HomeMy WebLinkAboutPermit Building 2002-5-3 (2)
.
I Job# 02-00308-01 I
.
Page 1 of4
TRAN#:01-Q008823
MAY 03 2002
$ -3773.68
032
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-00308-01
225 Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 5983 Obsidian Ave Spr
Assessors Map#: 18020300
Lot: 21 Block: Addition:
Tax Lot #: 00507
Subdivision:Jasper Meadows
. Hayden Homes .' " <, ~~, _~ , l'"
An \::.I'J ,IV ",Vlw~" , 0 Utllli\!
Address: fo\l0\i\P.9,,~ox\8f\3ed by the regon t fo~' City/StatelZip:
" '+;';,-'~':nn Gonter. Those rules are se ' . '
Scope Of Work: 'Single gamily' ,~esidence)AR 952-00'1- New
, OAA8o,,-Uv I-ue; Iv "..~~".
In090 ,BrookfieldJbtain copies of the rules by
o . IVI.A "'-J ~__ ,.,~~-,,,,,,,?+,..,tephone
ca\l:~I'jISl,same.as 02ro.0~00-Q' """~r nr
numtJglIjO.0K~1lI8!fCDRJsA'NITJ\Ry"g;'STORM UNTIL INFRASTRUCTURE IS ACCEPTED BY THE
Contractor Type lC.ontractor"I'(), "'l~-n44). Registration # Expiration Date Phone
General Contr Hayden Homes 92208 7/29/2003 541-501-4332
PO Box 883, Sprin9field, OR 97478
Electrical Contr . - Christenson Electric Inc
111 SW Columbia SttSte480, Portland,
.., '" .v.... . ~
OR 97201--5~agO G38N3I/'lV~GJ
Mechanical Q913tr 03 Hgh\~~~~lfIMil\il@1r1 ~Wditioning 184164
iON S\ l\l/'lj;lBi~d~~'~!l./Ml1~ 9i\1I\k
Plumbin~Y. 3Hi~1e~~~ Marlene Currier:~~)U'O~ 103570
648 W Oregon Ave, Creswell, OR 97426
Owner:
Phone Number: 541-501-4332
Springfield, OR 97478
Value: $113,772
458
5/1/2003
503-241-4812
6/25/2003
541-345-2838
",\(\~
12/15/2002 .o'/-o _~ 541-895-3758
Office Use
Quad Area:
# Of Units:
Constr. Type:
Water Heater:
4RSE
1
(VN) Wood Frame
Electric
Land Use:
Zoning Code:
Bedrooms:
Range:
Single Family Dwelling
LOR
3
Electric
# Of Buildings: 1
Occupancy Group: Dwelling
Heat Source: Forced Air Electric
Sq, Footage: 1420
To request an inspection call the 24 hour recording at 726-3769. All inspections 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
working day,
Verify Ground Rod
Footing
Foundation
Post and Beam
Floor Insulation
Ceiling Insulation
Shear Wall Nailing
Framing
Required Inspections
I Building I
-Install ground rod at footing, and call for inspection in conjuction with footing and/or foundation ir
-After trenches are excavated.
-After forms are erected but prior to concrete placement.
- Prior to floor insulation or decking,
- Prior to decking.
- Prior to cover.
- Before covering sheathing with finish materials,
- Prior to cover,
Street Improvement: Fully Improved
Curb Cut?D Improvement Agr.?D
San Sewer Depth (Ft): 6 4
Storm Sewer Available? 0
Special Req.:
Security Required:
Bond Begin DateTime: 00/00/0000 00:00:00 .
Special Instructions:
Other Utilities:
Project Supervisor:
Zoning: LDR
FloodPlain? 0 Wetlands? 2]
Journal numbers
1: 2000-01-0015 2:
Comments:Wetland Conservation Easement on lot
Wall Insulation
Drywall
Final Building
Rough Electrical
Electrical Service
Final Electrical
Underfloor Plumbing
Underfloor Drain
Rough Plumbing
Water Line
Sanitary Sewer Line
Storm Sewer Line
Final Plumbing
Underfloor Mechanical
Rough Mechanical
Final Mechanical
-I
-
Job# 02-00308-01 I
Required Inspections
Building
Page 2 of 4
- Prior to Cover
-Prior to taping.
