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Home My WebLink AboutPermit Building 2005-3-25 , Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . ~F CITY OF ~rKll~l>l'lELD Building/Combination. Permit PERMIT NO: COM2005-002I6 ISSUED: 03/25/2005 APPLIED: 02123/2005 EXPIRES: 09/25/2005 VALUE: $ 220,800.00 SITE ADDRESS: 2064 HARBOR DR ASSESSOR'S PARCEL NO.: l803112203500 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence replacing existing MH. Residential "Owner: ROBERT MENTZE Address: 2062 HARBOR DR 'OOltEld AliO 09 ~ ANIi SPRINGFIELD OR ~~'!J7mNOONli81i SI 80 038N3~Wm8 - . -. . Contractor Type General Electrical Mechanical Plumbing Phone Number: 54l-741-S599 lUI\J ::>1 .llVH1jO :)lM.1. O:lUI..,11 U:JLIUUI U.11 v >180M 3Hl jl ~1~GONTRA:G"EOR'INFORMJ\TION I ':I~I1UN License 8971 0 Contractor FM SHEET METAL OWNER FM SHEET METAL INC OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: _ Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Expiration Date 03/l512007 Phone 54l-344-6002 8971 0 03/15/2007 541-726-3000 I BUILDING INFORMATION' # of Stories: 2 Lot Size: Heigbt of Structure 36.00 Sq Ft 1st Floor: Type of Heat: . Heat Pump Sq Ft 2nd Floor: Water Type: Electric Sq Ft Basement: Range Type: Electric Sq Ft Garage/Carport ~~Itl~l Sl J91U~Path 1 Sq Ft Other: UOI1llOII,~8U~!IJ" 941 JOJ J~~ Occupant Load: J tmyEa;p~ff~I;i'~\~~600 :~~~S~~~ llBE~ OlOo-lOO-~6l:lVO Ul 52.50 tpJOJ l8S ~li~.e~OIl1 .~9lUlQll1l\lRli!lR~' 5.00 ~I!ln~~~~dope SQllUtAOlIOJ 'noA l~:NOwauV 60.00 ell . ot Coverage: 19.50 0.00 I R-3 11,761 1,512 788 VN ,2 REQUIRED PARKING , Total: 2 Handicapped: Compact: I PUBLIC-IMPROVEMENTS I Partially Improved No Sidewalk Type: DownspoutslDrains: 'Drywell - Provide Drywell Engineering Notes: SDC credits for MH applied to new bome - Drywell 2/2812005 CAS Pa\le I of4 Status Issued , 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Dwellin!!s Tvpe of Construction V Wood Frame " Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Perm ServlFdr 200 amps or less -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge 2 Baths One or Two Family Addressing Assignment Building Permit Dryer Vent Exhaust Hoods Pellet Stove/Insert Residence Wiring 1000 Sq Ft Residence Wiring Ea AddU 500 Sanitary or Storm Sewer Cap Sanitary Sewer - 1st 50 Feet SDC Sanitary/Storm Admin Storm Drainage Impervious Area UGB Plan Rev Mj/Min - Planning Vent Fan Total Amount Paid Initial Review Plannin!! Review 02/24/2005 02/24/2005 . I Valuation Descrintion I $ Per Sq Ft or multiplier $96.00 Square Footage or Bid Amount 2,300.00 Total Value of Project Fpp<, tiWLI Amount Paid Date Paid $623.29 $6.30 $4.41 $63.00 $10.00 $152.29 $106.60 $254.00 $31.00 $958.90 $6.00 $9.00 $30.00 $106.00 557.00 545.00 545.00 $3.70 573.94 5l56.00 512.00 2/23/05 2/24/05 2/24/05 2/24/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3/25/05 3125/05 3/25/05 3/25/05 3/25/05 52,753.43 I Plan Reviews I 02/24/2005 03/15/2005 APP' SKG WI TAJ Pa!!e 2 of4 " CITY v.. ~rK11~GFIELD Building/Combination Permit PERMIT NO: COM2005-00216 ISSUED: 03/25/2005 APPLIED: 02/23/2005 EXPIRES: 09/2512005 VALUE: $ 220,800.00 Value 5220,800.00 5220,800.00 Date Calculated 02/23/2005 Receipt Number 1200500000000000237 l200500000000000243 l200500000000000243 l200500000000000243 1200500000000000366 1200500000000000366 l200500000000000366 1200500000000000366 l200500000000000366 l200500000000000366 1200500000000000366 l200500000000000366 1200500000000000366 1200500000000000366 1200500000000000366 1200500000000000366 1200500000000000366 l200500000000000366 1200500000000000366 l200500000000000366 1200500000000000366 Waiting for a determination by Ken V re: floodplain requirements. . " CITY OF SPRlNu1'l~L1J Building/Combination Permit PERMIT NO: COM2005-00216 ISSUED: 03/25/2005 