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HomeMy WebLinkAboutPermit Building 2013-4- • i. ( SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR97477 r*Cii Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00638 www.springfield-or.gov permitcenter@spring field-or.gov PROJECT STATUS: Issued ISSUED: 04/17/2013 EXPIRES: 10/14/2013 STATUS DATE: 04/17/2013 APPLIED: 03/28/2013 SITE ADDRESS: 540 COLONIAL DR,Springfield,OR 97477 SCOPE: Single Family Residence ASSESOR'S PARCEL NO: 1703221200400 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: ST Livingroom expansion addition OWNER: DEVINE HEATHER E Phone Number: ADDRESS: 540 COLONIAL DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor DOUGLAS A MOORE CCB 86655 10/13/2014 541-915-7004 INSPECTIONS REQUIRED 1 Inspections 1020 Zoning Setbacks 1120 Foundation Foundation: After forms are erected but prior to concrete placement. 1150 Slab/Flatwork Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved. 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. 1530 Exterior Shearwall 1999 Final Building Final Building: After all required inspections have been requested and approved and the building 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 OrdinanrFn��Df the City of Springfield and the Laws of the State or Oregon pertaining to tt1AT^'PLS`tipIt9T�tbarr 11�d✓t¢ Wiles you to Otani $'will be made of_a"n,y,s,t ,1p� Ission of the Community Servi¢g 8fyiiere8t 1�l9 1 l�r re Dn Utili certity,51F[WITn Ms air W-IOZyre4IND mpliance with ORS 701.005 vtiflgiuue,Qt ji R It ?blare e to nsur� he proper time,that each addr� itiVej l�bMnJ tasfr r1 t set forth it h C�P}1Vff01 G�P��R@ET7�&e61G1 �L7N permit card I�1 e o !Ind the approved set of plans will re n I t a es AR 952-001- consiruncii n!`r � '��'������� ��®• �� Y bYaln cops s of the rules by ' qp DAY,'ERIOD. calling the center. (Note: the telephone number for the Oregon Utility Notification / /t � �U2� Center is 1-800-332-2344). Owner or Contractor Signature Date Springfield Building Permit 4/18/2013 10:29:34AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD << TRANSACTION RECEIPT SpriingfieldtOR 97477 .OREGON 541-726-3753 811-S PR2013-00638 www.springlield-or.gov 540 COLONIAL DR permitcenter©springfield-or.gov RECEIPT NO: 2013000771 RECORD NO: 811-SPR2013-00638 DATE:04/17/2013 (DESCRIPTION - , .. -__-ACCOUNT CODE/TRANS CODE - '__V AMOUNT DUE Residential Fire(.05 Per Sq Foot) 100-00000-424005 9111 20.10 SDC: Improvement Cost-Storm Drainage 440-00000-448028 1176 93.19 SDC: Reimbursement Cost-Storm Drainage 441-00000-448029 1177 63.97 SDC:Total Storm Administration Fee 719-00000-426604 1180 7.86 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 33.87 Structural Building Permit Fee 224-00000-425602 1002 282.25 Technology fee(5%of permit total) 100-00000-425605 2099 14.11 TOTAL DUE: 515.35 . .. . :. AMOUNT PAID•. _ ... _ r,. AYMENTTYPE P___. ________ON '- _,,,a,____MMENTS._.____ _____ ___„..,__ , _. Credit Card DEVINE HEATHER E 515.35 04009C TOTAL PAID: 515.35 SPRINGFIELD CITY OF SPRINGFIELD 225 FMh St � �� � TRANSACTION RECEIPT Springfield,OR97477 541-726-3753 811-S PR2013-00638 www.springfield-or.gov 540 COLONIAL DR permilcenler @springfield-ar.gov • RECEIPT NO: 2013000608 RECORD NO:811-SPR2013-00638 DATE:03/28/2013 :DESCRIPTION " Y ; ACCOUNT CODE__:_ AMOUNT_DUE5-1 Structural Plan Review Fee Residential 224-00000-425602 1061 183.46 TOTAL DUE: 183.46 PAYMENT TYPE, PAYOR^CASHIER:CCARPENTER L7, COMMENTSa.'