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Home My WebLink AboutPermit Building 2013-4- SPRINGFIELD 4 225 Fifth St .' �— CITY OF SPRINGFIELD Springfield,OR 97477 h . ( t Phone: 541-726-3753 '' osEGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2012-02562 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/17/2013 EXPIRES: 10/14/2013 STATUS DATE: 04/17/2013 APPLIED: 12/31/2012 • SITE ADDRESS: 5540 HIGH BANKS RD,Springfield,OR 97477 SCOPE: Single Family Residence ASSESOR'S PARCEL NO: 1702284301306 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Struc-New single family dwelling- Lot 1 Eureka OWNER: MIKE BLANKENSHIP CORP Phone Number: ADDRESS: 6063 THURSTON RD SPRINGFIELD OR 97476 L CONTRACTOR INFORMATION Contractor Type Contractor Name' Lic Type Lic No Lic Exp Phone Plumbing Contractor DOUGS PLUMBING INC CCB 110163 11/24/2013 541-688-3385 GERARD ELECTRIC (C)Electrical Cont 20-284C 07/01/2014 541-741-2596 Mechanical Contractor i COMFORT FLOW HEATING CO CCB 460 06/27/2013 541-726-0100 General Contractor MIKE BLANKENSHIP CORD CCB 78966 01/09/2014 541-746-0194 INSPECTIONS REQUIRED Inspections 1020 Zoning Setbacks 1090 Street Trees 1110 Footing Footing: After trenches are excavated. 1118 Footing Drain 1120 Foundation Foundation: After forms are erected but prior to concrete placement. 1160 UFER Ground Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 1220 Underfloor framing 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. 1520 Interior Shearwall Shear Wall Nailing: Before covering sheathing with finish materials. . ATTENTION: Or:g:^ is::: r c.;::i:;c ;,;,, to 1530 Exteft510,1 rjeag adopted by the Oregon Utility ranTl� 1540 Gy sQl�it�b'ard�k�ih�6r° IThOSe rules qi%A:i'P}ldr to taping. Lath/Plaster:J9pp l� r II lathin and sum in��OAR 952-001-0010 through OFlioard?interior and exterior are in placd,Nbtttt n s''r 1 LL XPIRE IF THE WORK 1999 Fin2lt u0' inuu I/lay °Dial" Copses Ot 'Final`guiiding: After all required insp�'diont1 4tUnveq�sEldT}�ailpc TntS NOT calling the center. (Note: thet ine buiiding is complete. COMMENCED OR IS ABANDONED FOR number for the Oregon Utility NosF^a.t. )n ANY 180 DAY PERIOD. Center is 1-8OG-332-23-,4,I. Springfield Building Permit 4/17/2013 11:59:18AM Page 1 of 2 r SPRINGFIELD 225 Fifth St-� 6 CITY``, OF SPRINGFIELD Springfield,OR 97477 _ C Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2012-02562 www.springfield-or.gov permitcenter @springfield-or.gov 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 or 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 - property, and the approved set of plans will remain on the site at all times during construction, &I t(//745 Owner or Contractor Signature Date Springfield Building Permit 4/17/2013 11:59:13AM Page 2 of 2 • SPRINGFIELD CITY OF SPRINGFIELD . cDH TRANSACTION RECEIPT Sprigfield,OR 97477 541-726-3753 811-S PR2012-02562 vA wspringfield-ogov 5540 HIGH BANKS RD permitcentera @springfield-or.gov RECEIPT NO: 2013000764 RECORD NO:811-SPR2012-02562 DATE:04/17/2013 DESCRIP_TION__ --_-�; _._ ?_ _ _, „_...