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Home My WebLink AboutPermit Building 2014-09-11SPRINGFIELD - --"' OREGON mm.springfield-or.gov CITY OF SPRINGFIELD Building / Residential Permit PERMIT NO: 811-SPR2014-01411 225 Fifth Sl Springfield,OR 97477 Phone: 641-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pofmiteenter@spdngfield.or.gov PROJECT STATUS: Issued ISSUED: 09/11/2014 EXPIRES: 03/10/2015 STATUS DATE: 09/11/2014 APPLIED: 06/30/2014 SITE ADDRESS: 2218 70TH ST, Springfield, OR 97478 SCOPE: Single Family Residence ASSESOR'S PARCEL NO: 1702353305607 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: S - New SFD Parcel 1 SAME AS 229 S. 70th OWNER: SLONECKERTROY Phone Number: ADDRESS: 1866 RIDGLEY BLVD INSPECTIONS REQUIRED 1020 Zoning Setbacks 1110 Footing EUGENE OR 97401 1118 Footing Drain 1120 Foundation Foundation: After forms are erected but prior to concrete placement. CONTRACTOR INFORMATION 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. Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone Mechanical Contractor HOME COMFORT INC CCB 113253 04/23/2016 503-623-2341 General Contractor _ INTENSIVE HOME INSPECTION INC CCB ---T63-372'-----F210-5/2014 1530 Exterior Shearwall 541-666.4126 Electdoai Contraclar SPRINTER ELECTRIC INC — --. CCB -- 174456 02/20/2015 541-743-1213 SURRETTS PLUMBING T (PB) Plumbing Cot 20-321PB 07/01/2017 541-741-3553 Inspections INSPECTIONS REQUIRED 1020 Zoning Setbacks 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 approved. 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. 1520 Interior Shearwall Shear Wall Nailing: Before covering sheathing with finish materials. 1530 Exterior Shearwall 1540 G su t I ,�, a to to in Lath/Plaster 7o�beirriade after all lathln and, y s , v YP RPp@�NKR�ry_W9 ojon I- / regtAtYxt �bLRQPf P 9 gg 9 P p t I,,, II,o oboard:,interiouand exterior are In olacesbuteltdmfdola�t�dr%.F):S�IDE II. 1110 W��hI� 1999 Final>90iOngttion Center. Those rll1etF8131 B0ildifiahAfler all required inspectiogj ItW$ opeW{'011 dseedlihcrSpti/KVdd' ' d"'inOAR952-001-0010 through Ot4r{fi0ttdtn8031complete. .PJCED Ofi IS ABANDONED 0090. YOH may obtain copies of the rules by Il DA1' PERIOD. calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-600-332-2344). Springfield Building Permit 9{1112014 10:32:22AM Page i Of 2 SPRINGFIELD 11 OREGON www.springfield-or.gov CITY OF SPRINGFIELD Building / Residential Permit PERMIT NO: 811-SPR2014-01411 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permit" nler@springf eld-or.gov By signature, I slate 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 9/11/2014 10:32:22AM Page 2 of 2 SPRINGFIELD ary OF SPRINGPIF:LD TRANSACTION RECEIPT Sp��gfield,OR97477 OREGON 811-SPR2014-01411 541-726-3753 mm.springfield-or-gov 221 S 70TH ST permitcenter@spdngfield-or.gov RECEIPT NO: 2014001418 RECORD NO: 811-SPR2014.01411 DATE: 06/30/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Same as Plan Review Submittal 224-00000-425602 1060 275.00 TOTAL DUE: 276.00 'PAYMENTTYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID ". Check OPM Ent. LLC 275.00 5377 TOTAL PAID: 275.00 L ELD -- CITY OF SPRINOPIGLD 225 Fifth St a� TRANSACTION RECEIPT Spnngfield,OR 97477 OREGON 541-726-3753 811-S P R2014-01411 w .spnngfield-oagov 221 S 70TH ST permitcenler@spnngfietd-or.gov RECEIPT NO: 2014002004 RECORD NO: 811-SPR2014-01411 DATE: 09/11/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Address Assignment, each new or change 