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Home My WebLink AboutPermit Building 1992-11-12COMM ERCIAL/ I N DUSTRIAL -'* PERMIT APPLICATION 225 Fiftn Street, Springfield, Oregon 97477 SPR]]t'GFIELE, LOCATION OF PROPOSED WORK:19rh and ilorr St.reets ASSESSORS MAP '/| -.-rOB NUMBER INSPECTION LINE: 726-3769 OFFICE: 726-3759 TAX LOT:\202 owNER: Vallev Childrenrs Clinic PHoNE: (503\ 746-5437 71p. 914't7 ADDRESS: OresonCITY:STATE: 1 55 West A Strpet - Rrri l dins A DEScRtpTtoN oF WoRK; Single story wood frame building, pediatri.c clinic NEW X REMODEL ADDITION DEMOLISH OTHER VALUE :S5l&€09=e€5#;rco NAME EXPIRES PHONE a a ARCHITECT: "/? t? TBG Architects & Planners/PC 1600 Val River Dr., Sulte 370 ADDRESS CONTRACTOR'S NAME ELECTRICAL: PHONE (503) 687-1010 CONST. CONTRACTOR # G EN E RAL: PLUM BI NG MECHANICAL: PLU MBIN G NO.FEE CHARGEeSingle Fixture /?2b Relocated Bldg (new fix. addtl) //a I Water Service ft ?a 1?'Sanitary Sewer ft 2{ f4'Storm Sewer ft /aa /Backf low Device TOTAL PERMIT ?ff MECHANICAL NO trtrtr CHA FIGF Z Furnace/burner & vent < 100,000 BTUs a % Furnace/burner & vent >100,000 BTUs Floor furnace and vent Suspended wall or f loor mounted unit heater Appliance Vent separate Stationary evap. cooler €Vent Fan/Single duct v /f Vent from System apart AC or htg. Mechanical exhaust hood and duct4+s%Z Permit lssuance $10.00 TOTAL PERMIT CE USE QUAD AREA:,-$cruu)-oF WATER HEATER: * OF BLDGS: LIGHTING POWER BUDGET: * OF UNITS: LAND USE: HANDICAP ACCESS FLOOD PLAIN ZONING CONSTR. TYPE: HEAT SOURCE: OCCY GROUP: # OF STORIES SQ. FT.$/SQ. FT.VALUE TOTAL VALUE OF PROJECT PLAN CHECK FEE DATE DEMOLITION ao // ?4. 76 7{, aqa BY ar-,.3 L FT. I FT. $U,u X X ?2.79 w I BUILDING PERMIT PLU M BI NG RBCUT .* 5% State MECHANI Su 5% State PAVI NG Surcha 5% State SIDEWALK VALUE Su rch FEN SQ. FTG MAIN SQ. FTG ACCESS SQ. FTG OTHER TOTAL PERIVIT FEES EXCLUDING ELECTRICAL o, SUBTOTAL PERM ITS SYSTEMS D EVELO PM E NT ?- 1 7 -O1-? \-x-L 6Tq?eo REQUIRED INSPECTIONS It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call 726'3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be readyfor inspection. Requests received before 7:OO a.m. will be made the same working day, requests made after 7:O0 a.m. will be madethe following work day. SITE INSPECTION: To be ,X ROUGH pLUMB;NG, ^ pAVtNG: After gravet is inmade after excavation, but ELECTRICAL & - place but priorlo placing prior to setup of forms. MECHANICAL: No work is to asphalt or concrete. be covered until these UNDERSLAB pLUMBING, inspections have been made SpEC;AL ;NSpECT;ONS: tn accordance ELECTRICAL & and approved. Section 306 of the State Speciatty Code MECHANICAL: To be made V a special inspector shall be employed before any work is covered. ? ATTIC DRAFT STOPS & by the Owner/ Contractor during ^rrarAlN lUAttff- construction of the following w6rk. A X FOOTTNGS & FOUNDATTONS: copy of the special testing reports shall To be made after trenches are FIREPLACE: Prior to placing be furnished to the Building Division. excavated and forms are facing materials and before erected, ail steel in place, but framing inspection' - srRUcruRAL CoNCRETE: ln prior to placing concrete. X FRAMING: To be made after excess of 2500 PS.l. (306 a.1) coNcRETE SLAB: To be the roof' all framing' fire made arter au insrab buirdins 3i::5 ::."]fl 3|3:I?;,';;:r" :lli,.fly.