__ _",. ::":,,,,-ACCOUNT-CODE/TRANS CODE_ :t L __ :,,AMOUNT_DUE_,.. Address Assignment,each new or change 224-00000-425602 1020 38.00 Curb Cut/Driveway 1st Cut 201-00000-428060 1141 97.00 Planning-Major Review-City 100-00000-425002 1231 211.00 Residential Fire(.05 Per Sq Foot) 100-00000-424005 9111 89.00 SDC:Administrative Fee-MWMC Regional Wastewater SDC 611-00000-426604 1189 10.00 SDC:Compliance Cost-MWMC Regional Wastewater SDC 444-00000-426607 1113 22.61 SDC: Improvement-Transportation SDC 447-00000-448027 1174 955.32 SDC: Improvement Cost- Local Wastewater 443-00000-448025 1184 779.80 SDC: Improvement Cost-MWMC Regional Wastewater SDC 445-00000-448025 1187 1,392.04 SDC: Improvement Cost-Storm Drainage 440-00000-448028 1176 319.08 SDC: Reimbursement-Transportation SDC 446-00000-448026 1173 262.11 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 1,597.71 SDC: Reimbursement Cost-MWMC Regional Wastewater SDC 444-00000-448024 1186 108.14 SDC: Reimbursement Cost-Storm Drainage 441-00000-448029 1177 219.04 SDC:Total MWMC Administration Fee—Local 719-00000-426604 1121 76.64 SDC:Total Sewer Administration Fee 719-00000-426604 1175 118.88 SDC:Total Storm Administration Fee 719-00000-426604 1180 26.91 SDC:Total Transportation Administration Fee 719-00000-426604 1190 60.87 Second Permit Discount 201-00000-428060 1148 64.00 Sidewalk up though 90 Feet 201-00000-428060 1142 97.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 112.89 Structural Building Permit Fee 224-00000-425602 1002 940.74 Technology fee(5%of permit total) 100-00000-425605 2099 61.84 Willamalane fees-Single family detached 821-00000-215023 1074 3,499.00 TOTAL DUE: 11,159.62 LPAYMENT_TY_PE' PAYOR `CASHIER:.JLARSON . COMMENTS __:.- . .AMOUNT PAID ___ Check MIKE BLANKENSHIP CORP 11,159.62 14424 TOTAL PAID: 11,159.62 SPRINGFIELD CITY OF SPRINGFIELD __Lear:Tsai - \CIREGON 6 TRANSACTION RECEIPT 225 Fifth St Springfie Id,OR 97477 541-726-3753 811-SPR2012-02562 www.springtield-or.gov 5540 HIGH BANKS RD perrnitcenter@springtteld-orgov RECEIPT NO: 2012002575 RECORD NO:811-SPR2012-02562 DATE: 12/31/2012 IDESoklEtkiN ,-4. 1, t,F :r.r... "--- .: * --.;:t ::.: -:.C.,,I,"7-Acbtairir.ttibEtniASs OboE ‘.:,'- : :--AM•iin■i-LDOE-riid Structural Plan Review Fee Residential 224-00000-425602 1061 611.48 TOTAL DUE: 611.48 i•?.-PAYMENT-17.TO'4:•'-'• PAYORce-SE1100:004RELENITIR-'SA -;4;iOPMMENTS.^CIF". 6.it:';' :V‘c,44 -AMOUNT PAID. '•:".....-.."- Check MIKE BLANKENSHIP CORP -----611.48 ----- 14192 TOTAL PAID: 611.48 • tructural Permit Application DEPARTMENT USE ONLY CITY OF SPRINGFIELD;OREGON Permit no.:c2 225 Fifth Street•Springfield,OR 97477♦PH(541)726-3753•FAX(541)726-3689 ea- 0 %" �c- Date:7 2/1?///Z This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuand/e or if work is suspended for 180 days. ...;LOCAL GOVERNMENT,,APPROVAL'+ , ; This project has final land-use approval. Signature: Date: FEE SCHEDULE This project has DEQ approval.. 1-.Val'uatibn-information `.:..^' Signature: Date: (a)Job description:Nc� s//[/ 6.6: 61--n_ Fp y,./u,; Zoning approval verified: ❑ Yes ❑No Occupancy it7/y Property is within flood plain: ❑ Yes ❑No Construction type( ✓? o- � �.° cg.CATEGORYt;QF ONSTRUCTION` - .