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HomeMy WebLinkAboutPermit Building 2013-6-12 SPRINGFIELD 225 Fifth St 4 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-SPR2013-01051 waw.springfield-or.gov permitcenter@springfield-or.gov PROJECT STATUS: Issued ISSUED: 06/12/2013 EXPIRES: 12/08/2013 STATUS DATE: 06/12/2013 APPLIED: 05/24/2013 SITE ADDRESS: 1500 KELLOGG RD,Springfield,OR 97477 SCOPE: Single Family Residence • ASSESOR'S PARCEL NO: 1703342207800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: STR-single family residence OWNER: NEPUTE JOHN Phone Number: ADDRESS: 1491 WIMBLEDON PL SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor FUTURE B INC CCB 36499 05/18/2014 541-744-2660 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. 1170 Post&Beam Post and Beam: Prior to floor insulation or decking. • • 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been ATTENTION: Oregon law reOPProyedDu to 1370 MasonrA1e-neerules adopted by the Oregon Utility . IJVl1��LOJ{III I/c�i101. Iiivou lu,..y u,..ocl rac.:11 Nt IICE. 1410 Underfi o-Insulatlon 41 LAri not-001-0010 through OAR 952-001- '^ PERMIT CI IALL EXPIRE IF THE Wpm( 14201nsulatieRSlapo'i Berfiery obtain copies of the rules by at iT IUnR17Fn IINnFRTHIS PERMIT IS NOT ti- 1430 Insulationi Wafer for.the Oreoan Utili?\WalLlnsulation� Prior to cover. COMMENCED OR IS ABANDONED FOR 1440 Insulation CeilingCenter iS 1-800-332-:Ceiling Insulation: Prior to cover. ANY 180 DAY PERIOD. 1520 Interior Shearwall Shear Wall Nailing: Before covering sheathing with finish materials. 1530 Exterior Shearwall 1540 Gypsum Board/Lath/Drywall Drywall: Prior to taping. Lath/Plaster: To be made after all lathing and gypsum board, interior and exterior are in place, but prior to plastering. 1999 Final Building Final Building: After all required inspections have been requested and approved and the building is complete. • Springfield Building Permit 6/12/2013 3:52:40PM Page 1 of 2 • • SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 et Phone: 541-725-3753 4" OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01051 srw.springfield-or.gov permitcenter @spririgfield-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 the property, and the'approved set of plans will remain on the site at all times during construction. • • Owner or Contractor Signature Date • • Springfield Building Permit 6/12/2013 3:52:40PM Page 2 of 2 • • SPRINGFIELD CITY OF SPRINGFIELD • 225 Fifth St •tO OREGON TRANSACTION RECEIPT 225 Fifth St 97477 547-726-3753 811-SPR2013-01051 www.springfleld-er.gov 1500 KELLOGG RD permitcenter @springfield-ar.gov RECEIPT NO: 2013001228 RECORD NO:811 SPR2013-01051 DATE:06/12/2013 s —21-AM OUNTDUEI'�"' Address Assignment,each new or change 224-00000-425602 1020 42.00 Planning-Major Review-City 100-00000-425002 1231 211.00 Residential Fire(.05 Per Sq Foot) 100-00000-424005 9111 115.70 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 955.33 SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 745.89 SDC: Improvement Cost-MWMC Regional Wastewater SDC 445-00000-448025 1187 1,392.04 SDC: Improvement Cost-Storm Drainage ,440-00000-448028 1176 572.39 SDC: Reimbursement-Transportation SDC 446-00000-448026 1173 262.12 SDC: Reimbursement