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HomeMy WebLinkAboutPermit Building 2013-8-16 SPRINGFIELD 225 Fifth St ' CITY OF SPRINGFIELD Springfield,OR 97477 =r Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01835 mint springfield-argov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 08/16/2013 EXPIRES: 02/11/2014 STATUS DATE: 08/16/2013 APPLIED: 08/16/2013 SITE ADDRESS: 4889 GLACIER DR,Springfield,OR 97478 SCOPE: Interior ASSESOR'S PARCEL NO: 1802051109600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: STR-Finish basement to add two beds,one bathroom OWNER: GREENE JEREMY ALLEN 8 SONDI DAWNNE Phone Number: 503409-1227 ADDRESS: 4889 GLACIER DR SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED • Inspections 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved. 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 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. 9(613 • ature Date t° teQuttesy ut" a o \aw OteO°a totO • \\ON'•Ot 9 d"the\es ate set \es as tereth°se to P 95 poi 1F THE S N K to\1ow Tu Gea i kV(°L19 plhe lute �pTICE: HALL EXPIRE OT Nottilcat° °M-13° ° coP\es of te\esoo`*' THIS PERMITS THIS pERED GPR95 ay obtatnNOta the N°t.\\eauon p.UTHORIZED u0R IS ABANDONED FOR ntel. l tJtdlty ?MOD. ye coo. th en ote9on w2-2344). CO1�4MEN�ED °Ong numbatGeotet 1s i g00-93 ANY 180 DAY PER • Springfield Building Permit 8/16/2013 2:27:31 PM Page 1 of 1 • • SPRINGFIELD - CITY OF SPRINGFIELD ' � 225 Fifth St � TRANSACTION RECEIPT Sprngrield.OR97477 O0.EGO�1 N 541-726-3753 811-SPR2013-01835 vnivw.spnngtiem-or.gov 4889 GLACIER DR permitcenter @springfeld-or.gov RECEIPT NO: 2013001787 RECORD NO:811SPR2013-01835 DATE:08/16/2013 DESCRIPTION _. -�r-.,',; c.f.! .'.,. 1 _=1:AllaeToIYf CODE/TRANS•CODE !C -t`AMOUNT n* SDC: Improvement Cost-Local Wastewater 443-00000-448025 1184 487.48 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 998.76 SDC:Total Sewer Administration Fee 719-00000-426604 1175 74.31 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Structural Building Permit Fee 224-00000-425602 1002 80.00 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 • TOTAL DUE: 1,654.15 PPAYMENT4g0E PAYOR CASHIER:Deelar L COMMENTC AMOUNT PAID Check GREENE JEREMY ALLEN 1,654.15 1017 TOTAL PAID: 1,654.15 SPRINGFIELDi+•• 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-SPR2013-01838 www.springfieldor.gov permitcenter @springfield-or.gov • • PROJECT STATUS: Issued ISSUED: 08/16/2013 EXPIRES: 02/11/2014 STATUS DATE: 08/16/2013 APPLIED: 08/16/2013 SITE ADDRESS: 4889 GLACIER DR,Springfield,OR 97478 SCOPE: Interior ASSESOR'S PARCEL NO: 1802051109600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: PLM-Finish basement to add two beds,one bathroom OWNER: GREENE JEREMY ALLEN&SONDI DAWNNE Phone Number: 503-809-1227 ADDRESS: 4889 GLACIER DR SPRINGFIELD OR 97478 • CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 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 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. O - -r or Con•- • igna ure Date 0Ut0 o°‘a\Nle0re9° ettocth NStON 0opta by to 1U`es ale 652 opt- PT�E tesaa Retu\estl lav\T Genet '(h h 0 ORK os P co\koN • ° 001001o�.tesoth Wa' NoUttc 