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Home My WebLink AboutPermit Building 1998-03-06SPFIi.GFIELD 225 North Fiftsh Street Springfield, OR 97477 COMMERCIAL/INDUSTRIAL PERMIT APPLICATION CITY OF SPRINGFIEI.D I COMMI'NITY SERVICES DIVISION BUILDING SAFETY o Page 1 ilob Nurnber: 980099 office: Inspection Line: 726 -3759 726 -3769 Location of Proposed Work: 253 S 15TH ST Assessors ttap #: L7033532 Tax Lot #: 07000 Owner: LLoYD/LMDA WEBB Phone #: 725-9L94 Address: 805 sotrTH 59TH STREET City/State/Zip: SPRTNGFTELD, OREGON 97478 Description Of Work: REMODEL/ADD OFFICES ADDTTION Value 0.00 SPruNGFTET,T', General-: Plumbing: Mechanical-: Electrical-: Contractor MCKENZIE COMMER 0045539 855 W 2ND EUGENE OR 974020000 TWIN RIVERS 0045848 2571. SE ERMINE ALBANY OR 97321OOOO coMFoRT FLOW 0000450 1951 DON ST #D SPRINGFIELD OR 97477 C&SELECTRIC OOO3849 PO BOX 1482 SPRINGFTELD OR 97477000 Const. Contractor #Expires o7 /21,/ee 0e/1-6/e8 o5 /27 / e8 oe/oL/e8 Phone 343 -7L43 928 -2292 726-O1,OO 74a-2236 PI,IN{BING No 3 Fee Charge 30.00 25.00 40.00 95.00 Single Fixt,ure Sanitary Sewer Storm Sewer TOTAT PERMIT 50 150 fr. fr. QUAD AREA: 2ISW -- OFFICE USE LAND USE:' 3999 ZONING CODE: HI Item ADDITION TOTAL VALUE OF PRO,JECT Square Feet x $/Square FeeE VaIue 151, 000.00 151,000.00 PIan Check Fee:356.o4 Rec #: 28572 DaEe: 01/26/98 Rec By: BUILDING surcharge/admin MECHANICAL Surcharge/admin PLUMBING Surcharge/admin SDC PAVING ?J',na 547.75 43 .82 0.00 0.00 95.00 7 .60 5,387 .95 379.00 SPFIilGFIELD Job Number: 980099 SPflNGFTEIT', Page 2 SUBTOTAL PERMITS TOTAI. PERMIT FEES EXCLI'DING ELECTRICAL 6,451_.L3 6 ,46L.L3 REQUIRED INSPECTIONS IE is the responsibility of the permit holder to see Ehat all inspections are made at the proper time. To request an inspection, ca)-l- 726-3769 (recorder), state your City designated job number, job address, Eype of inspection requested and when you will be ready for inspection. Requests received before 7:00 a.m. will- be made the same working day, requests made after 7:00 a.m will- be made the folLowing work day. Special Inspections: In accordance with SecLion 306 of the State SpecialEy Code a special inspector shalI be employed by the Owner/ConEractor during construction of any following "*rr work. A copy of Ehe special testing reports shall be furnished to Building Safety. In addition to the inspections specified, the Building Official may make or reguire other inspections of any construction work to ensure compliance with the Building, CiEy or Development Code. FOOTING - After trenches are excavated. FOITNDATION - After forms are erected buE prior to concrete placement. TNDERGROTND PLITMBING - Prior to filling trench. I,NDERGROI,ND ELECTRICAL - PTiOT TO COI/ET. ROUGH GAS - after line is installed and capped if not attached to an appliance ROUGH MECIINiIICAL - Prior to cover. STORM SEWER LINE - Prior to filling trench. SAI'IITARY SEvIER LINE - Prior to filling trench. STRUCTITRAL CONCRETE in excees of 2500 psi. To be done during conatr. by State Cert. Insp. Results to City Building Inspector ROUGH PLITUBING - Prior Eo cover. cAS SERVICE - After line is installed and line has been connected to a minimum of one apptiance. Pressure test done at this point. ROUGH ELECTRICAL - Prior to cover. ELECTRICAL SERVfCE - Must be approved to obtain permanent power. FRNIING - Prior to cover. !,!ECH/SI'B: FOTI,OWING ROUGH }TECIIA}IICAI, APPROVAI., PRIOR TO COVER rNSUL-V.B./SUB: TO BE CALLED FOR AT SAME TIME AS SUB FRAMING INSPECT DRYIIALL - Prior to taping. ROUGH GRA,DING - After gravel is in place but prior to placing concrete FINAL PAVING - AfLer paving is complete. FINAL PLITI{BING - When all plumbing work is complete. FINAL MECIIAI{ICAL - When all mechanical work is complete. FINAL ELECTRICAL - When al-I el-ectrical work is complete. FINAL FIRE - When a1f Fire Department requirements have been met. been met. FINAL/SI'B FINAL SITE PLAtiI - AfEer all requiremenLs have been met for Minimum Development Standards or from the Development Agreement. FINAL BUILDING - When all required inspections have been approved and the building is complete. --- ADDITIONAL COMMENTS ELECTRTCAL AND MECHANICAL PERMIT REQUIRED SPN'i.GFIELE, Job Number: 980099 OF Page 3 Plans Reviewed By: TOM MARX Building Site Reviewed By: LISA HOPPER Date: 03/o4/98 By signature, f state and agree, that I have carefully examined the completed applicaEion and do hereby certify that af1 information hereon is true and correct, and I further certify that any and al1 work performed shal-I be done in accordance with the Ordinances of the City of Springfield, and the Laws of the State of Oregon perLaining 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 furEher certify that only contracEors and employees who are in compliance with ORS 701.055 will be used on this project. T further agree to ensure that all- required inspecEions are requested at the proper time, that project address is readable from the street, that the permit card is located at the front of the properey, and the approved set of plans will remain on the site at all times during construction. Datet --- VALIDATION -.. 22Receipt Number Date Paid Amount Received Received By z'Zm6*{/.o* -ry -r, s/c/ E r CITY OFSPB OREGON NOTICE; JOB DESCRIPTION Data ![iring Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CO}TI?ACTOR INSTALI.,ATION ONLY ,B Electrical Contractor Business_Telecom- fnc. Address 1144 Gateway Ioop /i110 Ci ty Springfield phone 741-3380 Supervisor License Number 5 Expiration Date c Constr Contr. Number 67254 Expira tion Date 6l2tl96 Signature of Supervising Electrician D Ovners Name Address ^, ci Phone -t 2t"-q Lq sPt rELo) 1000 sq.ft. or less trach additional .500sq. ft or portion thereof Each Manuf'd Home. or -Modular 'Dwelling Sertice or Feeder $ 8s.00 s 1s.00 $ 40.00 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/vo1ts Reconnect oniy Temoorarv Services or Feeders Insiallaiion, Alteration or Relocation 200 amps"or less 201 amps to 400 amPs - Over 401 to 600 am Over 600 amPs or 1 Branch Circuits s s0.00 s 50.00 $100.00 $130.00 $300.00 $ 40.00 $ 40.00 $ ss.00 s 80.00 see rrBr' rps _000 volts aErit E Nev, Alteration or Extension Per Panel One Circuit $ 35.00 s;"h-AdJi iionaltt;";ii-"i "iit serviceoi-r..aerPermit - S 2'00 Miscellaneous (Service/feeder not included) OIINER INSTALLATION The installation is being made on piop"tty I ovn vhich is not intended for sale, lease or rent' Omers Signature: -Each installation Pump or irrigation - Sien/Outline Lighting- Limited EnergY/Res - Limited EnergY/Comm t 2,1L./\A.V\J s 40.00 $ 40.00 $ 20.00 $ 36.00 5. SUBTOTAL OF ABOVE 5Z State Surcharge 32 Administrative Fee TOTAL DATE: RECEIVED 1-a ELECTRICAL PERHTT APPLTCATTON land uor 225 FITTB STREET THIS PEHMIT AUTHORIZED SHALL EXPIRE IFTHE WORK UNDEB IH|S pER[4tT tS NOT Cost Sum . . r...r. :._ JOB N0 . on a7 ATTACHMENT A CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET NAME OR COMPANY LOCATION €5". 