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Home My WebLink AboutPermit Building 2003-10-8 (3) ~ . . CITY OF M'KlNGFIELD Building/Combination Permit PERMIT NO: COM2003-00610 ISSUED: 10/08/2003 APPLIED: 07/09/2003 EXPIRES: 04/08/2004 VALUE: $ 259,000.00 .. Status Issued 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 TYPE OF USE: New PROJECT DESCRIPTION: Medical Clinic- DRC# 2002-11397>> Issued temp electric only 091603.DB Commercial Owner: OREGON UROLOGY INSTITUTE Address: 1180 PATTERSTON STREET EUGENE OR 97401 Phone Number: 541-343-9250 I CONTRACTOR INFORMATION I Contractor AFFOLTER WEST & JONES MCKENZIE COMMERCIAL CONTRACTOR45539 07/21/2005 SCOFIELD ELECTRIC 38702 12/21/2005 HARVEY & PRICE CO 77 10/31/2004 TWIN RIVERS PLUMBING 17695 ",03/11/2005 I BUILDING INFORMATION I 0>:> '.~"" {:- ~ ~ ~-:s \,0 I:) ~ ,,,00~_~S:S' # of Buildings: ~ ~ # of Stories: &"7.1/)(;$ It,lftppeib'i> Primary Occupancy Group: B~C:S ~ Height of Structure ~ @.QlF !b q,S~t ~ RK~[>,' Secondary Occupancy Group: I-~ ~ :;(00 Type of Heat: ,'Ii ~0 ~0 &lJ~f2@:'FJ90r: Primary Construction Type ~1h~ ",c:5 Water Type: o~F(FIit~ !f Sci'F.@l'~ent: Secondary Construction Type: ~ ~ ~ Range Type: ~0~,0~~0C; ~o.:s ~~~ Q&f~e/Carport # of Bedrooms: #~~<:/, &- Energy Path: ~9 oq~. <;;);s' "oq Sq~:O~r: <<J ~ ~ <~ q,?$ #'~" 'S' ~OiniPei?6us Surface Area: -9,822.00 .,y ~ rr'<l:' <" .<1> '" j;)-...'Ii ~ !:'- ~'!l ~~..<./~ ~~. I DEVELOPMEN'J"ik"'aiiNI'Arlo~l-v ~I/)O' ~I/)~'b(;:,<;:) SETBAGKS_~ ,,'5 ~ ~ . W ~- :?- ~. (i " REQUIRED PARKING ~.~~~ ~#~~~~~ Front yard Se~~~ ~ ~ ,A<:/' Overlay Dis!i..O' 0" ..),.,0 Sb~ \,0" ~t/; Side 1 Setba<"it-l ~ ~ (ff ~~ # Street Trees Rijl!:,~<:)' # 0" CJ0{;' Side 2 Setback~ ~ .ff $' Paved Drive RqO:l ,,'Ii>:>~ Rearyard Setback; (is ~ % of Lot Coverage: ~ Solar Sethacks: ~ Contractor Type Architect General Electrical Mechanical Plumbing License Expiration Date Phone 541-342-6511 541-343-7143 541-686-8612 541-746-1621 541-688-1444 94,798 23,900 10,258 Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: Paee 1 of6 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Descrintion Tvne of Construction Use Bid Amount Use Bid Amount Use Bid Amount Bid Amount Bid Amount Bid Amount Fee Description Plan Review Comm/Ind/Public Plan Review Fire & Life Safety Plan Review CommlInd/Puhlic Plan Review Fire & Life Safety + 10% Administrative Fee + 7% State Surcharge Temp Power 200 amps or less -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Addressing Assignment Air Handling Unit 10,000 & Ovr Air Handling Unit Up to 10,000 Backnow 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 ServlFdr 601 to 999 amps Plan Review Commllnd/Public Plan Review Fire & Life Safety Sanitary Sewer - 1st 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement Sanitary Sewer Each Addt1100' SDC MWMC Administration . I Valuation Descriotion I $ Per Sq Ft or multiplier $1.00 $1.00 $1.00 Square Footage or Bid Amount 4,995,728.00 259,000.00 40,000.00 Total Value of Project Fp,,< P\WLI 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 9/17/03 10/8/03 10/8/03 10/8/03 1018/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 10/8/03 .1018/03 1018103 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 Paee 2 of6 . Lilt' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00610 ISSUED: 10/0812003 APPLIED: 07/09/2003 EXPIRES: 04/08/2004 VALUE: $ 259,000.00 Value Date Calculated $4,995,728.00 $259,000.00 $40,000.00 $5,294,728.00 0912212003 09/22/2003 09/22/2003 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 1~00200000000002288 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 Reimbursement SDC SanitarylStorm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Drainage Impervious Area Storm Sewer - 1st 50 Feet Storm Sewer Each Addt1100' Vent Fan Water