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Home My WebLink AboutPermit Building 2008-4-14 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00516 ISSUED: 04/14/2008 ,APPLIED: 04/14/2008 EXPIRES: 10/14/2008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 721 CITY VIEW BLVD ASSESSOR'S PARCEL NO.: 1703341404700 Springfield TYPE OF WORK: Bathroom PROJECT DESCRIPTION: Add bath to basement and install sump TYPE OF USE: Alteration Residential Owner: CHASE SHIRLEY ANNE Address: 721 CITY VIEW BLVD SPRINGFIELD OR 97477 Contractor Type General Electrical Mechanical Plumbing I CONTRACTOR INFORMATION I Contractor License PAGE REMODELING & CONSTRUCTION I 68337 JB ELECTRIC 104929 JAMES HEATING ARPS PLUMBING CO INC 38123 I BUILDING INFORMATION I # 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: # of Stories: R-3 Heig,,"'V6ra9 ~ ^NV - !Y.P.e: Atb3~N31NII'JO~ tHH 03NOO~rSf 'e': 03ZIHOHlnV 10N SI llINH3d =~~ .1.IWH3d SIHl }\\:lOM 3Hl:U 3Hsprinkled Buildini3:l1l0N n/a I DEVELOPMENT INFORMATION I Overlay Dist: # Stre-et Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Expiration Date 02/07/2010 03/14/2010 Phone 541-688-8787 541-687-5770 01/24/2010 541-484- 7246 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: AIIt:NTI~~O follow rul '" ity Notification Center. Those rules are set forth Sidewalk Type: in OAR 952-001-0010 through OAR 952-001- . 0090. You may obtain copies of the rules by Downspouts/Drams: calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-33~.2344). Pal!:e 1 of3 Status Issued 225 Fifth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Bid Amount Use Bid Amount Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Building Permit Dryer Vent Fixture Minimum/Adjustment Mechanical Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Paid CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00516 ISSUED: 04/14/2008 APPLIED: 04/1412008 EXPIRES: 10/14/2008 VALUE: $ 2,000.00 I Valuation Description I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 2,000.00 Value Date Calculated Total Value of Project $2,000.00 $2,000.00 04/14/2008 ~ Amount Paid Date Paid Receipt Number $20.00 $18.00 $21.60 $9.00 $50.00 $7.00 $80.00 $36.00 $244.85 $322.00 $28.34 $7.00 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 $843.79 I Plan Reviews I 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. Ul-eouiredJnsnections I Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Pa2:e 2 of 3 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2008-00516 ISSUED: 04/14/2008 APPLIED: 04/14/2008 EXPIRES: 10/14/2008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 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 times during construction. ~~;:;l~ Owner or Cont~rs Signature y/</,hf? Date Paee 3 of 3 Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Address. Pernut #. CO~ ZOOg- - 0 aSI 6 72.1 C (I-~ I/ILFlAI Ii Jv) ~ tI f Date: i//tf/~ ~ / I Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residentzal construction permlt applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be lssued. This statement lS required for residentzal buildmg, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensmg under ORS 701.010(7), need not submit this statement. This statement will be filed with the permlt. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: . ac 1. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. ~ 3A. ~y general contractor is~ C ~oJ t'" t ~J / (Name) f-f-s S 7 (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR o 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing tlus building permit of the name of the contractor. - I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. \ ,~~~~:~t) ~jt~f~ (White copy to lssumg agency permlt file, pmk copy to applicant) Property_owner doc 06-01-04 .:..) , A'cting as You~,dw'n General Contractor?' .. ~ ). ~ INFORMATION NOTICE 1'0 PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBiLITIES .: '; ." \. " . \ , \. , ( . NOTE. This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature, If you are actmg as your own contractor to construct a new home or make a substantIalllnprovemenf to an eXIStmg structure, you can prevent many problems.by bemg aware of the following responsIbilitIes and concerns. EmpRl!)yell" RespolIllsibilities . , You WIll, m most mstances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not hcensed with the ConstrucTIon CO,nt[actors Board to do labor.m constructing or to aSSIst m the constructIOn or Improveme~t of a residential ~tructure. As the employer, ,you ~ust comp~y with the foliowhlg: Oregon's Withholding 'fax Law: As an employer, you must WIthhold income taXes from employee wages at the time employees are paid. You W1ll be lIable for the tax payments even if you don't actually WIthhold the tax from your employees. For more mformatwn, call the Department of Revenue at 503-378-4988:; : Unemployment Insurance 'fax: As an employer, you are reqUIred to pay a tax 'for urtemployment msurance purposes on the wages of all employees. For more mformation, call the Oregon Employment Department at 503-947-1488. The Oregon Busmess IdentIficatIOn Number (BIN) is a combmed number for both' Oregog Wlthholdmg and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or \vww.dor.state or.us/formsoav,htmll for the appropriate forms. , ',. " .....~ I, . )' . - ,~ Workers' Compensation ~nSUlralllce: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtain workers' compensatIOn msurance for your employees. If you fall to obtam workers' compensaTIon msurance, ioti could be subject to penalties and be liable fo~ an claim cos~s If one of your employees IS injured on the Job. For more mformaTIon: call the Workers' CompensatJ.'on DiVIs'IOn at the Department of Consumer and Busmess ServIces at 503-947-7815 U.S. Internal Revenue Service: As an employer, you must Withhold federal mcome tax from employees' wages You WIll be lIable for the tax payment even Ifyoti didn't actually WIthhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or ViSIt theIr web SIte at \V\vW.lfS.l!OV Olther Re~poIQl8nbinntfttes mmdi AIre21~ o'ff COlIll<ceIrlIll~ Code Compliance: As the permIt holder for thIS project, you are responSIble for resolvmg any fallure to meet code reqUIrements that may, be brought to your attention throu9~ i:nspectIOns. Liability and Property Damage Insurance: Contact your msurance agent to see If you have adequate insuriu1ce' coverage for aCCidents and omiSSIOns such as fallmg tools, pamt over spray, water damage from pipe punctures, fire or work that must be redone - Time: Make sure you have sufficient tIme to supemse your employeeS~ - Expertise: Make sure y~u have the skIlls to act"as your own general contractor, to coordinate the work of rough-m and fimsh trades, and to notIfy buIlding offiCIals as the appropnate nmes so they can perform the reqUired mspectIOns. x -. If you have additIonal questions call the Construction Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052. Property _owner-doc 06-01-04 i --- t 1""' I I : rf'!Yf:.F- ~HAV'?T VT::t-:lT I F~ E;tt:.H.o.. 