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Home My WebLink AboutPermit Building 2007-4-9 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01/16/2007 EXPIRES: 11/02/2007 VALUE: $ 1,990,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3100 Martin Luther King Jr Pkwy Springfield ASSESSOR'S PARCEL NO.: 1703220003403 TYPE OF WORK: Medical Office PROJECT DESCRIPTION: Womens Care Associates Facility TYPE OF USE: New Commercial Contractor License THE HASKELL CO A F~RIDA CORP 147733 CHRISTENSON ELEC1J}le:.~~~ 458 MIKE PATTERSON V.&I;I.~i"J1.- lONn. 81746 ).m .I!~\f'f. """1 -0lt''\~f'i',..roJNiI rJiII!: lfl:!,rer. ~ Oy II, 'eq,,/r. Oqll~ ~t'.I&W8lel:-OOl hose 90,.& ps JldtPt Size: B f'/UIlt)61faWJU gySlb,tatU~rou "LJled-~i@11 UI1f:f~t 1st Floor: fit'fDr flmltj;. '17 oM.8.r~& (\'jJj @SSet r{)Ft 2nd Floor: VA Water 'PY@J.i . (lVote.'/e~ ~JP ~<. ' t Basement: Range Type~gOI1 Ut.: ~he 1fJ1!ft-'fru/e ~sq Ft Garage/Carport Energy Path:I')f)_,?~ Illtylv. ~J)d S Sq Ft Other: i41'(J Sprinkled Building~'<34"'" OtI6~1~. Occupant Load: ~~-~) ~~ ,/ft/S;C,q'DEVELOPMENT INFORMATION I c. tJrIiO'tfl/tf/i 1/ '01tt/tft,"'etO S/i4t?verlay Dist: Ny 18, . 4'Ct'O tJlIOt~:slt1&~Trees Rqd: o Oily pi: /s 4:~~~{;:~P;. fa/) fJllVOo 111// YVOfl.t ' WJ:'f\ /S Ifl_ I PUBLIC IMPROV~EN+s I Owner: WOMENS CARE PROPERTIES LLC Address: 598 E 13TH AVE EUGENE OR 97401 I CONTRACTOR INFORMATION I Contractor Type General Electrical Plumbing # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of 4 Phone Number: 541-686-3120 Expiration Date 05/11/2007 05/01/2007 12/21/2008 Phone 904-791-4674 541-688-6121 503.632-7374 10,455 105 REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01/16/2007 EXPIRES: 11/02/2007 VALUE: $ 1,990,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriution I Description Tvpe of Construction Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 1,990,000.00 Value Date Calculated Total Value of Project $1,990,000.00 $1,990,000.00 01/16/2007 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Comm/lnd/Public $4,360.30 1/16/07 2200700000000000056 -Mechanical Issuance Fee- $10.00 4/9/07 3200700000000000203 + 10% Administrative Fee $975.67 4/9/07 3200700000000000203 + 5% Technology Fee $435.56 4/9/07 3200700000000000203 + 8% State Surcharge $696.89 4/9/07 3200700000000000203 Add, Alter, Extend Circ $43.00 4/9/07 3200700000000000203 Add, Alter, Extend Circ Ea Add $279.00 4/9/07 3200700000000000203 Addressing Assignment $31.00 4/9/07 3200700000000000203 Air Handling Unit Up to 10,000 $16.00 4/9/07 3200700000000000203 Appliance Not Listed $36.00 4/9/07 3200700000000000203 Appliance Vent $6.00 4/9/07 3200700000000000203 Boiler/Comp Up To 100,000 btu $48.00 4/9/07 3200700000000000203 Building Permit $6,708.15 4/9/07 3200700000000000203 Exhaust Hoods $9.00 4/9/07 3200700000000000203 Fire SF Fee - Non-Residential $1,045.50 4/9/07 3200700000000000203 Fixture $714.00 4/9/07 3200700000000000203 Furnace - up to 100,000 btu $228.00 4/9/07 3200700000000000203 Not Covered Plumbing $84.00 4/9/07 3200700000000000203 Perm Serv/Fdr 200 amps or less $126.00 4/9/07 3200700000000000203 Perm Serv/Fdr 201 to 400 amps $75.00 4/9/07 3200700000000000203 Perm Serv/Fdr 401 to 600 amps $125.00 4/9/07 3200700000000000203 Plan Review Fire & Life Safety $2,683.26 4/9/07 3200700000000000203 Sanitary Sewer - 1st 50 Feet $45.00 4/9/07 3200700000000000203 Sanitary Sewer - Improvement $1,899.84 4/9/07 3200700000000000203 Sanitary Sewer - Reimbursement $2,498.88 4/9/07 3200700000000000203 SDC MWMC Administration $10.00 4/9/07 3200700000000000203 SDC MWMC Improvement $8,616.59 4/9/07 3200700000000000203 