Line - 1st 50 Feet Water Line - Each Addtl100' Total Amount Paid Fire Department Review Fire Department Review 07/10/2003 07/17/2003 Initial Review Initial Review Medical Gas Plan Review 07/10/2003 07/17/2003 Plan nine Review 07/10/2003 Plannine Review Public Works Review 07/1712003 07/10/2003 Public Works Review 07/17/2003 Revised Plan Review - Fir 09/19/2003 Revised Plan Review - Str 09/1912003 Revised Plans ReceivedIRo . $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 $159,514.96 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 I Plan Reviews I 08/2212003 08/25/2003 07/1012003 07/17/2003 08/11/2003 08/04/2003 08/07/2003 09/25/2003 09/19/2003 07/16/2003 OK GRG OK GRG APP LLH APP LLH OK SKG APP APP EMM APP SB APP SB OK GRG WE JMP Paee30f6 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00610 ISSUED: 10/08/2003 APPLIED: 07/0912003 EXPIRES: 04/08/2004 VALUE: $ 259,000.00 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 1200200000000002288 See attached document Site and foundation only. Plan Review: Medical office building; revised plans-site and foundation only. No changes from plan review of 8/22/03. Site Work and Foundation Only Levell Medical air, Oxygen, Nitrous oxide, Medical vacuum. Waiting for Final Site Plan Approval and Development Agreement. OK per Sarah Summers 10/7/03 Site and foundation only. 8/1/03 - Ken Vogeney routed fuil 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 8/2612003 structural review. Left message for Linn West on 9/19/2003 requesting missing information. Site and foundation only. . . CITY OF ~rK11'1ld'1J!,LD' Building/Combination Permit Status Issued PERMIT NO: COM2003-00610 225 Fifth Street, Springfield, OR ISSUED: 10/0812003 541-726-3753 Phone APPLIED: 07/09/2003 541-726-3676 Fax EXPIRES: 04/08/2004 541-726-3769 Inspection Line VALUE: $ 259,000.00 Structural Review 07/10/2003 08/11/2003 WE JMP 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 em ail 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 thl potential requirement to upsizc the sanitary line. Structural Review 07/17/2003 08/11/2003 WE JMP 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. Structural Review 09/25/2003 09/30/2003 WE JMP Linn provided the exiting plans. JMP called and faxed Linn for clarification/corrections on 5 points. Structural Review 10/07/2003 10/07/2003 APP JMP 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 A 1.1 or C1, and corrected reference for ceiling construction. SUB Review 07/17/2003 08/15/2003 APP JF Site and foundation only. See attached email from Jack Foster on 7/2412003 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. Paee 4 of6 . . CITY OF ~t'Klj~GFIELD Status Issued Building/Combination Permit PERMIT NO: COM2003-00610 ISSUED: 10/08/2003 APPLIED: 07/09/2003 EXPIRES: 04/0812004 VALUE: $ 259,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SUB Review 07/1012003 08/1512003 APP JF 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 ]?pollirptI I~ 1 SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection. 2 SUB Plumbing: Following City Rough Plumbing inspection approval and prior to cover. 3 SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. 4 SUB Ceiling Grid: Interior Lighting 5 SUB Exterior Lighting 6 SUB Final: After all required energy inspections have been requested and approved. 7 Site Inspection: To be made after excavation but prior to setting forms. 8 ErosionlGrading Inspection: After all erosion measures are in place. 9 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 10 Footing: After trenches are excavated. 11 Foundation: After forms are erected but prior to concrete placement. 12 Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. 13 Floor Insulation: Prior to decking. 14 Shear Wall Nailing: Before covering sheathing with finish materials. 