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Home My WebLink AboutPermit Building 2004-11-24 ._@F!JJ'lfgEI!~~," ~.._~~"",. I" \.,. -- .. ''.;. '. ~""'~~" CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2004-01309 ISSUED: 11/24/2004 APPLIED: 10/22/2004 EXPIRES: 06/15/2005 VALUE: $ 61,272,00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5964 Aster St ASSESSOR'S PARCEL NO.: ASTER MEADOWS SUB Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New- PROJECT DESCRIPTION: Single Family Residence, Aster Meadows lot 2 . Residential Owner: LARRY ALBERTS Address: 397 S 72ND ST SPRINGFIELD OR 97478 Phone Number: 541-747-0755 , :. , .. I CONTRACTOR INFORMATION I Contractor Type Generai Electrical Mechanical Plumbing Contractor DUANE A KNIGHTS JEM ELECTRIC iN'C MARSHALLS'INC" . Expiration Date 07/10/2005 09/07/2006 12/23/2005 Phone 541-726-2960 541-729-1074 541-747-7445 541-741-3553 # of Units: 1 Primary Occupancy Group: . R-3 Secondary Occupancy Group: U-l Primary Construction Type VN Secondary Construction Type: . # of Bedrooms: 1 600 240 Yes 37.60 REQUIRED PARKING Total: 2 Handicapped: Compact: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 69.00 i5.20 5.00 10.00 15.50 Overlay Dist: # Street Trees Rqd: . Paved Drive Rqd: % of Lot Coverage: . ..-;'... ... Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS I .'. 'Wt~~~pR~ Fully Impro~~ t\01\C\:: \1111 S\l~LL t'f,~QJM\/,JR \'l~:: \\-\\S ?OE~IEO \J~OER ~Bt\~OO~EO 'ttjf{' t\\J\\-\ EO OR \S t'\ . CO~\'JIE~~t\'i ?ER\OO, t\~'i '\ ~O Curbside 5' Curb and Gutter Notes: Paee 1 of 4 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 Gara2e Dwellin2s Gara2e . Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge 1 Bath One & Two Family Addressing Assignment Building Permit Curbcut Permit Exhaust Hoods Minimuril/Adjustment Mechanical Plan Review Major - Planning Residence Wiring 1000 Sq Ft Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC TranspoAdmin SDC Transpo Improvement SDC Transpo Reimbursement Storm Drainage Impervious Area Vent Fan Willamalane Single Family Total Amount Paid Initial Review Plannin2 Review 10/25/2004 10/25/2004 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01309 ISSUED: . 11/24/2004 APPLIED: 10/22/2004 EXPIRES: OS/24/2005 VALUE: $ 61,272,00 I Valuation Descriotion I , $ Per Sq Ft or multiplier $92.40 $24.30 Square Footage or Bid Amount 600.00 . 240.00 Total Value of Project ~ Amount Paid Date Paid $271.34 $10.00 $70,75 $49.52 $145.00 $31.00 $417A5 $75.00 . $9,00 $24,00 $103.00 $106.00 $237.64 $312.52 $10,00 $865.31 $82.03 $95.51 $72.76 $772.49 $175.13 $797.94 . $6.00 . $1,000.00 10/22/04 11/24/04 11/24/04 11/24/04 11/24/04 11/24/04 J 1/24/04 11/24/04 11/24/04 11/24/04., 11/24/04 11/24/04 11/24/04 11/24/04 11/24/04 11/24/04 11/24/04 11/24/04 l1/i4/04 11/24/04 11/24/04 11/24/04 11/24/04 11/24/04 $5,739,39 ,I Plan Reviews I' , 10/25/2004 11/17/2004 APP, LLH APP . TAJ Pa2e 2 of4 Value Date Calculated $55,440.00 $5,832.00 $61,272.00 .10/22/2004 10/22/2004 Receipt Number 1200400000000001500 1200400000000001653 . 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653' 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 1200400000000001653 I spoke with. Larry Alberts today, He told me to shift the rear setback . so it would be a minimum of 10 feet. I told him we needed 2 more revised plot plans. _~J!~';l!gF!.I.~er"_,, . 'ij' '. ... '. .. .~. * Status Issued CITY OF SPRINGFIELD . Building/~ombination Permit PERMIT NO: COM2004-01309 ISSUED: 11/24/2004 APPLIED: 10/22/2004 EXPIRES: OS/24/2005 VALUE: $ 61,272.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 10/25/2004 11/12/2004 APP CAS Partition incomplete, pending case. Called Engineer (Minium) to revise plans 10/29/04 CAS Received revised plan 11/12/04 10/25/2004 11/03/2004 OK RJB Public Works Review 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. Erosion/Grading Inspection: After all erosion measures are in place: Ufer 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 tloor insulation or decking, Floor Insulation: 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. . . Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. ' Final Building: After all required inspections have been requested and approved and the building is complete. Undertloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover 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. Rough Mechanical: Prior to Cover Final Mechanical: When all mech.anical work is complete. Rough Electric: Prim: to Cover Electric Service: Approval required prior to utility company energizing service, Final Electric: When all electrical work is complete. Curbcut - Standard: After forms are erected but prior to placement of concrete. Pae:e 3 of 4 Status Issued CITY OF SPRINGFIELD C Building/Combination Permit PERMIT NO: COM2004-01309 ISSUED: 11/24/2004 APPLIED: 10/22/2004 EXPIRES: OS/24/2005 VALUE: $ 61,272,00 '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 times d.rin~ C~?d ~/ __/ ~ /1-zY-t)1 .r ./ Owner or Contra~tors Signature Date Pae:e 4 of 4 225 Fifth Street Spl~iD'gf1eld, Oregon 97477 541-726-'3759 Phone rity of Springfield Official Receipt velopment Services Department Public Works Department Job/Journal Number COM2004-01309 COM2004-01309 COM2004-0 1309 COM2004-01309 COM2004-0 1309 COM2004-01309 COM2004-01309 COM2004-0 1309 COM2004-01309 COM2004-01309 COM2004-01309 COM2004-01309 COM2004-01309 COM2004-01309 COM2004-0 1309 COM2004-01309 COM2004-0 1309 COM2004-0 1309 COM2004-0 1309 COM2004-01309 COM2004-0 1309 COM2004-01309 COM2004-01309 RECEIPT #: 1200400000000001653 Date: 11/24/2004 Description Addressing Assignment Willamalane Single Family Building Permit I Bath One & Two Family . Vent Fan Exhaust Hoods Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Transpo Admin Plan Review Major - Planning Residence Wiring 1000 Sq Ft + 7% State Surcharge + 10% Administrative Fee Curbcut Permit Storm Drainage Impervious Area SDC Sanitary/Storm Admin Payments: Type of Payment Paid By Check LARRY ALBERTS INC Item Total: Check Number Authorization Received By Batch Number Number How Received djb 1272 In Person Payment Total: 11/24/2004 Page 1 of I 8:05:13AM Amount Due 31.00 1,000.00 417.45 145.00 6.00 9.00 24.00 10.00 312.52 237.64 175.13 772.49 82.03 865.31 10.00 72.76 103.00 106.00 49.52 '70,75 75.00 797.94 95.51 $5,468.05 Amount Paid $5,468.05 $5,468.05 , .. CITY OF Sh'dNGFIELD SYSTEMS DEVELOPMENI~f~~RKSHEET . JOURNAL OR JOB NUMBER: COM2004-01309 NAME OR COMPANY: Larry Alberts LOCATION: 5964 Aster St TAX LOT NUMBER: 0 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 1 ~UILDING SIZE (SF; 850 LOT SIZE (SF): I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x COST PER S.F. CHARGE I 2574.00 $0.310 = $797.94 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. x I COST PER S.F. x DISCOUNT RATE 1 I 0.00 I $0.310 50% = I 6530 r:n ~ o o u ~ ~ E-< r./) ...... t:l ga DISCOUNT $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY $797.94 $797.94 1070 A. REIMBURSEMENT COST: I NUMBER OF DFU's x COST PER DFU I 13 $24.04 $312.52 1091 B. IMPROVEMENT COST: I NUMBER OF DFU's x , 13 $18.28 $237.64 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $550.16 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADTTRIPRATE x I NUMBER OF UNITS x COST PER TRIP x NEW TRIP FACTOR I 9.57 I 1 $18.30 1.00 $175.13 1093 B. IMPROVEMENT COST: I ADT TRIP RATE I x NUMBER OF UNITS x I COST PER TRIP x I NEW TRIP FACTOR I 9.57 I ' 1 I $80.72 I 1.00 $772.49 1094 ITEM 3 TOTAL - TRANSPORTATION SDC =1 $947.62 ".