- When all required inspections have been approved and the building is complete.
Electrical
- Prior to cover.
- Must be approved to obtain permanent power.
- When all electrical work is complete.
1 Plumbing
- Prior to insulation or decking,
- Prior to cover or placement of concrete,
- Prior to cover.
- Prior to filling trench,
- Prior to filling trench,
- Prior to filling trench,
- When all plumbing work is complete.
1 Mechanical
- Prior to insulation or decking.
- Prior to cover.
-When all mechanical work is complete,
Sidewalk Type:
Additional ROW?
Size Of Line (in):
Downspouts/Drains:
Enchroachment Permit:
San Sewer Tee (in):
Bond End DateTime:
o
8
To Storm Sewer
4
00/00/000000:00:00 .
Types Of Warning Devices Reqd.
Overlay District:
# of Street Trees: 0
Land Use: Single Family Dwelling
Pave Driveway? 2]
3:
Additional Requirements:
Glenwood Area? 0 Required Attachments:
Source Locn:
Material:
Planner: Liz Miller
Urban Growth Boundary? 0
Quantity Of Fill:
Supplier:
Drainage:
Floodway FEMA: X-White
Flood Plain FEMA: 1166 of 2975
Construction Types:(VN) Wood Frame
Occupancy Groups:Dwelling
# Of Buildings: 1
# Of Bedrooms: 3
Handicap Access? D
iArea (Sq. Feet)
I Main: 1420 Accessory~OO
Fee
Same As Plan Review
Total Plan Check
Building Permit
State Surcharge For Building Permit
8% Building Administrative Fee
Total Building
Wiring Footage 1,000 Sq Ft or Less
Wiring Footage Each Add'l 500 Sq Ft
State Surcharge - Electrical
8% Admin Fee - Electrical
Total Electrical
Three Bathrooms
State Surcharge - Plumbing
8% Administrative Fee - Plumbing
Total Plumbing
Hood and Exhaust
8% Administrative Fee - Mechanical
Less than 100,000 BTU
Vent Fan to One Duct
Dryer Vent
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
Residential - Single Family - Storm
Residential Improvement MWMC
MWMC Administrative Fee
SDC Administrative Fee
Residential Sanitary MWMC
Residential - Improvement
Residential - Reimbursement
Sanitary Sewer SDC Reimbursement
Sanitary Sewer SDC Improvement
Total System Development
-I
-
Job# 02-00308-01 I
Page 30f4
Private Garage/Carp/Stor
# Of Stories: 2 Height (feet): 26
Current Units: Proposed Units:1
Census Code: New SF - detached
Total:1820
Paid On Receipt# Value/Quantity
Plan Check
05/03/2002 8823 1
Building
05/03/2002 8823 113,772
05/03/2002 8823
05/03/2002 8823
Electrical
05/03/2002 8823 1
05/03/2002 8823 2
05/03/2002 8823
05/03/2002 8823
Plumbing
05/03/2002 8823 1
05/03/2002 8823
05/03/2002 8823
Mechanical J
05/03/2002 8823 1
05/03/2002 8823
05/03/2002 8823 1
05/03/2002 8823 4
05/03/2002 8823 1
05/03/2002 8823
05/03/2002 8823
System Development
05/03/2002 8823 1,786
05/03/2002 8823 1
05/03/2002 8823 1
05/03/2002 8823
05/03/2002 8823 1
05/03/2002 8823 1
05/03/2002 8823 1
05/03/2002 8823 24
05/03/2002 8823 24
Fee Amount
$100.00
$100.00
$611.15
$42,78
$48,89
$702.82
$106.00
$38.00
$10,08
$11.52
$165,60
$306.00
$21.42
$24.48
$351,90
$9,00
$4.08
$12,00
$24.00
$6,00
$10.00
$3,57
$68.65
$487.47
$34.83
$10,00
$129,13
$332.86
$659.76
$155,13
$512,88
$389,76
$2,711.82
-I
Job# 02-00308-01
Fee
Paid On Receipl#
Willamalane SDC
05/03/2002 8823
S.F, Residence - Willamalane
Total Willamalane SDC
Planning Plan Review
Total Planning
Planning
05/03/2002 8823
Address Assignment
Total Permits w/o Srchg
Grand Total
Permits w/o Srchg
05/03/2002 8823
Plan Check Type
Checked By
Date Completed
Comment
Initial Review-Res
Lisa Hopper
Bob Kettwig
Liz Miller
04/04/2002
04/16/2002
04/11/2002
04/18/2002
Engineering-Res
Planning-Res
Structural-Res
Tom Marx
-
Page 4 of 4
Value/Quantity
Fee Amount
1
$1,000.00
$1,000.00
1
$55.00
$55,00
1
$8.00
$8.00
$5,163.79
By signature, I state and agree, that I have carefully examined the completed application and do
hereby certify that all information hereon is true and correct, and I further certify that any and all work
performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of
the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made
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 701.055 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 during construction.