Cost- Local Wastewater 442-00000-448024 1183 1,528.24 SDC: Reimbursement Cost-MWMC Regional Wastewater SDC 444-00000-448024 1186 108.14 SDC: Reimbursement Cost-Storm Drainage 441-00000-448029 1177 392.94 SDC:Total MWMC Administration Fee—Local 719-00000-426604 1121 76.64 SDC:Total Sewer Administration Fee 719-00000-426604 1175 113.71 SDC:Total Storm Administration Fee 719-00000-426604 1180 48.27 SDC:Total Transportation Administration Fee 719-00000-426604 1190 60.87 Second Permit Discount -201-00000-428060 1148 67.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 151.86 Structural Building Permit Fee 224-00000-425602 1002 1,265.50 Technology fee(5%of permit total) 100-00000-425605 2099 68.73 Willamalane fees-Single family detached 821-00000-215023 1074 3,410.00 TOTAL DUE: 11,620.98 - P.AYMENTaTYPE PAYOR C'ASHIEe it _aCOMMENTS AMOUNTAPID Check Future B Homes 11,620.98 • 1061 TOTAL PAID: 11,620.98 SPRINGFIELD`--- CITY OF SPRINGFIELD hi1 S., TRANSACTION RECEIPT Spnngfield,OR 97477 , l 541-726-3753 'OREGON 811-SPR2013-01051 wwws99999eld-or.gov 1500 KELLOGG RD perrnitcenter @springneld-or.gov RECEIPT NO: 2013001035 RECORD NO: 811SPR2013-01051 DATE:05/24/2013 DESCRIPTION -, n,.,...f a...�tt. 4 s ACCOUNT CODE/TRANS CODE 3 ..fAMOUNTI 117 ":- Structural Plan Review Fee Residential 224-00000-425602 1061 822.58 TOTAL DUE: 822.58 .lP,AYME P-ENTMMMTP.AYOR_ CASwER:;D wus Y COMMENTS. IMEW1 AMO011:i IP ' Credit Card dare butler 822.58 01734g TOTAL PAID: 822.58 • Structural Permit Application SPRINGFIELD DEPARTMENT USE ONLY , CITY OF SPRINGFIELD, OREGON S OREGON Permitno.:se _o%S-r 225 Fifth Street♦Springfield,OR 97477•PH(541)726-3753♦FAX(541)726-3689 Date: z.t�� This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days tssua ce or if work is suspended for 180 days. -`LOCAL-GOVERNMENT APPROVAL . Plumbing This project has final land-use approval. Signature: Date: N nical et, Mechanical This project has DEQ approval. Signature: Date: COVVI�LT - Zoning approval verified: ❑ Yes ❑No ' FEE'SCHEDULE Property is within flood plain: ❑ Yes ❑No 1.Valuation information _ . CATEGORY OFvCONSTRUCTION (a)Job description: 5'..p/N lbw../f IX Residential ❑Government ❑Commercial Occupancy 2'3 Li,._ JOB SITE INFORMATION AND LOCATION - Construction type: 'Jr Job site address: I SeYD /CECLCx-t(,-t eQ, Square feet: / 3/1 5-6 2 f City: 5 PI&INe•Flo_0 I State:O(k I ZIPq 7 y73- Cost per square foot: 1 Subdivision: tI V6F- et 2-0V6 I Lot no.: 3 Other information: Reference: 1 7-03--3`/'2-Z..1 Taxlot: C77 I(r) Type of Heat: - PROPERTY OWNER Energy Path: Name: 'mil'[(l CL t g Ho 0-1 ES � new ['alteration 0 addition Address: 1©Q, 1�ox 7 /2 c L- (b)SP21N, le L(> ZIP: 9 -a— (b)Foundation-only permit? ❑Yes No '3 13:ft'. City: C 1' State: J �yy� / Total valuation: $�/ Phone: 51q-yI3-3zs4' Fax: //- 7790( 0. ������ 2.Building fees ' '- E-mail: U/tE'(K (-)orH CS, C 0/1 (a)Permit fee(use valuation table): $ fr Building Owner or Owner's agent authorizing this application: (b)Investigative fee(equal to[2a3): $ -- (c) Reinspection($ per hour): $ -. (number of hours x fee per hour) Sign here:' - .)Enter 12%surcharge(.12 x[2a+2b+2c]): $ /(51 ❑This installation is being made on residential or farm property owned by me or a member of my immediate family,and is exempt from licensing (e)Subtotal of fees above(2a through 2d): S requirements under ORS 701.010. 