Prior to cover.
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 ofaoy 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 wiD 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
Date
9 of 9
Oct 31 02 11:428 C~8d@ communiC8t~'on 541-736-0666 p.2
225FlFTH STREET ' ELEc!AL PERNliT APPLICATION
SPRINGFIELD. OREGON 97477 . . , ,
G'S?ECTION REQUEST: 726:3769,,' ,Cii~'J"h Numh.;r 01-0 1.3. 7 g--o ,
OFFICE: 7:6.3759, ' '.'
. . '. '. .'.' .,.' ..,'," . 3. COlvlPLETEFEE SCHEPULE BELOW
',1. Jln.f..:;To',OI~~~S!~L::~~ON_ A~'~~bI,'.,
..yv (..Jc.,,~v ~ ~ew:RC5idcntial..Singlc or
. ..;
Multi..Fmnily per dwelling unit.
Se,,>ice Includell:
LEGAL DE~RIPTlON
I ~O .'.> 03Z.0
, II \1aS thO 101l0wing
JOB DESCRlPTlON . proiec~ as sUbm,uepecilic la~,ft. or Icss
"Ib,. '- j),+~ L;1Jl.i,~i\~~"~~' E.choddilioD.I;OO
zw I 00 fr ^r pemon
u~{Ova
Pennits "re llon-tr.nsfe?ooJe i\nd-riffiili~ "2- thereof_
if work is not stuned wilhin 180 ,rays '11-'0 :S~ 0 , I ",neil Milllufd Home or
cfii;uaec'e qr uwork i;~n4ee f"'l ~l)-' Mn~..T:'r BweHing
180 d;,,'s. llzeO Slgnalure - Service or Feed:r
~ AiJtOO
oz.8'O()
Items COSl
Sum.
S106.00
S 19.00
S 50,00
2. CONTRACTOR INSTALLATION ONLY B. Senice, or Feeders
. '. L...SCc de. c..o... M......J~o'" Inst"lIa~ilJn, Alterntions or
Ele:tncal'Contractor ~AJ.iL,:~<, ~c... Relociltlon:
Add:css //!(j. H(Jh~k. Blvd.'
Cit).~ Phone. 5<iJ-73b-c66tf
Supmisor License Nnmber ;:';;'05 LE=A .
ExpimtionDatc" /o/J./iJs'..'
#,. 'n"
'Consu"Contr. N\lu;bcr 1:J,;f,()I/'
, " ,
ExpirillionDotc '3' /';'o/C<I
,;\
200 amps or less' _ $ 53.00 _
201 amps to -l00 amps _ $ 7~0 _
401 "OJps to 600 8mps ~~ 0
601 oOJps to 1000 aIllps ~ ~ 10-
Over 1000 ",nps/voits j..\l\~'i:. '\ ~~~~ 00 =
ReC01~leClOnly ~\.\.~ y..\~ \l~~'9 .0.00_
^~\~~:....t..\\ S\l-~,,"\ ....l-\'V\i
C. ~l-J;lo'r'&'il.'\Q".'.:~~ .. dl!-~"\'
I",~~tl'R>il..~tt!i~~ . ~'ltiOO
. '..\ \\\\\l\~~c,'i:.\l, (}'i:.~'\
.l'''~.'\l\.'l{lrirs;e't\~ '
'.:' "~"~mp&'tb 'i!oo,omps
~ -10 1 te 600 amps
.., 'I;O'lcr,'600.amps,or.lOOO:vol,ts!see~': 1'; ~-i~~';.;:>i ~,I:d..'<.:'C:t:~',;
"B" nbove
. ',j
Signature uf SUJlc!"\'i:iin: Electrician
!J~~f~4~.A"~ "',';'",," ~,r.;,~t''.!~Qj'"''
"~~\" "t; D. Br<lnch'C.h:cuits';~:'t .;~; - _.1.... ..,-......'" '
OWllers Namc' 0 ~OT'.. Now Altemtiol1 or Eli)'9lJlinPer Ponel
:'. .. " .." " r' II . InC" r .' ~\~0S':l \)\1\\\':1
:"Ildrc~,' ,Cjff))., fJ.,('f()<l./"r I::.d ~ Ol1e\~ffil~~a<;\o\'l !I. \o~" _ S43 00 _
'. 5>). 9 0-1 _ 5 I'lL .O~a<;\O\'l \'\\1'1 a.~ase ".r::F/'-' ,
City SIJ.-L.I::>>1 Phone 00 ~i\U~' ~~Il=>~d~ljo\lilKCi[f\11l";lt~xei.1:Jl\$injce
~\';.~ s a.CO orl\<<e\'l2r ~&,ni""l" ,\\1'1 ~\) a $ 3 00 .
OWNER iNSTALLATION - f>- o>t<l~\e Ca\'l\a :..,0\,\\10 ~asO\: ~p!~,\\O\'l'o\'l- -
The installation is be:ng made on \0\\ ca.\\oll. ~f~lI"noou.<:rS"n;cC/ffedO'\\Qfit'lodlldcd)
property 1 own wlliolt is not intended ~o\\ \ a rar:;,?: n" o'E1t~; ;\~tiili'a\iO~.." ~O"~
, 1 1 Or>-'P ~<>] Rtlii'''' ..".\\\.] 0.0.,. $'000
,or sn e. Oil3e or rent. i(\ 'lou CfI:J t P ~r"5'&at!,q~_~~ _ ) . '
r:J)raQ. ~(\<;\\,\\a \~~\'!J~l~I:ightLDg ,50.00
. Ca.~ \ e~ \O~'~~i\t\'lecl'EJl<rgy.ReS S25.no _
\'I~~'O cel'illmited Enerfy:Comm I S~5 1)0 _
$50~00 "', ..
- $69.00''',' ..
--: ..~-
_ $100'.0'0' .'\
'" '
OWJlCI"J.: Si~nature:
.' .
",'- r..
',' ",'.,~.
I\:linimuD1 Elc'ctl'ic Pc.rmit'lnspcct,ionTce is S45.00 + S~rc1l1l1"gcs
4. SUBio~~t~i~~~'~'~ ..':'..'.~.?fj'l'oji::
7% Sbt~:Suj'ch'1iigeH ~i((~' -)~'.-
8%.A~:,,::ni::mti;';!e..y. RI ~~~
TOTAL " ..;) h_
:::\:~:~i71~ n. :.?j:;";:'.,~(,l:,': ,';~: ::~,.: /.-;
,
1.:~~~.r:::n()J. 'J' t'~-.;;'~"-~t "\~~~ '> .\',~. . ;
'.