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Home My WebLink AboutPermit Building 2008-8-25 _~RINGI"IliU.O ''''"','-'',' ~ ~ CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO ISSUED APPLIED EXPIRES' VALUE: COM2008-0I198 08/25/2008 08/11/2008 02/25/2009 $ 49,560 00 225 FIfth Street, Spnngfield, OR 541~726-3753 Phone 541-726-3676 FJX 541-726-3769Inspeclloll Lme SITE ADDRESS 1166 S 39TH S r ASSESSOR'S PARCEL NO 1802064200107 Spnngfield TYPE OF WORK Smgle Family ReSIdence TYPE OF USE AddItIOn ReSldent..1 PROJECT DESCRIPTION ReSldenllal addltlOlI (\7\781:-1:88-009- ~ SI Jalua:) I _0":'....... ....., If" IElrtllJnU UUl~-e-;..Il!,~VI\l /tt'l'tll -- - - - " . 6 :) auoljdajal aljl aloN) JalUao aljl ullre ^q salnJ aljllo saldoo ulBlqo ^BW no), '0600 -100-(;96l:1110 lj6noJljl 0100-~00-1:96l:1110 U\ _ _ _.... .^~. .~r"\ "(,H''P.nl1I10~ 4~JU}ld" Q,lOj .........I"~ --- -1..... . ~ onOJ I CONTRACTOR INFORMJ\!1', \(~'lNEI vb aljl ^quPo8JedJOop~NsOall.l.n~;llV 'ltrr...L n aJMBI lJ LIcense ExpiratIOn Date Phone Owner Address LAWSON WAYNE R & JENNIFERJ 1166 S 39TH ST SPRINGFIELD OR 97477 Contractor Type Applicant ArchItect General Electncal Mechamcal Plumbmg Contractor OWNER PAT GREENWELL OWNER BOB FISHER ELECTRIC 1NC OWNER OWNER 3447274 96275 01/25/2010 541-689~ 7973 # of Umts Pnmary Occupancy Gronp Secondary Occupancy Group Pnmary ConstructIOn Type Secondary ConstructIOn Type # of Bedrooms 1 R3 '0011:l3d NJO DB ~ AN'V -~JnVr.""'3 BUILDING INFORMATION Il:IO~ a3NOUNVHlllVl:l~3IaONUn03Zll:l0Hi~'V J.u'N SI1IVIIl:l3d SI # of Stories )ll:IOM 31U ~ltlIil~ lTv'HS llVII1:l3d SIHl Height of Structure 1400 Sq Ft 1st Floor :3::11J.ON424 Type of Heat Electnc Sq Ft 2nd Floor Water Type Electnc Sq Ft Basement Range Type Electllc Sq Ft Garage/CJrport Energy Path Sq Ft Other Spnnkled Bulldmg No Occnpant Load VB 3 I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback SIde 1 Sethack SIde 2 Sethack Rearyard Sethack Solar Setbacks 1500 2330 2600 000 Overlay DlSt # SII eet Trees Rqd Paved Dnve Rqd % of Lot Coverage Total Hand,cJpped Compact 2073 I PUBLIC IMPROVEMENTS I Street Improvements Storm Sewer Available Speual lost! uetlOn Storm water to Lurb SIdewalk Type Downspouts/Drams Curb and Gutter Notes Paee 1 of 4 CITY OF SPRINGFIELD' Building/Combination Permit Status Iss u ed PERMIT NO ISSUED: APPLIED: EXPIRES' VALUE' COM2008-01198 08/25/2008 08/11 /2008 02/25/2009 $ 49,560 00 225 FIfth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme I Valuation DescrlOtlon I A C - ReSlden Dwellml!s Tvpe of ConstrnctlOn AC - ReSldent..1 V Wood Frdme $ Per Sq Ft or multlpher $500 $105 00 Square Footage or BId Amount 1,00800 424 00 Value Date Calculated Description Total Value of Project $5,040 00 $44,520 00 $49,560 00 08/11/2008 08/11/2008 L.F""< P~lrIJ Fee DescnptlOn Amount PaId Ddte PaId ReceIpt Nnmbel Plan RevIew ReSIdentIal $265 42 8/11/08 1200800000000000861 -Mech