HomeMy WebLinkAboutPermit Building 2002-11-20 (2)
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. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 11120/2002
APPLIED: 07/23/2002
EXPIRES: OS/20/2003
VALUE: $ 5,467,000.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 110 International Way
ASSESSOR'S PARCEL NO.: 1703154000100
Spr
TYPE OF
Office
TYPE OF USE: New Commercial
PROJECT DESCRIPTION: Land Use: Professional Office Bldg, Zoning: CI, Foundalion & sitework for new office
bldg. Building plans submitled for permits 8/8102 dim
Owner: Pacific Source Health Plans
Address: 250 Counlry Club Road Eugene OR 97401
Contractor Type
Arcbitect
General
Electrical
Mechanical
Owner
Plumbing
Sewer
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy
P'rimary Construction Type
Secondary Conslruction
# of Bedrooms:
SETBACKS
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Pbone Number: (541) 686-1242
I CONTRACTOR INFORMATION I
(
Contractor
Robertson Sherwood Architecl
1996 LLC
Builders Eleclric Inc
Comfort Flow Heating Co
Pacific Source Health Plans
Twin Rivers Plumbing
Delta Construction Co.
License
Expiration Date Phone
(541) 342-8077
(541) 687-9445
(541) 485-0922
(541) 726-0100
(541) 686-1242
(541) 688-1444
(54 I ) 688-2233
BUILDING INFORMATION'
B
# of Slories:
Heigbt of
Type of Heat:
Waler Type:
Range Type:
Energy Path:
592,416
60,928
2
II-N
Lol Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GarageJCarporl
Sq Ft Olher:
Impervious Surface Area:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Total:
Handicapped:
Compact:
Overlay Disl:
# Slreet Trees
Paved Drive Rqd:
% of LoI Coverage:
Urban Fringe
1-\ \ 11::1'l IIUN:uregon law H:l4'IPUBLic.,ii\1PROVEMENTSI
follDW rules adDpted by th.3 0 'd" L" >
Street ., t'I'cation Center. Those rules are set IDr!
,~o I I hOAR 952-001-
Storm Sewe~-Aviiiliilile:,)01-0010 throug
,,",, . .' fthe rules by
SpeciallnsYJLC!i"":;U may obtain copies D
calling the center. (Note: the tel~~ho~e
Notes: number lor the Oregon Utility NDtlflCatlOn
Center is 1_800-332-2344).
Sidewalk Type:
I of 7
N OTI (,ll!':wnspoulslDrains
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
.'
. CITY OF SPRING FIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 11120/2002
APPLIED: 07/23/2002
EXPIRES: 0512012003
VALUE: $ 5,467,000.00
I Valuation Descriotion ,
Desc ription
Bid Amount
Bid Amount
Type of Construction
Use Bid Amount
Use Bid Amount
$ Per Sq Ft
$1.00
$1.00
Square Footage
5,467,000.00
837,000.00
Value
$5,467,000.00
$837,000.00
$6,304,000.00
Date Calculated
11/14/2002
11/14/2002
Total Value of Project
I Fees Paid I
Fee Description Amount Paid Date Receipt N urn ber Received By
Fire & Life Safety Plan Review $1,184.36 7/23/02 10019 IIh
Commercial Plan Check $1,924.59 7/23/02 10019 IIh
Fire & Life Safety Plan Review $8,132.86 8/8/02 10241 IIh
Commercial Plan Check $13,215.90 8/8/02 10241 IIh
State Surcharge - Electrical $4.83 9/13/02 10598 IIh
8% Admin Fee - Electrical $5.52 9/13/02 10598 IIh
Address Assignment $8.00 9/13/02 10598 IIh
Backflow Prevention Device $14.00 9/13/02 10598 IIh
Additional Driveway $35.00 9/13/02 10598 IIh
State Surcharge - Plumbing $47.67 9/13/02 10598 lib
8% Administrative Fee - Plumbi $54.48 9/13/02 10598 IIh
Planning Plan Review $55.00 9/13/02 10598 IIh
Temporary: 201 to 400 Amps $69.00 9/13/02 10598 IIh
Sanitary Sewer Footage $73.00 9/13/02 10598 IIh
New Curbcut $75.00 9/13/02 10598 IIh
