The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 1996-6-10 ,. ~ : I{ . SP,,!'FIELO .. . ". 0 owing project as oubmltted has the zc.n:ng, and does not require specific tand Sf ~N A approval. E:: Zoning ~ =;.A':"b"t~ lJ -c 0 "tfAp 1M 225 FIFTH STREET SPRINGFIELD. OREGON 97477 Autllorized Signature INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 .1. LOCATIO~F INSTALLATION S74LMA,L.I "'!.T. I J.fm:~PTIB(q05 JOB DESCRIPTION C-,I!.L ~ t.AIl. '-J """'>-I -;. '" N Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical ContractorJ'~A:l03 LA-rITV~~_S Address 4'S7C W. I'"' Av1::: City C:;-~r- ~.p Phone 2.'01 J7// r -~. --r-Z . ::>....'\' -'" C>c>)oo Supervisor License Number 7..n. Z.Sf C c... S; Expiration Date V ~., Constr Contr. Number C; :;'9,71 Expiration Date lolt::1c" Signature of Supervising Electrician JJw d c Owners Name 70/111 ~E3-I L Clo ,.j..1..6/Zoo~, 72~tt<- , <;IT"T~ Address IOc.j.S W..Ll.LA.G IL~;:;>IEr" , - Phone f,B ~-?n~< Ci ty )"-LlG~~ OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: DATE~------~~~-~;;----------------- RECEIPT 11: 21(<17_ RECEIVED BY: 'l~ ELECTRICAL PERMIT fftLIqATwr Ci ty Jot> tlumber v\'~\\.O-'Y\ COMPLETE FEE SCHEDULE BELOY ~ New Residential-Single or Mul ti-Family per dwelling uni t: : Service Included: Items Cost Sum 3. A. 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular 'Dwelling Service or Feeder 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 Only $ 85.00 $ 15.00 $ 40.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 volts see "B" above ,,' New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL E. Miscellaneous (Service/feeder -Each installation :t p~i~irrigation ~ign/ line Lighting ed Energy/Res Limited Energy/Comm $ 35.00 $ 2.00 not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 4O.CO y~.()U i.7.D ~-l,. LU ~)~ '1 ~lliN PERMIT APPLICATION 225 Fifth Street . ~ Springfield, OR 97477 <)r{..N A . ~ SITE ADDRESS: ~,4~~M() 1 1\, A(JO r ASSESSORS MAP: -l..:JfJ2.1:'L;_ , _ . ~ TAX LOT: , - - - { . - OWNER: FAS7 (~ CoC~~ (otC- TOIh !ZAf#JI..) PHONE: S7~ M411J <;,_ JO.JM?ER qtl~\trMy\ , Inspection Line: 726-3769 Office: 726-3759 ( )\Ur ).,~ .' / ADDRESS: CITY: <::; f7 a-....n; IZ, ~ l) I STATE: 6rZ. ZIP: C;7t./.77 BUSINESS NAME, FIRM HC,: f-A-c; r L,t:lNf: t' f'l,k :t'__e.. DESCRIPTION OF PROPOSED SIGN IS): Iplease check and complete all appropriate information) ?<.. Wall Freestanding _ Projecting Roof Marquee * -25.. Single Face Double Face Billboard Other Square Footage: I 1 ..e- Total Height above Grade: , II /~ 10 Verticai Dimension of sign or enclosure: S',," Horizontal Width of sign or enclosure: , " S (, Dimension from Grade to bottom of Sign Enclosure: 10 '4/1 Electrical Installation: _ Yes _ No (If yes additional electrical permit is required) . VALUE L OF SIGN: ., {OfJO, 0"0 Material Sign is constructed of: .::; t-I~?y'r ~~L- , Jf1Wrz>.L , <7"1 fp""A1>4!!<;. JUr<oC>>J /VBI J<.JC-.. , List ALL existing signage and allach a photograph of each sign: f7'.r0N (;:; laJ Type Sq. Ftg. (b) Type Sq, Ftg, Ic) Type Sq. Ftg, Id) Type Sq. Ftg, CONTRACTORliNST ALLER: ADDRESS: '-iS7u yJ~,..j I ATI TVDr.-t;: W' ({ ol1-, 4t~ PHONE: '2..I./.W--(, ~'te CITY: ~6~ STATE: fJ-{7 ZIP: CITY BUSINESS LICENSE NUMBER: ~ ~_.~)..L C;~)l, "/ ( l\~<Q 0 EXPIRES: ~ 1 tJ;o "L lD/C,C. lo 'ffi ,q( () CONSTRUCTION CONTRACTORS REGISTRATION NUMBER: EXPIRES: OFFICE USE Sign District: \'~N\QJ01a \L ((\ ---" ~~ Land Use: Quad Area: "r 1\')(0 ) Code Section: U-!L-/4 (, \ ) - b Approved By: \Ltx'\ I (~Ql/ DATE: D .3 'Cf//.J ~) Zoning: Sign Permit Fee: REQUIRED INSPECTIONS: Site to be made prior to sign placement Footing prior to placement of concrete , ~ttachment after fasteners are installed/prior to cover ~Elect.rical prior to energizing electrical installation ~Final completion of sign installation Additional Comments andlor Conditions: By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein 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. J further certify that oniy contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that project address is readabie 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 the installation of the signls). Signature N uJ- t.!- ( Date "5/7,,( jet( Validation: Amount Received: f}fli4.f'Y.