Iss 2+ Apphances- $42 00 8/25/08 2200800000000001291 + 10% AdmmlStrallve Fee $58 02 8/25/08 2200800000000001291 + 12% State Surcharge $67.08 8/25/08 2200800000000001291 + 5% Technology Fee $33 90 8/25/08 2200800000000001291 Bmldmg PermIt $422 03 8/25/08 2200800000000001291 Dryer Vent $800 8/25/08 2200800000000001291 FIre SF Fee. ReSldentldl $2120 8/25/08 2200800000000001291 FIXture $85 00 8/25/08 2200800000000001291 MIDlmum/AdJustment MechaDlcal $36 00 8/25/08 2200800000000001291 Plan ReVIew Mmor - PlanDlng $11900 8/25/08 2200800000000001291 SDC SaDltary/Storm Admm $799 8/25/08 2200800000000001291 Storm 01 311lagc ImpervlOuli Area $15982 8/25/08 2200800000000001291 Vent Fdn $800 8/25/08 2200800000000001291 Total Amount PaId $1,33346 I Plan ReViews I IDlllal ReVIew 08/12/2008 08/12/2008 APP NJM Pubhc WOI ks ReVIew 08/12/2008 08/15/2008 APP LKW Storm water to curb Plannm2 ReView 08/12/2008 08/20/2008 APP TAJ Structural ReVIew 08/12/2008 08/22/2008 APP CJC To Request an mspectIon call the 24 hour recordmg at 726-3769 All inspectIOns requested before 7'00 a m. WIll be made the same working day, mspectIons requested after 7'00 a.m. WIll be made the followmg work day Pal!e 2 of 4 CITY OF SPRINGFIELD ~ Building/Combination Permit Status Issued PERMIT NO: COM2008-01198 ISSUED: 08/25/2008 APPLIED- 08/II/2008 EXPIRES: 02/25/2009 VALUE- $ 49,560.00 225 FIfth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme Rp(\II.J{prll~ Footmg After trenches are excavated Foundallon After forms are erected hut pnor to concrete placement Post dnd Beam Pnor to tloor msulallon or deckmg Floor InsulatIOn Pnor to deckmg Shedr Wall Na"mg Belore covenng sheathmg wIth timsh matenals Frammg InspectIOn Pnor to cover dnd after all rough 10 mspectlOns have heen approved WalllnsulatlOn Pnor to cover Ce,lmg Insula lion Pnor to cover Hold Downs Installed Special InspectIOn performed pnor to placement of concrete ProvIde report to CII) BUlldmg Inspector Fmal BUlldmg After all reqUIred mspectlons have been requested and approved and the hUlldmg IS complete Penmeter FoundatIOn Drams After gravel and tilter cloth IS mstalled hut pnor to hacktill Undertloor Plnmbmg Pnor to msnlatlOn or deckmg Undertloor Dram Pnor to cover or placement of concrete Rongh Plumhmg Pnor to covel and mclndmg reqUIred testmg Water Lme Pnor to tilhng trench dnd mclndmg I eqUlred testmg Samtary Sewer Lme Pnor to tilhng trench and mclndmg reqUIred testmg Lme to Sepllc T dnk Pnol to tilhng trench and reqUIred testmg Storm Sewer Lme Pnor to tilhng trench Fmdl Plumbmg When all plnmhmg work IS complete Undertloor Mechdmcdl Pnol to IIIsnlatlOn or deckmg and mclndmg reqnlfed testmg Rough MechdDlcdl PrIor to Cover Fm,tl Mechnlllcal When all mechamcal work IS complete Rongh Electnc Pnor to Cover Fm,ll Electnc When all electncal work IS complete Page 3 of 4 Status Issued 225 FIfth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 In'pechon Lme CITY OF ~rKll~GFIELD Building/Combination Permit PERMIT NO: COM2008-01198 ISSUED. 