HomeMy WebLinkAboutPermit Building 2004-10-5
"
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: COM2004-01114
ISSUED: 10/05/2004
APPLIED: 09/08/2004
EXPIRES: 04/05/2005
VALUE: $ 200,131.00
SITE ADDRESS: 5955 Aster St 5957 Springfield TYPE OF WORK: Duplex
ASSESSOR'S PARCEL NO.: ASTER MEADOWS SUB
PROJECT DESCRIPTION: Aster meadows 1013 - Duplex
Owner: RW HOMES
Address: BOX 395 CRESWELL OR 97426
. '
I CONTRACTOR INFORMATION I
. '. n law requires you. ~v
ContractA' ,t:NT'ONd: Orego _he Oregorill.lli~se
RAKOC7tl)lMW~ ware 5at~rth
EVER~~f~~Wl;~ 6G~OAR9.~:m1.
DEAN H#lf\1~(g52-001-00, opies of the rules by
RS PLU~~lQ~t'\tP' the tele\bbtMf6
calling ~~iu;J.~1lJfiu"
number . 1 800-;;s~,-'.J" .
Center IS -
2 # of Stories:
R-3 Height of Structure
U-l ' Type of Heat:
VN Water Typ~:
Range Type:
Energy Path:
Sprinkled Building:
Contractor Type
General
Electrical
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:
Notes:
6
TYPE OF USE:
New
Residential
Phone Number: 541-513-2228
Expiration Date
OS/22/2006
08/12/2005
Phone
541-895-8606
541-607-6908
541-741-2880
541-461-4714
01104/2006
2
27.50
Wall Heat
Electric
Electric
Path 1
nJa
Lot Size: 6,060
Sq Ft 1st Floor: 936
Sq Ft 2nd Floor: 1,120
Sq Ft Basement:
Sq Ft Garage/Carport 449
Sq Ft Other:
Occupant Load:
I DEVELOPMENT INFORMATION'
. REQUIRED PARKING
"
Overlay Dist: Total: 4
# Street Trees Rqd: 2 Handicapped:
Paved Dr!v.~d: Yes fOwact:
% of~cG Wvfrn~tt SHAll EXP~~oF THE W '
1HIS PER 'INOER 1HIS PERMI11S NOT
.t.\J1! \r:;DI7~n - \S AtH\NUui~~t) rOI1
PUBLIC I ENW
RIOD.
Sidewalk Type:
18.00
5.00
31.00
22.00
0,00
Fully Improved
Yes
Pae:e 1 of 4
. Downspouts/Drains:'
Curbside 5'
Curb and Gutter
~1IIat~{I'~:~~~~f
f. ....
" --~:...",,_.~>. ~ ~ .;;c:....
~~ ",
" " ".- - - .. -. .
- .",_.,-,_., ...,-.-,.-....,---. ,-,--_.,,"
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-01114
ISSUED: 10/05/2004
APPLIED: 09/08/2004
EXPIRES: 04/05/2005
VALUE: $ 200,13LOO
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation DescriDtion I
Dwellinl!s
Garal!e
Tvpe of Construction
V Wood Frame
Garal!e
$ Per Sq Ft
or multiplier
$92.40
$24.30
Square Footage
or Bid Amount
2,056.00
418.00
Value
Date Calculated
Description
Total Value of Project
$189,974.40
$10,157,40
$200,131.80
09/08/2004
09/08/2004
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $581.04 9/8/04 1200400000000001322
-Mechanical Issuance Fee- $10.00 10/5/04 1200400000000001435
+ 10% Administrative Fee $179.19 10/5/04 1200400000000001435
+ 7% State Surcharge $125.43 10/5/04 1200400000000001435
. 2 Baths One or Two Family $508,00 10/5/04 1200400000000001435 .