- lftJlJt ~ate Paid: 2-1<;< J ') Received By: ~-!,.;-w , I"'" t~ Receipt Number: . . ./\ ' " " , - ',. . SIG N PERMIT APPLICATION "l~:' ~ The application on the reverse side needs to be completed entirely. If you are the sign contractorlinstaller" or if you are hiring a contractor, you need to make sure that both the CiW,of Springfield Business,Lic,e~se,Numb.er'a,nd the Registra,tion Number from the State of Oregon Construction Contraciors Bbard are listed on the application along ~ith the expiration date of each, ' " , " ~ . . . .' . If the sign you are proposing to install is iIIuminated,.an electrical permit application also needs to be completed. and signed by either 'a supervising electrician, iimited sign electrical contractor, or if you are the business owner' who also owns the building in which you are occupying, and you will b,e performing the electrical installation yourself, you may sign the electrical application. ',',.:' - ", ' '" ' , If there are existing wall and/or freestanding signs, a photograph Is) of eech existing sign needs to be allached to the application: The size of each existing sign also needs to be listed on the application. PLANS To submit for a sign permit, you need to prepare two complete sets of drawings showing all dimensions, total height, and a plot plan indicating where the proposed sign will be located, If you are installing a freestanding sign which exceeds 20 feet in total height, the footing detail needs to be' prepared and stamped by a registered engineer' 0; architect, After the plan revie,"Y process is completed, and, if your sign!s) is approved, one seH'1 plans-will be returned to you, The approved set of drawings need to be at the site when an inspection is requested for the inspectors reference. .. INSPECTIONS .' , Depending on your sign!s), you may be required to request one or all of the following inspections during the installation of , your sign: , .". . ' .... ' "\ ..... ," Site: To be requested after indicating on the lot where tha proposed sign will be located but prior to any work being performed for the installation of the sign. This inspection is required if there is a question on the location of the proposed sign, Footing: To be requested after excavation' and the forms are installed, but prior to pouring concrete, If there will be electrical conduit placed in the footing, it must also be in place prior to requesting this inspection, Attachment: To be requested when all fasteners are installed but prior to cover. , ,: ,j .' '" Electrical'::- To be requested after the electrical connection to the sign is made, but prior to energizing, . . . ." -, .~ . ..' ~', ~', Finai: After all required inspections are conducted and approved and the sign installation is complete, . \. . "',-l/..~ )~~ The inspections that are required for your sign installation will be indicated on the application during the plan review process, Failure ,to request ANY of the required inspections could result in sign removal in order to inspect the sign at the required intervals' of work. ' ' ' ',1 , - To request an inspection, phone 726-3769, This is a 24 hour recording. On the recording you will need to leave your City Designated Job Number, location of where the sign is being installed, the type of inspection you are requesting, and when you will be ready for the inspection, All inspections called in to the recorder prior to 7:00 a.m, will be made the same working day, all inspections phoned in after 7:00 a,m, will be made the following work day, If you have any questions regarding the application, required plans or inspections, please feel free to phone the Building Safety Division at 726-3759, City of Springfield Building Safety Division 225 Fifth Street Springfield, OR 97477 "\,'. ',., " ~, SPRINGFIELD . A JWUM~ER_ --Q5\LAY1 Inspection Line: 726-3769 Office: 726-3759 ^. 97477 ,. , PHONE: CITY: ~T. STATE: ,t}rZ- ~A<,'" L.A.,..;""," C'..f\C~~ ZIP: q7~77 BUSINESS NAME, FIRM EiC.: , , DESCRIPTION OF PROPOSED SIGN(SI: (please check and complete all appropriate information) ~Wall ><. Single Face Freestanding _ Projecting Roof Marquee ~ Double Face Billboard Other Square Footage: /7.a- Vertical Dimension of sign or enclosure: _1,/ ~ '7 ( I 10tal Height above Grade: IS "5b" orizontai Width of sign or enclosure: I " 10 S:}--z. I Dimension from Grade to bottom of Sign Enclosure: Iv I tL I' Electrical Installation: -1S.. Yes _ No (If yes additional electrical permit is required) VALUE ..I OF SIGN: l' !(X70. ~ Material Sign is constructed of: 'Si-lr-.-....... Mr.......,o.. L- List ALL existing signage and attach a photograph of aach sign: NoN ~ (a) Type Sq. Ftg. Ib) Type Sq. Ftg. (cl Type Sq, Ftg. (d) Type Sq. Ftg, ADDRESS: CONTRAcTORliNSTALLER: N~N Kt. IJ<ll.... l5lE C/670 ( AT'7V1)~ ~ PHONE: z,~'-l-~~, CITY: '5.Je:; ~rc:- STATE: oe- ZIP: Cj 7 4:v "2.. 10 fc7?:' It)'.30~Lfr /) -( CONSTRUCTION CONTRACTORS REGISTRATION NUMBER: (;3871 CITY BUSINESS LICENSE NUMBER: ~,-:-~' 1: r ,~_g50 (~O OFFICE USE EXPIRES: EXPIRES: Sign District: ~ (\/\0 J((l.1 aJJ Zoning: QG Sign Permit Fee: ~.W REQUIRED INSPECTIONS: Land Use: ~(() Quad Area: c3C ,A\Ju , Code Section: \ Q - I) -14-[r) ~ Approved By: l~l~ DATE: ls:J'3q~ ' ~ \ Site to be made prior to sign placement Footing prior to placement of concrete ~tachment after fasteners are installedlprior to cover' v/ Electrical prior to energizing electrical installation ~Final completion of sign installation Additional Comments and/or Conditions: By signature, I state and agree, that I have carefully examined the completed appiication and do hereby certify that all information herein 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. I further certify that only contractors and employees who are in compiiance with ORS 701.055 will be used on this project. Signa!ure yj(;J- (4- c- Validation: Amount Received: ~ bL ~ 12 ~/~I/CjC l{QjQDate Paid: 0 -fo-Q(;"7 / Ii:? Date Receipt Number: ,Received By: <:,.. \- -. . ., i.A....'to.