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Home My WebLink AboutPermit Building 1993-07-025r,rr IELE' RESID ENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 h, JOB NUMBER 225 Fifth Street Spri ngfield, Oregon 97 477 LOCATION OF PROPOSED WORK: ASSESSORS MAP: LOT:BLOCK: TAX LOT:Po/ SUBDIVISION: OWNER:PHONE; CITY:STATE: ADDRESS: €Sz-z /.o. Ex {tz 1**r*.,--#ztP: NEw / REMoDEL ADDrroN DEMoLTsH orHER Z.U,o.*-f*e?U?DESCRIBE WORK:lfu*al d,4 c-7zzp AD,"+G?nA ADDRESS EXPIRES PHONE qt( ?/r 7 CONTRACTOR'S NAME ELECTRICAL: MECHANICAL: PLUMBING: GENERAL: CONST. CONTRACTOR # \ RANGE: FLOOD PLAIN ZONING CODE: * OF BDRMS:OCCY GROUP: * OF UNITS: CONSTR. TYPE: HEAT SOURCE: WATER HEATER * OF STORIES: €_, SECONDARY HEAT: SOUARE FOOTAGE: QUAD AREA: # OF BLDGS To request an inspection, you must call 726-3769. This is a24hour recording. All inspections requested before 7:oO a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS l--l Temporary Electric t___J Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is complete. Sile lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to Final Electrical - When all electrical work is complete.cover, Underslab Plumbing/ Electrlcal / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain permanent electrical power. Final Mechanlcal - When all mechanical work is complete. F Footing - Alter trenches are excavated.Fireplace - Prlor to facing materlals and framlng lnsp. p Final Building - When all required inspections have been approved and buildin gis Masonry - Steel location, bond beams, grouting. completed. Framing - Prior to cover, Foundatlon - After forms are Other but prlor to concrete Wall/Ceiling lnsulation - Prior toplacement.cover. Underground Plumbing - Prior to filling trench.Drywall - Prior to taping. MOBILE HOME INSPECTIONS Underlloor Plumbing / Mechanical - Prior to insulation or decking.Wood Stove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After fireplace approvql and installation of unit. tr tr Blocking and Set-Up - When ail blocking is complete. Floor lnsulation - Prlor to decki ng.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.;;{ et.",ri"at Connection - When Fblocking, set-up, and plumbing' inspections have been approved and the home is connected to the service panel. ,/ | ,)[final - After alt required-:7^- rnspectrons are approved andporches, skirting, decks, and venting have been installed. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Waler Line - Prlor to filling trench.I-l Fence - When compteted Street Trees - When all required trees are planted. T Rough Plumbing - Prior to cover. Q? 3RNC-,- OFFICE USE - LAND USE: \ \SO tl E E r Slbrm Sewer - Prior to filling trench. tl Lot {aces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac. Setbacks P.L.HSE GAR ACC N S E IS THF- PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: X $/SQ. FT. t836) H.\d- (A) LUE Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the construction shall, in all respects, conform to the Ord adopted by the City of Springfield, incl Development Code, regulating the construct ans Reviewed By Date v: PIan Check Fee Date Paid: Receipt Nu Recei ded orbuildings, and may be sus at any time sof nances.upon violation of any p g the use of SYSTEMS DEVELOPMENT CHA (B)Tffi?#Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. PLUMBING PERMIT FT. Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS f MECHANICAL PERMIT Fu rnace Exhaust Hood Vent Fan No Wood Stove/ lnsert/Flreplace Unit Dryer Vent (D) Mechanical Permit lssuance State Surcharge Total Permit By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information hereon is true and correct, and I f urther 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 Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this prolect. 