3. Plan review fees gZ� ro CONTRACTORa,INSTALLATION .' ' (a) Plan review(65%x permit fee[2a]): $ Business name: /� (b)Fire and life safety(40%x permit fee[2a]): $ Address: (c)Subtotal of fees above(3a and 3b): $ City: State: I ZIP: 4.Miscellaneous fees ` Phone: - - Fax: - - (a)Seismic fee, 1%(.01 x permit fee[2a]): $ _ E-mail: (b)Technology fee,5%(.05 x permit fee[2a]): S/n3 °'b c1r , T�_,z CCB license no.: ,3(o ff`] TOTAL fees and surcharges(2eI-3c+4a+4b): S (7CY Print name: Signature: SUB-CONTRACTOR INFORMATION , Name CCB License# Phone Number Electrical P6*1 5 aerr willarnalane della Park and Recreation District / y Job. No. S(3— /DS / PARK AND RECREATION SYSTEM DEVELOPMENT CHARGE WORKSHEET Jan. 1-Dec. 31, 2013 C NAME: /Zt n� PHONE: q/ D 3 2' o ADDRESS: PUaasc <qzS CITY: rt-PEC-1) STATE:,*t2IP: c7)h/; LOCATION OF PROPOSED BUILDING SITE: Street address: Kee-LO 4l( Plat name:RVla ceiver 5 Tax Lot Number: /763 J�t[/'2 Z 070 1. DEVELOPMENT TYPE (Refer to development type definitions on the reverse.) A. Single-Family Detached) NO. OF UNITS / X$3,410 per unit= $ la B. Single-Family Attached NO. OF UNITS X$3,385 per unit= $ C. Multi-Family Apartment NO. OF UNITS X$3,021 per unit= $ D. Single Room Occupancy NO. OF UNITS X$1,510 per unit= $ E. Accessory Dwelling Unit NO. OF UNITS X $1,705 per unit= $ 2. SDC CREDIT Of applicable. SDC payer must furnish proof of credit approval.) ($ ? ) 3. TOTAL PARK AND RECREATION SDC ASSESSED • $ -Nap • Sr/ zY( i) City of Springfield Date of building permit submittal City of Springfield Date of building permit issuance SPRINGFIELD ' •• • 225 Fifth St ,_ , : CITY OF SPRINGFIELD Springfeld,OR 97477 • 5r '- Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone:541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR201 3-01 058 www.springfield-or.goy _ permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 06/12/2013 EXPIRES: 12/08/2013 STATUS DATE: 06/12/2013 APPLIED: 05/24/2013 SITE ADDRESS: 1500 KELLOGG RD,Springfield,OR 97477 - SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703342207800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: PLM-single family residence OWNER: NEPUTE JOHN Phone Number: ADDRESS: 1491 WIMBLEDON PL SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Plumbing Contractor OREGON CUSTOM PLUMBING INC CCB 191104 06/21/2014 541-434-1146 General Contractor FUTURE B INC CCB 36499 05/18/2014 541-744-2660 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` l :I7 . Rough Plumbing: Prior to cover and including required testing. 3999 Final RdaiRIRMIT SHALL EXPIREIFIIIRE17 9if\ 'en all plumbing work is complete. • AUTHORIZED ,,�UNDER THIS PERMIT IS NOT follio N LION" tOregon law re By signature,(IJstate Lant- forth lfvetC,v �1need the completed application tdo hf r(:erce fdy-_thatlaliV inn requires you to information hereon islrue cicLOag and I fife rtlfy�'that any and all work perform e I e d6110i rawort�•arice with the-gOrl Utility hO?t I xll I' : 9 p n. USA ( Ordinances of the Ciry of S rin fie/ d the Laws of the State or Oregon pertaining to tha���) s�enb�dlh @I rO ?d th fl NO are set forth OCCUPANCY will be made of any structure without