HomeMy WebLinkAboutPermit Building 2004-7-12
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Status
Issued
I'
I
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Lhie
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2004-00400
ISSUED: 07/12/2004
APPLIED: 04/12/2004
EXPIRES: 01112/2005
VALUE: $ 268,184.00
SITE ADDRESS: 6793 Aster St 208 S 67th Ct
ASSESSOR'S PARCEL NO.: 1702344403600
Springfield TYPE OF WORK: Duplex
TYPE OF USE:
New
PROJECT DESCRIPTION: St Lucia PL Subdiv.lot 19 - Duplex
Owner: COREY DEVELOPMENT LLC
Address: 3956 MIRROR POND WAY EUGENE OR 97408
Contractor Type
General
Electrical
Mechanical
Plumbing
Phone Number: 541-344-0250
A ~Of~J.fi6fJto
":IOW aoopwa uy u IV 3. 'W.w.... i1lty
Contractor Notification Center. Those rute&r!~.~~xPiration Date
CONSTRUCTI~~~~5~ 02/2412006
EVERYDAY E~,~~ltdB COples~ rules by 08/12/2005
COMFORT FLO~ai"ng the cantet' (Note: tIW~el~~ho~e 06/27/2005
RS PLUMBING ~<ttI~~Oregon. Utill~~~flcatlol\ 01104/2006
I Bu~iN~l~l.
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
2
R-3
U-l
VN
14.00
6.30
21.30
0.00
Residential
Phone
541-688-1907
541-607 -6908
541-726-0100
541-461-4714
6
# of Stories: 2
Height of Structure' 28.00
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path: Path 1
Sprinkled Building: n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
1,386
1,366
572
I DEVELOPMENT INFORMATION.
REQUIRED PARKING
4,
Pal!e 1 of 4
FullV Improved
Yes Downspouts/Drains: Curb and Gutter
Sidewalk is set back on Aster Street and curb side on Soufreiere Court. NO SANITARY SEWER
CONNECTION OR FINAL OCCUPANCY UNTIL APPROVAL OF PUBLIC IMPROVEMENT
PLANS, See Ron Sather for status of public improvement process #726-2240.
Overlay Dist: Total:
# 1\It~ Rqd: ~ E wotMndicapped:
Pa \ r~J1F SHALL EXP\RE 'ie/ft~T \S Nbtmpact:
% Rb\\~M~NDER 1HIS Biio"
~~"\MFNCED OR \S ABANDONED FOR
I PUBLIC ~mtE~lUU'
Sidewalk Type:
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2004-00400
ISSUED: 07/12/2004
APPLIED: 04/12/2004
EXPIRES: 01/12/2005
VALUE: $ 268,184.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriution 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
2,752.00
572.00
Value
Date Calculated
Description
Total Value of Project
$254,284.80
$13,899.60
$268,184.40
04/1212004
04/1212004
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $724.69 4/12/04 1200400000000000456
-Mechanical Issuance Fee- $10.00 7/12/04 1200400000000001067
+ 10% Administrative Fee $212.89 7/12/04 1200400000000001067
+ 7% State Surcharge $149.02 7/12/04 1200400000000001067
2 Baths One or Two Family $254.00 7/12/04 1200400000000001067
3 Baths One & Two Family $306.00 7/12/04 1200400000000001067
Addressing Assignment $62.00 7/12/04 1200400000000001067
Appliance Vent $12.00 7/12/04 1200400000000001067
Building Permit $1,114.90 7/12/04 1200400000000001067
Curbcut Permit $75.00 7/12/04 1200400000000001067
Dryer Vent $12.00 7/12/04 1200400000000001067
Exhaust Hoods $18.00 7/12/04 1200400000000001067
Furnace - up to 100,000 btu $24.00 7/12/04 1200400000000001067
Gas Outlets 1-4 $8.00 7/12/04 1200400000000001067
Plan Review Major - Planning $103.00 7/12/04 1200400000000001067
PW Mult Disc - 2nd Permit $-30.00 7/12/04 1200400000000001067
Residence Wiring 1000 Sq Ft $212.00 7/12/04 1200400000000001067
Residence Wiring Ea AddU 500 $76.00 7/12/04 1200400000000001067
Sanitary Sewer - Improvement $705.61 7/12/04 1200400000000001067
Sanitary Sewer - Reimbursement $928.24 7/12/04 1200400000000001067
SDC MWMC Administration $10.00 7/12/04 1200400000000001067
SDC MWMC Improvement $428.46 7/12/04 1200400000000001067
SDC MWMC Reimbursement $629.26 7/12/04 1200400000000001067
SDC Sanitary/Storm Admin $154.44 7/12/04 1200400000000001067
SDC Transpo Admin $111.63 7/12/04 1200400000000001067
SDC Transpo Improvement $1,454.83 7/12/04 1200400000000001067
SDC Transpo Reimbursement $329.78 7/12/04 1200400000000001067
Sidewalk Permit $75.00 7/12/04 1200400000000001067
Storm Drainage Impervious Area $835.20 7/12/04 1200400000000001067
Temp Power 200 amps or Jess $50.00 7/12/04 1200400000000001067
Vent Fan $42.00 7/12/04 1200400000000001067
Willamalane Attached (duplex) $1,848.00 7/12/04 1200400000000001067
Total Amount Paid $10,945.95
Pal!e 2 of 4
Building/Combination Permit
PERMIT NO: cOM2004-00400
ISSUED: 07/12/2004
APPLIED: 04/12/2004
EXPIRES: 01112/2005
VALUE: $ 268,184.00
