HomeMy WebLinkAboutPermit Building 2003-06-11Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
CITY F
Building/C ombination Permit
PERMIT NO: COM2003-00400ISSUED: 0611112003APPLIED: 0512212003
EXPIRESz l2llll2003VALUE: $ 198,180.00
SITE ADDRESS: 6889 Simeon Drive
ASSESSOR'S PARCEL NO.: 1702341107900
PROJECTDESCRIPTION: SFR
Owner: GRIppWAyNE
Address: 6833 SIMEON DR SPRINGFIELD OR 97478
Springgfield TYPE OF WORI(: Single Family Residence
TYPE OF USE: New Residential
Contractor Type
General
Electrical
Mechanical
0wner
Contractor
ALLANJAMES BRANDT
DEANS ELECTRIC
MARSHALLS INC
GRIPP WAYNE
CHAPIN ENTERPRISES
License
98891
99579
25790
Expiration Date
05/10/2005
0612012004
12t23t2003
Phone
s41-896-0583
541-935-5303
541-747-7445
INFORMATION
(
81994 05t0612004 541-485-1146
2 Lot Size:
29.00 Sq Ft lst Floor:
Forced Air Gas Sq Ft 2nd Floor:
Gas Sq Ft Basement:
Gas Sq Ft Garage/Carport
Path 1 Sq Ft Other:
Impervious Surface Area:
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary
Secondary
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
10,705
1,655
830
6s3
27.00
10.00
s.00
REQUIRED PARKTNG
Total: 2
Handicapped:
Compact:
32.00
43.00
o/o ofLot Coverage:
Funy Improved Sidewalk rype: curbside 5'
No Downspouts/Drains: Curb and Gutter
10 foot private slope easement - no grading in easement as per Ken Vogeney 61512003. Applicant
needs to sign easement document, signature must be notarized. Ask applicant to make a check for
$41.00 made out to Lane County Deeds and Records for recording fees.Notes:
Page 1 of4
r:L
\\
$\eo
Status Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
F PRIN
Building/Combination Permit
PERMIT NO: COM2003-00400ISSUED: 0611112003APPLIED: 0512212003
EXPIRESz l2llll2003VALUE: $ 198,180.00
Description
Dwellings
Garage
Tvpe of Construction
V Wood Frame
Garage
$ Per Sq Ft
$74.60
$19.60
Square Footage
2,495.00
653.00
st22t03
6mt03
6fiU03
6fiy03
6tru03
6t11t03
6ltu03
6ltu03
6nu03
6nu03
6nu03
6ltu03
6fiu03
6tru03
6tru03
6nu03
6nu03
6mt03
6mt03
6nu03
6fiu03
6nu03
6fiu03
6nu03
6nu03
6nu03
6nu03
6nu03
6nu03
6nu03
6nu03
6fiu03
6fiu03
6ltu03
Value
$185,381.00
$12,798.80
$198,179.80
Date Calculated
0512212003
0st22t2003
Amount Paid
Total Value of Project
Date PaidFee Description
Plan Review Residential
-Mechanical Issuance Fee-
+ l0Yo Administrative Fee
+ 7oh State Surcharge
3 Baths One & Two Family
Addressing Assignment
Air Handling Unit Up to 10,000
Annexed 2000
Building Permit
Curbcut Permit
Dryer Vent
Exhaust Hoods
Furnace - up to 100,000 btu
Gas Fireplace
Gas Outlets 1-4
Heat Pump
Plan Review - Planning
PW Mult Disc - 2nd Permit
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl500
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC NIWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
\Yillamalane Single Family
Receipt Number
1200200000000001307
1200200000000001491
120020000000000r491
r200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
120020000000000149r
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
1200200000000001491
r200200000000001491
$s76.81
$10.00
$153.44
$107.41
$306.00
$8.00
$8.00
$-1.41
$887.40
$75.00
$6.00
$9.00
$12.00
$15.00
$4.00
$12.00
$s9.00
$-30.00
$106.00
$9s.00
$486.91
$640.61
$10.00
$34.83
$332.86
$112.48
$49.26
$709.81
$160.87
$7s.00
$860.38
$s0.00
$24.00
$1,000.00
tr'pps Pnid
Total Amount Paid $6,965.66
Paee2 of 4
Valuation Descriotion I
F
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Ftx
541-726-37 69 Inspection Line
PERMIT NO: COM2003-00400ISSUED: 0611112003
APPLIEDT 0512212003
EXPIRESz l2llll2003VALUE: $ 198,180.00
Plan Reviews
Initial Review
Planning Review
Public Works Review
Structural Review
05t2312003
05t23t2003
05t23t2003
06t02t2003
APP
APP
LLH
AJD
06t02t2003 06/05/2003 APP DJW
05t2312003 0610912003 APP TCM
Tree Felling Permit required if more
than 5 trees are being removed
on-site. Located in Floodplain,
however, all related issues regarding
the floodplain were dealt with at
Subdivision stage. (Per Jim
Donovan, Planner for Levi
Landing).
