HomeMy WebLinkAboutPermit Building 2004-1-6 (2)
-.
..
Status
Issued
225 Fiflh Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa,
541-726-3769 Inspection Line
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01238
ISSUED: 01106/2004
APPLIED: 12111/2003
EXPIRES: 07/06/2004
VALUE: $ 139,809.00
SITE ADDRESS: 4042 Douglas Dr
,\SSESSOR'S :'.\RCEL NO.: 1802061111600
PROJECT DESCRIPTION: SFR
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE:
New
Residential
Owner: BRUCE WIECHERT
Address: 3375 PARK HILLS EUGENE OR 97405
I CONTRACTOR INFORMATION I
Contractor License
BRUCE WIECHERT CUSTOM HOMES INC 101717
L & E ELECTRIC INC 105475
COMFORT FLOW 460
STEVE R JOHNSON 65065
BUILDING INFORMATION I
Sidewalk Type:
Fullv Improved Curhside 5'
Yes NOTICE: DownspoutslDrains: Curb and Gutter
NO SEWER HOOK-UP OR Q~m;,!m.Vlllf~I\..~e I~~T PLANS ARE
ACCEPTED BY PUBLIC W9,wmoRIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Contractor Type
GCIlt'r:d
EIL'l'lril':I1
i\lt'(.'hallkal
Phlll1hing
If- ut"Unils:
Prilll:Jr~' Ol'l't'llancy Group:
~;l'r' 'ldary C' i1!l:lI1CY Group:
Prirll:lr~' Cun...:ruclion Type
Sl'l"ollthry CO!1'itruction Type:
# of Ikdrnull1s:
SETBACKS
Fr(lI1I~'anl S~:lhack:
Silk 1 ~~i.'lh:lrl,:
~idl' 2 ~;elh:l ~:
18.00
13.60
5.00
19,60
15.00
I~l':'ry~~nl Sl"'''lck:
SoLI:" S ':h:IC', :
Stn'dlll1pnl\"'llH.-'nfs:
SllJrlll Sew('r :\vailable:
Spl'l';al III~L ' ,;011:
t':olt's:
~.
Phone Number: 541-686-9458
Expiration Date
09/16/2006
03/30/2004
06/27/2005
03/12/2004
Phone
541-686-9458
541-933-2653
541-726-0100
541-342-3765
1
R-3
U-l
VN
# of Stories: 1 Lot Size:
Height of Structure 18.00 Sq Ft 1st Floor:
Type of Heat: Forced Air Gas Sq Ft 2nd Floor:
Water Type: Gas Sq Ft Basement:
Ra~~~J.~.\:i'Oregon law&Wq:ntees YSlf. f:it ~arage/Carport
A-mi'cl!W Mil: d b th~on Sliliii~ther:
fO~I~~~~I~,:-~~::.eTh~e rules are _~~iOUS Surface Area:
I DEvIDi1li:~""lJN"ORMl'Tf(l~.......it~~-;~.s \
, I... "' tfJ:I/I' , \ "lit>
0090. YOu:a~nt~O;'(N~te: the telepho~e REQUIRED PARKING
~tuat " r~ on Utility NotificatIon Total: 2
n#JSl~f ~~~!t;.@i .~nn_~32.2344)2 Handicapped:
Paved IJr,ve'ti.qil: Y Compact:
es
32.00
5,850
1,426
446
3
% of Lot Coverage:
I PUBLIC IMPROVEMENTS'
Pal!e 1 of4
-~. PRING.FIl!L.~_ I..
'!~-,:'
"ll. '" ~ aI!; '.
.,.. ...
--.., + .,. ~ - ."
Status
::;:.;ued
225 Fifl h Strwt, Springfield, OR
541-726-375:1 Phone
541- 726-3676 Fax
. 54 t -7 2G-l illt) Inspection Line
I)l'srrillliftll
Tvpe of Construction
I)wdlil1~s
V Wood Frame
Garaee
Gara!.!l'
.