15 Framing Inspection: Prior to cover and after all rough in inspections have heen approved. 16 Wall Insulation: Prior to cover. 17 Ceiling Insulation: Prior to cover. 18 Roofing: Prior to installing any roof covering. 19 Drywall: Prior to taping. 20 Firewall: Located and constructed according to plans. 21 Masonry: 22 Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. 23 Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide results to City Buiding Inspector 24 Roof Sheathing/Nailing: Before covering sheathing with finish material. 25 Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to placement. 26 Ceiling Grid: After drywall approval but prior to cover. 27 Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. 28 Epoxy Anchors: To he done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector. 29 Structural Welds: To be done during construction by State Certified Special Inspector. Provide Inspection test results to City Building Inspector. Paee 5 of6 . . Ul l' OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2003-00610 ISSUED: 10/08/2003 APPLIED: 07/0912003 EXPIRES: 04/08/2004 VALUE: $ 259,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 30 Final Fire Department. After all requirements of the Fire Department have been met. 31 Final Building: After all Conditions have been completed as required on Development Agreement. 32 Final Building: After all required inspections have been requested and approved and the huilding is complete. 33 Rough Grading: After gravel is in place but prior to placing concrete. 34 Final Paving: After paving is complete. 35, Underground Plumbing: Prior to filling the trench and including required testing. 36 Undernoor Plumbing: Prior to insulation or decking. 37 Undernoor Drain: Prior to cover or placement of concrete. 38 Rough Plumbing: Prior to cover and including required testing. 39 Shower Pan. Prior to covering and including required testing. 40 Water Line: Prior to filling trench and including required testing. 41 Sanitary Sewer Line: Prior to filling trench and including required testing. 42 Storm Sewer Line: Prior to filling trench. 43 Final Plumbing: When all plumbing work is complete. 44 Backnow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. 4S Rough Medical Gas: Prior to cover and including required testing. 46 Final Medical Gas: When all medical gas work is complete and certificate is provided to inspector from verifier. 47 Undernoor Gas: After line is installed and required testing and capped if not attached to an appliance. 48 Undernoor Mechanical. Prior to insulation or decking and including required testing. 49 Undernoor Gas: After line is installed and required testing and capped if not attached to an appliance. 50 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 51 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. 52 Rough Mechanical: Prior to Cover S3 Final Gas: When all gas work is complete. 54 Final Mechanical: When all mechanical work is complete. 55 Rough Electric: Prior to Cover S6 Electric Service: Approval required prior to utility company energizing service. 57 Final Electric: When all electrical work is complete. 58 Temporary Electric: Approval required prior to Utility Company energizing pole. 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 ofany 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 he 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. o.~,,2:~'::;r~~ <fS':)3l /o/gIo3 Date Paee 6 of6 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL'PERMrrAPPLICATION City Job Number c.o~'L==--OOblO Date 1. ~'~::eGA'iioN:ioffiNs1;Aj513iiiwN:$!i\lt!~%~ 3. ~"",c"".., """,..,~.,.,";~ "t;;.,.v~.:" "i -r......'..-".