*3"t HitT',rrr, ,service equipment, conduit, and vents are complete andpiping, accessories and other incir-arv equipment items are :i:'fl:n"li,ligi:,1'JJ;[3::: El?Xf],?E]?l,l",?,o"TH:".in place but before any ,/ tighteiing operations. (306concrete is placed. 4 INSULATION & VApOR a.6) ( UN DERGROUN D: Plumbing, electrical, gas, sanitary sewer, storm sewer, water and drainage lines. To be made prior to covering or f illing trenches. UNDERFLOOR: PIumbing, electrical, mechanical. To be made prior to installation of floor insulation, decking or f loor sheathing. POST & BEAM: To be made prior to installation of floor insulation, decking or floor sheathing. FLOOR INSULATION & VAPOR BARRIERS: To be made prior to installation of decking or floor sheathing. MASONRY: Steel location, bond beams grouting or verticals in accordance with u3c 2415. ROOF SHEATHING AND NAILING: Prior to installing any roof covering. BARRIER: To be made after all insulation and required vapor barriers are in place but before any lath or gypsum board interior wall covering is applied. FIRE & SEPARATION WALL: Located and constructed according to plans. LATH AND/OR GYPSUM BOARD: To be made after all lathing and gypsum board, interior and exterior, is in place but before any plastering is applied or before gypsum board joints and fasteners are taped and f inished. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete and form work and sub-base material in place. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. SPRAYED ON FIREPROOFING: U.BC. Standards 43-8. SPECIAL GRADING, EXCAVATION AN D FILLING: During earthwork. (306 a.11 & Chapter 29) GLU-LAM BEAMS: lnspection Certificate by an approved agency, furnished to the City's Building Division before beams are placed. (2501 U.B.C. STDS. 25-10,11). STRUCTURAL MASONRY: (306 a.7) .ln addition to the inspec- tions specified, the Building Official may make or require other inspections of any construction work to ensure compliance with the Building, City or Development Code. v x v ) { / FINAL PLUMBING FINAL ELECTRICAL FINAL MECHANICAL FINAL FIRE DEPARTMENT SITE PLAN REVIEW BOARD: Must be requested 2 days in advance of the date you wish inspection. AII project conditions such as landscaping, parking lot striping, etc. must be completed before requesting this inspection. FINAL BUILDING: Requested after the final plumbing, electrical, mechanical and Fire Department inspections are made and approved. No occupancy of the premises can be made until a Certificate of Occupancy has been issued by the Building Division and posted on the premises. AD L M PLANS REVIEWED BY D^rE ,/^29'Z By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein 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 Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that project 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 Signatu VtY)Date times during constructi n. DATE PAID: RECEIVED VAL ENAMOUNT REC RECEIPT *: t(' ,( / ( SlcN i'i:lilvll'r Al'l'Llc; -'r)l'l JtJ NLJMDI-II alb llJ', lrltlt Slrt:r:t Slrrirrglicld, Ol't 97477 ffi lnspcctiort Lirrc: 726-3769 OIfice: 726'3759 I-OCNI IOI'J OF PIIOI)OSED WORK n:l:;rs50ns N4A[):-__ owl!Etr OOO c TAXLOT PI{ONE:a+L - 5+31 Z-A4 tq5 /.). hADDNE:;t; STATE:ZIP:41+11ct't'Y: . .._5 ?