. U1:t' OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01238
ISSUED: 01106/2004
APPLIED: 12/1112003
EXPIRES: 07/06/2004
VALUE: $ 139,809.00
I Valuation Descrintion I
$ Per Sq Ft
or multiplier
$90.60
$23.80
Square Footage
or Bid Amount
1,426.00
446.00
Value
Date Calculated
Total Value of Project
$129,195.60
$10,614.80
$139,810.40
12/1112003
12/1112003
~
Fl'l'lkscripliuJI Amount Paid Date Paid Reeeipt Number
Plan Rc\'il.:\\ H,csidl'ntial $452.17 12/11103 1200200000000002582
.....:\Il'('h:lIlkal hSu3lH.'e Fee- $10.00 1/6/04 1200400000000000011
+ 10'X, "\dm:l~istrative Fee $121.37 1/6/04 1200400000000000011
+ 7'~;, St:ll~ SIII"charge $84.96 1/6/04 1200400000000000011
:2 Balhs (Jill: or Two Family $254.00 1/6/04 1200400000000000011
:\ddn";sill~', hsignnll'nt $8.00 1/6/04 1200400000000000011
Ap!'lialll'c \' "l~ $6.00 1/6/04 1200400000000000011
Building PlTlllit $695.65 1/6/04 1200400000000000011
Cl:rbcllt - C\l'rwidth Appl $35.00 1/6/04 1200400000000000011
ClIrlll'lIt p "!' .-:t $75.00 1/6/04 1200400000000000011
I.;'~'l'r VCIlI $6.00 1/6/04 1200400000000000011
E\'hallsl Ifnt .1,\ $9.00 1/6/04 1200400000000000011
Fllrll,Il"l' - 1 '0100,000 htu $12.00 1/6/04 1200400000000000011
Cas Fi 'l:pla~'t' $15.00 1/6/04 1200400000000000011
C:l-;Oulll'l': J-.t $4.00 1/6/04 1200400000000000011
Plan I{c\,j/", - Planning $59.00 1/6/04 1200400000000000011
I'\V .\1'111 " . " - 2nd l}ermit $-30.00 1/6/04 1200400000000000011
){esitlt'llCl' , iug 1000 Sq Ft $106.00 1/6/04 1200400000000000011
Ht'sidl'lIn" "' 'ing Ea AddtlSOO $38.00 1/6/04 1200400000000000011
S:wil<l:'Y ~; .,' - Improvement $344.20 1/6/04 1200400000000000011
~':'llit;lry Sl" "I' - Reimbursement $452.80 1/6/04 1200400000000000011
SDC :\1\\'" . .\dministration $10.00 1/6/04 1200400000000000011
snc .\:\\'.'.. - Improvement $214.23 1/6/04 1200400000000000011
snc .\:\1'". l{cil11hursement $314.63 1/6/04 1200400000000000011
SDC S'lIlit ''-'torm Admin $101.92 1/6/04 1200400000000000011
~.:C Tr:\I"j: \dlllin $53.94 1/6/04 1200400000000000011
SDC Trail... Improvement $727.42 1/6/04 1200400000000000011
SDe Tnlll"i:1, {{ciJllhursement $164.89 1/6/04 . 1200400000000000011
Sidewalk I' ;it $75.00 1/6/04 1200400000000000011
Storm Dr:" , ',C Impervious Area $889.00 1/6/04 1200400000000000011
Tl'!lIp !'unl'l' :10 amps or less $50.00 1/6/04 1200400000000000011
Vl'1I1 F'll! $18.00 1/6/04 1200400000000000011
\\'ill:lll :':,I'i" "illgle 17amily $1,000.00 1/6/04 1200400000000000011
., . I Amount Paid $6,377.18
Paee 2 of 4
_SPRI"lGFI> , o~~
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Status
'. sued
22, Fiflh Slreet. Springfield, OR
541-726<'1.- rhnnc
5-11-72(1<HI7 "ax
5.11-716<\7, Ilspcction Line
IlIilialltl'\'i.\\
Pll:lIllIill!! I'~ " i~w
Ful;lil: ',\,u' . !{c"icw
Stru('lllnll ""\'j(.w
To Rl"IU\'
,,:11 Ill' ,1.
dav.
.
. CITY OF ~rKlj~lJt<lJ<..L1J
Building/Combination Permit
PERMIT NO: COM2003-01238
ISSUED: 01/06/2004
APPLIED: 12/11/2003
EXPIRES: 07/06/2004
VALUE: $ 139,809.00
Plan Reviews I
12/12/2003 12/12/2003 APP RJB
12/12/2003 12/31/2003 APP TAJ
12/12/2003 12/26/2003 APP VRJ NO SEWER HOOK-UP OR
OCCUPANCY UNTIL PUBLIC
IMPROVEMENT PLANS ARE
ACCEPTED BY PUBLIC WORKS.
Applicant has applied for overwidth
driveway, application in review by
PW transportation, 12/26/2003.