224-00000-425602 1020 43.00 Continuing Education Fee 224-00000-425606 2.50 Planning - Major Review - City 100-00000-425002 1231 211.00 Residential Fire (.05 Per Sq Foot) 100-00000-424005 9111 93.75 SDC: Administrative Fee - MWMC Regional Wastewater SDC 611-00000-426604 1189 10.00 SDC: Compliance Cost - MWMC Regional Wastewater SDC 444-00000-426607 1113 22.58 SDC: Improvement -Transportation SDC 447-00000-448027 1174 2,015.25 SDC: Improvement Cost - Local Wastewater 443-00000-448025 1184 2,002.56 SDC: Improvement Cost - MWMC Regional Wastewater SDC 445-00000-448025 1187 1,474.57 SDC: Improvement Cost - Storm Drainage 440-00000-448028 1176 541.69 SDC: Reimbursement -Transportation SDC 446-00000-448026 1173 552.95 SDC: Reimbursement Cost - Local Wastewater 442-00000-448024 1183 4,102.84 SDC: Reimbursement Cost - MWMC Regional Wastewater SDC 444-00000-448024 1186 117.24 SDC: Reimbursement Cost - Storm Drainage 441-00000-448029 1177 372.68 SDC: Total MWMC Administration Fee — Local 719-00000-426604 1121 81.22 SDC: Total Sewer Administration Fee 719-00000-426604 1175 305.27 SDC: Total Storm Administration Fee 719-00000-426604 1180 45.72 SDC: Total Transportation Administration Fee 719-00000-426604 1190 128.41 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 132.37 Structural Building Permit Fee 224-00000-425602 1002 1,103.12 Technology fee (5% of permit total) 100-00000-425605 2099 57.31 Willamalane fees - Single family detached 821-00000-215023 1074 3,396.00 TOTAL DUE: 16,812.03 PAYMENTTYPE PAYOR CASHIER:CCARPENTER ''COMMENTS AMOUNTPAID Check OPM ENT 16,812.03 5435 TOTAL PAID: 16,812,03 Structural Permit Application 225 Fifth Street + Springfield, OR 97477 4 PH(541)726-3753 ♦ FAX(541)726-3689 Sfy-Wq SPRINGFIELD - 6ti % 0 E G 0 H This permit is issued under OAR 918-460-00_R1rP`MFmiB expt a if work is not started within 1 suspended for 180 days. LOCALGOVERNMENT APPROVAL This project has final land -use approval. Signature: Date; This project has DEQ approval. Signature: Date: Zoning approval verified: ❑ Yes ❑ No Property is within flood plain: ❑ Yes ❑ No _-CATEGORY OF CONSTRUCTION Residential ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION. , Job site address: ' S City: State:QP—\ ZIP. Subdivision: Lot no.: Reference: Taxlot: C4677 PROPERTY OWNER ' Name: g� Address: 2. I City: i✓ State: ZIP: q0 Phone: L _ p_ Fax: - - E-mail: Building Owner or Owner's agent authorizing this application: Sign here: ❑ This ilisWlaficm is being made on residential orfarm property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. CONTRACTOR INSTALLATION Business name: Address: City: State: ZIP: Phone: - - Fax: - - E-mail: CCB license no.: Print name: Signature: 3. Plan review fees -' (a) Plan review (65%x permit fee t2a]): SUB -CONTRACTOR INFORMATION - Name CCB License # Phone Number Electrical 1i -7f' Ect:Te 21L 4 Miscellaneous fees Plumbing T"n $ (b) Technology fee, 5%(.05 x permit fee[2a]): Mechanical (c) Continuing Education Fee $2.50 52.50 DEPARTMENT USE ONLY Permit no.: -51q .