2-pot- tat°°opa:lheteotP,oakon 140IICE:M1� SHA�IEXP1RpERM,T ,SN01 090.N \4 the a�bpte9p°632 23 4). pu`THOR ZED '3OR IS A THIS OVI°NE�FOR ca 99 tot the. 1.600- �OM�4ECED �O� .0/Ge°tet is ANy 180 OF`/ PER • Springfield Building Permit 8/16/2013 2:29:07PM Page.1 of 1 SPRINGFIELD -- CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Springfield,OR 97477 OREGON 541-726-3753 811-SPR2013-01838 www.spnngfieldocgov 4889 GLACIER DR permitcenter @spnngfield-or.gov RECEIPT NO: 2013001789 RECORD NO:811SPR2013-01838 DATE:08/16/2013 DESCRIPTION fi n E',g: t-Wi + '+Ar, ru'r, G.'a.%. :ACCOUNTtCODE/TRANSICODE`_' f -, � :AMOUNTD Fixture 224-00000-425603 1005 84.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.08 Technology fee(5%of permit total) 100-00000-425605 2099 4.20 TOTAL DUE: 98.28 k=PAYMENT.;TYPEa.4 -y PAYOR T`caswER:.DSOWLSSV;-M,1ti71.COMMENTS.c-vk`s Lfer,.=f . t,:*:'AMOUNT`PAID;'., 1,y-Ua;; Check GREENE JEREMY ALLEN 98.28 1017 TOTAL PAID: 98.28 • • SPRINGFIELD 225 Fifth St " CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 °REGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01837 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 08/16/2013 EXPIRES: 02/11/2014 STATUS DATE: 08/16/2013 APPLIED: 08/16/2013 SITE ADDRESS: 4889 GLACIER DR,Springfield,OR 97478 SCOPE: Interior ASSESOR'S PARCEL NO: 1802051109600 TYPE OF STRUCTURE: Residential • PROJECT DESCRIPTION: MEC-Finish basement to add two beds,one bathroom OWNER: GREENE JEREMY ALLEN&SONDI DAWNNE Phone Number: 503-809-1227 ADDRESS: 4889 GLACIER DR SPRINGFIELD OR 97478 CONTRACTOR INFORMATION b Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone OWNER GCB 000000 08/01/2025 -INSPECTIONS REQUIRED Inspections 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 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. • O ontractor Signature Date • tO ultes y°u.. law teq t)uUty • Oce9°n the oveQon torch PTTE00141adoPted boy e toles ate set rules &R952"-°° HIS*WV r.0T No 1. follow ttonOen0��pthroughOA the by Viella�M1TSHAD Notlfioa 001 of[h L in OPRyoU may obtain dote:the teopr oatton MIS ? Z0\3 PBANpONtip FOR ... ;.. 0090• the °en Oregon Otilit2344� kO1H 0 0 1S Gone/ for the. eg°".332- �OMMEW-1 pER10p• nu m— Oentel is ANy -‘18°V)P Springfield Building Permit 8/16/2013 2:31:11 PM Page 1 of 1 • SPRINGFIELD- 225 Fifth St CITY OF SPRINGFIELD ca »?Ae-'" ` E�oN TRANSACTION RECEIPT 9pnngfield.ORa7477 . 541-726-3753 811-SPR2013-01837 wwwspringfield-cr.gov 4889 GLACIER DR permitcenter@springfield-or.gov RECEIPT NO: 2013001790 RECORD NO:811-SPR2013-01837 DATE:08/16/2013 DESCRIPTION-.4 . gjjar P 1 4`;..+`a-S ACCOUNT_CODE/TRANS CODE t .?S L AMOUNT CIMA First Appliance Fee 224-00000-425604 1006 80.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 - 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 PAYMENT4TFPEe' ,`_PAYONcnswER:oeow ev :�' , ""'rCOMMEN78' AMOUNTVPAID _ Check GREENE JEREMY ALLEN 93.60 1017 TOTAL PAID: 93.60 r SPRINGFIELD+•-e 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 • hitcbttiti Ph one: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01836 www.springfield-ar.gov permitcenter @springfield-or.gov • PROJECT STATUS: Issued ISSUED: 08/16/2013 EXPIRES: 02/11/2014 STATUS