1sA A c-DEVELOPMENT TYPE:/tfl*.'V? BUiLDING SI b,d 7t o .l'/o e A-t1 ,'t're :.?/f OT SIZ.YiY, @ 7 Ft 1.ST0RM DRAINAGE 0Zx ef)-@. - 7{35 TI{PERVTOUS SQ Fr 7.€35^X $0.226 PER SQ. FT $ ,4 02/ 2. SANITARY SEWER_CITY NO. OF PFU'S a7 X $46. 86 PER PFU $ 7,7 z (See Reverse Side) 3. TRANSPORTATI0N fia>.e,,r/ 5tfl,'ze - 7/o NO OF UNITS X TRIP RATE X COST PER TRIP Z o aof {v + A ,a 6 x ;.3/ x$472.4e / ,(o y,{-JZ/ x$472.49 Cte),{or a^ MWMC CRED]T IF APPLICABLE (SEE REVERSE) TOTAL-MI,JMC SDC SUBTOTAL (ADD ITEMS i,2,3 & 4) 5. BASE CHARGE (SUBTOTAL ABOVE) X .05 &- l*p,r* aa'4t2. ,L 4 ,l 4,2 !o t -?,92?- 1s agos ) q7 ' to4 3? X x $472.49 /o'/'t-/$3 3"" 4. SANITARY SEI^IER-MWMC NO. OF FEU'S ?2 /-??3./b x lOD>ptR FEU + $10 I\4WMC/ADM FEE $ (?@- $ 57 $ lsa- mdinator Date TOTAL SDC 14 f FIXTURE UNIT CALCULATION TABLE: Number of New Fixtures X Unit Equivalent = Fixture Units (NOTE: For remodels, calculate only t, FIXTURE TYPE Bathtub..... Drinking Fountain.... Floor Drain................. lnterceptors For Grease/Oil/Solids/Etc lnterceptors For Sand/Auto Wash/Etc Laundry Tub/Clotheswasher.. Clotheswasher - 3 Or More.,.... Mobile Home Park Trap (1 Per Trailer)...... Receptor Fcir Refrigerator/Water Station/Etc Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single Stall.... Shower, Gan9.,.........., Sink: Bar, Commercial, Residential Kitchen.... Urinal, Stall/Wall... ..i........... Toilet, Public lnstallation Toilet , Private. ,ET additional fixtures) NUMBER OF * NEW FIXTURES UNIT EOUIVALENT FIXTURE UNITS - - '- -/- -- - ._- -- 4 2 1 2 3 adlHe 6 2 6 6 1 3 2 1 2 2 1 6 4 Miscellaneous: TOTAL FIXTURE UNITS CREDIT CALCULATTON TABLE Based on assessed value. lf improvements occurred after annexation date in table, calculate credits se arates. Year Rate per $1,OOO Assessed Value Credit for Parcel or Land Only lf Applicable lmprovement (if after annexation date) Ann X$ (Rate X Assessed Value)x$ (Rate X Assessed Value) CREDIT TOTAL $ Year Annexed Rate per $1,OOO Assessed Value 1979 or before 1 980 1 981 1 982 1 983 1 984 1 985 1 986 $3.97 3.89 3.83 3.70 3.55 3.39 3.20 2.91 1 987 1 988 1 989 1 990 1 991 1992 1 993 1 994 1 995 1 996 $2.56 2.17 1.73 1.31 o.92 o.v4 o.61 o.45 o.31 o.17 RUNOFF COEFFICIENTS FOR STORM DRAINAGE (For Estimating Purposes Onlyl Residential... ;................... :... O.4 Commerica1......................... O.9lndustrial... O 5 Governmenta1...............,...... O.5 lMPERVlous AREA = TorAL Lor slzE x RUNOFF coEFFtctENT CITY OF SPRINGF'ELD, OREGO'V SPBIi|GFIELD BACKFLOI{ PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: INSPECTION LINE: 726-3759 726-3769 cR-JOB LOCATION: ASSESSORS MAP *:TAX LOT fi: ADDRESS:= la1tr PHONE *:lzcqtv CITY:srArE: GRECTON zrn: Qf41? BACI(FLOI{ PERMIT IS $15.00 +(STATE SURCHARGE) * $.45 (ADMIN. FEE) = $16'20 CONTRACTOR: ADDRESS:PH0NE *: A AA.:AAq CITY: lco :CR zrr: otl { {O EXPTRES ' 6 30.Q8 /g BY SIGNING THIS