APPLIED: 02/23/2005 ' EXPIRES: 09/25/2005 VALUE: $ 220,800.00 Status Issued 225 FifthStreet, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 54l-726-3769 Inspection Line Plannin!! Review 03/21/2005 03/21/2005 APP TAJ Applicant provided additional elevations for the building site on 3/21/05. According to the applicant's surveyor, the entire building footprint is outside the 100 year 1100dplain. The Floodway boundary Is also delineated on the plans. No construction activity, disturbance, grading or filling is allowed within the Floodway area. Drywell required 2/28/2005 CAS Public Works Review Structural Review 02124/2005 02124/2005 0212812005 03/22/2005 APP APP CAS TCM 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. I ~enuired In~nel':tinn~ I Electric Service: Approval required prior to utility company energizing service. Erosion/Grading Inspection: After all erosion measures are in place. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Freestanding Pellet Stove: After Installation. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. FEMA Certificate Required: FEMA Certificate required to be completed and presented to the City of Springfield prior to requesting any final inspections on this project. 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. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are Installed. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to 1100r insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Walllnsulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Roof SheathinglNailing: Before covering sheathing with finish material. 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. Underl100r Plumbing: Prior to Insulation or decking. Underl100r Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and Including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Pa!!e30f4 . " L11 r' OF ~rKll'lld'lJj,LD Building/Combination Permit PERMIT NO: COM2005-002I6 ISSUED: 03/2512005 APPLIED: 02/23/2005 EXPIRES: 09/25/2005 VALUE: $ 220,800.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 54l-726-37691nspectlon Line Line to Septic Tank: Prior to filling trench and required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. UnderOoor Mechanical. Prior to Insulation or decking and Including required testing. 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 wlIl remain on the site at all times during construction. .~~ 3-dS -65 Owne;or Contractors Slgn~ Date Paee 4 of 4 ~ITY OF SaGFIELD SYSTEMS DEVELOPME&RKSHEET JOURNAL OR JOB NUMBER: COM2005-00216 NAME OR COMPANY: Robert Mentze LOCATION: 2064 Harbor Dr TAX LOT NUMBER: 1803112203500 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF' 477 LOT SIZE (SF): 1 STORM, DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S,F. I I CHARGE I 0.00 I $0.310 = I $0.00 I 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 477.00 I $0.310 I 50% I = I ITEM I TOTAL - STORM DRAINAGE SDC S73.94 o Ir; II ~ 18 I~ IW-l E-< tIl a ~ DISCOUNT $73.94 S73.94 _11070 2 SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x COST PER DFU I 0 $24.04 SO.OO 1091 B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 0 $18.28 SO.OO 11092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , SO.OO I :l....IBcANSPO~TATION A. REIMBURSEMENT COST: I ADTTRIPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI 9.57 I I ' 0 I S18.30 I 1.00 I SO.OO 1 1093 B. IMPROVEMENT COST: I I ADTTRIPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI 9.57 I I 0 I $80.72 I 1.00 I SO.OO 1 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = , SO.OO I 4, SANITARY SEWER - MWMr. il A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I I $82.03 = SO.OO 1 1054 B. IMPROVEMENT COST: I INUMBER OF FEU's I x ICOST PER FEU , I 0 I I $865.31 = SO.OO 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) SO.OO 1054 MWMC ADMINISTRATIVE FEE SO.OO ~11056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, SO.OO SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , S73.94 5, ADMINISTRATIVE FEE: I SUBTOTAL I x ADM. FEE RATE 1= CHARGE 1 I S73,94 I 5% I $3.70 TOTAL SANITARY ADMINISTRATION FEE: 3.70 f079 .TOTAL TRANSPORTATION ADMINISTRATION FEE: SO.OO 1078 ----.. Cheryl Slaymaker 2/28/2005 TOTAL SDC CHARGES =, $77.64 PREPARED BY DATE - . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT'" DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS r BATHTUB 2 2 3 0 I DRINKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE lOlL I SOLIDS I ETe. 0 0 3 = 0 'I INTERCEPTORS FOR SAND I AUTO WASH I ETe. 0 0 6 = 0 I I LAUNDRY TUB 0 0 2 = 0 I ICLOTHESWASHER I MOP SINK 1 1 3 = 0 I ICLOTHESWASIIER - 3 OR MORE (EAl 0 0 6 = 0 I IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 :1 IRECEPTOR FOR REFRIG I WATER STATION I EYe. 0 0 1 = 0 I RECEPTOR FOR COM. SINK I DISHWASHER I EYe. 0 0 3 = 0 I ISHOWER. SINGLE STALL 0 0 2 = 0 I I SHOWER. GANG (NUMBER OF HEADSl. 0 0 2 = 0 I ISINK: COMMERCIAURESlDENTIAL KITCHEN 1 1 3 = 0 I ISINK: COMMERCIAL BAR 0 0 2 = 0 I ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0 I ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 2 1 = 0 I URINAL. STALL I WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 I ITOlLET. PRIVATE INST ALLA TION 2 2 3 = 0 I MISCELLANEOUS DFU TYPE NUMBER OF EDU'S I 20 = 0 , TOTAL DRAINAGE FIXTURE UNITS 0 :]. ~.EDU (Equivalent Dwelline. Unit) is a disc~ eQuivalent to B sincle family dwelline. unit (20 DFU's) set at 167 J!;allons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$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 ELGlBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDIT RATE $0,00 x $5.29 o TOTAL MWMC CREDIT = $0.00 II . - MEMORANDUM Citv of Sorin\!field DATE: March 17,2005 TO: Tara Jones FROM: Ken Vogeney (f-, SUBJECT: Flood Plain Review for Robert Mentze, 2062 Harbor Drive, COM2005-00216 I've reviewed the flood plain information that you provided me that was prepared for the subject building permit by Mr. Mentze's surveyor, James McLaughlin. The subject property is located downstream of the FEMA identified Base Flood water surface elevation for the 1 OO-year flood of the WilIamette River of 450 feet based upon FEMA's datum. Mr. McLaugWin determined that the elevation of the existing ground at the northerly comer of the property is 451.03 feet. FEMA FIRM Panel I 144 shows a portion of the subject property in Shaded Zone X, which is used for areas within the 500-year flood plain or areas that are subject to less than I foot of flooding during the 100-year flood event. Panel 1144 shows that the remainder of the subject property is within the Willamette River floodway. Unfortunately, the documentation that I was provided does not indicate the boundary of the floodway on the subject property or any other existing or proposed ground elevations on the subject property. Furthermore, the provided copy of Panel I 144 is not to the same scale as FEMA's published Panel 1144; it includes tax lot boundaries' that are not shown on the published Panel I 144; and this tax lot information does not appear to be drawn at the same scale as the provided Panel 1144. Although the applicant has demonstrated that the northern comer of the property is above the Base Flood Elevation of 450, the documentation does not provide evidence that the remainder of the property or the location of the proposed development, including any fill or structure, is outside of the Willamette River Floodway, An additional note for your information, the documentation I received includes a note stating that "House floor required to be 12" min. above