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 Signatu 3Date ring con ruction.I tion the site MISCELLANEOUS PERMITS Mobile Home State lssuance Total Miscellaneous Permits (E) @ rch e l6(fr Demolition State Surcharge State Sur Sidewalk Curbcut ft ft TOTAL AMOUNT CUE (excluding electrical) (A, B, C, D, and E Combined) r]ll$ ER VALIDATION: BECE|VED BY AMOUNT RECEIPT N DATE PAIT) t t Permit No:3 Address: lssued Date R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment is required for residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt f rom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable blanks,and initial boxes 1 and 2, and either box 3A or 38 I own, reside in, or will reside in the completed structure I understand that I must register as a construction contractor if the structure is sold or offered for sale before 1 2 3 or_!pon(r.\ld-o I4r.-A My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3.B I will be my own general contractor. lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certily that the above information is correct and that I have read and understand the lnlormation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. L 7 -r- ?3! gnature Permit licant CONSTRUCTION CONTRACTORS BOARD 0244J 8191 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT q,N, INFOR]TATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ilt-17ou ar€ acting as your own contractor to construct a new home or make a substantial imffotrc.ment.to an existing structure, ,you can prevent many problems by being aware of the following responsibilities and areas of concern EMPLOYER RESPONSIBILITI€S:' lf you hire persons not registered with the Construction Contractors Board to do labor in construpting or assisting in the construction or iriprovgment of a re'gidential structure, you will, in most inbtances, O1a'lirLO to be ai "employer" and the people you hir:e w-ill be "employees". As the employer, you must compty wi!!1 the following: ii. . Oregon's Wilhholding tax Law: As an.employer, you mgst withhold income tixes.tlom eriiOloyee wages at uwillp.eiiaureio,tnetixpaymenisevenifyoudon'tactuiitywithhoidthe tax from your employees. For more information, call the Oregon Department of Rqv.gnuq,at 378-3390. Unemployment lnsurance Tax . : , i.: ,.. _,,.i As an employer, you are required to pay a tax forijnempioyment insurance purposes on the wages of all.employe€s. For mor.e information, call the Oregon f,mployment Dfuision DHR at 378-3224. ' i.i, .i ..1,-^ - ri,::,'... .. I ;-r': . Workers' Compensation lnsurance: As an erlployeriryou are-subiect to the OregOn Vllorkers' Compensation Law, and must obtain workers' compensation insurance.for your employees. lf you fail to obtain workers' compensation insurance, yeu rnay be subiect to penalties and will.H:tisle.for all claim bosts if 'sn6 of your employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at ST3-7434. U.S. lnternal Revenue Service ,.As.an eqployer, you must You w able for thh payment even if you didn't a the lnternal Revenue Service at 221-3960. ryilhhqld federal income tax from employees'wages. ,ci8altyl witfr-hoiq 4" 1ar, Fgq more information, call RC OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Gompliancg As.thepe.r'rnit holder forthis project, you are responsible for resolving any failure to meet code requirernents that may be brought to your'.attention through inspections. Liability ahd Property Damage,lnsilrance: Gontact your insurafiee'agent to see if you harre adequate insurance chasfallingtools,paintoverspray,,waterddlnagefrompipepunc- tures, fire, or work that must be re-done. Time to Supervise Employeee: .Make sure you have sufficient time.tb supervise your employees. 'rt'''r: ' 't' ' ''- Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trqdes, irnd to notify building officials at the appropriate times so they can perform the required inspections. - ,::,j.'= t':-' ,i', ,. i . -- . lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-3P8-4621 NOTE: This lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. 