_; AMOUNT PAID Credit Card DEVINE HEATHER E 183.46 03452d TOTAL PAID: 183.46 • Il Structural Permit Application DEPARTMENT USE ONLY 5 GFlaD --^. ., CITY OF SPRINGFIELD, OREGON : a r�. _.. . ._ . "'�� Permit no.�� _�F 225 Fifth Street♦Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 c� — Date: -r/1 13 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuancor 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"uattort information ( - `.^ • Signature: - Date: (a)Job description: i Z X 33 mPew t.ur61ls SPsce IT7od Zoning approval verified: ❑ Yes ❑No Occupancy t/5 1' Property is within flood plain: ❑ Yes ❑No Construction type: f/.a V oN G-rAolt /wooD Fi'=4.r. .• ids+ k 'CATEGORY-. OF;CONSTRUCTION, ,ilglc- ;i:j, Square feet I-10 2 [3 Residential ❑ Government ❑Commercial Cost per square foot: 62 3rit JOB SITE INFORMATION?':AND LOCATION Other information: Job site address: Silo Ca(0N 1Art 1 v Type of Heat: a-A S fin State: O✓2 ZIP:Q 74 Energy Path: Subdivision: Lot no.: a to 6 O • 7o g 22-1 a Tax ❑ new ❑ alteration 40 addition Reference: PROPERTY OWNER .. - - (b)Foundation-only permit? El Yes .No Name: }�C?TNWe INS Total valuation: , I $ 25;960 Address: , 2 'Building:fees ,,;._. j 1 1 t, p�[•,C 0 Co Go oN/Aa (a) Permit fee(use valuation table): - Oo L. State: oQ ZIP: 174 (b)Investigative fee(equal to [2a]): $ Phone:Stfl-' F 0 6 Fax: - - (c)Reinspection($ per hour): - • E-mail: 'a q .1 A ( , 0) t (number of hours x fee per hour) $ • This installation is being made on resident al or farm property owned by (d)Enter 12%surcharge(.12 x[2a+2b+2c]): $ .3777 me or a member of my immediate family,and is exempt from licensing . requirements under ORS 701.010. _.. p. (e) Subtotal of fees above(2a through 2d): $ f Sign here: 1 - 1 'A • i.[ K- 3:Plan rev w fives s y 3,v, ? +t' >'� "f.c.''}d MI A Ai CONTRACTOR INSTALLATION (a)Plan review(65%x permit fee[2a]): $ /8 3 t{ (b)Fire and life safety(40%x permit fee[2a]): S Business name: . III co •u y • W.12e.p,- ., . (c) Subtotal of fees above(3a and 3b) S Address: Ill9'i • • , QET f. State: O2 i4;,Miscellaneous fee ' Ps^ w . •2^,:.- . Phoney{(-91D= 7oc r/ Fax: - _ (a) Seismic fee, 1%(.01 x permit fee [2a]) $ TOTAL fees and surcharges(2e+3c+4a): 5 - j3� E-mail: VN I rre_ t. ,e n _ T.Nor CCB license no.: r 6 7. 5 • OW / a " , �"-'SUB CONTRACTOR.lNFORMATION` y MM Name CCB License Number Phone Number Electrical Plumbing Mechanical • SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 j: OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00707 www.springfieldor.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/18/2013 EXPIRES: 10/05/2013 STATUS DATE: 04/18/2013 APPLIED: 04/08/2013 SITE ADDRESS: 540 COLONIAL DR,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703221200400 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: EL Livingroom expansion addition . OWNER: DEVINE HEATHER E Phone Number: ADDRESS: 540 COLONIAL DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor DOUGLAS A MOORE CCB 86655 10/13/2014 541-915-7004 INSPECTIONS REQUIRED III Inspections 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 front of the property, and the approved set of plans will remain on the site at all times during construction. ft /, 40..