HomeMy WebLinkAboutPermit Electrical 2004-6-28
SPRINOFIELD ,
'" ;'1.9.oL~0
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (5~1)726.3b1l9 "'o~:.~.\'" _~
ELECl'RICALPERMITAPPLlCATION ~ i1t6 <'O'l~ '1"~~;"6""
. /_ J 006(0 / -'~@1'::>;" I; p..... 9",;, '<1'..
City Job Number uJ/YlZO 0 - Date b c;.' ~::~...... 6 8.0 0'~i1 '
~ 8,,, 0';' 6"1' 8t~
1. L1JOCAfIONOBi:NSTAi!ci.fiOMI.iJ;''''''i'i~ 3. ~coMP'[;iiFjfEE'SCHEDiJS~' "'-W:~~'~!~ii'!~qo.l
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JOB DESCRJPTION 1000 sq. ft. or less " $106.00
\ r (I Each additional 500 sq. ft. or
LoJ \J 0 -h4--<; r.:::- portion thereof $ 19.00
l' :)::"::.':": ,'c':"':CITY DF1~~ktNGFIELB~'(jREG6N,'-'-"'r \.,,~;(:~
'~il""t I .1 ~~ i'...., ...... ~', " , ~... .,'d>; -', "-~?~r-~r'
~... '"l ~ .... . ~ _ . '... 0\0- , -...._ . . ." ~_ _...... ~ . .."",.,.,./1.
. Permits are non-transferable and expire if work is
~ not started within 180 days of issua'nce or if work is
Suspended for 180 days.
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
2 l!cONFIDicroRhNs'Txr'i/4,.TION;-o'NLlgl B. [~~~g'iif)F~~ffid,t~irisf~lia'ii~t,I/'lt~fiitii>~s ~.t'Relhc'aii~n;' '1
. ~,':'.:.'r.r-.....~~~"....-:......~~~t',.,-~..'",:;o.-;_..".T~'~!""~~.",:,r.",,"",.~.-:-,"~""..."'<j,<.J ." ~ -~ ~'''':.'..&~I.\I?',;'\';\>:'' "....... '~Q..-~..~_ r..,.~ ~'.""..,~,-l'-~'
.~" '.
Electrical Contractor .5 e ~ ... ,.. e T;.,,~ j., .z;;~TTB'~~;J:"<tly the oregon ~\II!L $ 63.00 .
fo\IOW~4flQ1~letl are .... ...rn, $ 75,00
Addressolt! Ala l$yI'J,jJ IS Ij.ld'.~.. ta QPUun/J\GhotO~~ft9,~~!t!~ $125.00
In 0.... . ...,,11111 "IV ,J_ - ~
Q09O. 'f8b~Prnl~"'e telep"~ $163.00
Phone . S-,.).1-~837 c:aU~~tpOOaWp~\\ityNO\iliP.Ati.&ll $375.00
.' ' ~W1:::fl~-2344). $ 50.00
"?... - -r;, b C ~:r~'-" """,s,,,,,,,,,,,,_v"F'" ""'-"f>r{.'\"~ "'r~)~~.-", '.>","::1
Supervisor License Number .."')nl. q_~ '-\ L . 'it egtp'!>r~r,y erYlc~es:o.r:.:. ee~e~s; ~< ':'4, ~ ~,~~,f ~. fif"'t Lt
Expiration Date 10; 10.<' Installation, Alteration or Relocation
I ' 200 Amps or less
Constr. Contr, Number ..;l. () - ~ C L 6' 20 I Amps to 400 Amps
: ' 40 I Amps to 600 Amps
Expiration Date /0),/0,'<. ,.' Over 600 Amps or 1000 Volts see "B" above.