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I ~::r-,'I-;:; I ~ '7Tf'<l~, '.I ) roo- -"1"- - t '---r- .,.. - , '7N ., ~- i-r \ f Vf~"" t-t c r - 51 b n '.h '7 E '7 ~ P.I;:..;<- "21::0?' ~ f- ; . ;J ~ ~ -::'.: ~ e-/'I 0 v r; ~ \!,-j ''7 p~ ~-- 'SU1F-~.e-/-:..l-\kSe 7"21 c,\T"'-I '-JiE:N ~!-\lP f-f',o '/"--; H'''; ; ~~,'--:;"-1 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET mURNAL OR JOB NUMBER C0M2008-005 I 6 NAME OR COMPANY ShIrley Chase LOCATION 721 CIty VIew TAX LOT NUMBER 170334 I 404700 DEVELOPMENT TYPE SmgIe FamIly ResIdence NEW DWELLING UNITS 0 BUlLDING SIZE (SF: 0 LOT SIZE (SF) I STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S F x COST PER S F CHARGE I 0 00 $0 346 = I $0 00 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F x I COST PER S F x DISCOUNT RATE I I 0 00 I $0 346 50% I ITEM 1 TOTAL - STORM DRAINAGE SDC $0.00 I 12632 rn r.r.l Q o u ~ r.r.l r-< rn ...... o ~ DISCOUNT $000 $0.00 11070 2 SANITARY SEWER - CITY A REIMBURSEMENT COST I NUMBER OF DFU's I x I 12 I B IMPROVEMENT COST I NUMBER OF DFU's x I 12 COST PER DFU $26 83 $322.00 11091 COST PER DFU $20 40 $244.85 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $566.85 3 TRANSPORTATION A REIMBURSEMENT COST I ADT TRIP RATE I x I NUMBER OF UNITS x I COST PER TRIP x I NEW TRIP FACTOR I 957 I I 0 I 2043 I I 00 $0.00 1093 B IMPROVEMENT COST ADT TRIP RATE x I NUMBER OF UNITS I x COST PER TRIP x NEW TRIP FACTOR 957 I 0 I $9010 I 00 $0.00 1094 ITEM 3 TOTAL - TRANSPORTATION SDC =, $0.00 4 SANITARY SEWER - MWMC A REIMBURSEMENT COST INUMBER OF FEU's x COST PER FEU I 0 $95 35 = $0.00 ", 1054 B IMPROVEMENT COST INUMBER OF FEU's I x COST PER FEU I 0 $990.39 = , $0.00 lOSS MWMC CREDIT IF APPLICABLE (SEE REVERSE) =, $0.00 1054 MWMC ADMINISTRATIVE FEE =' , $0.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = , $0.00 -- SUBTOTAL (ADD ITEMS 1,2,3, & 4) = I $566.85 5 ADMINISTRATIVE FEE ' ... SUBTOTAL x ADM FEE RATE 1= CHARGE $566 85 5% I $28 34 11079 TOTAL SANITARY ADMINISTRATION FEE 2834 TOTAL TRANSPORTATION ADMINISTRATION FEE $000 11078 I Kaye Wilson 4/14/2008 TOTAL SDC CHARGES =, $595.19 PREPARED BY DATE <: DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FlXTURES) NO OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 0 0 3 = 0 I DRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 = 0 LAUNDRY TUB 1 0 2 = 2 ICLOTHESW ASHER / MOP SINK 1 0 3 = 3 ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 \MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC 0 0 1 = 0 RECEPTOR FOR COM SINK / DISHWASHER / ETC. 0 0 3 = 0 SHOWER, SINGLE STALL 1 0 2 = 2 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 = 0 SINK COMMERCIAL BAR 0 0 2 = 0 SINK WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 SINK SINGLE LA V ATORY/RESIDENTIAL BAR 2 0 1 = 2 IURINAL, STALL / WALL 0 0 5 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET~ PRIVATE INSTALLATION 1 0 3 = 3 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 12 *EDU (EqUIvalent Dwelling Umt) IS a discharge eqUIvalent to a smgle family dwelling umt (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 J994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE $529 $529 $519 $512 $498 $4 80 $4 63 $440 $407 $367 $322 $273 $225 $180 $159 $145 $125 $109 $092 $072 $048 $028 $009 $005 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0 00 x $5 29 = , $000 