„, 9_ /, _ , Owner or Contractor Signature Date • • ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE' Notification Center. Those rules OAR 952-001- n OAR 952 001 0010 throng THIS PERMIT SHALL EXPIRE IF THE WORK 0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR number fforterisO1e800-332-2344)ification ANY 180 DAY PERIOD. Springfield Building Permit 4/18/2013 10:39:43AM - Page 1 of 1 • SPRINGFIELD --- CITY OF SPRINGFIELD TRANSACTION RECEIPT 9priingfe14oR 97477 OREGON 541-726-3753 811-SPR2013-00707 www.springfieid-or.gov 540 COLONIAL DR permitcenter @springfield-or.gov RECEIPT NO: 2013000774 RECORD NO:811-SPR2013-00707 DATE:04/18/2013 IDESCRIPTION�� - ` - ` _ .,_ : : ACCOUNT CODE/TRANS CODE , __ ,__AMOUNT DUE;.-; Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 55.00 Branch circuits without service or feeder-each additional 224-00000-426102 1004 12.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 8.04 Technology fee(5%of permit total) 100-00000-425605 2099 3.35 TOTAL DUE: 78.39 _IE AMOUNT PAID LPAYMENT TYPE -'� PAYOR cnswER:w.RSOR "_ � - . �COMMENTS - � - � --.' Credit Card DEVINE HEATHER E 78.39 06490C TOTAL PAID: 78.39 Electrical Permit Application-Electrical Permit 2009 Rev.pdf http://www.springfield-or.gov/dsd/Building/Library/Electrical Permit... Electrical Permit Application DEPARTMENT USE ONLY CITY Y r,1' SNK1NG1'11'.1.1). OREGON pemrit no.:S(3 r Ze ci 215 Fifth Strnt•Spuna6<id,OR 97477*PB(50)726d753e F.lr(5J)726J689 Date: 3i 7��1 3 • 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 ISO days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? 0 Yes 0 No Number of lnspectloos per item() Qty. Cost ea. Total CATEGORY OF CONSTRUCTION Residential,per unit,"n'ice included: $1 Residential 0 Covenantal I 0 Cmmnercial JOB SITE INFORMATION AND LOCATION 1.000 sq.n.mlesa(J) f136.60 i Job site address: thereof cch additional 500 sq.ft.or portion E 25.00 E S90 Co/oh//si_ Pie city:'SeA 4046,-teed (State: 01? ZIP: Limited energy(2) 5 32.00 S Reference: I Taxlol.:/703-22 Each manufactured home or modular o Ym 583.00 f DESCRIPTION OF WORK dwellivgsmice or feeder(2) 4 I/ k- hi 0 o /n-/� Services or feeder,:rnrtallanon,alre anon.'decor:on AJ 0- +may 1.��fci/ 200 amps or less(2) S 81.00 S A)ots h n Al Y ERTY OWNER 201 to 400 amps(2) S 95.00 E Name: -'l e,Amet DEIthf,e JOI to 600 amps(2) 5155.00 S Address: .5- lo Ulm N/AL 9 l 601 to 1.000 amps(2) $205.00 S Ci p Stare: n ZIP: Over 1.000 amps mantel('_) $669.00 E ty' Sp Fes I QF Reconnect only(2) f 63.00 S Phone: SN1- 4.$ gold Fax: - - d. E-mail:he.A44hs/,VCi e0V1t'tfwla ll.en m Temporary sen-Ices or feeders:insrallanon.chernnon.Ielocanon dal 200 amps or Ins(2) S 63.00 E This installation is being made on residential or from property owned by me or a member of my immediate family.This 201 to 400 amps(2) S 87.00 E property is not intended for sale.exchange lease,or rent.OAR 479.540(1)and 4 5 ). p 401 to 600 amps(2) (126.00 S . . Signature: l ,1 .411�4 Re Over 600 amps or 1.000 volts.see services or feeders section above__ Tr CONTRACTORvINNS,,STIU.LLATION Broach circuits:am alteration,nrension per panel Business name: NC K..- a.Fcc for branch circuits with purchase of a service or feeder.fee: Address: Each branch circuit I I S 6.001 S City: I State: I ZIP: b.Fee for branch cimdta without purchase of a service or feeder fee: Phone: - - I Fax: - - First branch circuit(2) 1 S 55.00 $_SPO E-mail: Each additional branch circuit Z. S 6.00 S s r p CCB license no.: I BCD license no.: 31Ise tut notes fees:strive or feeder nor included Signing superv'isor's license no.: Each pinup or inigatior circle(2) S 6300 S Print name of signing supervisor: sign or outline lighting(2) S 63.00 S Signal circuit or a limited-energy panel. S 63.00 I Signature of signing wpm-visor: alteration.or extension(2) Each additional inspection:(I) $58.00 S APPLICANT USE (..;44) Eater subtotal of above fees 61.