I 00 year flood level." The applicant should be cautioned that, according to FEMA rules, lowest floor elevation for the house would be the ground level in the crawl space under the house if it is not constructed as a slab on grade. Conclusion: Based upon the information provided to me, the applicant has not demonstrated that their proposed development is exempt from the City's Flood Plain Overlay (Article 27) regulations. Page 1 of 1 V:\devclopement review\DRC\2005\F1ood Plain Review Memo 2062 Harbor.DOC I . :X' . Permit #: eo"" 'l.O ~ 00 Z-I b Address: "Z..ofoL( Hit (L.r:,(J'IL tI "- Issued by: bg Date: 3/z.. ~ /0 \" f 8); \ ; ", .... ", ,,' Construction Contractors Board 700 Summer St NE Suite 300 PO Bos 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constrnction permit applicants who are not licensed with the Constrnction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the app.up.:ate blanks and initial boxes I and 2, and either box 3A or 3B: )211. ~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. ~A. My general contractor is R ~ ~,~L (Name) ~7fU (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. Ifl 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 this 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. /~~PPlicant) '3ft\~r- I (D~ u (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-0l-04 ~ Adnnn~ ~~' ~1UlIr ((1)wnn CG~nn~nllll C~~Irtal~~~~? INFORiVlATIONNOTICE TO 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 acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. JEmlPnoyer JReslPollRsnbillities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the D~I'<u;"uent of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-809l or www.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer; you are subject to the Oregon Workers' Compensation Law, and must obtain.workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim' costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-78l5. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at l-800-829-4933 or visit their web site at www.irs.l!Ov. OtlbleJr lReslPolmsfilbfiRfitfies amll AJreas olf Concerlms Code Compliance: As the permit holder for this project, you are responsible for resolving any failUre to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insutance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be ~edone. - ; Time: Make sure you have sufficient time to supervise your employees, !Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and fmish trades, and to notify building officials as the al'l',vp,;ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-462l) or write the agency at PO Box l4l40, Salem, OR 97309.5052. Property_owner.doc 06-0l-04 225 Fifth Street SpringjJeld, Oregon 97477 54i.:726-3759 Phone . -ird' .aD ljEi,""-'-'" '-.-".-"','. ',i, ;"-:k. " .......'~ ,.,1 IllliiJ..ty of Springfield Official Receipt 9ve1opment Services Department Public Works Department Job/Journal Number COM2005-00216 COM2005-00216 COM2005-00216 COM2005-00216 COM2005-00216 jCOM2005-00216 ~COM2005-00216 COM2005-00216 COM2005-00216 COM2005-00216 COM2005-002l6 COM2005-002l6 COM2005-002l6 COM2005-002l6 COM2005-00216 COM2005-002l6 COM2005-002l6 LDP2005-00052 Payments: Type or Payment Check f'l " , . 'j 'I 3/25/2005 RECEIPT #: 1200500000000000366 Date: 03125/2005 Description Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Addressing Assignment Stonn Drainage Impervious Area SDC Sanitary/Stonn Admin Building Pennit 2 Baths One or Two Family Sanitary Sewer - 1st 50 Feet Sanitary or Stonn Sewer Cap Vent Fan Exhaust Hoods Dryer Vent Pellet Stove/Insert -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee UGB Plan Rev MjlMin - Planning LDAP Short Fonn Impacted New Paid By ROBERT MENTZE Item Total: Check Number Authorization Received By Batch Number Number How Received djb 5043 In Person Payment Total: Page I of I 8:09:23AM Amount Due 106.00 57.00 31.00 73.94 3.70 958.90 254.00 45.00 45.00 12.00 9.00 6.00 , 30.00 lO.OO 106.60 l52.29 156.00 600.00 $2,656.43 Amount Paid $2,656.43 $2,656.43 ':>"':." . ". crlY OF'L__1NGFIELD~'OREGbN :" .' -'. . l.'