HomeMy WebLinkAboutPermit Building 2004-11-9 (2)
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
.~ CITY OF SrKll'lul'l1!,LU
Building/Combination Permit
PERMIT NO: COM2004-00899
ISSUED: 1110912004
APPLIED: 07/20/2004
EXPIRES: 05/09/2005
VALUE: $ 194,040.00
SITE ADDRESS: 7303 Forsythia St
ASSESSOR'S PARCEL NO.: 1802021205100
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New ResidentIal
PROJECT DESCRIPTION: New Single Family Residence. Lot 93 McKenzie Hills - First Addition. Parcel tags
removed per RBK for LDAP Pending and Public Works Hold, SKG 7/21/2004.
Owner: RGG LLC n. n law requires you to
Address: PO BOX 5578 .J!."'w;ll~tl~R '!IfA'iI~ e Oregon Utility
'_ll_.. ",I.". Adooted by th ~.. 'M.h
'.-;' N'~tlficatlon Center. Those 'UI"'~ ~'_- _-:_ M'
OAR 952-001-0~~NIMA(!;H)R INFORMATION I
In btain cop Ie:; v. .". . -. - .
~~plI:lm-:a~e~ter. (Note: the telephone License
so~'F;~~j1>>~~~Mij)RPlotlflcatlon 123081
sTM~~r is 1_800-332-2344). 147618
OWNER
TOMS PLUMBING SERVICE INC 159425
Contractor Type
General
Electrical
Mechanical
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:
BUILDING INFORMATION'
1
R-3
U-l
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
3
34.00
Wall Heat
Electric
Electric
Path 1
n/a
3
I DEVELOPMENT INFORMATION I
20.00
50.00
20.00
10.00
0.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Expiration Date
OS/22/2006
04/30/2005
Phone
541-521-7006
541-221-2665
05/12/2006
541-607-8879
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
9,584
960
816
98
515
Hillside
5
Yes
23.60
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
Sidewalk Type:
DownspoutslDralns:
Fullv Improved
Storm Sewer Available:OT.II'F' Yes
Special Instruction: ~HlsS~ffi~rTigh~[r r~~~etrfA~WORK
Notes: AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Paee I of4
Curbside 5'
Curb and Gutter
Description Tvpe of Construction $ Per Sq Ft Square Footage
. or multiplier or Bid Amount
Bid Amount Use Bid Amount $1.00 8,368.00
Dwellines V Wood Frame $92.40 1,874.00
Garae:e Garae:e $24.30 515.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
Plan Review Residential
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
3 Baths One & Two Family
Addressing Assignment
Annexed 1979 or Before
Building Permit
Copies - Ea Addtl @ 50 Cnts Ea
Copy 6th @ 75 cents
Curbcut Permit
Dryer Vent
Exhaust Hoods
Minimum/Adjustment Mechanical
Miscellaneous Copy Chgs
Plan Review Major - Planning
PW Mull Disc - 2nd Permit
Residence Wiring 1000 Sq Ft
Residence Wiring Ea AddU 500
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Admin
'SDC Transpo Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
.
I Valuation Descrintion I
Total Value of Project
]?pp< P'iIilIJ
Amount Paid
Date Paid
$568.36
$10.00
$143.84
$100.69
$306.00
$31.00
$-144.00
$874.40
$8.00
$0.75
$75.00
$6.00
$9.00
$18.00
$24.00
$103.00
5-30.00
$106.00
$57.00
$438.72
$576.96
$10.00
$865.31
$82.03
$110.91
$61.96
$772.49
$175.13
$75.00
$680.76
$50.00
$12.00
$1,000.00
7/20/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
11/5/04
Paee 2 of 4
.
CITY OF ~t'K11'1ul'l1!,LD
Building/Combination Permit
PERMIT NO: COM2004-00899
ISSUED: 11/09/2004
APPLIED: 07120/2004
EXPIRES: 05/09/2005
VALUE: $ 194,040.00
Value
Date Calculated
$8,368.00
$173,157.60
$12,514.50
$194,040.10
11/0212004
11/02/2004
11/02/2004
Receipt Number
2200400000000000945
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
2200400000000001379
.
.