Status
Issued
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
06/03/2004
06/03/2004
06/07/2004
I Plan Reviews I
06/03/2004 APP
07/07/2004 APP
06/15/2004 APP
LLH
TAJ
VRJ
Structural Review
05/04/2004
DLM
05/06/2004 APP
Structural Review
05/03/2004
05/03/2004 WE
DLM
CITY OF SPRINGFIELD'
NO SANITARY SEWER
CONNECTION OR FINAL
OCCUPANCY UNTIL APPROV At
OF PUBLIC IMPROVEMENT
PLANS, See Ron Sather for status oj
public improvement process
#726-2240.
Received fax of proposed changes
for fire separation from designer.
Further modification is required to
meet Code requirement. Called
designer - He will respond with
additional corrections. 5/4/2004 dim
Received additional drawing needed
to complete the review. 5/6/2004 dim
See documents for Plan Review
Comments
Need additional and revised
information for fire separation
between units at upper level and at
patio. Contacted designer and
requested the additional
information. 5/3/2004 dim
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.
~eouire~nsnections I
Site Inspection: To be made after excavation but prior to setting forms.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
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.
Firewall: Located and constructed according to plans.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Sidewalk - Setback: After forms are erected but prior to placement of concrete.
Curbcut - Second: After forms are erected but prior to placement of concrete.
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to floor insulation or decking.
Pal!e 3 of 4
-WIL~,~~'~~f,!':J;t"'P
j ~,
~^- .....~"';~...,--'..._-
{,
......... -- .-.
CITY OF SPRINGFIELD'
Building/Combination Permit
Status
Issued
PERMIT NO: cOM2004-00400
ISSUED: 07/12/2004
APPLIED: 04/12/2004
EXPIRES: 01/12/2005
VALUE: $ 268,184.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Underfloor Plumbing: Prior to insulation or decking.
Underfloor Drain: Prior to cover or placement of concrete.
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 Gas: After line is installed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
Rough Mechanical: Prior to Cover
Final Gas: When all gas 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 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 during construction.
'\)\:\r\,). ~\
Owner or Cont,"cton Signature )
! l\~\ {)4
Date
Pa2;e 4 of 4
. 225 F,ifth Street
Springfield, Oregon 97477
541-726-3759 Phone
iii~
Job/Journal Number
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
Payments:
Type of Payment
Check
CreditCard
7/12/2004
RECEIPT #:
1200400000000001067
Description
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
Building Permit
2 Baths One or Two Family
3 Baths One & Two Family
Furnace - up to 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
-Mechanical Issuance Fee-
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Addressing Assignment
Willamalane Attached (duplex)
+ 7% State Surcharge
+ 10% Administrative Fee
Plan Review Major - Planning
r:ty of Springfield Official Receipt
velopment Services Department
Public Works Department
Date: 07/12/2004
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Paid By
COREY DEV
DEBRA COREY
djb
djb
Page I of2
5065
000436
In Person
055457 In Person
Payment Total:
10:57:41AM
Amount Due
75.00
75.00
(30.00)
835.20
928.24
705.61
329.78
1,454.83
629.26
428.46
10.00
154.44
111.63
1,114.90
254.00
306.00
24.00
42.00
12.00
18.00
12.00
8.00
10.00
212.00
76.00
50.00
62.00
1,848.00
149.02
212.89
103.00
$10,221.26
Amount Paid
$1,721.26
$8,500.00
$10,221.26
.lob/Journal Number
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004c00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
COM2004-00400
Payments:
Type of Payment
Check
CreditCard
7/12/2004
RECEIPT. 1200400000000001067
Description
Sidewalk Permit
Curb cut 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
Building Permit
2 Baths One or Two.Family
3 Baths One & Two Family
Furnace - up to 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
-Mechanical Issuance Fee~
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Addressing Assignment
Willamalane Attached (duplex)
+ 7% State Surcharge
+ 10% Administrative Fee
Plan Review Major - Planning
)ate: 07/12/2004
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Paid By
COREY D,EV
DEBRA COREY
djb
djb
5065
000436
1".
