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Home My WebLink AboutPermit Building 2009-7-6 CITY, OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00708 ISSUED: 07/06/2009 APPLIED: OS/21/2009 EXPIRES: 01/06/2010 VALUE: $ 191,914.30 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1242 W Qninalt St ASSESSOR'S PARCEL NO.: 1703273106800 Springfield TYPE OF WORK: Single Family Residence PROJECT DESCRIPTION: Single Family Residence TYPE OF USE:. New Residential Owner: Address: CHRISTOPHER & STEPHANIE BEECK PO BOX 11621 EUGENE OR 97440 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor EQUITY HOME BUILDERS, LLC DML ELECTRIC, INC CROWN HEATING LLC NORTHWEST MECHANICAL LLC License 176016 161264 171074 186277 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Constrnction Type: # of Bedrooms: 1 R-3 # of Stories: 2 Height of Structure .25.50 Type of Heat: orced Air Electric Water Type: Electric Range Type: Electric Energy Path: Sprinkled Building:. No VB 3 J DEVELOPMENT INFORMATION I .18.50 Overlay Dist: 10.00 # Street Trees Rqd: 10.00 Paved Drive Rqd: 96.50 % of Lot Coverage: 70.75 . you to ~ 1"..1 rpC1UweS .... c1\,rr:l0N. VI v'::)""'" .... -~"'" ,,,,,., Subdivision Not lfcdepted, adopted by tht[,PUBLIC,/MPJWVEMENTS, !olloW ru es Those I , 'u ,- Street Improvements: ation centeoL'F '11"1. ,nn OARd 95~-U by lW,""-;" 9~" 001-0 ' u y- mprove e rules . ~ !\.~\ Ot:.~ . COpies 1..11 III Storm Sewer AViiilalile'r U may obtain , \\1eYl~,ephone Speciallnstructllfn90\'I. gO tStorm'watel,tt\Q1~rb \\,ia ~eep,h6lf\ ca 10 \\'-'''' e on Ull\l\, " ~ , . . mber 10f the.?~ ~n _332-2344). Notes: SubdlvlSiIA\ lias 8~(1been'aecep~ed Frontyard Sethack: Side 1 Setback: Side.2 Setback: . Rearyard Setback: Solar Setbacks: Phone Number: 541-517-2483 " Expiration Date 05/04/20 II 08/27/2010 07/1112010 04/10/2011 Phone 541-382-0803 541-923-9897 541-420-3307 541-504-1988 Lot Size,: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: OccupaM Load: 9,025 1,017 785 462 REQUIRED PARK[NG 2 Yes [3.80 Total: , Handicappcd: Compact: 2 Sidewalk Type: Downspouts/Drains: ,.. ....":""'~... r"" ',. ';"';:: Cnrbside 7' Curb and Gntter ii-:iS PERMIT SHALL EXPIRE IF THE WORK AU fHORIZED UNDER THIS PERMIT IS NOT COMMENCEO OR is ABANDON-ED FOR ANY 180 DAY PERiOD, Pa2e 1 of 4 _~!il~!l:\!~F;t@:~: , ~ii .11I' . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Description Tvpe of Construction Garaee/Misc SF/Dnplex U VB Utilitv R-3 VB 1&2 Familv Fee Description Plan Review Residential + 12% State Surcharge + 5% Technology Fee 1st Appliance 3 Baths One & Two Family Addressing Assignment Building Permit Curbcut Permit Dryer Vent Exhanst Hoods Fire SF Fee - Residential Fireplace (Listed) Gas Outlets 1-4 Heat Pump Plan Review Major - Planning PW Disc - 2nd Permit 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 SanitarylStorm Admin SDC Tran Reimburs-Residential SDC Trans Improvement-Resident SDC Transportation Admin Sidewalk Permit Storm Drainage Impervions Area Temp Power. 