HomeMy WebLinkAboutPermit Building 2002-6-27
,-
. C'
,.~-
225 Fifth Street
Springfield, OR 97477
Job# 02-00695-01
Page 1 of 5
TRANS#:Ol-0009764
DA TE ; ,JUN 27 2002
AMT RECD:2 $ 5462,56
CHANGE:
CASHIER:061
CITY OF SPRINGFIELD, OREGON
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Job Number: 02-00695-01
Office: 726-3759
Inspection Line: 726-3769
Location Of Proposed Site: 6747 Aaron Ln Spr
Assessors Map#: 17023411
Lot: 100 Block: Addition: 2nd
Owner:
Address:
Bruce Wiechert Custom Homes Inc
3375 Park Hills Dr
Scope Of Work: Single Family Residence
Contractor Type
General Contr
Electrical Contr
Mechanical Contr
SFR
Contractor
Bruce Wiechert Custom Homes Inc
3375 Park Hills Dr, Eugene, OR
97405-5515
Stoppani Electric
987 Fayette, Eugene, OR 97402
Comfort Flow Heating Co
1951 Don Street, Springfield, OR 97477
Steves Plumbing
PO Box 70553, Eugene, OR 97401
Tax Lot #: 13400
Subdivision: Levi Landing
Phone Number: 541-686-9458 . ~ .
City/State/Zip: Eugene, ORl~.~15
New va~~~~~87
" '--.1.~~~ ""~~ ~ ~t:S
v: ~ ~ ~~
,) ~ iC.~ \.(\<:S
~Y"- ~. ~~
~~t~~~~~ration Date
...(:)~~~() ~ ~~~~2002 541-686-9458
~~~'\~~~~~~ ~ q,-
~ ~~v ~ ~ ",~"
2~~ ,f6' 6/10/2003
Phone
541-688-8720
00460
6/27/2003
541-726-0100
, ~'"'
65065 . as "1<3/1'2/2004
ao.',)'~ \y\,\\"\~
<,'.n aN~ t_ ()ta~O~ ",-Po\ ,ot\~
~ ,,-\'v\V'::1 A 'O'l \1'- ~aS ~\V ':'Z-uv.
Off~ce,'UseAo\i'~ - sa tU Ol\~ 9";) - 'e'l
"i\t:. .,. s au ::\'(\0 ;n r tu\e;:l
Quad Area: 4RNE Land-U,sei tu\8 Sililgle~Fa81i1~c[!)~ell19gX\e ~,\Q,fEBuildings: 1
~O\ V" -,,,\\ v"'" '00'\ ,. 'f;)\e'O \e\e?,\" '^(\
# Of Units: 1 Zon~8~~!)'de~'2..~.9J~' 1\)\-a.\fI CO te..\'(\e o\\~.9.ci:lpancy Group: Dwelling
Constr. Type: (VN) Wood Frame Bedr~o!ps'?~0\,)2:<,a"1 O\\\et_ \~O u\\\\\"1 ~AA~eat Source: Forced Air Electric
Water Heater: Gas Rang~:090.. I'\<:?asce Ote~Ofl ~?-.?.?.:?> Sq. Footage: 1635
v _\\\(\YJ ,.~ne ....nfl..
v"'" t'u'. 'C,-'"
To request an inspection call the 24 hour recording{at'o/~~-3.t69~e~i1 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.
Plumbing Contr
Site
Verify Ground Rod
Footing
Foundation
Post and Beam
Floor Insulation
Ceiling Insulation
Shear Wall Nailing
541-342-3765
Required Inspections
I Buildin~ I
- To be made after excavation but prior to setting forms.
-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.
Framing
Wall Insulation
Drywall
Hold Downs Installed
Vapor Barrierllnsulation
Final Building
Temporary Power
Rough Electrical
Electrical Service
Final Electrical
Underfloor Plumbing
Underfloor Drain
Rough Plumbing
Shower Pan
Water Line
Sanitary Sewer Line
Storm Sewer Line
Perimeter Foundation
Drains
Final Plumbing
Underfloor Mechanical
Rough Gas
Rough Mechanical
Gas Service
Final Gas
Final Mechanical
SW-Curbside
CC-Standard
I Job# 02-00695-01 I
Required Inspections
Building
- Prior to cover.
- Prior to Cover
-Prior to taping.