-�' -«S Square feet: �3y7 / U O residential ❑Government ❑Commercial Cost per square foot: JOB SITE INFORMATION?SA■D LOCATION ` JJ Other information: Job site address: ,rst{p II Q� &1/ t/215 Type of Heat: City: s p State: ZIP: Energy Path: ,---2. ipn Subdivision:Ii4 Cs9 Lot no.: i mew ❑ alteration ❑ addition Reference: /702_ 2,7-tf3 Taxlot:O/30L (b)Foundation-only permit? ❑Yes No PROPERTY OWNER yo // 6- 71/K&Q t-044-19 Total valuation $��/ -_ Name: P 2; Budding fees, e a '; ;, Address: ,y (a)Permit fee(use valuation table): . Se-3r 0 City: - State: ZIP: (b)Investigative fee(equal to[2a]): $ Phone: - - Fax: - - (c)Reinspection($ per hour); $ E-mail: (number of hours x fee per hour) This installation is being made on reside�.+-I or farm property owned by (d)Enter 12%surcharge(.12 x[2a+2b+2c]): $ 1f2 me or a member of my immediate f.�r and is exempt from licensing requirements under 0RS 711.0 0. (e) Subtotal of fees above(2a through 2d): s / 1 3=Ylan rvew ee 1q -Ii a *1ti F- .i Sign here: (a) Plan review(65%x permit fee[2a]): $ (al/41. CONTRACTOR INSTALLATION;. (b)Fire and life safety(40%x permit fee[2a]) $ Business name: /✓l t[l� Z one 0s Ito 6..413-�I Address: 623 R5/19A! (c) Subtotal of fees above(3a and 36) $ , / City: SPPD State: f2 ZIP�79 4.?1VItscellaneous..fees j.70?r,.., Phone: - Fax: 5,30,_. 7vE.�-$ (a) Seismic fee, 1%(.01 x permit fee[2a]) $ 5Y/ �/t r!S E-mail: TOTAL fees and surcharges(2e+3c+4a): S/-7/...2 L - CCB license no.: / L Print name: / V Ai. 6L•*vr - ''rle (2 . Signature: /� . VSUB CONTRACTOR'INFORMATION]'` - , ;,.*;'' Name CCB�Li^ce'n`se Number Phone Number Electrical ‘zfli vo 4-aCr Ili-2S9,L Plumbing V'OU S ,r_n.G 6 F-37� Mechanical 9i-S) riot° Qt7,awillamalane tPark and Recreation District Job. No. S/ z —2 5-62_ PARK AND RECREATION SYSTEM DEVELOPMENT CHARGE WORKSHEET January 1-December 31, 2012 NAME: =71-cf1/lw PHONE: ?to: 0/ 5e/ ADDRESS:Mi.? 77/124;727"/ QdCITY: gip)) STATE:/PX ZIP: %7V 7d LOCATION OF PROPOSED BUILDING SITE: Street Address: 61—Y6 /// /6.�'* /l'-5 Plat Name:L44.42e7cn- / Tax Lot Number: /7/-3 2e X%.7 U/ 32c 1. DEVELOPMENT TYPE (Refer to development type definitions on the reverse.) A. Single-Family Detached NO. OF UNITS / X$3,499 per unit = $ 7y S� B. Single-Family Attached NO. OF UNITS X$3,437 per unit= $ C. Multi-Family Apartment NO. OF UNITS X$2,839 per unit= $ D. Single Room Occupancy NO. OF UNITS X$1,420 per unit = $ E. Accessory Dwelling Unit NO. OF UNITS X$1,750 per unit.= $ 2. SDC CREDIT(If applicable.SDC payer must furnish proof of credit approval.) ($ �� ) 3. TOTAL PARK AND RECREATION SDC ASSESSED $ ?Ll SGI 7z / ) / / / 2. City of Springfield Date of building permit submittal Jr X72/ City of Springfield Date of building permit issuance SPRINGFIELD - 1 225 Fifth St hirSCOREGON CITY OF SPRINGFIELD Springfleld,OR 97477 Phone: 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2012-02565 www.springfield-or.gov permitcenter @springfield-or.gov • PROJECT STATUS: Issued ISSUED: 04/17/2013 EXPIRES: 10/14/2013 STATUS DATE: 04/17/2013 APPLIED: 12/31/2012 SITE ADDRESS: 5540 HIGH BANKS RD,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1702284301306 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Plum-New single family dwelling- Lot 1 Eureka OWNER: MIKE BLANKENSHIP CORP Phone Number: ADDRESS: 8063 THURSTON RD SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OOUGS PLUMBING INC CCB 110163 11/24/2013 541-688-3385 General Contractor MIKE BLANKENSHIP CORP CCB 78966 01/09/2014 541-746-0194 L INSPECTIONS REQUIRED Inspections 3130 Footing/Foundation Drains 3170 Underfloor Plumbing Underfloor Plumbing: Prior to insulation or decking. 