200 amps or less Vent Fan Willamalane Single Family Total Amount Paid I Valli Ition Descrintion I .1111 n $Per Sq Ft or mnltiplier $37.72 $96.83 Sqnare Footage or Bid Amonnt 462.00 1,802.00 Total Valne of Project Ff-'P:~ P':)\IiLJ Amount Paid $704m $232.58 $114.76 $79.00 $402.00 $38.00 $1,083.19 $88.00 $9.00 $13.00 $113.20 $20.00 $7.00 $17.00 . $211.00 $-30.00 $134.00 $75.00 $546.95 $719.29 $10.00 $1,009.17 $97.90 $128.04 $201.54 $888.98 $75.19 $88.00 $590.77 $63.00 $36.00 $2,858.00 $10,623.63 Date Paid 5/21/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 7/6/09 Paee 2 of 4 CITY. OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00708 ISSUED: 07/06/2009 APPLIED: OS/2112009 EXPIRES: 01106/2010 VALUE: . $ ']9],9]4.30 Valne: Date Calculated $17,42Ci.64 $174,487.66 $191,91~.30 OS/21/2009 05/21/2009 Receil1t Number 2200900000000000545 120~900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 1200900000000000774 Status Iss u ed CITY OF SPRINGl'u,LD Building/Combination Permit PERMIT NO: COM2009-00708 ISSUED: 07/06/2009' APPLIED: OS/21/2009 EXPIRES: 01/06/2010 VALUE: $191,914.30 225 Fifth Street, Springfield, OR 541-726-3753 Phone ' 541-726-3676 Fax 541-726-3769 Inspection Line I Plan Reviews , Structural Review OS/26/2009 Initial Review OS/22/2009 OS/26/2009 APP LLH Public Works Review OS/26/2009 OS/28/2009 WI LKW Structural Review OS/29/2009 OS/29/2009 WI KLK Public Works Review 06/22/2009 06/22/2009 APP LKW Storm water to cnrb via weep hole Plannine Review. OS/26/2009 06/26/2009 APP DDK Approved as shown on plans, Structural Review 07/02/2009 07/02/2009 APP KLK To Request an inspection call the 24 hour recording at 726-3769. All inspections 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. . ~e(JlliredJn~nection"'l Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Cnrbcut - Standard:. After forms are erected but prior to placement of concrete. Sidewalk - Cnrbside: After forms are erected but prior to placement of concrete. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspcction in conjnnction!with footing and/or 'oundation inspection. Footing: After trenches are excavated. Foundation: After forms arc erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. FlooiInsulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have bee~ approved: Wall Insulation: Prior to cover. Ceiling Insnlation: Prior to cover. Drywall: Prior to taping. Underground Plumbing: Prior to filling the trench and including required testing. Perimeter Foundation Drains: After gravel and tilter cloth is installed but prior to backfill. Paee 3 of 4 _~"~'~!3Y;lliIIqk & .'.', . . ,. . . ,. ,4' 'l CITY OF SPRINGFIELD Building/Combination Permit Status Iss u ed PERMIT NO: COM2009-00708 ISSUED: 07/06/2009 APPLIED: OS/21/2009 EXPIRES:. 01/0612010 VALUE: $ 191,914.30 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 reqnired testing.. Sanitary Sewer Line: Prior to filling trench and including reqnired 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 reqnired testing. "1 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 ap~liance. 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 Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Underground Electric: Prior to,cover Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is coinplete. Final Building: After all required inspections have been requested and approved and the building is complete. By signature, 1 state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 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 w~rk described hereio, and that NO OCCUPANCY will be made of any structnre withont permission of the Commnnity.