State Surcharge For Building P $83.05 9/13/02 10598 IIh
8% Building Administrative Fee $94.91 9/13/02 10598 IIh
Water Service Footage $115.00 9/13/02 10598 IIh
Number of Fixtures $224.00 9/13/02 10598 IIh
Storm Sewer Footage $255.00 9/13/02 10598 IIh
Foundation Only $1,186.40 9/13/02 10598 IIh
Paving $2,015.15 9/13/02 10598 IIh
Gas Outlets 1-4 $4.00 11/20/02 1200200000000000275 IIh
-Mechanical Issuance Fe.... $10.00 11/20/02 1200200000000000275 lib
Heat Pump $12.00 11/20/02 1200200000000000275 IIh
Air Handling Unit Up to 10,000 $16.00 11/20/02 1200200000000000275 IIh
Furnace - up to 100,000 btu $24.00 11/20/02 1200200000000000275 IIh
Boiler/Comp 3-15 HP $44.00 11/20/02 1200200000000000275 IIh
Vent Fan $60.00 11/20/02 1200200000000000275 IIh
Planning Final Occy Inspection $110.00 11/20/02 1200200000000000275 IIh
+ 7% State Surcharge $168.63 11/20/02 1200200000000000275 IIh
+ 8% Administrative Fee $192.72 11/20/02 1200200000000000275 IIh
Perm Serv/Fdr 201 to 400 amps $300.00 11/20/02 1200200000000000275 IIh
Perm Serv/Fdr 1000 amps/volts $375.00 11/20/02 1200200000000000275 IIh
Perm Serv/Fdr 200 amps or less $504.00 11/20/02 1200200000000000275 IIh
Fixture $1,134.00 11/20/02 1200200000000000275 IIh
Add, Alter, Extend Circ Ea Add $1,230.00 11/20/02 1200200000000000275 IIh
2 of 7
. CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 11120/2002
APPLIED: 0712312002
EXPIRES: 0512012003
VALUE: $ 5,467,000.00
.
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
+ 7% State Surcbarge
+ 8% Administrative Fee
Storm Drainage Impervious Area
Building Permit
$1,334.32
$1,524.94
$10,000.00
$17,767.75
11/20/02
11/20/02
11/20/02
11/20/02
1200200000000000275
1200200000000000275
1200200000000000275
1200200000000000275
IIh
IIh
IIh
IIh
Total Amount
$63,684.08
I Plan Reviews ,
Engineering-CIIIP 08/29/2002 Appr PO
Engineering-CIIIP 09111/2002 Pend PO
Engineering-CIIIP 09/19/2002 Appr PO
Fire Department Review 10/02/2002 09/30/2002 OK AG
Fire Marshal-CIIIP
09/11/2002
Appr AG
3 of 7
Foundation & Site only
Waiting for foundation plan to be
issued
1. Fire department connection shall
be mounted between 18 incbcs and
48 inches above grade.
2. Fire line shall be installed and
tested per NFP A 24.
3. Call for piping inspection prior 10
backfilling.
4. Call for pressure testing and
nusing of underground lire line,
minimum 56 seconds at hydrant;
verify minimum fire now
requirements with now test.
5. Fire hydrant shall be fitted with a
5 inch storz type seamcr port fitting
compatiable with City of Springfield
Fire Department litting.
6. Combustible construction will not
be permitted until the on site lire
hydrant has been installed, tested,
and approved.
7. Pipe under driveway shall be
buried a minimum of 3 feet per
NFPA 24.
8. Provide sign age at FDC.
Foundation & site only
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fire Marshal-C/I/P
.
09/23/2002
4 of 7
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 1112012002
APPLIED: 0712312002
EXPIRES: 0512012003
VALUE: $ 5,467,000.00
Appr AG
Plan review - New Construction of a
65000 sq ft, 2 story, office building.
Type II-N(sprinkled) conslruction.
1. Provide lire sprinkler plan
submittal for review and approval
by the City of Sprlnglield Fire
Marshal's Office.
2. Provide submittal for review and
approval by the City of Springficld
Fire Marshal's Office of the FM 200
clean agent suppression system.