CITY VI< ~t'K11'luN1!,L1J
Building/Combination Permit
PERMIT NO: COM2004-00899
ISSUED: 11/09/2004
APPLIED: 07/20/2004
EXPIRES: 05/09/2005
VALUE: $ 194,040.00
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Amount Paid
$7,178.31
I Plan Reviews I
Initial Review
Plan nine Review
Public Works Review
07/2012004
07128/2004
07/23/2004
07/20/2004
07/28/2004
07/2312004
APP
APP
WE
SKG
TAJ
VRJ
Structural Review
11/0212004
11/04/2004
APP
DLM
Prior to issuance of LDAP and
Building permit bonding
requirements must be met. PW's
waiting for bonding documents and
bond payment. LDAP and Building
permit need to be issued
concurrently.
Set aside letter for LDAP has been
approved by City Attorney's office.
See Documents for plan revIew
comments
Public Works Review
11/0212004
11/0212004
APP
VRJ
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Site Inspection: To be made after excavation but prior to setting forms.
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.
Foundation: After forms are erected but prior to concrete placement.
Slab: To be made after all inslab building service equipment, conduit piping and otber equipment items are in
place but prior to concrete.
Floor Insulation: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials.
Framing Inspection: Prior to cover and after all rougb in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Structural Concrete: In excess of 2500 psi.. To be done during construction by a State Certified Inspector.
Provide results to City Buiding Inspector
Hold Downs Installed: Special Inspection performed prior to placement of concrete. ProvIde report to City
Building Inspector. .
Final Building: After all required inspections have been requested and approved and the building is complete.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Underslab Plumbing: Prior to filling the trench and including required testing.
UnderfIoor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Paee 3 of 4
.
.
CITY OF SPRIl'luN1!,LD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2004-00899
ISSUED:' 11/09/2004
APPLIED: 07/20/2004
EXPIRES: 05/09/2005
VALUE: $ 194,040.00
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
Water Line: Prior to filling trench 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 all plumbing work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do bereby 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 tbe 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 tbat only contractors and employees wbo 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~h. e ermit card is I ted at the front of the property, and the approved set of plans will remain on tbe site at all
times during cons uction
(~ d /c1loy
Owner" Contractors Signature Date
Paee 4 of 4
. 225 Fifth Street
Sprinl:t'ield, Oregon 97477
541-726-3759 Phone
.
.
~
~.'.l
AY of Springfield Official Receipt
~~elopment Services Department
Public Works Department
Job/Journal Number
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004.00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004.00899
COM2004-00899
COM2004.00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004.00899
COM2004-00899
COM2004.00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
COM2004-00899
Payments:
Type of Payment
Check
Gash
11/512004
RECEIPT #:
2200400000000001379
Date: 11/05/2004
Description
Addressing Assignment
Willamalane Single Family
Sidewalk Pennit
Curbcut Pennit
PW Mult Disc - 2nd Pennit
Stonn Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
Annexed 1979 or Before
SDC Sanitary/Stonn Admin
SDC Transpo Admin
Plan Review Major. Planning
Miscellaneous Copy Chgs
Copy 6th @ 75 cents
Copies - Ea Addtl @ 50 Cnts Ea
Building Pennit
3 Baths One & Two Family
Vent Fan
Exhaust Hoods
Dryer Vent
-Mechanical Issuance Fee-
Temp Power 200 amps or less
Minimum! Adjustment Mechanical
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
JONATHAN PARKER
JONATHAN PARKER
Item Total:
Check Number AuthoriZation
Received By Batch Number Number How Received
JMP 17100 In Person
lMP In Person
Payment Total:
Page I of2
2:28:09PM
Amount Due
31.00
1,000.00
75.00
75.00
(30.00)
680.76
576.96
438.72
175.13
772.49
82.03
865.31
10.00
(144.00)
110.91
61.96
103.00
24.00
0.75
8.00
874.40
306.00
12.00
9.00
6.00
10.00
50.00
18.00
106.00
57.00
100.69
143.84
$6,609.95
Amount Paid
$6,609.00
. $0.95
$6,609.95
v
" CITY OF SI- __tNGFIELD, OREGON __
. ,- .
SI"'R1N~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (5~1)726-3'/iJjlY.,;-~ ~ .~
ELECTRICAL PERMIT APPLICATION "__ ,___ -1,,1, ~'" ~." 0'0< '.. .
