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Home My WebLink AboutPermit Building 2005-01-04Building/Combination Permit Status Issued PERMIT NO: COM2004-01513 0u04t200s 12n0t2004 09n6t200s $ 125,220.00 225 Fifth Street, springfietd, oRATTENTION: Oregon law requires you to IIS;J,E?] s4t-726-37s3 phone d--- -' - fottow rules adopteO Oy the Oregon Utifrtv *-P,I}IE-P:s4t-726-3l76nax Notificationcenter. Thoserururu,.rci;;;t#,T31+Jst 541-726-3769 Inspection Line in OAR 952-001-001 O through OAR 952-001-YALUrl: is 1-800-332-2344). TypE oF usE: New PROJECT DESCRIPTION: Casey Meadows sub lot 2 - Sf& same as COM2004-013641947 Yolanda SITE ADDRESS: 1923Y' ASSESSORIS PARCEL NO.:Oregon Util # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o oILot Coverage: OF WORK: Single Family Residence Residential PhoneNumber: 541-344-2010Owner: Address: CRESCENTHOMES 22TO COMSTOCKAVENUE EUGENE OR 97408 Contractor Tvpe General Electrical Mechanical Plumbing # 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: Contractor CRESCENT HOMES INC STEVE HAUCK MICHAEL GRIF'F'IN CHAPIN ENTERPRISES INC License 132267 1476t8 150189 81994 Expiration Date tu28t2006 04t30t2005 0u23t2007 05/06/2008 Phone 541-344-2010 541-221-2665 541-942-8339 541-485-1146 I R-3 U VN 1 20.50 Gas Gas Gas Path I nla I Yes 34.10 Sidewalk Type: Downspouts/Drains: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 4,792 1,251 400 3 20.00 5.00 5.00 32.90 0.00 REQUIRED PARKING Total: 2 Handicapped: Compact: Curbside 5r Curb and Gutter Fully Improved Yes Notes: Storm Drainage piped to curb face l}t23t2}04 CAS Page I of4 L(rl\ I r(AL I (rI( il\r(rt(lvtA I l(r1\ r Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005APPLIEDz 1211012004EXPIRESz 0911612005VALUE: $ 125,220.00 Description Dwellinss Garage Tvpe of Construction V Wood Frame Garage $ Per Sq Ft or multiplier $92.40 $24.30 Square Footage or Bid Amount 1,250.00 400.00 Value $115,500.00 $9,720.00 $125,220.00 Date Calculated 12n0t2004 12110t2004 Fee Description Plan Review Same As -Mechanical Issuance Fee- + l0o/o Administrative Fee + 7o/o State Surcharge 2 Baths One or Two Family Addressing Assignment Building Permit Dryer Vent Exhaust Hoods Furnace - up to 100,000 btu Gas Fireplace Gas Outlets 1-4 Heat Pump Plan Review Major - Planning Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl500 Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan Willamalane Single Family Curbcut Permit Sidewalk Repair Permit Amount Paid Total Value of Project Date Paid t2n0t04 u4t05 u4t05 y4t05 y4t05 u4t05 u4t05 u4t0s il410s u4t05 u4105 u4t0s u4t05 u4t0s U4t05 u4t05 u4t05 u4t05 U4t05 u4t05 u4t05 u4t05 u4105 U4t05 U4t0s u4t05 y4t05 y4t05 u4t05 3/30/05 3/30/05 Receipt Number 2200400000000001499 r200s00000000000009 1200s00000000000009 1200s00000000000009 1200500000000000009 1200s00000000000009 1200500000000000009 r200500000000000009 1200500000000000009 r200500000000000009 1200500000000000009 1200500000000000009 1200500000000000009 1200500000000000009 1200500000000000009 r200500000000000009 1200500000000000009 1200s00000000000009 r200s00000000000009 1200500000000000009 r200s00000000000009 1200500000000000009 1200500000000000009 1200s00000000000009 1200500000000000009 1200500000000000009 1200s00000000000009 1200500000000000009 1200500000000000009 3200500000000000110 3200s00000000000110 $100.00 $10.00 $116.82 $81.77 $2s4.00 $31.00 $650.1s $6.00 $9.00 $12.00 $1s.00 $4.00 $12.00 $103.00 $106.00 $38.00 $36s.60 $480.80 $10.00 $86s.31 $82.03 $107.69 $6s.48 $772.49 $175.13 $712.0s $50.00 $12.00 $1,000.00 $80.00 $10.00 Fees Paid Total Amount Paid $6,337.32 Paee2 oI 4 Valuation Descriotion I PRIN Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005APPLIEDz 1211012004 EXPIRESz 0911612005VALUE: $ 125,220.00 Plan Reviews Initial Review Planning Review Public Works Review Structural Review 12n4t2004 12tr4t2004 12n4t2004 1211412004 12n4t2004 12122t2004 12n7t2004 01/03/2005 APP APP APP APP SKG TAJ CAS DJB Needs survey because of minimum side setbacks. Storm drain piped to curb face 12n7t2004 cA's same as COM2004-01364 Renrrirpd fnsnecfions 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Curbcut - Standard: After forms are erected but prior to placement of concrete. Post and Beam: Prior to floor 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. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor 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 lilling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. 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 Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Paee 3 of4 Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005APPLIEDz 1211012004 EXPIRESz 0911612005VALUE: $ 125,220.00 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 correcf and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springlield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAIICY 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 street, that the times Owner or Contractors Signature to ensure that all inspections are requested at the proper time, that each address is readable from the IS at the front of the property, and the approved set of plans will remain on the site at all Date Paee 4 of4 F' Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005APPLIEDz 1211012004EXPIRES| 07t04t2005VALUE: $ 125,220.00 SITE ADDRESS: 1923 Yolanda Ave Springfield TYPE OF WORK: Single Family Residence ASSESSOR'S PARCEL NO.: 1703244301002 TYPE OF USE: New Residential PROJECT DESCRIPTION: Casey Meadows sub lot 2 - SFR, same as COM2004-013641947 Yolanda Owner: Address: CRESCENTHOMES 22lOCOMSTOCKAVENUE EUGENE OR 97408 PhoneNumber: 541-344-2010 License Expiration Date 132267 1u28t2006 147618 04t30t2005 1s0189 0u23t2005 81994 05/06/2008 Contractor Type General Electrical Mechanical Plumbing Contractor CRESCENT HOMES INC STEVE HAUCK MICHAEL GRIFFIN CHAPIN ENTERPRISES INC Phone 54t-344-2010 541-221-2665 541-942-8339 s41-48s-1146 CONTRACTOR INFORMATION PUBLIC TMPROVEMENTS # 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: ffim.r-^,*rr I #'rst;;;' ttirie: the telephgl" Lot si"'R-3 , , U-eisltref€Sgrcrrr. Urrlrty NolNQft'on Sq Ft lst Floor:u "'"'t"yeBRf#agtl-auO-332^2344)cas Sq Ft 2nd Floor: VN Water Type: Gas Sq Ft Basement: Range Type: Gas Sq Ft Garage/Carport 3 Energy Path: Path I Sq Ft Other: Sprinkled Building: nla Occupant Load: REQUIRED PARI(NG Overlay Dist:Total:20.00 s.00 5.00 32.90 0.00 I . Yes 4,792 1,251 400 ,, H\S PE-i Handicapped: Compact: Fullv Improved Yes 34.10 Sidewalk Type: Downspouts/Drains: Curbside 5' Curb and Gutter ,PMENT INFORMATION Notes: Storm Drainage piped to curb face 1212312004 CAS Page I of4 ABAN Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005 APPLIEDz 1211012004EXPIRES: 0710412005VALUE: $ 125,220.00 Description Dwellinss Garage Fee Description PIan Review Same As -Mechanical Issuance Fee- + l0o/o Administrative Fee + 77o State Surcharge 2 Baths One or Two Family Addressing Assignment Building Permit Dryer Vent Exhaust Hoods Furnace - up to 100,000 btu Gas Fireplace Gas Outlets 1-4 Heat Pump Plan Review Major - Planning Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl500 Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan Willamalane Single Family Total Value of Project Date Paid Type of Construction V Wood Frame Garage $ Per Sq Ft or multiplier $92.40 $24.30 Square Footage or Bid Amount 1,250.00 400.00 Value $115,500.00 $9,720.00 $125,220.00 Date Calculated 12n0t2004 12n0t2004 Amount Paid Receipt Number 2200400000000001499 1200500000000000009 r200500000000000009 1200s00000000000009 1200500000000000009 1200s00000000000009 1200s00000000000009 1200500000000000009 1200s00000000000009 1200500000000000009 