Addressing Assignment $62,00 10/5/04 1200400000000001435
Building Permit $893.90 10/5/04 1200400000000001435
Curbcut Permit $75.00 10/5/04 1200400000000001435
Dryer Vent $12.00 10/5/04 1200400000000001435
Exhaust Hoods $18.00 10/5/04 1200400000000001435
Minimum/Adjustment Mechanical $36.00 10/5/04 1200400000000001435
Plan Review Major - Planning $103,00 10/5/04 1200400000000001435
PW Mult Disc - 2nd Permit $-30.00 10/5/04 1200400000000001435
Residence Wiring 1000 Sq Ft $212.00 10/5/04 1200400000000001435
Residence Wiring Ea Addtl 500 $38.00 10/5/04 1200400000000001435
Sanitary Sewer - Improvement $621.52 10/5/04 1200400000000001435
. Sanitary Sewer - Reimbursement $817.36 10/5/04. 1200400000000001435
SDC MWMC Administration $10.00 10/5/04 1200400000000001435
SDC MWMC Improvement $1,730,62 . 10/5/04 1200400000000001435
SDC MWMC Reimbursement $164.06 10/5/04 1200400000000001435
SDC Sanitary/Storm Admin $198.87 10/5/04 1200400000000001435
SDC Transpo Admin $132.91 10/5/04 1200400000000001435
SDC Transpo Improvement $1,544.98 10/5/04 1200400000000001435
SDC Transpo Reimbursement $350.26 10/5/04 1200400000000001435
Sidewalk Permit $75,00 10/5/04 1200400000000001435
Storm Drainage Impervious Area $1,396.86 10/5/04 1200400000000001435
Temp Power 200 amps or less $50.00 10/5/04 1200400000000001435
Vent Fan $24.00 10/5/04 1200400000000001435
Willamalane Attached (duplex) $1,848.00 10/5/04 1200400000000001435
Total Amount Paid $11,788.00
Pal!e 2 of 4
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2004-01114
ISSUED: 10/05/2004
APPLIED: 09108/2004
EXPIRES: 04/05/2005
VALUE: $ 200,131.00
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
Structural Review
09/09/2004
09/09/2004
09/09/2004
09/09/2004
I Plan Reviews I
09/09/2004 APP
09/27/2004 APP
09/23/2004 APP
10/04/2004 APP
SKG
TAJ
MS
RJB
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 Insp'ection: After aU 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 floor insulation or decking.
Ftoor 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.
Firewall: Located and constructed according to plans.
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.
Underfloor 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.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete,
Temporary Electric: Approval required prior to Utility Company energizing pole.
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical.work is complete,
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
Pal!e 3 of 4
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-01114
ISSUED: 10/05/2004
APPLIED: 09/08/2004
EXPIRES: 04/05/2005
VALUE: $ 200,131.00
Issued
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 Sta,te 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 ~rmit card is located at the front of the property, and the approved set of plans will remain on the site at all
t;mes durin V truetionol,} "^
own.::: ;rf!o~gn:;:r) ~ Dat. /0 J 17./ 0 tf
Paj!e 4 of 4
225 Fifth Street,
Springfield, Oregon 97477
5..41'-726-3759 Phone
Job/Journal Number
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114 .
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-01114
COM2004-0 1114
COM2004-01114
COM2004-01114
Payments:
Type of Payment
Check
10/5/2004
RECEIPT #:
1200400000000001435
Description
Addressing Assignment
Willamalane Attached (duplex)
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Building Permit
2 Baths One or Two Family
Vent Fan
Exhaust Hoods
Dryer Vent
Minimum! Adjustment Mechanical
-Mechanical Issuance Fee-
Sidewalk Permit
Curbcut Permit
PW Mult Disc - 2nd Permit
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 Major - Planning
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By Received By
EVERGREEN LAND TITLE CO . djb
Page 1 of 1
"':ty of Springfield Official Receipt
,velopment Services Department
Public Works Department
Date: 10/05/2004
Item Total:
Check Number Authorization
Batch Number Number How Received
26942 In Person
Payment Total:
10:11:00AM
Amount Due
62.00
1,848.00
212.00
38.00
50.00
893.90
508.00
24.00
18.00
.12.00
36.00
10.00
75.00
75.00
(30.00)
1,396.86
817.36
621.52
350.26
1,544.98
164.06
1,730.62
10.00
198.87
132.91
103.00
125.43
179.19
$11,206.96
Amount Paid
$11,206.96
$11,206.96
CITY OF SptrNGFIELD SYSTEMS DEVELOPMEN."~RKSHEET
JOURNAL OR JOB NUMBER: COM2004-01114
NAME OR COMPANY: RW Homes
LOCATION: 5955 Aster Street 5957
TAX LOT NUMBER: 0
DEVELOPMENT TYPE: SINGLE F AMlL Y RESIDENCE
NEW DWELLING UNITS 2 BUILDING SIZE (SF' 0 LOT SIZE (SF):
L STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x COST PER S.F. CHARGE '
I 4506.00 $0.310 = I $1,396.86
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS ST x I COST PER ST I x 1 DISCOUNT RATE I
I 0.00 I $0.310 I' 50%
ITEM 1 TOTAL - STORM DRAINAGE SDC '$1,396,86 I
2. SANITARY SEWER - CITY
A REIMBURSEMENT COST:
1 NUMBER OF DFU's x
1 34
B. IMPROVEMENT COST:
1 NUMBER OF DFU's x
1 ' 34
6060
r/J
P-1
Q
'0
u
~
P-1
E-<
r/J
......