08/25/2008 APPLIED. 08/1112008 EXPIRES. 02/25/2009 VALUE' $ 49,560.00 By SIgnature, I state and agree, that I have cdfefully examllled the completed appliCatIOn and do herehy cerhfy that all IDformatlOn hereon IS trne and correlt, and I further certIly that any and all work performed shall be done ID accordance WIth the 01 dmances of the CIty of Springfield and the Laws of the State of Oregon pertalDlDg to the work descnbed herem, and that NO OCCUPANCY will be made of any structure WIthout permISSIon of the Commumty ServIces DIVISIOn, BUlldmg Safety I lurther cerhfy that only contractors and employees who are m compliance WIth ORS 701 005 WIll be nsed on thIS project I further agree to ensure that all reqUIred mspectlOns are requested at the proper hme, that each address IS readahle from the street, that the permIt card IS located at the tront of the property, and the approved set of plans WIll remam on the SIte at all times durmg constru IOn 1 0 J{F\/\ _ Pa~e 4 of4 xl/) SiD';: Date [nstaller '?~J <}/ {AS L (Title as shawn Oil DE"Q uc.et'oSe) ~ Telephone c.,Sy. S(~~L. '" '" Gil LIcense # 3"l {9~ C; Bonding Company 0 ~:c G.:> _ ~/JnIJ~A/'2.- f'2'1.e~ (S'gna....,{ ",u) (Date) tf fnstaUed by O....ner- '" f-< ..J ." ~ (SlgRG1lJre of Owner) (Dote) :> Z w Name 6: Address of pe:rson(s) to receive. form I j) LO/-l) (0V'"l l! /;y S 3 '1-t:Jo <{()m.~J-leJrf W 97'177 . o u OJ Z ." ..J ~ ~VicINi:TY' -MAP~"'~'-~ au' _~aM ~~ on ." .- N '" '" ,.., ." '0 .... ." 0.. '" ,.., ..., ,.., '" '" o N "- ,.., ,.., "- =:=:=:=:=: a a III .. III MUST BE IN INK Permit # 5frJZ-l/o2 Twnshp I<;t; Range tJ2 SectlonO.6 '-/ Z. Tax Lot 14 Z Standard System V Alterootlv~ ?ystem Typp / Site Location (Street Address) //6b S 3'f7/i. .5T 5?'tf DETAIL SYSTEM S.LIt: PLAN (AS-BUILT*) S+V .uJ- 1(.,'-7 -t+CM.~ 'l 2.1' scale f\ '''''~G \)-~ rD.'! - Ex\>I-"Jk I L__I1<-::! _L/~~ Go' N FOR OFFICE USE ONLY I~ppraved COMMENTS .4.4;,,)~ d'LT. Not Approved J~~ -1 : N1 "ATTACH MATERIALS LIST Needs Corrected System CapacIty 3~ ..---. ~:-:"F{/..'" \."JI' .....,~d Date gal/day SIgnature (-,=j-:~orJ:. ./,,-; or-Date L-.1" ~ - .---., . / 75-~'7;> INST All.ATION RECORD & CERTIfICATE OF SATISFACTORY COMPLETION "he. s'gned by the County's Enylronmental Health Spe"allst ThiS certlfJCCl.te IS eVidence as per ooS 454 665 of SQtlsto.ctory ci:lmpletlon of Q subsurface sewage dlspo.sal.system at the above ICtrotlon To request InSpec.tlcn, re.turn thiS form and the Ma.terlalsust to iAne County land Management DIVlS1Clrl located In. the basement Clf 'the PublIC 5erVlce BUlld,ng 125 East 8~ A",,"ue, Eugene O~ 97401 f\fORM.S\As l3ul~t Form...::om 7l..