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 tim;:;~ c?;;) 7AIoq otlr or Contractors Signature Da{e I Paee 4 of 4 .'~...;. '.-' 225 Fifth Street+Springfield, OR 97477+PH(541)726.3753+FAX(541)726-3689 I Permit no.: l ']1-1ct> I Date: Electrical Permit Application This permit is issued nnder OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. . \ 201 to 400 amps (2) 401 to 600 amps (2) 601 to 1,000 amps (2) Over 1,000 amps or volts (2) Reconnect only (2) $ 81.00 $ 95.00 $158.00 $205.00 $469.00 $ 63.00 \ \ , I \.., I (A) Enler subtotal of above fees I. (Minimum Permit Fee $58,00) .. 1 (B) Enter 12%surcharge(.12x [A]) .. 1 I (e) Teclmology Fee (5% of [A]) .1 r TOTAl; fees and surcharges (A through C): I '~!l~ $~.td\ . $1~{Jd . ~a,Is5.2.41 440.2584.] (9/0S/COM) ~ .~ WiUamalane t . Park & Recreation District Job. No. (1q -1Le SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR2009 NAME: ~\\'{\~3n~er~~~j MC-l4HONE: ~\1~1)~4-8~ ADDRESS:QO ~ \\ \Qt\ CITY rl~~ STATEm..,ZIP: ct1+\1) LOCATION OF PROPOSED BUILDING SITE: Street Address: 12..4'L 0 QO i (VAt Plat Name: (~uiM.1+-.. Tax Lot Number: 1'7tJ6'J.lo I D&'lsa:) 1. DEVELOPMENr TYPE (Check appropriate dwelling(s). [Melling type definitions are on the back.) . A. Sinale-Familv Detached . . NO. OF UNITS \ B. Sinale-Familv Attached NO. OF UNITS X $2,858 p.er unit =, $ J8.~.<<J X $3,100 per unit = $' C. Multi-Familv Aoartment NO. OF UNITS X $2,641. per unit = $' D. Sinale Room Occuoancv NO. OF UNITS X $1 ;321 per unit = $, E. Accessorv Dwellina Unit NO. OF UNITS X $1,550 per unit = $' $)Jj~{XJ @ WILLAMALANE SDC 2. .SDC CREDIT (If applicable) SDC payer must furnish proof of Willamalane Credit approvaL) $ 3. TOTAL WILLAMALANE NET SDC ASSESSED . (if SDC reduced for Credit) ~\ ~!tf)or2__._. . Developm"e~~be"art;;;nt City of Springfield . $ ~.oCJ . ~ {o,_~i1P\ Date '. 5 , , I -r::-;' Structural Permit Application - 225 Fifth Street. Springfield, OR 97477. P,H(54 1)726-3753 . FAX(541)726-3689 l~gf~~r3j'~"~~"!lY~f?~tq~~Y~\i Perll)itno.: C'( - ~ I Date: 5 - 2-J. --ecr This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is . snspended for 180 days. 1~~\::"~J~~f;~4;!~J;_~Q:G,A~G~9ygRNM~!-It~t:?\:R:eBQ'YA4~r1:7t~!~~::~k1{1 I T~jsproject has final land-use approval. I Signature: Date: I T~is project has DEQ approval. I Signature: Date: I (a) Job description: /JfJ,u ~ \ I Zoning approval verified: DYes D.Na I I Occupancy - \J I Property is within flood plain: DYes D No I I Construction type: I Squarefeet: 19. t-, z. 1...~....}.>'l,.,,~~...,~~.,~.~.,~~a.,l., "'~"'~..' ,) .,~D..,,~~,?,?_~,:m.,,__,~,~~. t~..,~..,... J. ..'g.... ,.~~l11ill. ._ _:~.~i~~ffi"'\%~lr I Cost per square foot: '.;',j,'i'!lCMJ()B+SITE:,INfiO~N1'" !IO,N,i""IIIDi!U()C"'IION;;.~'Jf;;. I Other information: I Job site addre:s \ '2.. ~ 'Z... \,.,)eb\" Ell ~\@\+ fW e. I I Type of Heat: I city:<;,\>n_l"a.~\e~\r\ I State: 0v.. l ZIP: I I Energy Path: I SUbdlvlslOn:~ I L!l.tPO.iJ.) I I D D . ~ new alteratIOn D ad~ition I Reference: I' f1...I).1 Taxlot: VIP. I . . I "(:~;J,.'J<-":')'>Ja'G,t.,.-",.f e-k\i.;~~'inR".'