HomeMy WebLinkAboutPermit Building 2014-09-11SPRINGFIELD
OR
c
OREGON
www.spdngfield-or.gov
PROJECT STATUS:
STATUS DATE:
CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2014-01410
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
To mitcenter@spnngfield-acgov
Issued ISSUED: 09/11/2014 EXPIRES: 03/10/2015
09/11/2014 APPLIED: 06/30/2014
SITE ADDRESS: 225 S 70th ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1702353305605
PROJECT DESCRIPTION: S. New SFD Parcel 2
OWNER: SLONECKERTROY
ADDRESS: 1866 RIDGLEY BLVD
EUGENE OR 97401
OWNER: SLONECKERTROY
ADDRESS: 1866 RIDGLEY BLVD
SCOPE: Single Family Residence
TYPE OF STRUCTURE: Residential
Phone Number:
Phone Number:
EUGENE OR 97401
CONTRACTOR INFORMATION
Contractor Type
Contractor Name
Lic Type
Lic No
Lie Exp
Phone
Mechanical Contractor
HOME COMFORT INC
CCB
113253
04/23/2016
503-623-2341
General Contractor
INTENSIVE HOME INSPECTION INC
CCB
163372
12/05/2014
541-668-4126
Elecbical Contractor
SPRINTER ELECTRIC INC
CCB
174456
02/20!2015
541-743-1213
SURRETTS PLUMBING
(pg) plumbing Coi
20-321PB
07/01/2017
541-741-3553
INSPECTIONS REQUIRED
Inspections
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 Safely. 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.
6wner or Contractor Signature Date
ATTE- (TION: Oregon 1,1,' 11 lequnas You to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-0010 thrones of the rut 001
0090. You may obtain cop
eSbY
calling the center. (Note: tha telephone
number for the Oregon Uillity Notification
Springfield Building Permit Center is 1-800-332-234 4).9/11/2014 1e22:67AM
f lei:.
PERMIT SI1AI_L EXPIRE IE THE WOI''I(
`IORIZED UNDER THIS PERMIT IS NOT
!iJ NCED OR IS ABANDONED FOR
lY i A DAY PERIOD.
Page 1 of 1
SPRINGFIELD
CITY OF SPRINGFIELD
t 1 '4'- ` - 225 Fdth St
��„ TRANSACTION RECEIPT Springfield,OR97477
-" OREGON 541-726-3753
6�
811-SPR2014-01410
wmv.springfield-or.gov 225 S 70th ST permitcenler@spdngfield-or.gov
RECEIPT NO: 2014001998 RECORD NO: 811-SPR2014-01410
DATE: 09/11/2014
DESCRIPTION I
ACCOUNT CODEITRANS'CODE
AMOUNT DUE "
Address Assignment, each new or change
224-00000-425602
1020
43.00
Continuing Education Fee
224-00000-425606
2.50
Encroachment
201-00000-428060
1143
286.00
Planning - Major Review - City
100-00000-425002
1231
211.00
Residential Fire (05 Per Sq Foot)
100-00000-424005
9111
99.70
SDC: Administrative Fee - MWMC Regional Wastewater SDC
611-00000-426604
1189
10.00
SDC: Compliance Cost - MWMC Regional Wastewater SDC
444-00000-426607
1113
22.58
SDC: Improvement - Transportation SDC
447-00000-448027
1174
2,015.25
SDC: Improvement Cost - Local Wastewater
443-00000-448025
1184
1,931.04
SDC: Improvement Cost - MWMC Regional Wastewater SDC
445-00000-448025
1187
1,474.57
SDC: Improvement Cost - Storm Drainage
440-00000-448028
1176
608.63
SDC: Reimbursement - Transportation SDC
446-00000-448026
1173
552.95
SDC: Reimbursement Cost- Local Wastewater
442-00000-448024
1183
3,956.31
SDC: Reimbursement Cost - MWMC Regional Wastewater SDC
444-00000-448024
1186
117.24
SDC: Reimbursement Cost - Storm Drainage
441-00000-448029
1177
418.73
SDC: Total MWMC Administration Fee — Local
719-00000-426604
1121
81.22
SDC: Total Sewer Administration Fee
719-00000-426604
1175
294.37
SDC: Total Storm Administration Fee
719-00000-426604
1180
51.37
SDC: Total Transportation Administration Fee
719-00000-426604
1190
128.41
State of Oregon Surcharge (12% of applicable fees)
821-00000-215004
1099
141.84
Structural Building Permit Fee
224-00000-425602
1002
1,181.96
Technology fee (5% of permit total)
100-00000-425605
2099
75.55
Willamalane fees - Single family detached
821-00000-215023
1074
3,396.00
TOTAL DUE: 17,100.22
PAYMENT TYPE PAYOR CASHIER: CCARPENTER
COMMENTS
AMOUNT PAID
Check OPM ENT.