-® itIll Date: d 80 days of ssuance or if work is FEE SCHEDULE 1. Valuation information (a) Job description: �f K Eaat Occupancy Construction type: Square feet: 114 y/ Cost per square foot: Other information: Type of Heat: Energy Path: V ❑alteration ❑addition (b) Foundation -only permit? ❑ Yes No Total valuation: S 1Building fees (a) Permit fee (use valuation table): $ (b) Investigative fee (equal to [2a]): S (c) Reinspection ($ per hour): (number of hours x fee per hour) $ (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ (e) Subtotal of fees above (2a through 2d): S 3. Plan review fees -' (a) Plan review (65%x permit fee t2a]): $ T 7 (b) Fire and life safety (40%x permit fee [2a]): $ (c) Subtotal of fees above (3a and 3b): S 4 Miscellaneous fees (a) Seismic fee, 1%(.01 x permit fee [2a]): $ (b) Technology fee, 5%(.05 x permit fee[2a]): S (c) Continuing Education Fee $2.50 52.50 TOTAL fees and surcharges (2e+3c+4a+4b+4c): S 9 rw SPRINGFIELD 1 CITY OF SPRINGFIELD f try O"aeON Building / Residential Permit PERMIT NO: 811-SPR2014-01482 vrmv. Springfield-or.g ov PROJECT STATUS: Issued ISSUED: 09/11/2014 STATUS DATE: 09/11/2014 APPLIED: 07/09/2014 SITE ADDRESS: 221 S 70TH ST, Springfield, OR 97478 225 Fifth Sl Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pe rmitcenter@spdngfield-ocgov EXPIRES: 03/10/2015 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1702353305607 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: M- New SFD Parcel 1 SAME AS 229 S. 70th OWNER: SLONECKERTROY ADDRESS: 1866 RIDGLEY BLVD Phone Number: EUGENE OR 97401 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor OWNER CCB 000000 08/01/2025 —.—..-._.—____...-_.-_____-___�_--_-_—T— Mechanical Contractor HOME COMFORT INC CCB 113253 04/23/2018 503-623-2341 Inspections INSPECTIONS REQUIRED 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 Final Gas: When all gas work is complete. 2999 Final Mechanical Final Mechanical: When all mechanical work is complete. By signature, I stale 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 properly, and the approved set of plans will remain on the site at all times during construction. ItL-N11 1 renno liwv -r - °N �rp��ColiKa"b(o?Si¢'St�§`9on Utility uloatlon (tether. Those rules are set forth )AR 052-001-0010 through OAR 952-001. 0. YOU may obtain Copies of the rules by tiling the center. (Note: the telephone iniber for the 01egoo Utility Notification Center is 1-800-332-2344). Date 'I Rli/111 SIWLF CXPIRF IF THE WORK l i_0 UNDER 1-1-118 PERMI7 1S NOT �K11 D 011 IS AGAN00NE0 F013 Pf R10D, Springfield Building Permit 9/11/2014 10:30:48AM Page 1 of 1 SPRINGFIELD GFLD CITY OF SPRING171FLD -225 EXLI"VtO RECEIPT Fifth St Springfield,OR97477 ,,TRANSACTION 224-00000-425604 1006 19.00 Continuing Education Fee 541-726-3753 811-SPR2014-01482 First Appliance Fee vnmv.springfield-ocgov 221 S 70TH ST permitcenter@springfield-ocgov RECEIPT NO: 2014002002 RECORD NO: 811-SPR2014.01482 DATE: 09/11/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Air conditioner 224-00000-425604 1006 19.00 Continuing Education Fee 224-00000-425606 2.50 First Appliance Fee 224-00000-425604 1006 82.00 Flue vent for water heater or gas fireplace 224-00000-425604 1006 10.00 Furnace - up to 100,000 BTU 224-00000-425604 1006 19.00 Gas Piping - each additional above 4 224-00000-425604 1006 10.00 Gas Piping up to outlets 224-00000-425604 1006 8.00 Range hoodlother kitchen equipment 224-00000-425604 1006 15.00 Single -duct exhaust (bathrooms, toilet compartments, utility room, 224-00000-425604 1006 50.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 25.56 Technology fee (5% of permit total) 100-00000-425605 2099 10.65 TOTAL DUE: 251,71 'PAYMENTTYPE ;PAYOR CASHIER:CCARPENTER - 'COMMENTS AMOUNTPAID Check OPM ENT 251.71 5435 TOTAL PAID: 261.71 SPRIN�LeReCON ISSUED: 09/11/2014 EXPIRES: 03/10/2015 APPLIED: 07/09/2014 225 Fifth St 1 t CITY OF SPRINGFIELD Springfield,OR97477 General Contractor OWNER CCB 000000 00/01/2025 SURRETTS PLUMBING (PB)Plumbing Cot 20-327P6 07/01/20171/2017 541-741-3553 Inspections Phone: 641-726-3753 3130 Footing/Foundation Drains Building / Residential Permit Inspection Phone: 541-726-3769 Underfloor Plumbing: Prior to insulation or decking. 