Sd~ D~=;';~::;:;;,;::/"'::~~C~;''''j
, /' Each Additional Circuit or with
Owners Namy;'-1?Of{LL 1 ~~~r-f LAczoLdsy s:~~:.O~,F:~~er,~e~it,.v^<. "._..~,~,oo, ,W . .,
Address 1/ () ( nt..-tL <::" <I.......... E. ~~~c~Il.a!'~us ,<Ser:)1~~!fteger,j~~ie.~-~,1!'jls~'.tt,tst~1l~t~ll,
, '\'\t'~'l.j,,"'- -
City (- 3A.c-&f e ~hone ~\ll\C ~N\"4.~Ii\~l~t{;\~ p~~M\1 \S ~Plo.oo '
I ~\1fEg8h~h\f' r-.~~~OON~U rvn $ 50.00
OWNER INSTALLATION f~~~'tl! $ 25.00
The installation' is being made on property I own which ~~5Qe~~~ercial V $ 45.00 'i ~
is not intended for sale, lease or rent. Minim~m Electric Permit Inspection Fee is $45.00 + Surcharges
City ,e;,<tC',,~
"
$ 50.00
$ 69.00
$100.00
Owners Signature:
4 ~r.S~~;"'4\O~'T.'-'!iT.:'O~r.c'~'ii"O",VE'" --.,-' , ,h~"~,,:j',~, ~'<"J
. '.. LlD:!.',"'~,' T-~ '", ,. .".... ,'-', _.",:;-, ,,"'ri'
. -'L..~,-"'r,~""t"..;"'J_l "'.. 'to --::.J:"_ "',~"~ '"'''' ',,' -'-,/"1'>:: _'" '.. ,
Inspection Request: 726-3769
TOTAL
/
i..()
'311
'-fro
1; 52- ~
7% State Surcharge
10% Administrative Fee
Shared Drive(T:)lBuilding Forms/Electrical Permit Application 1-Q3.doc
Status
Issued
.
. CITY OF ~rtOl'luFIELD
Building/Combination Permit
PERMIT NO: COM2003-00610
ISSUED: '10/08/2003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2400 Hartman Ln
ASSESSOR'S PARCEL NO.: 1703223300600
Springfield TYPE OF WORK: Medical Office
PROJECT DESCRIPTION: Medical Building
TYPE OF USE:
Commercial
Owner: OREGON UROLOGY INSTITUTE
Address: 1180 PATTERSTON STREET EUGENE OR 97401
Contractor Type
Architect
General
Electrical
Mechanical
Medical Gas
Plumbing
Sewer
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Typc
Secondary Construction Typc:
# of Bedrooms:
Front yard Setback:
Side 1 Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
New
Phone Number: 541-343-9250
~
Expiration Date
Phone
541-342-6511
541-343-7143
541-686-8612
541-746-1621
541-688-1444
541-688-1444
541-688-2233
07/21/2005
12121/2005
10/31/2004
031ll/2005
03/11/2005
2 Lot Size:
39.00 Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Electric Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
nla Occupant Load:
B
1-1.2
V1hr
94,798
23,900
10,258
,9,822.00
1 DEVELOPMENT INFORMATION I _~\L
f ~~t.If4'lll'V1RED PARKING
Overlay.INt'\C~:. ~~\.\. t.'#.?\~t. i~NI\~ ~t\!P.~
# StreetifL'\~~fifl'iJ,.loJI\i ~\'i\lt.~ i\'\\S ? O"t.O 'IDlAdicapped:
Paved D~W \\\It.\l ~ \S ~~~"O Compact:
% of Lot ~ ~~~Ct.O Q ~\QO. .
~~\" '\~\} 'i)~'{ ~'t:
I PUBLIC IMPROVEMENTS I
Paee 1 of7
Sidewalk Type:
DownspoutslDrains:
o
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Bid Amount
Bid Amount
Pavine:
Use Bid Amount
Use Bid Amount
Use Bid Amount
Fee Description
Plan Review CommflndiPublic
Plan Review Fire & Life Safety
Plan Review CommlInd/Public
Plan Review Fire & Life Safety
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
-Mechanical Issuance Fe....
+ 10% Administrative Fee
+ 7% State Surcharge
Addressing Assignment
Air Handling Unit 10,000 & Ovr
Air Handling Unit Up to 10,000
Backtlow Device
Building Permit
Exhaust Hoods
Fixture
Furnace - more than 100,000
Furnace - Unit Heater
Gas Outlets 1-4
Not Covered Plumbing
Paving
Perm ServlFdr 1000 ampslvolts
Perm ServlFdr 200 amps or less
Perm ServlFdr 201 to 400 amps
Perm ServlFdr 401 to 600 amps
Perm Serv/Fdr 601 to 999 amps
Plan Review Comm/lnd/Public
Plan Review Fire & Life Safety
Sanitary Sewer - 1st 50 Feet
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
Sanitary Sewer Each Addtl1 00'
SDC MWMC Administration
.
