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Home My WebLink AboutPermit Building 2005-3-11 '\ -:_~,~BUi~Ji.',~J 'Co ~ 'I l.J. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line !;" / CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00145 ISSUED: 03/11/2005 APPLIED: 02/04/2005 EXPIRES: 09/11/2005 VALUE: $ 162,640.00 SITE ADDRESS: 6075 Orchid Ln ASSESSOR'S PARCEL NO.: JASPER MEADWS 2 AD Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence, Jasper Meadows 2nd Add lot 113 Owner: HAYDEN ENTERPRISES Address: 2622 SW GLACIER PL #110 REDMOND OR 97756 Contractor License Expiration Date HAYDEN ENTERPRISES 92208 07/29/2007 THORNTON ELECTRICl~C; ON: Oregon lavlt~res you. ~o 10/01/2006 PACIFIC AIR COMF~)R\-N~ s a. dopted by tmj)reg.o. n. Utl~I~9f/25/2006 JET MECHANICAL~S~~~_~;~:'rpntp.~. Th~~~S~~~~ ;;~ ~';\)~/10/2006 lnBtJll:1J..wm'N1F0RMxTf'O~dof the rules by 0090 You may UUlCll1I VVt",! I hone ' ciUtf~t~esenter. (Note: .t.he teo ~\catibftt Size: ~~tt9f ~SlaW'jon Utility t e~ijl Sq Ft 1st Floor: nUType ~~t~s 1-8(P~h~i~~t ~~ Sq Ft 2nd Floor: Water Type: Gas Sq Ft Basement: Range Type: Electric Sq Ft Garage/Carport Energy Path: Path 1 Sq Ft Other: Sprinkled Building: n/a Occupant Load: Contractor Type General Eiectrical Mechanical Plumbing # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: 1 R-3 U VN 20.00 10.00 6.30 44.90 5.00 Residential Phone Number: 541-461-5091 I CONTRACTOR INFORMATION I Phone 541-501-4332 541-686-4151 541-672-9510 503-363-2334 9,661 1,550 400 3 I DEVELOPMENT ll'll'uRMATION I REQUIRED PARKING Overlay Dist: lO!\CE: loi8~ WORK 2 # Street Trees \!qtl~ ERM\1 SHAll EXPIRE IH~.ruicap~~: Paved Drive Rqh~IS P - UND~es1HIS PEClM~1>dcl: ~ I % of Lot CoveJ;liige:HORIZED O:"20d''ABANDONED fOR COMMENCED K \5 , ..., ... "n I'f\V PFRIOD. '-4.1\1 l I""'" - I PUBLIC IMPROVEMENTS' Sidewalk Type: Downspouts/Drains: Fully Improved Yes Curbside 5' Curb and Gutter Notes: No hook-up to City Infrastructure until Public Improvements accepted by the City; Storm drainage piped to curb face. 2/7/2005 CAS Pa2e 1 of4 ~~~~~l~sm!c~"_",,,"~.. ~ '! II. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction V Wood Frame Garal!e Dwellinl!s Garal!e I Valuation DescriDtion I $ Per Sq Ft or multiplier $96.00 $25.00 CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-00145 ISSUED: 03/11/2005 APPLIED: 02/04/2005 EXPIRES: 09/11/2005 VALUE: $ 162,640.00 Square Footage or Bid Amount 1,590.00 400.00 Total Value of Project ~ Value Date Calculated $152,640.00 $10,000.00 $162,640.00 02/04/2005 02/04/2005 Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $500.76 2/4/05 1200500000000000156 -Mechanical Issuance Fee- $10.00 3/11/05 1200500000000000320 + 10% Administrative Fee $122.34 3/11/05 1200500000000000320 + 7% State Surcharge $85.64 3/11/05 1200500000000000320 2 Baths One or Two Family $254.00 3/11/05 1200500000000000320 Addressing Assignment $31.00 3/11/05 1200500000000000320 Appliance Vent $6.00 3/11/05 1200500000000000320 Building Permit $770.40 3/11/05 1200500000000000320 Curbcut Permit $80.00 3/11/05 1200500000000000320 Dryer Vent $6.00 3/11/05 1200500000000000320 Exhaust Hoods $9.00 3/11/05 1200500000000000320 Furnace - up to JOO,OOO btu $12.00 3/11/05 1200500000000000320 Gas Outlets 1-4 $4.00 3/11/05 1200500000000000320 Plan Review Major - Planning $103.00 3/11/05 1200500000000000320 PW Disc - 2nd Permit (Street) $-30.00 3/11/05 1200500000000000320 Residence Wiring 1000 Sq Ft $106.00 3/11/05 1200500000000000320 