17,100.22
5434
TOTAL PAID: 17,100.22
SPRINGFIELD
OREGON
wvnu springf ield-or. gov
TRANSACTION RECEIPT
811-SPR2014-01410
225 70th ST
CITY OF SPRINGFIELD
225 Fifth Sl
Springfield,OR 97477
541-726-3753
pormitc nter@spnngfield-or.gov
RECEIPT NO: 2014001419 RECORD NO: 811-SPR2014-01410 DATE: 06/30/2014
DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE
Structural Plan Review Fee Residential 224-00000-425602 1061 768.27
TOTAL DUE: 768.27
PAYMENTTYPE PAYOR CASHIER: CCARPENTER COMMENTS AMOUNT PAID
Check OPM Ent, LLC 768.27
5377
TOTAL PAID: 708.27
WD
' ' C1TY OF SPRINGFIELD, 012EGON "
u
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 1
suspended for 180 days.
-LOCAL GOVERNMENT 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: 2zk5 70*` 54.
City: State: 0/~' ZIP:q'7cf70
Subdivision: I Lot no.:
Reference: 6 ?OJ -331 Taxlot: 0560
PROPERTY OWNER .
Name: U 5w4u fC .c LLC
Address: itz �r,s 13 t` y]r,.c .
City:
State: ( ZIP:"'(61
Phone: Sift- 5_ 117
Fax: - -
E-mail:
Building Owner or Owner's agent authorizing this application:
Sign her ------
❑ Thi stallation is being made on residential or farm 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 .
SUB -CONTRACTOR INFORMATION'
Name
CCB License N
Phone Number
Electrical r-
S�r.�.�,r
(c) Subtotal of fees above (3a and 3b):
S
Plumbing
Surra pl..w.%r .\+In
(a) Seismic fee, 1%(.01 x permit fee [2a]):
Mechanical
Int 6MFb2i-
(b) Technology fee, 5% (05 x permit fee[2a]):
$ S �0
DEPARTMENT USE ONLY
Permit no.:�'/ e/_ /q/a
Date:
or if work is
FEE SCHEDULE
1. Valuation information
(a) Job description: 1_i% - ef1-6?6e_J_ 2—
Occupancy t�3
Construction type.
Squarefeet: `qa
Cost per square foot:
Other information:
Type of Heat:
Energy Path•
�ew ❑alteration ❑ addition
(b) Foundation -only permit? ❑ Yes ❑ No
Total valuation:
S t
2. Building fees
(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
$
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
$
(d) Enter 12% surcharge (.12 x, [2a+2b+2c]):
$ �L
(e) Subtotal of fees above (2a through 2d):
S
3. Plan review fees .
(a) Plan review (65%x permit fee [2a]):
$
(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 �0
(c) Continuing Education Fee $2.50
S2.50
TOTAL fees and surcharges (2e+3c+4a+4b+4c):
S 2(s
SPRINGFIELD
1 t.