_kw4t:Ew-- VALLOI tLPL2^t S cLtNtcllL,:ilNt::lS NAMt, IlttM ETC Dt_5Ctill,-l-lot! oF t)l toposED slGN(S): (plcase chccl< artrl <;ornlrlcte all appropriate irrforrrtatiort) Vt:rtit:itl Dirrtcnsi<rtt [)irrtr:rtsit.ttt f rtltrl Gr lo l)(,ttorIl of Sign: of sigrr or enclosure 'irrlt: 2r_6r, .. _- Wrrll y' Ftccstanding ____ Sir.rglc Face - Doutlle Face 5ir1tr;rrc Focltage z4q -_ Projectittg -- Billboatd *tr Elcctrical lrrstallation: -_ Yes X ,o (lf yes ad<Jitiortal perrnit is required) _ RooI - Marquee Total l-lei0ht above Grade (.L l, Florizontal Width of sign or enclosure:6 tr. VALUE:2O. oa AL YS-411JV 14 trt V tu(LMrrtr:rirtl [iigrr is corlstructcd of t.ist Al-L r;xistirtg sillrtlrgc;rrlcl itttacll a plrotograplt of eaclt sigrr Sq. Ftg frortE (b) Typc (d) Type Sq. Ftg Sq. Ftg (;r) -l'yDr: Sr1. Ftg (r;) J'ytrr: CONI I tN CIOtt/INSTALLI-R e PHoNE: +g€'5;+b Cll-Y: __-_-__-_Eu4 CON:i TIIL,,C: TIOI{ COI! I-IIACTORS ItEG ISTNATION NUMBEN Az?o1 STATE:o&.ztP: ?1 4oz EXPIBES: I >->o -13 EXPIRES: G -9r4ClrY BUSINESS L|C|:NSE NUMBER: --1-Z e OFFICE USE Larrd Usc: Codc Section Approvcd By: Ouad AreaSigrr District Zortirtg Sirln ['t:t rtttt Ft.le: 2 @ DATE: llt.OUltiID INSPI]C1-IONS . ,- Sitc to lrr.: ntadc prior to srUn.lrlacctrtcttt /=ruorr,u ;r,(. placernent of concrete n ttacllmetlt af tcr {astclte rs are installcd/prior to cover --lElectricalprior to errergizing .2:- Final c<6rpletion ol sign installation Arlrlitrtrrta.|Cotntnt:rltsarrd/orConditiolts: slrrirr1lliilld, arrd tltc Luws 0l the srate of orcg<rrr pertairring to tlre work dcscribecl hcrcirt. lfurther certify that orrly contractors arttj ,:,,tl,lrryr,cs wlr<l irrC irr cornplinrrcc witlr ORS 7O1.055 will be usctl on this projeCt. I f urrlrr:r .r0rce to onsure thrrt all rerluired inspectiorrs are requcsted at the proper time, that proiect ackJress is readable frorn the street, tllat tlro lrcrrnrt <;ard is located at thc lrorlt oI tlrc propcrty, arrd the approvcd set of plans will rcmairr on the site at all timcs durin0 the installotiofl ol tlrc si0rt(s) Sigrratut c Date 3- t1 47 V;rlrrtittiott: Flcccipt Nuntber + -q6t Received By 3 CS Anrount Received syrooct Datc Paid aol qt ADDrtrfirr: . *.---IL.!-o- -QeQ|fen- L SIGN PENMIT APPLICATION 'l lrg ;r1llrlrr:1tlrl1 o1 tllo rcvcrsc si<je rrcerls to llc r;ornltletcd r:rrtircly. lf you are lhe sigrr contractor/illstall{.r, <lr il you are lrli19 a c()ltrirctor, you rreed ro rnakc surc tlral. botlt tlte City ol Sprirrglield Business License Nurnber and the Begistration Nurnlter f rorll tlre Statc ol Oregon Corrstructiorr Contractors Boartl are listed on tlre application along with tlre expiratiort date ol eat:1.r. ll tlre sigrr you are.proposirrg is illuminate<J, an clectrical perrnit applicatiort also needs to be completed and sigrred by either . ,rgluruigi,,g clectrician, lirnitctJ sign olcctricol colltr0ctor, or il you 0r0 tlte buslrtoss ownor wlto also owns tlro Dulldlrtg irt wlrich you arc occupyi69, and you will be performing the electrical installation yourself, you may sign the electrical a pplica tion. lf thcre arr: existirrg wall and/gr freestarrding signs, a photograplr(sl of each oxisting sign needs to be attached to the allplicatiorr. Ttre size of cach existing sign also needs to be listed on the application. PLANS 'l'o subrnit lor a sign permit, you need