I Valuation Descrintion I
$ Per Sq Ft
or multiplier
$1.00
$1.00
$1.00
Square Footage
or Bid Amount
4,995,728.00
40,000.00
259,000.00
Total Value of Project
Fpp< PIilLI
Amount Paid
$11,247.05
$6,921.26
$895.80
$551.26
$5.00
$3.50
$50.00
$10.00
$2,298.80
$1,533.40
$8.00
$15.00
$432.00
$42.00
$16,477.65
$9.00
$2,464.00
$45.00
$12.00
$4.00
$112.00
$1,082.40 .
$375.00
$126.00
$825.00
$375.00
$163.00
$-885.24
$-544.76
$45.00
$5,954.66
$7,833.44
$14.00
$10.00
Date Paid
7/9/03
7/9/03
7/16/03
.7/16/03
9/17/03
9/17/03
9117/03
10/8/03
10/8/03
10/8/03
10/8/03
10/8/03
10/8/03
10/8/03
1018/03
10/8/03
10/8/03
10/8/03
10/8/03
1018/03
10/8/03
1018/03
10/8/03
10/8/03
10/8/03
1018/03
10/8/03
10/8/03
10/8/03
10/8/03
1018103
1018/03
10/8/03
10/8/03
Paee 2 of7
. Lll f OF SrK11'\i\Jl'1ELJJ
Building/Combination Permit
PERMIT NO: COM2003-00610
ISSUED: 10/08/2003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
Value
Date Calculated
$4,995,728.00
$40,000.00
$259,000.00
$5,294,728.00
09/22/2003
09/22/2003
1112412003
Receipt Number
1200200000000001735
1200200000000001735
1200200000000001772
1200200000000001772
1200200000000002143
1200200000000002143
1200200000000002143
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SDC MWMC Improvement
SDC MWMC Rcimbursemcnt
SDC SanitarylStorm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Rcimbursemcnt
Storm Drainage Impervious Area
Storm Sewer - 1st 50 Feet
Storm Sewcr Each Addtl1 00'
Vent Fan
Watcr Line - 1st 50 Feet
Water Linc - Each AddtllOO'
+ 10% Administrative Fee
+ 7% Statc Surcharge
Low Voltage - Commercial Indus
Total Amount Paid
Fire Department Review
Fire Department Review
Fire Department Review
Fire Department Review
Initial Review
Initial Review
Medical Gas Plan Review
.
$721.36
$6,894.71
$1,829.87
$3,619.31
$54,880.71
$12,440.40
$20,248.38
$45.00
$224.00
$42.00
$45.00
$14.00
$4.50
$3.15
$45.00
$159,567.61
10/8/03
10/8/03
10/8/03
10/8/03
1018/03
10/8/03
1018/03
10/8/03
10/8/03
10/8/03
10/8/03
10/8/03
6/28/04
6/28/04
6/28/04
I Plan Reviews I
07/10/2003
07/17/2003
08/22/2003
08/25/2003
1210312003
12/03/2003
03/31/2004
03/31/2004
07/10/2003
07/17/2003
08/07/2003
07 II 012003
07/17/2003
08/11/2003
OK
OK
OK
OK
APP LLH
APP LLH
OK SKG
Paee30f7
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00610
ISSUED: 10/08/2003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200200000000002288
1200400000000000986
1200400000000000986
1200400000000000986
GRG
GRG
See attached document
Site and foundation only. Plan
Review: Medical office building;
revised plans-site and foundation
only. No changcs from plan review
of 8/22/03.
Plan Review: Fire Alarm system for
om. Joh #COM2003-00610.
Contractor: SimplexGrinnell.
GRG
GRG
Additional strobcs and/or horn
strobes shall be installed in the areas
of corridor numbers 022, 040, 045,
047, and 048 (NFPA 72-1999 Table
4-4.4.2.1 )
Plan Review: Sprinkler system
suhmittal for Oregon Urology
Institute. Job #COM2003-00610.