(7 - $lt rL( APPLICANT'S COpy " ~\ , SEPTIC INST ALLA TION PERMIT SP087182 Parccls 18-02-06-42-00107 SIte: JASPERRD/S 39TH/l/2 Ml TO SITE 1166 S 39TH ST SPR Applicant ROWERS JEFF PO BOX 67 CRESWELL OR 97426 Owner' LAWSON WAYNE R & JENNIFER J 1166 S 39TH ST SPRINGFIELD OR 97477 Site Inspection Number' Worl, DeScription. RELOCATING A LINE FOR A PROPOSED ADDITION System Type: REPRMJR ,STD Issued Date. 06120/2008 Explrdtlon Date. 06/2012009 INSTALLATION REOUIREMENTS' Projected Dally Flow 0 gallons Dral!'fleld Size 0 feet SpeCIal CondItions Install as per submitted site plan Replacement area IS now limited Alternative treatment If future fallure occurs All DEQ setbacks and rules apply Call 682-3751 for inspectIOn Septic Tank Size 1000 gallons Trench Depth 30 In OTHER REOillREMENTS. 1 InstallatIOn of an effluent pump reqUIres and Electncal Permit 2 Install dtsposal trenches on contour The trench bottom shall be level Within a tolerance of plus or mmus one (l) Inch over the entlle trench length 3. Minimum of eight (8) mch fall from top of septic tank outlet to top of first header pipe leavmg D-box 4. New systems must meet set? reqwrements in Table I {2/4'~ --~ Jay ~:r:, Envlronmen1a1 Health SpeCialist 06/20/2008 Datc LANE COUNTY ON-SITE-SEW AGE OFFICE 125 E 8TH Avenue, Eugene OR 97401 PH (541) 682-3754 Fax (541) 682-3947 T d Ll7mTI7L 01 WOdj d9T ::::: <<- 20 8002-S2--:-~ . .-- 225 Fifth Street Sprmgfield, Oregon 97477 541-726-3759 Phone City of Sprmgfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008~0 1198 COM2008-01198 COM2008-01 ]98 COM2008~0 1198 COM2008~0 1198 COM2008-0 1198 COM2008~0 1198 COM2008-01198 COM2008-0 1198 COM2008~0 1198 COM2008-01198 COM2008-0 1198 COM2008~0 1198 Payments Type of Payment Check LRecelOtI RECEIPT #. 2200800000000001291 Date. 08/25/2008 DeslnptJon Fire SF Fee ~ Re'ldentml BUlldmg Permit Fixture Vent Fan Dryer Vent Mlmmum/AdJuslment Mechanical -Mech Iss 2+ Apphances- SDC SamtarylStorm Admm Storm Dramage ImpervIOus Area Plan Review Mmor - Plannmg + 5% Technology Fee + 12% State Surcharge + 10% Admmlstlatlve Fee PaId By JENNIFER LA WSON Item Total Check Number AuthoflZdtlOD Received By Batch Number Number How Received , CJC 1649 In Person Payment Total Page I of 1 2 57 09PM Amount Due 2120 422 03 8500 800 800 3600 4200 799 15982 11900 3390 6708 5802 $1,06804 Amount Paid $1,06804 $1,06804 8/25/2008 225 Fd'th Strect Sprmgfield, Oregon 97477 541-726-3759 Phone ~._,P~IN~Ft~ ,. , <., ' .....--:- *' ~ - City of Sprmgfield Official ReceIpt Development Servlccs Department Public Works Department RECEIPT #: 1200800000000000908 Date. 08/25/2008 10 59 15AM Job/Journal Number COM2007-00960 COM2007-00960 DescriptIOn FLS Safety Systems Review + 10% Admmlstrcltlve fee Payments Type of Payment Check P.,d By INTEGRAl ED ELECTRONICS Item Total Check Number AuthOrizatIOn Received By Batch Number Number How Received Amount Due 480 00 4800 $528 00 Amount Paid CJC 4826 In Person Payment Total $528 00 $528 00 \o...r/;)~ 1>~ ~ l.Rcccmtl Page 1 of 1 8/25/2008 ":1 II II Ii II II, Status Issued II 225 Fifth Street, Springlield, OR 541.726-3753 Phone " 541-726-3676 Fax 541-726-3769Inspeclion Line ~ . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-01l98 ISSUED: 08/25/2008 APPLIED: 08/11/2008 EXPIRES: 03/26/2009 VALUE: $ 49,560.00 " SITE ADDRESS: 1166 S 39TH ST ASSESSOR'S PARCEL NO,: 1802064200107 Springlield TYPE OF WORK: Single Family Residence " 'I PROJECT DESCRIPTION: Residential addition II , TYPE OF USE: Addition Residential Owner: Address: II LAWSON WAYNE R & JENNIFER J 1166 S 39TH st SPRINGFIELD OR 97477 II jr , , I, CONTRACTOR INFORMA,T10N , Contractor Type Applicant Architect General Electrical Mechanical Plumbing Contractor O~NER PAT GREENWELL ~:WNER BOB FISHER ELECTRIC INC " OWNER II qWNER License Expiration Date Phone 3447274 96275 01/25/2010' 541.689-7973 BUILDING INFORMATI~N' 3 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: I 14,00 Electric Electric Electric Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: SqFt Basement: Sq Ft Garage/Carport Sq Ft Olher: Occupanl Load: 424 # of Units: . Ii Primary Occupancy Group: I[ Secoudary Occupancy Group: Primary Construction TypJ " Secondary Conslruction Type: # of Bedrooms: I R3 VB No REQUIRED PARKING Front yard Setback: Overlay Dist: Total: . Side I Setback: 15,00 #Street Trees Rqd: Handicapped: to S'd 2 S b k d ,,",uiri~CI1I\res you I e et ac : 23,30 Pave Drive Rqd: ATTENTION' ()regon .,,,, pac" Utility Rearyard Setback: "26.00'" .'0/0 of Lot Coverage: follow rukOj 72jOpted bYsethr~I~~eir~~ettorth Solar Setbacks: 0,00 Notification Center. Tl10 hOAR 952-001- r'''TlnE - or' ~~<"tl'>rn'la ...J .v. 11 ~11 Uf\n 'O:JJt- v...,. -. ies 01 tne h.H'c.:.;) L,t THIS PERMIT ~,HALL EXPIRE ,.I I:.~~L,,~PROVEMENTSI)090., You may ~~::'I(~~fe: the te\epho~e StreetlmploYfl*-.~iIED UNDER THIS PERMIT IS NOT caISI1ieml\~l~egon Utility Notllicatlon Storm Se.feP,.\'V'lifl1\f.EO ciR IS ABANDONED FOR, nu~~:n8Ismh~q.332.23~~h) and Gutter S 'II' ,,'" ,l"~ DAY ",~n"""" peCla ~struchon:, r~,turw l!:',ater to curb I DEVELOPMENT INFORMATION I Notes: ... ":;,,;;,.,,~...;:;........,... i I' Pa~e I of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone JI 541-726-3676 Fax I! 541-726-3769 Inspection Li~e Description Tvpe of Construction II AC - Residential i V Wood Frame > 1~ II " A.C. - Residen Dwellines ~ , Fee Description ' II' Plan Review Residential !~ -Mech Iss 2+ Appliances- ,1 + 100/0 Administrative Fee:: + 12% State Surcharge + 5% Technology Fee Building Permit Dryer Vent Fire SF Fee - Residential Fixture Miuimum/Adjustment Mechanical Plan Review Miuor - Plan~ing SDC Sanitary/Storm Adm!n Storm Drainage Impervious Area Vent Fan + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Add, Alter, Extend Circ EA Add Perm Serv/Fdr 200 amps 0'1' less i! " Total Amount P~id Initial Review 08/12/2008 Public Works Review 08/12/2008 Plan nine: Review 08/12/2008 Structural