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 3315 Water Line 3400 Storm Sewer Storm Sewer Line: Prior to filling trench. 3500 Rough Plumbing Rough Plumbing: Prior to cover and including required testing. 3999 Final Plumbing Final Plumbing: When all plumbing 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 or 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 insp ctions are requested at the proper time,that each address is readable from the street,that the permit card is located at the nt of the property, and the approved set of plans will remain on the site at all times during construction. .... TTE N: Oregon law requires you to rul s adopted by the Oregon Utility P'OTICE: Al A f ,fig-atinn ,Pntpr Those rules are set forth �/ rL lc . No Y�'?��),., PERMIT SHALL EXPIRE IF THE WORK Owner or CorlO�4 1-0010 through OAR 952-001- Date AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification ANY 180 DAY PERIOD. Center is 1-800-332-2344). Springfield Building Permit 4/17/2013 12:02:16PM Page 1 of 1 • I SPRINGFIELD drY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Springfield.OR 97477 — - OREGON 811-SPR2012-02565 541-726-3753 www.springfield-or gov 5540 HIGH BANKS RD permitcenter@springfield-or gov RECEIPT NO: 2013000763 RECORD NO:811-SPR2012-02565 DATE:04/17/2013 s--`,A'AnnotinribilEAA One or Two Family Dwelling with Two Bath 224-00000-425603 1005 374 00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 44 88 Technology fee(5%of permit total) 100-00000-425605 2099 18.70 TOTAL DUE: 437.58 LPAY.66EN:t TYRE:R;:-'1'04t.O.F:t -77CA8}.6i61:1:LA*N "77:::7.:77 :COMMENTS.:n:747i 72:77,7j:7 AnnouNT,PARL.: = Check— MIKE BLANKENSHIP CORP 437.58 14424 TOTAL PAID: 437.58 SPRINGFIELD 225 Fifth St ' � CITY OF SPRINGFIELD Springfield,OR97477 ir 'A-1- Phone: 541-726-3753 � OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2012-02564 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/17/2013 EXPIRES: 10/14/2013 STATUS DATE: 04/17/2013 APPLIED: 12/31/2012 SITE ADDRESS: 5540 HIGH BANKS RD,Springfield,OR 97477 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1702284301306 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Mech-New single family dwelling- Lot 1 Eureka OWNER: MIKE BLANKENSHIP CORP Phone Number: ADDRESS: 8063 THURSTON RD SPRINGFIELD OR 97478 L CONTRACTOR INFORMATION . ` Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Mechanical Contractor COMFORT FLOW HEATING CO CCB 460 06/27/2013 541-726-0100 General Contractor MIKE BLANKENSHIP CORP CCB 78966 01/09/2014 541-746-0194 INSPECTIONS REQUIRED Inspections 2200 Underfloor Mechanical Underfloor Mechanical. Prior to insulation or decking and including required testing. 2300 Rough Mechanical Rough Mechanical: Prior to Cover 2999 Final Mechanical Final Mechanical: When all mechanical 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 or 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 insp- lions are requested at the proper time,that each address is readable from the street,that the permit card is located at the fr.jt of the property, and the approved set of plans will remain on the site at all times during construction. Yifil2___ Owner or Contractor Sign- ur- Date ATTENTION: Oregon law requires you to NOTICE: follow rules adopted by the Oregon Utility • THIS PERMIT SHALL EXPIRE IF THE WORK n OAR Notification Center.1 Those rules are set forth 'UTHORD_ED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the p by rrMtNCED OR IS ABANDONED FOR calling the center. (Note: the telephone - ')Cnlnll. number for the Oregon Utility Notification Center is 1-800-332-2344). Springfield Building Permit 4/17/2013 12:07:21PM Page 1 of 1 r• SPRINGFIELD -- CITY OF SPRINGFIELD i - TRANSACTION RECEIPT SpriingfeldOR 97477 OREGON 541-726-3753 811-S P R2012-02564 www.springfield-or.gov 5540 HIGH BANKS RD permitcenter @springfield-or.gov RECEIPT NO: 2013000761 RECORD NO: 811-SPR2012.02564 DATE:04/17/2013 [DESCRIPTION _ ACCOUNT CODE/TRANSgCODE„ AMOUNT First Appliance Fee 224-00000-425604 1006 79.00 Furnace-up to 100,000 BTU 224-00000-425604 1006 17.00 Range hood/other kitchen equipment 224-00000-425604 1006 13.00 Single-duct exhaust(bathrooms,toilet compartments, utility room: 224-00000-425604 1006 27.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 16.32 Technology fee(5%of permit total) 100-00000-425605 2099 6.80 TOTAL DUE: 159.12 E PAYMENT TYPE PAYOR - CASHIER JLARSON • COMMENTS, - _ AMOUNT PAID -., Check MIKE BLANKENSHIP CORP 159.12 14424 TOTAL PAID: 159.12 • SPRINGFIELD 225 Fifth St ' CITY OF SPRINGFIELD Springfield,OR 97477 { < Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2012-02563 www.springfield-or.gov permitcenter @springfield-or goy . PROJECT STATUS: Issued ISSUED: 04/17/2013 EXPIRES: 10/14/2013 STATUS DATE: 04/17/2013 APPLIED: 12/31/2012 SITE ADDRESS: 5540 HIGH BANKS RD,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1702284301306 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Elec-New single family dwelling- Lot 1 Eureka OWNER: MIKE BLANKENSHIP CORP Phone Number: ADDRESS: • 8063 THURSTON RD SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone GERARD ELECTRIC (C)Electrical Cont 20-284C 07/01/2014 541-741-2596 General Contractor MIKE BLANKENSHIP CORP CCB 78966 01/09/2014 541-746-0194 INSPECTIONS REQUIRED .` Inspections 4000 Temporary Power Service 4225 Service or Feeder - 4500 Rough Electrical Rough Electric: Prior to Cover 4999 Final Electrical 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 or 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 from the property, and the approved set of plans will remain on the site at all times during construction. Owner o ontractor Signature Date ATTENTION: Oregon law requires you to NOTICE: follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 'IITHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by 'MMENCED OR IS ABANDONED FOR - calling the center. (Note: the telephone PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). Springfield Building Permit 4/17/2013 12'.04.57PM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD kir225 Fifth St TRANSACTION RECEIPT Springfield,OR97477 � 541-726-3753 OREGON 811-SPR2012-02563 www.springfield-or gov 5540 HIGH BANKS RD permitcenter©springfield-or.gov RECEIPT NO: 2013000762 RECORD NO:811-SPR2012-02563 DATE:04/17/2013 (DESCRIPTION a_- ACCOUNT_CODE/TRANS_CODE_ > • _AMOUNTDUE3 Each added 500 sq.ft. or portion 224-00000-426102 1004 50.00 Residence wiring 1,000 sq.ft. or less 224-00000-426102 1004 134.