-~..._""'.'''k_' ,~."',... ".J ,,-~)c!AI;~~i'I't..;J'f:J 2400 Hartman Lane LEGAL DESCRIPTION 1703223300600 JOB DESCRIPTION F.l~~tri~Hl for New BuildinQ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ..,. -..".~. .'f'.;>.T.....G" :,T'-"<' (.,'>h<.,:-"",, -"~=;:::":<'f'" "" ~~;1L;i':'.-H''''-'~.- :"''''''':''';'~.."'''ll 2. f,j\~g,1Y.IR,A~~~l~~kAEf!,gg~~p~r~ Electrical Contractor Scofield Electric Address PO Box 2765 City Eugene 97402 Phone 541-686-8612 Supervisor License Number 3240S Expiration Date 10-01-2004 ,,~A, ~- ~ ~*" ~~ Constr. Contr. Number 20-Ie ~-.... '" ~Qo.. ~ _~, '<.-J , ~ ~'5:> Expiration Date 10-01-2004.ci$fQ<';;_$ <(}"# ~" Sign~a~ture o~s~uperviSing E:~~ ~ o <:s .~ ^.:;s c--Q:. ~r::s , I' &- ~'~-<5> ~v ~~ ':?~ ~~~~ Owners Name ~ -<-<'~N'~Q.\\(.';lJ.{'Qlogy ,..; *- :-0' Address 1180~~t~'ion ~- City Eugene 97401 Phone 541-343-9250 OWNER INST ALLA nON The installation is being made on property 1 own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Service Included \Il,e D~\e _ S\~f\a 1000 sq. ft. or less "".,,11 '" Each additional 500 s'q~ ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B.-s~g.Wt~~2f.~.~m;~~~Tfi~t~rr~ti'~~lt~AJT~;:fiti()~i'~.~)~R~'i~~~ri6it\!,i~~ .",:~."::..":,,, ..~~~,..~."""_I'-""iO;,,,".~.r,."..:< -i'~_'.,"r..~" ,;'"(.,"~'~.~'." II':;, ",<"!.. . ~'.~n ....<!, --.'-~;' "'.";oJ,,1:!3 200 Amps or less 2 $ 63.00 126.00 201 Amps to 400 Amps 11 $ 75.00 825.00 40 I Amps to 600 Amps 3 $125.00 375.00 601 Amps to 1000 Amps 1 $163.00 163.00 Over 1000 AmpsN oils 1 $375.00 375.00 Reconnect Only $ 50.00 .. , , 'C'~, T' '~~l:".i."~'''''-;;'I''''"S::,:<",!-;-",,\.,.'I''{''~''':'F....t~~d'-:~.""".:w'~i-:,.tt\'1t\1I:)" ".Ii. ~",,';';""j12.1iI;- '.~~::~,'~ "'.....~~~ .:. 'emnOr3rY~ ~r.'1cesor"" '.ee ers~;-t~~~l,~!j.r;':~I:l':lF'i~;.F-: J.;~'~(<', \ ..,).,;'1J',;t...."<~ .,."..1";..__,,,.,,.,,, ....-.<' '~~_~~-"" . __. ,-,It',. 'c, . ".. ,. '''\\''~ .....,.. -AO ~,,1 . Installation, Alteration o~!:!.~~nlfl .... ' ,$' ~ II> !l: Ii> 200 Amps or less 0(S. Io..'li 10..0 .""(,) ,,0 'ZI$ 50.00 201 Amps to 400 ~~00 0",1li.,. 'Z>...v."."o-'~$'~9.00 40'1 Amps to 600$nD~'~ ~O ,...~-,,0~,~.t>Ii$100.00 ~ '0-'" 000 ~ ~....- ","' o.,.~e;:~,~~.~~~~~f!:~~~~~.,m"'.'U,;<iWi;;';.'..,..~"'~~.., D. ~Bl "ncl~,~~~~tf~,t~"'f.~~c0~,,". ,( "'~~"" .'.C":-'-. .,"'~".S",..' .,., ,~,_ . ";:.;,, '" . ~ . L'~J. ."" ,',' "~, . ' New ~~~01C ~ ExJs~i.?-'il Pq R\\liel .e.'L''; Vs::> 0 'li ~ r::5 O!l....e-E~C,".to~ 55 ::\ ~ Io..flj ~r:5 $ 43.00 ERt~a~~~.~uit,'ifJr,Ftlt<: SetYlc~r~~P~~ ~~ 256 $ 3.00 768.00 E. .1Nl~~!~~~Y.~~rm~~Kili~1~'i.1illj~~~:~~r@:(~lEf~\~j Pump or irrigat1bn $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial 2 $ 45.00 90.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ~SVB,""'TO,'TA'if)O:E~O'VEliit!:~~'~s'ij;f,t'i~ ~~.:rw~'''1~;~:~Ail:''Ri-?:}:Y~~A~':t~~,~-";::;:f?.f.i{ti~j,~;.~#...<:.jf~~~:t~;11. 2,722.00 7% State Surcharge 10% Administrative Fee 190.54 272.20 TOTAL '.lR4.74 Shared Drive(T:)!Building Forms/Electrical Permit Application I-D3.doc , ~~~ . ~tr? ELECTRlCAL~RM APP ICATION0c'~:~~o.~\<0 / City Job Number Date ~ ~<O\ ,,0 . ~# .10 ^ . 1. l LOCA110N OF INSTALLA1'ION . ,I 3. I ,COllfPLET1j: F~S~D~B~W",/' (\\ \ \-\l\rlo.i) 'li)O(L . .~'<~<v 1-J'/.,-:,<0 ./ LEGAL DESCRIPTION. A. ~ New Residcntial-'- ~i.l\gI€o~~'fti-FamilY per d'l'Clling nnil. \ f\[)?,fJJl,?-,~rfJ..&) Service Included v .,..>",0" . CITY OF ~.~.lrnGFIELD, OREGON lJ 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only ~ .~~ r ,,,,r:::s _~ c. I Temporary Services '1fli?~~JO!)';", ". . .,;' . '!J" ~ ~~' ,f 0<'- ..0'X "- Expiration Date _"'. !:<.'" ~ ,,~ Installation, A1tera!Jlln~llr~o~Iml)'l> 0 ,~ ~, - <; 0 '<1'(1. ...;S-,t:' ~ t::./\ N"'\ , " ~ Q.<l$ .;;> 200 Amps or le~lb-~ ~0 ~0'l> O"F ~0 ;<'1 ~o $ 50.00 ...aJ.VV -:$ ,6 ~r:::s 201 Amps to @o~~~ tf ~ ?>-0 ,~ti $ 69.00 -::Y\."....~"f'. 