\ ., . ",' , . .' . ~ . '.. \.,. S,P ,RIN,O, ",m. D ~~",' ~. ,~".'" ~..",. ~, '" _1/: ._,,~\ fl' " .A!.. ;,>;~ ':J.iIJI 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3~9 " " ELECTRICAL PERMIT APPliCATION, ~o"<i> '0" . ....o~ O,lz.,. r:.-C-: OOZ!(., Date"~ ~../ ".,:10 - -1....$ 0.:::"'"",' . . - ~ ~~'" ' .,r"n .~,,__'..... ..-" ~'~.'-~~" ~ ~ "OIt7'IMft:'; :'-r' .... ~''fC:'. a.,\ ......,.,. .";,, V"'", 3. ,'COMPDETEFEE, "B .toO ,."'..;,,,,"""': t"',......,., ,"A.."-'hrn.v;"""'" ",v'''''l.~~'~ .~~ -J~i:Wo.:o/~ ..,.~r., ":,.l ,.,~~),,'~ ,I,t ())O' ...., d' Ill, "~~6 A. ~~~€s.'~tiilJ'sffi'g"'~~~h~t~:-F w4~1~~Jfli~~g-',~~i~;t li';;JO,'lZOo~"~"."'-~-"'--"'''''''' ,~,...,i'J'~~''':: ~ ....... :.i\..""&~'~~'" ,,;.-1 C}. IS' Service Included ~ ,,-' "b ~" tr ~~ '0 106.08>:'o4.Ct" CO 'tI-,,,,- 19. 1? tX) City Job Number l,i:OOAfioNOt.INSiXbiAfidN;ilt;: /,;,ij 1. ~~,a..;:...~".-- ..,..,......,.._.._ .....,-...."''''-....--. "",,_,,_""''"_'''.,.i'i.,>.' 2 0 c;!f.. IJll rbor lk LEGAL DESCRIPTION (eo~ II 2.Z.-<91 $00 JOB DESCRIPTION r;J--sc:"- ~/Iy /b/~ 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof I Permits are non-transferable and expire if work is Each Manufact'd Home or ,~ not started within 180 days of issuance or if work is Modular Dwelling Service or $ 0 00 Suspended for 180 days. Feeder . ^.,');~ 2 ~{CdNT, 'RAcrolFtNSTA i.f:'ATIONO$;.'i" rlT,'O~h.OiSf':~k(';;G:Ee.~s.,;j:ns'i~"iti:;n; Ait~r.d;'iis or.R~loc,jtion:" ,;J . l ..~., ~ ~ -...., -,-~ '''~'>'- oJ:'_ ... - ,..- '"""'1"'~'''''' I es a :?<i: "f . 1- '.-~.;)_,.ou..tO"'f,.",~ .' ....j, - u, ... ....../,,-. J!';J, :J Notification C. Y ne Oregon Utility Electrical Contractor in Ol.D "52 200 AJnpslD~lll@lS are st. $ 63.00 J - 01-IW th. e 'orth 0090. Yo may 0 (II ;"""pSl~()Q>>\jIjI!152-o0t. $ 75.00 Address calli "'thee t ~~~6'lSQlf~leSbY $125.00 ::- U<_ N='" ,00/ ~b;'~~",..",. . ::EE .".' .~~ / Installation, Alteration or Relocation .- 200 Amps or less -w/).o 1 Amps to 400 Amps 401 Amps to 600 Amps I ~ as.9t $ 69.00 $100.00 C:'\ --.:: Expiration Date >< Owners Name "eokp:/. ,/?/~ Address R5 b t5'~ ~J?oJZ- LJ l2.- City ~/b Phone 7y/-fJS9CJ OWNER INST ALLA nON Over 600 Amps or 1000 Volts see "B" above. , D r-B.t\':, ;,~"'h...IC'-'.~'.c6"<<'ts' ,;' "_;~}i6':r .r~%~: .I;"\~'-)~ :.~,,'1" ~"~',: c.~~_'):,~ " .~:'~ ~; .' ,i;:j NOTICE: ., r~nc ,_fr~U1,,/, . ,:x.;...~;" (.".... ' , ".c' ,", " '~'" '. ,1 ,.,. ,/r....'nr.."H: TUr- \f'r\B'" THIS PERMNe%I~~~tationo"'.J!4tenslon Per Panel ^1'THORIZE.Qn\:lQ!N:liil THIS PERMIT IS NOT $ 43.00 COMMENC~~)M<!!til?~I<P~liKQV wilhl ANY 180 O'serYIco,orJ'eeder Pemut /'IT r-cn.uu. E. E~~I!;~;';:~l~~~~~r~~~r:fi.~t:b,~I9d~d);;j:Ach.~~#i~ri.~ti;;!!..1 $ 3.00 The installation is being made on property I own which is not intended for sale, lease or rent. Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential , $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges . y. ;;;;JJ~ (J rr ","> ...'-y..~- -'.......,;..,~;.....- :.,~. ;.... <>':":_f '';-1"",/:.';',';;:''~\\/''''f \,,;-"l 4. "SUBTOTALo.f7ABOVE"'J'.'..,:""f" c,' "..' I. .. ..-~-;.:-:..<:,~", "~;".~" ". ''!il~ ....-..~." '. .",,'!f:?::r - '.' ",. '.' -, ~... .. .' .,..... .. .:}P"'...."" .,. ."".'.. '_.'_ .. ~,.....'.':'~.. '. ~ '. "... ' '.' '"<..:, 7% State Surcharge 10% Administrative Fee 1191,00 ( I, Ifl ~"{O .f I 'il'). 1-1 Inspection Request: 726-3769 TOTAL Shared Drive(T:)lBuilding Fonns/Electrical Pennit Appliclltion 1-03.doc