0244J 10t24t89 CITY OF OREGON SPRINGF!ELD D EV ELOP M ENT S ERV I CES D EPA RT M E N T 225 FIFTH STREET SPRINGFIELD, OR 97477 (503) 726-s753 FAX (503) 726-3689 MANUFACTURED HOME SET-IJP AGREEMENT As required by the City of Springfield Developrnent Code, I understand and agree that with the approval of the attached pe e of ng manufactured homes vill be placed at Springfield, 0regon, City Job NumberXType I Manufactured Home. A multi-sectional (double vide or vider) unit vith an enclosed f I,1e1' area o f not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet inwidth, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thermal envelope meeting performance standards rlhich reduce heat loss to levels equivalent to the performance standards required of single family dvellings constructed under the State Specialty Codes. Type I1 Manufactured Home. A unit of not less than 12 feet in vidth vi th an enclosed floor area o f not less than 500 square feet, that has a nominal roof pitch of 2 feet in height for each l-2 feet in vidth andthat has no bare metal siding or roofing. I further state, by my signature belov, that I have been provided vith thefolloving information: - Manufactured Home blocking - Sanitary sever connection - Vater line connection - Electrical connection - Street tree standards - Minimum requirements for permanent steps I also understand that if I am irtstallirrg a Type I Manufactured Home, the homeshall be enclosed at the perimeter vith stone, brick or other masonry materials, and vith no more than L2 inches of the enclosing material exposed above grade. t 3 ture te -- /08 N0.luqz4 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (C0MMERCIAL & RESIDENTIAL) NAME OR COMPANY:lU 9 /3b q /,/z4 u sr./aoz Z4 ?001LOCATION: DEVELOPMENT TYPE: BUILDING SIZE: 1.DRAI Ue P,w 20 LOT SIZ sQ. Ft E IMPERVIOUS SQ. FT qqb x $0.192 PER SQ. FT. 2 SANITARY EWER-C ITY NO. OF PFU,S 1 X $39.78 PER PFU (See Reverse) TRANSPORTAT ION NO OF UNITS X TRIP RATE X COST PER TRIP x - x$401-05 3 x $401 .05 x $401.05 X X $ suBTorAL (ADD ITEMS 1,2, & 3) $ 46?b-a 4. ADMI NISTRATIVE FEES BASE CHARGE (SUBT0TAL ABoVE) X .0s TOTAL-CITY SDC 5. SANITARY SEWER-MWMC N0. 0F PFU,S ,(. rq . x $13.62 PER PFU + $10 My1MC ADMIN. FEE $ (Use PFU Total From Item 2 Above) MhlMC CREDIT IF APPLICABLE (SEE REVERSE) Kip Burdick SDC Coordinator TOTAL-Mt,lt.,lc SDC TOTAL SDC 21s19 $ s 4qz 7 FIXTURE U'NIT CALCUIATIun{ TABLE: ruumoer of New Fixtures X Ur,,- Equivalent = Fixture Units (NorE: For remodels, calculate only the NEJ additional fixtures) NUMBER OF UNIT FIXTURE FIXTURE ryPE NEW FIXTURES EQUIVALENT UNITS -(/ Bathtub....... Drinking Fountain..... Floor Drain. I Laundry Tub/Clotheswasher.......-....." Clotheswasher - 3 Or More-.---...... Mobile Home Park Trap (1 Per Trailer) I nterceptors For G rease/Oil/Solids/Etc""" " """ " Interceptors For Sand/Auto Wash/Etc""""""""" Receptor For RefrigeratorAVater Station/Etc"""" Receptor For Commercial Sink/Dishwasher/Etc" 2 1 2 3 6 2 6 6 1 3 2 1/Head 2 2 1 6 A Shower, Single Stall....... Shower, Gang........-. Sink, Bar, Commercial Urinal, Stall/YVall.. Wash Basin/Lavatory, Single......'.-. Water Closet, Public lnstallation-. Water Closet, Private. Miscellaneous: CREDTT CALCULATION TABLE calculate credits separates- TOTAL FIKI-URE UNITS Based on assessed value. lf improvements occurred after annexation date in table' x$Credit for Parcel or Land Only lf Applicable lmprovement (if after annexation date) Residential.. Commercial (Rate X Assessed Value)x$ (Rate X Assessed CREDIT Value) TOTAL $ RUNOFF COEFFICIENTS FOR STORM DRAINAGE Governmental...........---.-...-... 0.4 0.9 0.45 0"5 lndustrial..... Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value 1979 or before 1980 19Bl 1982 1983 '1984 $2.83 2.76 2.71 2.60 2.46 2.33 1 985 1 986 1987 1988 1989 1990 1991 $2.16 1.90 1.60 0.25 0.87 0.50 0.16 IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT I ,I tJ 7 C'TY OF OREGO'U SPrlINGFTELO 225 PTYTE STREET SPRINGPIEI.D, OREGON 97477 ELECTRICAL PERHIT APPLICATION City Job Nunber 3. COHPI-.ETE PEE SCMDULE BELOV A. Nev Residential-Single or Hulti-Family per dvelling unit. Service Included: f tems Cos t 1000 sq.ft. or less S 85.00 Each additional 500 sq. ft or portion thereof S 15.00 Each Manuf'd Home or -Hodular Dvelling I Service or Feeder I S 40.00 B Services or Feeders Installation, Alterations or Relocation: % 200 amps or less 201 amps to 400 amps -401 amps to 600 amps -601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0nly One Circuit S 35.00 Each Additional Circuit or vith Service, or Feeder Permit I S 2.OO >AY- INSPECTION REQTJEST: OFFICB: 726-3759 1 OF 726-376e 1l)aC EB #iid5ff'q+:-C,qr}lli DB Sum not included) 40.00 40. 