3. All Assembly rooms sball be shall
be posted with the maximum
occupancy load permitted In
accordance with Art. 1007.2.6 of the
19980SSC,
4. Provide Special Inspection
certification and testing
documentation from an Oregon
registered Electrical Engineer
verifying egress lighting meets all
requirements of Article 1003.2.9 of
the 1998 OSSC.
5. Areas of Rescue Assistance shall
be provided in accordance with
Article 11 07 of the 1998 OSSC.
Provide plan suhmittals and cut
sheets specifying equipmenl,
drawings, locations and othcr dctails
specilied in Article 1107 of the OSSC
for review and approval.
6. Rooms numhered 220,221,222
show an egress path through more
than one intervening room. Please
provide verllication that the design
shown meels the requirements of
Article 1004.2.2 of the 1998 OSSC or
redesign to meet the requirements of
this article.
7. Exit sign age shall comply with Ihe
requirements set forth in Article
1003.2.8 of the 1998 OSSC.
Occupancy will not be granted If Ihe
requirements of this article are not
met. For Instance, page E-2 of Ihis
submittal does not show the rcquircd
number of means of egress signs for
the 1st noor Multi Purpose room.
8. Provide a fire alarm plan
submittal for review and approval
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review-CIIIP
Initial Review-CIIIP
Plannlng-CI1IP
Plannlng-CIIIP
Revised Plan Review - Stru
Revised Plans ReceivedIRo
.
01/01/2005
10/15/2002
07/24/2002
08/09/2002
07/24/2002
10/15/2002
10/31/2002
. CITY V!' ~rRINGFIELD .
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 11120/2002
APPLIED: 07123/2002
EXPIRES: 05120/2003
VALUE: $ 5,467,000.00
by the City Fire Marshal's Office.
9. All duct detectors within the
building shall be monitored by the
lire alarm panel. Please provide
specilications and cut sheets for the
duct detectors including mounting
and manufacturers testing
instructions with the fire alarm
submittal.
10. FM 200 system shall be
monitired by the Fire alarm pancl.
11. Provide address n's on the
building clearly visible from the
street and contrasting in color with
their background.
12. Provide a Knox Box keyed entry
system above the right front door
jamb (or in a location approved by
the Fire Marshal) the Knox shalll be
supplied with a Master key for the
building. Contact the City Fire
Marshal's Office for a Knox box
application.
13. The underground, lire line,
on-site hydrant and other
appurtenant equipment shall be
Inspected, and approved by the Firc
Marshal's Office In accordance with
NFP A 24 prior to the
commencement of combustiblc
construction.
14. The lire lane shall be marked
with signage or curb painting in
accordance with article 901.4.5 of
the 1997 Uniform Fire Code.
Appr LH
Appr LH
Appr AD
Plans for structure sub milled
Needs LDAP prior to issuance of
foundation permit.
Corrective LDAP must be resolved
prior to building permit issuance
Response to Tom Rogers letter from
Robertson/Sherwood Archltccts Fed
Ex'd to Tom Rogers. Lettcr dated
10/15/02 from John Bramwell and
Included structural calculations. See
job file for copy of letter.
Received from architect, engineer's
response to plan review comment
structural Item #4. Faxed to Tom
Rogers.
Pend AD
10 LLH
10 DLM
5 of 7
.
i'
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
. CITY OF SPRINGFIELD I
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 11/20/2002
APPLIED: 07/23/2002
EXPIRES: 0512012003
VALUE: $ 5,467,000.00
Structural Review
10/0 1/2002
10 DM
Structural-CIIIP
Structural-CI1IP
08/26/2002
Appr TR
10 TR
SUB - Commllnd
08/20/2002
Walt JF
SUB - Commllnd
08/2112002
Appr JF
FedEx'd Exiting Plans for both
noors to Tom Rogers 10/01/02 dim
Foundation and site only
Fed Ex'd plans and specs for
building
Building envelope and hvac pass.
Lighting currently has failed.
Calculations appear to indicate that
the planned interior lighting load
exceeds the budgeted allowable
wattage by 2,697 watts. Have placed
a call with Builders Electric to work
out the lighting situation. Will
notify building when matter is
resolved. J. Foster
Lighting Issues have been resolved
for now and can pass the lighting
portion of review
To Request aD 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 Reuuired InsDections I
I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
2 Footing: After trenches are excavated.
3 Foundation: After forms are erected but prior to concrete placement.
4 Underground Plumbing: Prior to filling the trench and including required testing.
5 Storm Sewer Line: Prior to lilling treuch.
6 Underground Electric: Prior to cover
7 Water Line: Prior to filling trench and including required testing.
8 Final Building: After all Conditions have been completed as required on Development Agreement.
9 Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
10 Fire Department Sprinkler System: Prior to cover. Hydro pressure test, fire line now test.
II Fire Department Underground Sprinkler System: Prior to cover. Hydro pressure test, fire line now test.
12 Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
13 Rough Grading: After gravel is in place but prior to placing concrete.
14 Final Paving: After paving is complete.
IS Temporary Electric: Approval required prior to Utility Company energizing pole.
16 Sanitary Sewer Line: Prior to filling trench and including required testing.
17 Framing Inspection: Prior to cover and after all rough In inspections have been approved.
18 Wall Insulation: Prior to cover.
19 Ceiling Insulation: Prior to cover.
20 Rooling: Prior to installing any roof covering.
21 Drywall: Prior to taping.
22 Firewall: Located and constructed according to plans.
23 Masonry:
6 of 7
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: 02-00881-01
ISSUED: 11120/2002
APPLIED: 07123/2002
EXPIRES: 05/20/2003
VALUE: $ 5,467,000.00
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
24 Ceiling Grid: After drywall approval but prior to cover.
25 Epoxy Anchors: To be done by Certllied Spcial Inspector. Provide Inspection results to City Building Inspector.
26 Structural Welds: To be done during construction by State Certilied Special Inspector. Provide Inspection test
results to City Building Inspector.
27 Special: See Plan Reviewer or Inspectors Notes for specilic requirements.
28 Special: See Plan Reviewer or Inspectors Notes for specilic requirements.
29 Special: See Plan Reviewer or Inspectors Notes for specilic requirements.
30 Final Building: After all required Inspections have been requested and approved and the building is complete.
31 SUB Final: After all required energy inspections have been requested and approved.
32 Undernoor Plumbing: Prior to insulation or decking.
33 Rough Plumbing: Prior to cover and including required testing.
34 Final Plumbing: When all plumbing work Is complete.
35 Rough Gas: After line Is installed and required testing and capped if not allached to an appliance.
36 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.
37 Rough Mechanical: Prior to Cover
38 Final Gas: When all gas work Is complete.
39 Final Mechanical: When all mechanical work Is complete.
40 SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
41 Rough Electric: Prior to Cover
42 Electric Service: Approval required prior to utility company energizing service.
43 Final Electric: When all electrical work is complete.
44 SUB Ceiling Grid: Interior Lighting
45 Curbcut - Standard: After forms are erected but prior to placement of concrete.
46 Curbcut - Second: After forms are erected but prior to placement of concrete.
47 Rough Electric: Prior to Cover
48 Electric Service: Approval required prior to utility company energizing service.
49 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 furth~agree to ensure that all required inspections are requested at the proper time, that each address is readable from
the str t, t atthe.p mil card is located atthe front of the property, and the approved set of plans will remain on the site
ataJrti'es ~~~//~ A.. II _or
(' ~ ,~~___- ~ 1\~Zt7-DC
O~,Jor Contracto-rs Signature - Date
7 of 7
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LEGAL DESCRIPTION Scn'icc Includcd:':.'{,:>:
/703, 154 0 C> 0/00 101l0""(\\>' ltcms Cost S~~~;':',
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~~''f'Yfl 4.-;:>"r'-':"~'4\t",,,!; "'!'~~':JCl,Ai~"!';\~t>-,,"f l~'(t~..."",- .f,.. 'I :,-" ".~" "~",;" ...... . t.: . '. . ,,~~S" "~~"r;.'JP...,:--J~1 "~'i.'
k~qc\', ::~SBOlr:C().')tr.::I)!l.!'!2qer.r~.~7,l!Y,l-'-'.." :t, 'JI1!S,t!!!!:i!iol'; -:\I!~!":!!j~n;o!": Rclociit.ion ;2!/r'"N"~:;~/':':! \:':~
~~;:1~,~ .. ~J"lJ;:;?-:"..t~~~~l,I;jiA ....:'..,.'?i.,..$..~:..' '::~-"" ~1$.~ittl-(~~:}"1.{r-~"\'!',!",~:",~",~~~~~, '~~V'': .""~'~,~ .....':. '\;1'_-!~.".r~';:::_;,~_\', ~h~~ '~.'