..O'-o....E-'..R'.. Tv.""'.iJ":O~"'-..".N;~E' R.....'.0F.:-J4'.ih;(>'"-'tifi']J~~(""'~.;'fi0.,.+jfLl'.1 I (b) FoundatIOn-only penUlt? 0 Yes DNa 1~::'~Y.~~~~~e;':~~~'1:;.~~4t~;r I Total valuation: I Address: 'V<"I 1Z,O)(. \ \ \o'L\ :h I . ,-..,.., """,.0 I a~ I'" (a) Permit fee (use valuation table): City: \ l......~ State: \'- ZIP:-. . . I Phone 5.ft>~ nli--2Y~Fax . II (b) Investlgal1ve fee.(eqUal to [2a]): I .. . I (c) Reinspection ($ per hour): E.mall: (nwnber of hours x fee per hour) This installation is bein? made. on resi~ential 0: fann property ~wne~ by' I (d) Enter 12% surchar e (.12 x [2a+2b+2c]): me or a member of my Immediate family, and IS exempt from hcensmg g, requirements underORS 701.010. . (c) Subtotal of fees above (2a through 2d): $ I I I I I I I I I I I I I I I I $ $ $ I $ I $ ~ Sign here: 1;~~}{!~~i~~t[CONf~~~jt~:),B~JN~fgM:~~TfQ:N~~W(~l11~lt~:-t~~1 I Business namc: cQ()1:N . \\i::m.~ 0)\ \d e.ts.UCL I Address \l?-'~ KSbJ u'5\l~ht"l"~St-PJ' I I City ~V'Cl' State: I?F- 1_ ZIP:~II .. 0 . _ I Phone,8J-1 -^<f::i2....CfJ;..l'J~ Fax:ffil -3~3, -1~L5 I I (a) SOlsnllc fee, 1 Vo(.OI x permll fee [2a]): $ , \ I E-mad'.Cl..M'( c:..ctj)i~ e._,)f'i\d\"l'"C\o.db:u'\d.~ TOTAL fees and surcharges (2e+3c+4a), $ '-! l CCB license nn.: I :::H..ootLo I - r Printnamc: ~_ plNt~ L I I Signatur '// I I (a) Plan review (65% x permit fee [2a]): I (b) Fire and life safety (40% x permit 'fee [2a]): I (e) Subtotal offees above (3a and 3b): 1:~Bt I $ ~~0~ \1--;'- \ . \0 ti<...-:-- 7- '1tr0 ~ gs.s . f& .... I Name I Electrical I Plumbing I Mechanical ~.i:l,!,:()NTRAC;J()~iltlF,()BM"'JI()III;;,i!!ii:l1:'"tl1i\i1!;1iJil1 \~~il:::;umher 1e4~~Oq\t;I:~~~~ I ~(Q z..~-:r- I ~l-~15-~4'f23I L ~ I D";fLt 15l L -4z.o- 350-:rj A !. -"'~. :I. ~i'\ Plum bing Permit Application I ,OgP{.RT'1'ENTUSE ONLY .1 Permit no:: Cf - ~ I Date: This permit is issued under OAR 918-780~0060. Permits are issued only to the person or contractor doing the work. Permits expireifw~rk is not started within 180 days ofissuance or if work is suspended for 180 days. I - - . LOCAL-GOVERNMEN1;.'APPROVALI Zoning approval verified? 0 Yes 0 No I I Sanitation approval verified? 0 Yes 0 No I ICATEGORY,:OF.CONSTRUCTION',; - ..1 I 0 Residential I 0 Government I OCommercial I I --JOBi'SITE,-INF:ORMATION[.ANO..UOCATION. J I Job site address: L1... Y 1. IA)est'f~.lJlf)a I +- ttVe- City:<2':f'rLYlQfvp1d I State: b1[I ZIP: Subdivision:C~) lW'tA.-11- I.Lot no.: 1.... I I: ,':, 'if' ;:~} .-.~..,;~:X:-:;;:DESCRI ~JION~:OF.f:;WORK~;-i~~.;I~"'_~D'lc~:o/<:::4j~~ :t~2:f\S~~r;~Wl- ~f~\f~ : . m. ,. PROPER'~. OWNER" p.,".-. .. ., . ',-.~" ",-,,,.~,.,,,; - " 'li~Iij _ _ ~:"X.!f"~".L';:::';J;, I Name C-1\rl~tn\)lt1V~Iiit1{.LStLLlh::l (] if: Vi'.(' l4.. I Address'tb b6X \\LQ1,,\ _' - - l City: Fi.)qen t', -l-St~te ~ I zlP:9.-=t4LlD Phone:fJ4'\' -: f> 1i--2J/91:J Fax: E-mail: This installation is being made on residential or farm property owned by me or a member afmy immediate family, and is exempt from licensing requirements under OAR 918-695-0020. Signature: 1 ".C ONT. .RA. .CTOR~INSTA"L:;A. TION'" .;.',-,rV'.,A' .:1 '. ,';'" _, ;, L,;, ,',il.,"''''.~ ,,-, 0,..