\~) .....1~:(;. SIGN PERMIT APPLICATION 'j'~~IAf . ..... _V"\ The application on the reverse side needs to be completed entirely. If you are the sign contractorlinstaller, or if, you are hiring a contractor, you need to make sure that both the City of Springfield Business License Number ~ndth~.Regis'tration' Number from the State of Oregon Construction Contractors Board are list~d'bn~ihe1applii:atil)n"alo';g 'with'th,'-'e~6iration .. r' . date of each, ., ,,,., r..~i'\'''''''''' ,.,-,.., ".' ~\' 'Ie \"\H..';~ 'Jr'1:' \ t.,.. \. ""''1:, ,'. ......,.1. \ If the sign you are proposing to install is illuminated" an electrical permit application also needs to be.completed and signed' by either a su~per'vising electrician, limited sign ele~ct'rital contractor, or if you are the busi~ess'own'er wtio als~4owns the building in' ";hich you are occupying, and you will be performing the electrical installation yourself, you may sign the electrical application. :~, _..~;- j"'i .' _, ~.,.',) (.J.,_; . '. ,....." \.: If there are existing wall andlor freestanding signs, a photograph!s) of each existing sign needs to be allached to the application. The size of each existing sign also needs to be listed on the application. PLANS , '. .... To submit for a sign permit, you need to prepare two complete sets of drawings showing all dimensions, total height, and a plot plan in,dicati'1g ,where the proposed sign will be located. If you are installing a freestanding ,sign which exceeds 20 feet in total heiglit, the ,footing detail needs to be prepared',md\stamped by a registered engirie~'r 'or 'architect. After the plan review process is completed, and, if your signls) is apl,,6;'ed?'one set of ,plans will be returned to you. The approved set of drawil"!g~s.JI~eed to be at the site when an inspection 'is requested f9r:the (inspectors reference. , .iNSPECTIONS' \' , '.," ':~""l'~: .'~ ~\ Depending on your sign Is)' you may be required to request one or all of the following inspections during the installation of your sign: . ~ _"'~'~ . '\ . ../ .~L.'.> Site: , To be requested after indicating on the lot where the proposed sign will be located but prior to any work being performed for the installatio'1:qf,t~e 'sign. This inspection is required if there is a question on the location of the proposed sign, Footing: To be requested after excavation and the forms are installed, but prior to pouring concrete. If there will be electrical conduit placed in the footing, it must also be in place prior to r,equesting this inspection, ~ttach~ent:, To be requested when all fasteners are installed but.Pri?' ,to ~~~er., ' " , .. r ".~1">..1~~~-: ;!-,-:J'..: .~.:'~-...J -'"....,--''\ Electrical: I..~. To be requested after the electrical connection to the sign is made, but prior\to, energizing. -h ;. . _o..."...\. . ,'" \ ,..' Qf"'tW ~ I ...... " . v- 01. \, Final: After all required inspections are conducted and approved and the sign instaliat.lon is complete. ,\ .- ,...., '-,...... -~,~....'". "'_.':;,)'_~'" . "":. " "'_-'\.~'_' .......~_)t'tfi The,insi"ections that are required for your sign instaliation will be indicated on the application during the plan review process. Failure to,request ANY of the required inspections'Could result in sign removal in order to inspect the sign at the . , _ . + - - . J . . ~ '-... . ...r required inte-rvals of' work. ..... '.-' . ,-: ", ! ~... To request an inspection, phone 726-3769. This is a 24 hour recording. On the recording you will need to leave your City Designated Job Number, location of where the sign is being installed, the type of inspection you are requesting, and when you will be ready for the inspection. All inspections called in to the recorder prior to 7:00 a.m. wili be made the same working day, a!1 inspections phoned in after 7:00 a.m. will be made the following work day. If you have any questions regarding the application, required plans or inspections, please feel free to phone the Building Safety Division at 726-3759. City of Springfield Building Safety Division 225 Fifth Street Springfield, OR 97477 , : \ -Y; .'l....~)i.-'~ -' , . '. _to ( ~IGN PERMIT APPLICATION 225 Fifth Street ~(b~ " C.-. ~ _ Springfield, OR 97477 . ~ ~ ~~~~jf\_ . f'MT ~ ~('-e-,. -s/4~ SPRINGFIELD JWUM~ER Inspection Line: 726-3769 Office: 726-3759 C\CO\ l~ SITE ADDRESS: ASSESSORS MAP: TAX LOT: - ( l 1'-1/ r--. {;_-..:.