3200 Sanitary Sewer Fax: 541-726-3676 3315 Water Line PERMIT NO: 811-SPR2014-01483 3400 Storm Sewer vrvnvapnngfield-or.gov 3500 Rough Plumbing permilcenter@springfield-ocgov PROJECT STATUS: Issued STATUS DATE: 09/11/2014 ISSUED: 09/11/2014 EXPIRES: 03/10/2015 APPLIED: 07/09/2014 SITE ADDRESS: 221 S 70TH ST, Springfield, OR 97478 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1702353305607 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: P- New SFD Parcel 1 SAME AS 229 S. 70th OWNER: SLONECKER TROY ADDRESS: 1866 RIDGLEY BLVD EUGENE OR 97401 Phone Number: CONTRACTOR INFORMATION Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone General Contractor OWNER CCB 000000 00/01/2025 SURRETTS PLUMBING (PB)Plumbing Cot 20-327P6 07/01/20171/2017 541-741-3553 Inspections INSPECTIONS REQUIRED 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 Plumbing Rough Plumbing: Prior to cover and including required testing. 3999 Final Plumbing Final Plumbing: When all plumbing work is complete. By signature, I stale 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 Stale 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 properly, and the approved set of plans will remain on the site at all times during construction. w en r or Contractor Signature Date AI TGh11'10111: Orarlal I ."a' requires you to got/ rlts< cloy :>(I by the Oregon Utility Tllo>e rules are set forth in 0AII 052-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling thG center. (Noce: the telephone SpringfigljIpprthag q"lille Oregon Wilily Notification 9/1112014 1029:45AM Centesis 1-800-332-2344). S PLRMF(SI TALL EXPIRE IFTFiE WORK "OP1/H) UNDER tHl S PERMIT IS 1\101 L;!rLl) OR IS ABANDONED FOR '�Y FI 1:10D, Page 1 of i SPRINGFIELD " " CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Springheld,OR97477 OREGON 811-SPR2014-01483 541-726-3753 w v.spdngfeld-or.gov 221 S 70TH ST permitcenter@spdngfield-or.gov RECEIPT NO: 2014002003 RECORD NO: 811-SPR2014-01483 DATE: 09/11/2014 DESCRIPTION ACCOUNT CODEITRANS CODE AMOUNT DUE Continuing Education Fee 224-00000-425606 2.50 One or Two Family Dwelling with Three Bath 224-00000-425603 1005 494.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 59.28 Technology fee (5% of permit total) 100-00000-425605 2099 24.70 TOTAL DUE: 580.48 'PAYMENTTYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID .Check _.OPM ENT...._ _. .....580.48 5435 TOTAL PAID: 580.48 SPRINGFIELD - 225 Fifth St ' �-- CITY OF SPRINGFIELD Springfield,OR97477 f Phone: 541-726-3753 ="' OReGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01481 vmw.spnr gfield-or.gov permitwnter@spdngfield-or.gov PROJECT STATUS: Issued ISSUED: 09/11/2014 EXPIRES: 03/1012016 STATUS DATE: 09/11/2014 APPLIED: 07/09/2014 SITE ADDRESS: 221 S 70TH ST, Springfield, OR 97478 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1702353305607 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: E- New SFD Parcel 1 SAME AS 229 S. 70th OWNER: SLONECKER TROY Phone Number: ADDRESS: 1866 RIDGLEY BLVD EUGENE OR 97401 CONTRACTOR INFORMATION Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone General Contractor OWNER CCB 000000 06/01/2025 _-_-.__._.._.____r---_.____---_...__�_,._a_.�._A__—.