City Job Number {}-I-ooe'?,} Date)tVSfo4:~ ~o,>~" 'c~ 0'~"~~"6
. ' "0' _ '" ~ 9",,~,
I. ki..ocATION.'OFINSTJ,.I.i4.Tw'N---:::';;",:'j 3. 'I'COMPLETEFEESCH'E'f;.,.,..ii'DE 'w,'lr~f."'!1"\;!!;}),f,-:,;;1
i' .. ..,...,~ ' '.., '"""","" " ,.,.. .'... '",' > -- .-u..:Wd'~, .., '~'t,)\. "t. '."1
~~~D~SC:;~!jI.)& Sf: A. t,.&,i.W1R~~j~eri'i~lg,;i~ili~~.@r;:ai~~ ~~:~~~
1&02.. Ol.I'Z- OS;-IOO Service Included , ~ '" ..
J08 DESCRIPTION 1000'sq. ft. or less ~, ~6.1lQ.~
f) Each additional 500 sq. ft. or __
S'II\Sk f~JIy /VSJdoAN_ / portion thereof ~- 'i -"'$19.0 ~J
Permits are non-transferable and expire jfwork is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder
2. Wf.R~gQ!!:'pY~T~~{i,:~t!PM'~Q~.4r1 B. I: :$~q:.ig~~~~~-~:f,e~~~_~ry.;~t'~p~~.i!~i~~~~~~t~~_(~~~:~E!tJK4~~~f!1
Electrical Contractor 9-k'IC- t-!.~
$50.00
)~
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
~. 401 Amps to 600 Amps $125.00
ATTENTlON: Oregon taw ~ yo~\~ 60 I Amps to 1000 Amps $163.00
..lIlJWruletadGi\teRl byth~regon ~tf~ Over 1000 AmpsIVolts $375.00
Notification Center. Tho lUllS" "'" ~52.001. Reconnect Only $ 50.00
In OAR 952-oG1.()010 rop~~: ~~~e~Ule~y ~'l.. r,&""...,k.i'".....,,'..,,~,~-_..,.'" ~~" ;;I'!"""'1~SlO..-l.'i~
Supervisor~~~Ur11lletl o~ In co ,,, ~ " C. lfiTemporary(Se"rylces.or,F:eeders!.:r..""'iti"~'\!lHr.;"""",,,,,,~
c:alllng the center. (NOte; "'" .,,1,:\ jO~,
. . / 0 Ut'lllty Notification
Expiration DtlaJnbAr fj:lrthe regon ,
/Center 181-80o-a~;':.""""I'
Constr. Contr. Number
/
./
Expiration-Date
S' / fS "EI ..
/gnature 0 upefVIsmg ectnclan
Address
City
Owners Name ~,A<( ,,~~ TJ'
Address /J/J /07:>< \'"": \- ;> s:P,
City mc;t.ZJE Phone (-.f;,~ - {b2\,
- 7'71/aJ
OWNER INSTALLATION Limited EnergylResidential $ 25.00
The installation is being made on property I own 1hich'l C. Limited Energy/Commercial $ 45.00
is n~ntended for sale, lease or rent. ;~~ PEW~ b>>],:'@~Mt}~Im;~9BY,:,I~.$,:5~0~:\surcharges
I. e~ ~~~H;;'~g1~5~NU~';A,'" 5~;:
/ ,--.., 10% Administrative Fee 5 0-0
Inspection Request: 726-3769 TOT AL ~ '?0 ,5D
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
,Over 600 Amps or 1000 Volts see "8" above.
~~".:""'" ,,' .J.....,'.' \':" t'" ~"~ ,."",. """'J t...,....,~,'1/o.;~'~~m
D. I Bra~u~liiGI.r,~~_I,ts,'~.~"r.~/_}il.'if{~.z.~~,~I,~:~'~.l~r:.:t-~f~y~lt.'7f.~<r., . ~ ' , ! '
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
.....
$ 50,,00
$ 69,,00
$100.00
5l:>>
$ 43.00
$ 3.00
t:; '~." ,.-":' '"4''_''' - .""1":l-t~,c;%,W~~', ~":li-.n"', .d"'.!""""""t\r.rr~"",:w"I.."l' +t!\
E. t!il~I!~~!~.n!$~~~,(~~,,!'Y~~etrefd~.t:!'9ttIn~l.li!t.ea)g~!!S~t!!i~~Ua.tlon "
Pump or irrigation
Sign/Outline Lighting
$ 50.00
$ 50.00
Shared Drive(T:)/Building Forms/Electrical Permit Appliclltion I.03.doc
.' .