o
~
DISCOUNT
$0.00
$],396.86
1070
I
1 COST PER DFU
I' $24.04
$817.36
1091
$18.28
$621.52
1092
=,
$1,438,88
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
3. TRANSPORTATION
A REIMBURSEMENT COST:
I ADTTRIPRATE x
I 9.57
B. IMPROVEMENT COST:
ADT TRIP RATE
9.57
NUMBER OF UNITS x I COST PER TRIP
2 I $18.30
x INEWTRIPFACTOR
I 1.00
1093
$350.26
x
NUMBER OF UNITS x I
2 I
= ,
x I NEW TRIP FACTOR
1 LOO
1094
COST PER TRIP
$80.72
$1,895,24
$1,544,98
ITEM 3 TOTAL - TRANSPORTATION SDC
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's x COST PER FEU
I 2 $82.03
B. IMPROVEMENT COST:
INUMBER OF FEU's
1 2
x
leOST PER FEU
i $865.31
= $164.06 11054
= $1,730.62 l. 1055
$0.00 1054
$10.00 1056
= I $1,904.68
=1 $6,635.66
CHARGE
$331.78
198.87 '11079
"
$132.91 1-1078
TOTAL SDC CHARGES =, $6,967.44
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC
SUBTOTAL (ADD ITEMS 1,2,3, & 4)
5. ADMINISTRATIVE FEE:
SUBTOTAL x I ADM. FEE RATE
$6,635.66 I 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Matt Stouder
PREPARED BY
9/23/2004
DATE
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUN ALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUNALENT UNITS
I BATH11JB 2 0 3 = 6
I DRINKING FOUNTAIN 0 0 1 = 0
IFLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0
LAUNDRY TUB 0 0 2 = 0
CLOTHESW ASHER I MOP SINK 2 0 3 = 6
\CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (1 PER lRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRIG I WATER STATION I ETC. 0 0 1 = 0
IRECEPTOR FOR COM. SINK I DISHWASHER I ETC. 0 0 3 = 0
I SHOWER, SINGLE STALL 0 0 2 = 0
I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 2 0 3 = 6
I SINK: COMMERCIAL BAR 0 0 2 = 0
I SINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 4 0 1 = 4
URINAL, STALL/WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
TOILET, PRIVATE INSTALLATION 4 0 3 = 12
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 34
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$I,OOO
ASSESSED VALUE
$5.29
$5.29
$5.19
$5.12
$4.98
$4.80
$4.63
$4.40
$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 ELGlBLE FOR ANNEXATION CREDIT?
(Enter] for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
o
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE 11000 CREDIT RATE
$0.00 x $5.29
= ,
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE 11000 CREDIT RATE
$0.00 x $5.29
o
=
$0.00
TOTAL MWMC CREDIT
f\1\ . '.
~ ~r~:Willamalane
~..J..... ""'fI Park & Recreation District . Job. No. ~-O II ~
"". SYSTEM DEVELOPMENT CHARGE
WORK'SHEET '
NAME:. J LJ J4.0#le.,,~
AD6RESS: ,/Pr.-O. ~ jCfy-, '~f,Jc:.-II
, I
tOGA TION OF PROPOSED BUILDING SITE: "
Street Address: , 9isS-/r-t( ~7- .A->ckr Sr-
I'
Plat Name: Alr Ma-J-dr Tax Lot Number: kjL:1
PHONE: fs-rfD S-13-22ZB'
, ~,
STATE: 0(( ZIP: '17-L/2b
1~ 'DEVELOPMENT TYPE: (ChecK appropriate dwelling(s). sac calculations and dwelling t
, yPe definitions are on the back.)