Review 08/12/2008 CITY OF SPRlr~\Jl'lELD Building/Combination Permit PERMIT NO: COM2008-01198 ISSUED: 08/2512008 APPLIED: 08/11/2008 EXPIRES: 03/26/2009 VALUE: $ 49,560.00 I, Valuation Deserintion I $ Per Sq Ft or multiplier $5.00 $105,00 Square Footage or Bid Amount 1,008.00 424,00 Value Date Calculated $5,040,00 $44,520,00 $49,560,00 08/11/2008 08/1112008 Total Value of Project F"p<, P",irl J Amount Paid $265.42 $42.00 $58.02 $67.08 $33,90 $422,03 $8,00 $21.20 $85.00 $36,00 $119,00 $7,99 $159,82 $8,00 $14.80 $17.76 $7.40 $75.00 $73.00 $1,521.42 Date Paid Receipt Number 8/11108 8/25/08 8/25108 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 8/25/08 10/23/08 10/23/08 10/23/08 10/23/08 10/23/08 1200800000000000861 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001291 2200800000000001550 2200800000000001550 2200800000000001550 2200800000000001550 2200800000000001550 I Plan Reviews ., 08112/2008 08/15/2008 08/20/2008 08/22/2008 APP NJM APP LKW Storm water to curb APP TAJ APP CJC Paee 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit Ii Status Issued !i " 225 Fifth Street, Springfield, OR 1 541-726-3753 Phone II 541-726.3676 Fax , !I 541-726-3769 Inspection Lihe 1! PERMIT NO: COM2008-01198 ISSUED: 08/25/2008 APPLIED: 08/11/2008 EXPIRES: 03/26/2009 VALUE: $ 49,560,00 II To Request an inspecti?n call the 24 hour recording at 726-3769, All inspections requested before 7:00 a.m, will be made the srme working day, inspections requested after 7:00 a,m. will be made the following work day." .. 'I il RrrrwirPrl T\I~'1r,r~tlr~ Footing: After tren~hes are excavated, , 1" Foundation: After forms are erected but prior to concrete placement. , I Post and Beam: Prior to 1100r insulation or decking, , I Floor Insulation: Prior to decking. 11 Shear Wall Nailing: iiBefore covering sheathing with finish materials, Framing Inspection:'! Prior to cover and after all rough in inspections have been approved, 11 Wall Insulation: Pri~r to cover. . Ceiling Insulation: ~rior to cover. Hold Downs InstallelI: Special Inspection performed prior to placement of concrete, Provide report to City Building Inspector, :1 " . . l .Final Building: After all required inspections,have been reqnested and approved and the building is complete. r - . , ' Perimeter Foundation Drains: After gravel and tilter cloth is installed but prior to backfill, I' ' ' UnderI100r'Plumbin~: Prior to insulation or decking, ' i! Underfloor Drain: f>>rior to cover or placement of concrete. , \ Rough Plumhing: Prior to cover and including required testing. Water Line: Prior t~ tilling trench and including required testing. I! Sanitary Sewer Line:,: Prior to filling trench and including required- testing. Line to Septic Tank:, Prior to filling trench and required testing. I, Storm Sewer Line: Prior to filling trench, il Final Plumbing: Wheu all plumbing work is complete, Underl100r