SDC MWMC Reimbursement $820.93 4/9/07 3200700000000000203 SDC Sanitary/Storm Admin $1,325.70 4/9/07 3200700000000000203 SDC Transpo Admin $1,955.84 4/9/07 3200700000000000203 SDC Transpo Improvement $27,297.95 4/9/07 3200700000000000203 SDC Transpo Reimbursement $6,188.04 4/9/07 3200700000000000203 Special Waste Connection $56.00 4/9/07 3200700000000000203 Storm Drainage Impervious Area $18,298.56 4/9/07 3200700000000000203 Storm Sewer - 1st 50 Feet $45.00 4/9/07 3200700000000000203 Temp Power 200 amps or less $50.00 4/9/07 3200700000000000203 Paee 2 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01/16/2007 EXPIRES: 11/0212007 VALUE: $ 1,990,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Vent Fan Refund - Admin Fee Refund - Electrical Refund - Surcharge + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Fixture $18.00 $-4.00 $-40.00 $-3.20 $14.00 $7.00 $11.20 $140.00 4/9/07 4/30/07 4/30/07 4/30/07 5/10/07 5/10/07 5/10/07 5/10/07 3200700000000000203 VOUCHER # 117955 VOUCHER # 117955 VOUCHER # 117955 2200700000000000717 2200700000000000717 2200700000000000717 2200700000000000717 Total Amount Paid $87,986.66 I Plan Reviews , Fire Department Review 02/01/2007 02/01/2007 OK GRG See attached document for Fire Department Plans Review comments. Initial Review 01/16/2007 01/16/2007 APP LLH Public Works Review 01/22/2007 02/08/2007 APP JHJ Attached SDC Worksheet. (JHJ) Structural Review 05/02/2007 05/02/2007 APP DJP Plans reviewed on or about 2/8/07. No structural plan review was entered. Used information written on plans to make entry. Structural Review 01/16/2007 To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~eouireCUnsnections I Site Inspection: To be made after excavation but prior to setting forms. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roofing: Prior to installing any roof covering. Masonry: Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Paee 3 of 4 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01116/2007 EXPIRES: 11102/2007 VALUE: $ 1,990,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide results to City Buiding Inspector Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector. High Strength Bolting: To be done during construction by a State Certified Special Inspector. Provide inspection results to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to City Building Inspector. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Grading: After gravel is in place but prior to placing concrete. Final Paving: After paving is complete. Rough Plumbing: Prior to cover and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When aU plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When aU electrical work is complete. Roof Sheathing/Nailing: Before covering sheathing with finish material. 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 of Oregon pertaining to the work described herein, and that NO OCCUPANCY wiJ) 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 cons uction. J~~ ~ V (~ 5~;:; r r - Owner or Contractors Signature Date Paee 4 of 4 r 225 Fifth Street SpdngfieIil, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00068 COM2007-00068 COM2007 -00068 COM2007 -00068 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Fixture + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By MIKE PATTERSON PLUMBING Cjhr of Springfield Official Receipt I lopment Services Department Public Works Department 2200700000000000717 Date: 05/10/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 010922 In Person Payment Total: Page 1 of 1 10:06:40AM Amount Due 140.00 7.00 ] 1.20 14.00 $172.20 Amount Paid $]72.20 $172.20 5/] 0/2007 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED :04/09/2007 APPLIED: 01116/2007 EXPIRES: 10/09/2007 VALUE: $ 1,990,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3100 Martin Luther King Jr Pkwy Springfield ASSESSOR'S PARCEL NO.: 1703220003403 TYPE OF WORK: Medica) Office PROJECT DESCRIPTION: Womens Care Associates Facility TYPE OF USE: New \) Commercial Owner: WOMENS CARE PROPERTIES LLC Address: 598 E 13TH A VE ~ EUGENE OR 97401 ~\:)~ i.