. ,
, A., lliDqle-F8mily Det:;3ched
Single Family home
'NO. OF UNITS
Manufactured home not in a park
,X $1.000 per unit, == $'
8. Sinqle-F8mi~Attached
NO. OF UNITS
.9-,
X ,$924 perunit . ==, $ ~Lft?J
C. Mulfi~F9mi1v Apartment
NQ. OF UNITS
. X .$692 per unit = $
D~ .M~mt1facft1md Home P8rt
. . ,
NO. OF UNITS
, WILlAMALANE SDC
, X $699 per unit':::: $
$ 'lf33e
, ' ,
2. sac CREDIT (ifiIppllcable) SDCiJayer must furnish proof of
Willamalane Credit apprqval. See SOC Credit Worksheet. $
3~ TOTAL WILLAM'ALANE NET SOC ASSESSED
Of sac reduced for Credit) , $
~
Development Services Department
,City of Springfield '
------ .
(0 I ~ I
Date
~8L{B,
a~
:9 .o,.OSPRINO\FIQ.D '
O'o&.s .
225 FlJ! Itl STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX..qS5~!~6-r~.9
ELECTRICAL ffE~-#'XLICATION . 'tI}Of't~&(j
City Job Number \' 7\ .l)\ \. \ ~ bate .s'~l}a't.,& :--
1. {~m:1~~ 3.
~ ffi+< ( ~
- -. - -
\~m:,-~ ~\ m(f5~ A. Service Included
JOB DESCRIPTION
. \'}\ l)\O~,
, pe:~;ts\re non-transferable and expire if work is
.t,. not started within 180 days of issuance or if work is
Suspended for 180 days.
1000 sq. ft. orless
Each additional 500 sq. ft..or
portion thereof
2:
f
'2. rL pO
-1!(d)
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
2. B.
Electrical Contractor FVe (lj D()J"t El eJ. S.f"J; cQ) ~ C 200 Amps or less
I 7 201 Amps to 400 Amps
Address 11n if J 52 G ~~)- i D 1')1')) 6 N 40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsIV 0115
Reconnect Only
Supervisor License Number if b 0<;]:; c.
Expiration Date / () / 1/2001 Installation, Alteration or Relocation \
I I . 200 Amps or less \. $ 50.00
Constr. Contr. Number 116 "3 '71 201 Amps to 400 Amps . $ 69.00
a/r'\ I 0:- 401 Amps to 600 Amps $100.00
Expiration Date ~ I ~ I ~ tv 0 TI C E: Over 600 Amps or 1000 Volts see "B" above.
Signature of Supervising Electrician :01 S PER M I 70S
A / ,kJ ~ ------m- COMTHORIZED UH6f*mgo~ofl:HfnW@RKrpanel
. 71/c:2y4<.A 4!/jt~ MENCED 00nFff.' i\jf~Ir" ERMIT IS NOT
/ ~'\ 1\ ArlY I ~O DAY p~A .DdIfilMkl~/l&rJWith
Owners NR \ ttU N\ PS ~M~t'e or Feeder Permit
Addrey\ )' \ .r2A5 E.
City \' . (~\_ Phone_ Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergyIResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
~~rn .00
~ l,aY
f1. b-.gb
'^~\~
City CUCi PIo\.Q.
J
bor~b9o'l
Phone
l&~t[INSTAISfrATIONJ requires you to
follow rules adopted by the Oregon Utility
N oWP;~ !wi~~\atiQ..q;i~.:.q~U;rgl !!1~~el~IlIP!,ORr~sl::~\f8 r'fll?-ich
I',,., fisiDO,t ,intended.for\~s~e; -leaseuoli'f.lent.'1R 952 001
.Ivr" vvc:....-VVI.V_fV UIIV ~l un .-
0090. You may obtain copies of the rules b\
O,wners Sia~ature, (N h ' J
. Gallli Ig LI ~~ ~~j lLer. ate: t e telephone
number for the Oregon Utility Notification
!""'_,_..._..:.......f nn.n. "''11''\ nl""l A A\
__............. ,_ I _~"'~ \Jv/;,.,,-.tJ-v--t-rJ.
Inspection Request: 726-3.169
$ 63.00
$ 75.00
$125,00
$163.00
$375,00
$ 50.00
!fi) /J)
$ 43.00
$ 3.00
r~~'f.~I~ "
4. K:i$JlJ1IO}:'
1f~:~;2'i~:;ik'dr;~i:l~1'Ef:#
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive<T: )/Buildinl( Forms/Electrical Permit Application (.a3.doc