The URL can be used to link to this page

Home My WebLink AboutPermit Building 2004-12-10Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PROJECT DESCRIPTION: Single Family Residence ATTEImoM ocgon hw lcqtd?ec ffigtr No t follow rulo6 adopted bytn Oregon UtiffIplfppt Notlficatlon Center. Those rules are set ftflp1pB5t h OAR 952-001O010through OAR 952-0flLUE: coM2004-01364 12110t2004 Lu03t2004 09t07t200s . $ 125,220.00 I of the rules V SITE ADDRESS: 1947 Yolanda lu$ber for the Oregor6YffifldetifpgligbF WORK: Single Family Residence AssESSoR'S PARCEL No.: 1703244301monter is 1-800-332-2344). TYPE OF USE: New Residential PhoneNumber: 541-344-2010Owner: Address: Contractor Type General Electrical Mechanical Plumbing CRESCENTHOMES 22TO COMSTOCKAVENUE EUGENE OR 97408 Contractor CRESCENT HOMES INC STEVE HAUCK MICHAEL GRIFFIN CHAPIN ENTERPRISES INC License 132267 t47618 150189 81994 Expiration Date Lu28t2006 04t30t2005 0u23t2007 05i06/2008 Phone 541-344-2010 s4t-221-2665 541-942-8339 541-485-1146 CONTRACTOR INFORMATION BUILDIN( # 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: # ofStories: I Height of Structure 20.50 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Gas Energy Path: Path I Sprinkled Building: nla Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I R-3 u-1 VN 4,839 1,251 400 3 20.00 5.00 5.00 32.90 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: I Yes 34.10 REQUIRED PARKING Total: 2 Handicapped: Compact: Fully Improved Sidewalk rype: curbside 5' Yes Downspouts/Drains: Curb and Gutter Prior to CO driveways on lots 2 & 3 must be replaced with curb, or within 2 years time frame per Subdivision Agreement-cash bond currently in place for work to be done. 1112912004 CAS ]E IF THE WORK PERMIT IS NOT DONED FOR Pase I of4 DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Notes: F 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: COM2004-01364ISSUED: 1211012004APPLIED: 11/0312004 EXPIRESz 0910712005VALUE: $ 125,220.00 Description Dwellines 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 12fiot2004 12n0t2004 Amount Paid Total Value of Project Date PaidFee Description Plan Review Residential -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 Addtl 500 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 PW Disc - 2nd Permit (Street) Sidewalk Permit Receipt Number 120040000000000r5s2 1200400000000001720 120040000000000r720 1200400000000001720 r200400000000001720 120040000000000r720 1200400000000001720 1200400000000001720 120040000000000r720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 120040000000000r720 1200400000000001720 r200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 120040000000000r720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 r200400000000001720 1200400000000001720 1200400000000001720 3200s00000000000r r I 3200500000000000111 3200500000000000111 $422.60 $10.00 $118.32 $82.82 $254.00 $31.00 $650.15 $6.00 $9.00 $12.00 $30.00 $4.00 $12.00 $103.00 $106.00 $38.00 $36s.60 $480.80 $10.00 $86s.31 $82.03 $103.68 $66.00 s772.49 $175.r3 s642.32 $50.00 $12.00 $1,000.00 $80.00 $-30.00 $80.00 tu2t04 t2n0t04 t2n0t04 t2lt0t04 12fiot04 t2n0t04 tzlt0t04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2n0l04 12fiot04 t2n0t04 12n0t04 t2n0t04 tzlt0t04 12fiot04 t2n0l04 t2n0t04 12n0t04 t2n0t04 tzltot04 t2n0t04 t2n0t04 12fiot04 t2n0t04 t2lt0l04 t2n0l04 3/30/05 3/30/05 3/30/0s Fees Paid Total Amount Paid $6,644.25 Pase 2 of 4 Valuation Descrintion I Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line PERMIT NO: COM2004-01364ISSUED: 1211012004APPLIED: 11/0312004EXPIRES: 0910712005VALUE: $ 125,220.00 Plan Reviews ***PLAN REVIEW*** Initial Review Planning Review Public Works Review Public Works Review Structural Review 1u03t2004 tU03t2004 Lu03t2004 1y3012004 1u03t2004 1u29t2004 tu08t2004 LU3012004 APP DON APP APP CAS VRJ l. Need I survey because of minimum side setbacks 2. Street tree planting and placement must meet conditions 24 from the tentative partition approval (SLJB2004-00008), attached to the building permit plot plan. As per plans 11/8/2004 CAS Left message for Marc at954-1372 regarding the need for a LDAP prior to issuance of building permit. ru03t2004 t,/t8t2004 APP RJB 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. 