CITY OF alNGFIELD SYSTEMS DEVELOPME'WORKSHEET
r-
Im
W
10
10
I~
I~
m
6
~
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I
I 2196.00 I 50.310 I = $680.76
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I
I 0,00 I 50.310 I I 50% ~ I
ITEM I TOTAL - STORM DRAINAGE SDC $680.76 ~
2, SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x
I 24
B. IMPROVEMENT COST:
I NUMBER OF DFU's I, x
I 24 518.28
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
L STORM DRAINAGE
COM2004-00899
RGG LLC
7303 Fors'::lhia Street
18020212 Tax Lot 05100
SINGLE F AMIL Y RESIDENCE
I BUILDING SIZE (SF;
o
LOT SIZE (SF):
9584
DISCOUNT
$0.00
$680.76
1070
COST PER DFU
524,04
5576.96
11091
I
".,1",
= I
$438.72
1092
51,015.68
), TRANSPORTATION
~.
. A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x !NEWTRIPFACTORI
I 9.57 I I 1 I I 518.30 I 1.00 5t75.13 1093
B. IMPROVEMENT COST:
I ADT TRJP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x !NEW TRIP FACTORI
I 9.57 I I I I I 580.72 I 1.00 5772.49 1094
ITEM 3 TOTAL - TRANSPORTATION SDC = , 5947.62 I
-
4, SANITARY SEWER - MWM~ I
A. REIMBURSEMENT COST:
/NUMBER ~F FEU's I x ICOST PER FEU
I I 582.03 = 582.03 I 1054
B. IMPROVEMENT COST: I
INUMBER OF FEU's I x ICOST PER FEU
I I I I 5865.31 = 5865.31 I 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) (5144.00) 1054
MWMC ADMINISTRATIVE FEE 510.00 I 1056
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, 5813.34 I
SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ , $3,457.40 I
~ ADMINISTRATIVIi .FF'
I SUBTOTAL x I ADM. FEE RATE I~ I CHARGE
I 53.457.40 I 5% 5 I 72.87
TOTAL SANITARY ADMINISTRATION FEE: 110.91 11079
TOTAL TRANSPORTATION ADMINISTRATION FEE: 561.96 11078
Matt Stouder 7/23/2004 TOTAL SDC CHARGES =, $3,630.27
PREPARED BY DATE
.
.
DRAINAGE'FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAlNAGE FIXTURE UNITS
(NOTE: FOR REMODELS. CALCULATE ONLY TIlE NET ADDITIONAL FIXTIJRES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
I BATHTUB 2 0 3 = 6
IDRINKING FOUNTAIN 0 0 1 = 0
IFLOOR DRAIN 0 0 3 = 0
I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
I LAUNDRY TUB 0 0 2 = 0
ICLOTHESW ASHER / MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0
IRECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
I SHOWER. SINGLE STALL 0 0 2 = 0
ISHOWER. GANG Q'lUMBER OF HEADS) 0 0 2 = 0
ISINK: COMMERCIALlRESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
ISINK: SINGLE LA V A TORY/RESIDENTIAL BAR 3 0 1 = 3
I URINAL. STALL/WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET. PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S .~
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 24
.EDU (Equivalent DwellinR; Unitli! a discl1a:rRe eauivalent to a single family dwellinR unit (20 DFU's) set at 167 ~lIons per day
MWMC CREDIT CALCULA TION TABLE: BASED ON COUNTY ASSESSED VALUE
1
I
I
Ir-:-~~ED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
200t
CREDIT RATE/$I,OOO
ASSESSED V AWE
$5.29
$5.29
$5.19
$5,12
$4,98
$4.80
$4.63
$4.40
$4.07
$3.67
$3.22
$2.73
$2,25
$1.80
$1.59
$1.45
$1.25
$1.09
$0.92
$0.72
$0.48
$0.28
$0.09
$0.05
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$27.22 x $5.29
~ I
$144.00
CREDIT FOR IMPROVEMENT (IF AITER ANNEXA llON)
VALUE /1000 CREDIT RATE
$0.00 x $5.29
o
TOTAL MWMC CREDIT
=
$144,00
. .. I .. . "!j:OFl:"~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541f~*~.o,o . ~ .6!. .