~-:"~:-~M___ ^~/"'Fk'!O" ~1ep.~;',"';;:~~:~,j';-:;':i:'I"~ ~ ',,!.l.t*~"T-'i~~:~ifl:.{"'~:J~f~r\,.;t;..'~'~: .." ..J~:"'l'~.'n~...'1-.:' -~V~":/~"
!~'t'~t~F~piration Date lu - -. :.::4f~ """\~:'-}, ;. .:.,I ,;~t}1i-d"'20~.~"n'l'sqr.:les,s;~';;;,,,,:~i'_)':\"" \',: ;i,', i". '$,50:00~~
ft~J'~~. "J.~.:'.J, 'I!.;...t, ..L ':I\'.'~'~~"1.~.\t.':!;"~:~~;';'~':'~:~(201'arilps to'. 400-a'nlps .. :\\.:}'. ,,~.!..,.,{ "I;:l '," $6900' " . , .
~~~'~"'~i{"'-o'~. '~"").""':t ""'~-';:';l\~>l,jX/~~i-:t ,': ~ .' ,..<'r..I.~~l'. ",:.~~' ..' '.'~
:~":f:.'~~i~.~~~:1;":i:. ,Sign:. '. e, .f. SUllcn'ising Elcctdcian ..~... '.;\;Over.40 I to 600.ainp's~:~:..'f;'i~",t\~.~ \_,\,/1:' _J?r~'{f.'$)06..00' ~ I I. .
'!.I..'..'....,.~" ~":J;" ,..:::~'-;~.JJ:O" .__" '\"', i.'" "",1-', '_ >';' ,~(,_
l-;..k'j~.,i,;-~~ 3i~f.' .;.;','..:r-:\ fP'~~'~+t.~ Over 60C)'nnips or 1000 vOlts'see -', ~"~~~,~'l'''';;.;'~' ..~...,: , .: .
{f'~~ ~. .," (~',~' ~'~"i-''''''''"': '. -.,..' ,f'.., ':';)-'4'" "';'..,..,1..
\f~ ~":"'t', 1?(~~l~".:J,').~'~\m. ,>>1t-:t.. ~ "B"abovc i.' ....\II:.""'~;I'-;,!t.~".,:.
..t;U.:~)~~ '.'-Y.>' 'l'-.~~~f" _/ .::-,-:ti''/~. ( !.t~,;,}.'~::1,:\.....t'~'I.'.~ .'" ..,..
~,~':.i-,r.,~, f ~\.li/.tl!,. ,-'-A'/i'l-.....". ~l';' : f1h.n.i .,~d--i\..~ '., ,'.
~.;~t:~I'4t,:#1~~;,;'.~"fi~Ji:$t~~i't~;';H;;~..." C' . D. n,.anch Cil!~;iiIS . .i.'~/~i(;:~.;;~F,({:
it~};~):~~~;.: .O\~_nc.r.s:~iu~e.:~~~.. ,;1'0'<~~f.'0.~:~.. <~(J\..)yr f' Ncw:A-lteration or ~~Iension Per Pa~tel "./.' :~'" ~~. "i~ ','
!)$~' -i.ll,:"'"1...'1,: '~fI:;... '. ,.......~~~h"..'. ' "''1: . ,. ".., . ~' .. . '.' ,., '1'1'
A'V::'..;,f". [l<"5, "'1.~'fo2"'<S"""'O-~i'iit.11~~, ""~'*Al;"~f: I ~d . i.,', '. ,. . , . , ':' ,.,. ,;: .