401 AmPb~liQf:l.Q1p:l@V ~0'l> ~0"'" ~O-f" $100.00 Expimti Date ~~'f- ~~'f- O~"~~ ~~1$9I--.fc~1..ti... ,~..nl?' .<. _ ~_ ,J \. ver ,~r "'-w 0 'I>.,.~"~'),libove. .t.: 'n'~' .:s ~ . ",I" '!:t" -..:.v Illre ofSupe~~,~cian ~ ,D. . _ 'AAh~-..01. ~.",~?>.,'J . ~ Q.'<; ~ ~ q: ..6.....:~\~:'~;~or.~."'~O>.\J ~ ~ ~ ~ ~ ~o~er..~ W'(jU.;,ulO~er Panel ....~ .~~ ""~ ~<::> ~~i!I; ~ ,) ~~0 ~0 .~ $ 43.00 ~~' ,,,:v ::<: il1'&;~l::~lIt#with ~~\ ~:J ,t. \.s.~ grF'ffierJleeJft $ 3.00 Owners Name )~ :sn~ ",0 .'Ii t:'~ . '" , Address 1W f' , _ E. I Misc.llaIlll~ns (Service/feeder not inSlnded) -Each Instnllntion I City ~ Phone ~ OWNER INST ALLA nON JOB DESCRIPTION ~re non-tran ra~le and ex~e ~~~l~ not started within 180 ays of issuance or if work is Suspended for 180 days. 2. I'CONTRAqOR INSTALLATION ()NI;Y/I City Supervisor License The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 . 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. L ~er"ises o~ Feeder~ - Inst~llatioil, Alterations 0'" Rt"locat~on: $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Pump or irrigation Sign/Outline Lighting Limited EnergyIResidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permillnspection Fee is $45.00 + Surcharges 4.1.$UBTOTALOF A{lOVZ;: I ~.(f) '~'i r;::. .n ~9). 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)lBuilding FonnsIElectrical Permit Application 1-03.doc 225 Fifth Street Springfield, Oregnn 97477 541-726-3759 Phone Job/Journal Number COM2003-0061O COM2003-00610 COM2003-00610 COM2003-00610 COM2003-0061O COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-0061O COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-0061O COM2003-00610 COM2003-00610 COM2003-00610 COM2003-00610 COM2003-0061O COM2003-0061O COM2003-0061O COM2003-00610 COM2003-00610 COM2003-0061O COM2003-00610 COM2003-00610 COM2003-006l0 COM2003-0061O COM2003-0061O COM2003-006l0 COM2003-00610 COM2003-00610 -,. ~ .......~..~-~~.. .....', WI": ..... . ." m... .i.. 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" ...-,/' "'-, City of Springfield Official Receipt Development Services Department Public Works Department Date: 10/08/2003 1:34:29PM Receipt #: 1200200000000002288 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration Storm Drainage Impervious Area SDC Sanitary/Storm Admin SDC Transpo Admin Fixture Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addtl 100' Water Line - 1st 50 Feet Water Line - Each Addtl 100' Storm Sewer - 1 st 50 Feet Not Covered Plumbing Furnace - more than 100,000 Gas Outlets 1-4 Furnace - Unit Heater Air Handling Unit Up to 10,000 -Mechanical Issuance Fee- Addressing Assignment Perm Serv/Fdr 200 amps or less Perm Serv/Fdr 201 to 400 amps Perm Serv/Fdr 40 I to 600 amps Perm Serv/Fdr 60 I to 999 amps Perm Serv/Fdr 1000 ampslvolts Storm Sewer Each Addtl 100' Backflow Device Plan Review Fire & Life Safety Plan Review Conun!lndIPublic Building Permit Paving Air Handling Unit 10,000 & Ovr Exhaust Hoods Vent Fan + 7% State Surcharge + 10% Administrative Fee Amount Paid Item Total: 7,833.44 5,954.66 12,440.40 54,880.71 6,894.71 721.36 10.00 20,248.38 1,829.87 3,619.31 2,464.00 45.00 14.00 45.00 14.00 45.00 112.00 45.00 4.00 12.00 432.00 10.00 8.00 126.00 825.00 375.00 163.00 375.00 224.00 42.00 (544.76) (885.24) 16,477.65 1,082.40 15.00 9.00 42.00 1,533.40 2,298.80 $139.841.09 . . 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Payments: Type of Payment Check .' it-........;J:~=.~. '...... ........... ;, .. . .. .~ ,....1 ".....,'""^,'"... ,...., " Paid By Receipt #: 1200200000000002288 Check Number Received By Batch Number Authorization Number OREGON UROLOGY INSTITUTE Jmp 306530 City of Springfield OmCial Receipt Development Services Department Public Works Department Date: 10/08/2003 1:34:29PM ., How Received In Person Payment Total: Amount Paid $139,841.09 $139,841.09 . .