°(311nimom Permit Fee 558.00) 5 (B)Enter 12%surcharge(.12x[Al) f XP,Y (C)Technology Fee(5%of[A]) S b TOTAL fees and surcharges(A Through C): S i 3j, 440-25844(9,08:CO)4) • 1 of 1 3/19/2013 9:18 AM • • > SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 t Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00708 www.springfield-or.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/18/2013 EXPIRES: 10/15/2013 STATUS DATE: 04/18/2013 APPLIED: 04/08/2013 SITE ADDRESS: 540 COLONIAL DR,Springfield,OR 97477 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1703221200400 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: ME Livingroom expansion addition OWNER: DEVINE HEATHER E Phone Number: ADDRESS: 540 COLONIAL DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor DOUGLAS A MOORE CCB 86655 10/13/2014 541-915-7004 INSPECTIONS REQUIRED Inspections 2255 Gas Pressure Test 2300 Rough Mechanical Rough Mechanical: Prior to Cover 2310 Rough Gas Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 2995 Final Gas Final Gas: When all gas work is complete. 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 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 constr tion. - l 8 - l� Owner or Con ractor Signature Date -; ATTENTION: Oregon lathe requires Utito NOTICE: follow rules adopted by 9 Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT in 0090. 952-001-0010 obtain through OAR th 952 ooi COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by calling the center. (Note: the telephone ANY 180 DAY PERIOD. number for the Oregon l 11" 'r/ -I'"�2rinn Center lc 1 £, Springfield Building Permit 4/18/2013 10:41:50AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD _, s 225 Fifth St TRANSACTION RECEIPT Springfield.OR 97477 { OREGON 541-726-3753 \OR 811-S PR2013-00708 www.springfield-or.gov 540 COLONIAL DR permitcenter©springfield-or.gov RECEIPT NO: 2013000776 RECORD NO:811-SPR2013-00708 DATE:04/18/2013 tDESCRIPTION__.., .c._u._.__' __ _-______ ._._Y_ 1,_ ACCOUNT_CODE/TRANS:CODE--____;._-AMOUNT DUE 1 First Appliance Fee 224-00000-425604 1006 79.00 Gas Piping up to 4 outlets 224-00000-425604 1006 7.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.32 Technology fee(5%of permit total) 100-00000-425605 2099 4.30 TOTAL DUE: 100.62 LRAYMENT TYPE • :,,:...PAYOR CASHIER:JLARSON COMMENTS .- :� ._ " 'AMOUNT PAID • .—• . -'_1 Credit Card , DEVINE HEATHER E 100.62 06490C TOTAL PAID: 100.62 • • • Mechanical Permit Application-mechanical permit 2009 Rev.pdf http://www.springfield-or.gov/dsd/Building/Library/mechanical permi... Mechanical Permit Application DEPARTMENT USE ONLY City OF SPRINGFIELD, OREGON Penni(no.:S(3 '9 C 225 Fifth Sum•Satiafeld.OR 914)]•PH(541)726-3753•FAX(541)726-36119 0 Date: 3 ,'z z-7,s This permit is issued under OAR 918-440-0050.Permits expire If work Is not started within 180 days of Issuance or If nark is suspended for 180 days. CATEGORY OF CONSTRUCTION FEE SCHEDULE Residential ❑Govenunent ❑co Commercial Residential Qty.. Cast Total JOB SITE INFORMATION AND LOCATION First Appliance I $79.00 $ /'T Job site address: Syo Cof ,i IAtr Ve• Furnace/burner Including ducts and vents city:5pgity 6(IC it/ 1 State:04_ I zIP:4't41i Upto 100k BTU'hr. $17.00 $ Over look BTUdu. $20.00 $ Refeience: I Taxlot.: DESCRIPTION OF WORK ifeaters/smyesivevts Unit heater $17.00 S 2e Io e.7e Gat Pe enter- (Me f[r Wood'pen&Jgassme/Bm $38.00 S Racrypa6/alter/add to heating appliance' LxrsN� Ne471Nb 1)QT� tN 040,r