Page 2 of 5
- To be made after insulation and required vapor barriers are in place, but prior to any wall coverir
-When all required inspections have been approved and the building is complete,
I Electrical I
-Approval required prior to SUB energizing pole.
- Prior to cover.
- Must be approved to obtain permanent power.
- When all electrical work is complete.
I 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.
-After gravel and filter cloth is installed, but prior to backfill.
-When all plumbing work is complete.
I Mechanical
-Prior to insulation or decking.
-After line is installed and capped if not attached to an appliance.
- Prior to cover.
-After line is installed and line has been connected to a minimum of one appliance. Pressure tes
-When all gas work is complete.
- When all mechanical work is complete.
I Public Works I
-After forms are erected but prior to placement of concrete
-After forms are erected but prior to placement of concrete
Street Improvement: Fully Improved
Curb Cut?~ Improvement Agr.?D
San Sewer Depth (Ft): 6 4
Storm Sewer Available? D
Special Req.:
Security Required:
Bond Begin DateTime: 00/00/0000 00:00:00 .
Special Instructions:
Other Utilities:
Project Supervisor:
Sidewalk Type:
Additional ROW?
Size Of Line (in):
Downspouts/Drains:
Enchroachment Permit:
San Sewer Tee (in):
Bond End DateTime:
Curbside - 5'
D
8
To Curb and Gutter
6
00/00/0000 00:00:00 '
Types Of Warning Devices Reqd.
I Job# 02-00695-01 I
Overlay District: Floodplain Overlay
# of Street Trees: 3
. Zoning: LDR
FloodPlain? ~ Wetlands? D
Journal numbers
1: 1997-06-0142 2: 2002-06-0177 3:
Comments:City Eng. Determined Floodplain - FEMA Elevation Cert. required
Page 3 of 5
land Use: Single Family Dwelling
Pave Driveway? ~
Additional Requirements: Development Review Required
Glenwood Area? D Required Attachments:
Source locn:
Material:
Planner:
Urban Growth Boundary? D
Quantity Of Fill:
Supplier:
Drainage:
Floodway FEMA: See Above
Construction Types:(VN) Wood Frame
Occupancy Groups: Dwelling
# Of Buildings: 1
# Of Bedrooms: 2
Handicap Access? D
-Area (Sq. Feet)
Main: 1635 Accessory:460
Fee
Residential Plan Check
Total Plan Check
Building Permit
State Surcharge For Building Permit
8% Building Administrative Fee
Total Building
Minimum Electrical Permit Fee
Wiring Footage 1,000 Sq Ft or Less
Wiring Footage Each Add'l 500 Sq Ft
Temporary: 200 Amps or Less
State Surcharge - Electrical
8% Admin Fee - Electrical
Total Electrical
Minimum Plumbing Permit Fee
Two Bathrooms
State Surcharge - Plumbing
8% Administrative Fee - Plumbing
Total Plumbing
Hood and Exhaust
One to Four Outlets
Minimum Mechanical Permit
8% Administrative Fee - Mechanical
Less than 100,000 BTU
Vent Fan to One Duct
Flood Plain FEMA:
Private Garage/Carp/Stor
# Of Stories: 1 Height (feet): 23
Current Units: Proposed Units:1
Census Code: New SF - detached
Total:2095
Paid On Receipt#
Plan Check
06/12/2002 9541
Buildin~
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
Electrical
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
Plumbing
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
Mechanical
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
Value/Quantity
Fee Amount
130,987
$433.16
$433.16
130,987
$666.40
$46,65
$53.31
$766.36
1
3
1
$.00
$106.00
$57.00
$50.00
$14.91
$17.04
$244.95
$.00
$254.00
$17.78
$20.32
$292.10
1
1
$9.00
$4,00
$.00
$4.64
$12.00
$18.00
1
3
Job# 02-00695-01
Page 4 of 5
Value/Quantity Fee Amount
Fee
Paid On Receipt#
Mechanical
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
Gas Fireplace
Dryer Vent
Mechanical Issuance
State Surcharge - Mechanical
Total Mechanical
New Sidewalk
New Curbcut
Multiple Permit Discount - 2nd Permit
Total Public Works
Public Works
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
96
1
1
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
System Development
06/27/2002 9764
06/27/2002' 9764
06/27/2002 9164
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
06/27/2002 9764
1
1
1
20
20
2,606
: 1
1
S.F. Residence - Wi llama lane
Total Willamalane SDC
Willamalane SDC
06/27/2002 9764
1
Planning Plan Review
Total Planning
Planning
06/27/2002 9764
1
Address Assignment
Total Permits w/o Srchg
Grand Total
Plan Check Type
Permits w/o Srchg
06/27/2002 9764
1
Checked By
Date Completed
,.