~ - OWNER: , PHONE: ADDRESS: CITY: '5 ~1~rIC-:t...O \ BUSINESS NAME, FIRM ETC.: MAr 1/..) STATE: ,~ ZIP: ~7t/.1( ~T LAfo)~ , - rrrce: C.-c:.- ~Wall 7Z Singie Face Freestanding _ Projecting Roof Marquee ~ .)...~ ~ DESCRIPTION DF PROPOSED SIGNISI: (please check and complete all appropriate information) Double Face Billboard Other SquilTe Footage: If.:, a- Vertical Dimension of sign or enclosure: 4-' Total Height above Grade: Horizontal Width of sign or enclosure: ..f' Dimension from Grade to bottom of Sign Enclosure: , " 7.." Electrical Installation: _ Yes ~ No Ilf yes additional electrical permit is required) VALUE OF SIGN: .f 500 - Materiai Sign is constructed of: PA\"1t<O WOOD S/b~ List ALL existing signage and attach a photograph of each sign: fJ 0 N C- (al Type Sq. Ftg, Ib) Type Sq. Ftg. Icl Type Sq. Ftg. (dl Type Sq. Ftg. CONTRACTORIINST ALLER: ADDRESS: 4S1\) W' CITY: hJfO ~ ~fDtJ I \ {.{. LA-tTf\Jl),:..<;: PHONE: ~t/~-(, ~'C CONSTRUCTION CONTRACTORS REGISTRATION NUMBER: STATE: E>f2- G 3'B'1 f ZIP: Q7J.oZ EXPIRES: CiTY BUSINESS LICENSE NUMBER: CJ"50(1, " EXPIRES: OFFICE USE J Sign District: l'~\ Q\r'OO.cu)Land Use: b~) ,QU~d tr~ 3~fJ Zoning: S ~ lv, Code Section; " ;}, - r -L~,~ t ~ ~ l Sign Permit Fee: '-\'\) , Approved By: it.J. \Ill n,-,,~?JL,( _ DATE: I REOUIRED INSPECTIONS: [Q \0 L{b I Site to be made prior to sign placement Footing prior to placement of concrete ~hment after fasteners are installedlprior to cover Electrical prior to energizing electrical installation ~ Final completion of sign installation Additional Comments andlor Conditions: By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein 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, I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. Signature 'Nw ~ C Date (,1'- (Cj? Validation: Amount Received: it)V c;1-(1S! ~ ,Date Paid: Receipt Number: ,Received By: ~ l/7 . {~4'0 !.LDv V ' . . ,.~,~'. I ., , , l..-1 ;-~. " SiGN PERMIT APPLICATION The application on the reverse side needs to be completed entirely. If you are the sign contractorlinstaller,. oUf you are hiring a contractor, you need to make sure that both the City of Springfield Business'License Number and the'Registration Number from the State of Oregon Construction Contractors Board are listed 6i1'ih-e application along with the- e'xpiration date of each. t:~.{\~ . oJ ,.;\<.-... If the sign you are,proposing to install is iIIuminated"anllectrical permit application also needs,to,be completed'and signed by either a sup~ervising electrician, limited sign ele<ttHcal contractor, or if you are the business:ow~er v':;ho "als~ owns the building in which you are occupying, and you ~i~ b~~~r~o~mipg th: j~'!.9trif.al in~t~lIat!on yourself, you may sign the electrical applicatIOn. . , ., ; .' If there are existing wall andlor freestanding signs, a photograph(s) of each existing sign needs to be allached to the application. The size of each existing sign also needs to be listed on the application, -.. " PLANS . . , To submit for a sign permit, you need to prepare two complete sets of drawings showing all dimensions, total height, and a plot plan indicating where the proposed sign will be located. If you are installing a freestanding sign which exceeds 20 feet in total height, the footing detail needs to be prepared and stamped by a registered engineer' or 'architect, After the plan review process is completed, and, if your sign(s) is approved, one set of pians will be returned to you. The approved set of drawings:need to be at the site when an inspection is requested for the~in'spectors reference. .... INSPECTIONS .. \. 1'". , " ,- ,~,o- " .. " Depending on your sign!s). you may be required to request one or all of the following inspections during the installation of your sign: ~ I ~.~. 'i":,"~.l :. .t.hl-.. ..~ . - .. Site: To be requested after indicating on the iot where the proposed sign will be located but prior to any work being performed for the installation 'of 1the sign. This inspection is required if there is a question on the location of the proposed sign. Footing: To be requested after excavation and the forms are installed, but prior to pouring concrete. If there will be electricai conduit placed in the footing, it must also be in place prior to r,equesting this inspection. Attachment: To be requested when all fasteners are installed but prior to cover, - . .