to prepare two cornplete sets ol clrawings showing all dimensions, total height, and o;r16r plarr irirliuatirrg where iliu proposcrJ sign will bc located. lf you arc instal!ing a {rccstanding sign rvhich cxceeds 2O t(.:ot iri total tteigttt, tlre footirrg rJetail nccrJs to be prepared and stamgred by a registercd engineer. After the plan rcview l)r()(:()ss is crtlrltlctcd, arr<1, il your sigrr(s) is approved, otle sct will be returtted to you. The approved set of drawings necd to l)o at tlrt: site wlrerr an irrspcction is rc(luostcd lor tlrc itlspectors rcference' INSPECI-IONS Dapcrrrlilg ()n your siurr(s), yor.r rnay bc rctluirr:rJ to rc(luest one or all ol the lollowing inspectiorrs during tlrc irtstallatiorl r.rl yotrr sigrt: Siirc: 1'o be requested after.irrtlir;atirrg on the lot where the proposed sign will be located but prior to any work beirrg peiforrned for the irrstallatiorr o{ the sign. This inspection is required if there is a question on the locatittr.t ol the proposetl stgtt. Fo,ti.11: 'l'o ltrl requestecl af ter excavittion arrd tlre forms are installed, but prior to pouring concrete. lf there will be clc(:trical corrtluit Jtlaced irr thr: kroting, it rnust also be in place prior to requestin0 this inspection. Alar:lrrnenr: l-g lte rcrlucsLcd wtlerr all Iasterrers are installed but prior lo cover. E:lcctrical: To bc requestcd aftcr the clectrical connectiorr to the sign is made, but prior to energizing. Fipal: Atter all required inspections are conducted and approved and the sign installation is complete. 'l'hc irrspecrions that are requirccl lor your spccif ic sign will be indicatcd on the application during the plan review process' Failure to rc(lucst ANY of the required irrsJtcctiorrs could result in sign removal in order to inspect the sign at the required irrtr:rvals o[. work. To rcqucst rrrr irrspectiorr, Jrhone 726-376g. This is a 24l.rour recording. On the recording you will need to leave your City t)csignatcd Jol.) lJur-rrber. locaticln oI whcre tlrc sign is being installed, the type of inspection you are requesting, and when you will brr rcady tor the inspectiorr. All inspcctions called in to the recorder prior to 7:0o a.m. will be made the same workirri; tlly, trll insl ections phoned in altcr 7:00 a.m. will bc madc the Iollowing work day' lf you 5;rvt-. any questions rcgarrling the applicatiorr, required plans or inspections, please feel free to ptrone the Building Salc:ty Divisiorr ot 720-3759. City ol' Sprirrgl'icltl llrrildirrg Srrl'ely l)ivision 225 I,'il'th Strcet S;r'irrgl'ickl, Oll 97477 I C'TY OF OREGO'U 5i,l ilra(:r rcLt) ah 225 FIFTB STREEI SPRINGFIELD, OREGON 97477 INSPBCTI0N REQUEST? 726-3769 OFPICE: 726-3759 t^PERHIT APPLICATION City Job Nuurber COHPLETE FEE SCEEDULE BELOU Nev Residential-Single or MuIti-Family per dvelling unit. Service Included: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Hanuf'd Home or Hodular Dwelling Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 r"t'41i t:r -3 A 1 LOCATION OP INSTALI^ATIONLeoo N. tqs 5c Sum JOB t Permits are non-transferable and expirelf vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. CONTRA TOR TNSTALI,ATION ONLY Electrical Contractor +if Address t fo t ?.