PERMIT/APPLICATION, I AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE IIAS BEEN INSTALLED S VISIBLE FOR INSPECTION (726-3769). r ALSO STATE THAT ALL INFoRMATIoN 0N THrS PERMIT/APPLICATIoN IS CORRECT. c,^.qA DATr FOR OFFICE USE CO}+TTRUErION CONTRACTORS REGIJ-Abltscffi DATE OF APPLICATION:t&u loRECEIPT #: TOTAL AMOUNT COLLECTED: ISSUED BY: JOB #: OVNER: C'TY OF OREGON SPF|I...gFIELD D EV E LOP M ENT S ERVICES DE PART M E NT h,225 FIFTH STREET SPRINGFIELD, OR 97477 (s41) 72s_37s3 FAX (541) 726-368e September 18,1997 Lloyd Webb DBA Smith Sheet Metal 253 South l5th Springfiel( OR 97477 Subjec[ Minimum Development Standaxds requirements for proposed use at 253 S. t5th Street Dear Mr. Webb: The Springfield Development Code (SDC) 3 I .0 l0 requires any business that has changed use or expanded by no more than fifty percent or 10,000 square feet to be reviewed for Minimum Development Standards (lv{DS). These standards help establishments comply with new development standards without the cost and time required for a full site plan review. Your proposal to construct a 2,800 square foot addition requires an MDS review. The following conditions must be met at253 South l5th Sreet to successfully complete the MDS process: Sidewalks: Improvement Agre€ment 8826098(I.A. 564) and 8826099(I.A. 563 & 666) agree to steet improvements along the frontage of South lSth Steet and South B steet. Planter Stips: In addition to planting required in accordance with Section 31.140 of this Code, a five foot (5') planting strip is required along l5th Street and B Street. Planted materials shall cover 65 percent of the planting area within 5 years of the date of installation. The planting area must be irrigated or be planted with drought resistant materials. Proposed plant materials shall have a 90 percent survival rate over a 5 year period without an irrigation system {SDC 3 1.0 I 0(Z)(c)}. Parking: All parking areas must be paved with a durable dust free surface which includes asphaltic concrete or portland cement. It is agreed by the applicant that the gravel parking area on tax lot 7000 will be paved when B Street is improved and/or when parking demand increases. Improvement Agreements 563 & 666 provide for future sheet improvements to B Street. Trash Receptacles: All tash receptacles must be screened from public view. Usually, all improvements must be completed within a 90 day time period from the date of this letter; however, as long as there is a definite time schedule for the improvements, a brief time extension will be permitted. In our September 12,1997 conversation we agreed that the site modifications will be completed by July of 1998. If you have any questions concerning this approval or any conditions contained herein, please contact me at your convenience. Cordially, I Building Kitti M. Gale ,*%rfr' D/ -U). C'TY OF SPR'INGFTELD,OREGO'V I THIS PERMIT SHALL EXPIRE IF THE WORK 22s Frvrl sl'REEr AUTHORIZED UNDER THIS PERMTT tS NOT SPRINGFIELD, SPFTNGFIELD ELE TRTCAL PERHIT APPLICATION ob Nunber ( d ooqq SCMDULE BELOV Residential-Sing1e or INSPEGTION REQIIB OFFICE: 726-375 1 ffir JOB DESCRTPTI Permits are non-transferable and expire if vork is not started vithin 180 days ;; i;;;.;"" ot if vork is susPended for 1B0 days. 2. CONTRACTOR INSTALI.,ATION ONLY Electrical Contractor Soni trol Secur i ty Address P .O. Box 21009 Ci ty Eu ene Phone 46'l - 5678 Mu1ti-FamilY Per dvelling un Service Included: I tems 1000 sq.ft. or less Each additional 500 sq. ft or Portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less,oi ;;" to 4oo amps --l 401 amps to 600 amPS -_60J. amps to l-000 amPs- Over 1000 amPs/voIts -- Reconnect OnlY C D E I,EGAL103 DESCRrBrrory3Q \)o it. Cos t $ 8s.00 $ 1s.00 $ 40.00 $ s0.00 $ 60.00 $100.00 $130.00 s300. 