permission of the Community Service U v19Y6111 Be lr4irI$. aigty, i furtherOAR 952-001- rn h. certify that only contractors and employees who are in compliance with ORS 701.005 will tFi ser76li,thtkpgotict.II,furth�ragreele rules b to ensure that all required inspections are requested at the proper time, that each addresPti� ddedterftprn tt Ke site t,rthatlthetele , y permit card is located at the front of the roe eurn .r I.;i 1icat. p property,rty, and the approved set of plans will remain on the�aits tlai�tirit s dunng.11ty NptifiCal;on construction. 332-2344). Owner or Contractor Signature Date • Springfield Building Permit 6/12/2013 3:50:09PM Page 1 of 1 r r SPRINGFIELD --- CITY OF SPRINGFIELD 1�• ..,, .. 225 Fifth St OREGON TRANSACTION RECEIPT SpringFeld,OR97477 541-726-3753 811-SPR2013-01058 wwwspringfield-or.goy 1500 KELLOGG RD permitcenter @springfield-or.gov RECEIPT NO: 2013001227 RECORD NO:811 SPR2013-01058 DATE:06/12/2013 o - ' p l o - i _ -3:7:1* Ari, ?-r-ACCOUNT.CODERRANS`CODE_ -'• -. _`'AMOUNT;DUE' One or Two Family Dwelling with Two Bath 224-00000-425603 1005 411.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 - 49.32 Technology fee(5%of permit total) 100-00000-425605 2099 20.55 TOTAL DUE: 480.87 t PAYMENTeRYPE . .P..AYOR. cnsriiirttard COMMENTS AMOUNTpPAID- Check Future B Homes 480.87 1061 TOTAL PAID: 480.87 SPRINGFIELD 225 Fifth St hr• CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 EGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01057 . www.springfield-or.gov permitcenter @springfeld-or.gov PROJECT STATUS: Issued ISSUED: 06/12/2013 EXPIRES: 12/08/2013 STATUS DATE: 06/12/2013 APPLIED: 05/24/2013 SITE ADDRESS: 1500 KELLOGG RD,Springfield,OR 97477 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1703342207800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: MEC-single family residence OWNER: NEPUTE JOHN Phone Number: ADDRESS: 1491 WIMBLEDON PL SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor FUTURE B INC CCB 36499 05/18/2014 541-744-2660 Mechanical Contractor COMFORT FLOW HEATING CO CCB 460 06/27/2013 541-726-0100 INSPECTIONS REQUIRED 1 Inspections 2200 Underfloor Mechanical Underfloor Mechanical. Prior to insulation or decking and including required testing. 2210 Underfloor Gas Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. 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 CC Final Gas: When all gas work is complete. 2999 FirislrMeeh§nical Final Mechanical: When all mechanical work is complete. PHIS PERMIT SHALL EXPIRE By signature, st Ndla rrht { v ne the completed application and do hereby certify that all informal ri,fiereon :t� or ct, nF11-f�Nhbt� Kilt any and all work performed s W ftk-dghe�intaeordance with-tbaulres you t0 Ordinances of th n /a1 1 8sT®9e State or Oregon pertaining to the drptlt;deseribed Lterein; d,t a.N „g ,S Dies are Utility OCCUPANCY will be Pf R.structure without permission of the Community Servicetpiiiylsion;Buil nglSafeixt.l��r�F}e�les are set forth certify that only contractors and employees who are in compliance with ORS 701.005 will tie,ree44on Jis 9i y, 1lUfuytnef,fgte®AR 952-001- to ensure that all required inspections are requested at the proper time, that each address 6 red I r m t estreet, a .