*t I Phone aTZ-fit'\ Supervisor License Ntimber Ztz- f,Lc- Expiration Date / o:t -71 Constr Contr. Number fi?yy Expiration Date -( Signature of Supervising Electrician B. Services or Feeders Installation, Alterations 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 On1y s s0.00 $ 60.00 s100.00 $130.00 $300.00 s 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 4., " 'f ,.,.*-f 200 amps or less $ 40.00 Over 401 to 600 amps _ $ 80.00 0ver 600 amps or 1000 volts see "Brr above 0vners Nafie l/o Address 9^-*-< Ci ty Phone 'l'/ b- f L{ 31 OVNER INSTALI.ATION The installation is being made on property I own which is not intended for sale, Iease or rent. Ovners Signature: DATE: RECEIPT *: RECEIVED B D. Branch Circui ts Nev, Alteratlon or Extension Per Pane} Onb Circuit S 35.00 Each Additional Circuit or vith Service or Feeder Permit S 2.00 E. I'liscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/ou tl ine Ligh ting- Limi Ener /Res SUBTOTAL OP ABOVE 5X State Surcharge TOTAL c/, $ $ s s 00 00 00 00 40. 40. 20 m ted Ener 5 36 Z--' L9 /JfSgAEffiffr?HangI I City E -?c.^t @ CITY OF SPR'NGF'ELD, OREGO'U 225 FTrry]E STRBBT sPRrNGrrBID, OREGoN 97477 INSPECTION REQI BST. 726<3769 0PPICB: 72:,6-3759 j-lC The following proiect as sl:bmitte:i has the following h BIJCTRICAL PERHIT APPLICATION city Job Nvnber q) t)q|. 3. COHPIATB PBE SCEEDUI,E BELOS Nev Residential-Single or MuIti-Family per dvelling unit. Service Included:Items Cost sPa.|rIGFtELD 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Servlce or Feeder Services or Feeders InstalIation, Alterations 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 On1y STIBTOTAL OP ABOVB 5Z State Surcharge TOTAL LC 1. LOCATION OP INSTALTATION aturo ^). rqTL A tacAl DEscRrpTroN 11o3?Say os)a).t JOB DBSCRIPTION Iv-.'strr\\c.t io ur of f hcar.o" S Yste n', 1""'i r 1 permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork ls suspended for 180 days. 2. COTURACTOR INSTALI^ATION ONLY B. Elec trical Contractor@, =.*i. Address l9 \D TtL City Evrbl-v.r u Phone b[b-1l.69 Supervisor Licens e Number la}LNE T- Expiration Date ole I c. Constr Contr. Number tat 8 Exoiration Date Signature of Supervising Electrician 0vners Name \/o 1J.,. ,(l'o 'oro. ,u, Address 1 /A) Ci ty Phone 1+L -suz) OSNER INSTALI,ATION Temporary Services or'Feeders Insta1lation, Alteration or Relocatiop Sum $ 8s.00 $ 1s.00 $ 40.00 200 amps or less 201 amps to 400 amPs _ Over 401 to 600 amps 0ver 600 amps or 1000Efts $ 40.00 $ ss.00 $ 80.00 see rrBrr a5oTil $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 $ s $ $ The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. 0mers Signature: D. Branch Circuits B Nev, Alteration or Extension Per Panel One Circuit $ 35.00 Each Additional Circuit or with Service or Feeder Permit $. 2.00. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation - Sign/0utline Lighting- Limited Energy/Res Limited fnergy/Comm j 40 00 00 00 00 3r-.otl 40 20 36 5 DATE: 1vt RBCBIVBD )3t ool,te 31 .?o N0.q LI zqb CITY OF SPRINGFIELD -SI:]I{: DEVELOPMENT CHARGE WORKSHEET (PRoFESSIoNAL OFFICES & INDUSTRIAL) NAME OR COMPANY:Auu S Curs rc - 92-b2- _ LOCATION:\ qTli d,o.514.\-1 ob 2-b DEVELOPMENT TYPE:LL " NEW r&TEt cCu trl tC SIZ Ft $ Gq le:- 21++3 BUILDING SIZE: 1. STORM DRAINAGE IMPERVIOUS SQ. FT. 0.5 X 1-bbr+x $0.192 PER SQ- FT SANITARY SEWER-CITY NO. OF PFU,S 0.5 X 5O X $39.78 PER PFU (See Reverse) 2 J TRANSP0RTATI0N o--?