Comment
Initial Review-Res
Lisa Hopper
Denny Wright
Liz Miller
06/13/2002
06/19/2002
06/18/2002
Engineering-Res
Planning-Res
Needs to pick up LDAP
Structural-Res Bob Barnhart 06/21/2002 Needs to sign disclaimer
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.
$9.00
$6.00
$10.00
$4.06
$76.70
$75.42
$75.00
$-30.00
$120.42
$711.44
$34.83
$10.00
$132.81
$332.86
$659.76
$155.13
$427.40
$324,80
$2,789.03
$1,000,00
$1,000.00
$55.00
$55.00
$8.00
$8.00
$5,785.72
Signature
7
I Job# 02-00695-01 I
Page 5~ 71o~
Da(e I
-'-
SPRiNGFIELD '~'"""'c'~'
-=~~
225 5th STREET, SPRINGFIELD" OR 97477
-
(541) 726-3753
FAX(541) 726-3676
Estimated Base Flood Elevation & Disclaimer
The calculated Base Flood Elevation (BFE) for 10t#.4ail, Levi Landing.....
Second Addition is '5'11, 9 'feet above mean sea level, based on the current
FEMA datum information. The floor level of the residence to be placed on
the lot must be certified at least one foot above the Base Flood Elevation as
indicated above. (Please note - the City's surveyed benchmark datum information and
the FEMA benchmark datum are not the same for this area. Add 0.30jt to the City's
benchmarks to adjust to the FEMA benchmark elevations. )
The estimated base flood elevations in this area are based on interpretation
of scientific and engineering evaluations known to the city at this time.
Largerfloods can and will occur on rare occasions. Flood heights may be,
increased by human-made or natural causes. The City's estimation of a
base flood elevation does not imply that land within this area will be free
from flooding or flood damages or that conformance with the requirements
of the City will protect the property from flooding or flood damages.
The City, its officers, agents and employees shall not be liable for any flood
damage that may result from estimation of base flood elevation or any other
administrative decision made regarding administration of the City's
, Floodplain Development Code. ,The developer of this property may elect to
perform additional scientific and engineering studies for consideration by
the City to further refine the estimated base flood elevation for this property.
The developer of this property may also elect to undertake additional
development and construction measures in addition to those required in
article 27 of the Springfield Development Code designed to avoid or
minimize the potentialfor flood hazards and damage. Such additional,
measures are subject to City approval.
Acknowledgment:
I hereby acknowledge receipt of a copy of this document:
Name (print) \)e~"c)L j;esf-u" e-/ . .
Signature (if ~j~.. Date &/A 7/0 v
(This copy to b'e1'fgned by Owner's authorized agent and retained in City addres{ file) . / '
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET
JOURNAL OR JOB NUMBER: 02-00695-01
NAME OR <:OMPANY: Bruce Wiechert Custom Homes
LOCATION: 6747 Aaron Ln.
TAX LOT NUMBER: 17-02-34-11 Tax Lot # 13400
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS: 1 BUILDING SIZE: 2210 SF LOT SIZE:
. .
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS S.F. COST PER S.F.
x
2606.00 $0.273
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F. x COST PER S.F. I x DISCOUNT RATE
0.00 $0.273 50%
r ITEM 1 TOTAL - STORM DRAINAGE'SD~..
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
. NUMBER OF DFU's I x - COST PER DFU
20 $21.37
B. IMPROVEMENT COST:
NUMBER OF DFU's I x COST PER DFU
,20 $16.24
r ITEM 2 TOTAL. - CITY SANITA~~ SEWER SDC
3. TRANSPORTATION
A.REIMBURSEMENT COST:
ADT TRIP RATE NUMBER OF UNITS
x
9.57 1
B. IMPROVEMENT COST:
I ADT TRIP RATE NUMBER OF UNITS
I 9.57 x 1
I ITEM 3 TOTAL - TRANSPORTATION SDC
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
'NUMBER.oF FEU's x COST PER FEU
1. $332.86
B. IMPROVEMENT COST:
NUMBER OF FEU's COST PER FEU
x
1 $34.83
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
SUBTOTAL OF MWMC REIMBURSEMENT, IMPROVEMENT & CREDIT
MWMC ADMINISTRATIVE FEE
I ITEM 4 TOTAL - MWMC SANITARY SEWER SDC
I SUBTOTAL (ADD ITEMS 1,2,3, & 4) ,
5. ADMINISTRATIVE FEE: '
SUBTOTAL ADM. FEE RATE
x
$2,656.22 5%
-
Steve Templin 6/19/2002
SDCCOORDINATOR DATE
5968 SF
.'