religcmtion unit or cooling system' k, S58.00 So PROPERTY OWNER absorption system Name: aCG7 a-/et 3 came Evaporated cooler $13.00 S Address: Sy0_eta to N /4G 72r Vent fan with one dnct'appliavice vent $9.00 S / Hood with cxhamt and duct $13.00 $ City: 5�/2t Al $/e lA I State:O e Zn':t3 1' Floor finnace including vent $58.00 S Phone:$14ftS3 '1076. I Fax: - - Gas piping E-mail: One to four outlets I $1.00 $ 7 il at �Phon�P'✓Q'ade n progeny Q gowned by me WI This installation my i is being made on nd is exempt from m me or a Additional outlets units,including $4.00 $ member of my inuncdinic(amity-and is exempt Gom licensing Air-handling uvih,Including ducts requirements 11 der 0.SS7 s0t1.010. '/ �s Up to 10.000 CFM $11.00 $ Signature: $.YI pA 2( 1/1/1/(J `(�/s/ 1/✓ `cl. Over 10.000 CFM $20.00 S CO TRACTOR INSTALLATION Compressor/absatpdon system/heat pump Business name: � Up to 3hp.!IOOk BTU $17.00 S DUI Up to 15hp'SOOk BTU $29.00 $ Address: Up to 30110.000 BTU $43.00 $ City: I State: ZIP: Up to 50 hp'1.750 BTU $57.00 S Phone: - - I Fax: - - Over 50 hp9.750 BTU $95.00 S E-mail: Incinerators Domestic incinerator I I $20.001 $ CCB license no.: Commercial Print name: Enter total valuation of mechanical system and installation costs S Signature: Enter fee based on valuation of mechanical system.etc. $ Miscellaneous fees hems et t Total t Reinspection $58.00 S Specially requested inspections(per hr.) $58.00 $ Regulated equipment*classed) $13.00 $ Each additional inspection:(1) 55800 $ APPLICANT USE (A)Enter subtotal of above fees(or enter set minimum fee of 5 79.00) $ (B)Investigative fee(equal to IA)) 5 (C)Enter 12:smcharge(12 x IA-B]) $II 3 (D)Seismic(0%1%(01 a[A]) S (ElTechtology Fee(5%of IAJ) $- l/ 440-2545.1(1198 COM) TOTAL fees and surcharges(A through E): S - CV I of 1 3/19/2013 11:08 AM r / ' SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 tit* Phone: 541-726-3753 • OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00709 www.springfield-or.gov permitcenter@springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/18/2013 EXPIRES: 10/05/2013 STATUS DATE: 04/18/2013 APPLIED: 04/08/2013 SITE ADDRESS: 540 COLONIAL DR,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703221200400 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: PL Livingroom expansion addition OWNER: DEVINE HEATHER E Phone Number: ADDRESS: 540 COLONIAL DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor DOUGLAS A MOORE GCB 86655 10/13/2014 541-915-7004 INSPECTIONS REQUIRED Inspections 3315 Water 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 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 the property, and the approved set of plans will remain on the site at all times during construction. acetg Owner or Contractor Signature Date ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE: Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK 0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone ,OMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification NY 180 DAY PERIOD. Center is 1-b00-3322-2344). Springfield Building Permit 4/18/2013 10:49:24AM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St ' (4°,9%, OREGON TRANSACTION RECEIPT Springfield,OR 97477 541-726-3753 811-SPR2013-00709 www.springfield-or.gov 540 COLONIAL DR pennitcenter @springfield-or.gov RECEIPT NO: 2013000775 RECORD NO: 811-SPR2013-00709 DATE:04/18/2013•`DESCRIPTION ._„ _` ACCOUNTmCODEITRANS;CODE_ -_Ii: ° AMOUNT_DUE''' State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.12 Technology fee(5%of permit total) 100-00000-425605 2099 3.80 Water Line 224-00000-425603 1005 76.00 TOTAL DUE: 88.92 -._ . PAYMENT TYPE 1 �PAYOR_ CASHIER':JLaasoN � �*yCOMMENT3 '_ AMOUNT PAID •_ ��±��-3 Credit Card DEVINE HEATHER E 88.92 06490C TOTAL PAID: 88.92 Plumbing Permit Application '; > DEPARTMENT USE ONLY,�i's! ,� 3��t SPRINGFIELD•'aR°Yn ' 1-Wn ' t""L• ` ,i'3d}a:£ . 