The URL can be used to link to this page

Home My WebLink AboutPermit Building 2009-7-6 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00817 ISSUED: 07/06/2009 APPLIED: 06/09/2009 EXPIRES:. 01/06/2010 VALUE: $ 213,299.00 225 Fifth Street, Springfield; OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1223 W Quinalt St ASSESSOR'S PARCEL NO.: 1703273107400 , Springfield TYPE OF WORK: Singh; Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single Family Residence wi attached garage Residential Owner: NORTHWEST BANK Address: 4900 MEADOWS RD STE 410 LAKE OSWEGO OR 97035 Contractor Type General Electrical Mechanical Plumbing. , CONTRACTOR INFORMATION I Contractor License EQUITY HOME BUILDERS, LLC 176016 DML ELECTRIC, INC 161264 CROWN HEATING LLC 171074 NORTHWEST~E;PM.ffiM\lB\,"W\uires y~~,i~,?277 AII~I~I''''''''' -"j 1.......,.." .......""...-.. ,'_ I !loW rulesla(ImmDINGINEORMkTlOl\flo o ., "'A' _ II / I . Notilication (;8111"" ";;;;ol1gh OAR 9b;<-UU'- in OAR 952-001-0C#1Sf'SJ8F!.~.i 01 the rules by 2 0098-.-}{ou may otml~mltS~,~~"ttir~)hO~e 27.50 calling the centJf<'l!leoOf Heat'; NotllForc;;a Air Gas h (?l./~Q , V"'''-) nu}\,Bier lor t e. watecO'Fy,pe:2344). Gas center 11l.1-~ge T"yp~: Gas 3 Energy Path: Sprinkled Building: Expiration Date 05/0412011 08/2712010 07/11/2010 04/10/2011 Phone 541-382-0803 541-923-9897 541-420-3307 541-504-1988 # 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: Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: Lot Size: 6,486 Sq Ft I st Floor: . 928 Sq Ft 2nd Floor: 1,052 Sq Ft Basement: Sq Ft GaragelCarport 572 Sq Ft Other: , Occupant Load: No I DEVELOPMENT INFORMATION' REQUIRED PARKING 55.00 5.00 10.00 36.00 35.50 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: 0/0 of Lot Coverage: I Yes 24.00 Total: . Handicapped: Compact: 2 I PUBLIC IMPRO*;.\~~~1r SI-I"ll EXPIRE If lI1T\~V~~~ I nloJ , ~~,1. \iFw11l\~.Pn~\iM\ Fully Improved AUTHORIZED UNSlI~ABANOONED fOR Curbside 7' Yes COMMENCED O~6 trpoutslDrains: Curb and Gutter Storm water to weep hole in curb ANY i 80 DAY PERI . Notes: Subdivision.has not been accepted Paee 1 of 4 ._~~,~~90i,,~~i -~ '. ..I. 'tir Status Issued CITY OF SrK11~u"lELD Building/Combination Permit PERMIT NO: COM2009-00817 ISSUED: 07/06/2009 APPLIED: 06/09/2009 EXPIRES: 01/06/2010 VALUE: fil3,299.00 225 Fifth Street, Springfield, OR .541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I V~lu~tion Descrio!ion .1 GaraeelMisc SFlDunlex U VB Utilitv R-3 VB 1&2 Familv $ Per Sq Ft or multiplier $37.72 $96.83 Square Footage or Bid Amount 572.00 1,980.00 Valne Date Calculated Descriotion Tvne of Construction . Total Value of Project $21,575.84 $191,723.40 $213,299.24 0611012009 0611012009 Fp~<, P'WU Fee Descriotion Amount Paid Date Paid Receipt Number Plan Review Residential $616.77 619109 1200900000000000639 + 12% State Surcharge $252.57 716109 2200900000000000757 + 5% Technology Fee $123.09 716109 2209900000000000757 1st Appliance $79.00 716109 2200900000000000757 3 Baths One & Two Family $402.00 716109 2200900000000000757 Addressing Assignment $38.00 716109 2200900000000000757 Building Permit $1,172.73 716109 2200900000000000757 Curbcut Permit $88.00 716109 2200900000000000757 Dryer Vcnt $9.00 716109 2200900000000000757 Exhaust Hoods $13.00 716109 2200900000000000757 Fire SF Fee - Residential $127.60 716109 2200900000000000757 Gas Outlets 1-4 $7.00 716109 2200900000000000757 Heat Pump $17.00 716109 2200900000000000757 Perm ServlFdr 200 amps or less $81.00 716/09 2200900000000000757 Plan Review Major - Planuing $211.00 716109 2200900000000000757 Plan Review Residential $145.50 716109 2200900000000000757 PW Disc - 2nd Permit $-30.00 716109 2200900000000000757 Residence Wiring 1000 Sq Ft $134.00 716109 2200900000000000757 Residence Wiring Ea Addtl 500 $100.00 716109 2209900000000000757 Sanitary Sewer - Improvement $631.10 716109 2200900000000000757 Sanitary Sewer - Reimbursement $829.96 716109 2200900000000000757 SDC MWMC Administration $10.00 716109 2200900000000000757 SDC MWMC Improvement $1,009.17 716109 2200900000000000757 SDC MWMC Reimbnrsement $97.90 716109 2209900000000000757 SDCSanitarylStorm Admin $144.90 716109 2200900000000000757 SDC Tran Reimburs-Residential $201.5i . 716109 2200900000000000757 SDC Trans Improvement-Resident $888.98 716109 i200900000000000757 SDC Transportation Admin $73.29 716109 2200900000000000757 Sidewalk Permit $88.00 716109 2200900000000000757 Storm Drainage Impervious Area $695.12 716109 2200900000000000757 Temp Power 200 amps or less $63.00 716109 2200900000000000757 Vent Fan $27.00 716109 2200900000000000757 Willamalane Single Family $2,858.00 716109 2200900000000000757 Total Amount Paid $11,205.22 Paee 2 of 4 _~~~~N$:;~~Rj \ f Status Issued 225 Fifth Street, Springficld, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00817 ISSUED: 07/06/2009 APPLIED: 06/09/2009 EXPIRES: 01/06/2010 VALUE: $ 213,299.00 Plan Reviews I Structural Review 06/10/2009 Initial Review 06/0912009 06/1012009 Initial Review 06/10/2009 06/10/2009 Public Works Review 06/1012009 06/1 012009 Public Works Review 06/23/2009 06/2312009 Structural Review 06/2312009 06/2312009 Plannin2 Review 06/1 0/2009 06/29/2009 Structural Review 07/0212009 07/02/2009 WI NJM APP LLH WE LKW APP LKW Subdivision has not been accepted /Storm water to weep hole in curb. WI KLK APP DDK Approved according to plans. For purposes of setbacks the south property Hoe will be considered to be the rear property.line. APP KLK To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will bemade the same working day, inspections requested after 7:00 a.m. will 'be made the following work day. I ~rnllirp1Jnsnections I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction'with footing aod/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to deckiog. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspcction: Prior to cover and after all rough in inspections have been approved. Walllnsnlation: Prior to cover. Ceiling Insnlation: Prior to cover. Roof Sheathing Drywall: Prior to taping. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provid,e report to City Building Inspector. Final Bnilding: After all required inspections have been requested and approved and the building is complete. Undergronnd Plumbing: Prior to filling the trench and inclnding required testing. Pa2e 3 of 4 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-00817 ISSUED: 07/06/2009 APPLIED: 06/09/2009 EXPIRES: 0]/06/2010 VALUE: $213,299.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone .541-726-3676 Fax 541-726-3769 Inspection Line U nderfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and inclnding 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 plumhing 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 appliaoce. 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. Ufor Electrical Ground: Install ground rod at footing and call for inspection in conjuction with footing and/or foundation inspection.. I Rough Electric: Prior to Cover Electric Service: Approval reqnired prior to utility company energizing service. Final Electric: When all electrical work is complete. By signature, I state and agree, th'at I have careruity examined the completed applicu'tion and do h~reby certify that all information hereon is true and correct, aJld I further certify that any ;md 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 strncture withont 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 plaos will remain on the site at all times during construction. ~~9 7/U/Oo, r or Contractors Signature I Date I <. Pa2e 4 of4 ~ ~. Willamalane t~ Park & Recreation District Job. No. 00 "6\1 SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: \J.1\!\\\\\.OM)\ :Dl)J\j(... PHONE: Afll 1............. D~A.\O ("tJ . fM/\-:2'3 ADDRESS:~I'f) U.O{J(AlllJ::> ~~li.t:t (Qs~TE~ZIP: ~ ILJO LOCATION OF PROPOSED BUILDING SITE: Street Address: l,qg,ro 1.0 (lQtiM.Qf:. ~. Plat Name:~ Tax Lot Number: 11~.Qtr51 D'40 () .1. DEVELOPMENT TYPE (Check appropriate .dwelling(s). Dwelling type definitions are on the back.) A. Sinale-Familv Detached NO. OF UNITS \ X $2,858 per unit = . cV $ ~f)5f6. B. Sinale-Familv Attached NO. OF UNITS 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 Dweflina Unit NO. OF UNITS X $1 ,550 per unit = $' $ AP7 ~p:'P? rj WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer must furnish proof oi Willamalane Credit approval.) $. 3. TOTAL WILLAMALANENET SDC ASSESSED ~':7~"~f;~"){~ Development se~t~ ~partll)lfnt City of Springfield . / .. I1~Q Dc) $ JlTX..V- ( b ti 0 j 7 Date 5 225 Fifth Street t Springfield. OR 97477tPH(541)726~3753tFAX(54])72(}.;.3689. ~r;Wi~rDEPARTMEN1ltiusEf0N'[~,;x~.. '<)W;~T0\'\""'0".' ''''''"^'~~''='-'-'''''~'''''~~''''-'-''~-m''' ".~'~:"" .... i';._, _..~..jffi;.,--,._~ ""'{""'''..'"'.'''.....~~'''''~.H...~__'.""'..'''''__,_"",, ..="""'''- .. I "01 .' .. Pennitno.: I Date:~" U -~ Electrical Permit Application This permit is issned nnder OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180 days of issuance orifwork is suspended for 180 days. ' 1"'i"'~li'rE;fi(()CAl!;:1:G.0VERNMENT,{fi;F!RR()VA(.