&"1-< ,.... I Business name N \0 l'Ile.c11a,o}('al. LU'- I I Address:'l/5 ~}1')imr;r>t.J~ r;;rt" '2 D J I I City:(hf'dff'lfrlli I Stat;--~ .1 ZIP:c::rr~ -. I Phone'Y-II-8/S-fliffb.2, I Fax: fI-I/-50Q-bffb \ I E-mail:il)nl~Y~lltt(<)hr$mOJL.(' \; I CCB lic'!!nse no.: 1%1..:::r-=l-l BcD license no.: I Plumbing license no.: ., I I Print name:'3(yO(M I.( .u,tcliCV I I Signatur(' 1/~'U1f.J' /\ I VV IV ~~ .225 Fin't;. Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 I. ; \! . 440-2500-J (11108/COM) I.". . "'C. }:.F:EE' SCHEOULE- 1 1,.'D.~~;;rii>~o~>;. .. .,-, .16ty.1 Cost Total 1 ea. . cost I New residential I I bathroom!l kitchen (includes: first 100 feet of water/sewer lines, hose $238.00 $ bibs, ice maker, unde!jloor low-point' drains and rain:'drain packages) . 2 bathrooms/} kitchen $374.00 I $ I 3 bathrooms!l kitchen $439.00 1 $ 1 Each additional bathroom (over 3) $95.00 1 $ 1 Each additional kitchen (over 1) $95.00 1 $ 1 Residential fire sDrinklers (includes!olan review) I o to 2,000 square feet I $58.00 $ I 2,00lto 3,600 square feet $115.00 $ 1 3,601 to 7,200 square feet $174.00 .> I 7,201 square feet and greater $232.00 $ I Manufactured dwellin20r pre-fab (circle one) I I Connections to building sewer and , I $58.00 , $ I water supply I Commenial, industrial, and dwclJin"gs other than one- or I two-family I Minimum fee I I $58.00 I $ 1 I Each fixture $19.00 $ 1 I Miscellaneous fees I I 100' storm, sewer, water line $76.00 I $ I 'I Each fixture, appurtenance, and piping $19.00 $' I I Storm water retention/detention facility $19.00 I $ 1 I Irrigation systems $19.00 $ 1 I Piping or private-stann drainage " $19.00 $ I svstems exceeding the first 100 feet 1 Specialty fixtures $19.00 $ I ) Reinspection (no. ofhrs, x fee per hr.) $58.00 $ 1 I SP~cial requested inspections (no. of " $58.00 $ hrs. x fee per hr.) I Each additional inspection: (I) $58.00 $ I 'Medic~al'~({as :pii,fiigi;:;;t(--(, .; ~i ~<I Minimum fee $ I Enter value of installation and equipment $_, I Enter tee based on installation and equipment value. I (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Investigative fee (equal to [A]) 1 (e) Enter 12% surcharge (.12 x [A+B]) I (D) Technology Fee (5% of [A]) I TOTAL fees and surcharges (A through D): $ $ $ $ $ j .~r~ '. ' Mechanical Permit Application I. DEPARTMENT USE ONLY I . COM'~- Permit no'.: ~~ I Date: This permit is issued under OAR 918-'440-0050. Permits expire if work is not started within 180 days ofissuance or if work i,s suspended for 180 days. 1 . CATEGORY OF CONSTRUCTION , . ,~ 'I r @.esidential i 0 Government I 0 Commercial I 1 .JOB SITE'INFORMA'fIOI'l,AND; LOC.~TION',..". \.1 " I Job site address: \ 'Z....~ 2.. \. )e::,-\- ~dN:..\ ~ ~~ 1 \) II ~~~~i~~.5;.\.~~ I State: o. .~. LO~ ;:~2~,. : . . Di:SCRIPTION,.OF. .wO~K.i. ..: _,I 1~~~tlym,~I~le~ I, .;", . ~.c'.~' "~PR0F1ERTY.f6WNER'f'4;;;\f'~. I Name(lkismDhofr:<t(pJ1anle, ~t<'t'l... I I Addre~\( II bZI 1 I CityA)::./,f'Jfl.(J, 1 State: OTZ 1 ZIP:'1r<NIJI 1 Phone~-611--Z.4$~ Fax: -I I E-mail: 1 This installation is being made on property owned by me or a member of my- immediate family, and is exempt from licensing requirements under ORS 701,010. Signature: I CONTRA. C..T. O.R. .'IN'S' TA.l'l"AT.IO N. . . ,.... ., "'",',:.,,.,_'j,,'. >__,____'",.:_' ..:_i,',,__J~~?:,:,'j,-:,~ I Businessname(~njlflil1IYJJLC I 1 AddressZ9J'11A/G(~, .. 