5wa 't`, iVF: „i. -., `'34 :.:: . m ? r't -7 "t - SPRINGFIELD' v �` 'a A. Permit no.: S I > '� C0 /. ` ; ITY OF SPRINGFIELD OREGON X2 w'rr xn - mss : s 5" ie l /'S''§'it 225 Fifth Street • Springfield,OR 97477 • PH(541)726 3753 • FAX(541)726-3689 Date: 2 / This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days-of issuance or if work is suspended for 180 days. - , ' r "LOCAL; GOVERNMENT„APP,ROVAL°' x ,;2 _:'; 4.14-0W SC HEDULE x `. : Zoning approval verified? ❑ Yes ❑No Descrlptwn Qty `,Cost Total=' .,=-J. . ..�.. .� 4�.., • .. � Y r E",:y „ea.; ;_ cost; .< . Sanitation approval verified? ❑ Yes ❑No - New residential ' CATEGORY OF CONSTRUCTION I bathroom/I kitchen(includes first 100 feet of water/sewer lines, hose cil Residential ❑Government ❑Commercial bibs, ice maker, underfloor low lout-point $238.00 $ , JOB- SITE INFORMATION;AND,%LOCATION ? i,w''. ,. drains and rain-drain packages) 5 y0 co 2 bathrooms/1 kitchen $374.00 $ Job site address: hi /,,yL jjy. �Q�NB ( 3 bathrooms/1 kitchen $439:00- $ City l I State: pi ZIP:7 1 .03_ ca li Each additional bathroom(over 3) $95 OO' $ Reference: Taxlot.: 0 400 Each additional kitchen(over 1) $95.00 $ . t ,*."v>-,;DESCRIPTION;Or,WORK ,'„+ 41 6:_a Residential fire sprinklers(includes plan review) A161/6 W 1 ' LfAIt 0 to 2,000 square feet $58.00 $ 2,001 to 3,600 square feet $116.00 $ PROP.ERTY. :OWNER ,r =- ` x vl ,,,; k;t 3,601 to 7,200 square feet $174.00 $ Name: I4era--'Pee. 1) av/Ni 7.201 square feet and greater $232.00 $ Manufactured dwelling or pre-fab(circle one) Address: ,57./0 ea/on IyL .r Connections to building sewer and - / water supply $58.00 $ City: cer, ucy1c e(cl State: oil ZIP: Commercial, industrial,and dwellings other than one-or Phone:Sl/I-153 (1'D76, Fax: - - two-family Minimum fee $58.00 $ V E-mail: head/,Cde V I V1&&,'k/liAAOA I . (t9tin This installation is being made on residential or farm property Each fixture $19.00 $ owned by me or a member of my immediate family, and is Miscellaneous fees exempt from licensing requirements under OAR 918-695-0020. 100' storm,sewer,water line / $76.00 $7 6 4 Signature: 44 1xJ..P Vvv wV Each fixture, appurtenance,and piping $19.00 $ CONTRACTOR.INSTALLATION Storm water retention/detention facility $19.00 $ Business name: (Xi/AA-7C Irrigation systems $19.00 $ Piping or private storm drainage $19.00 $ Address: systems exceeding the first 100 feet City: State: ZIP: Specialty fixtures $19.00 $ Reinspection(no.of hrs.x fee per hr.) $58.00 $ Phone: - - Fax: - - Special requested inspections(no.of E-mail: hrs x fee per hr.) $58.00 $ CCB license no.: BCD license no.: Each additional inspection: (I) $58.00 $ Plumbing license no - iVI'edlcal gas 4inig t 'cx . s,.ed`d;i Minimum fee $ Print name: Enter value of installation and equipment$— Enter fee based on installation and equipment value. $ Signature: � % 711 x = i,:"APPLICANT USE e. `i`tirei t ig (A) Enter subtotal of above fees / (Minimum Permit Fee$58.00) - $ 7C (B)Investigative fee(equal to[A]) - $ (C) Enter 12%surcharge(.12 x [A+B]) $17//Z (D)Technology Fee(5%of[A]) $ 1j TOTAL fees and surcharges(A through D): $ '3y 2- 440-2500-J(I 1/08/COM)