ELECTRICAL PERMIT APPliCATION O~t& ~ o&~:&c ~ ~ .
. ~ ~~. .~~~
City Job Number COMz,,04-ooK'99 Date ""o,'~ '& "V6~
"/~ '- 9~. -'''.IA.'
61: ""\ :fJ': 'rc9
1. 'ljJ(;ieJI'Fi()Nl@FJiNSt~!T!rJ4;'Fi6N~ 3. le"'.:.....J!E'tEIFEEI~:!Yiu' 'El ...'Iii )\O~~I~Jo.oII!WWaIbII
"..,,---. _~, ." ."...,~ "._". _ ,~.:.'k; ~'1~-'\;.~-" '~~
730"3 h,..z.S_-I-L.:7A s. t- '&, ::>, ~~"o;qo"..
LEGAL DESCRIPTION ' A. N~,;fR""ilt:n1i:II!!ISi:'-gle of tin'" . . /...,~,. weili.fg~';ffi .
I g-a L 0'"-1 LOS ( 0 0 Service Included
JOB DESCRIPTION 1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
E "M"~III""II'''''''' '{S"" .' ~!":.!'c,,",'~ ~lt"'I-"-"~E'.I- "ll-.I!I!!II
ti01\Ct'. ~^\:ti~~~~.:~\"t;~~~lr;t;I~~'1f UUeU).< achlln.~, allonl
"-UIS \lC\Piil)1P or\inig~tjon-\\ o"C\) "nil. $ 50.00
,n '~I', \ U "J - . "0 1'1'
",,,\\-\OI"SigiilOuthne\bgnting< $ 50.00
r'>U .'l'( \' Iln v
OWNER INSTALLATION CON\MtE.i~~~ ~'!:.",rw.igesidential $ 25.00
The installation is being made on property I own which r>-N'i '\ thtmlted Energy/CommercIal $ 45.00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
'S. f(L
Permits are non-transferable and expire If work is
not started within 180 days of issuance or If work Is
Suspended for 180 days.
2 r€()~€TltRJINS'T:Alrd"4~i7i0NleN.t~"
. ... 1...0. M... I... I,..-I.oil. 01 1 "dl~ ,11:""".1. ;",....1 ',~.
Electrical Contractor
0TWf
HRu:/r-
l
Address p. O.
City ~
Phone
8td- \- 8>10(,,$
Eo ~ "f-I.3ro I
Supervisor License Number
3s =r:t s
Expiration Date I 0 - ( - 0 7
Constr. Contr. Number 14l-b1B
~ t.f-3o-0.s
Expiration Date
Signature of Supervising Electrician
a~
v
12&&
Address +:;>0 G D /"
Owners Name
LLC.
'S<;7g
City
f"'-v\.&f.:;-/lff-r' Phone
Owners Signature:
Inspection Request: 726-3769
s
lOb
S7
$19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B ~s., 1.1. JII I l:"IFIlI"'d~ Ill'i"I~IMt"I'III..1 II.'" ..11. ~ll' ..1.,:.1..1 ~,II i'R' '11-'11.1>. I ~
. I ervlcesor ee ers~ ~~_~ allOo,,,,,, terahonsJof'l e ocahon:
, ......~. J I_I.. ,I.. .,gl, I. , ,'~I Ol~ 1 i. I, ,,,,.. I I I I , , I
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Om-lInooTA~on law requires YO~3115.00
~qlJ!)!1lyadopted by the uregon US"s(Y.oo
C ~I.x;r<'ii~~,i~~,~:.:;,~, ~sf.r..~..r. r.."J. h. '.O.FeS., edn:,I.~S, are ~e\f~,~~
oj~J1lP_o~~r.y.{ er;vlceS\or.: ,ee .e~,
0090. You may obtain copies at t e ru es y
In~~l/gn.;~t"!:~~.I9" o!~lociitlolielephone
2lllM'I11PM>t<iessle Oregon Utility Notific<sliSlfuo
201 Amps t9~Q;Ainps"800"332"2344). $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
D.I~r~ri~~~i~c
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with'
Service or Feeder Pennit
"~: _.'~~.J'~'-:~t"'."..~-':.:~ ....' h''1~''n.
$ 43.00
$ 3.00
4.
/63
J I f.{ I .
/670
I "'!o?!-
7% State Surcharge
I 0% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FormslElectrical Pennit Application 1"()3,doc