.. '. ,p;~'~ k . .,tu"'''''sr-)jt". \j-'~"" ~"' .','.'" "., I
~:'Sl,J1.:~ps~~.A(]dress',.. _,-: . \.~:.t .'".A......., .... - l IA f..,::> , One Circuit _' $43.00
~;'::'~'*'-~fi~llii;:;"a-'i..--:~..; .~'I':.J~'.-.'~';'" _H....~,,_~' 'r "..' .:..1:.', "
. S~:~<fi~s~;.~:~~~~;;?":'"..;hO~{:~lQ; -12 Ii l Each Additionnl Circuit or with Service., ,. ". "'0'
~~/;" ".~t~t'f"~;I:~:',/~ ~~~"}':~ .~' .- ".>;.:,<',~'(; '-~(.':.:' or. Feeder PCfllllt ~ $ 3,?O !1..:::.
>,:>,,'\!~OWNERINST&t~'JIII~N(',. . .... . .
\~;'. i J~"i'r('Tjle 'in.stalla.iio~ is ,~/~Jnf.\ll~~)<w:~~n law reqUires IE~~f:\scellancous (Scn'icC/fecdel" nut inclnllcd)
,,:. .:."~:~:Jpropertij,O\\W!tri\ICIi.~"\l'),%rinllJniled by the Oregon Utility .Each installation .,.
:,:'.: :~l);fo(sitl~,f)~~E'y~fe"rilqrrcenl~r:T~ose rules are set fort~P()mpor irrigatioa $50.00
\, ,:::;;'~\5)'w.:~.(~;.::"".:/.IW:,O'lf.fl,~9.?r.O.01,;Q9.JQt.hrP. U.9h OAR 952-001-Sign/Onliine Lighting $5(),00
::; < :X~\j~~l~~l~;:s',~i~~'?b\.~Y,?-U r!}'8.y ~~1",in c6Pi~s of the rules byLimited EnergylRes $25.00
,:i .~: "il~\~l :."':""F~"?J" c?lling\t~~center.(Note:,thetelephone LlIllIted Energy/Comm $~5,()0
,.: '.':,:,~~,::> . .""~, ':',ntlmoor;fdrlhe'Oreoon titilitv Notification
''-,'.; . "-':.'f":~."'( "~""";':-:.'/l,".'" ,;.:E:eiiterifd-800"332.2344). Minimulll Electric Pennit"tnspcction Fee is S~~UIII + Surcharges
'<N'o'Tl'~ir;::~!..~:.'~: y' '1'~:.;~'~';:,;: .:....-~: .: '...{ ~. SUBTOTAL OF ABOVE Z II 0'7
JHIS;PE'IiMiTSHAL( ExPj.RfiFTHE' WORK' . 7% State Surchargc I P. rs ~
,AuTHORIZED UNDER THIS"PERMllISNOl " 8% Administrative Fcc / Y l 7Z.
.. _~,' -, "''\'"' .,'" '," ~ ~'-; . ,-'''" ..' ,.'" _ ... . J '.'.
'COMMENCED OR,IS'ABANDONED fOR,' .,> \.,
. ANY'''SO' DAY PERIOD. . . .'. ."
- . .
... , .", ",. ~'.'
.-<U",,- . "'225 I'IETH,STREET ~" ,;,C ",".',Yi ..}
.r::q\!~rll,. . ~"'"' ~ ;:'~"~ ~" " '~'. .. " .".' , ~,'.'\ f~A'''''':''1 ~'1
I~'\"~t. 'SPRlNGFIELD OREGON 9747..7 ;'V" .'l
lf~",~@. ! INSPECTiON'illi'UE's'{':726~316~:~ i'lil
1:;:'!iir,:~17..'; r~ .':'n... ":~'~".' '".... . 'Q~1ffi,; /f.;h ~"" ~."~ .~
"Ii.t,. , O!j"FI\3r:<.iZ.f~;n.,5,9r.lI'" ~t.. .!&!~~;
r. . 1.1' t~./i!,' ,~k", .i' ~ it' ~-
111m"': filS 1"'". I-'~l ,,, ~o. If' ./...." " 11 ,~.,
,'.Qi"1j2. '~l. LQ,CATION OFINSTALDATION i!i'
."',).:~ ti~ -1-1 C) TI'YiSe.mo ,~'\i' n ~
TOTAL
Z770~
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