Residence Wiring Ea Addtl 500 $38.00 3/11/05 1200500000000000320 Sanitary Sewer - Improvement $383.88 3/11/05 1200500000000000320 Sanitary Sewer - Reimbursement $504.84 3/11/05 1200500000000000320 SDC MWMC Administration $10.00, 3/11/05 1200500000000000320 SDC MWMC Improvement $865.31 3/11/05 1200500000000000320 SDC MWMC Reimbursement $82.03 3/11/05 1200500000000000320 SDC Sanitary/Storm Admin $114.98 3/11/05 1200500000000000320 SDC Transpo Admin $64.60 3/11/05 1200500000000000320 SDC Transpo Improvement $772.49 3/11/05 1200500000000000320 SDC Transpo Reimbursement $175.13 3/11/05 1200500000000000320 Sidewalk Permit $80.00 3/11/05 1200500000000000320 Storm Drainage Impervious Area $797.94 3/11/05 1200500000000000320 Vent Fan $18.00 3/11/05 1200500000000000320 WiIlamalane Single Family $1,000.00 3/11/05 ~200500000000000320 Total Amount Paid $6,977.34 Pal!e 2 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00145 ISSUED: 03/11/2005 APPLIED: 02/04/2005 EXPIRES: 09111/2005 VALUE: $ 162,640.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Planninl! Review Public Works Review 02/07/2005 02/07/2005 02/07/2005 I Plan Reviews' 02/07/2005 APP 02/25/2005 APP 02/0712005 APP SKG TAJ CAS No hook-up to City Infrastructure until Public Improvements accepted by the City; Storm drainage piped t( curb face 2/7/2005 CAS Structural Review 02/0712005 03/0712005 APP JB To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~eouire<UnSDections , Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Erosion/Grading Inspection: After all erosion measures are in place. Vfer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulatiori: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Vnderfloor Plumbing: Prior to insulation or decking. Vnderfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Shower Pan. Prior to covering and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Vnderfloor Mechanical. Prior to insulation or decking and including required testing. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Pal!e 3 of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00145 ISSUED: 03/11/2005 APPLIED: 02/04/2005 EXPIRES: 09/11/2005 VALUE: $ 162,640.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all ~:6 dh~ Owner or Contractors Signature ~ / ' Pa2e 4 of 4 225 'Fifth Street, Spr~ngfield, Oregon 97477 541-726-3159 Phone r'ity of Springfield Official Receipt ~velopment Services Department Public Works Department RECEIPT #: 1200500000000000320 Date: 03/11/2005 3:03:42PM Job/Journal Number Description Amount Due COM2005-00 145 Addressing Assignment 31.00 COM2005-00145 Willamalane Single Family 1,000.00 COM2005-00145 Sidewalk Permit 80.00 COM2005-00 145 Curbcut Permit 80.00 COM2005-00 145 PW Disc - 2nd Permit (Street) (30.00) COM2005-00 145 Storm Drainage Impervious Area 797.94 COM2005-00 145 Sanitary Sewer - Reimbursement 504.84 COM2005-00 145 Sanitary Sewer - Improvement 383.88 COM2005-00145 SDC Transpo Reimbursement 175.13 COM2005-00 145 SDC Transpo Improvement 772.49 COM2005-00 145 SDC MWMC Reimbursement 82.03 COM2005-00 145 SDC MWMC Improvement 865.31 C8M2005-00 145 SDC MWMC Administration 10.00 COM2005-00 145 SDC Sanitary/Storm Admin 114.98 COM2005-00145 SDC Transpo Admin 64.60 GJM2005-00145 Plan Review Major - Planning 103.00 COM2005-00 145 Building Permit 770.40 COM2005-00 145 2 Baths One or Two Family 254.00 COM2005-00 145 Furnace - up to 100,000 btu 12.00 COM2005-00 145 Vent Fan 18.00 COM2005-00 145 Appliance