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 29.64 Technology fee(5%of permit total) 100-00000-425605 2099 12.35 Temp services 200 amps or less 224-00000-426102 1003 63.00 TOTAL DUE: 288.99 PAYME. NT TYPE',w PAYORv„CASHES:.ILARSON ;"COMMENTS - r. � - °.AMOUNT PAID Check MIKE BLANKENSHIP CORP 288.99 14424 TOTAL PAID: 288.99 • • Electrical Permit Application DEPARTMENT USE ONLY SPNINGFIEL�'�3i[;--'£:�n 'C ITY O F SPRIN,GuFIELD,< Os Rif.EGON, t , ` .: Pettit no ; S/ 2 rt . -Y(. In :ii x -cr _ :Z a-�ti . tr ?ar li;; , * 721'.. , • 7.Y&3 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 .. . Date: ? Z I ?, ) / -Z- This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT`APPROVAL 'FEE SCHEDULE ` Zoning approval verified? ❑ Yes ❑No Number of inspections per item () Qty. Cost Total ;'CATEGORY:OF :CONSTRUCTION . - Residential,per unit,service included: Dtsidential ❑Government ['Commercial , 1,000 sq.ft. or less(4) ( $134.00 $ /'3y :JOOITE -INFORMATION `AND LOCATION Each S6 y 0 /Y/(j/'h3; 7� hereo additional Job site address: ditional 500 sq. ft. or portion $ 25.00 $s-a City: j"rPto State:, ZIP: 97y7er Limited energy(2) $ 32.00 $ Reference: /76Z_ aizis Taxlot.: i)/36(,. Each manufactured home or modular $ 63.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) W(t (�"'b L 7-1=��V PL✓� Services or feeders: installation, alteration,relocation 200 amps or less(2) . $ 81.00 $ PROPERTY. OWNER : 201 to 400 amps(2) $ 95.00 $ 401 to 600 amps(2) $158.00 $ Name: L.>T/(z_C-7._,Otl e 601 to 1,000 amps(2) $205.00 $ Address: gk9 3 cs-7ZAA/ /21) City: State:Q'YL ZIP:c'2Y ZC Over 1,000 amps or volts(2) $469.00 $ ty Sf°FcO Reconnect only(2) $ 63.00 $ Phone: - - Fax: - - E-mail: Temporary services or feeders: installation, alteration,relocation This installation is being made on residential or farm property 200 amps or less(2) / $ 63.00 $ 637. owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 87.00 $ property is not intended for sale,exchange, lease, or rent. OAR 479.5400) and 479.5600). 401 to 600 amps(2) $126.00 $ Signature: Over 600 amps or 1,000 volts,see services or feeders section above :CONTRACTOR INSTALLATION Branch circuits: new, alteration, extension per panel Business name:Ce-vrr.- EInc 11—tc_ a. Fee for branch circuits with purchase of a service or feeder fee: Address qSq�'+/A(t`e,J 3' r`CI Each branch circuit $ 6.00 $ City:c S,prt..-Cc_///c State:6/2. ZIP.f�7'/7'7 b.Fee for branch circuits without purchase of a service or feeder fee: Phone: ✓✓ -f(- .2SYEs Fax: SQ..-Z- First branch circuit(2) $ 55.00 $ E-mail: / Each additional branch circuit $ 6.00 $ CCB license no.: O 7I` .S. BCD license Cno,20 _2 Y Z C Miscellaneous fees:service or feeder not included Signing supervisor's license no.: j 6 5-t Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor: Cja.,-L� A i( Each sign or outline lighting(2) $ 63.00 $ Signature of signing supervisor/El Signal circuit or a limited-energy panel, $ 63.00 $ g gn g alteration,or extension(2) Each additional inspection: (1) $58.00 $ 'APPLICANT, USE (A) Enter subtotal of above fees- $ j, (Minimum Permit Fee$58.00) (/ 7 (B)Enter 12%surcharge(.12 x[A]) $ 29‘°N 35 (C)Technology Fee(5%of[A]) $ 1 2 TOTAL fees and surcharges(A through C): $ 2859e 440-2584-1(9/08/COM)