- -. / (npe u.bo (u-t*rc) : Tere Krre = Z 3?1'-*O NO_bi UNITS X TRIP RATE X COST PER TRIPetuZ.bts x $401.0s ADMINISTRATIVE FEES BASE CHARGE (SUBToTAL ABoVE) X .05 l^L .)t ?- Kip Burdick SDC Coordinator x $401.05 x $401.0s $ SUBT0TAL (ADD ITEMS 1,2, & 3)Bo41 ?9 TOTAL_CITY SDC s d 0.5 X 0.5 X 0.5 X X X X 4 NO. OF PFU'S bO X $13.62 PER PFU + $10 Mh,MC ADMIN. FEE (Use PFU Total From Item 2 Above) MI,,MC CREDIT IF APPLICABLE (SEE REVERSE) TOTAL-Mt,lMC SDC TOTAL SDC $ Wod;LY #ut1b \\ aLZ;l *tt tl Itslqs'l.L*1Lbot t5 Cr-t r tt t, q 5. SANITARY SEWER-Mt,lMC FIXTURE UNIT CALCUI-ATION TABLE: tlumuer of New Fixtures X unit Equivalent = Fixture Units (NOTE: For remodels, calculate only the NET additional fixtures) NUMBER OF UNIT FIXTURE FIXTURE TYPE NEW FIXTUHES EQUIVALENT UNITS Bathtub. Drinking Fountain. Floor Drain.. lnterceptors For Grease/Oil/Solids/Etc................, I nterceptors For Sand/Auto Wash/Etc.................. Laund ry Tub/Clotheswasher Z Clotheswasher - 3 Or More..-......... Mobile Home Park Trap (1 Per Trailer).........-........ Receptor For RefrigeratorAVater Station/Etc........ Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single Stall 2 1 2 3 b ? 6 o 1 3 2 1 2 2 .l t) 4 /Head Sink, Bar, Commercial Urinal, StallflVall.... Wash Basin/Lavatory, Single. Z --4- Water Closet, Public lnstallation.. l9 2+ Water Closet, Private..... Miscellaneous: TOTAL FIXTURE UNITS 5o CREDIT CALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table, calculate credits separates. ble Z'bb x $1r,q1 z1++2 t1 + Credit for Parcel or Land Only lf Applica lmprovement (if after annexation date) Residential....,.-.- (Rate X Assessed Value) X$ (Rate X Assessed Value) CREDIT TOTAL = $ RUNOFF COEFFICIENTS FOR STORM DRAINAGE a1+E Commercial 0.4 0.9 0.45 0.5lndustrial-...- Government a|..... - - - - -. -. -. " " " " Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value 1979 or before 't980 198'l 1982 1983 '1984 $2.83 2.76 2.71 2.60 2.46 2.33 1 985 1986 1 987 1 988 1 989 1 990 1991 $2.16 1.90 1.60 o.25 0.87 0.50 0.16 IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT I CITY OF SPRINGF.INLD APPLICATION AND AGREEMEM FOR SEWER HOOKUP Application is hereby made by the undersigned property owner for permission to connecE Ehc following described property to a city sanitary se!/er 1ine, ovrned and maintailed by the CiEy of Springfield, and I agree to pay such a hookup charge of $4.50 per front foot of Ehe property for the first 150 feet in depth to be served by such city server line in lieu of an assessment againsE the described property. An additional $0.03 per square foot will be charged for any additional property beyond the first 150 feet. ProperEy Description:Address: 19th &tQt Street Beginning at a point North 158.32 feet and West 40.0 feet from the Southwest corner of the FeLix Scott Jr. Donation Land Claim No. 51, Section 25, Township 17 South, Range 3 West of the WiLlamette Meridian; thence South LL4.93 feet to the Northerly margin of reLocated tQ' Street; thence along sald Northerly margln a1o18 the arc of a 368.31 foot radius currre left (the chord of which curve bears South 63" 10t 20tt West 201-.86 feet) a distance of 204.48 feet; thence Leaving said Northerly margin North 83.80 feet; thence East 27.00 feet; thence North L22.24 feet; thence East L53.1-2 feet to the ?OIM OF BEGINNING, in Lane County' Oregon. rRpIrK Sewer hookup charge:front feet @ $4.S0 per front foot = 25,284 square feet G $0.03 per sq. ft.