=1 $711.44
=1 $0.00
=r $711.44
x
COST PER TRIP
$16.21
x
NEW TRIP FACTOR
1.00 =,
x
COST PER TRIP
$68.94
x
NEW TRIP FACTOR
1.00 =1
=1
=1
$427.40
=1
=r
$324.80
$752.20
$155.13
$659.76
$814.89
=1
$332.86
=1
=,
=,
=1 $10.00
=r--i377.69
=1 $2,656.22
$34.83
$0.00
$367.69
=1
$132.81
TOTAL SDC CHARGES = $2,789.03
~
~
Q
o
U
~
~
~
~
~
Cj
gz
11070./
1091 /.
/
1092'
1093'/
,
" /'
I .11094<
I I
l
I
I
I
II
II
105Y/
1056
1073
'.~
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES .. DRAINAGE
( # NEW' - UNIT ' FIXTURE
FIXTURE TYPE # OLD ) x EQUIVALENT = , UNITS
BATHTUB ( 1 0 ) x 3 = 3
DRINKING FOUNTAIN ( 0 0 ) x 1 = 0
FLOOR DRAIN ( 0 0' ) x 3 = 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. ( 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 I MOP SINK ( 1 0 ) x 3 = 3
CLOTHESW ASHER - 3 OR MORE (EA) ( 0 0 ) x 6 = 0
MOBILE HOME PARK TRAP (1 PER TRAILER) ( 0 0 ) x 12 = 0
RECEPTOR FOR REFRIG / WATER STATION / ETC. ( 0 0 ) x 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. ( 0 0 ) x 3 = 0
SHOWER, SINGLE STALL ( 1 0 ) x 2 = 2
SHOWER, GANG (NUMBER OF HEADS) ( 0 0 ) x 2 = 0
SINK: COMMERCIALIRESIDENTIAL KITCHEN ( 1 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 ( 2 0 ) x 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU's*
( 0 0 ) x 20 = 0
TOTAL DRAINAGE FIXTURE UNITS =, 20
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
CREDIT FOR LAND (IF APPLICABLE)
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE, CALCULATE CREDIT SEP ARA TEL Y
YEAR CREDIT RATE PER $1,000 YEAR CREDIT RATE PER $1,000
ANNEXED ASSESSED VALUE ANNEXED ASSESSED VALUE
1979 OR BEFORE $4.92 1990 $2.06
1980 $4.83 1991 $1.64
1981 $4.77 1992 $1.45
1982 $4,64 1993 $1.31
1983 $4.47 1994 $1.13
1984 $4.30 1995 $0.97
1985 $4.09 1996 $0.82
1986 $3.78 1997 $0.63
1987 $3.41 1998 $0.41
1988 $2.98 1999 $0.22
1989 $2.52 2000 $0.04
VALUE /1000 CREDIT RATE
0.000 X $0.04 =1
0.000 X $0.04 =1
TOTAL MWMC CREDIT =1
$0.00
$0.00
$0.00
u;)/u~/u~
cny Of .sPRl~GnLLD
~\{\~
o 'l.O~~~0'
225 FIFTH STREET , ~~~~
SPRINGFIELD, OREGON 97477 ~~~V
INSPECfION REQUEST: 726-376~1&~'Q '~ri\~
OFFICE: 726-3759 "oo,fb:~ ~0o...sW
~~o' {\o
1. LOCATION OF ~~tt~~ON . .
~:~~SC~~L<1. :\~n ~
L..-c, 1- ! 0 0 ~b e'o c.,,~{\'l
JOB DESClUPTION ~.' == _,.~
-, ~F [..t--O.Umr_ -)". ~
I
Permits are nOll-transferable and expire
if work is not Stalted within 180 days
of issuance or if\\lork is suspended for
180 days.