--- OREGON
N w .springfteld-or.gov
CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2014-01477
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@spdngrield-or.gov
PROJECT STATUS: Issued ISSUED: 09/11/2014 EXPIRES: 03/10/2015
STATUS DATE: 09111/2014 APPLIED: 07/09/2014
SITE ADDRESS: 225 S 70th ST, Springfield, OR 97477 SCOPE: Plumbing Only
ASSESOR'S PARCEL NO: 1702353305608 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: P- New SFD Parcel 2
OWNER: SLONECKER TROY Phone Number:
ADDRESS: 1866 RIDGLEY BLVD
EUGENE OR 97401
OWNER: SLONECKERTROY
Phone Number:
ADDRESS: 1866 RIDGLEY BLVD
EUGENE OR 97401
CONTRACTOR INFORMATION
Contractor Type Contractor Name
Lic Type
Lic No
Lie Exp
Phone
General Contractor OWNER
CCB
000000
08/01/2025
Mechanical Contractor HOME COMFORT INC
CCB
113253
04/23/2016
503-623-2341
Electrical Contractor SPRINTER ELECTRIC INC CCB
174458
02/20/2015
541-743-1213
SURRETTS PLUMBING
T (PB) Plumbing Coi
20-321PB
07/01/2017
541-741-3553
INSPECTIONS REQUIRED
Inspections
3130 Footing/Foundation Drains
3170 Underfloor Plumbing Underfloor Plumbing: Prior to insulation or decking.
3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing.
3315 Water Line
3400 Storm Sewer Storm Sewer Line: Prior to filling trench.
3500 Rough 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;fruQQQQJ��Qt $��I�lptt�v(_aY)M%allwork performed shall be done in accordance with the
Ordinances ofthe CitRt (�lil br��t' �-aws IfEE>h''1{rPOp Ptd P{1 pertaining to the work described herein, and that NO
OCCUPANCY will bg o t�h G��'�l6tttti�q`t�oyu Dper lssa P pfe mmunity Services Division, Building Safety. I further
certify that only contd�'��'fsrOK F 06'wh' hOal5 ih0 JS�pf� rl'c�e�w1 1 iRS 701.005 will be used:on�i0iis project. I further agree
to ensure that all reglilr � p��fi$$$AAAQ �Q��It6( �a �h'd`p+ �fe� (�IrliteU hat each address is readabialfrprp lh2,Plf��j, 1911;(1WE IF THE WORD
permit card is locate&1�(�1#e �fbNt bPih��ib}p�fl �f �iFeo�(� }oV; gotlbf plans will remain on the site1�t �Ilti� t uti� NIS PERMIT IS NOT
construction. calling the center. (Note: the leleh lone
number for the Oregon Utility Notification :ENIG[D OR IS ABANDONED FOR
?er is 1-800-332-2344). ,0 DAY PERIOD.
Owner or Contractor Signature Date
Springfield Building Permit 9/11/2014 10:20:55AM Page 1 of 1
SPRINGFIELD
CITY OF SPRINGFIELD
DESCRIPTION
TRANSACTION RECEIPT
225 Fifth St
Spnngfield,OR97477
OREGON
811-SPR2014-01477
541-726-3753
www.spnngfield-ocgov
225 S 70th ST
permitoenter@spnngfield-ocgov
RECEIPT NO: 2014001997 RECORD NO: 811•SPR2014.01477
DATE: 09/11/2014
DESCRIPTION
ACCOUNT CODE/TRANS 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
PAYMENT TYPE PAYOR CASHIER: CCARPENTER
COMMENTS
AMOUNT PAID
........Check -. OPM ENT.
...580.48.....