0o s 40.00 Sum Supervisor License Number i bn RET Expiratlon Date Constr Cont r. Number 651 49 -t- Expiration Date 6-28-00 Signa ture of S1 Electrician Ovners Name 5, Address )53 5. I 5t^ Ci ty Phone ?e6 -q TemporarY Services or Feeders i"si.lf"ilon, Alteration or Relocation 200 amps or less $ 40'9q ,oi ;,r;= to 4oo amPs -_- t ::'99o;;. abr to 6oo amPs - $ eo:99 Over 600 amps or fbOO voTTs see "B" above Branch Circuits Nev, Alteration or Extension Per Pane} One Circuit $ 35' Each Additional Circuit or vith Service oi Peedet Permit -- S 2' Miscellaneous (Service/feeder not -Eaeh instaflation Pump or irrigation- Sign/Outline Light ing-- Limi ted EnergY/Res - Limi ted EnergY,/Comm I SUBTOTAL OF ABOVE 52 State Surcharge 3Z Administrative Fee TOTAL 00 OVNER INSTALLATION The installation is being made on piop"tty I ovn vhich is not intended ior-sale, Iease or rent' Ovners Signature: 00 included ) @ 5 00 00 00 00 $ 40. $ 40. s 20. s 36. 3+#- --Tas--?* sa DATE: RXCETVED IS ABANDONED FOR ,r,tr"ftLI6a3 LOCATION OF 7 Sht r{/l1t I COMM ERCIAL/I N DUSTRIAL PERMIT APPLICATION 225 Fifth Street, Springfield, Oregon 97477 LOCATION OF PROPOSED WOBK: ASSESSORS MAP; SPRINGFlELr,JOB NUMBER INSPECTION LINE: 726-3769 OFFICE: 726-3759 /7-a7-%-72 rAX Lor; 2ru4) PHONE; ZIP:STATE: 4 * CITY: ADDRESS: OWNER: NEW - REMODEL ADDITION DEMOLISH OTHER VALUE: DESCRIPTION OF WORK: ELECTRICAL: PHONENAMEADDRESS ADDRESS EXPI RES PHONE *a CONTRACTOR'S NAME ARCHITECT: MECHANICA CONST. CONTRACTOR # GENERAL: PLUM BING PLUMBING NO.FEE CHARGE Single Fixture Relocated Bldg. (new fix. addtl) Water Service (t Sanitary Sewer ft. Storm Sewer It Backf low Device TOTAL PERMIT MEEHANIEAT NO trFF CI{ARGFZFurnace/burner & vent <100,000 BTUs 6 ,/Z.Q Furnacelburner & vent >100,000 BTUs Floor furnace and vent Suspended wall or f loor mounted unit heater Appllance Vent separate 2 Stationarv evao. - /cooter t*'714>A /?.?o Z Vent Fan/Singl.e duct -Z a Vent System apart from AC or htg. Mechanical exhaust hood and duct Permit lssuance $10.00 TOTAL PERMIT ,?.4; _ OFFICE USE _ LAND USE: ZONING* OF UNITS: HANDICAP ACCESS: FLOOD PLAIN: LIGHTING POWEB BUDGET: WATER HEATER: OCCY GROUP: * OF STORIES: QUAD AREA: g OF BLDGS: CONSTR. TYPE: HEAT SOURCE: $/SQ. FT.VALUESQ. FT. TOTAL VALUE OF PROJ X X SO. FTG MAIN SQ. FTG ACCESS SO. FTG OTHER DATEPLAN CHECK FEE BYRCPT# 72. zy'o BUILDING PERMIT PLUMBING DEMOLITION 5% State Surcharge 5% State Su rcharqe MECHAN^CAL, /2fMlrrr'7 r'Q,4 2e .e2 FENCE VALUE $ 5% St6te ' Su rcharqe 7z - / -22' ^1a SIDEWALK FT. SUBTOTAL PERMITS PAVING CURBCUT FT. SYSTEMS DEVELOPMENT TOTAL PERMIT FEES EXCLUOING ELECTRICAL -:? fo 226- ?