#fie permit card is located at the front of the property, and the approved set of plans will remain o�the nt ei�'�SiR1esidu ng ple5 of the rules by anuiy �e ter. (iNote: the teleph::,= construction. number for the Oregon Utility Notification • Center is 1-800-332-2344). `�---- - ■ r\-- ...---- V00 / 3 Owner or Contractor Signature Date • Springfield Building Permit 6/12/2013 3:48:09PM • Page 1 of 1 SPRINGFIELD - CITY OF SPRINGFIELD )1 - 225 Fifth St " O OREGON TRANSACTION RECEIPT Spnngfield,OR 97477 541-726-3753 811-SPR2013-01057 www.spnngfield-or.gov 1500 KELLOGG RD permitcenter©spnngfield-or.gov RECEIPT NO: 2013001225 RECORD NO:811 SPR2013-01057 DATE:06/12/2013 DESCRIPTION __. au3` ACCOUNS CODE/TRANS CODE ` .'..:..,,,ctT;'' AMOUNT.C"7>ai".a First Appliance Fee 224-00000-425604 1006 80.00 Flue vent for water heater or gas fireplace 224-00000-425604 1006 10.00 Furnace-up to 100,000 BTU- - . )224-00000-425604 1006 18.50 Gas Piping-each additional above 4 224-00000-425604 1006 9.00 Gas Piping up to 4 outlets 224-00000-425604 1006 7.50 Range hood/other kitchen equipment 224-00000-425604 1006 14.50 Single-duct exhaust(bathrooms, toilet compartments, utility room: 224-00000-425604 1006 40.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 21.54 Technology fee(5%of permit total) 100-00000-425605 2099 8.98 TOTAL DUE: 210.02 P.AYMENTSTYPE P.AY,OR*CASHIER:>JL'ARSON COMMENTS AMQUNTjPAID Check Future B Homes 210.02 1061 TOTAL PAID: 210.02 • • SPRINGFIELD- 225 Fifth St - CITY OF SPRINGFIELD Springfield,OR97477 'fie OREGON Phone: 541-726-3753 Building / Residential Permit Inspection Phone:541-726-3769 Fax:541-726-3676 PERMIT NO: 811-SPR2013-01056 www.springfield-ar.gov permitcenterQspringfield-ar.gov PROJECT STATUS: Issued ISSUED: 06/12/2013 EXPIRES: 12/08/2013 STATUS DATE: 06/12/2013 APPLIED: 05/24/2013 SITE ADDRESS: 1500 KELLOGG RD,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703342207800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: ELE-single family residence OWNER: NEPUTE JOHN Phone Number: ADDRESS: 1491 WIMBLEDON PL SPRINGFIELD OR 97477 CONTRACTOR INFORMATION 1 Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone DEAN'S ELECTRIC INC (C)Electrical Cant 20-319C 07/01/2014 541-935-5303 General Contractor FUTURE B INC CCB 36499 05/18/2014 541-744-2660 INSPECTIONS REQUIRED Inspections 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 front of the property, and the approved set of plans will remain on the site at all times during construction. - ‘/26.) fS -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 THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- `11THORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules b "1MENCED OR IS ABANDONED FOR calling the center. (Note: the telept:..=_. y number for the Oregon Utility Notification • " ri AY PERIOD. Center is 1-800-332-2344). • Springfield Building Permit 6/12/2013 3:45:50PM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD • 225 Fifth St ` e�oN TRANSACTION RECEIPT Spdngtield,OR 97477 AP 541-726-3753 811-SPR2013-01056 w w.springfield-or.gov 1500 KELLOGG RD permitcenter @springfield-or.gov • RECEIPT NO: 2013001226 RECORD NO:811-SPR2013-01056 DATE:06/12/2013 . IeYXcia:7lhX[o]�Is d._.., �u�,:�*� ' � ��..-. r�."