5434
TOTAL PAID:
580.48
SPRINGFIELD
�"`OOREG 0N
v .sprmgfleld-ongov
CITY OF SPRINGFIELD
Building If Residential Permit
PERMIT NO: 811-SPR2014-01478
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permilce nler@sp6ngheld-orgov
PROJECT STATUS: Issued ISSUED: 09/11/2014 EXPIRES
STATUS DATE: 09/11/2014 APPLIED: 07/09/2014
SITE ADDRESS: 225 S 70th ST, Springfield, OR 97477 SCOPE:
ASSESOR'S PARCEL NO: 1702353305608 TYPE OF STRUCTURE:
03/10/2015
PROJECT DESCRIPTION: M - New SFD Parcel 2
OWNER: SLONECKER TROY Phone Number:
ADDRESS: 1866 RIDGLEY BLVD
EUGENE OR 97401
OWNER: SLONECKERTROY
ADDRESS: 1866 RIDGLEY BLVD
Phone Number:
EUGENE OR 97401
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
CONTRACTOR INFORMATION
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.
Contractor Type
Contractor Name
Lic Type
He No
Lic Exp
Phone
General Contractor
OWNER
CCB
000000
08/01/2025
Mechanical Contractor
HOME COMFORT INC
CCB
113253
04/23/2016
503-623-2341
Electrical Contractor
SPRINTER ELECTRIC INC CCB v
174458
02/20/2015
541-743-1213
SURRETTS PLUMBING
(PB)Plumbing Coi
20-321PB
07/01/2017
541-741-3553
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 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 ensurethaja�lfpyrlr��rs 1�crt([r,�tiir,�regstq��yty{Rreper time, that each address is readable from the street, that the
permit card i�>Ii4&�je��(.J�ieafi�i/r4f thgrflR�rty�rIn`;�r�ved set of plans will remain on the site at all times during
constructioR$1ltification Center. Those FUIOS are Set forth
in 0A 11 Y - 1 0010 thro h OAFS 952-001-
r I t1 o the rules byI! ERi��IT SHALL EXPIRE IF THE WORK
VDER [HIS PERMIT IS NOT
Owner or Conttag19esignature s.tion Date art ;1r�nENCL"D OR IS ABANDONED FOR
(.ent2,r I
Springfield Building Permit �.,,., ,�.� ,._..:�. 0/11/2014 10'. 19:32W6 I . `i0 DAY PERIOD. Page 1 of 1
SPRINGFIELD '-
CITY OF SPRINGFIELD
t
TRANSACTION RECEIPT
225 Fifth SI
Continuing Education Fee
224-00000-425606
Spdngfield,OR 97477
° =`-"`^^ OREGON
811-S P R2014-01478
541-726-3753
w .sp6ngfield-ocgov
225 S 70th ST
permits nter@spdnglield-ocgov
RECEIPT NO: 2014001995 RECORD NO: 811-SPR2014-01478
DATE: 09/11/2014
DESCRIPTION
ACCOUNT CODE/TRANS CODE
AMOUNT DUE
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
Range hood/other 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
21.12
Technology fee (5% of permit total)
100-00000-425605
2099
8.80
TOTAL DUE: 208.42
"PAYMENT:TYPE :PAYOR CASHIER: CCARPENTER
COMMENTS
AMOUNT PAID
Check OPM ENT.
208.42
5434
TOTAL PAID: 208.42
LSPRINGFIELD .