00 20. 00 Permi ts are n ransferable and expire if vork is not started vithin 180 days of issuance or if work is suspended for 180 days. 2" CONTRACTOR Electrical Con Address ONLI tract s s0.00 s 60.00 s100.00 $i30.00 $300.00 s 40.00 Ci ty Supe Phone mberrv 1 sor ense Nu q4ss Expiration Date \D,\,qS Constr Contr. Number 1..p3\3I Expiration Date \e et q3 Signature of Supervising Blectrician /r). Ovners Name Add ress Ci ty Phone STALINTION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent, Ovners Signature: DATE: Temporary Services or Feeders Installation, Alteration or Relocation D. Branch Circuits Nev, Alteration or Extension Per Pane1 200 amps or less S 40.00 201 amps to 400 amps - $ 55.00 0ver 401 to 600 amps - $ 80.00 0ver 500 amps or 1000 volTs see trgrt "f,f,fi iI c h E Hiscellaneous ( Service/feeder -Each installation Pump or irrigation S Sign/0utIine Lighting- S Limi ted Energy/Res - $Limited Energy/Comm $ 5 ST'BTOTAL OP ABOVE5f State Surcharge TOTAL BRECEIVED oo o SPRI]{GFIELE) RESID ENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PRO ASSESSORS MAP: JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 11 * TAX LOT: LOX BLOCK:SUBDIVISION PHONE: ZIP: L STATE: OWNER: ADDRESS CITY: DEMOLI R DESCRIBE W9FIK: NEW - REMODEL ADDITION GENERAL: ADDRESS EXPI RES PHONECONTRACTOR'S NAME ELECTRICAL: MECHANICAL: PLUMBING: CONST. CONTRACTOR # FIANGE: FLOOD PLAIN - OFFICE USE _ LAND USE: WATER HEATER: #OFB ZONING CODE: I OF BDRMS:OCCY GROUP: * OF STORIES:SECONDARY HEAT: SQUARE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: # OF UNITS: - To request an inspectlon, you must call 726-3769. This ls a 24 hour recording. All inspectlons requested before 7:00 a.m. wlll be made the same working day, lnspections requested after 7:00 a.m. wlll be made the following work day. REOUIRED !NSPECTIONS Temporary Electric Mechanical - Prior to Final Plumbing'- When allplumbing work is complete.cover. Site lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to cover. Underslab Plumbing/ Electrlcal / Mechanical - Prior to cover.Electrical Service - Must be approved to obtain permanent electrical power. Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting. Foundation - After forms are erected but prior to concrete placement. Other Underground Plumbing - Prior to filling trench. MOBILE HOME INSPECTIONSUnderlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Slove - After installation. Post and Beam - Prior to floor insulation or decking.tnsert - After flreplace approval and lnstallation of unit. Blocking and Set.Up - When ail blocking is complete. Floor lnsulation - Prior to decking.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation ls complete, forms and sub-base material in place. Water Llne - Prlor to filling trench.l--l Fence - When completed. Rough Plumbing - Prior to cover. Street Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. QUAD AREA: Final Electrical - When all electrical work is complete. E tl tl E E tl tl E E E l-l Fireplace - Prlor to faclng - materlals and framlng lnsp. l-l Framing - Prlor to cover. l-l Wall/Ceiling lnsulation - Prior tolJ cover. l-_l Drywall - Prior to taping. tl P.L.HSE GAR ACC N S W E Lot faces Lot sq. ftg. Lot coverage Topogfaphy Total helght Lot Type - lnterior - Corner - Panhandle - Cul-de-sac i IS THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be slgned and approved by the Historlcal Coordinator prior to permit lssuance. APPROVED: BUILDING PERMIT ITEM SQ. FT.X $/SO. FT. = VALUE Main Garage Carport Total Value Bulldlng Permlt Fee State Surcharge Total Fee (A) BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that lhe sald construction shall, in all respects, conform to the Ordinance adopted by the City of Springfleld, lncluding the Development Code, regulatlng the construction and use of bulldings, and may be suspended or revoked at any tlme upon violation of any provisions of sald ordinances. Plan Check Fee: Date Pald: Recelpt Nu Recelved By: Plans Reviewed By Date Systems Development Charge ls due on all undeveloped properties within the City limits which are being lmproved. PLUMBING PERMIT ITEM Flxtures Residential Bath(s) Sanltary Sewer Water Storm Sewer FEE No FT. FT. FT. Moblle Home Plumblng Permlt State Surcharge Total Charge (c) ADDITIONAL COMMENTS MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan No Wood Stove/ lnsert/ Flreplace Unlt Dryer Vent Mechanical Permlt lssuance State Surcharge Total Permlt J (D).4sei I By slgnalure, I state and agree, that I have carefully examlned the completed applicatlon and do hereby certlfy that alt lnformation hereon ls true and correct, and I f urther cerilfy that any and all work performed shall be done in accordance wlth the Ordinances of the City of Sprlngfleld, and the Laws of the State of Oregon pertalnlng to the work descrlbed herein, and that NO OCCUPANCY will be made of any structure without permission of the Building Safety Divlslon. I further certlfy that only contractors and employees who are ln compliance with ORS 7O'1.055 will be used on thls project. I further agree to ensure that all required inspections are requested at the proper time, lhat each address ls readable from the street, that the permlt card ls located at the lront of the property, and the approved set ol plans wlll remaln on the site at all times durin g con.ructlon Slgnature Date =- MISCELLANEOUS PERMITS MobilO Home State lssuance State Surcharge Sldewalk - ft Curbcut - lt Demolltlon State Surcharge Total Mlscellaneous Permlts (E) VALIDATION: RECEIPT NUMB DATE PAID AMOUNT R RECEIVED ECEI ( otoL TOTAL AMOUNT DUE (excludlng elr i6 (A, B, C, D, and E Comblned) * 75 SYSTEMS DEVELOPMENT CHARGE (SDC) (B) CITY OF SPRINCFIELD,OFEGO'V 225 RI,Ytg SIBEBI I SPRTNGPIELD, OREGON 97477 INSPBCTION REOUBSTz 726-3769 0PPICE: 726-3759 1. LOCATION OP I,BGAL DESCRIPTION JOB DESCRIPIION YL<, 5\ Permits are non-transferable and explre if vork is not started vithin 180 days of issuance or if work ls suspended for 180 days. 2. . COITTRACTOR INSTALI.ATION ONLY Electrical Contractor Address fr,(s .{Ls.6 zGt ci Phone 7\-o ?.6Y Supervisor Licens e Number X"(,L-S Expiration Date Itr a r1 Constr Contr. Number '7\f 7 f Expiration Date L 7 of Supervlsing Electrician Ovners Name l'<** Z Address t\61 tu 1'4'fr^ Ci ty {Phone OSNER INSTALI.ATION The installation is beirig made on property I own vhlch is not intended for sale, lease or rent. 0vners SigBature: SPRT]{GFIELO ETJCTRICAL PERHIT APPLICATION City Jo,b Number 97O?Z / COHPLETE SCEBDTILE BBLOS A. Nev Residential-Single or Multi-FamiIy per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less $ 85.00 nach additional 500 sq. ft or portionthereof $ 15.00 Each Manuf'd Home or -Hodular DveIIing Servlce or Feeder $ 40.00 B Services or Feeders Installation, Alterations or Relocation: $: -we/\50 -Y.3 Sum .h"t,t- 200 amps or less 201 amps to 400 amps -401 amps to 600 amps 601 amps to 1000 amps- Over 1000 amps/volts Reconnect 0nly 60. 100. r.30. 300. 00 00 00 00 00 00 00 00 50 40 $ $ $ $ $ $ Slg4ature/1_ 200 amps or }ess $ 40. 201 amps to 400 amps - $ 55. 0ver 40L to 600 amps - $ 80. Over 600 amps or 1000 voT[s see " C Temporary Services or Feeders InstaIIation, Alteration or Relocation Sove D. Branch Circuits Nev, Alteration or Extension Per Pane} one circuit t- $ 35.00 jtr Each Addi tional Circuit or uith Service or Feeder Permi t $ 2.00 00 B"a r E.Miscellaneous (Service/ feeder -Each installation Pump or irrigation $ Sign/0utline Lighting- S Limited Energy/Res $ Limited Energy/Comm $ not included) 40.00 40.00 20.00 DATE: RECEIVBD a= /^ _."= a7 aza , 5. SUBTOTAL OP ABOVB 5Z State Surcharge TOTAL