12/12/2003 12/29/2003 APP TCM
'n inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
the same working day, inspections requested after 7:00 a.m. will be made the following work
I I?r~n<nprtjn~
1)r.".. rJ"drical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or.
fOIlP ion inspection.
2 Fill: . Afh'r trenches are excavated.
J FlItll.. :UII: After forms are erected but prior to concrete placement.
-l P. .,. :;calll: Prior to floor insulation or decking.
::; 1:0 .'Ialion: Prior to decking.
6 Shl';' all Nailing: Before covering sheathing with finish materials.
7 Fra" '1~ Inspcclion: Prior to cover and after all rough in inspections have been approved.
X \Val:' 1~II!:1ti(ln: Prior to cover.
9 Cl'ili'l'! Insulation: Prior to cover.
1 fI !)r~.\" 'I: Priur to taping.
11 ri,t;. ';Idln~: After all required inspeclions have been requested and approved and the building is complete.
12 l:I\"' ; n- Plumbing: Prior to insulation or decking.
J:1 l 'u ,., r D ra in: Prior to cover or placement of concrete.
J-I Ro!'" "ltnhing: Prior to cover and including required testing.
l' \\'. '.'l': Prior to filling trench and including required testing.
16 S" Sl'Wer Line: Prior to filling trench and including required testing.
17 :--:1411 ~.'\cr Line: Prior to filling trench.
1 N F:II:: t'llIhing: When all plumbing work is complete.
II) U lid, Ill" i\ ICl'hanical. Prior to insulation or decking and including required testing.
"" I{uu' 'a" Aftcr line is installed and required testing and eapped ifnot attached to an appliance.
21 ( ;"s S . ,T: ;\ ftcr line is installed and line has heen connected to a minimum of one appliance including required
I ':<i Ii' , l'S II rc test done at this point.
22 I{lll< 'vdwllical: Prior to Cover
D Fiu,,: When all gas work is complete.
"4 Fi. haul""I: When all mechanical work is complete.
2, T" ). FII'dric: Approval required prior to Utility Company energizing pole.
26 1<1":' .:l'l'lrit': Prior to Cover
27 r, (' ',':rvlcc: Approval required prior to utility company energizing service.
2X 1 Ii, rir: When all electrical work is complete.
Paee 3 of 4
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.
. CITY OF SPRINGFIELD.
Building/Combination Permit
_SPRINOPI1. 'I
",';r-
Slatlls
lied
PERMIT NO: COM2003-01238
ISSUED: 01106/2004
APPLIED: 12/11/2003
EXPIRES: 07/06/2004
VALUE: $ 139,809.00
2~5 Fifth SII
541-72(,-37:
5..tl-72(i-:1(I~
S.11-7~(I-.r"
t. Springfield, OR
. IJOIIC
.X
''illertion Line
I:~. ,i~llatll'.'. .t.'te "lid agree, that I have carefully examined the completed application and do hereby certify that all
j"r"rlll'>li, :In is true and correct, and I further certify that any and all work performed shall be done in accordance with
tli" Ordilla, Ir tlie City of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and
that i\0 O( ,',\i\CV will be made of any structure without permission of the Community Services Division, Building Safety.
I rurtli"r n I' ':"It IIuly contractors and employees who are in compliance with ORS 701.005 will he used on this project..
I rurthn;l. II "uslIre that all required inspections are requested at the proper time, tbat each address is readable from the
stn'l't, th,,: "rmit card is located at the of the pro rand-the'approved set of plans will remain on the site at all
"'""{j Jt"" I - Co, - 0 '-f "&
0" 1It'!" Hf (
'..l'"tor~ Signature
Date
Paee 4 of 4
225 Fifth Street '
Springfield, Oregon 97477
541-726-3759 Phone
Job/.luurllal j\'umber
COM2003-0 1238
COM2003-01238
COM2003-0 1238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-0 1238
COM2003-01238
COM2003-01238
COM2003-0 1238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-0 1238
COM2003-0 1238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
COM2003-01238
Payments:
Type of Payment
CreditCard
sr;lINOFlm..O
_.~
-.:::-~.'1t
Heeuipt #: 12IJU41J1JIHIIJUIJIJlHHHlII
UC~l'ripliun
Addressing Assignment
Willamalane Single Family
Temp Power 200 amps or less
Sidewalk Permit
Curbcut Permit
Curbcut - Overwidth Appl
PW Mult Disc - 2nd Permit
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transpo Admin
SDC MWMC Reimbursement
Building Permit
2 Baths One or Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Appliance Vent
Dryer Vent
Gas Outlets 1-4
Gas Fireplace
-Mechanical Issuance Fee-
Plan Review - Planning
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
djb
Check Number
Batch Number Authorization Number
Paid By
BRUCE WIECHERT CUSTOM
000268 080539
City of Springfield Official Receipt'.