$ 7s7.94 Ihis agreement has been computed as being one-haLf (\) of the equivalent cost of an eight (B) inch LateraL sanitary sesrer at the rate of $4.50 per abutEing front foot and does not include the cost of a house connection to said ciEy selJer, sewer user charges, plumbing permits or other such cosEs to be assumed by the property o!,,ner. TNGF TELD OR]IGON l7-+: RSC By: Dat e: STATB 0F OREGOI( ))ss County of Lane ) BE IT REMEMBIIRED, thar on rhis ZZ day of ,ilA,r c/-/. before nre, the undersigned, a Notary Public in and for the said Count personally appcared the rvithin named .t e. B/i, k ho.n- w 7.3, and State, knornrn to me to be the identical indi and acknowledg I^IITMSS my hand and seal this day lrra y".t lasE above written. ary Public ed to mJtnat __*!eu __ executed the same freely and voluntarily. 3^-A. aL \qtf My Conmission iixpircs tu@ , OREGOTU Ait, 225 FIFTII STRBEf, SPRTNGFTEU), OREGON 97477 INSPECf,ION RBQUESTz 726-3769 OFFICE: 726-3759 rr-]j.[1 1 OF Permits a transferable and explre if vork is not started wlthin 180 days of issuance or if vork ls suspended for 180 days. 2. COIITRACTOR INSTALI.ATION ONLY Electrical Contrac Addres ci Phone Supervisor cense Ndmber Expiration Date Constr Contr. Number Expiration Date 6/D q,L Signature of Supervi Blectrician Ovners Address Ci ty Pf,onu-J ALI.ATION The installatlon is being made on property I ovn which is not intended for sale,'Iease or rent. Ovners Signature: DATE:. RECEIPT APPLICATION COHPI^ETB IIEE SCTIEDULE BBLOV Residential-Single or t per dvelling unit. Service fncluded:Items Cost 1000 sq.ft. or Iess Each additional 500 sq. ft or portion t hereo f Each Hanuf'd Home or Modular DveIIing Service or Feeder s 8s.00 $ 1s.00 s 40.00 oi'izsd Signetl Sum LC) B Services or Feeders Installation, Alterations or Relocation: 200 amps or less 3- 201 amps to 400 amps 401 amps to 600 urps -i--601 amps to 1000 amps_ Over 1000 amps/volts $ 50.00 $ 60.00 $100.00 $130.00 s300.00 $ 40.00 @ = C. Temporary Services or Feeders Insta1lation, Alteration or Relocation 200 amps or less S 40.00 201. amps to 400 amps $ 55.00 0ver 600 amps or 1000 volts see I'B[ above p. Branch Circuits Nev, Alteration or Extension Per Pane1 One Circuit S 35.00 Each Acldi tional Circuit or with Service or Feeder Permi l S 2.00 ua E. Miseellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/OutIine Lighti Limi ted Energy/Res Limi ted Energy/Comm STIBTOTAL OP ABOVE 5Z State Surcharge TOTAL 00 00 00 00 40. 40. 20. 36. $ s $ s RECEIVED BY: 5 ng4-ru () :ftrtllNGl:IGLU \, %, 225 tr[.rtl sTRriril: SI'IIINGFIELD, OITI.:GON 97477 INSPSCTION REQUIIST | 726-3769 0FPICE: 7?.6-3759 ].. LOCATION OI' INSTALLATION BLACTI\ICt\L INTLIQ,N1ON City Job Number 3. COHPLBTB t'BB SCTIEDULB DBLOV Nev Residential-Single or HuIti-FamiIy per dvelling unit. Service fncluded: Items Cost 1000 sq.ft. or less Each adcli tlonal 500 sq. ft or portlon thereof Each Manuf 'd llome or -Modular Dvelling Service or Feeder $ Bs.0o $ 15.00 $ 40.00 B Services or Feedersfnstallatlon, Alterations or Relocation: a A LEGAL DESCRIPTIONlMr-z<-z?