r200500000000000009 1200s00000000000009 1200500000000000009 1200s00000000000009 1200500000000000009 1200500000000000009 1200500000000000009 1200s00000000000009 1200500000000000009 1200s00000000000009 1200s00000000000009 1200s00000000000009 r200500000000000009 1200s00000000000009 1200s00000000000009 1200s00000000000009 1200500000000000009 1200500000000000009 1200500000000000009 $100.00 $10.00 $116.82 $81.77 $2s4.00 $3r.00 $6s0.15 $6.00 $9.00 $r2.00 $15.00 $4.00 $12.00 $103.00 $106.00 $38.00 $365.60 $480.80 $10.00 $865.31 $82.03 $107.69 $65.48 9772.49 $175.13 $712.0s $s0.00 $12.00 $1,000.00 t2n0t04 U4t05 u4t05 U4t05 U4105 u4t05 u4t05 U4t05 U4105 u4105 u4t0s y4t05 u4t05 U4t0s u4t05 u4t05 u4t05 u4t05 u4t0s u4t05 u4t05 u4t05 u4105 u4t05 U4t05 u4t05 u4t05 U4t05 u4l0s Fees Paid Total Amount Paid $6,247.32 Paee2 ol 4 Valuation Descrintion Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 lnspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005APPLIED: 1211012004 EXPIRESz 0710412005VALUE: $ 125,220.00 Plan Reviews Initial Review Planning Review Public Works Review Structural Review 12n4t2004 12n4t2004 12n4t2004 12n4t2004 12n412004 12122t2004 12n7t2004 01/03/2005 APP APP APP APP SKG TAJ CAS DJB Needs survey because of minimum side setbacks. Storm drain piped to curb face 12n7t2004 cAS same as COM2004-01364 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor 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. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor 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. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. 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 Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Reorrired fnsnecfions Paee 3 of4 Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line PERMIT NO: COM2004-01513ISSUED: 0110412005APPLIED: 1211012004EXPIRES: 0710412005VALUE: $ 125,220.00 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times i-1-c>{ Owner or Contractors Signature Date Page 4 of 4 I GITY OF SPk,r'IGFIELD SYSTEMS DEVELOPMENT . .IRKSHEET JOURNAL OR JOB NUMBER: COM2004-02513 NAME OR COMPANY Crescent Homes LOCATION:1923 Yolanda St TAX LOTNT]MBER:1703244301002 DEVELOPMENT TYPE: NEW DWELLING TINITS I. STORMDRAINAGE DIRECT RLINOFF TO CITY STORM SYSTEM BUTLDTNG SrZE (SFl 1651 LOT SIZE (SF): CHARGE $712.05 IMPERVIOUS S.F 2296.95 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. 0.00 NUMBER OF DFU's 20 B.IMPROVEMENT ADT TRIP RATE 9.57 COST PER S.F, $0.310 COST PER S.F $0.310 COST PER DFU s24.04 $ 18.28 NTIMBER OF TINITS I NUMBER OF LNITS I ADM. FEE RATE 5Yo DISCOUNT RATE 50Y" $712.0s DISCOT]NT $0.00 x x x x x x x x ITEM I TOTAL - STOR]VI DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBT]RSEMENT COST: ITEM 2 TOTAL - CITY SAI\IITARY SEWER SDC $846.40 3. TRANSPORTATION A. REIMBT]RSEMENT COST: xx xx COST PER TRIP $ 18.30 COST PER TRIP $80.72 s947.62 NEW TRIP FACTOR r.00 NEW TRIP FACTOR r.00 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBTIRSEMENT COST: NUMBER OF FEU's I x B. IMPROVEMENT COST: NUMBER OF FEU's I MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMIMSTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE: $957.34 CHARGE $r73.17 SUBTOTAL $3.463.41 TOTAL SANITARY ADMINISTRATION FEE: TOTAL ADMINISTRATION FEE: Cheryl Slaymaker 12t1612004 NUMBER OF DFU's 20 $712.05 $36s.60 $772.49 $82.03 $86s.31 $0.00 $3,636.58 I 070 I 091 1092 I 093 1094 1055 I 054 1056 1079 I 078 ar!noO & rr.lFa oo r', IIEil 3@- COST PER FEU $82.03 COST PER FEU $865.31 ,463.41 PREPARED BY DATE TOTAL SDC CIIARGES x DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FXTURES xUNTT EQUIVALENT: DRAINAGE FXTURE T,MTS FOR CALCULATE ONLY THE NET ADDITIONAL NO. OF FIXTURES LNIT FIXTURE TYPE NEW OLD ALENT MISCELLANEOUS DFU TYPE TOTAL DRAINAGE FXTURE I]NITS lsa toa mit set at 1 67 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 