DATE: 08/16/2013 APPLIED: 08/16/2013 SITE ADDRESS: 4889 GLACIER DR,Springfield,OR 97478 SCOPE: Interior ASSESOR'S PARCEL NO: 1802051109600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: ELE-Finish basement to add two beds,one bathroom OWNER: GREENE JEREMY ALLEN&SONDI DAWNNE Phone Number: 503-809-1227 ADDRESS: 4889 GLACIER DR SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone OWNER CCB 000000 08/01/2025 _ INSPECTIONS REQUIRED 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. - - •' ner or •ntractor Signature Date • reQuttes Y 00101 o ted by the Oes ate sett00 tes ad op Those tuh pPR952 00\0tu OeuteOt0tntoug otthetutesbY EWpRK ��OPRtgS�may °btatn ooP1e the te.e. t6 SNI Q1RPE�M,� D1p1 �tot�CE. S p Vo to center. log�uGtY�oCtflcaiton TA ttTH R1ZE O. • PNV 130 D P • Springfield Building Permit 8/16/2013 2:33:38PM . Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St CO; TRANSACTION RECEIPT Spdngfield,OR97477 -- OREGON 541-726-3753 811-SPR2013-01836 www.spdngfield-or.gov 4889 GLACIER DR permitcenter@spdngfield-or.gov RECEIPT NO: 2013001791 RECORD NO:811-SPR2013-01836 DATE:08/16/2013 DESCRIRTION..,. .iES Fi"#". i. 5{. S Z'3_ .Lis-12.:,,'ACCOUNTCODELTRANSeCODE_ z _f?i'':.i.:AMOUNT DUE 4' Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 6.50 Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50 Branch circuits without service or feeder-each additional 224-00000-426102 1004 13.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 '.YMEAT, : ..HIERTI•O"°" 'R'° aAMOUNT PAID rPAYMENT;TYPE'.��,1'F'"'PAYOR�;=casNieR:Deow�ser ��..�aCOMMENTS-t���..- 'i-. ._ -., ,R._t Z>'4e%;-_ Check GREENE JEREMY ALLEN 93.60 • 1017 TOTAL PAID: 93.60 • • • • Structural Permit Application SPRINGFIELD-- DEPARTMENT LISE ONLY =: r a a� .:n Y .:CITY OF SPRINGFIELD`OREGON < c,q ,. a. es:: Permit no 5/3-O iSYC 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 oaESOr. Date: i�in, , This permit is issued under OAR 918-460-0030.Permits expire if work is not started within 180 days iss %nee or if work is suspended for 180 days. . -sdL•OCAL,GOYERNMENS-APPROVA'L" sr.x t �'< -� '"' 's7 Mm U -,��, , ,.,:t FEE;SCHEDULE ,; xs .*�* �„�, This project has final land-use approval. ' i...-i r 'rti y ilaizx:141 `i.i Valuaion iifor l ou , >i Signature: Date: ... (a)Job descriptio¢ 1t K,f f c This project has DEQ approval. Occupancy O Signature: Date: Z Zoning approval verified: ❑Yes ❑No Construction type: )3, Property is within flood plain: ❑Yes ❑No Square feet: `fir ',*- ..aCATEGGRY.,,OF,CONSTRUCT16TISSy..NKW-: Cost per square foot: , trrsidential ❑Government ❑Commercial Other information: k%.4-I07,41-513'1:g13;'JE:INFORMATIO/N A,ITC/(,LOCATI641 `?°�-, q Type of Heat: Job site address: 7�li S{ ? (�I/°e-K✓- ' y a_ Energy Patth�� City: S fl-3 I State: -ZIP: 97g45 ❑new 1Salteration ❑addition Subdivision: Lot no.: (b)Foundation-only permit? ❑Yes �•No +� �` Reference: I r� Taxlot: a ■a d Total valuation: Y3fev ;.4r x. : . ..PRO PE RTY„OWER TT; i "' a t T-Bulding:fe4V vwe r�7' e a No- r g e; Name: ,_. 10-12&-,_. 10-12&-14"111 Cr f ,� r (a)Permit fee(use valuation table): $ Address: Li f°( 64-A-c. ' O2 (b)Investigative fee(equal to [2a]): $ City: 5 p(j[.. --j.6 Staten(_ ZIP: (c)Reinspection($ per hour): $ Phone:5 3. 