- 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's x ICOST PER FEU I 1 I $82.03 = . $82.03 1054 B. IMPROVEMENT COST: NUMBER OF FEU's x ICOST PER FEU 1 $865.3 1 = $865.31 11055 M~C CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMINISTRATIVE FEE $10.00 11056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I $957.34 SUBTOTAL (ADD ITEMS 1,2,3, & 4) = 1 $3,253.06 5. ADMINISTRATIVE FEE: I SUBTOTAL x ADM. FEE RATE CHARGE I $3,253.06 5% $162.65 TOTAL SANITARY ADMINISTRATION FEE: 95.51 , 1079 I TOTAL TRANSPORTATION ADMINISTRATION FEE: $67.14 11078 "..- Cheryl Slaymaker 11/23/2004 TOTAL SDC CHARGES =1 $3,415.71 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUlV ALENT ~ DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS BATHTUB 1 0 3 = 3 DRINKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 ILAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER/MOP SINK 1 0 3 = 3 ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0 I SHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCWJRESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1 IURlNAL, STALL/WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 1 0 3 = 3 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 13 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4 AO $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I 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 = .. .. .Construction Contractors Board 700 Summer St NE Suite 300 . PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us .4!,;...___,.w:ffi. Permit #: CO W\ -z..o-t!!JJl"'.- 01"'30 7, Address: 5' 7 b ,-( A-s TbIL Issued by: ' '() ~ Date:) / - Z l( -0 Lr- Statement: Information Notice to Pro'perty Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not llcensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits, Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit, , f' Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. ~ 2. I own, reside in, or will reside in the completed structure, I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion, M' 3A. My general contractor is D IA/!rrlt::' K:v~ PI. ~ l-f-s (Name) - }2/12. (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR o 3B. I will,be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board.' If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name ofthe contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice t9 Property Owners about Construction Responsibilities on the reverse side of this form. ~-. _ ~ 1/-- :::Li-DLj (~ature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 .,. .. " , . :t. ,.. ,. '\!' ",r~,,~I~ Actinig'a's-Your9wn General Contractor?. ~NIFORMATlbN NOT~CE TO' PROPERTY OWNERS ABOUT CONSTRUCTION RESPONS~BILlTIES ~ . t. -,.) _. ;, ., . ::f' '" ~;' ..- ---~-- --~ ---.-- -. .. NOTE: This Information Notice to Property Owners about Construction Resporlsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your ~wn contractor to construct a new home or make a substantial i1U~' ovement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilit~es You will; in most instances, be ruled to be an~'employer" and the contrac~ors you contract with will be "employees" if you us~ contractors not licensed with the Construction Cqntractors Board. to do labor. in COl1StructiI:1g or to assist in the construction,or improvement of a residential s~cture. As th~ employer, you must comply' with the fon~~ing: Oregon's Withholding Tax Law: As anempioyer, you inust withhold income taxes from employee wages at the time employees are paid, You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-3784988. '. . Unemployment Insurance Tax: As an employer, you are required to pay' a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon EmploymentDepartment at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and . Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmll for the appropriate fOi;ms~. . ... " .' Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must-obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you"couldbe subject to penalties and be liable for ~ll Claim costs if one of your errlployee.sisinjured on the job. For more information, call the Workers' Compensation DIvision at the Department of Consumer- and. Business Services at 503-947-7815. . U.s. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages, You will be liable for the tax payment even if you didn't actually withhold the tax, For a Federal EIN number, call the IRS at 1-'800-829-4933 OI-' visit their web site at www.irs.1!ov. . . . . --...- . .Other.Responsibiljtiesa~<<fAreas of Concerns . '. Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to ):'our attention through inspections. , .' Liability and Property Damage' Insurance: .! Contact ''your: insurance agent to see if you 'have adequate insurance' coverage for accidents and omissions such as falling tools, paint over spray, water damage from pip,e punctures, fire or work that must be redone, ..' , ' .--/ \~ l:~ -- ':~ -....... :'.1 ,-_ -' - '. -... ~ . ..... . Time: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have the skills'to ac't as your own general c()ntiactor"tocoo~airiate the work of rough-in and finish trades, and to notify building officials as the appropriate ti~es so they can perform the required inspections. If you have additional questions call the Construction Contiactors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052, ..' ...." Property_owner. doc 06-01-04 . 225'FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Cu y'V\ Z.O'o u - 01 30 q Date / - z 'i -0 -;- 3. COMPUIJ:. FEE SCHE[)ULE BELOW; 1. l,OC4T10NJ)F IlVSTALLilTIONj ,~q(~L/ Il~~r LEGAL DESCRIPTION ,tsTciL I\IlbA do~v ~ S (,).. d (~+ c.. 2- JOB DESCRIPTION Swo- d, I L! L, \_ uJ UL ~ Permits a're non-transferabll and expire if work is i' not started within 180 days of issuance or if work is Suspended for 180 days. Service Included A. ,New Residential- Single or Multi-Family per dwelling unit. L-,-,,---:___,,______-,',::-_~:_,_';-_:-_,_":'::':;,-:'___ -..-'--:' ',;:::-;-:-,.---:-::-.-:--,'-:,::-:-----,.-".-/,---.-: -______:'.-_<__ - - ::?:__::.<_:___,- - '-,- __,,_:__ -__'-,,-::-__ ___:,:'...:_:__ -,,'-:-_,,-,___,___._, ':-::>-- ---:-- ---.-,_,.-.-:_---__,____: - -: .- - -" -- - -'-:'-::-'--':- 'c I $106.00 /0 b 1000 sq. ft, or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $ 19.00 $50.00 2. B. or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Phone j;XC? - (0 7c/ Over 1000 AmpsN olts , Reconnect Only' ATTENTION: Oregon law requires you. ~o Supervisor License Number -Q(~~~~~~e~o1rlmt3~m~~t~.~r}C~~~!~~S Expiration Date /0 - 0 ( 4n ~R)952-001-001? ttyrll~J1Pa2~~.~?_?:'~ or Relocation . u0::fu.1fuu IIIQ)I obtain co )Ies OT In~ J II f /] ?.eQ\.Trng the center, (N8il'fR~WJI~one b fJ-. ~~I~.I;.~. f(;~ tt:le OregoWUt\IWV~~t\tl~fV' $ 69.00 C Center is 1-806033'~~~~00 Amps $100.00 Expiration Date A 1 - 07 - 0/ . i Lj 10 Over 600 or 1000 Volts see "B" above. Signatur of Supervising Electrician D. f If) ./ New Alteration or Extension Per Panel ) / I / JA.' //'--"- One Circuit $ 43.00 ~ (/ "~ Each Additional Circuit or with I ^ n I J Service or Feeder Permit o ers Name. ~1...4'L", ;4-( IO~ --S ddress :J' <7 7 -7 z '"'-~n1'\~;- E. '. 'D'~11 S\1~ll .'T' .,-. __ '\. lH\C: ptni\.l " . 'T" lie:. n\=Q"', I \~ ~ () ,- w Phone . "'L\Cl"'lcD U\,l[:[tl?ultlp~rr'uTW\(~OJ;lI'.~ 1-\ U 11 I \I ~ ~ f' . ',riQ l'~ (:: U . r ~J K , ., ^ - \~ C E. D 0 R \ S;~gril0'ut e bglitmg OWNER INSTALLATION CO\J,hlt ..R''TleL' dE /R'd' 1 , Y 180 \j{\Y Pt. \ly.lILl1te nergy eSI entia The installation is being made on property ~~~ which Limited Energy/Commercial is not intended for sale, lease or rent. Electrical Contractor 3EIM Address t/1q ,)r~~ ~ JdttA City Constr. Contr. Number $ 63.00 $ 75.00 $125.00 $163,00 $375.00 $ 50.00 $ 50.00 $ 3.00 City $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 100 7c.{ L /0 to I 2 L.{ ~ Owners Signature: 4. 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03.doc