Vent 6.00 COM2005-00 145 Exhaust Hoods 9.00 COM2005-00145 Dryer Vent 6.00 COM2005-00145 Gas Outlets 1-4 4.00 COM2005-00145 ~Mechanical Issuance Fee- 10.00 COM2005-00 145 Residence Wiring 1000 Sq Ft 106.00 COM2005-00 145 Residence Wiring Ea Addtl 500 38.00 COM2005-00145 + 7% State Surcharge 85.64 COM2005-00 145 + 10% Administrative Fee 122.34 "j Item Total: $6,476.58 Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Amount Paid Check HAYDEN ENT djb 15406 In Person $6,476.58 Payment Total: $6,476.58 3/11/2005 Page 1 of 1 ,/ , . CITY OF S{.fiNGFIELD SYSTEMS DEVELOPMENT C0M2005-00145 Hayden Homes.' ~075 Orchid Ln Jasper Meadows 2nd Lot III SINGLE F AMIL YRESIDENCE 1 BUILDING SIZE (Sf: iRKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: ' , TAX LOT NUMBER: DEVELOPMENT TYPE: ; NEW DWELLING UNITS l"I.l ~ Cl 10 , U'. ~. ~ l"I.l - o ~ " . 9661 LOT SIZE (SF): 1906 1. STORM DRAINAGE DIRECT RUNOFF TO CIlY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S,F. . CHARGE j 2574.00 ,I $0.310 J = I $797.94 RUNOFF ROUTED TODRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. . x ' COST PER S.F. ~ x DISCOUNT RATE 0.00 ' $0.310 I 50% , ITEM 1 TOTAL - STORM DRAINAGE SDC J $797.94 , ,. DISCOUNT $0.00 5797.94 1070 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: ~ NUMBER OF DFD's x 21 B. IMPROVEMENT COST: ) NUMBER OF DFD's x I . 21 1 COST PER DFU $24.04 = J 5504.84 1091 I 11092 = I $383.88 $18.28 = I 5888.72 ITEM 2 TOTAL- CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE l x I 9.57 B. IMPROVEMENT COST: ADT TRIP RATE x 9.57 x NEW TRIP FACTOR 1.00 = J COST PER TRIP $18.30 . " NUMBER OF UNITS x 1 5175.13 1093 x NEW TRIP FACTOR 1.00 = J COST PER TRIP $80.72 ' $947.62 NUMBER OF UNITS x 1 5772.49 1094 "I = I ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER- MWMC , A. REIMBURSEMENT COST: NUMBER OF FEU's x 1 ICOST PER FEU , $82.03 582.03 1054 = \ '! B. IMPROVEMENT COST: NUMBER OF FEU's . 1 x ICOST PER FEU I $865.31 = I 5865.31 1055 =1 SO.OO 11054 =1 ,510.00 1056 MWMC CREDIT IF APPLICABLE (SEE REVERSE) . MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC 5957.34 ~ ..... .... .._~ ...- ,.... ...-..--..-- --., 53,591.62 , =1 = J SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) 5. ADMINISTRATIVE FEE: I SUBTOTAL x I ADM. FEE RATE I $3,591.62 I 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: CHARGE $179.58 Ip079 1078 114.98 $64.60 ...-- ...-- -., -. = , , $3,771.20 TOTAL SDC CHARGES 3/11/2005 Cheryl Slaymaker PREPARED BY DATE ,. ~....- ...-'. .-... --. DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NvMBER OF NEW FIXTURES x UNIT EQUN ALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TilE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS ~----.. . . '" BATHTUB 2 0 3 -. 6 DRINKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE I OIL / SOLIDS / ETC. 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER / MOP SINK 1 0 3 = 3 jCLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK /DISHW ASHER / ETC. 0 0 3 = 0 SHOWER, SINGLE STALL 0 0 2 = 0 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3 SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 SINK: SINGLE LAVATORY/RESIDENTIALBAR 1 0 1 = 1 URINAL, STALL / WALL 0 0 5 = 0 rOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDD'S 20 = 0 :TOTAL DRAINAGE FIXTURE UNITS 21 ;EDU (Equivalent Dwellin~ Unit) is a disc~ equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day - - MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE !' YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985, 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$ 1 ,000 ASSESSED VALUE .