Page 2 of2
In Person
055457 In Person
Payment Total:
10:57:41AM
Amount Due .
75.00
75.00
(30.00)
835.20
928.24
705.61
329.78
1,454.83
629.26
428.46
10.00
154.44
111.63
1,114.90
254.00
306.00
24.00
42.00
12.00
18.00
12.00
8.00
10.00
212.00
76.00
50.00
62.00
1,848.00
. 149.02
212.89
103.00
$10,221.26
Amount Paid
$1,721.26
$8,500.00
$10,221.26
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENf'J~RKSHEET
JOURNAL OR JOB NUMBER: Com2004-00400
NAME OR CaMP ANY: Corey Development
LOCATION: 6793 Aster Street & 208 S 67th Court
TAX LOT NUMBER: 17023444 tI 500
DEVELOPMENT TYPE: SINGLE F AMlL Y RESIDENCE
NEW DWELLING UNITS 2 BUILDING SIZE (SF: 3324 LOT SIZE (SF):
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x COST PER S.F. CHARGE
I 2880.00 $0.290 $835.20
RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. I x COST PER S.F. x I DISCOUNT RATE DISCOUNT
I 0.00. I $0.290' I 50% $0.00
ITEM 1 TOTAL - STORM DRAINAGE SDC , $835.20
2. SANITARY SEWER - CITY
. A. REIMBURSEMENT COST:
NUMBER OF DFU's x COST PER DFU
41 $22.64
B. IMPROVEMENT COST:
I NUMBER OF DFU's
I 41
x [ COST PER DFU
, $17.21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =,
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE x NUMBER OF UNITS x I
I 9.57 2 I
B. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS x
I 9.57 I 2
ITEM 3 TOTAL - TRANSPORTATION SDC = ,
$1,633.85
COST PER TRIP
$17.23
x INEW TRIP FACTOR
I 1.00
COST.PER TRIP
$76.01
$1,784.61
x NEW TRIP F ACTORI
1.00
6003
$835.20
$928.24
$705.61
$329.78
$1,454.83
= $629.26 . 1054
= , $428.46 11055
" $0.00 11054
, $10.00
= , $1,067.72 1056
---
= , $5,321.38
CHARGE
$266.Q7
154.44 1079
$111.63 1078
TOTAL SDC CHARGES $5,587.45
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's x COST PER FEU
I 2 $314.63
B. IMPROVEMENT COST:
INUMBER OF FEU's
I 2
x ICOST PER FEU
I $214.23
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SD(
SUBTOTAL (ADD ITEMS 1, 2,3, & 4)
5. ADMINISTRATIVE FEE:
ISUBTOTAL I x I ADM. FEE RATE
, $5,321.38 l I 5%
TOTAL SANITARY ADM1N1STRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Virginia Jurasevich
6/14/2004
PREPARED BY
DATE
r:/)
f.I.1
~
o
u
~
f.I.1
r-<
r:/)
I~
1107,0
1091
1092
1093
1094
~ '..
DRAINAGE FIXTURE UNIT (DFU)"CALCULATION TABLE
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
CREDIT RA TE/$I ,000
ASSESSED VALUE
$5.04
$5.04
$4.95
$4.88
. $4.75
$4.58
$4.41
$4.20
$3.88
$3.50
$3.07
$2.60
$2,14
$1.71
$1.52
$1.38
$L19
$1.03
$0.87
$0.68
$0.46
$0.27 I
'$0.09
$0.04 .
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
IS LAND ELGIBLEFOR ANNEXATION CREDIT?
(Eriter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
CREDIT FOR LAND (IF APPLICABLE)
VALUE I 1000 CREDIT RATE
$0.00 x $5.04
= I
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0.00 x $5.04
TOTAL MWMC CREDIT
=
o
o
1979
$0.00
o
$0.00
225 FIFTH STREET
SPRlNGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELE CAL PERNfIT APPLICATION
City Joh NumhcrL~ -IJ/)~O
3. COMPLETE FEE SCHEDULE BELOW
1. LOC~Jj.QN RF I~TALLATI~~. .
. u,'lg-a H~T/er~ Zl)~ b.~~.Rcsidcntial-Singlcor
. crort Multi-Family pcr dwelling unit.