10 foot private slope easement - NO
GRADING IN EASEMENT as per
Ken Vogeney 61512003. Applicant
needs to sign easement document,
signature must be notarized and
returned to the City Surveyor. Ask
applicant to make a check for $41.00
made out to Lane County Deeds and
Records for recording fees.
To Request an inspection call the24 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 Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
2 Curbcut - Standard: After forms are erected but prior to placement of concrete.
3 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
4 Footing: After trenches are excavated.
5 Foundation: After forms are erected but prior to concrete placement.
6 Post and Beam: Prior to floor insulation or decking.
7 Floor Insulation: Prior to decking.
8 Shear Wall Nailing: Before covering sheathing with finish materials.
9 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
10 Wall Insulation: Prior to cover.
1l Ceiling Insulation: Prior to cover.
12 Drywall: Prior to taping.
13 Final Building: After all required inspections have been requested and approved and the building is complete.
14 Underfloor Plumbing: Prior to insulation or decking.
15 Underfloor Drain: Prior to coYer or placement of concrete.
16 Rough Plumbing: Prior to cover and including required testing.
17 Water Line: Prior to filling trench and including required testing.
18 Sanitary Sewer Line: Prior to filling trench and including required testing.
19 Storm Sewer Line: Prior to filling trench.
20 Final Plumbing: When all plumbing work is complete.
Paee 3 of4
Renrrired Insnections
t
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Frx
541-7 26-37 69 Inspection Line
Building/C ombination Permit
PERMIT NO: COM2003-00400ISSUED: 0611112003APPLIEDz 0512212003
EXPIRESz l2llll2003VALUE: $ 198,180.00
2l Underfloor Mechanical. Prior to insulation or decking and including required testing.
22 Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
23 Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
24 Rough Mechanical: Prior to Cover
25 Final Gas: When all gas work is complete.
26 Final Mechanical: When all mechanical work is complete.
27 Temporary Electric: Approval required prior to Utility Company energizing pole.
28 Rough Electric: Prior to Cover
29 Electric Service: Approval required prior to utility company energizing service.
30 Final Electric: When all electrical work is complete.
By signatureo 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 Springlield 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 construction.