1
�'40REGON
v .spnngfieid-ocgov
CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2014-01479
PROJECT STATUS: Issued
STATUS DATE: 09/11/2014
ISSUED: 09/11/2014
APPLIED: 07/09/2014
SITE ADDRESS: 225 S 70th ST, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1702353305608
PROJECT. DESCRIPTION:.... ...E-. NewSFD Parcell
OWNER: SLONECKER TROY
ADDRESS: 1866 RIDGLEY BLVD
EUGENE OR 97401
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@spdngfield-or.gov
EXPIRES: 03/10/2015
SCOPE: Electrical Only
TYPE OF STRUCTURE: Residential
Phone Number:
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
08/01/2025
Mechanical Contractor HOME COMFORT INC
CCB
113253
04/23/2016
503023-2341
Electrical Contractor SPRINTER ELECTRIC INC CCB
174458
02/20/2015
541-7431213
SURRETTS PLUMBING
(PB) Plumbing Coi
20-321PB
07/01/2017
541-741-3553
INSPECTIONS REQUIRED
Inspections
4225 Service or Feeder
4500 Rough Electrical Rough Electric: Prior to Cover t0
4999 Final Electrical Final Electric: When all electrical work is complete. r-, til I )Ml ()I RVUtlht
adi,l n b)
the
On y
By UKr'-�� i , r, (hose rules are set forth
Ig`A t ep-r:state and agree, that I have carefully examined the completed application and d4 hergby certdy tFi3f a�li (, �{ UC it pA(19�2-001•
infalowt op�i�j�, , Ilu �dLeQQQrr��1{a{�d 1 f hjgg'?. t y that any and all work performed shalWp jotrpyrt ac'ci}�l }rid Withi g os of the rules by
Or j❑ ❑c f p m Itllandlr w of i\State or Oregon pertaining to the work sc Ib$d�heeeitir'ali2�t}i o
�,PPPI � J �� �' oJ. t o e: tale telephone
0 PA; II' e f 5trilQWr Tth'Su ehYlission of the Community Services Dlvislo I rr 15af� { furtMdr
ceti �l{Nofrj-+�ii{�t r�iorscaJtfj?$1,t4��,�� G,�1hS(3 in compliance with ORS 701.005 will be used on hi"s prpj�cUlc� rt�Fi��'�irleUtllity i�10U11CatI0R
�r5'�Z (119th))"t¢9 L� j0tp bi � 32 23A�).
to re 0 r ections are requested at the proper time, that each address is nada a fromttj(�atCedf tl�a�'F�1
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 11:10:54AM Page 1 of 1
SPRINGFIELD
A _ - CITY OF SPRINGFIELD
- 225 FHIh St
w, TRANSACTION RECEIPT Spnngfield,OR97477
OREGON 641-726-3753
811-S P R2014-01479
w springfield-oraov 225 S 70th ST permitcenter@spnngfield-ocgov
RECEIPT NO: 2014001996
RECORD NO: 811•SPR2014.01479
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
224-00000-425606
1032
2.50
Residence wiring 1,000 sq. ft. or less
224-00000-426102
1004
151.00
State 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
Check OPM ENT.
5434
_. .244.69
TOTAL PAID: 244.69
Electrical Permit Application =pa1NGF1ED _ ;
zi
225 Fifth Street♦ Springfield, OR 97477+PH(541)726-3753*FAX(541)726-3689 '
DEPARTMENT USE ONLY
Permit no.: 51 V — /!52
Date: 9///
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
I ❑ Government I
❑ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 2Z SA 7c) C`
City: E I State; o',k ZIP: g %(7
Reference:
Taxlot.:
DESCRIPTION OF WORK`
$ 28.00
$
S(p
PROPERTY OWNER
r
Name: U77✓� c
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� (Lt ALL 2
Address: -?
City:
State:OSZ
ZIP: (Q
Phoned -7/3-
Fax!�G (-84i - d-,�,
E-mail:
CCB license no.: '7
BCD license no.: C2
Signing supervisor's license no.: S �%
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-1 (5/21/2014/COM)
FEE SCHEDULE
Number of inspectionsper item O
Qty,
Cos[
ea.
`Total
cost
Residential, per unit, service included:
1,000 sq. ft. or less (4)
$151.00
$
Each additional 500 sq. ft. or portiorc
thereof
Z
$ 28.00
$
S(p
Limited energy (2) _..
......$.36.00...$.._
Each manufactured home or modular
dwelling serviceor 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)
$527.00
$
Reconnect only (2)
$ 71.00
1 $
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 1
1
$ 7.00 1
$
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 orjeeder not included
Each pump or irrigation circle (2)
$ 71.00
$
Each sign or outline lighting (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)
$ --7
%� /
(B) Enter 12% surcharge (.12 x [A))
$ 2Y
(C) Technology Fee (5% of [A])
$ 3�
(D) Continuing Education Fee $2.50
$2.60
TOTAL fees and surcharges (A through D):
$ `�
A