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. 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. Curbcut - Standard: After forms are erected but prior to placement of concrete. 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. 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. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to fiIling trench and including required testing. Sanitary Sewer Line: Prior to {illing 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. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. Paee 3 of4 SKG TAJ l(eoulred lnspecilons I 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: COM2004-01364ISSUED: 1211012004APPLIED: 11/0312004 EXPIRESz 0910712005VALUE: $ 125,220.00 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 Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover 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 Springlield 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 the front of the property, and the approved set of plans will remain on the site at all times during *r/s- Owner or Contractors Signature Date Pase 4 of4 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: COM2004-01364ISSUED: 1211012004APPLIED: 11/0312004EXPIRES: 06/1012005VALUE: $ 125,312.00 SITE ADDRESS: 1947 Yolanda Ave ASSESSOR'S PARCEL NO.: 1703244301004 PROJECTDESCRIPTION: Single Owner: CRESCENT Address: 2210 COMSTOCK Springfield TYPE OF WORI(: Single Family Residence OF USE: New Residential olthe {u\Bs hY Phone Number: 541-344-2010 Contractor Type General Electrical Mechanical # 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: Cedsr CRESCENT HOMES INC STEVE HAUCK MICHAEL GRIFFIN CHAPIN ENTERPRISES INC 1 R-3 u-1 VN \c1 License 132267 147618 150189 81994 # ofStories: I Height of Structure 20.50 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Gas Energy Path: Path I Sprinkled Building: nla Expiration Date tu28t2006 04t30t2005 0u23t200s 0s/06/2008 Phone 541-344-2010 541-221-2665 541-942-8339 541-485-1146 3 Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 4,839 1,251 400 2t{ 1H rgE H P\RE 1H IS PER Rqd: ABAN DONE:\S WORK REQUIRED PARKING ALL EX M\1 Total: Handicapped: Compact: IF.tHE IS NOT20.00 5.00 5.00 32.90 0.00 D TOR Yes 34.10CD. ANY 1 Fullv Improved Sidewalk rype: curbside 5, Yes Downspouts/Drains: Curb and Gutter Prior to CO driveways on lots 2 & 3 must be replaced with curb, or within 2 years time frame per Subdivision Agreement-cash bond currently in place for work to be done. 1112912004 CAS DEVELOPMENT INF( PUBLIC IMPROVEMENTS Notes: Page I of4 tt u lLl-rtl\ (, rN.t! \r.ruvra:l!z!] 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: COM2004-01364ISSUED: 1211012004APPLIED: 11/0312004 EXPIRES: 06/1012005VALUE: $ 125,312.00 Description Tvpe of Construction Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7%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 Total Amount Paid Total Value of Project Date Paid Value Date Calculated Receipt Number 1200400000000001552 1200400000000001720 1200400000000001720 120040000000000u20 1200400000000001720 1200400000000001720 120040000000000u20 1200400000000001720 1200400000000001720 1200400000000001720 r200400000000001720 1200400000000001720 120040000000000r720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 1200400000000001720 120040000000000u20 1200400000000001720 1200400000000001720 1200400000000001720 r200400000000001720 1200400000000001720 Amount Paid $422.60 $10.00 $118.32 $82.82 $254.00 $31.00 $650.15 $6.00 $9.00 $12.00 $30.00 $4.00 $12.00 $103.00 $106.00 $38.00 $36s.60 $480.80 $r0.00 $865.31 $82.03 $103.68 $66.00 s772.49 $175.13 $642.32 $50.00 $12.00 $1,000.00 $6,514.25 $ Per Sq Ft or multiplier Square Footage or Bid Amount tu2t04 t2n0t04 12t10104 t2^0t04 t2n0l04 12fi0t04 t2n0t04 t2n0t04 t2n0t04 t2lt0l04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2n0t04 t2lt0t04 t2lt0t04 t2n0t04 tzlt0t04 t2tr0l04 t2n0t04 t2n0t04 tzlt0t04 t2n0t04 t2n0t04 Fees Paid Plan Reviews APP SKGInitial Review tu03t2004 tu03t2004 Paee 2 of 4 Valuation Description I 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: COM2004-01364ISSUED: 1211012004APPLIED: ll/0312004EXPIRES: 06/1012005VALUE: $ 125,312.00 Planning Review Public Works Review Public Works Review Structural Review tu03t2004 1u29t2004 APP TAJ 1. Need a survey because of minimum side setbacks 2. Street tree planting and placement must meet conditions 2-4 from the tentative partition approval (SU82004-00008), attached to the building permit plot plan. As per plans 11/8/2004 CAS Left message for Marc at954-1372 regarding the need for a LDAP prior to issuance of building permit. til03t2004 LU30t2004 ru08t2004 1u30t2004 APP DON CAS VRJ [u03t2004 til18t2004 OK RJB To Request an inspection call the 24 hour recording at 726-3769. AII 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. 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. Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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. 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. Underfloor Plumbing: Prior to insulation or decking. 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. Underfloor 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 Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Paee 3 of4 Reouired fnsnections 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: COM2004-01364ISSUED: 1211012004APPLIED: 11/0312004EXPIRES: 06/1012005VALUE: $ 125,312.00 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 /2-/C-OC/ C)wner or Contractors Signature Date Page 4 of4 CITY OF SPx'^IGFIELD SYSTEMS DEVELOPMENT - JRKSHEET OR JOB NUMBER: COM2004-01364 NAME OR COMPANY Cresent Homes LOCATIONT 1947 Yolanda St TAX LOTNUMBER:0 DEVELOPMENTTYPE NEW DWELLING UNITS BUTLDTNG SrZE (SF) 1651 LOT SIZE (SF) 1. STORM DRAINAGE DIRECT RTINOFF TO CITY STORM SYSTEM 4839 IMPE,RVIOUS S.F. 2072.00 RLNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED CITY STANDARDS IMPERVIOUS S.F. 0.00 NIIMBER OF DFU's 20 B. TMPROVEMENT COST: NIA4BER OF DFU's 20 ADTTRIP RATE 9.57 SI.,TBTOTAL $3.393.68 COST PER S.F. s0.310 COST PER S.F $0.310 COST PERDFU s24.04 $18.28 NUMBER OF T]NITS I NUMBER OF T]NITS I ADM. FEE RATE 5o/o CHARGE $ilz.32 s642.32 DISCOT]NT $0.00 x x x x x x x x x ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CIry A. REIMBURSEMENT COST: ITEM 2 TOTAL - CITY SAIYITARY SEWER SDC 3. TRANSPORTATION A. REIMBTIRSEMENT COST: $846.40 COST PER TRIP $r 8.30 COST PER TRIP $80.72 s947.62 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR L00 xx B. IMPROVEMENT COST: ADT TRIP RATE 9.57 ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER. MWMC A. REIMBI]RSEMENT COST: NLIMBER OF FEU's I B. IMPROVEMENT COST: NUMBER OF FEU's I xx MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATryE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBToTAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE: $3J93.68 CHARGE r 69.68 TOTAL SANITARY ADMINISTRATION FEE: CherylSlaymaker 1y812004 FEE: DISCOLINT RATE 5lYo COST PER FEU $82.03 $480.80 $0.00 00 1070 l09l 1092 1 093 1094 I 054 1056 1079 a Ir.l LJo(-) HFa t)r! IIE COST PER FEU $865.3 r PREPARED BY DATE TOTAL SDC CHARGES $9s7.34 FIXTT]RE TYPE MISCELLANEOUS DFUTYPE TOTAL DRAINAGE FIXTT]RE T]NITS *EDU lsa BEFORE 1979 DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FD(TURES x UMT EQUIVALENT: DRAINAGE FD(TURE UNITS FOR CALCULATE ONLY THE NET ADDMONAL NO. OF FIXTURES LINIT NEW OLD ALENT NUMBER OF EDU'S MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR unit set at I 67 CREDIT FOR LAND (IF APPLICABLE) DRAINAGE FIxTURE 0 0 0 1979 1979 1980 1981 1982 r983 1988 1989 1990 1991 1992 1993 1994 1995 1996 toa $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $+.