\ .C ,~C'\ ,,\,\,(. S ,\'! . .. ~~~~~~~CTORINFORMATION. ~-;S S ((. ~~ Contractor Type C~_~{\~r,\~~ ~~\:)~ License General ...r~'5~Ii~:1Ie'FO A FLORIDA CORP 147733 ~~ \ ~ ~<V'(o.~~~<\) \) .\:)~ \~\\:)<\). I BUILDING INFORMATION I '\~ ~\:)~ ~<v<\) ((.~~.. '.' \ " # of Units: ~'\. ~<v~ <\)~ # of Stories: :\,0":> 0(\ .~ ,..)\~1 Lot Size: Primary Occupancy ~;.:~;.~~ B Height Of. Str.ucttit>e:e~ ,~~t~_. 2_1~OO " Sq Ft 1st Floor: ~.:! , ,),' 0' "'" ~Jv c::, Secondary Occupancy up: Type of He,!!"t: ~el . ~l!rce~,Wir(~s ~ Sq Ft 2nd Floor: Primary Construction ype V A Water :r.y'p.el.\'I.: <..~ O~.El!lct!;icF~~o.;Sq Ft Basement: __VI A\> j e .:(\ ~.,\. ~..' ~.. Secondary Construction Type: R~!!.ge'Tj)P:~<f.' . ~OJ ;: Q ~b~~Dti~:;~.." Sq Ft Garage/Carport # of Bedrooms: ,Enerlrl''tP. lith: ~~0 ,:..{o',J!,^'f:: ':'P,ath~1 Sq Ft Other: .\\~ f1~ 0"'" (';." OY \;\'. ~.", . .~. ,[p,iiil~l.eo 8uil.d\.n'g: ~p' . .~\ il/~~" Occupant Load: A~.,~ r.e. ~ .,..,.~ ..\.0 ,,"~ .....0\ ~l cQEVJiJ!,QRMENIF 1NEO'R,M~ TrlON c' I .,..... .1\".... ~l,....\" :;:P' ,.,\" <.\'V ~ <"- ~ c/~. \), ,'0' ~O O~ ',to'" :'(".'" ~...f!, '. '-S- !9~~~,~~)'PJ~l::t)\~\~ f'\.\)Oj fttStreee:rLe.es;;Rqd: v I,V .."".",. 'IV Paved'Drive Rqd: ~~t,~ %,"of Lot Coverage: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: 'Phone Number: 541-686-3120 Expiration Date 05/11/2007 Phone 904-791-4674 10,455 105 REQUIRED PARKING Total: Han~icapped: Compact: Sidewalk Type: Downspouts/Drains: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Paee 1 of 4 Value Date Calculated Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01/16/2007 EXPIRES: 10/09/2007 VALUE: $ 1,990,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Bid Amount Use Bid Amount $1.00 1,990,000.00 $1,990,000.00 $1,990,000.00 01/16/2007 Total Value of Project ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Comm/Ind/Public $4,360.30 1/16/07 2200700000000000056 -Mechanical Issuance Fee- $10.00 4/9/07 3200700000000000203 + 10% Administrative Fee $975.67 4/9/07 3200700000000000203 + 5% Technology Fee $435.56 4/9/07 3200700000000000203 + 8% State Surcharge $696.89 4/9/07 3200700000000000203 Add, Alter, Extend Circ $43.00 4/9/07 3200700000000000203 Add, Alter, Extend Circ Ea Add $279.00 4/9/07 3200700000000000203 Addressing Assignment $31.00 4/9/07 3200700000000000203 Air Handling Unit Up to 10,000 $16.00 4/9/07 3200700000000000203 Appliance Not Listed $36.00 4/9/07 3200700000000000203 Appliance Vent $6.00 4/9/07 3200700000000000203 Boiler/Comp Up To 100,000 btu $48.00 4/9/07 3200700000000000203 Building Permit $6,708.15 4/9/07 3200700000000000203 Exhaust Hoods $9.00 4/9/07 3200700000000000203 Fire SF Fee - Non-Residential $1,045.50 4/9/07 3200700000000000203 Fixture $714.00 4/9/07 3200700000000000203 Furnace - up to 100,000 btu $228.00 4/9/07 3200700000000000203 Not Covered Plumbing $84.00 4/9/07 3200700000000000203 Perm Serv/Fdr 200 amps or less $126.00 4/9/07 3200700000000000203 Perm Serv/Fdr 201 to 400 amps $75.00 4/9/07 3200700000000000203 Perm Serv/Fdr 401 to 600 amps $125.00 4/9/07 3200700000000000203 Plan Review Fire & Life Safety $2,683.26 4/9/07 3200700000000000203 Sanitary