Contractor: Harvey and Price.
Designer: John Portz. Plans checked
via NFPA 13-1999.
Provide exterior alarm bell on wall
outside sprinkler riser room.
Site Work and Foundation Only
Levell Medical air, Oxygen,
Nitrous oxide, Medical vacuum.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Plannine Review
Plannine Review
Public Works Review
Public Works Review
Revised Plan Review - Fir
Revised Plan Review - Str
Revised Plan Review - Str
Revised Plans ReceivedlRo
Structural Review
.
07/10/2003
07/17/2003
07/10/2003
07/17/2003
09/19/2003
09/19/2003
03/31/2004
07/16/2003
07/10/2003
08/04/2003
08/07/2003
09/25/2003
09/19/2003
04/01/2004
07/16/2003
08/1112003
APP
APP
APP
APP
OK
WE
APP
10
WE
Paee 4 of7
. CITY OF SPRINlJl'u'LlJ
Building/Combination Permit
PERMIT NO: COM2003-00610
ISSUED: 10/08/2003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
EMM
SB
SB
GRG
JMP
JMP
JMP
JMP
Waiting for Final Site Plan
Approval and Development
Agreement. OK per Sarah
Summers 10/7/03
Site and foundation only.
811/03 - Ken Vogeney routed full
plan set to Steve Barnes for review.
Site and foundation only. 7-30-03:
Ken Vogeney routed plans to Steve
Barnes to reveiw.
Response to 8/26/2003 structural
review. See attached comments.
Response to 8/26/2003 structural
review. Left message for Linn West
on 9/19/2003 requesting missing
information.
Received fax from Linn West
proposing a concept to change the
configuration of the 2 hour
occupancy separation wall. Called
him to discuss after talking to Tom
Marx. Linn will refine and
formalize in drawings to be
submitted for approval.
Site and foundation only.
See attached fax sent 8/11/2003 to
Linn West requesting Special
Inspection and Testing Forms. See
attached fax sent 8/13/2003 to Linn
West requesting Drainage Plan
revisions. Followed up with an
email request. See attached fax sent
8/19/2003 to Linn West requesting
verification of counts of plumbing
and mechanical units. JMP called
Linn West on 8/21/2003 to request
exiting plans and locations of rated
walls. See attached fax sent
8/26/2003 to Linn West with 30
structural review comments. JMP
called Larry McGinnis and Twin
Rivers Plumbing on 8/26/2003 to
notify of undercount in sinks and th.
potential requirement to upsize the
sanitary line.
. CITY OF SPRING1<lJ!,LU
Building/Combination Permit
PERMIT NO: COM2003-00610
ISSUED: 10/08/2003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
.
-u:.......~
.~.~_.~
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Structural Review
07/17/2003
08/11/2003
WE JMP
Structural Review
09/25/2003
09/30/2003
WE JMP
Structural Review
10/07/2003
1010712003
APP JMP
SUB Review
07/17/2003
08/1512003
APP JF
SUB Review
07/10/2003
08/15/2003
APP JF
Site Work and Foundation Only.
See attached fax sent 8/11/2003 to
Linn West requesting Special
Inspection and Testing forms. See
attached fax sent 8/13/2003 to Linn
West requesting Drainage Plan
revisions. Followed up with an
email request.
Linn provided the exiting plans.
JMP called and faxed Linn for
clarificationlcorrections on 5 points.
Linn stated that there are no
conflicts between the final site plan
documents and the building permit
drawings, deleted wall and door in
med gas room, added windows for
protection, stated that L2 should be
used for storm drains rather than
AI.l or C1, and corrected reference
for ceiling construction.
Site and foundation only. See
attached email from Jack Foster on
7/24/2003 to John Pearson updating
review progress and then the
attached fax sent to Linn West
7/24/2003 by jmp to request the
building envelope energy code forms
and worksheets.
See attached email from Jack Foster
on 7/24/2003 to John Pearson
updating review progress and then
the attached fax sent to Linn West
on 7/24/2003 by jmp to request the
building envelope energy code forms
and worksheets.
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.Rpn~
SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing Inspection.