~~/'l-l1lhJ f\ot Nl'l.Lla ~ IUIr
~
-s - 3. - 02.....
Date
..,
.
1-
~?"Jb. Willamalane
'"t" "'f' Park & Recreation District Job. No. (J)i...m 30~: () 1
"., SYSTEM DEVELOPMENT CHARGE
. . WORKSHEET
NAME:\_~~~fJ . PHONE: ffi~.~.
'ADDRESS: Q.~.~ Bre J~STATE:~zIP:c:t"1411
LOCATION OF PROPOSED BUILDING SITE:
Street Address: J:;C;g'"5 ()(!;S;'{)/A;d ~
Plat Nam . Q ~ _ Tax Lot Number: \ m~l
1.DEVElP nENT TYPJ; (Check approprlale dwelfing(s). SOC calculalions and dwelfirig l
we definitions are on the back.)
A S.lnoIA-F~milv DAI~chAd
\ Single Family home
NO. OF UNITS \
Manufactured home not in a par1<.
X $1,000 per unit = $ ,ULO.cO
B. mnCJIA-F~milv Alt~chAd
NO. OF UNITS
X $924 per unit . _. $
C. Multi-Familv Aoartment
NO. OF UNITS
X ,$692 per unit =..$
D. M~nlJf~ctlJrAd HnmA Parte,
NO.OFUNITS
WllLAMAlANE SDC
. X $699 per unit .. $
$ \cro. d:)
(25
$ \COOp:)
2. SDC CREDIT (II appncable) SOc-payer must fumlsh proof of
WiUamalane Credit approval, See SOO Credit Worl<sheet. $
3~ TOTAL WllLAMALANE NET SDC ASSESSED.
(If soe reduced for Credill
\\~~ j
Development selVices~ent
City of Springfield
..s,-S
Dale
, 02-.
CITY OF SPRINGFIEL~STEMS DEVELOPMENT CHARIWORKSHEET
JOURNAL OR JOB NUMBER: 02-00308-01
NAME OR COMPANY: HAYDEN HOMES
LOCA nON: 5983 OBSIDIAN AVE
TAX LOT NUMBER: 18-02-03-00 TL:00507 JASPER MEADOWS LOT #21
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS: I BUILDING SIZE: 1820 SF LOT SIZE: 6792 SF
1 STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTE~
I IMPERVIOUS S,F, I xl COST PER S.F. I
I 1785,60 I I $0.273 =1
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IIMPERVIOUSS,F'lxl COSTPERS.F. Ixl DlSCOUNTRATE I
0.00 I $0,273 1 50%
I ITEM I TOTAL - STORM DRAINAGE SDC .
2 SANITARY SEWFR - r.ITV
$487.47
=1
=1
$0.00 ~
S487.47---.J J 1070
A. REIMBURSEMENT COST:
I NUMBER OF DFU's 1 x I COST PER DFU
24 1 1 $21.37
B. IMPROVEMENT COST:
I NUMBER OF DFU's I 'I COST PER DFU
I _24 _ $16.24
I ITEM 2 TOTAL - CITY SANITARY SEWER SDC
3 TRANSPORTATION
A. REIMBURSEMENT COST:
I ADTTRlPRATE I 'INUMBER OF UNITS I xl
9.57 I 1
B. IMPROVEMENT COST:
I ADTTRlPRATE l'INUMBEROFUNlTSlxl
9.57 I I 1
I ITEM 3 TOTAL - TRANSPORTATION SDC
4 SANITARY SEWFR - MWMr
=1 $512.88
=1 $389,76
=r-"S902.64
COST PER TRIP IxlNEWTRIP FACTOR I
$16,21 I 1.00 =1 $155,13
COST PER TRIP
$68.94
J I NEW TRIP FACTOR I
XI 1.00 1=1 $659,76
=1$814.89
A. REIMBURSEMENT COST:
I NUMBER OF FEU's I (I COST PER FEU
I $332.86
B. IMPROVEMENT COST:
II NUMBER OF FEU's I x I COST PER FEU
I 1 $34.83 1
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
~UBTOTAL OF MWMC REIMBURSEMENT, IMPROVEMENT & CREDIT
MWMC ADMINISTRA nVE FEE
----_.--
I I'rEM :jTOTAL - MWMC SANITARY SEWER SDC
I S~TOTAL(ADDITEMS 1,2,3,&~
115 A~:~~:~ TIVF1 :IE:DM, FEE RATE
I $2,582,69 5%
I SteNe- T e.mpUnt 04/16/2002
SOC COORDlNA TOR DATE
=1
$332.86
=1
=1
=1
=1
1
I
I
I
=1 $377.69,-..L1
=C,$2.582.69'il
$34.83
$0.00
$367,69
$10.00
=1 $129,13 1
TOTAL SDC CHARGES = -$2,711.82 I
r/J
.~
Cl
o
u
~
~
r/J
-
\:J
~
1091
I
l-I
1092
1093
1
1
1094
1055
1056
1073
. .
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
[ NUMBER OF NEW FIXTURES x UNIT EQUlV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITtONAL FIXTURES)
NO, OF FIXTURES DRAINAGE
( # NEW # OLD ) UNIT FIXTURE
FIXTURE TYPE x EQUIVALENT = UNITS
BATHTUB ( 2 0 ) x 3 6
DRINKING FOUNTAIN ( 0 0 ) x I 0
FLOOR DRAIN ( 0 0 ) x 3 = 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. ( 0 0 ) x 3 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC, ( 0 0 ) x 6 0
LAUNDRY TUB ( 0 0 ) x 2 0
CLOTHESW ASHER / MOP SINK ( I 0 ) x 3 3
CLOTHESW ASHER - 3 OR MORE (EA) ( 0 0 ) x 6 0
MOBILE HOME PARK TRAP (I PER TRAILER) ( 0 0 ) x 12 0
RECEPTOR FOR REFRIG / WATER STATION / ETC, ( 0 0 ) x 1 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETe. ( 0 0 ) x 3 0
SHOWER, SINGLE STALL ( 0 0 ) x 2 0
SHOWER, GANG (NUMBER OF HEADS) ( 0 0 ) x 2 = 0
SINK: COMMERCIAL/RESIDENTIAL KITCHEN ( I 0 ) x 3 3
SINK: COMMERCIAL BAR ( 0 0 ) x 2 0
SINK: DOMESTIC BAR ( 0 0 ) x 1 = 0
WASH BASIN ( 0 0 ) x 2 0
LAVATORY ( 3 0 ) x 1 3
URINAL, STALL / WALL ( 0 0 ) x 5 0
TOILET, PUBLIC INSTALLATION ( 0 0 ) x 6 0
TOILET, PRIVATE INSTALLATION ( 3 0 ) x 3 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU's'
( 0 0 ) x 20 0
TOTAL DRAINAGE FIXTURE UNITS =1 24
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE
IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE, CALCULATE CREDIT SEPARATELY
YEAR
ANNEXED
1979 OR BEFORE
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
CREDIT RATE PER $1,000 II
ASSESSED VALUE
SoI.9Z----
SoI.83
SoI.77
SoI.64
SoI.47
SoI.30
SoI.09
S3.78
S3.41
S2.98
S2.52
CREDIT FOR LAND (IF APPLICABLE)
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
YEAR
ANNEXED
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
CREDIT RATE PER $1,000
ASSESSED VALUE
S2.06
SI.64
SI.45
SUI
SI.l3
SO.97
SO.82
SO.63
S0.41
SO.22
SO.Q4
VALUE / 1000 CREDIT RATE
0,000 x $0,00 =1
0,000 x $0.00 =1
TOTAL MWMC CREDIT =1
$0.00
$0.00
$0,00
JOB DESCRIPTION \~qp, 1000 sq,ft, or less
<.. ~ . l2.v:.; ~ ~ Each additional 500
,",' I .:.,~ I,UN:U,egon la\~cf.E\l.liitrP\litiOliI to
Permits are 'lon-transferable and e{piffiw rules adopted by tl1teQmgon Utility
if work is not started within 180 dhy~ification Center, Thos€Bilrl\i)M1lnu&l~9r
of issuance Of if work is suspended 'f6r'\R 952-001-0010 thrdY.!!1!ltllllf.El\9l5Hn:a01-
180 days. ,:.., l090. Youmayobtaincop1i!ltvi~LQJif~4lgs by
,", calling the center. (Note: the telephone . "
2, ~ONTRACTOR INST~LATI0N,(j)!\lI:.l1jrtheQ}e~ll!nJ/lMV'~Il~~Ii!'Ation ,',
Chnstef1!301J EleSJPc, Inc. D.B;-:j\...teris1_800_3~~2J!~'p'n,AItera~ions~r, ." '. :~
Electrical'Cantraclor:., Philins F.lf'C'tric Relocation: :', ~"':;~' v,. ":,':' .,,' ''-i
'to <:. .~;,I /:"\" . ',1",_ ,J.I--.:.:.\{~" -w"~:;,,\
'1/..: "':': ~.: ", ,.:';;~ ,-~~~ ~ . ," r, .. -": :'~'\
Address .1298' Rf'thf'l Drivf' . ";'.' """ 200 amps 01" less, ,:, - " , ": ": $'63,60. ,
":'" ';", '; /. >.' 'f >"'-. 201 amps to 4QO amps.' , . ,'. ,,"$,75,00'" '. j
Cif)Eug"",,.-nR ..~ 'P!,ane (S~~')'hRA';:hi2F' - 401 amps to 6PO amps' : " . , $125:00, ;
,97402""', .".;", ,""'>~601ampsto'1000amps'. ''':',$16~,QO,''',
Sllpervisa..License'Nuinber -2710<:, ,.1 .:' i.:,:'QverIOOOamps/valts "$375,00 '. ~
~\ ..-f :' f ',.jJ,_l "w .~:~.. ~ "~'l._:.' i"'~' . ,..".,.,',.,...~.:;~~eco~.mect_Oiili ..' :-"':~$'.50.00"~~1
t.;'!'..':.:; Expiration Date ..?, lO/ofim ',,;', ,0' .., '",::, ,- . " ., : '; .,..' ~ ,,'.", . -::--1
\. :::; ...<,'.. ,': . . ..' '''-''' .~,". .'. '.,,', ."'--_.OOltwl.lwfi'..~~Fq.ii'&orFeeders '. "...... "J
::: '".' "'constr~an:r"N~~ef ..' ?'h~Yl5la3H6;'N' i.g: V S'. ". ~1.ruh~o~,Aft\!H'tiono; I,{~.o:~t;'iln' .. , ".'
, , ~ -,....,~;, ',,' ,.,. ".~ <;J v. lU03nN:1~1I1l0n,. ..,.','. ,.' '. ,\
':' :';\r,." )Expiralian Date . "in ffilfmSllI,It\lH3d SI~r:a~,a~(1~31~I~J?~S ~,': ,':'..:.:i ~$50.00 ~;
.?~;:'..-:,,~,; >h .. )lHO~.3HLI1:!lfhlJG.:'Il\1HS~).~1f;~0a.mP~";.. ~'$69.00" " .:
~,.' 'n t;' :'. .,., S~gn}turc,af 5."pervIsmg Eleetnel3n --"-'~.o ~ps . :' ,'....--;-"- ~1?0,00 ~
'~ . .:h:' ':.. ~ ~ ,,' ",~:, -. :6" ~"'-,?-... .or.!2E~ ~o!,~ s~e.. ~.: ,,- .: >~.', '; .