LE\G~h)rt.344.~~~d1 Servicc Included: Items Cost
"\ :he fOIJ~win9 r .
JOB DESCRIfTION .;~nlng. and d~e~ect as SUbrnMJNP s~.ft. or less
r])Ll pl_~ _ prova/ not reqUirelS~n8~~~tdVi&a~
I Zoning __~ sq. ft or por11tJi'te
Permits are non-transferable and e\.1H~ ----2:L y_ ~
if \vork is not started within 180 da}l$thorize . ' ---- 0 E:ach M,lillif'ct-H.etne or
of issuance or if work is suspended for cf Signature 10 u~Ug
180 days. ffice..QJ::J~:der
, . , . --rLIJ: \;~Jr\P\K
2. CONTRACT~,f,., .3.,.~..f~..... ~L..... A:. I~~. ~ PNFr.,.F...\.....'.i; \-._..... ,.1=. Bl.......'.'..~''VI~,~~fr Fe.edcrs .
...",.,;;"c,nf1t "., [. :?~:'i ~ .]\ttS allatlOn AlteratIOns or
Electrica 1. Contrac~r ft~~~~if.)f~~~~t..i~~ \j .J?:r.~~)~ t\Rel ocation: '
Address P. M.E 11i~;'J~~'~J'~.~~ \~:t.)~;~'f\l fJV~nv~ 200 amps or less
"\ \j j'\ I \ ~. . 20 1 amps to 400 amps
City [UC:ff'J.... Phone 601- b9rY6 401 amps to 600 amps
601 amps to 1000 amps
Supervisor License Number L/ 60~ :) O\'er 1000 amps/volts
Reconnect Only
/> 71.. _ b J D. Branch Circuits \0
Owncrs Namc ( ~ ut:l/Ar~~. l.--Ce. .1\'C~.~~\""rSion Per Panel
,..4 ~. Otago" \8 OtegoO ,ortn
Address 35,5'Z; ~VA"d ~ ,A,. ." pteo O\lt&~r~~aJe Se\ o\;r'"
- r - ""rr... X s aDO 1" "''r.ose {\1 OPo.f\ 952-
City bl4a,v~, Phonc,,~~~.i~eot~~)'~~~~~~f*,Ja(J~n ~~\\ith Service
"7-1Df;,. . 't'iC';."'\\'vt.\ n.,2-QO'\" ""~~~hij'Wep"o~e $ 3.00
OWNER INSTALLATION \\\ _,PO ~;1..i {{\'3'j obt~\'l\'V)'l.e',~, ~o\\\\ca'i.\on
The installation is being made on Q\).:J. \ \'r\tfC~~cc~~I~'..i1le/feedCr not included)
I I . h' . d d ~\\'r\c . e v~e~~rJ <:1n<:l~ ,.,..,,.
property own w llC IS not mten e C<> .' \r": ~ \0' t\"\ .. :.\)U'(i.;llGSf (tlOn
for sale, lease or rent. t\\",('(\.'''' cen\ef \S '\5Llmp or irrigation $50.00
Sign/Outline Lighting $50.00
Limited EnergyIRes $25.00
Limited Energy/Comm $-l-5_00
Expiration Date 10 I G I f 1..00Li
. I
Constr Contr. Number 13 b '31 /
C. Temporary Scrvicesor Feeders
Installation, Alteration or Rclocation
Expiration Date
~/{2/0 S-
200 amps or less
20 I amps to 400 amps
Over 401 to 600 amps
Oyer 600 amps or 1000 volts see
"E" abo\"e
Signaturc of Supcrvising Elcctrician
.;r+-..., ~
j?! /f 7/'/';"
,rv.....r7/.<. ..
OWIlCJ'S Signaturc:
Sm:n
2- $106.00 2/2..
-1 $ 19.00 lh
$ 50.00
$ 63.00
$ 75.00
$125.00
$163,00
$375.00
$ 50.00
V $50.00 5'D
$69.00
$100.00
$43.00
Minimum Electric Permit InsJlcction Fcc is S-J5.()(} + Surcharges
-J. SUBTOTAL OF ABOVE
7% Statc Surchargc
8% Administrativc Fee
TOTAL
~3Z;.e. a
~...Z.~
3j_~o
;;75:11>