Deyelopment Services DepartmeJit
]'ubJic 'Yorks Department
Oatc: UI/U6/2UU4
10:34:57 At\1
Amount Paid
Item Total:
8.00
1,000.00
50.00
75.00
75.00
35.00
(30.00)
889.00
452.80
344.20
164.89
727.42
214.23
10.00
101.92
53.94
314.63
695.65
254.00
12.00
18.00
9.00
6.00
6.00
4.00
15.00
10.00
59.00
106.00
38.00
84.96
121.37
$5,925.01
.
.
How Received
In Person
Payment Total:
Amount Paid
$5,925.01
$5,925.01
CITY OF S!NGFIELD SYSTEMS DEVELOPMEN_ORKSHEET
JOURNAL OR JOB NUMBER: Corn2003-01238
NAME OR COMPANY: Custom Homes
LOCATION: 4042 Douglas Drive
TAX LOT NUMBER: 1802061 I tll 1600
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF: 1872 LOT SIZE (SF):
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I
3065.50 $0.290 I = I $889.00
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I DISCOUNT
0.00 I $0.290 I I 50% = I $0.00
ITEM I TOTAL - STORM DRAINAGE SDC $889.00
2. SANITARY SEWER - crr'(
5850
r/J
~
o
o
u
~
~
r/J
~
Cj
~
$889.00
11070
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU
20 I $22.64 $452.80 1091
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU
20 I $17.21 $344.20 1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $797.00
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIP FACTORI
9.57 I 1 I I $17.23 I 1.00 I $164.89 11093
B. IMPROVEMENT COST:
I ADTTRIPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIP FACTORI
I 9.57 I 1 I I $76.01 I 1.00 $727.42 1094
ITEM 3 TOTAL - TRANSPORTATION SDC = I $892.31
,
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER ~F FEU's I x ICOST PER FEU
I $314.63 = $314.63 . 1054
B. IMPROVEMENT COST:
INUMBER ~F FEU's I x ICOST PER FEU
$214.23 = $214.23 I 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 I 1054
MWMC ADMINISTRATIVE FEE $10.00 I 1056
ITEM 4 TOTAL - MWMC SANITARY SEWER SDl = , $538.86 I
SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ , $3,117.17 J
~. A[)MINISTI{ATIVE FEE: I
ISUBTOTAL I x I ADM. FEE RATE r I CHARGE
I $3.117.17 I 5% $155.86
TOTAL SANITARY ADMINISTRATION FEE: 101.92 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: $53.94 1078
Virginia Jurasevich 12/26/2003 TOTAL SDC CHARGES = $3,273.03 l
PREPARED BY DATE
. .
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FlXTURE UNITS
(NOTE' FOR REMODELS. CALCULATE ONL V THE NET ADDITIONAL RXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 1 0 3 = 3
DRINKING FOUNTAIN 0 0 1 = 0
FLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
LAUNDRY TUB 0 0 2 = 0
CLOTHESW ASHER / MOP SINK 1 0 3 = 3
CLOTHESW ASHER - 3 OR MORE (EA). 0 0 6 = 0
MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
SHOWER, SINGLE STALL 1 0 2 = 2
SHOWER. GANG Q'lUMBER OF HEADS!. 0 0 2 = 0
SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3
IS INK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2
ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1
I URINAL. STALL! WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 20
.EDU (Eauivalent Dwellin~ Unit) !!.! discttarae eauivalent to a single family dwellin~ unit (20 DFU's) set al 167 ~lIons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
L YEAR CREDIT RA TE/$I,OOO 'j I
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 0
I BEFORE 1979 $5.04 (Enter I for Yes, 2 for No) ,I
I 1979 $5.04 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 0
I 1980 $4.95 (Enter I for Yes, 2 for No)
I 1981 $4.88 BASE YEAR 1979
I 1982 $4.75
I 1983 $4.58 CREDIT FOR LAND (IF APPLICABLE)
I 1984 $4.41 VALUE /1000 CREDIT RATE
I 1985 $4.20 $0.00 x $5.04 ~ I $0.00
I 1986 $3.88
I 1987 $3.50 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
I 1988 $3.07 VALUE/1000 CREDIT RATE
I 1989 $2.60 $0.00 x $5.04 0
I 1990 $2.14
I 1991 $1.11
I 1992 $1.52 TOTAL MWMC CREDIT = $0.00
I 1993 $1.38
I 1994 $1.19
I 1995 $1.03
I 1996 $0.87
I 1997 $0.68
I 1998 $0.46
I 1999 $0.27
I 2000 $0.09
II 2001 $0.04 I
.
