HomeMy WebLinkAboutPermit Building 2003-8-20
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2003-00649
ISSUED: 08/20/2003
APPLIED: 07/22/2003
EXPIRES: 02/20/2004
VALUE: $ 169,604.20
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 684 Aspen St
ASSESSOR'S PARCEL NO.: 1703342300300
Springfield TYPE OF WORK: Single Family Residence
Contractor License Expiration Date
RUHOFF HOME BUILDERS INC 130797 \0 07/13/2004
BINNS ELECTRIC CO 73762 ~~eS ~0~\\~\\~0~/06/2005
ROLFS eo..'J 0'(\ \O{\'
EUGENE PLUMBING CO ...()'{\ \'Q.~~~~~~e s~~,~i09/2004
BUlLDI~G\~b~~;l~\j;o~~ ~~\)\eS \
~~ S 'Q.\r ~. \ \ . '(O\)~ 0\ \~ ~O'(\~
~Qf'St'b~i~:a'(\\eC)C),\ C) \~ co~\es~el.e\e~~~esa~:
\O\Hei",Ii'f'~ Stai\:tuc.p'Q.\'\\ "'\10:\.e'f8.09~0\S\q Ft 1st Floor:
;:J.\\..l~- ,..1)'0" QV" I \1' .'~\\:] ~
~O'l'Y~J"OfU'e{\\0-~ F~~ed-~d.f,E:i'~~t~'2>llt~q Ft 2nd Floor:
\'(\ "@~ffritYp~\e ce O~e~::'W.fs'fiiic Sq Ft Basement:
~~g~l\~e\.o~ \~e . S vCO"ftiectric Sq Ft Garage/Carport
Ene~g~hC: e'(\\e~ 'I Minimu Sq Ft Other:
<(\\} Impervious Surface Area:
REQUIRED PARKING
Overlay Dist: I.\NO"''' 2
# Street Tree~.~t~:. II ~?\RE \ \lI3It~a:
Paved Drive tifd:~' ?t.RN\\\ Sf\t>. ~... f\\S ?t. \ ijf{
% of Lot cov~~\-\OR\lt.\) \j~~~~~\)f\~\)O~t.O '
r.()~N\:~~~~1 D\=R\OO. . ..
I PUBLIC IMPROVEl\fKNi{Sl
AC Mat Sidewalk Type: Setback 5'
Yes Downspouts/Drains: To Storm Sewer
NO OCCUPANCY UNTIL ALL CONDITIONS OF PARTITION ARE MET, INCLUDING
DRIVEWAY PAVING. As per Land Use Decision #2002-06-0168, requires storm drainage to be
hard piped to private storm line that outfalls to City public storm line in Aspen Street. No sheet
flow allowed as per Springfield Development Code. Intrusion of footings, eaves or any other
portion of the proposed structure into easement areas is prohibited.
TYPE OF USE:
New
PROJECT DESCRIPTION: SFR
Owner: RUHOFF CHAD
Address: 3993 MIRROR POND WAY EUGENE OR 97408
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Mechanical
Plumbing
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
1
R-3
U-l
VN
3
SETBACKS
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
55.00
29.00
32.00
10.00
15.00
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Pae:e 1 of 4
Residential
Phone
541-334-6550
541-687-1362
741-0002
541-484-7440
1,313
528
1,600
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2003-00649
ISSUED: 08/20/2003
APPLIED: 07/22/2003
EXPIRES: 02/20/2004
VALUE: $ 169,604.20
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
Dwellim!:s
Garal!:e
Garal!:e
Tvpe of Construction
V Wood Frame
Garal!:e
Garal!:e
$ Per Sq Ft
or multiplier
$90.60
$23.80
$23.80
Square Footage
or Bid Amount
1,313.00
528.00
1,600.00
Value
Date Calculated
Description
Total Value of Project
$118,957.80
$12,566.40
$38,080.00
$169,604.20
07/24/2003
07/24/2003
07/24/2003
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $409.92 7/22/03 1200200000000001805
-Mechanical Issuance Fee- $10.00 8/20/03 1200200000000001990
+ 10% Administrative Fee $7.20 8/20/03 1200200000000001990
+ 10% Administrative Fee $123.62 8/20/03 1200200000000001990
+ 7% State Surcharge $5.04 8/20/03 1200200000000001990
+ 7% State Surcharge $86.53 8/20/03 1200200000000001990
2 Baths One or Two Family $254.00 8/20/03 1200200000000001990
Add, Alter, Extend Circ Ea Add $9.00 8/20/03 1200200000000001990
Addressing Assignment $8.00 8/20/03 1200200000000001990
Building Permit $793.15 8/20/03 1200200000000001990
Dryer Vent $6.00 8/20/03 1200200000000001990
Exhaust Hoods $9.00 8/20/03 1200200000000001990
Furnace - up to 100,000 btu $12.00 8/20/03 1200200000000001990
Minimum/ Adj ustment Mechanical $6.00 8/20/03 1200200000000001990
Perm Serv/Fdr 200 amps or less $63.00 8/20/03 1200200000000001990
Plan Review - Planning $59.00 8/20/03 1200200000000001990
Residence Wiring 1000 Sq Ft $106.00 8/20/03 1200200000000001990
Residence Wiring Ea Addtl 500 $38.00 8/20/03 1200200000000001990