Sewer - 1st 50 Feet $45.00 4/9/07 3200700000000000203 Sanitary Sewer - Improvement $1,899.84 4/9/07 3200700000000000203 Sanitary Sewer - Reimbursement $2,498.88 4/9/07 3200700000000000203 SDC MWMC Administration $10.00 4/9/07 3200700000000000203 SDC MWMC Improvement $8,616.59 4/9/07 3200700000000000203 SDC MWMC Reimbursement $820.93 4/9/07 3200700000000000203 SDC Sanitary/Storm Admin $1,325.70 4/9/07 3200700000000000203 SDC Transpo Admin $1,955.84 4/9/07 3200700000000000203 SDC Transpo Improvement $27,297.95 4/9/07 3200700000000000203 SDC Transpo Reimbursement $6,188.04 4/9/07 3200700000000000203 Special Waste Connection $56.00 4/9/07 3200700000000000203 Storm Drainage Impervious Area. $18,298.56 4/9/07 3200700000000000203 Storm Sewer - 1st 50 Feet $45.00 4/9/07 3200700000000000203 Temp Power 200 amps or less $50.00 4/9/07 3200700000000000203 Vent Fan $18.00 4/9/07 3200700000000000203 Total Amount Paid $87,861.66 Pae:e 2 of 4 - CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01/1612007 EXPIRES: 10/09/2007 VALUE: $ 1,990,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fire Department Review 02/0112007 I Plan Reviews I 02/0112007 OK GRG See attached document for Fire Department Plans Review comments. Initial Review Public Works Review Structural Review 01116/2007 0112212007 01/16/2007 01/16/2007 02/08/2007 APP APP LLH JHJ Attached SDC Worksheet. (JHJ) To Requestan inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~eouiredJnsnections , Site Inspection: To be made after excavation but prior to setting forms. Erosion/Grading Inspection: Prior to ground disturl;>ance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roofing: Prior to installing any roof covering. Masonry: Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide results to City Buiding Inspector Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector. High Strength Bolting: To be done during construction by a State Certified Special Inspector. Provide inspection results to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to City Building Inspector. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Grading: After gravel is in place but prior to placing concrete. Pal!e 3 of 4 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-00068 ISSUED: 04/09/2007 APPLIED: 01/16/2007 EXPIRES: 10/09/2007 VALUE: $ 1,990,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Paving: After paving is complete. Rou'gh Plumbing: Prior to cover and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When aU plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Roof Sheathing/Nailing: Before covering sheathing with finish material. 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 of 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 ~~~ Owner or Contractors Signature Anrl- I' Date l' ;Z807 "' Pal!e 4 of 4 2250 FifthoStreet Springfield, Oregon 97477 541-726-3759 Phone Cit'" of Springfield Official Receipt L lopment Services Department Public Works Department Job/Journal Number COM2007-00068 CO M2007 -00068 COM2007-00068 COM2007 -00068 COM2007-00068 COM2007-00068 COM2007 -00068 COM2007-00068 COM2007-00068 COM2007 -00068 COM2007 -00068 COM2007-00068 COM2007-00068 COM2007 -00068 COM2007 -00068 COM2007 -00068 COM2007 -00068 COM2007 -00068 COM2007-00068 COM2007-00068 COM2007-00068 COM2007 -00068 COM2007 -00068 COM2007-00068 COM2007-00068 COM2007 -00068 COM2007-00068 COM2007 -00068 COM2007-00068 COM2007 -00068 COM2007-00068 CO M2007 -00068 COM2007-00068 COM2007-00068 COM2007-00068 COM2007 -00068 Payments: Type of Payment Check cReceint 1 RECEIPT #: 3200700000000000203 Date: 04/09/2007 Description