/9/ SPFliTTGFIELO EIJGTRICAL PERHIT APPIJCATION : 225 FIFTE STREET SPRINGFTELD, oREGoN 97 477 INSPECf,I0N REQIESTt 726-3769 OFFICE: 726-3759 1. IOCATION OFz(D ts d,transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2 CONTRACf,OR INSTALI.ATTON ONLT *bi F D-ra ^ ^11. Ci ty Job Nnrnbe, ?fuA??' 3. COMPT,ETB FEE SCEEDTII,E BEIOV A. Nev Residential-Single or Multi-Family per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500sq. ft or portion thereof Each Hanuf'd Home. or -Hodular 'Dve1ling' Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 .8. Services or Feeders Installation, Alterations or Relocation: Sum Electrical Contractor Address C tS {t\o cfnr t',,('rrn. 200 amps or less 201 amps to 400 amps --f 401 amps to.600 amps 601 amps to 1000 amps- Over 1000 amps/vo1ts -Reconnect OnIy $ s0.00 s 60.00 @cis100.00 $130.00 s300.00s 40.00 Supervisor cense Number l/-.,(a S Expiration Date to-t-q8 Constr Contr. Number_j !{{ Expiration Date q-t-q 8 Signature of Supervising Electrician Ovners Name Address 2 O ci . Phoner2::%rr' O9NER c Temporary Services or FeedersInstallation, Alteration or Relocation 200 amps'"or less 201 amps to 400 amps -over 401 to 600 amps -Over 600 amps or 1000-i6l[-ts see trBn a566 D. Branch Circuits Nev, Alteration or Extension per panel E One Circuit $ 35.00 Each AdditionalCircuit or vith Serviceor Feeder permi t Z $ 2.00 4. Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/OutIine Lighting- Limited Energy/Res -Limited Energy/Comm $ 40.00 $ ss.00 $ 80.00 e The installation is being made onproperty f ovn vhich is not intendedfor sale, lease or rent. 0vners:$ignature: s 40.00 $ 40.00 s 20.00 s 36.00 5 SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL DATE: RECETVED B c4 IJGAL DESCRTPTION ,/^ urz ^z ?7 ez?*z> Phon"_rl4)4L3b t€€ SP,r. -FIELD PERHIT APPLICATION ob Nunber SCEEDTILE BELOII ial-Single or per dvelling uni t. uded: (r$ 225 FIFTE SPRINGFTELD, OREGON 97417 INSPECITION REQTESTz 726'3769 OFFICE: 726-3759 OF ON 5 1$\E 1t^tb Permits are non-transferable and expire if vork is not started vithin LBO days of issuance or if vork is suspended for 1.80 days. 2. COI\ITRACTOR INSTALLATION ONLY Electrical Contracto q Address Phone I tems Cos t s 8s.00L000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular DvelIing Sertice or Feeder $ 1s.00 s 40.00 Services or Feeders InstalIation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _ 60J. amps to 1000 amps_ Over L000 amps/volts Reconnect Only Temporary Services or Feeders Installation, Alteration or Relocation o Service Incl SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL Sum ee rrBrr a5ove B Ci ty I Supervisor License Number Expiration Date Constr Contr. Number fi4q Expiration Date Q-t Signature of Supervising Electrician Ovners Name Addres Ci ty Phone OVNER INSTALLATION The installation is being made on property I olrn vhich is not intended for sale, lease or rent. 0rners Signature: DATE: 200 amps''or less -l-201 amps to 400 amps _Over 401 to 600 amps Over 600 amps or 1000-voITs s s0.00 s 60.00 s 100. 00 $130.00 s300.00 s 40.00 -q( c s $ $ s 40.00 55.00 80.00 t- D. Branch Circuits Nev, Alteration or Extension Per Panel One Circuit $ 35.00 Each Additional Circuit or vith Service or Feeder Permit S 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation S sign/0utline Lighting- $ t imi ted Energy/Res $ Limited Energy/Comm $ 40.00 40.00 20.00 36.00 0 BRECEIVED CITY CrF SPAri.,G FlEl"n OREGON 5 rr C ty \tq t)b'qt'-t*