Sanitary Sewer - Improvement $326.99 8/20/03 1200200000000001990
Sanitary Sewer - Reimbursement $430.16 8/20/03 1200200000000001990
SDC MWMC Administration $10.00 8/20/03 1200200000000001990
SDC MWMC Improvement $34.83 8/20/03 1200200000000001990
SDC MWMC Reimbursement $332.86 8/20/03 1200200000000001990
SDC Sanitary/Storm Admin $161.23 8/20/03 1200200000000001990
SDC Transpo Admin $49.02 8/20/03 1200200000000001990
SDC Transpo Improvement $727.42 8/20/03 1200200000000001990
SDC Transpo Reimbursement $164.89 8/20/03 1200200000000001990
Storm Drainage Impervious Area $2,177.90 8/20/03 1200200000000001990
Vent Fan $12.00 8/20/03 1200200000000001990
Willamalane Single Family $1,000.00 8/20/03 1200200000000001990
Total Amount Paid $7,432.76
Pal!:e 2 of 4
.CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2003-00649
ISSUED: 08/20/2003
APPLIED: 07/22/2003
EXPIRES: 02/20/2004
. VALUE: $ 169,604.20
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review
Plannin2 Review
Public Works Review
I Plan Reviews I
07/24/2003 APP
08/14/2003 APP
07/31/2003 APP
LLH
TAJ
VRJ
07/23/2003
07/24/2003
07/24/2003
Structural Review
07/24/2003
08/14/2003
APP TCM
NO OCCUPANCY UNTIL ALL
CONDITIONS OF PARTITION
ARE MET, INCLUDING
DRIVEWAY PAVING (see Don
Branch or Kitti Gale). Sanitary and
Storm sewer not shown on site plan.
As per Land Use Decision
#2002-06-0168, requires storm
drainage to be hard piped to private
storm line that outfalls to City
public storm line in Aspen Street.
No sheet flow allowed as per
Springfield Development Code.
Sanitary sewer to Aspen Street. If
applicant has NOT applied for an
encroachment permit, please do so
prior to any work in ROW or PUE.
SDC impervious surface includes
paving for 8 feet for driveway and
all other pavement. Curbcut permit
included in bp for 672 Aspen.
Intrusion of footings, eaves, or any
ohter portion of the proposed
structure into easement areas in
prohibited.
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. .
l...Jl.eouirerUnsnections I
1 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
2 Footing: After trenches are excavated. .
3 Foundation: After forms are erected but prior to concrete placement.
4 Post and Beam: Prior to floor insulation or decking.
5 Floor Insulation: Prior to decking.
6 Shear Wall Nailing: Before covering sheathing with finish materials.
7 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
8 Wall Insulation: Prior to cover.
9 Ceiling Insulation: Prior to cover.
10 Drywall: Prior to taping.
11 Final Building: After all required inspections have been requested and approved and the building is complete.
Pa2e 3 of 4
,_~~aJ:I.':o!~~I~'~:,,",n ..".~"".,
"r
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2003-00649
ISSUED: 08/20/2003
APPLIED: 07/22/2003
EXPIRES: 02/20/2004
VALUE: $ 169,604.20
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-:726-3769 Inspection Line
12 Underfloor Plumbing: Prior to insulation or decking.
13 Underfloor Drain: Prior to cover or placement of concrete.
14 Rough Plumbing: Prior to cover and including required testing.
15 Water Line: Prior to filling trench and including required testing.
16 Sanitary Sewer Line: Prior to filling trench and including required testing.
17 Storm Sewer Line: Prior to filling trench.
18 Final Plumbing: When all plumbing work is complete.
19 Underfloor Mechanical. Prior to insulation or decking and including required testing.
20 Rough Mechanical: Prior to Cover
21 Final Mechanical: When all mechanical work is complete.
22 Rough Electric: Prior to Cover
23 Electric Service: Approval required prior to utility company energizing service.
24 Final Electric: When all electrical work is complete.
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 ~ny 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
times during construction.