- 27=e> JOD DESCRITTTON7W Vnu^e, O:,frnARAt= tlspf_ Permits arc non-transferable ancl expirelf vork is not started vlthin 180 daysof issuance or if vork ls suspended for 180 days. 2. COI.NR.ACTOR INSTALL\TION ONLY Iilec t ri cal Con t rac to, &tcZZZ. €(ZZT. Add r.'ess Ci ty l'hone Supcrvisor License Ndmber Expiratiorr Date Constr Contr. Number Expiration Date Signature of Supcrvising Electrician Owners Name . Atld ress Ci ty . Plronr. $ s0.00 s 60.00 $100.00 $130.00 $300.00 $ 40.00 D. Branch Circui ts Nev, Alteration or Extenslon per panel 0ne Ci.rerr i 200 amps or less A201 anrps to 400 amps 401 amps to 600 amDs --601 amps to 1O0O "rps*over 1000 amps/voIt; -Reconnect Only Sum Serz e€, @ c Tempo-rary Services or Feedersrnstallarlon, Alrerari";-;;-;elocarion 200 amps or lest 201 ;;;; ;; ;il"^_-_ - $ 4o.oo over oo6 "ro""lr"l33o-*r," l"lo;fg "# Lc lidd i t ional ll. oo 0\tt'l[It lNsT,ur,ruoH ht i\Ntr[r\\un \s \e\ng made on Cir 0r cl.li t or vi th Service Feeder permi t 56 $ z.oo //2,g l'liscellaneous (Service/teeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Light i"sz- S 40.00 &"?* LimitedEnergy/Res - S20.00 E propert) I ovn vhich is not intended for sale, Iease or rent. 0vners Signature: 5 SUDTOTAL OT ABOVE 5f State Surcharge TOTAL DATE: RIICRIPT #,-.-_-__ I(IiCI.]IVTID I}Y: q.-- .:ffi ,l ElEtd-Xrcr,+t- ilaE-*: / / I /xs y'auar/ O*r**urt (our- @ 'Dg A*rrazeas Ezg-<zx)aiL PasrutT Fess Al{ Bnset uib*/ Asex t)tn<xnx-t /ttJ/) PtsNEu seuEl)al.Ei 45 P*gsgttT€b ai 77ta *l>Pk)vEl> Bt.tr-rpa;rs - 4AtusZ-tLtEo75 7-o TVtEt€ F€E:. eo7Ll BE tylhaEi Ensett> ttibN 77tE ht41u ' , )a/u*t_ iHSTt+LLArZo,4 @ -TUIS PA'LJ*.T tutu$'T- 2".2t'4)>.y' Lry7k tlLt- nrf naEs ot= T7/€ /.1?o N, E C, A*.1) 3Tt>"8 a)= oRE<c,N /lcto o ftuetTy' (aDf , (sfrurrzAtty' Not€ nxncr{ s-/7 aF N.EZ- ) +l **,!LI & 225 PIFTE STREEf, SPRINGFIEID, OREGON 97477 INSPECTI0N REQUESTz 726-3769 OFFICE: 726-3759 Signature' 1 OF Permi ts n-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2 CONTRACf,OR ONLY 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf 'd llome or Modular DweIling Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 Services or Feeders Installation, Alterations 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 Temporary Services or Feeders Installation, Alteration or RelocationI ).oo .1-l)200 amps or less t $ 4( 0ver 401 to 600 amps _ S 80.00 0ver 600 amps or 1000 volts see rrBrr above D. Branch Circuits Nev, Alteration or Extension Per Panel One Circuit S 35.00 Each A<ldi t ional Circui t or vi th Service or Feeder Permit S 2.00 land t'i50 ELECTRICAL PERHIT CATI City Job Nunber FEE SCTIEDULE BELOV Nev Residential-Single or MuIti-Family per dvelling unit. Service Included: I tems Cos t Miscellaneous ( Service/feeder -Each installation Pump or irrigation $ sign/outline Lighting- S Limi ted Energy/Res $ Limi ted Energy/Comm S ST'BTOTAL Ot' ABOVE 5f State Surcharge TOTAL eb Zoni \t-a A B Sum not included ) 40.00 40. o0 20. o0 Electrical Contract Address ci tt)alllL Phone Ovners Name Address Cl ty Phone OIINER INSTALI,ATION The installatlon is being made on property I own vhich is not intended for sa1e, Iease or rent. Ovners Signature: DATE: - RECEIPT $ s0.00 $ 60.00 s100.00 $130.00 $300.00 $ 40.00 ,uo"r;;, [r""n"" Ndmber Expiration Date iD tq3 Constr Contr. Numbe Expiration Date Signature of Supervis BIec clan c. E RECEIVED B 5 p