6t _p 7 Fax: - _ (number of hours x fee per hour) gel. E-mail: �ytp� LOA (d)Enter 12%surcharge(.12 x[2a+2b+2c]): $ f (e)Subtotal of fees above(2a through 2d): $ agent Building Owner or Owner's 3mPlan revievP]fees ira ^: ntligtla .�4„-�i,.i (a)Plan review(65%x permit fee[2a]): $ - _ (b)Fire and life safety(40%x permit fee[2a]): $ ❑This - llation is •In made on residential or farm property owned by (c)Subtotal of fees above(3a and 3b): $ me or a member of my immediate family,and is exempt from licensing `4";Miscellaneoiis fees ' '"" s if requirements under ORS 701.010. x '-`3` VU�i ' ".�.�'i• .y ,."4- ... _. _ _.ti , r" (a)Seismic fee, 1%(.0l x permit fee[2a]): S -�' 10-??O „CONTRAC OR-INTALLATION:-it sy :.n [ � �- - -- (b)Technology fee,5%(.05 x permit fee[2a]): $ e Business name: j>L-n Chi / 3 Address: TOTAL fees and surcharges(2e+3e+4a+46): $ �- • City . State: ZIP: - Phone: - - Fax: - - / ! S E-mail: (/J CCB license no.: Print name: Signature: SU13 CON RAGTOR INFORMATIVe Name CCB License# Phone Number Electrical Plumbing Mechanical . •Plumbing Permit Application DEPARTMENT-USE ONLY SPRINGFIELD a-'I e C E I NIi OF S RNGF D OREGOF ° ' se Permit no.: -57-7 ^v /.83e 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: 51/403 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. 'R41 fi , ;cant Y . .t t :LOCAL•iGOVERNMENT APPROVAL .�„P,by.."t~z,i �eF�ef , k.:_.��. �.., F,EE;+SChIEDULE', ,,,v,r__,ff Zoning approval verified? ❑ Yes ❑No a D'escrlptlon "i cii r ,°n -kc'or: Cost,, +'Total -cJs Sanitation approval verified? Ill Yes 'x?w:.4Rait'tanaz' '` ^""'. .F Y<-. ,°ea , ,cost -; ❑No New residential • '` "" :CATEGORY OF 'CONSTRUCTION ' '3.` ` a: 1 bathroom/1 kitchen(includes:first - ❑Government ❑Commercial 100 feet maker,water/sewer lines, hose $262.00 $ bibs, ice maker, underfloor low-point JOB^SITE=INFORMATION; AND .LOCATION-Eain drains and rain-drain packages) Job site address: s gt5x) 6-I Acres- 2 bathrooms/I kitchen $411.00 $ City:^5('� -pd) State:otZ IZZIP:9 9 3 bathrooms/1 kitchen $483.00 $ Each additional bathroom(over 3) $104.50 $ Reference: f oft)LO S L ( Taxlot p 56C3 0 Each additional kitchen(over 1) 5104.50 $ ,tPi":i r„ .� 1ADESCRIPTION.`OF WORK'EVai r+`.z--n Residential fire sprinklers(includes plan review) POD � i,^ 0 to 2,000 square feet $80.00 $ 2,001 to 3,600 square feet $128.00 $ '_a`'`310 -1 Iii1R0 Fs ERTrisOWN E13:1::1?•,cfnlynjggrigi 3,601 to 7,200 square feet $192.00 $ Name: -v -j ,yysy 'Q 7,201 square feet and greater $255.00 $ Manufactured dwelling or pre-fab(circle one) Address: 1-(fir l 'CC_ _ Connections to building sewer and water supply $80.00 $ City:Sfl E2 in State:on ZIP:97(( Commercial,industrial,and dwellings other than one-or Phone 8-9t11-1217- Fax: - - two-family E-mail: 2 Minimum fee ( $80.00 $ `) 3��N�A2t__'[oM Each fixture -(-0/ This installation is being made on residential or farm property 3 $21.00 $ owned by me or a member of my immediate family, and is Miscellaneous fees exempt from licensing re. under OAR 918-695-0020. 100' storm,sewer,water line $83.50 $ Signatue - ; Each fixture,appurtenance,and piping $21.00 $ .'.;- < ONTRACT.OR'INSTALLATION {' c s,i;. Storm water retention/detention facility $21.00 $ Business name: c. WK ems` Irrigation systems $21.00 $ Piping or private storm drainage Address: systems exceeding the first 100 feet $21.00 $ City: State: ZIP: Specialty fixtures $21.00 $ Reinspection(no.of hrs x fee per hr.) $80.00 $ Phone: - - Fax: - - Special requested inspections(no.of E-mail: - hrs.x fee per hr.) $80.00 $ CCB license no.: BCD license no.: Each additional inspection:(1) $80.00 $ Plumbing license no Medial gas¢pipmg,A[R 'uf;*t i. 4 Minimum fee $ Enter value of installation and equipment$ ' Print name: Enter fee based on installation and equipment value. $ Signature: - u=ar n .t cx t n r-+ h s��s � i�*���"t�tAPPLICANT°,USE#�<�''�` �i<'. '.k'�'4t* `:0 (A) Enter subtotal of above fees - �'/ (Minimum Permit Fee$80.00) $ /`i (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) $ /0 0 8. (D)Technology Fee(5%of[A]) $ yr° TOTAL fees and surcharges(A through D): $ ?eye! 440-2500-I(4/1/2013/COM) q` L�- Mechanical Permit Application DEPARTMENT,USE ONLY � / „ OITkY OF SPRINGFIELD REGON at; Permit no.: SI O e 3 ++Sa + n.. 225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 $�'`f,°4 a_y 03 � � Date: � �6 This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. igTAMOVEG..�ORYOE,CON STRUCTI_O N t ; "1r + >'; t FE ULEz ny E SCHED I1'kesidential ❑ Government ❑Commercial `Residential 3 NtCost : Total .. , ..�..,...£_ .s's Qty./ <3 JOB ;SITE,,INFORMATION-AND zLOCA\TION 'C First Appliance $80.00 $ Job site address: L('7.,GL.�/cil— X41 E.— Furnace/burner including ducts and vents City: 5—P1=3 State:c4L ZIP: / 7 7 Y Up to 100k BTU/hr. $18.50 $ Reference: / St Z.O r e ( Taxlotp S6po Over ers/ BTU/hr. $22.00 $ t 1, 5„ x .v p,,, .,t Heaters/stoves/vents { DE§CRIPTION OF£WORK.e _,, ;1144 , sve Unit heater $18.50 $ 9 >�905473,4'r '4 grtrzo4 Bitc.Qprivyip Wood/pellet/gas stove/flue $42.00 $ Repair/alter/add to heating appliance/ w s sL §,a��r , refrigeration unit or cooling system/ $80.00 $ }- %'re t� ;4, yr,$'PROPERTY ,OWNER -s { i`; 41 s',- absorption system Name: ' -C�1MY/ C Vent an with one duct/appliance cooler $14.50 $ Address: Lige (..,t r 17duct/appliance vent I $10.00 $ Hood with exhaust and duct $14.50 $ City: S 6 at& a et1c State: art_ ZIP:9 ' Floor furnace including vent $80.00 $ Phone::3-807- /227-- Fax: - - Gas piping E-mail: r °\ e�,�•M•,�-�wv (cr✓1n One to four outlets $7.50 $ This inst)lat7ifn is being madeYn property owned by me or a Additional outlets(each) $4.50 $ member of my immediate famil pt from licensing Air-handling units,including ducts requirements u•• SRS t .1 0. Up to 10,000 CFM $12.00 $ Signature: Over 10,000 CFM $22.00 $ vi+ klr 'r._a; AGTORiINSTALLATIONs ?,t Compressor/absorption system/heat pump Up to 3 hp/100k BTU $18.50 $ Business name: p Cr Up to 15 hp/500k BTU $32.00 $ Address: Up to 30 hp/1,000 BTU $47.50 $ City: State: ZIP: Up to 50 hp/1,750 BTU $62.50 $ Phone: - - Fax: - - Over 50 hp/1,750 BTU $104.50 $ E-mail: Incinerators Domestic incinerator $22.50 $ CCB license no.: Print name: Enter total valuation of mechanical system and installation costs$ Signature: Enter fee based on valuation of mechanical system,etc. . $ q f Coft .� 11.§-611:4 ols`4 M1S e11aneoUS fees ,yq ,--;s hems a -ea ' '- c"st. Reinspection $80.00 $ Specially requested inspections(per hr.) $80.00 $ Regulated equipment(unclassed) $14.50. $ Each additional inspection:(I) $80.00 $ ` t4 i APPLICANt USE' Ziost nl (A)Enter subtota . ::: ees(or enter set SC) minimum fee o 80.00 (B)Investigative ee(equal to[A]) $ cn (C)Enter 12%surcharge(.12 x[A+B]) $ 7 (D)Seismic fee, 1%(.01 x[A]) $ (E)Technology Fee(5%of[A]) $ t� 440-2545-J(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ 9 e_f Electrical Permit Application DEPARTMENT USE ONLY p� µ}�q SPNINGFIELO 'y�3y.. s v j ? X14 Pemitnn.�3 D/� . 225 Fifth StreeNSpriagfield,OR 97 r 477♦PH(541)726-3753♦FAX(541)726-3689 Date: 0 r3 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. c', ";LOCAL;GOVERNMENT APPROVAL r, _, ` ` t ,mss„ =FEE,r,SCHEDULE ,, , s';! `g. Zoning approval verified? ❑,Yes ❑No Number Of inspections per item ^` t t Cost Total CATEGORY OF;sCONSTRUCTION ,_, `, �' Or r� - - "°" -. , _ cost .; Residential,per unit,service included: sldential ❑ Government ❑Commercial 1,000 sq.ft.or less(4) $147.50 $ JOB`'SITE-INFORMATIOW'AND LOCATION.=' Each additional 500 sq.ft.or portion � `7 Job site address. if GlfreicFr—i I© 2 thereof - $ 27.50 $ City: .Se'iQ State: IL_ I ZIP: 5747 Limited energy(2) $ 35.00 $ Reference: I 2616 s-1 Taxlot.: O /qtoOt Each manufactured home or modular ?:DESCRIPTION``OF, WORKI? dwelling service or feeder(2) $ 69.00 $ Services or feeders: installation, alteration,relocation k1d%9-45 tw tpM4T e@ -C ?n? 200 amps or less(2) $ 89.00 $ l '"N -St-k (),-)ZPP-Ig- ,..",, , t r,.` ,."PROPERTY,;OWNER ,'„1". :-:?,7,2:.:::-,gTCia 201 to 400 amps(2) $ 104.50 $ Name: j 312-ali G 401 to 600 amps(2) $174.00 $ Address: 1i ggi tr p2 601 to 1,000 amps(2) $225.50 $ City: eaboarpattzm State:OB ZIP:4,91.1' Over 1,000 amps or volts(2) $516.00 $ Phon 3- ? -[2_2.7- Fax: - Reconnect only(2) $ 69.00 $ E-mail: ` Temporary services or feeders: installation, alteration, relocation® -C.¢»tix 200 amps or less(2) This ins a lat n is being made o esidential or farm property 5 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 479.561 . 401 to 600 amps(2) $138.50 $ Signa ro: _ _ Over 600 amps or 1,000 volts,see services or feeders section above 'W:, ;:--ONT.RACTOR-,INSTALLATION ",-; 7xi;tom; Branch circuits:new, alteration, extension per panel Business name: OW NC"— a.Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit $ 6.50 $ City: - State: ZIP: b.Fee for branch circuits without purchase of service or feeder fee: Phone: - - Fax: - - First branch circuit(2) $ 60.50 $ /7I_ E-mail: Each additional branch circuit (�, $ 6.50 $ CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included Signing supervisor's license no.: Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $ Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $ g g P - alteration,or extension(2) Each additional inspection:(1) $ao.00 $ °ani M`: 'r << „ tl...trnAFMPL`ICANT USEra . `- , `? v- n (A) Enter subtotal of above fees (Minimum Permit Fee$80.00) $ l ` (B)Enter 12%surcharge(.12 x[A]) - $ C/O (C)Technology Fee(5%of[A]) $ 17.4 TOTAL fees and surcharges(A through C): $ 73 60 440-2584-1(4/012013/C0M) '