Signature
Pase 4 of 4
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Receipt #: 120020000000000 1 49 1 Date: 0611112003
1
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2d03-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
coM2003-00400
Addressing Assignment
Willamalane Single Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Plan Review - Planning
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
Annexed 2000
Building Permit
3 Baths One & Two Family
Fumace - up to 100,000 btu
Air Handling Unit Up to 10,000
Vent Fan
Exhaust Hoods
Dryer Vent
Gas Outlets l-4
Gas Fireplace
Heat Pump
-Mechanical Issuance Fee-
+ 7oh State Surcharge
+ l0o/o Administrative Fee
8.00
1,000.00
106.00
95.00
50.00
59.00
75.00
75.00
(30.00)
860.38
640.61
486.91
160.87
709.81
332.86
34.83
10.00
112.48
49.26
(1.41)
887.40
306.00
12.00
8.00
24.00
9.00
6.00
4.00
15.00
12.00
10.00
107.41
153.44
6lrr/2003 8:59:04AM Page I of2
ltem Total:$6,388.85
cRcceipt.rpt
*tltslEsilla,
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Receipt #: 12002000000000 01491 Date: 0611112003
Payment Total:$6,388.85
((,
(
611U2003 8:59:04AM Page2 of2 cRcceipt.rpt
djb
( , ilo.: 04-'10-0148A
Fed.eral Emergency Management Agency
*'
LOMADate: Jan 2004Page 1 ol 2
LETTER OF MAP AMENDMENT
DETERMTNATTON DOCUM ENT (REMOVAL)
COMMUNlTY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION
CITY OF SPRINGFIELD, LANE COUNTY,
OREGONCOMMUNITY
COMMUNITY NO.: 4{5592
NUMBER: 4l (BgCl l6'rF
IIAME: I-ANE COUNTY, OREGON AND
INCORPORATED AREAS
AFFECTED
MAP PANEL
DATE:06/02/1999
Lot 46, Levi Landing Second Addition, as shown on the Plat recorded in File
75, Slides 1 152 through 1 155, in the Office of the Recorder, Lane County,
Oregon
FLOODING SOURCE: CEDAR CREEK APPROXIMATE IITITUDE & LONGITUDE OF PROPERTY: 44.054, -122.9(E
SOURCE OF LAT & LONG: PRECISION lilAPPtNG STREETS,I.0 DATUiI: NAD 83
DETERMINATION
OUTCOME
WHAT IS
RE[,tOVED
FROM THE
SFItA
LOT BLOCTV
SECTION SUBDIVISION STREET FL@D
ZONE
1% ANNUAL
CHANCE
FL@D
ELEVATION
(NGVo 2e)
LOWEST
ADJACENT
GRADE
ELEVANON
(NGVD 29)
(NGVD 29)
LOWEST
LOT
ELEVATION
Levi Landing
Second Addition
Structure
515.0 feet 515.7 feet466889 Simeon Drive
X (shaded)
Special Flood Hazard Area (SFHA) - The SFHA is an area that wouH be inundated by the flood having a 1-percent chance of being equaled or
exceeded in any giwn year (base flood).
ADDITIONAL CONSIDERATIONS (Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.)
PORTIONS REMAIN IN THE SFHA
This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property
described above. Using the information submitted and the effective National Flood lnsurance Program (NFIP) map, we have determined that the
structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in
any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP
map; therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance
requirement to protect its financial risk on the loan. A Prefened Risk Policy (PRP) is available for buildings located outside the SFHA. lnformation about
the PRP and how one can apply is enclosed.
This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. lf
you have any questions about this document, please contact the FEMA Map Assistance Center toll free al (877) 33G2627 (877-FEMA MAP) or by letter
addressed to the Federal Emergency Management Agency, 3601 Eisenhower Avenue, Suite 600, Alexandria,VA223}4-il39.
Version 1.3.3 '1 02426CASLrDEC03 1 05320 1 48
Doug Bellomo, P.E., CFM, Acting Chief
Hazard ldentification Section, Mitigation Division
Emergency Preparedness and Response Directorate
Washington, D.C.20472
,{o.: 04-10-0148A
Federal Emergency Management Agency
Washington, D.C. 20472
Date: Jan 9,2004 LOMAPage 2 of 2
LETTER OF MAP AMENDMENT
DETERMTNATTON DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDTT|ONAL CONSIDERATIONS)
PORTIONS OF THE PROPERTY REMAIN lN THE SFHA (This Additional Consideration applies to the preceding 1
Property.)
Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood
Hazard Area. Therefore, any future construction or substantial improvement on the property remains subject to Federal,
State/Commonwealth, and local regulations for floodplain management.