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-368:",,~:~~~Q~
ELECl'RlCAL PERMIT APPliCATION .O,00~o' ,0 V
City Job Number LojA1 z-OO) - 0 I 2.-3 E' Date ,;.\""~00'
,,\\0 (;\0
\0 ~
..,._" '-v.;: ./-.---.., ':'-'-''W!.; "."~~'"
, . , 8,',(')l:1' i<i'
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CITY OF S: ,1NGFffiLD, OREGON ,':,
200 Amps or less $ 63,00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
O~er 1000 AmpsNol~oU \~\'j $375.00
Reconnect ~\)\leS {\ U\\\\ l\ $ 50.00
Ia.'l'l ~ eQ,o iI. \0
'I/7Lf-S ~~~~~e11f~~~
~~ 1,0 &009 ~~os ~~ ~e II) e
p..~..... lu\0S e~~~OA1~JI1lo1ll'0~a~l'n
\OI~~\~&\\O~'2.~~~&rq;. \~e ~O\\~\c3\\o I $ 50.00 5"'0
~0~f'.~95 ~~IO~~~!f~S,-"b.b.'\. $69.00
, 90.-iOU \~do:t<l~~~P~' $100.00
~O ~,,{\9 \~e. \lo(\
.:.~ el \<ll5vtr_600 Kmps or 1000 Volts see "B" above.
~'O lil'i"1!(ij,"i:j,''''''-'~~~_
{\\) OC~~e~~
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
n ," W' . \L 1. C ,__ 1.1-.. Service or Feeder Permit
Owners Name' ..., '(oJ <-<::..- \ e C/V ~ v T vS7V"" ITUY" ~
'3 . 1.fi\\'r;~~~~~i=.'~'lll-~-'li!!!ft\';til"'\lr"'''!'SI
Address '?, '7 S- P '^" IL 1+; \\~ E. ~~_~.......~~! 'r(w~l!!~"...e,.'!l!!rl!~
City Evr.pnp. Phone bg{'-9Lff'~ PumporirrigatiXt.'j...?\\\~~\\\tI\\ \~~ $50.00
.J ~\)1~~~~~h't\\'2l\DC)~t.1J t\)I' $ 50.00
OWNER INSTALLATION \'t\\~~e,;~t~~ $ 25.00
The installation is being made on ,.._,._../ I own which Jl>1j~~~ercial $ 45.00
is not intended for sale, lease or rent MiQi~I'h~'~~~:":;~nspection Fee is $45.00 + Surcharges
,~\~.)
4. tsm~iti'~i~ I 7/..{
7% State Surcharge . I 3. ::>'8
10% Administrative Fee I 9' I{ 0
'Z 'Z b~
1. 0.:006;4\-. 'OMeEjJNj-:-;A'i:r;Wii1lQ~~
1 ~-""" ,'El' .~"', ..,~,.,.."..~jiijj"" '
701../2 \)0I.)J\0-.5 ~v
LEGAL DESCRIPTION
I f5 o?..o ~ {j
1/ boo
JOB DESCRIPTION
>rCL.
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.
Electrical Contractor
lie EI.pI'Jrrc...
J(Jf}f.J Auo eeL
Address f;J95.~
City 'So ~I d
Phone <133 -JS9E3
Supervisor License Number
Expiration Date
IO-()I ~OLf.
Expiration Date
1054 '7S
:5 - iLl -olf
Constr. Contr. Number
Sign~/uP71:ol .
Owners Signature:
Inspeetlon Request: 726-3769
3.
A. 1i\N~.IR'"ilitfttir.i=rSi'~ i~ 011
~. ~b"""'"'''' 'l
Service Included
I tJ:?
3.8
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
I
L
$ 19.00
$106.00
Each Manufac!' d Home or
Modular Dwelling Service or
Feeder
B.ILW.#~d!P$i'a1. "rr;~. ..., ,~J&'g.
--;: - !);fJ,li. - j!:Q-:..iJl i...il' ' ",', 'A}" ,
$50.00
$ 43.00
$ 3.00
TOTAL
Shared Drive(T:)IBuilding FormslElectrica1 Permit Am>Ucatioo 1-D3.doc