HiU 17: U ~ .t.il ;) 417 ~ t) J t) /) 9
~(J(J::
Ity Job Number~2 - O.L26:1<) - 0 I
B. Services Or Feeders
I nstaJ.t4tioll, Alterations or
~~t6{l:
Ad<hess 't57 k~ ~ . ~'\~~I=
(/. ~ ~ ~ s to 400 amps
CitL~~ _ Phone GEf ~.g7LD ~":. S ~:~ S ,to 600 amps
0. ~ "\~ ~WU 1 amps to 1000 amps
Supeivlsor License Number ,J.. /00 ~ ~-x..~ ~<:(:. &~ Over 1000 amps/volts
",..N,. ~ -;) ~<:s f? ~ Reconnect Only
Expiration .Date /Or- I ~ ~~ .;;s f\)<:(:. ~<::).
/) ~~" 9.t'<:~'\,v~ ~<f C. Temporary Services or Feedel"$
Constr Contr. Nwnber ,LLft"-:.:j."fj_~~\J ~ Installation, Alteration or Relocation
,~'.y ~v <::)'c
,Expiration Dale ---LQ.~ (~ 0 ~~~ 1;. ,CO~ 200 amps Of less
~ 20] amps to 400 amps
Signature of Supervising Electrician OverstR1 to,6oo amps
/}. /J E~~6bic..~s or 1000 volts see
110:- ."., DAA. " J-eJB0~a~Y9;(.":)\jP:J'O~
" \7ll/Y~ 0($:. ~0<:$ ~0 Q)~ ~0 0
'V;;-t , , ~ ~ c? RilI("Bf.luu:li'Ci~\litS'
Owners Name I,t> 'f V L <..- U ~ e vh~}- C <J ;":~r-~ ,N~~~-a'i\'!P-~ ~-)fXlension Per PiUlcl
P , ~.J' "$'\ 00 ~ 0 ....0 ~
Address J, '5 7 ~ (/.. y ~ \;h \ I S 0,0 ';,..00A..,V:::-O ~{'&?~~.:c~t~O ~.
~'J;>O~:I.' (.":)~ ~6~ 0' .~ ~
City_{.-0~GiI.C ,-,-PbODC fa ".b-<1.~q~,t>i~P })(.":)"!!-.~"~~~gJk:u Circuit or Wlth Service
iJ A0" ~ ...., ~~ & ~ot 17~ederPemnt $ 3.00
~RINS no ~. -'....0<::- >S ;::\ ~ ~0"~....
O......'L TALLA N 'i(' ~~~ ~ ffjCi; {::-'li CJ0 0 'XCfJ
The installation is being made on ,is- ~(j g;. OJ 0'::' "&-0 ~Q.Fi.~Mjscellaneous (Service/feeder not included)
property I own which is not intended ~O O"f ~ ~ 1".0' ~Each installation
ti 1 1 .r.. n.,<:)' ~~ ~ t">~Pump' .
or sa e, ease or rent. .~. ,,-J tft 0 (jVJ or l\'Iiganon
<3.) (j ~ Sign/Outline Lighting
o Limited Energy/Res
Limited b1crgy/Comm
A. New ~dendaJ-Single or
Multi-FllIIliJy per dwelling unit.
Service lDcludt:d:
1000 sq..fi. or less
Each additional 500
sq. Ll or portion
Lhcreof
Each MiUlUfd Home or
Modular Dwelling
Service or Feeder
2. CONTRACTOR-INSTALLATION ONLY
Electrical Contractor >TO f"4N I EL~I/C'
Owners Signature:
Itcms Cost Sum
.,J_$106.oo JJ1.o.cO
~ $ 19.00 $.ci>
$ 50.00
S 63.00
$ 75.00
$125.00
$163.00
5375.00
S 50.00
..-L $50.00 15D.CO
$69,00
$]00.00
$043. 00
550.00
$50.00
$25.00
$45,00
Miuimum Electric Pemut Inspection Fee ii $4S.00 +
SurcbargCi
190:~3IHS~8 ~ ~
: 39N~H8 u--'
9S'39~S $ l:a83~
2002 "2 Nnr:31~a lW~ n~~~~~' .
\'9L6000-W:#8N~~1. .~ .
4. SUB'fOT AL OF ABOVE
7% State Surcharge
8% AdminiSllllove Fee
TOTAl...
&/~_a)
'7~1b ,~ .4 I
B~ 1?(>1
&44.'kJ