~. ',.. ~.' . " - ~. . /.. . ,-"'; . . :.J,...., .... '_ Electrical' " 'To be requested after the electrical connection to the sign is made, but prior 'to .energizing, ,,_,I I . .:: . ~"-l {~, C ,.' Final: After all required inspections are conducted and approved and the sign installation is complete. '. , . ,. .,,'J -,-)~'O:~(~:_, The inspections :that are required for your' sign installation will be indicated on the application during the plan review process. Failure to request ANY of the required inspections .could result in sign removal in order to inspect the sign at the required intervals of work, ' ' '\ , , ~ , , , To request an inspection, phone 726.3769, This is a 24 hour recording. On the recording you will need to leave your City Designated Job Number, location of where the sign is being installed, the type of inspection you are requesting, and when you will be ready for the inspection. All inspections called in to the recorder prior to 7 :00 a.m. will be made the same working day, all inspections phoned in after 7:00 a.m. will be made the following work day, If you have any questions regarding the application, required plans or inspections, please feel free to phone the Building Safety Division at 726-3759. City of Springfield Building Safety Division 225 Fifth Street Springfield, OR 97477 . i~: ...:J~'-~.:;:..,<" i_ :.. :,,'~. '. '.' i , . City 0; Springfield 225 Fifth St~eet Springfield, OR 97477 (503J 72&-3753 T~an5action number- 021469 May 09, 1336 3:44 PM ~eceived f~om: FAST :ont~act/Owr~ = 574~ lodr'ess:! SfS GAH 5T lANe: COFFEE CO MAIti ST ;ity: EUENE St; OR Zlp: 37401 -B'Jilding- lob *: 351633 )eSCT ipt. ion -~ T Fee :leci;r-ical ~t8t,e Supchar"ge ~i~ Adnlin Fee 3b~OO 1.80 1.06 -Business Licenses- ~5iness Licence I. 000000 lescr-ipt, ion Fee ~l.;:jr'l1l Syst.elll 40.00 Tot;Jl, ,,,.t, Received= Chech jf. 393 i 78..88 78.88 C:'8ck Thank you, Heidi K. ~./ 11 .,_", ." . .- 225 ,FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: . 726-3759 ELECTRICAL PERMIT APPLICATION Ci ty Job Number 95/ 0 CZ '7 3. 'COMPLETE PEE SCHEDULE BELOY 1. LOCATION OF INSTALLATION c:: '7'ib Mc"V"l~ ~'t, LEGAL DESCRIPTION 1702-:;.,3'--'/ / , 6/10L JOB DESCRIPTION I '-k' ~ '7~ I b 'r 1, I f?.p VoI'6(f~ a Ia,y~ Permits are non-transferable and expire if york is not started vithin 180 days of issuance or if york is suspended for 180 days. A. New Residential-Single or Hulti~Family per dvelling unit. Service Iricluded: ri:ems Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof, ' Each Manufid Bome or' Modular Dvelling Service or Feeder 2. CONTRAClOR INSTALLATION ONLY B. Services or Feeders C-".fI;,.....xw,rt; x. Installation,' Alterations Electrical Contractor RlJiz'~ / L-.~Jl, ~11._:-or Relocation:, ' Address /.;l ,:/ '1 0. ul. City J:= '.J'3.e.J..~ Phone ?,:? "7 'i :;o<iJ. Supervisor Licen.se Number 9'1).;e c T Expiration Date /0-/ -9' 6 , - r,C! C. Constr Contr. Number 70 Iv ) /fJy).ol Expiration Date "l/zl / 7/ I Sigoature <J"f ~~e~ Eiectrician ~p(/c .,/"" ;, ~s Name;;;~+ L;;0 (/) Address 975 Oa ~ 5f-- Ci ty 6"t-l-,.0A-L-- Phone 0(5 3 -.,) of; <,- , u .- O\INER INSTALLATION The, installation is beirig made on property I own which is not intended for sale, lease or rent. Owners Signature: -' --------------------------------------- DATE:C; -1-t1./.o J I 200 amps or less 201 amps to 400 amps 401 amps ,to 600 amps 601 amps to 1000 amps, Over 1000 amps/volts Reconnect Only Sum $ 85.00 $.15.00 $ 40,00 $ 50.00 $ 60.00 $100.00 , $130.00 $300.00 $ 40.00 Temporary Services or'Feeders Installation, Alteration or Relocation 200 amps or less $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps $ 80.00 Over 600 amps or 1000,volts see "B" D. Branch Circuits a1lOVe New, Alteration or Extension Per Panel One ci rcuit Each Additional Circui t or wi th Serv'ice or Feeder Per'mi t $ 35.00 $ 2.00 not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OP ABOVE 5% 'State-Surchaore Ai' _~_-r74C'7 /,.I" nl"flMl ..., - 40.00 40.00 20.00 36.00 _ 2.ffi , f7l) $ $ $ $ , .. , ,50'!TO r <;,0 v ..r" r ..=~ ~ .e.li...J~"'f~:/J.llt'f~I~I.".,:1 ~t'l..a DEVELOPMENT SERVICES 225 FIFTH STREET SPRINGFIELD, OR 97477 . Building Division .'1 !Y \ r.1 E)(PiREO ORDER ~ ;) NO suell NUMB r: \IP.CA~T ACOHf:.5S ~"^U..flCIENT 'lO'''' ~ .;:> . 'l"OTKI .......,.. o ,TEM?TfO, :'.It. 07.0 MAl\.. RECt:.PTM.....- o REFUSED ,- - - --....... ----"';":.. - ~, ~.- ----~J....-----.~~ ~ ~ - -,- -- ....- -_....- Fast Lane Coffee Co, 975 Oak Street Eugene, OR 97<1fll " q7~Oi0007 iN OS/i3/Qb RETURN TO SENDER FORWARD ORDER ON FILE UNABLE TO FORWARD RETURN TO SENDER I I T FASTQ75 NO 111.;,11.,...11..11,.11".11.,.11..,11."..,1111,..11...11".1 '; ,* . .7 . . - 1h-: ~o:kJV!i:1g t:'~ot:...'ct lIIf\ F:'\Jbml\1 ..... 1.,:,n\ri;), :;trod O(lbB not requlre epec~ \and ~... a;'r;r-:"~'t!l. c.., ~~~~:~:GON 97477 Zoning e ,ELECTRICAL PERMIT ~PLICATION INSPECTION REQUEST: 726-~Mll 5--'1. -q fo ,City Job Number iq / 0 or ~ OFFICE: . 726-3759 A~.1lll1P lItI- 'S. Ro.,,,,,....,, rr." SCHEDULE BELOV ~' 1. LOCATION OF INSTALLATION t::; '7 'fh rv!r.IV1~ SJ, A. New Residential-Sirigle or ' .. Multi-Family per dwelling unit. ';, , Service Iricluded: LEGAL DESCRIPTION n02?,3l-l J , 61102- JOB DESCRIPTION / h ~ 95-1 b 'r 9 Ip VoI-#?1 /J ky~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. - Items / 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each H<inuf'd Home or' Modular Dwelling Service or Feeder 2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders t.vi1d""Je~o..rt; X Installation, Alterations Electrical Contractor Ruiz', 'L".(:,'<..'~1L_:-or Relocation: ' Address /.;/:J '1 jJ, 7H. Ci ty ;:::: "3U, e.. Phone?, J? "7 '1 :;o.:x Supervisor Licen.se Number 91). lZe T Expiration Date /U-/ -9 t ^c! c. Constr Contr. Number 70 Iv ) /fJY).o1. /llzl/"J/ I Sign~e~Electrician C~....?/~/C ~ .. ~s Name!C~+ L~ en Address 97<7 Oa.~ "51- City~ Phone0e3-;(0'6~ OWER INSTALLATION Expiration Date The, installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: .. --------------------------------------- DATE: C)-1~q(6' :J" IlRr.F,TPT #: :L1'-f/o'1 WL. 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only Cost Sum $ 85.00 $.15.00 $ "0.00 $ 50.00 $ 60.00 $100.00 , $130.00 $300.00 $ 40.00 Temporary Services or'Peeders Installation, Alteration or Relocation 200 amps or less $ 40.00 201 amps to 400 amps $ 55.00 Over 401 to 600 amps' $ 80.00 Over 600 amps or 1000,volts see liB" D. Branch Circuits at>ove New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation' Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm One Circuit _ ,': Each Additional Circuit or with Service or Feeder Pe,rmi t E. 5. SUBTOTAL OF ABOVE 5%State~ch~e Ad ' ~ -5'7, ti rf'A'i-u1 1. --= I $ 35.00 $ 2.00 not included) v ( . , $ 40.00 $ 40,00 $ 20.00 $ 36.00 !/tt,0Z? 5~'cro 1<:.0 J.:.Of?'.... -. SI:"'.FIELD , '" ct ae lubmllted has e 1he tollowlng pr",e 01 &quire opecil1c 'and use zoning, and does n r approval. ('~(l Zoning~-- f Dole L( - \ s..q 0 9747l hortzed Slgnature_ 726-'-j 10':1 225 FIFTH STREET SPRINGFIELD, OREGON INSPECTION REOUEST: OFFICE: 726-3759 'f 1. LOCATIOp OF INSTAJ,.!j\TION .Q:\ ~ 1- ~\L\-\O ~\ IIJ\ !",\}\f)I)). ) LEGAL P&S.CJAIfTrON n 11 \\Nl,.t..,-,)~\ \)\~\\)-)...- . .... - - - ,,~QJ~BQ )E~'(itu~J~ ~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical contractorQ10\V 00.//t''j f/l"dV1C AddressflO. BQ~ Q';)';).O! Ci ty ~<.obevt e. 0/7'0,:,) Phone (,'13 . f;53 73 " Supervisor License Number 39t;;). <{ ~ Expiration Date ICI'f5 Constr Conn. Number 959/0 Expira tion Da te 6/""1(, Signature of Supervising Electrician , IJ)~A,~ ~ owne-rs Name ~ lJ~ ~f\g, 0~' Address C\f\s (Q()~ _ ,. Ci ty 0.1\9-1\0 Phone \0 ~3'~D6S OVNER rfu~TION The installation is being made on property I own which is not intended for sale, lease or rent, Owners Signature: DATE~----------------~~\~~l\l]J----- ~g~~~Djf~y: Cd\\0~\\'\ ELECTRICAL PERMIT rf'PLICATION Ci ty Job Number G\ 5 \ illCQ\ COMPLETE FEE SCHEDULE BELOV New Residential-Single or ~ Mul ti-Family per dwelling uni t. -, ..,' Service Included: . '.' It ems Cos t' Sum 3. A. 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular Dwelling Service or Feeder 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 Only $ 85.00 $ 15.00 $ 40.00 $ 50.00 ill $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 $ 40.00 $ 55.00 $ 80.00 volts see "B" above Branch Circuits ,- New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permi t 1 ~ E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ 35.00 $ 2.00 &h not included) $ $ $ $ 36.00 l\ ~\) ~ '-,;> '':D() ..:J, (/lJ y,:-) ~ Of;) 40.00 40.00 20.00 " -. .' .. CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE (COMMERCIAL 1 INDUSTRIAL) Name or Company: FAST Location: 5746 Developement Type, C LANE CO MAIN ST Building 1. STORM DRAINAGE Impervious Sq Ft 1.0 X 2. SANITARY SEWER Number Of PFUs (see Page 2) - CITY 1. 0 X 16 3. TRANSPORTATION Number Of Units 1,0 X .2475 X X Trip Rate 4.930 X Transportation Total 4. SANITARY SEWER - MWMC Number Of PFUs o MWMC CREDIT If Applicable (see Page 2) TOTAL - MWMC SDC SUBTOTAL - (Add Items 1, 2, 3 & 4) 5. ADMINISTRATIVE FEES Base Charge (Subtotal Above) X TOTAL SDC Reviewed By, TROY MCALLISTER Size: X 0.210 Job No., 951699 Lot Size: Per Sq' Ft Per PFU X Cost Per Trip 437.93 $534.35 X X Per PFU + MWMC Admin Fee 18,750 X 43.43 0.50 Date, 12/13/95 Page 1 Sq c:<< $0.00 $694.88 $534,35 $0.00 $0.00 $0,00 $1,229.23 $61,46 $1,290.69 , . , Job Number: 951699 FIXTURE UNIT CALCULATION TABLE Fixture Type Bathtub Drinking Fountain Floor Drain Interceptors For Grease/Oil/Solids/Etc Inteceptors For Sand/Auto Wash/Etc Laundry Tub/Clotheswasher Clotheswasher - 3 Or More Receptor For Refrigerator/Water Station/Etc Receptor for Commercial Sink/Dishwasher/Etc Shower, Single Stall Shower, Gang Sink, Bar, Commercial, Residential Kitchen Urinal, Stall/Wall Wash Basin/Lavatory, Single Water Closet, Public Installation Water Closet, Private Miscellaneous Number of New Fixture o o 1 o o o o o o o o 4 o 2 o 1 o . Page 2 Unit Equivalent 2 1 2 3 6 2 6 1 3 2 2 2 1 6 4 Fixture Units o o 2 o o o o o o o o 8 o 2 o 4 o TOTAL FIXTURE UNITS 16 CREDIT CALCULATION TABLE: Based on assessed value, If improvements occured after annexation date, credits are calculated separately. (calculations are by $1000) Year Annexed: Credit For Parcel Or Land Only If Applicable: Improvement (if after annexation date) : o X 0.00 o X 0,00 0.00 0.00 $0.00 (If land value is multiplied by 1 then the parce1/1and credit is not accurate,) CREDIT TOTAL . COMMERCIAL/INDUSTRIAL PERMIT APPLICATION ~ . JOB NUMBER <=J -;:;; I ~~ ~ S' 225 Fifth Street, Springfield, Oregon 97477 INSPECTION LINE: 726.3769 OFFICE: 726,3759 / ASSESSORS MAP' / LOCATION OF PROPOSED WORK' S 7 'fib /11";,, JlJ - 0;;) - sJ - '-f/ ..s: :J'-. Spr/"q-f:e/o! v /90.;( TAX LOT: oW:ER:_F",~+ J..€Vl,. (,,-tt--c:e. ADDRES'" 9 '7~ Ot:! k _\ ~"'- CITY: EUj e{\€. , 1 c'.,,+<<T \ L.=> ~r",.... Roell t .J 78'0 PHO~~' I'M: 6'3'3-",)085" 6~~'~"'$? 97 'flfo ZIP: STATE: _10 R DESCRIPTION OF WORK' NEW V REMODEL I ' 0 c,,":s+rv<t '1){.:;J g' W"o.,,{ ("","t'~c+lo" _('",+",,1 Ch T"..--rr.: VALUE: ~4e;; b1fnj r ADDITION DEMOLISH OTHER CONTRACTOR'S NAME GENERAL:l!1.",11 a -rJ. C"'n!:.-tr-'< 1-,,," PLUMBING: A I ""...+ P/uvn ,,: "j MECHA~ICAL' (' =_ .f.,,,..t ~(ow ELECTRICA" (" V" ow VAil.." ADDRESS <() ,("".'U:;'If"J ADDRESS /'UO (0 /,,(Jr~ Rl Sf= 10 c"Jpne. '-.I CO NST. CONTRACTOR' I:..pr;,')~+;-,,(J .:It:Vl?~'')O PHONE 3'f::J-t,>;'/t NAME ARCHITECT: tv!or'(,5 RJJen EXPIRES ,/% PHONE 7't 7..- 'i 31/ ~/l ~<~ ~ '7,;) 9- /7'f-.:;) 3'1-:1-);>/01 68'1 -6,;), 3. J , i PLUMBING I I MECHANICAL I I NO, FEE CHARGE I I- ... t:J:jAor.J: I 1 &f Single Fixture /L; 9'P. c,Q 1 Furnacefburner & vent '" 6.-....... I < 100,000 BTUs 1 Relocated Bldg, I I Furnacel burner & vent 1 Inew fix. addtl) > 100.000 BTUs I~ Water Service 7.6.-1 I Floor furnace and vent 1 It. I '3/d Sanitary Sewer ~.-I 1 Suspended wall or floor I II. mounted unit heater I<~' Storm Sewer %5.-=>1 I Appliance Venl I Vt::>", separate I I /~.'t? I .Stationaryevap. \ Backflow Device cooler 1 -- Vent Fan/Single 3",-1 duel I Vent System apart I from AC or htg. 1 Mechanical exhaust 1 hood and duct 1 1 I I Permit Issuance $10,00 I , I TOTAL PERMIT ,:?,,~- I TOTAL PERMIT h?.&', -"" I ,/~ I - OFFICE USE - HANDICAP ACCESS: FLOOD PLAIN' ZONING: OUAD AREA' . OF BLDGS' LAND US" . OF UNIT~' OCCY GROUP: . OF STORIES: CONSTR, TYP" HEAT SOURCE: LIGHTING POWER BUDGET: WATER HEATER: ., SO, FT. $/SO. FT, VALUE SO, FTG MAIN X SO. FTG ACCESS ~~r X SO, FTG OTHER X TOTAL VALUE OF PROJECT PLAN CHECK FE.E /;;''7'.33 RCPP /7' '5e3 DATE /,,?h.~ BY //~ , 1 BUILDING PERMtT 15% State Surcharoe I MECH1~;? 15% State r.l5: Surcharoe ,/-;J 1 PAVING ::<'~. S2:> I -:J.G>~ 7.~- /O-;.;..t:'" /.5;:_71> -.~ 1 PLUMBING 5% State SurcharQe FENCE VALUE $ SIDEWALK ::<'6 ~ .s-.- 1'.=4':'- ?,9r I DEMOLITION CURBCUT FT. FT, SUBTOTAL PERMITS SYSTEMS DEVELOPMENT ?"?? ?5'" /:.?~.<.:..". TOTAL PERMIT FEES I EXCLUDING ELECTRICAl 1~'5Y' Y"r ~ . REQUIRED INSPECTIONS . It Is the responsibility of the pHmli holder to see that all Inspections are made at the proper time. To requast an Inspection, call 726.3769 (recorder), state your City designated job number, Job address, type 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, SITE INSPECTION: To be made after excavation, but prior to setu p of forms, ;( ROUGH PLUMBING, ELECTRICAL & MECHANICAL: No work is to be covered until these Inspections have been made and approved. PAVING: After graver is in place but prior to placing asphalt or concrete. UNDERSLAB PLUMBING, ELECTRICAL & MECHANICAL: To be made before any work Is covered. ATTIC DRAFT STOPS & CURTAIN WALLS SPECIAL INSPECTIONS: In accordance Section 306 of the State Specialty Code a special Inspector shall be employed by the Ownerl Contractor during construction of the following work. A copy of the special testing reports shall be furnished to the Building Division. . )l.. FOOTINGS & FOUNDATIONS: To be made after trenches are excavated and forms are erected, all steel In place, but prior to placing concrete. FIREPLACE: Prior to placing facing materials and before framing Inspection. STRUCTURAL CONCRETE: In excess of 2500 P,S,I. (306 a,1) '" FRAMING: To be made after the roof, all framing, fire blocking and bracing are in place and all pipes, chimneys and vents are complete and the rough electrical, plumbing and mechanical are approved. STRUCTURAL WELDS: Performed on lhe job, (2722 f) j' CONCRETE SLAB: To be made after all Inslab building ~ervlce equipment, conduit, piping, accessories and other anCillary equipment Items are In place but before any concrete Is placed. A" INSULATION & VAPOR BARRIER: To be made after all Insulation and required vapor barriers are In place but before any lath or gypsum board Interior wall covering is applied. FIRE & SEPARATIDN WALL: Located and constructed according to' plans. HIGH STRENGTH BOLTING: During all bolt instatlation and tightening operations. (306 a,6) v UNDERGROUND: Plumbing, electrical, gas, sanitary sewer, storm sewer, water and drainage lines. To be made prior to covering or filling trenches. SPRAYED ON FIREPROOFING: U.B.G, Standards 43.8. UNDERFLOOR: Plumbing, electrical, mechanical. To be made prior to Installation of fioor Insulation, decking or fioor sheathing. SPECIAL GRADING, EXCAVATION AND FILLING: During earthwork, (306 a,11 & Chapter 29) .x LATH AND/OR GYPSUM BOARD: To be made after all lathing and gypsum board, Interior and exterior, is In place but before any plastering Is applied or before gypsum board joints and fasteners are taped. and finished. GLU.LAM BEAMS: Inspection Certificate by an approved agency, furnished to the City's Building Division before beams are placed, (2501 U,BC, STDS.25'10,11). POST & BEAM: To be made prior to Installation of floor Insulation, decking or floor sheathing. STRUCTURAL MASONRY: (306 a.7) FLOOR INSULATION & VAPOR BARRIERS: To be made prior to Ins~3nation of decking or floor sheathing. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete and form work and sub.base material in place. *'n addition to the Inspec. tlons specified, the Building Official may make or require other Inspecllons of any con:;tructlon work to ensure compliance with the Building, City or Development Code, MASONRY: Steel location, bond beams grouting or verticals in accordance with UBC 2415, ROOF SHEATHING AND NAILING: Prior to installing any roof covering. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. ------------------------------------------------------- .( y FINAL ELECTRICAL FINAL PLUMBING SITE PLAN REVIEW'BOARD: MUSI be requested 2 days In advance of the date you wish Inspection. All project conditions such as landscaping. parking lot striping, etc, must be completed before requesting this Inspection. % FINAL MECHANICAL .'JI' ; FINAL BUILDING: ReQuesled after the final plumbing, electrical, mechanIcal and Fire Department inspectIons are made and approved. No occupancy of the premises can be made until a V CertifIcate of Occupancy has. been issued by the Building Division ---,4- FINAL FIRE DEPARTMENT and posted on the premises, / ADDITIONAL COMMENTS: /7.k P 'l?~ A~'l' ~......_ ~ ~") .&".h'_('/./~ $r?1;? /11I$i7ci?~~ if ~;:l#:P 0'7:',y-_mC:;k~/.V";~ /.??-23 '~5 ~ /.., PLANS REVIEWED B "./?~, ?'?'7<<?DATE /.2~/?...., c::;-- , y~ ~- - - ~ By signature, I state and agree, that I have carefully examined the completed application and do hereby ceTtl fy th~t all Informallon herein 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 Sprlngfleid. and the Laws of the State of Oregon pertaining to the work described herein, and thaiNO 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 wil~..be u~~~d.on this project. . . . I further agre'e to ensure that all required lnspectio~s 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 property. and the approved set or plans will remain on the site at all tlm~s ::I~~~/struct~n, -~d'~/ Date '3 -.26- 9'f, slgna:J<i'X .., r { -/" VALlDA"tJN\ AMOUNT RECEIVED:, ~<f. %~~ RECEIPT ': ,4...\) 6~J1 DATE PAID ; C' 07J..o ~f-:, RECEIVED BY: '\}I ~ ~ /'~ . . SPRINGFIELD , rl z.:.~ing, and does not require opec~ c n a~IProvel.. r \ I ZOOlo9_ " D'le~ 42,:i,:.umatii~ET ~ A'SllmGFftLD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 c;((,N g WGSr 1. LOCATIO~ OF INSTALLATION 5'7 <.J..lV) M411J -=>1', Y:-ftt1..~PTrJlql1S JOB DESCRIPTION N~N <;(bN Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical contractor-&..l to!..' nvo0 Address 4"570 \.It'- r/J.(,. A~, ' Ci ty ~I'-n:- Phone ~1.j.4 -{, 7,~ Supervisor License Number 7,0 ''?-~L.C.-<''< Expiration Date -z-..I C,i Cons tr Con t r. Number c':;13 7 I Expira tion Da te 10 f'1? Signature of Supervising Electrician Np~ (.[. (' Owners Name t-r'\'ST ~ (A)f'FE::6- Cf 0 Tt) .... tz:o bf.I <- Address ,Ull!-~ IAL" ,..", ",y,,G - Ci ty l::::V~ Phone ~3.' Zll~ OVNER INSTALLATION ELECTRICAL PERMIT ^y\LICATION City Job Number, '1 ~ \ \m COMPLETE FEE SCHEDULE BELOV 3. New Residential-Single or ~ Multi-Family per dwelling unit. Service Included: Items Cos t { Sum ~ $ 85.00 A. 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home, or Modular Dwelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: $ 15.00 $ 40.00 200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amI's to 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps/volts $300.00 Reconnect Only $ 40.00 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see liB" above " New, Alteration or Extension Per Panel $ 35.00 $ 2.00 not included) E. Miscellaneous (Service/feeder -Each installation /L;~or irrigation ~, ig Outline Lighting Ited Energy/Res Limited Energy/Comm One Circuit Each Additional Circuit or with Service or Feeder Permit $ $ $ $ 4flCO ,...(j,OU 4:!./I1) 40.00 40.00 20.00 36.00 <Wl The installation is being made on property I own which is not intended for sale. lease or rent. Ovners Signature: DATE~---~~t;-~-l:-------------------- RECEIPT #: 215'<1'/ RECEIVED BY:, tv ~'