Addressing Assignment Fire SF Fee - Non-Residential Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin Furnace - up to 100,000 btu Boiler/Comp Up To 100,000 btu Air Handling Unit Up to 10,000 Appliance Not Listed Exhaust Hoods Vent Fan Appliance Vent Fixture Sanitary Sewer - 1 st 50 Feet Storm Sewer - 1 st 50 Feet Special Waste Connection Not Covered Plumbing Temp Power 200 amps or less Perm Serv/Fdr 200 amps or less Perm Serv/Fdr 201 to 400 amps Perm Serv/Fdr 401 to 600 amps Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Plan Review Fire & Life Safety -Mechanical Issuance Fee- Building Permit + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By HASKELL Item Total: Check Number Authorization Received By Batch Number Number How Received 95698 In Person Payment Total: Jmp Page 1 of 1 3:19:36PM Amount Due 31.00 1,045.50 18,298.56 2,498.88 1,899.84 6,188.04 27,297.95 820.93 8,616.59 10.00 1,325.70 1,955.84 228.00 48.00 16.00 36.00 9.00 18.00 6.00 714.00 45.00 45.00 56.00 84.00 50.00 126.00 75.00 125.00 43.00 279.00 2,683.26 10.00 6,708.15 435.56 696.89 975.67 $83,501.36 Amount Paid $83,501.36 $83,501.36 4/9/2007 ~-- \ ~V:,r;:95~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PE~IT ~.fU9A1JPN CIty Job Number ~ 'l-1:.-A A.J loLJ Date 1. i LOCATION OF INSTALLATION 3. 5\OC) ~L\C '~('9\Cw4 LEGAL DESCRIPTION \ V103'L1DO O?j\~ JOB~fRJPTION <;(,{W4-~ \ wile Pe,.,,,, "~Sferable and espi<< ifwo,k is \ not started within] 80 days of issuance or if work is Suspended for 180 days. COMPLETE FEE SCHEDULE BELOW. A. New Residential- Single or Multi-Family per dwelling unit. _m ,.._ ,_, Service Included 1000 sq. ft. or Jess Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 2. CONTRACTOR INSTALLATIONONLY B. or Installation, Alterations or Relocation: Electrical Contractor ~^--.. h Itl sf Pfl-Slf)f) S. Dh1~() V1vG '1- \ \ $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 \~tO 'l~tv \ 'L. C;) pzJ 8t2L ntLl' 200 Amps or Jess 201 Amps to 400 Amps 401 Amps to 600 Amps , . ./ '.~TJrt 601 Amps to 1000 Amps City ~]J..J2-- Phone jp ~ G, b~1Ii NTlO~ver~OOO AmpsNolts N '. W rUles Reconn~~w . OM/cation CluOPfed b requires Supervisor License Number 4 Ol q -.S~~~~R 952_i:r1t~r:~;p~.~h&O'c~fJ~:U!~~r '., ) 0U JJg.1f)"th.'. ..&lirSqf(r."Jldt9...,~._,c f Ca//' rnay Obt. rO~Qh 0 Set fOrth IDOl n~g the ceAPJ~iti1ttl~i~ffffi\fi.~~~l9f~'tion ( r fOr thef!j9l<<ib~4M:l~~ t the rUles by \ 4 S1' Center i;'9!~R@sl.tl0i!1flP~~~fhone / 401 W.g)"~Jfi@.!jJftfpatiOI1 Expiration Date l / {) 7 Over 600 or"J1 000 Volts see "B" above. Signatu./r~Of Su rvising, D. New Alteration or Extension Per Panel One Circuit own'er Is Name --: . >-.1". f\S fll1 n II ~ l,"() Each Additional Circuit or with V Ll.X)$'f{ l · V lJ l1.! ~"'""" Service or Feeder Permit Address b9,6 \. t ~ \6'\h ~~ E. City ~e.no. . Phone ~O~b.6\1() Pump or irrigation $50.00 - -- \ Sign/Outline Lighting $ 50.00 OWNER INST ALLA TION Limited Energy/Residential $ 25.00 The installation i~e~~t3'~e on property I own which Limited Energy/Commercial $ 45.00 is not intended fOT~/~ ~~~Mlf~HALL EXPIRE IF T~iW~M{ Electric Permit Inspection Fee is $45.00 + Surcharges Owners SignaturtA.UT~ORIZED UNDER THIS PERMIT !St~TOTAi.?F~OYE ...-.;.....--,....": \ oCZ16 cp COMMENCED OR IS ABANDONED FOR'''~'''' '""~...-_."_.~~,.._~~-"'~".,~....~~~..=..- ANY 1 80 DAY PFRtQO. 8% State Surcharge 5'L .LA ~ ~ 10% Administrative Fee lP~ Inspection Request: 726-3769 ~~~\J ~~ ~OT.u... ~ 9b t;Q.J~O ~ <::u ~$ \ ShoredDri,,(f)ln";Jdi"gF~Ow.:PPH~W ~-'\ Address !?1)D Expiration Date Constr. Contr. Number $ 50.00 $ 69.00 $100.00 .5Ot:O $ 43.00 C\4 $ 3.00 i.~2.. ~