SUB Plumhing: Following City Rough Plumhing inspection approval and prior to cover.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
Epoxy Anchors: To he done by Certified Spciallnspector. Provide Inspection resuits to City Building Inspector.
Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test
resuits to City Building Inspector.
Final Fire Department. After all requirements of the Fire Department have been met.
Paee 5 of7
.
. \..-11 i' 0.. ~I"Kll'1u..IELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-00610
ISSUED: 10/0812003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Final Building: After all Conditions have been completed as required on Development Agreement.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Grading: After gravel is in place but prior to placing concrete.
Final Paving: Aftcr paving is complete.
Undergronnd Plumbing: Prior to filling the trench and including required testing.
UnderOoor Plumbing: Prior to insulation or decking.
UnderOoor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Shower Pan. Prior to covering 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. .
Storm Sewer Line: Prior to filling trench.
Final Plumhing: When all plumbing work is complete.
BackOow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
Rough Medical Gas: Prior to cover and including required testing.
Final Medical Gas: When all medical gas work is complete and certificate is provided to inspector from verifier.
UnderOoor Gas: After line is installed and required testing and capped if not attached to an appliance.
Underfloor l\'1cchanical. Prior to insulation or decking and including required testing.
UnderOoor Gas: After line is installed and required testing and capped if not attached to an appliance.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
Rough Mechanical: Prior to Cover
Final Gas: When all gas work is complete.
Final I\1cchanical: \Vhen all mechanical work is complete.
Rough Electric: Prior to Cover
Electric Service: Allproval required prior to utility company energizing service.
Final Electric: "'hen all electrical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Curbcut - Close & Repair: After forms are erected but prior to placement of concrete.
Curhcut - Close & Repair: After forms are erected hut prior to placement of concrete.
Curheut - Standard: After forms are erected but prior to placement of concrete.
Curbcut - Second: After forms are erected but prior to placement of concrete.
Low V ollage: Prior to cover.
SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
SUB Ceiling Grid: Interior Lighting
SUB Exterior Lighting
SUB Final: After all required energy inspections have been requested and approved.
Site Inspection: To be made after excavation but prior to setting forms.
Erosion/Grading Inspection: After all erosion measures are in place.
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 other 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 rough in inspections have been approved.
Wall Insulation: Prior to cover.
Paee 6 of7
-~li!rt,:~,F,I~<?
. ~_'H~ ..,.
'.. ....... -"
.
. CITY OF ~rK11'lld'1Ji,L1J
. Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-00610
ISSUED: 10/08/2003
APPLIED: 07/09/2003
EXPIRES: 12/28/2004
VALUE: $ 5,294,728.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Ceiling Insulation: Prior to cover.
Roofing: Prior to installing any roof covering.
Drywall: Prior to taping.
Firewall: Localcd and constructed according to plans.
Masonry:
Bolls Installed in Concrete: To he done by a State Certified Special Inspector. Provide inspection test reports to
City Building lnspcctor.
Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector.
Provide rcsults to Cily Iluiding Inspector
Roof Sheathing/Nailing: Before covering sheathing with finish material.
GIu-Lam Ilcams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to
placement.
Ceiling Grid: After drywall approval hut prior to cover.
By signature, 1 slatc and agree, that 1 have carefnlly examined the completed application and do hereby certify that all
information hereon is true and correcl, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of thc City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made orany structure without permission urthe 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 permil card is locatcd at thc front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contraclors Signature
Date
Paee 7 of7
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
Job/Journal Number
COM2003-006l0
COM2003-00610
COM2003-00610
Payments: .
Type of Payment
Check
6/28/2004
RECEIPT #:
....~RINQ..1lLD .
u... ._"a. 'u' !
Ia,.. i
.ilY of Springfield Official Receipt
Wvelopment Services Department
Public Works Department
1200400000000000986
Date: 06/28/2004
9:21:29AM
Description
+ 7% Stale Surcharge
+ 10% Administrative Fee
Low Voltage - Commercial Indus
Paid By
SECURETECH INC
Amount Due
3.15
4.50
45.00
$52.65
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 1338 In Person
Payment Total:
Amount Paid
$52.65
$52.65
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