This attachment provides additional information regarding this request. lf you have any questions about this attachment, please contact the FEMA Map
Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, 3601 Eisenhower
Avenue, Suite 600, Alexandria, VA 22304-6439.
Doug Bellomo, P.E., CFM, Acting Chief
Hazard ldentification Section, Mitigation Division
Emergency Preparedness and Response Directorate Version 1.3.3 1 02426CASLTDEC031 053201 48
Federal Emergency Management Agency
Washington, D.C. 20472
January 9,2004
MR. WAYNE A. GzuPP
6889 SIMEON DRIVE
SPRINGFIELD, OR 97478
CASE NO.:04-10{148A
COMMUNITY: CITY OF SPRINGFIELD, LANE COUNTY,
OREGON
COMMLINITY NO.: 415592
DEAR MR. GRIPP:
This is in reference to a request that the Federal Emergency Management Agency (FEMA) daermine if the
property described in the enclosed document is located within an identified Special Flood Hazard Area, the
area that would be inundated by the flood having a I -percent chance of being equaled or exceeded in any
given, year (base flood), on the effective National Flood Insurance Program (NFIP) map. Using the
information submitted and the effective NFIP map, our determination is shown on the attached Letter of
Map Amendment (LOMA) Determination Document. This determination document provides additional
information regarding the effective NFIP map, the legal description of the property and our determination.
Additional documents are enclosed which provide information regarding the subject property and LOMAs.
Please see the List of Enclosures below to determine which documents ire enclosed. Other dtachments
specific to this request may be included as referenced in the Determination/Comment document. If you
have any questions about this letter or any of the enclosures, please contact the FEMA Map Assistance
Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency
Management Agency, 3601 Eisenhower Avenug Suite 600, Alexandria VA 2230+@39.
Sincerely,
Doug Bellomo, P.E., CFM, Acting Chief
Hazard ldentification Section, Mitigation Division
Emergency Preparedness and Response Directorate
LIST OF ENCLOSURES:
LOMA DETERMINATION DOCUMENT (REMOVAL)
cc:State/Commonwealth NFIP Coordinator
Community Map Repository
Region
CITY OF Srr(INGFIELD SYSTEMS DEVELOPMEI A/ORKSHEET
JOURNAL OR JOB NUMBER: COM2003-00400
NAME OR COMPANY Wayne Gripp
LOCATION 6889 Simeon Dr
TAX LOT NUMBER 1702341 rrL07900
DEVELOPMENT TYPE:
NEW DWELLING UNITS BUILDING SIZE (SF) O LOT SIZE (SF):1 0890
U)H
U
&r!F(n
o
E]&
1070
1091
1092
1093
1094
1054
1055
1054
1056
1079
1078
1. STORM DRAINACE
DIRECT RUNOFF TO CIry STORM SYSTEM
IMPERVIOUS S.F. X CHARGE
$860.381.00
RUNOFF ROUTED TO DRYWELL DESIGNED AND TO CITY STANDARDS
IMPERVIOUS S.F
0.00
x COSTPER S.F
$0.282
x DISCOUNTRATE
50Vo
DISCOUNT
$0.00
ITEM 1 TOTAL. STORM DRAINAGE SDC $860.38 I $860.3E
2. SANITARY SEWER - CIry
A. REIMBURSEMENTCOST:
NUMBER OF DFU's
29
x COST PER DFU
$22.09 = f----$640.61
B.IMPROVEMENT
NUMBER OF DFU's
29
x COST PER DFU