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0 00 x $5 29 o TOTAL MWMC CREDIT $000 = 225 Fifth Street Springfiel'tl, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 COM2008-00516 Payments: Type of Payment Check cRecemtl RECEIPT #: 1200800000000000349 Date: 04/14/2008 DescriptIOn BUlldmg PermIt FIxture Vent Fan Dryer Vent Mmlmum/ Adjustment Mechanical ~MechanIcal Issuance Fee- + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admm PaId By SHIRLEY CHASE Item Total: Check Number Authorization Received By Batch Number Number How ReceIved dJb 1002 In Person Payment Total: Page 1 of 1 2:27:21PM Amount Due 5000 8000 700 700 3600 2000 900 2160 1800 32200 244 85 2834 $843.79 Amount Paid $843 79 $843.79 4/14/2008 upt- V' !' ~ ~~'\ ~ rtV v\ ~~a CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: cOM2008-00516 ISSUED: 04/14/2008 APPLIED: 04/14/2008 EXPIRES: 10/24/2008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 721 CITY VIEW BLVD ASSESSOR'S PARCEL NO.: 1703341404700 Springfield TYPE OF WORK: Bathroom TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Add bath to basement and install sump Owner: CHASE SHIRLEY ANNE Address: 721 CITY VIEW BLVD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor License PAGE REMODELING & CONSTRUCTION I 68337 JB ELECTRIC 104929 JAMES HEATING ARPS PLUMBING CO INC 38123 BUILDING INFORMATION I Expiration Date 02107/2010 03/14/2010 Phone 541-688-8787 541-687-5770 01/24/2010 541-484-7246 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 n/a I DEVELOPMENT INFORMA nON I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: ui~p.ctD % of Lot Coverage: NT\ON', Oregon laW re6regon Utility ATTE dopted by the set forth fnl10W ru\es_ a :";':' ,hose rules ~~e "CI")J)n1- I PUBLIC IMPROVEMN~i:$~~.~O;'~OOi 0 thrOUI~~ ~[t~;; ;ules by II' @ p.\!.9.btalll cop telephone 0090.. YOUthl~~'h1\r~I~fl't:YpiU6t: ~htve Notification calling . _ f"\rAC10n 1,1, mber tor Do:w1I'sJ1Q~tJ!YJ~Jn~4). nu Center IS ,-B Street Improvements: Notes: Storm SewtN~rJ4P!6[e: Special InsfJ'jI~eoji1ERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, Page 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Type of Construction Bid Amount Use Bid Amount Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Building Permit Dryer Vent Fixture Minimum/Adjustment Mechanical Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: cOM2008-00516 ISSUED: 04/14/2008 APPLIED: 04/14/2008 EXPIRES: 10/24/2008 VALUE: $ 2,000.00 I Valuation Description I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 2,000.00 Value Date Calculated $2,000.00 $2,000.00 04/14/2008 Total Value of Project ~ Amount Paid Date Paid Receipt Number $20.00 $18.00 $21.60 $9.00 $50.00 $7.00 $80.00 $36.00 $244.85 $322.00 $28.34 $7.00 $6.80 $8.16 $3.40 $48.00 $20.00 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/14/08 4/24/08 4/24/08 4/24/08 4/24/08 4/24/08 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000349 1200800000000000394 1200800000000000394 1200800000000000394 1200800000000000394 1200800000000000394 $930.15 I Plan Reviews' 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. ~eouiredJnsDections . Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Pal!e 2 of 3 CITY OF SPRINGFIELD. Status Issued Building/Combination Permit PERMIT NO: cOM2008-00516 ISSUED: 04/1412008 APPLIED: 04/14/2008 EXPIRES: 10124/2008 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover 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 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 times during construction. Owner or Contractors Signature Date Page 3 of 3 Date ZON vJ.l INITIALS () M DATE t:..J~'LL/ ~off SOURCE 0fS~ <J -;).J ,,0 (( . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH,(541)726-3753 · FAX. (541)726-3689 ELECTRIC~PERMIT APP.LICATION CIty Job Numb ;Aro zr "'~I{'? - - -., 1. LOCATION OF INSTALLATION: '1~1 CAJJ'VUi4J ~ lJil , LE.GAL ~E6C~TION ~ \(O'~ 3f1-'-f 0 4-7(1) JOB DESCRIPTION 3'f1 +h~ '" d ly.An~\lA Uc~ 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. ,'" " " -..... ~ } l ~ CONTRACTOR INSTALLATION ONLY , ;' ~ ~ ( " Electncal ContIactOl JE:> E"LECTll. \ L , f>J t... Address Lito <is ,,; I ~ 1\ ~fm :)\ CIty . EL>c.,E~E Phone f 0<61- ~ b 1'10 SupervIsor License Number 3 <151- ~ ~ ExpIratIOn Date I 0 . I - I 0 Constr ContI Number 1(;)4 q.:l q r' -ExpIratIOn Date 3 -, L/ . .J 00" \ I I I I \ I upervtsmg trIcIan "~ y . / own=L~ 'f I Oc {( Gh <q --> Addr,,;1;2 \ C J-l-tlf YVQv. ') \3,\ voL- CIty '5r/ 0 (t____ J Phone OWNER ~9&ATION The mstallatlOn IS bemg made on property lawn whIch IS not IDtended for sale, lease or rent Owners SIgnature Inspection Request: 726-3769 :?t~9 ~\ ~ \L1/'~ol 0 3, COMPLETE FEE SCHEDULE BELOlV A, New Residential- Single or Multi-Famil) per dwelling unit. Service Included 1000 sq ft or less Each addItIonal 500 sq ft or portIon thereof $106 00 $ 19 00 Each Manufact'd Home 01 Modular Dwellmg Service or , Feeder <' '. ~Attmt"l\~ "r~~on ta~reqUlyeS you to " ' B. SerHces Ot'~. S".!. 'In]'tal Itl<m... teR11:iD.IijIfutmlocatlOn:' fo11ow ru es aoop eo uy e-vn::y 'I ,,\ It6icatlon Center. Those rules are set forth 200 AmPSi~PdA~ 952-001-0010thrnllgh o,.J\:9!2-001- 201 Amps~~~9 ~may obtain copies of:ltl1~ ooles by 401 Amps to&@i~~\.l1ijJl'Ci center. (Note: the $Ejl~~e .n"Ilm""~r fOr. the Oregon Ul. I\iw ~~lflcatlorl 601 Amps t"'1'I!I\J\,/"l\J11'p1i ~ 00 G-30;-234 ~ 00 Over 1000 Amps/V oG1:~nter IS 1-8 ... $3 5 00 Reconnect Only $ 5000 $50 00 f ?"'< v ~~ ,.. c. ~ ~emporary Se:r~ic~s ~or Feeders, '" '~:\"1~;jrtr:.~ ' 1"~,t t 1 ~ ...,.. InstallatJmrj\ff;1~Fm1P1l sm€/!tc[~~RE IF THE WORK 200 AmpiLbrlOOfl!ZED UNDER THIS PER~lfolI$)NOT 201 Am@SJp.ItmQJWiID OR IS ABANDONEi}$(9lR 401 Amp.m~~V PERIOD. $10000 ()ver 600 Amps 01 !OOo, Volts see "B~: above D. ' nra~~h Circuits; ;,' , ':.' New Alteration or Extension Per Panel One CIrCUlt Each AddItIonal CIrcmt or wIth ServIce or Feeder Permit L)tcP .~ $jtoo- Lfrs bU " , E. Miscellaneous (Service/feeder no~'include~I) -Each Installation r Pump or ffiIgatlOn $ 5000 SIgnJOutlme LIghtmg $ 5000 LImIted Enelgy/ResldentIal $ 25 00 LIIlllted EneIgy/Commercwl $ 45 00 Minimum Electric Permit Inspection Fee is $45,00 + surChargetJO 4. , SUBTOTilL ~F ABOVE ",~ " (rJ; . 8% State Surcharge - 3 . 4<J 10% AdmmlstratIve Fee g, I iL, 5% Technology Fee 02./1:'; TOTAL $. gt,p .30 ShaI ed Dnve(T )lBmldmg Fonns/Electncal Penmt Apphcatlon 8-06 doc 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-005l6 COM2008-005l6 COM2008-005l6 COM2008-005l6 COM2008-00516 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: 1200800000000000394 Date: 04/24/2008 DescriptIOn Add, Alter, Extend Clrc Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State Surcharge + 10% AdminIstrative Fee PaId By ALONSO/JB ELECTRIC Item Total: Check Number AuthorIzatIOn ReceIved By Batch Number Number How ReceIved nJm 058577 Phone Payment Total: Page 1 of 1 8:25:38AM Amount Due 4800 2000 340 8 16 680 $86.36 Amount PaId $86 36 $86.36 4/24/2008