+o $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 x1985 1986 1984 1987 VALUE / IOOO $0.00 CRE,DIT RATE $5.29 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE/ IOOO CREDITRATE $0.00 x $5.29 TOTAL MWMC CREDIT 1998 1999 1997 $1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 BATHTUB 2 0 3 6 DRINK]NG FOUNTATN 0 0 I 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LALINDRY TUB 0 0 2 0 CLOTI{ESWASHER / MOP SINK 1 0 3 3 CLoTHESWASFTER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWER, SINGLE STALL 0 0 2 0 SIIOWER, GANG G\r{JMBER OF rmADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 3 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOLTBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 2 URINAL, STALL/WALL 0 0 5 0 TOILET, PT]BLIC INSTALLATION 0 0 6 0 TOILET, PzuVATE INSTALLATION 2 0 3 6 20 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE $0.00 0 00 2000 2001 20 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone 5Pil}TGFIGLO Ctty of Springfield Official Receipt relopment Services Department Public Works Department RECEIPT#: 1200400000000001720 Date: 1211012004 8:43:09AM Job/Journal Number coM2004-0r364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 coM2004-01364 Description Addressing Assignment Willamalane Single Family Temp Power 200 amps or less 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 2 Baths One or Two Family Fumace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent Gas Outlets l-4 Gas Fireplace Heat Pump -Mechanical Issuance Fee- Building Permit Plan Review Major - Planning Residence Wiring 1000 Sq Ft Residence Wiring Ea Addti 500 + 7o/o State Surcharge + l0% Adminishative Fee Amount Due 31.00 1,000.00 50.00 642.32 480.80 36s.60 175. I 3 772.49 82.03 865.31 10.00 103.68 66.00 254.00 12.00 12.00 9.00 6.00 4.00 30.00 12.00 10.00 650. ls 103.00 106.00 38.00 82.82 I18.32 Item Total:$6,091.65 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid CreditCard MARC GRASSAUER djb 087251 In Person Payment Total: $6,091.65 $6,091.65 r2n0t2004 Page I of I CITY OF SPRINGFIELD, ORECON 225 FIFTH STREET . SPRINGFIELD, Ox_97477 o PH:(541)72G3753 o FAX: E L E CTRI CAL P E RM IT,qP P LI CATI O N City JobNumber Lci".Z*^<=c( -e /36Y Date l.3. qLn LEGAL DESCRIPTION {7r> 3 7L1,43 Otaal ,t o-oaa o -oY 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 sFrtlt{{}r!G.Ll, S.t A.Cfrse'y vnEa<locs\ ,AV lo*- Ll 6JOB DESCRIPTION t^Jt&r gF(L Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ) Electrical Contractor Address Phone ?avAws Supervisor License Number 3++s Expiration Date /O'r -01 Constr. Cont. Number 19 ?or8 Expiration Date 'l -N'os Signature of Supervising Electrician owners Name Cfr > cE* L &-"= Address ZZIO Co,---s,Fo<-b- k City /:_1.LG-th/€ phone 34 oto OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Z I 36 $50.00 B. STrE H*wt^200 Amps or less P, o, &r ?tst" t fi to 400 Amps to 600 Amps P/RE /F $ 63.00 $ 7s.00 s125.00 $ 163.00 .00 $ 50.00 $ 69.00 $100.00 A Cify CO /S PEfi /vtl0N Installation, Alteration or Relocation 200 Amps or less / 201 Amps to 400 Amps 401 Amps to 600 Amps 7%o State Surcharge l0% Administrative Fee TOTAL AN c to Over 600 or 1000 Volts see "B" above. D. adoptod by fis Oegon drhdB E. $ s0.00 $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges t3 5b I 1q9 ZZb qb Inspection Request: 726-37 69 4. Shared Drive(T:)/Building FormVElectrical Permit Application l -03.doc COMPLETE FBEOFINSTALI,ATION or ,SA & rsry - re CO NTRACT O R IN STALI.ATI ON ON LY Services or Feeders: Installation, Alterations or Relocation: Installation