.'9
~-~
C-- -----'
r5/~! cr3
. OW,ner or Contractors Signature
Date
Pa2e 4 of 4
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
COM2003-00649
Payments:
Type of Payment
Check
Reccipt#: 1200200000000001990
Description
Addressing Assignment
Willamalane Single Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transpo Admin
Plan Review - Planning
Building Permit
2 Baths One or Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Dryer Vent
-Mechanical Issuance Fee-
Minimum! Adjustment Mechanical
+ 7% State Surcharge
+ 10% Administrative Fee
+ 7% State Surcharge
+ 10% Administrative Fee
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
Paid By
RUHOFF HOMEBUILDERS
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receip~
Development Services Department
Public Works Departmen"
Date: 08/20/2003
2:27:39PM'
Amount Paid
8.00
1,000.00
106.00
38.00
2,177.90
430.16
326.99
164.89
727.42
332.86
34.83
10.00
161.23
49.02
59.00
793.15
254.00
12.00
12.00
9.00
6.00
10.00
6.00
86.53
123.62
5.04
7.20
63.00
9.00
$7,022.84
Item Total:
How Received
In Person
Payment Total:
Amount Paid
$7,022.84
$7,022.84
..
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 1 0 3 = 3
DRINKING FOUNTAIN 0 0 1 = 0
FLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
LAUNDRY TUB 0 0 2 = 0
CLOTHESW ASHER / MOP SINK 1 0 3 = 3
CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
SHOWER, SINGLE STALL 1 0 .2 = 2
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 II
SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASIN/DOUBLE LA V A TORY 0 0 2 = 0
SINK: SINGLE LA V A TORY/RESIDENTIAL BAR 2 0 1 = 2
URINAL, STALL! WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 0
TOILET, PRIVATE INST ALLA TION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 19
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day J
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
CREDIT RA TE/$I ,000
ASSESSED VALUE
$4.92
$4,92
$4.83
$4.77
$4,64
. $4.47
$4.30
$4.09
$3.78
$3.41
$2,98
$2.52
$2.06
$1.64
$1.45
$1.31
$1.13
$0.97
$0.82
$0.63
$0.41
$0.22
$0,04
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGIBJ-,E FOR ANNEX. CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
o
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0.00 x $4.92
= L
$0,00
I
I.
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0.00 x $4.92 = ,.
o
TOTAL MWMC CREDIT
= r
$0.00
,-
CITY OF SPR.....;FIELD SYSTEMS DEVELOPMENT WORKSHEET
I JOURNAL OR JOB NUMBER: Corn2003-00649
NAME OR COMPANY: Chad Ruhoff
LOCATION: 684 Aspen
TAX LOT NUMBER: 17033423 tl300
DEVELOPMENT TYPE: SINGLE F AMIL Y RESIDENCE
NEW DWELLING UNITS ";.' 1 BUILDING SIZE (SF: 3454 LOT SIZE (SF):
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS S.F. x I COST PER S.F. CHARGE I
7510.00 I $0.290 = $2,177.90
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F. x I COST PER S.F. x DISCOUNT RATE I DISCOUNT
0.00 I $0.290 50% = , $0.00
ITEM 1 TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
NUMBER OF DFU's x I COST PER DFU
19 I $22.64
B. IMPROVEMENT COST:
NUMBER OF DFU's
19
x I COST PER DFU
I $17.21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =,
3. TRANSPORTATION
A. REIMBURSEMENT COST:
ADT TRIP RATE I x I NUMBER OF UNITS x
9.57 I 1
B. IMPROVEMENT COST:
ADT TRIP RATE I x I NUMBER OF UNITS x
9.57 I 1
ITEM 3 TOTAL - TRANSPORTATION SDC = I
4. SANITARY SEWER" MWMC
A. REIMBURSEMENT COST:
NUMBER OF FEU's x COST PER FEU
1 $332.86
B. IMPROVEMENT COST:
INUMBER OF FEU's x COST PER FEU
I 1 $34.83
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER sm = ,
SUBTOTAL (ADD ITEMS 1,2, 3, ~ 4)
5. ADMINISTRATIVE FEE:
SUBTOTAL x ADM. FEE RATE
$4,205.05 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
= I
Virginia Jurasevich
PREPARED BY
7/30/2003
DATE
$2,177.90
$757,15
COST PER TRIP
$17.23
x INEW TRIP F ACTORI
I 1.00
COST PER TRIP
$76.01
$892.31
x INEWTRIP FACTORI
I 1.00
.. ..... ."
o
Cf.l
~
o
o
u
~
~
E-<
CI':J
>-<
c:>
~
$2,177.90
1070
$430.16
1091
$326.99
1092
I
$164.89
1093
$727.42
1094
$332.86
1054
3.