, ~'-'. -";" ,- '" "l~"'.''':''.. "Btlabove '--_' ....~." ',' -,'. r ' ,,(
~~Pl"~~~':;'\:;::: ":".'7~ /\ ----- ~':' ;.: \>~:',:""i" '. :'1:!
.i:"_'{~'~ ,-~::';:"-;;;;::~:r:'-,,'i:'H 1", ""\":1.~:16,~~N~,~~,,:~nl.i1ps D. Branch CI~CUlts, .' f' ".' .", ,^.;.' . ~,;~,_.i
.,..:::;.::;..,' ,JQivners Ni'me~'" ..'i-:......~ Newil\.ltciation orJ:;.xtensianPe!P~nel ..~ .";,' '., .', ':~
,',;";:/. ':." Ad~;e's~" :r:o~f\~l' i~~:~\ on/&;;:;:\ }:',;:'! c$~~::~O' , ,1
. -----:.. .' ' ....
.!:.,.." :., .'...,", ".'
..,' -' ':, ;'.' ~' .'
. ..., ,..CitySt"U~
'. . -.'
'..'
. . .'~'
."
',tt',;
.... "
,l;' ,'''''.
I: ,~,(.:
"..':'
';"',::."',
"",.'.'
:\, .
~;t~ _~
,{ ~~
f~'" ,,~'~..."~
. . ,
. '.<"0-
, - '~.."
~f l' i' ...;
,""'., .,-,
~ ';:"~i ~ ',';
" ,- "~
",
e;,'" ~v
'f:>1i- \'l)
. 'il:l)c~c ~
#- ~0 ...
225 FIFTH STREET ,;~V~~\\0~ ELEC~" PEro"m APPLICATION .' fL.
SPRINGFIELD, OREGON 97477.0c\'/j,\eO'. .;;;t!;:i.,}
gx~~i~I~~_~?~UES:~)~~~~~~:-;: . City Job Nu.mbe",m.-, ~ :~oi - 0," . ~."i~')-
, ' . .' ..'.. ~e \,,~' ,/;-,,', ,~(.'" ':..,. , .~OMPLETE FEE SCHEDULE BELOW 'l.~
1. LOCATIONOF~~LMIO ," ,:i'."..., . 'J]
c,'1 'i/O;' iJ P:>c, ~ni'i+1.:J"'.~u;:c:::. 'A.:'N~w Rcsidential'Single 0.. : ,,;' ..
0.,,\0 ".~i' . Multi-Family pc.. dwelling unit. .. :
LEGAL DESCRIPTION .t:.'<'o<\ Sen'ice Included: ',.'
Jill 01 0 ~ 00 (')0''00'1 Items Cost Sum ';
. , cf)
-.l.. $106,00 Jf2...to.
~,c0
~ $ 19.00
$ 50.00
. ~ '
,v..' .I., :;~.. -, ,",":".: -~'> 1
:: "'I>hone:<j{"Sc'.5~u>
Each Additional Circuit or with Service
Of Feeder Permit.
~;- . I
j; 3,00'
.),..,'
,.".
'>'-.
. '. ." '. ~..; :.:::_ ~..' .:/':""\. ',J~': "./
OWNER INSTALLATION'.. , ;,\'
. 'l'he Installation is'1ieing made'on :'.
propenY'].o~ri:wfuchis.'notintended". ,
..foT'sale;.lease 'or.rent. . '.. .... '-_'~';.-.~'i"::",
..;; . '-
.'.,
. . ,
:>::'~"Owncrs Si'gna~ur.e: .
,'"
,....:' ."
~;.~r, '
,I
'.
Minimum Electric Permit Inspection Fee is S45,()() + Slll'chal-ges
,.. \.lA({),
4, SUBTOTAL OF ABOVE ~.
7% State Su..cha..ge \ t).D.6....
8%-Administrative Fee , \ .~
TOTAL -lln~.~
~~1VCB