Mechanical. Prior to insulation or decking aud including required testing, ~I Rough Mechanical: ,Prior to Cover ~I Final Mechanical: When all mechanical work is complete, il . Rough Electric: Prii'r to Cover Final Electric: When all electrical work is complete, Page 3 of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-01I98 ISSUED: 08/25/2008 APPLIED: 08/IVio08 EXPIRES: 03/26/2009 VALUE: $ 49,560,00 225 Fifth Street, Springfiel~, OR 541-726-3753 Phone 541-726-3676 Fax I 541-726-3769 Inspection Li~e if By signatnre, 1 state and ag'~ee, 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 anil the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY wil'l be made of any structure withoot permission of the Community Services Division, Building Safety, 1 further certify that only c~ntractors ,md employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure th~t all required inspections are requested at the proper time, that each address is readable from the street, that the permit card iis located at the front of the property, and the approved set of plans will remain on the site at all times during construction,il . '- ,,1j? :1:,.1\-'711 12 ,~j/5U d' 'F'A"'~ Owner or Contractors Signature 1 , / () - '2.. 3-oQ Date Pace 4 of 4 Ii . s!:~= ~ ~~~~ ~ ~ DATE'\Q-2...",->-c:l6: ~ ' SOUR~{)0I\/7) . , Date \ il\ 1.),\ Or{ . '" CITY OF ,SPRThfGFIELD, OREGON . . " 225 FIFTH STREET. SPRINGFIELD, OR 97477,' PH:(541)726-J75J . FA){, (541)726-J689 " ELECTRICAL PERMIT APPLICATION City Job Nulnber f.oN\ (ro Ok 0 I \ Cl ~ . New Alteration or ,Extension Per Panel On C. , '. '$'50'0"0' to e lTC~t . ()rpgor \';l.t,N reoul " ; ,'",. Each AdditiAiGiJui\-1\lit~Ar with d by IIC"" r~re9on \),\I,"Y S . 'lfo"""""'m" 7 aou\-,,9/' ,. $'5'00'i fortll ervIce or txlUW r T1"'...... -.,,(.>S .. , Not'lf'\cation enter. ,--' ,"' r'.,V" ',r.!'.l!Ul' _ ^"~r'o~hr("\!I,,i,-,.,n......- E. lm~'figfr~~~~'~~'fi1ia~:i~~m~~I~lIiifion/ '4 "'''''''''i. ' jf ,,'r" '-"'""~.' ". ",' . .....,.j\'>.t,.,<;%l"'j _ _'" .,.,.It",", '~'-;ir .' .~Iiing the center. \ \J;il;~y:':~;;il;cation , Phone Pump or lITl Rfuer for ,the Oreqon . ,,$ 57.0u NOT! C E: SigIilOutline ~ghtin!Center is 1.8UU-""",.,,~457:00 . OWNER INST#iffi\rr!~~lIT SHALL EXPIRE IF THE WOR~imited EnergylResidential ,$ 29.00 The installation iSi]l~iiig)!ii~l9d.p.(OJ%f\Y"l%~<iIIIT IS NO}imited Energy/Commercial $ 52,00 is not intended f~('IWI;,j~E~ee~ IS ABANDONED FOWliimum Electric Permit Iuspection Fee is $52.00 + Surcharges Own S. ANY 180' DAY PERIOD, 4. Il1swmT.oR1!lH'ai?ElIliIII..!)l!l!.,"i!ilM, ,Pl,,-rll'lii~ ILl" OJ ers 19natute. p.;;~'cw;,h~;l't''''''''''''~'''''''"c'O~~"<1f~''%iG"'",,d*i;,tfK0!Dii@>~W~~~i.l!1l~ t) 12% State Surcharge ' Il, ll" 10% Administrative Fee I L/ \W 5% Technology Fee 1, Lj 6 " 1 ~t...~-:GA"'."~U"'''''''.O'-';~i)~:::,:::,:,..,.,.:,::...:-;'~Jl~i;1iiJ!f&.)