$ 16.79 = f----T486191
ITEM 2 TOTAL - CITY SANITARY SEWER SDC 127.52
3. TRANSPORTATION
A. REIMBURSEMENT COST:
ADTTRIP RATE
9.57
NUMBER OF UNITS
I
x COST PER TRIP
$r 6.8 r
x NEW TRIP FACTOR
1.00 = I $160.87
B.IMPROVEMENT
ADT TRIP RATE
9.57
x NUMBER OF UNITS
I
x COST PER TRIP
$74.17
x NEWTRIP FACTOR
1.00
ITEM 3 TOTAL. TRANSPORTATION SDC ;870.68
4. SANITARY SEWER - MWMC
A. REIMBURSEMENTCOST:
NUMBER OF FEU's
I
x
= I $332.86
B. IMPROVEMENT COST:
NUMBER OF FEU's
I
x
= I $34.83
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =
= I ($1.41)
= I $10.00
$376.28
COST PER FEU
$332.86
COST PER FEU
$34.83
SUBTOTAL (ADD ITEMS I,2,3, &4)I@
5. ADMINISTRATIVE FEE:
SUBTOTAL
$3,234.86
x ADM. FEE RATE
57o
CHARGE
$161.74
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:t W.26
D. Wright 6t5t2003
PREPARED BY DATE
TOTAL SDC CHARGES = f T3r%.60
1
x
DRAINAGE FIXTURE UNIT CALCULATION TABLEDIU
NUMBER OF NEW FXTURES X UNIT EQUIVALENT = DRAINAGE FXTURE UNITS
DRAINAGE
FIXTURE
UNITS
NO. OF FIXTURES
FIXTURETYPE NEW OLD
(NOTE: FOR REMODELS,CAT.CULATE ONLY THE NET ADDITIONAL FIXTURES)
UNIT
EQUIVALENT
2 0 3 b
DRINKING FOUNTAIN 0 0 1 0
DRAIN 0 0 3 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0
SAND A 0 0 6 0
UNDRY TUB 1 0 2 2
SINKHER /1 0 3 3
ASHER. 3 OR MORE 0 0 6 0
1 PER 0 0 12 0
FOR REFRIG / WATER STATION / ETC.0 0 1 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0
SINGLE STALL 1 0 2 2
OF 0 0 2 0
SINK: COMMERCIAI-/RESIDENTIAL KITCHEN 1 0 3 3
SINK:BAR 0 0 2 0
SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 2
LAVATORY/RESIDENTIAL BARSINK:2 0 1 2
STALL/WALL 0 0 5 0
0 0 6 0
PRIVATE INSTALLATION 3 0 3 o
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
0
TOTAL DRAINAGE FD(TURE UNITS
*EDU lsa toa unit set at 167
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
CREDIT RATB$I.OOO
ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENTELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
0
2000
CREDIT FOR LAND (IF APPLICABLE)
VALUE / IOOO CREDIT RATE
$35.37 x $0.04
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE/ IOOO CREDIT RATE
$0.00 x $0.04
TOTAL MWMC CREDIT
BEFORE 1979 $4.92
1919 $4.92
I 980 $4.83
l98t $4.77
t982 $4.64
1983 $4.47
1984 M.30
1985 $4.09
1986 $3.78
1987 $3.41
1988 $2.98
1989 $2.s2
1990 $2.06
l99l $ r.64
1992 $1.45
t993 $1.31
1994 $1.r3
t995 $0.97
t996 $0.82
t997 $0.63
1998 $0.41
1999 $0.22
2000 $0.04
20
1
!-d-
I $1.41
FIFIH STREET JCAL
Nlulti-Fnmil-v p er dn'elling unit.
Included:
or less
Home or
Drvelling
Senice or Feeder
B. Services or Feeders
Instirllittion, A
Relocirtion:
200 amps or less'i
201 amps to 400
401 antps
1 antps
D. Branch
E. I\Iis
Limited Energf iRes :
Liurited Energ/Comm
I\Iinintum Elcctric Permit Inspcction
1. SUBTOTALOFABOVE
79'u Statc Surch:trge
lOroL Admin i st.r':ttir.e Fce
' $ 50.00
s25.00
s-t5.00
Items Cost
$ r06.00OBD
Electrical'
Address
l^.!) $ 1e.00
xggg
Elect
TOTAL
Fec is S-15.00 + Srrrchilrges
iflvork is 'started within 180
of issuance
180 dai's.
rvork is
p
tottu
made
6)
J03.1 uJ