<~l::~d .. :' .: -; '$1.25. $1.09 ., $0.92 $0.72 :,. $0.48 .$0.28.. $0.09 : $0.05' . IS LAND ELGmLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGmLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT $0.00 = . . () o ' "' 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-368~"'~ " . ELEcl1:<.lCAL P~RMIT APPLICATION ':~ <Q~~0:~e,C'~': City Job ~umber \' S. \L\S Date '1>-'" "'-s o..!f0 v' ,0 "~'>"." '" "'1< ,~>~ -~"'.~;<")' "'in ,--; r, -" :~:'1.- ~- ,'~ ~ ~ ' -. ~Q;;. o'.'~~, "; <'~ 1. l~~CiA}'I~~,~g!,{~[1:L~'!?9~_ "s_,.^,," -~. J'" 3.;. ~91lftI:~:!~'~711~Jf!iE!?V .. .~_ \J2\)\\ S \.\.1( ~~~ . \~Q l> . ~ .. ' . _'..""."'..,.. .'.., """""-',,, ..~",.. .'.~'.. "'.~~.'.'., .'.. .' ",v""'.',,'" ,."'''',.,''';'; ";.......'" ,.."'.,',+ ".;., - ,.,'.; ,;..,..';. ;,., LE,GAL DESC~TION . J\ A. }',~~l~l~~~l~~~rs;~~~~~~~~-~~JP~~X:~~e:~,c~~~,~!!!~~.~~~i~tLlj': \\ ~ <<_d\.~ \ <J{'(\OC)L Service Included ,l /' ,:,c 0 JOB DESCRIPTION ~ l q<;o 1000 sq. ft. or less S .,..>"" \ $106.00 ,lDlo~ ~ -t\f\l t ) - D - ^ Each additional 500 sq:'ft. or" CIJ - ~":~:~n:~f' ~ ..ndoxpir, ,'--01 J :::~o:::::'dHom'or t- $19.00 3~. not started within 180 da Modular Dwelling Service or Suspended for 180 days. Feeder ir;Oiv[Ji;tC'!'Pl{ IN$;t4LtAtIONPNLY',:.: B. ... Services ot:Feeders:.,.cInstalIatiori;Altenitions or Reloc<ltion:' . 2. ';;;.i.~,,;'...;..~<;;;..i.~~ti'd&,:;:',;"~;....>;~1&Yd.;;'':''':''''''I,';~;_:_::::,;~v-l<~~...:;,..,L:-\".01di;" ,.:~:..;,.;.'~;l:')L~',:"'::,,;,,_ '",;,,-:'.:.J-.V ~:~:,..: ;;;_l~.~-;~'L ';~~,ili~""" '-~.~; ........_~.:~~,L~. ~,.. _.:_~;':'i:<l, ':_..;; .);:rJ.>;~.:, .,;;.."'" -~:,.~,,-.t" '-:":':. .-'--;;:'~-,~;,:,~ ;,:'" ~ "~- ". .'~ $50.00 Elk,l K~ 200 Amps or 16ss 201 Amps to 400 Amps 401 Amps to 600 Amps " " , 601 Amps to 1000 Amps Phone 9)~ 'W~-t ~r;9c~)Ve;IijJ9gBtr1~sNolts , ; 0, .,.' .' -~J;2~Reaqn~et,Ohr~' ycu to 11.'c.~]n 0~-~', 7 iTC-TJ,sg .1 , ....... ~ -...i >.JJ I' J r, . I IIll}j.\Fi .:' '?.., . ~. , Supervisor License Number 3D I ;e()~~,f'\"~I~'~-"'~~" ~~?~, , -> , / Ccdling .ihe cen (o./n COPies qf the I ;/0<'. . Expiration Date 10/1- 0 to nUmber fm ~'hQ ter. O\tm~IIM~<m1tJtek'atIWOr Relocahon ~" Ore'oo~(*r ' IJpnone . ' , Center is 1_8"'0 ' t&iwNreftfflc~tion Constr. Contr. Number 1/ h 3.~ / Ozep~.Ii9.400 Amps 401 Amps to 600 Amps , Over 600 Signature of Supervising Electrician D. .n1 ,~~ New Alteration or Extension Per Panel 4/L"A-~ ~~~ One Circuit ~ ? -LJ~~~V r , Each Additional Circuit or with " ^ '" )..... ~ rI fA ,.:; Service or Feeder Permit $ 3.00 Owners ~~ (A \LA \. . q u~ 1\ W-....J ',' ,i C:. "1 Address V U-~~'V\ AA ~ - (~'l;I'/' ,,~_~';~-~~~~~;~~~~~~r:ii~/~~~fle:-!~~!N~~~~~e,d)-E~~~\nsi~~_a~?n ~ J~ _ I r 'I L 1 I ,- 'I I ( ~ hone 2..'2B. l('f)\' . :~cPA~p~d~~~mIIJ2~,~ti6Ii\IGJ~,r:_~ ~r.!L~ ,',C,_. .../. I ' Sign/Outline . ighting Limited Energy/Residential Limited Energy/Commercial Electrical Contractor ~R4 J1(J .^ J Address;:: 0 6&ir wL/ i) City EZer $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 t2f Expiration Date ((/-1_ !) f. $ 43.00 City $ 50.00 $ 50.00 $ 25.00 $ 45.00 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: 4. SUBTOTALOFABOt1E: -,),''",',-,::.-#,- \44 .cO 'l().O~ l4-.4-0 \ l()~ 18 'v_ ,<',:~ ""',,,v:,""-"C;: ,. 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Fonns/Electrical Pennit Application J -03 ,doc