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Home My WebLink AboutPermit 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