�;�'_'•ACCOUNT CODE/TRANS CODE^:; rAMOUN DUE:_:: Each added 500 sq.ft. or portion 224-00000-426102 1004 82.50 Residence wiring 1,000 sq. ft. or less 224-00000-426102 1004 147.50 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 27.60 Technology fee(5%of permit total) 100-00000-425605 2099 11.50 TOTAL DUE: 269.10 PAYMENT1TXPE PAWR airgg: ,141MXWIE15 MMENTS AMOUNTPAIO Check Future B Homes 269.10 1061 TOTAL PAID: 269.10 • • Electrical Permit Application DEPARTMENT USE ONLY SPRINGFIELD CITY OF SI'RLNGFITLD, OREGON Permitno.: 5/7-70 St 225 Fifth Street•Springfield,OR 9 7 4 77 4 111(541)726-37534FAx(541)726-3689 I OREGON Date: 570`( /-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 180 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑ No Number of inspections per item() Qty. Cost Total CATEGORY OF CONSTRUCTION ea. cost _ Residential,per unit,service included: KResidential I ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 1,000 sq. R.or less(4) $147.50 $/92$0 y Each additional 500 sq. ft.or portion • Job site address: ICOU - 1(_-,L-x R-b , thereof 3 $ 27.50 $a' 5�� CityCTR(1LL''kr(€LO I State: o� ZIP:C176(7.5- Limited energy(2) $ 35.00 $ - Reference: (7- 03 -3t(—2z I Taxlot.: 07$x5 Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) S INL-7 L FA I L Y Services or feeders: installation,alteration,relocation ^ � c..�,�, 200 amps or less(2) $ 89.00 $ /vv / R Y OW -- - 201 to 400 amps(2) $ 104.50 $ PROPERTY OWNER _ ._ Name: Fun) it -� 140vn .S 401 to 600 amps(2) $174.00 $ Address: 40/4 P U . 130x 76(ZS- 601 to 1,000 amps(2) $225.50 $ City:S'12/ft*F/Ctn I State: G•GL I ZIP: G2 747r- Phone-ft Over 1.000 amps or volts(2) $516.00 $ (S 7 Reconnect only(2) $ 69.00 $ 2`�`'o Fax (l -74�{DI(l, . E-mail: Temporary services or feeders: installation, alteration, relocation �4N -EU'0t4iE3-1-For�6S ,covt--,_ 200 amps or less(2) This installation is being made on residential or farm property $ 69.00 $ owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 $ property is not intended for sale,exchange, lease,or rent. OAR 479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $ Signature: Over 600 amps or 1,000 volts,see services or feeders section above CONTRACTOR INSTALLATION Branch circuits: mew..alte,'aion,extension per panel Business name: De t 5 ELEc--rrcic a. Fee for branch circuits with purchase of a service or feeder fee: Address: P,O, .O x 2COS Each branch circuit $ 6.50 $ City: El.,�..ig a C State: tog_ ZIP: ct7WOZ b. Fee for branch circuits without purchase ofa service or feeder fee: Phone:. - - Fax: - - First branch circuit(2) $ 60.50 $ E-mail: Each additional branch circuit $ 6.50 $ CCB license no.:2.O -31 Lc.] BCD license no.: Miscellaneous fees:service or•feeder not included Signing supervisor's license no.: SS ( r1 s Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor:CA 3 Le,..7i5 Each sign or outline lighting(2) $ 69.00 $ Signature of signing supervisor: / Signal circuit or a limited-energy panel, $ 80.00 $ alteration,or extension(2) Each additional inspection:(I) $80.00 $ APPLICANT USE (A) Enter subtotal of above fees $ � (Minimum Permit Fee$80.00) 2 .-, � (E)Enter 12%surcharge(.12 x[A]) $ 7 7Ee (C)Technology Fee(5°A•of[A]) $ / Z21_.° 440-2584-1(4/OIR013/CObM) TOTAL fees and surcharges(A through C): $ Z6,io i /