1 1 City: r{:::,;/.JIlfi r Stcrt~zIPCf77'O/I 1 Phone:!'1fi ~'i'lb' ~ 307 1 Fax: ':J'II,.; ~ ~ '?oZ/ I I E.mailc.ra.JrIWift~ (:] beMhn>>d~Ald,(>~ \1 CCBhcenseno /7/ (,)7Y I ",}I Print name. "S.f-~pVlo/) c.~ I .1 Signature ~ep1~ )1,. 1 440-2545..1 (I 1 lOB/COM) I i I ,~:~~d~:~:~. . ;" I Qty'I"$7;~: IFurnace/burner including ducts and ,vents I Up to lOOk BTUIhr. I I lOver lOOk BTU/hr. ! Heaters/stoves/vents I Unit heater I Wood/pellet/gas ~tovelt1ue I Repair/alter/add to heating appliance/: refrigeration unit or cooling system! . absorption system I Evaporated cooler I I Vent fan with one duct/appliance vent . I Hood with exhaust and duct I I Floor furnace including vent I I Gas piping lOne to four outlets I Additional outlets (each) I Air-handling units, including. ducts I Up to 1O,0iJ0 CFM 1 .1 $11.00 I $ lOver 10,000 CFM I I $20.00 $ I Compressor/absorption system/heat pump I Up to 3 hpllOOk BTU $17.00 I $ I Up to 15 hp/500k BTU $29.00 I $ I Up to 30 hpll ,000 BTU $43.00 $ I Up to 50 hpll,750 BTU $57.00 $ I Over.50 hp/l,750 BTU $95.00 $ I Incinerators I Domestic incinerator I;ChmmerCiaW"::",:"'.<'; , I.Ellter total valuation of mechanical system and installation cost,<; $_ I Enter fee based on valuation of mechanical system, etc. I'Mjs~fila:n~oiJfU~~s;: llItemsl ~~~t I Reinspection I I $58.00 I $ I Specially requested inspections (per hr..) I $58.00 $ I Regulated equipment (unclassed) $13.00 $ I Each additional inspection: (I) $58.00 $ .FEE SCHEDULE, $17.00 I $ $20.00 $ $17.00 I $ $38.00 I $ $58.00 $13.00 $ $9,00 I $ $13.00 I $ $58.00 I $ I I $7,00 I $ $4.00 I $ $20.00 I $ I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79;00) , I (B) Investigative fee (equal to [A]) I (C) Enter 12% surcharge (.12 x [A+B]) I (D) Seismic fee, 1%(01 x [A]) I (E) Technology Fee (5% of [A]) I TOTAL fees aud surcharges (A through E): $ $ $ $ $ $ I Total I cost I I 1 I I I I I I I I I I I I I I I I I I I I I 1 I I $ $ $ Total cost I j j City of Springfield Official Receipt Development Services Depar.tment Public Works Department 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal'Number COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 COM2009-00708 Payments: Type of Payment Check cReceintl RECEIPT #: Date: 07/06/2009 10: II :22AM 1200900000000000774 Description SDC Trans Improvement-Resident SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transportation Admin Plan Review Major - Planning Building Permit 3 Baths One & Two Family I st Appliance Vent Fan Exhaust Hoods Dryer Vent Gas Outlets 1-4 Fireplace (Listed) Heat Pump + 5% Technology Fee + 12% State Surcharge Addressing Assignment Willamalane Single Family Fire SF Fee - Residential Temp Power 200 amps or less Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Tran Reimburs-Residential Amount Due 888.98 97.90 1,009.1'7 10.00 128.04 75.19 211.00 1,083.19 402.00 79.00 36.00 13,00 9.00 7.00 20.00 17.00 1]4,76 232.58 38.00 2,858,00 113.20 63.00 134.00 75.00 88.00 88.00 (30.00) 590.77 719.29 546.95 201.54 $9,919.56 Paid By EQUITY HOMEBU]LDERS Item Total: Lheck Number Authorization Received By Batch Number Number How Received Amount Paid In Person Payment Total: 3631 $9,919.56 $9,919.56 IIh Page I of I 7/6/2009