~O-'";i7!i$l!il-W:JI!II'~''":"!ll'~if~. ' "'-' H'~.lhl1"i:>~"'''u:<,'''''' .::,' . ,. ' "","""""''''''~,.",.''~~,~", _"""'~"""",l!IIh' ,'. T '-. .~, ,l,Cj-lli ;:;+ 1\ \d1 LEGAL DESCRIPTION:!I 'I). .' \ "(.,, \<:JLALr ,\ Yi\-f o. I: JOB DESCRIPTION: mC\""TIA'lV\ I \'(tY.-rJ.../ "'+ 2-- CJO \: 0 I Permits are nou-transfefuble and expire if work is not started within 180'd~ys of issuance or if work is . , Snspended for 180 days. ii 1"""t\!'h"'iWi~ffi:'i;:t." r,:::x"".'''''.-'''(jr<::nw>1.w;rii;;, ""';i,"''''![:,~Jllf~,((il'''''d''!'''''''*iw%''','~~':I:.~~I. eol!-lmR7A(Jli.fjl(f1NSrr,,~:iPNrOl''''Ij;t{;r _2.. %""""",l!'!lI~t~I""'''''''','''':iIDih'':;iiL;;;;'lS:%";~r'1?Ji!;'''?'",WIi''k''ltM!\'''Jjl'SPM'lh'x;sjkf;""""""ii"',. s", Electrical Contractor 8." F'J h ~ ,C Address t.~() fu~~ ~ ~ rl--<--- City !; Lx'.. -L._ . Phone G;,.li'S 7'77? I Supervisor License Numb~r -;;;, 7 '7 <\ S , IL..:"~;:on Date Ii Ih-:n r - /b 'I /'1 Constr. Contr. Number', -I (., ""L- 7 e;- II 10-: 0\- IV' Ii Signature of Supervising Electrician Ii ' "O~ru.d-P-fJ! --4l-e- Expiration Date Owners Name \'()CUkY\ 0 \ fU,1 1"''''''' lJll Address ',- City ,Inspection Request: 72673769 3. 1~l!i!iijlit~l~Bi~tL~T!.8I1II11 A ;~~'1:R~idr:tSif~si~~~I~]~~1Mli~F-=iY~~imlr~mif~1f~~ ~."ifu1""""'~",";"'~"""-",""0""'id~~....""g:g";,^,,-,,,~;c.0_'".",";..,,,,,,.,.YiliE.t't"""""_'~'0_..,...g,,);,,,,,,-.~ Service Inclnded 1000 sq, ft. or less Each additional 500 sq, ft. or portion thereof . Each Manufact' d' Home or Modular Dwelling Service or Feeder $12Loo $ 22,00 $57.00 1mi$i1IY~t}0";!iiM~r:!tF":~~mii!Jfui~;l8i1%\1t.?'ti0fra'H~mtltit;I'lI1&~!"il'''F~M;$'i'~.'!\!1~Wilk~#&'S ''''0 ". .'r4il'~ B. ~'S~ia".o'r,Eee""rs:""InscillatioID'(Uel:lltions'lll'~ el1l6ltioii:%'Ill!' ~j~''''!!.iJ4:.'((hi'T:B<=",''!''''''1<di)i~)<;<i:*''t~~-1)illq"OC'",S".w'''"'''_'.i'jmi$'!~~01fi1iH;bf;~'Iiii";;';-"1"",""",l'"",l'l,,,;,$ 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to I 000 Amps Over 1000 Amps/V olts Reconnect Only I $ 73,00 $ 86,00 $143,00 $186,00 $426,00 $ 57,00 Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 D, $ 57.00 $ 79,00 $114,00 TOTAL 11\'l.QlR Shared Drive(T:)IBuilding Fonns/Electrical Permit Applicatioo H8,doc City of Springfield Official Receipt Development Services Department Public Works Department 225 Fifth Street . Spi-irigfield, Oregon 97477 541-726~3759 Phone Ii Job/Journal Number COM2008-0 1198 COM2008-0 1198 COM2008-0 1198 COM2008.0 1198 COM2008-0 1198 Payments: Type of Payment CreditCard cReceintl 1 ~CEIPT #: Date: 10/23/2008 2:56:06PM 2200800000000001550 Description Penn Serv/Fdr 200 amps or less Add, ~Iter, Extend Circ Ea Add ,C + 5%'i:Technology Fee + ] 2'-:" State Surcharge + 10% Administrative Fee Ii Amount Due 73,00 75.00 7.40 17,76 14,80 $IM7,96 il Paid By I ,I ROBERT 0 FISHER t Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid kr 032575 In Person Payment Total: $187.96 $IM7.96 Pal(e I of I 10/23/2008