__ _._-_._-________ Electrical Contractor SPRINTER ELECTRIC INC CCB —____-__.__-.43__..__— 174458 02/20!2015 541-743-1213 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 111M PERMrr SI-IAI_L CVIRE IF THE WORK AU 11IORIZF-D UNDER 7NIS PERMIT IS NOT GW;.[�AENGED OR IS ABANDONED FOR APlY 180 DAY PERIOD. 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 calling the Center. (Note: the telephone number for the Oregon Utility Notification ,enter is 1-E00.332-2344). Springfield Building Permit 9/11/2014 11:14:25AM Page 1 of 1 LINELD � CITY OF SPRINGFIELD 225 Fdlh St RTRANSACTION RECEIPT Spdngfield,OR97477 OREGON 541-726-3753 811-SPR2014-01481 vnvw.spdngfield-or.gov 221 S 70Th ST permitoenter@springfield-ocgov RECEIPT NO: 2014002001 RECORD NO: 811-SPR2014-01481 DATE: 09/11/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Each added 500 sq. ft. or portion 224-00000-426102 1004 56.00 Electrical Continuing Education fee Residence wiring 1,000 sq, ft. or less 224-00000-425606 1032 224-00000-426102 1004 2.50 151.00 Slate of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 24.84 Technology fee (5% of permit total) 100-00000-425605 2099 10.35 TOTAL DUE: 244.69 ,PAYMENTTYPE PAYOR CASHIER:CCARPENTER - COMMENTS AMOUNT PAID -- -- - Check OPM ENT 244.69 5435 TOTAL PAID: 244.69 Electrical Permit Application 225 Firth Street+Springfield, OR 97477+PH(541)726-3753*FAX(541)726-3689 —- -' DEPARTMENT lUSE / ONLY Permit no.: Date: & 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 - Zoning approval verified? ❑ Yes ❑ No CATEGORY OF CONSTRUCTION ❑ Residential ❑ Government❑ Commercial JOB SITE INFORMATION AND LOCATION Job site address: e,7 City: State: ZIP: Reference: I Taxlot.: -DESCRIPTION OF WORK' Limited energy (2) _.... PROPERTY OWNER Name: Address: City: State: ZIP: Phone: Fax: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: CONTRACTOR INSTALLATION Business name: S gl Address: 3�x q7 I City: State :Ost ZIP: Phone -- // - I Fart j-ty� - E-mail• ( c crt . CCB license no.: j'7 BCD license no.: Cas" Signing supervisor's license no.: S '�y% Print name of signing supervisor: Signature of signing supervisor: 440-2584-3 (5/2112014/COM) FEE SCHEDULE Number of inspections per item O Qty. Cost ea. Total ` cost -' Residential, per unit, service included: 1,000 sq. ft. or less (4) $161.00 $ 7 Each additional 500 sq. ft. or portion thereof $28.00$ S`� Limited energy (2) _.... $ .36.00 - $ - - Each manufactured home or modular dwelling service. or feeder (2) $ 71.00 $ Services or feeders: installation, alteration, relocation 200 amps or less (2) - $ 91.00 $ 201 to 400 amps (2) $106.00 $ 401 to 600 amps (2) $178.00 $ 601 to 1,000 amps (2) $230.00 $ Over 1,000 amps or volts (2) $627.00 $ Reconnect only (2) $ 71.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) $ 71.00 $ 201 to 400 amps (2) $ 98.00 $ 401 to 600 amps (2) $142.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 7.001 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 62.00 $ Each additional branch circuit $ 7.00 $ Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) $ 71.00 $ Each sign or outline fighting (2) $ 71.00 $ Signal circuit or a limited -energy panel, alteration, or extension (2) $ 82.00 $ Each additional inspection: (1) $82.00 $ APPLICANT USE (A) Enter subtotal of above fees (Minimum Permit Fee $82.00) $ (B) Enter 12% surcharge (.12 x [A]) $ 0 1 (C) Technology Fee (6% of [A]) $ () 3 (D) Continuing Education Fee $2.50 $2.60 TOTAL fees and surcharges (A through D): $ 2 t