20 DRAINAGE FIXTURE UNITS 0 2 1979 BEFORE 1979 $5.29 $5.29 $5.1 I $5.12 $4.e8 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 IS LAND ELGIBLE FORANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR ]-AND (IF APPLICABLE) 1979 1980 1981 1982 1983 1984 1985 1986 1987 I 988 1989 r 990 1991 1992 1993 1994 1995 I 998 1999 2001 2 VALIIE / lOOO $0.00 CREDIT RATE $5.29x CREDIT FOR IMPROVEMENT OF AFTERANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $5.29 TOTAL IT{WMC CREDIT 1996 1997 $1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 BATHTUB 2 0 3 6 DRINKING FOUNTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LALNDRY TUB 0 0 2 0 CLOTHESWASHER / MOP SINK 1 0 3 3 cLoTmswASrrER - 3 oR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWER, SINGI-E STALL 0 0 2 0 sHowE& GANG OUMBER OF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 3 SINK: COMMERCTAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 ,|2 TIRINAL, STALL/WALL 0 0 5 0 TOILET, PT]BLIC INSTALLATION 0 0 b 0 TOI LET, PRTVATE IN STALLATION 2 0 3 6 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 0 2000 NUMBER OF EDU'S .225 Fifth Street Springfield, Oregon 97 477 5+1-726-3759 Phone 1t+y of Springfield Official Receipt relopment Services Department Public Works Department RECEIPT #: 1200500000000000009 Date: 0110412005 1l:41:03AM Job/Journal Number coM2004-01513 coM2004-01513 coM2004-0lsl3 coM2004-01s13 coM2004-01513 coM2004-01513 coM2004-01s13 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-0lsl3 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-01513 coM2004-0lsl3 coM2004-01513 Description Addressing Assignment Willamalane Single Family Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Plan Review Major - Planning Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin Building Permit 2 Baths One or Two Family Furnace - up to 100,000 btu Exhaust Hoods Dryer Vent Gas Outlets l-4 Gas Fireplace Heat Pump -Mechanical Issuance Fee- Vent Fan + 7o/o State Surcharge + l0% Administrative Fee Amount Due 31.00 1,000.00 106.00 38.00 50.00 103.00 712.05 480.80 365.60 t75.t3 772.49 82.03 865.31 10.00 r07.69 65.48 650. I 5 254.00 12.00 9.00 6.00 4.00 15.00 12.00 10.00 12.00 81.77 116.82 Item Total:$6,147.32 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard MARC GRASSAUER djb 050951 In Person Payment Total: 86,147.32@ U412005 Page I of 1 rl':xt8xx'* CITY OF SPRINGFIELD, OREGON 225 FIFTH STREET . SPRINGFIELD, OR 97477 o PHz(541)726-3753 o FAX: E LE CTRI CAL PE KMIT APPLICATI ON CiryJobNumber U -Oi{75 Date l.3. n 23 Y. loJo s7- LEGAL DESCRIPTION A. l+o3Z+t3 o t@L Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder SFfIIn.GFIl:LE) 06.00 $50.00 $ 63.00 $ 7s.00 $12s.00 $163.00 $ 43.00 $ 3.00 $zo JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 7 Electrical Contractor fiwe Hatrcr Address P. O, Box ABb i rhone fit -auas SupervisorLicenseNumber 3:+S Expiration Date lo,t*o-1 Constr. Cont. Number 14+tots Expiration Date 4-s-os Si gnature of Supervising Electrician owners Name Qry--ur^* y'"*u-- Address ZZt O 6>-*-=lr-c-V I V City €X<=eru4- Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: $37s.00 s s0.00 9 3 6,e City C. D. E. Installitlsli,Atermf obIEnffiFS of the rules by 2oo AmpgallreSthe cente 2ol Amfi.BwAerpIe ot r. (Note e {o q) 4ol Amps1o666Qffir is 1 Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 25.00 Limited Energy/Commerciai $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 1Yo State Surcharge 10% Administrative Fee TOTAL l1't,oo_ tgss Pump or irrigation Sign/Outline Lighting Limited Energy/Residential' $ s0.00 s s0.00 l1,tto I LaG,qBInspection Request: 726-3769 4. Shared Drive(T:)/Building FormVElectrical Permit Application l-03.doc LOCATION OF COMPLBTE B. Services or Feeders -Installation, .A,lterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only \Y Ptt