.~00 06V>'-
~<$" ~'<
t>S .~
~ ~
v~\J
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726~0~
ELECTRICALR~_~T 'PLICATION ~0'~:0~
, ~##
City Job Number . Date 19 R'O
0<:;
1.
J~o\ ~~S <6\w
P<<mits m non-t"..,fenble and eXPir~'k is
not started within 180 days of issuancer::~~rk is
Suspended for 180 days.
2.
Electrical Contractor % / AJ /1) S E'LEL/~/c...
Address
~ 16 tu I/-L-L.-I <; -#c
City E vC, €lif}E Phone t,g7-I?bl-
Expiration Date
3oc.f/~
10/0 I / C:<OO.
f ,
Supervisor License Number
Constr. Contr. Number 7.3 7 {,.., 7 _
-C/L6
Expiration Date (" - ~ - 0 ~
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A.
Nmv.iCr.ncluded
T ,WQ6 ~CIn ft. or less $106.00
TE~rPMctMb1ia<t5W.~'@(PfRE IF THE WORK
~lp1)H0Rmcr!/j:lfJNDER THIS PERMIT i~ NOT $ 19.00
C1MM~atic~41nm~NDONED FOR
ANM.o~Q)lJDA\fefi~IWlce or $5000
Feeder' .
B.
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C.
Ins~T.Jl~o~i1-I'~~~~~tffi%f R~oati;m! t; 0 Y v .
Jol'bw r es ad t . c. .'~
.1'Q~t1'#remRfrt~en~P ed oy the Oregon U$i50,AlO
urO~wr~!5~W/bt~ Those rUles are S8$ f@ROO
~~19IWR'Am.ri}? thro~gh UAR 952$,r~moo
,..<>.11< y ooram caples aT me rules b}
OVeRlu01{11.. oel1:i~~. e "" v:e.
D.
New AlteratIOn eJ..'i:lt~6J;~~).
One Circuit
Each j'ldditional Circuit or with
Service or Feeder Permit
$ 43.00
0;
.3. $ 3.00
E.
Pump or irrigation
Sign/Outline Lighting
Limited EnergyIResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
12--
7% State Surcharge
10% Administrative Fee
~ol.r
-;>
TOTAL
;ZO
1) /../ 2 '1
Shared Drive(T:)/Building FonnslElectrical Permit Application I-03.doc
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAX: (541)726-3680'7;i0 ,0&
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ELECTRICAL PERMIT APl'kIq~TION <t~0 ~o
City Job Number ~t)l)'\1}.()D3.~ Date ~o~:~ oo~O;
3.
"30 t.f /-<f7
/0 / () I / .z OD 4
, ,
737bZ-
? /&/ oZooSc-{(~
,
Signature of Supervising Electrician:r\ E.~.\
/ #' ~l / / ~\\o'l'J {~~~~fa ~\Wto~n~i~Efe1\\~iael
fA t:2-vt1..-. /C /~~ No\\\\ca.\\~~'\cQR'\ 'n co?\eS 0 \e\e?Y\O:.\\Cf"\
\. Op..? 9~'f*,~1~b~~\~~i~~~~\\\\C
rc. \~090'~~~~~~~8~~~'~i~AA).
t\ (i) _^ ",J Ca.\\\
t{Un~Y~u~
1.
JOB DESCRIPTION
~on- d expire if work ~
not started within 80 days of issuance or if work is
Suspended for 180 days.
2.
Electrical Contractor'~ iN tV 5 t LEt7l'l--/L-
~ .
Address 2 (0 WAL..L-J.S ~ =-
City Eu ro 6UE Phone (, G 7 ~ /:, (,,2-
Supervisor License Number
Expiration Date
Constr. Contr. Number
Expiration Date
Owners Name
Address 9>~ :\
City ful{ m
OWNER INSTALLA nON
Phone lftA. ~arrD
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
lDla ,CP
~8" ~OO
\
'2-
$ 19.00
$50.00
B.
~J~~ ol~~ ALL EXPIRE If THE WO~~.oo
1im1pl~~ 40'Q~~ 1HIS PERMIT \8 NP15.00
MdI~\h~~4gQog~W ABANDONFO FOR $125.00
(9Q)~tllQ,~~og\).J~nD $163.00
~~ 1<bill> llAt\l,r~b1lP . $375.00
Reconnect Only $ 50.00
c.
Installation, Alteration or Relocation
ff
200 Amps or less $ 50.00
201 Amps to 400 Amps . $ 69.00
uIJ \C
401 Amps to 600 Amps\le,;:> ~ .,'\'J $100.00
, Il'J {BU." \,)\\ \
~\above.
$ 43.00
$ 3.00
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
7% State Surcharge
10% Administrative Fee
~~
\ 0 .fP>
\4AQ
~.~)
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc