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HomeMy WebLinkAboutPermit Building 2013-11-7 SPRINGFIELD 225 Fifth St ` CITY OF SPRINGFIELD Springfield,OR 97477 --,`ice Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02094 wwwspringfield-or.gov permitcenter©springtield-or.gov PROJECT STATUS: Issued ISSUED: 11/07/2013 EXPIRES: 05/06/2014 STATUS DATE: 11/07/2013 APPLIED: 09/17/2013 SITE ADDRESS: 1025 G ST,Springfield,OR 97477 SCOPE: Interior ASSESOR'S PARCEL NO: 1703351103500 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: ST-Interior remodel to convert storage space to office space OWNER: CATHOLIC COMMUNITY SERVICES LANE CO LLC Phone Number: 541-345-3628 ADDRESS: 1025 G ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor INTEGRITY CUSTOM BUILDERS INC CCB 106923 06/12/2014 541-942-8852 Plumbing Contractor JOE PISCOPO PLUMBING LLC CCB 167915 01/10/2014 541-510-0770 r INSPECTIONS REQUIRED Inspections 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. 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. 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. 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. ( I (-1 / 13 �r��� Owner or Contrao iBrggurb" Oregon law requires you to Date .01 ICE. follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth HIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- UTI;ORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by ;OMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). Springfield Building Permit 11/7/2013 11:02:08AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD kGON TRANSACTION RECEIPT 541-726-3753 811-SPR2013-02094 www.springfield-or.gov 1025 G ST permitcenter©springfield-or.gov RECEIPT NO: 2013002457 RECORD NO: 811-SPR2013-02094 DATE: 11/07/2013 `DESCRIPTION .. : ' • ' ACCOUNT CODEITRANS.DODE a:7-'•:11;_ ;_'AMOUNT_DUE,_t Building Permit Fee 224-00000-425602 1002 827.50 Fire, Life, Safety Plan Review 224-00000-425602 1077 331.00 Planning-Minor Review-City 100-00000-425002 1231 119.00 SDC: Improvement Cost- Local Wastewater 443-00000-448025 1184 1,253.50 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 2,568.28 SDC:Total Sewer Administration Fee 719-00000-426604 1175 191.09 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 . 99.30 Technology fee(5%of permit total) 100-00000-425605 2099 41.38 TOTAL DUE: 5,431.05 !._.PAYMENT TYPE PAY,OR ...CA6HlErs_ccnRPENfER COMMENTS ,-,,`._..,,,.- '.- - •'AMOUNT.PAID Check CATHOLIC COMMUNITY SERVICES 5,431.05 v� 33539 LANE CO LLC . TOTAL PAID: 5,431.05 • SPRINGFIELD . S '' CITY OF SPRINGFIELD Springfiel225 Fifth d,t OR 97477 C:"`i Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02423 www.springfield-or.gov permitce nter @s pringfield-or.goy PROJECT STATUS: Issued ISSUED: 11/07/2013 EXPIRES: 05/06/2014 STATUS DATE: 11/07/2013 APPLIED: 10/31/2013 SITE ADDRESS: 1025 G ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1703351103500 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: - PL-Interior plumbing remodel to convert storage space to office space OWNER: CATHOLIC COMMUNITY SERVICES LANE CO LLC Phone Number: 541-345-3628 ADDRESS: 1025 G ST SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION II Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor INTEGRITY CUSTOM BUILDERS INC CCB 106923 06/12/2014 541-942-8852 Plumbing Contractor JOE PISCOPO PLUMBING LLC CCB 167915 01/10/2014 541-510-0770 L INSPECTIONS REQUIRED Inspections 3150 Underslab Plumbing Underslab Plumbing: Prior to filling the trench and including required testing. 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. (1 (( .3 Owner or Contractor Signature Date ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility :TICE: ICE: Notification Center. These rules are sei forth .IS PERMIT SHALL EXPIRE IF THE WORK • in OAR 952-001-0010 through OAR 952-001- I;ORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by calling the center. (Note: the telephone IMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification Y 180 DAY PERIOD. Center is 1-800-332-2344). Springfield Building Permit 11/7/2013 11:05:50AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Springfield.OR97477 OREGON 541-726-3753 811-SPR2013-02423 www.springfield-or.gov 1025 G ST permitcenter @springfield-or.gov RECEIPT NO: 2013002458 RECORD NO:811-SPR2013-02423 DATE: 11/07/2013 ;DESCRIPTION _^ • -.._«: , ____ACCOUNT_CODE/TRANS CODE__ _;.._�__.AMOUNT DUE_.3 Floor drain/floor sink/hub 224-00000-425603 1005 21.00 Sink/basin/lavatory 224-00000-425603 1005 63.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 15.12 Technology fee(5%of permit total) 100-00000-425605 2099 6.30 Water closet 224-00000-425603 1005 42.00 TOTAL DUE: 147.42 le PAYMENT TYPE- PAYOR CASHIER CCARPE_NTER --_-. COMMENTS AMOUNT PAID Credit Card CATHOLIC COMMUNITY SERVICES 147.42 005240 LANE CO LLC TOTAL PAID: 147.42 • SPRINGFIELD 225 Fifth St hi '(°°— CITY OF SPRINGFIELD Springfield,OR 97477 \`OREGON Phone: 541-726-3753 ' Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02329 wwwspringfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 11/07/2013 EXPIRES: 05/06/2014 STATUS DATE: 11/07/2013 APPLIED: 10/21/2013 SITE ADDRESS: 1025 G ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703351103500 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: EL-Interior remodel to convert storage space to office space OWNER: CATHOLIC COMMUNITY SERVICES LANE CO LLC Phone Number: 541-345-3628 ADDRESS: 1025 G ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor INTEGRITY CUSTOM BUILDERS INC CCB 106923 06/12/2014 541-942-5852 Plumbing Contractor JOE PISCOPO PLUMBING LLC CCB 167915 01/10/2014 541-510-0770 Electrical Contractor FIRST LIGHT ELECTRIC INC CCB 179416 11/27/2013 541-726-2961 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. Owner or Contractor Signature Date ATTENTION: Oregon law requires you to •- follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by NOTICE: calling the center. (Note: the telephone THIS PERMIT SHALL EXPIRE IF THE WORK number for the Oregon Utility Notification AUTHORIZED UNDER THIS PERMIT IS NOT Center is 1-800-332-2344). • COMMENCED OR IS ABANDONED FOR . Springfield BuilgniXe2 0 DAY PERIOD. 11/7/2613 11:00:07nM Page 1 of 1 • • SPRINGFIELD CITY OF SPRINGFIELD 1A .c>r- 225 Fifth St o E�oN TRANSACTION RECEIPT Springfieltl,OR97477 541-726-3753 811-S PR2013-02329 www.springfield-or.gov 1025 G ST permitcenter @springfield-or.gov RECEIPT NO: 2013002456 RECORD NO:811-SPR2013-02329 DATE: 11/07/2013•(DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE_.._) Branch circuits with service or feeder each circuit 224-00000-426102 1004 130.00 Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 26.28 Technology fee(5%of permit total) 100-00000-425605 2099 10.95 TOTAL DUE: 256.23 7. PAYMENT_TYPE_._ _:PAYOR___caswR_R:ccpRPENTEre_ __ _COMMENTS ____._-_ _.___-_- ._._;-:'AMOUNT PAID.T —_— _____) Check i CATHOLIC COMMUNITY SERVICES 256.23 33539 LANE CO LLC TOTAL PAID: 256.23 • • • SPRINGFIELD 225 Fifth St `'i – CITY OF SPRINGFIELD Springfield,OR 97477 ` hhft' l� Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02330 www.springfield-or.gov pennitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 11/07/2013 EXPIRES: 05/06/2014 • STATUS DATE: 11/07/2013 APPLIED: 10/21/2013 SITE ADDRESS: 1025 G ST,Springfield,OR 97477 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1703351103500 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: ME-Interior remodel to convert storage space to office space OWNER: CATHOLIC COMMUNITY SERVICES LANE CO LLC Phone Number: 541-345-3628 ADDRESS: 1025 G ST SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor INTEGRITY CUSTOM BUILDERS INC CCB 106923 06/12/2014 541-942-8852 Plumbing Contractor JOE PISCOPO PLUMBING LLC CCB 167915 01/10/2014 541-510-0770 L 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. ,1 I 0 ''— iti l4" 0L___ / ( '7 ( C2) Owner or Contractor 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- AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). Springfield Building Permit 11/7/2013 10:58:34AM • - Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD = ya.. 225 Fifth St TRANSACTION RECEIPT SpringfielQOft97477 OREGON 541-726-3756 811-SPR2013-02330 • www.springfield-ocgov . 1025 G ST permitcenter @springfield-or.gov I RECEIPT NO: 2013002455 RECORD NO:811-SPR2013-02330 DATE: 11/07/2013 [DESCRIPTION - ACCOUNT_CODEITRANS CODE - AMOUNT DUE_J Mechanical Permit fee(based on value of work) 224-00000-425604 1006 193.58 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 23.23 Technology fee(5%of permit total) 100-00000-425605 2099 9.68 _ -- TOTAL DUE: 226.49 PAYMENT TYPE;_ AMOUNT PAID PAYOR CASHIER:CCARPENTER COMMENTS -„- �._._ . .. ._.._.. J Check CATHOLIC COMMUNITY SERVICES 226.49 33539 LANE CO LLC TOTAL PAID: 226.49 • SPRINGFIELD — CITY OF SPRINGFIELD 225 Fifth St NU, TRANSACTION RECEIPT Spfngfield.OR 97477 'r OREGON 541-726-3753 811-SPR2013-02094 www.spdngfieldor.goy 1025 G ST permitcenter@spdngfeld-or.gov RECEIPT NO: 2013002052 RECORD NO: 811-SPR2013-02094 DATE:09/17/2013 DESCRIPTION` ...' ft eV xa : TA n- '' '4� g .. ,&. dcy �#� tin �-`�c-r' �ACCOUNT'CODEITRANS CODE_=;-'�.�.��, AMOUNT'DUE�m Structural Plan Review Fee Commercial 224-00000-425602 1060 537.88 TOTAL DUE: 537.88 ;k=PAYMENT TYPE LI-PAYOR r - s COMMENTS ".. _i9;45 14,1 AMOUNT PAID_._ r't..•Credit Card CATHOLIC COMMUNITY SERVICES 537.88 002872 LANE CO LLC TOTAL PAID: 537.88 • x; -�. asraF.� Electrical Permit Application :.. DEPARTMENT:uSE;ONLY SPRINGFIELD t.a s ..,"d'df.2%t1GF'^ }�9i CITY OFKrySPRINGFIELD;OREGON . "' . "3 232 f tas.i " ~ ..»,s6twst ,a; r,.!se:..,, 4 4f,zke ,, ,s,,,, : �,l i * Permitno.: 225 Fifth Street t Springfield,OR 97477 t PH(541)726-3753 t FAX(541)726-3689 Date: 704///Y 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. ' LOCALGOVERNMENTAPP„„ROYAL ' ,'d 5 a”" ''" =='' �. a ,.:. �< .,. `� F,EE�$CFIEDULEfrit,.��� .u�3 g approval verified? ❑ ❑ ric tuber of n pections per rt m O"E ?Qty Zonin a rova]verified. Yes No Cost Totalrl.+ , ,4 ki:t .w., vsesu.,, aa-m ._.-.f �,, ,� OTC= 'We osta 4CATEGORY OPriCQNS,T,RUCT1QNs A Residential,per unit,service included: El Residential I ID Government [Commercial 1,000 sq.ft. or less(4) $134.00 $ Ps JOB'3SITEINFORMATIONANDALOCATIONw'_ � Each additional 500 sq. ft. or portion �, Job site address: ./7 thereof $ 25.00 $ City: S nlr`A I State: I ZIP: 57 V 7) Limited energy(2) $ 32.00 $ Subdivision: /PO 7 7(7/ I Lot no.: MO Each manufactured home or modular $ 63.00 $ z ,, i- : DESCRIP:T,ION'gyOFWORK re b- - dwelling service or feeder(2) Services or feeders: installation, alteration, relocation 200 amps or less(2) $ 81.00 $ 1r;{, r`•'74:112ROP,ERTaciwt,ERNA :s,,;, _,.;' 201 to 400 amps(2) $ 95.00 $ Name: (tat Ltd. 401 to 600 amps(2) $158.00 $ Address: /D 2 r c 1/45 r 601 to 1,000 amps(2) $205.00 $ City: ,5fFLr) 7 State: I ZIP: f?p 77 Over 1,000 amps or volts(2) $469.00 $ Phone: yer 3a z_Y' Fax: - - Reconnect only(2) $ 63.00 $ E-mail: X 3i Temporary services or feeders: installation,alteration,tiioon,relocation This installation is being made on residential or farm property 200 amps or less(2) , . Y ,0 $U (- 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 479.560(1). 401 to 600 amps(2) $126.00 $ Signature: Over 600 amps or 1,000 volts,see services or feeders section above 9afir`r =;:txtCONTRAC,T,QR INSTALLATIQ.N`g an Branch circuits: new alteration, extension per panel Business name: Pr/45't Z c4& Elv:6,7;G 7>�C a.Fee for branch circuits with purchase of a service,ar ler fee: Address: �5�97 ��/ -�Jg ,e,,4 Each branch circuit � S-1 $ --r Citys ,i State:00C ZIP: 9"2 6425 b. Fee for branch circuits without purchase of a service or feeder fee: Phon $q' ,(- 90a ' Fax - V/ S6-a.2' / First branch circuit(2) $ 55.00 $ E-mail:Sy/�, pa ,, S�G ,A U Each additional branch circuit $ 6.00 $ CCB license no.: /795/6 BCD license no.: c'-- Miscellaneous fees:service or feeder not included Signing supervisor's license no.: d7a/VO—S Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor:(��, At •supervisor -- � ` a sign or outline lighting(2) $ 63.00 $ Signature of signing supervisor: + Signal circuit or alimited-energy panel, $ 63.00 $ ////- alteration or extension(2) Each additional inspection:(I) $58.00 $ x $f' v tTlit 'r dir ,,.v. �.r. ;;. z, aflw,a ISPPLICAN1Tt�USE ?'�._��kr�` '`���.a (A) Enter subtotal of above fees (Minimum Permit Fee$58.00) $ (✓ - (B)Enter 12%surcharge(.12 x[A]) $ 7,6?A (C)Technology Fee(5%of[A]) $ w 2.r-- TOTAL fees and surcharges(A through C): $25'6 2;3— 440-2584-3(9/08/COM) . 10/19/2013 16:14 54174422272 CCSLC INC PAGE 03/03 Mechanical Permit Application ,• DEPARTMENT USE.:ONLY - SOeMOF,RO ti iPT CITY Ob .SPRINGFIELD, OREGON : . :..a,u� ns .y?' •.i Permit no.: 5t 3r 233c) Q H. -5 Fifth Street• Springfield,OR 97477 . PH(541)726-3753 • FAX(541)726-3689 y Date: 70 J Z e (1 7 t. • 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. CATEGORY,OF•-CONSTRUCTION ; ,F,EE SORE[S:CILE ' ❑Residential ❑Government 0 Commercial 1/4Et051tl?ntiaL c?.. ' lt: Qty Ff JGm bs 1c'bbtsat l ' JOB ,;SITE INFORMATION`.'AND .LOCATION.:'''' FirstApplisnce $80.00 Job site address: /0 9S G 5+' €t - Furnace/burner including ducts and vents Ci ty: s P �[J State: ZIP: R 7 4.e-9 9 Up to 1001cBTU/hr. $18.50 $ Over 100k BTU/hr. $22.00 $ Reference Taxlot.: o I coo Heaters/stoves/vents A '' DESCRIPTION ,O!F WORK '.:' Unit heater $18.50 $ kIVGEG '^9ftt(4 f7 rDr iwkr+o/ Woodpellct/gasstoveflue $42.00 $ V'e - 'oct2 ( Repair/alter/add to beating appliance/ ,, refrigeration unit or cooling system/ $80.00 $ Pk#OPERTY OWNER k�:. Co. absorption system Name:Cai0 L, Cn,..rn:F Se,l,.+.-t3 ,.g� Lame Evaporated cooler $14.50 $ Address: 1J a5' G Sf-re Vent fan with one ductappliance vent $10.00 $ // rr Hood with exhaust and duct $14.50 $ City: 5' ,-,,,k a.(C- State: OC ZIP: 47117'7 Floor furnace including vent _ $80,00 $ Phon 13F1& 5C2-8 FaxSt1[?'t`I aa77� Gas piping ' E-mail: 4 v tcl li '-n L CCs j t , o . One to four outlets _ $7.50 $ This installation is being made on property�ned by me or a Additional outlets(each) $4.50 $ member of my immediate family, and is exempt from licensing Air-handling units,including ducts requvertietits under ORS 701.010. Up to 10,000 GEM - $12.00 $ Signature: Over 10,000 CFM $22.00 $ + ;i`" 'GO,NTRAbtdI INATALLAtJc N: , *^'° ,;? Compressor/absorption system/heat pump I Business name: �, _5 lip to 3 hp/look BTU $18.50 $ Address: -41//612/4 ni/9/C 511— Up to ]5 hp/l.00 BTU $47.50 $ a Up to 30 hp/1,000 BTU $47.50 S City: i/ 'a 71 State: ZIP: 92474 Up to 50 hp/1,750 BTU ._ $62.50 $ Phone:4/- 2 - — 74115 I Fax:64/ ° 79/-(3?2f Over 50 hp/1,750 BTU ( $104.50 $ E-mail: 4[,irjArtellia •40 eid(vec �.antis_ • Incinerators l .,�...,, Domestic incinerator $22,50 I $ CCB license no.,:/ Print name: �fi. h f 021/— F ter totetc al o . � ech l " . , " 1- � Enter total valuation of mechanical system Signature: and installation costs 5, /2-0,..--, Enter fee based on valuation of mechanical system,etc. $ rr 0:14 #90: u`t eCS4 ' '-.Reins ea os ' Reinspectien * $80,00 $ Specially requested inspections(per hr.) $50.00 $ — Regulated equipment(unclassed) $14.50. $ .- Each additional inspection:(1) $80.00 $ tv, k';xd'' Mr.,.710:1lNT',, riv':'n ) S `+ 3'i (A)Enter subtotal of above fees(or enter set ry minimum fee of $80.00) $/997l'- (B)Investigative fee(equal to[A)) $ (C)Enter 12%surcharge(,12 x[A+B)) $ " IS 1>1- (D)Seismic fee, 1%(.01 x[A]) $ L (E)Technology Fee(5°4 of[A]) $ ¶4 440-2545-1(4l1/2013 ICON) TOTAL fees and surcharges (A through E): $2ef(_ ,.► Structural Permit Application SPRINGFIELD ' WEFARTMENTainii. LY CITY OF SPRINGFIELD, OREGON ya% Permit no Q 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3669 r" OREGON v"1 3 �� Date: g/0 r This permit is issued under OAR 918-460-0030.Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. )> °'M `?LOCAL GOVERNMENT„APPROVAL Y Wgj EMr, '`,flIT `FEE°SCHEDULE,,,, s , :.;,_; ", °,,.?. This project has final land-use approval. 1 Valaatwo mfo�m Tion^ v r+`a, ax Me' 'g' ""''`� fit__, �+ .a ^S*_i >,d:+..-..-� .a*< �*a�;!va Signature: Date: (a)Job description: '>zte,E, S — / This project has DEQ approval. `�L` , Date: Occupancy t Signature: p Zoning approval verified: ❑Yes ❑No Construction type: y/7� Property is within flood plain: ❑Yes ❑No Square feet: "LJ 1 _,E CATEGORY,'O TOONSTRUCTtPTI.,.na Cost per square foot: ❑Residential ❑Government Commercial Other information: m-. �,1,���, ,JOBr`SITE.,':,INFORMATIONIAND„LOCATION/j;�.'%y�,�' Type of Heat: Job site address: ]l10 a c -G S'f"v'ee-T Energy Path: - City: Cp in n q+t e.(L State: Oa ZIP: 97 yV 7 [Hew alteration ❑addition Subdivision: J Lot no.: /1'''S-35--/I (b)Foundation-only permit? ❑Yes ❑No • Reference "Jo 3 3 5/! Taxlot: O 3 co ao3c o° Total valuation: F $/J.SQ(z A' ,,h. 2 `a.e: T" t »_.r h'F e+ T ,'t y -ei II tie, .F' Z '^ ''4�i ,- CT 1 `'^4: *.L,..,:,„,,,G,_�;€t v_v;,PROPERTYQWNER ��° e.._.„Y„�� �2�'Butldtti'fees"� � .4"� :s + x��' ` :. , Name: Co 4 )1 L_ Co en., • t`‘ ScCv.ccs bC Lao,e Co . (a)Permit fee(use valuation table): $ / Address: j o LC G Strea - (b)Investigative fee(equal to[2a]): $ City: Sp r...`\- ,ill State: ID Q- ZIP:97 477 (c)Reinspection(S per hour): 3rfs $1(7 NL( 27-7 (number of hours x fee per hour) $ Phone: s'�I I- -"S(,� Fax: E-mail: -[-m‘4.1 ken,.(6 cc lc , o rp (d)Enter 12%surcharge(.12 x[2a+2b+2c]): S J (e)Subtotal of fees above(2a through 2d): $ Building Owner or Owner's agent authorizing this application: k3: la tevwfe i7,W` ' 1?..;• ` a =z (a)Plan review(65%x permit fee[2a]): - $ s ei Yo Sign here: \ - (b)Fire and life safety(40%x permit fee[2a]): $ ❑This installation is being 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 ,'45-Mrscellaneous fees r {>F 7'' i1'r- , k r'r requirements under ORS 701.010. ° .(a)Seismic fee, I%(.Ol x permit fee[2a]): $ -s G:ia CONTRACTORINSTALLATIQN ” „ t: r '� _aas � tw is "`-T l (b)Technology fee,5%(.OS x pemtit fee[2a]): S Business name: / -ha /� TOTAL fees and surcharges(2e+3c+4a+46): $ Address: /-03/ Mr, .0 _ City: / 1', ,� - State: n/. ZIP: _ , it —IA—Phone: 't.Ji/ i I v /II Fax: - - 0 h E-mail: _ At!YG, _ 1 ,/ CCB license no.: /0 9 Z,3 A / .. Print name: - 7 VA O / / Signature: / .. kip .- ,-Tt SUB CONTRACTOR_€INFORMATION ns_ Name CCB License # Phone N u m be r Electrical 4 Pi C/ $GN c I Plumbing 6(.6,414,7'715 5y/ 7nc �SC610 ntIs l 510 07 7 b Mechanical na f cAnsen ye;