~:7f.1 , Ilf~~;~~i:~~~~~~~i~~~~0F~€~N~~RU€:rI()~;;,iillillr"fJ1ili0 I Residential, per unit, service ineluded: I i:'~;~~~~~I:rEi!IN~~R~~~7;~~~N021~~€~~':~~~~1 I 1,000 sq. ft. or less (4) \ $134.00 $ J~I~ I ) .L<'\^~ \ vL I Each additional 500 sq. ft. or portion, A $ \(1).1-.;"J Job site address: \,?-L. '7.., \} ~ (Io\JII"\a. + j,tV~ thereof "\ $ 25.00 V- I CityS'r\~ p1d r State: ~ 12... 1 ZIP: I Limited energy (2) 1 $ 32.00 $ 1 I Subdivi;ionG~{\ft\ +- L Lot no.: ~ I I Each manufactured home or modulmC, I I 6300 I I' :;.~il!i!hill.OES€RIR:r10N;0FJW0RK'I;.1IiIlI~.JI dwelling service or feeder (2) i, $. $ IlJP1U fC1l\<:::;\-'\\X'::\TiM S'\nq\f' ~ I I Servicesorfeeders: installation, alt~ratlOn,relocation I ..\~ r~~to~ \'1omtP \ 1 1200,":"PS:~~~:,~2! lU I I $ 81.00 $ 1 '4!!ltl1lil.za;:!3:t.it~1:::F!R0F,!ER1WiJl.0WNERi!:~lii!!i;i:(4~~.~~tmP eI1202..""4~0 amps (Z) y~~",." 1 1 $ 95,00 $ I 1 Name:~ \1f'Yrl"'~ ~ ,a~-"~IJ~IFi9tl~~bP~wRp~i7r~~i~;ih 1 I $168,00 $ 1 1 Address: Ft-'Lct Uflnf'(<<.lAvt"'_ :. !r;:'r~ ~~;-oo; l'od1~9!i\9rl&Q9IlJ!!lPf(2)52-001-, I I $205,00 $ I I City: 5l.ofVI-P- I State CQ.. 1c.z.I~:f11#[)lLYlotllPYer;lW60ampstbtvolis.'J~):Y I 1 $469,001 $ I I Phone~~:z,-lbr<.1 Fax: _ ca!iingt~e;,:'C~I::~~~~~~~~~i?W:~:~~';;i~nl $ 63,001 $ 1 I E-mal.l' 11Ul llUOI lV' .. 01'. I Temporary)~enr.ice!i or feeders: installation, alteration, relocation 1 . r"mtel IS ,,--, . ,.,... ~v' ." .. This installation is being madeonreside~tial or fann property, I 200 amps or less (2) I I $ 63,00 I $ I owned b~ me or a member of my Immediate family.ThlS 1 201 to 400 amps (2) $ 8700 I $ 1 prop.erty IS not mtended for sale, exchange, lease, or rent. OAR I I' I 479.540(1) and 479.560(1). 401 to 600 amps (2) 1 $126.00 $ Signature: . [ Over 600 amps or 1,000 volts, see services or feeders section above I I~W&jii1~E~~r~:C0N;r~CR0R..~INSmAul~A-JIONi!..f,;it~:i~~~ I Branch circuits: new, alteration, ext~'nsion per panel I I Business name:D1Y\ L e\~~.C _ I I a. Fee for branch circuits with purchare ofaservice or feeder fee; I I Addresslilal ~\J\JS.)fuc...e_'V\ I 1 Each branch circuit 1 $ 6,00 I $ I I City:''?-ec-\'lY\bV'\l\ '.1 State: ()'ll- I ZIP:G"T~I I b. Feeforbranch circuits without purchase ofa service or feeder fee: I I Phone:f:HI -L/lli-~ '54>81 Fax:ffil-q2.~-3;::T~ I First branch circuit (2) 1 I $ 55.00 I $ 1 .1 E-mail:t..I&..I...Jeclv-i.c:..iv\{l.~al..ll.CoW\ 1 Each additional branch circuit 1 1 $ 6.001$ I I CCB Iicen~e no.: llel z..L.gL{ I BCD license no.: ~ 'SIte I I Miscellaneous fees: service or feedeli,not !ncluded I : I Signing supervisor'Slicense no.: gaS', . MnTICE: 1 EachPum~o>-~\!PWCf~'J\IU~'~ $ 63.00 I $ I 1 Print name of signing supervisor: Y>AAI".J *"~I" I't/?N1_\i\a.lh\t.~~.II(~~~li~~~n, \~ 1'1\ I $ 63.00 $ I I Signature of signing supervisor: ~ I'\. _ ~1l-\O~\7IE~~~r&1\c:l.K\f#S\W~'I'''-~ ~1L.':'b1, $ 63.00 $ I \ Nl,~tn,.F. '" (2 . COMN t hiiN"?@\!i\@bl.Jinspection:(I) ,I I $58.00 ~ />.N'Y 1 BO Irlf.-~-'_:1A:F!.....F!'iII"':.fN:TllIU'.S..E-EJfjJ€@-'fSI:J"'m'p:.J:;4.' 3'*W5t@t!Jl1Nlmv7':t14fir%@iwtklfJmi1V.e'l+wl,;;,~~.. . ilfilL ... ..... .*i1001ii!j!~3~ill1l1gilltitA\ffrnp%.1l \ ~ , ....c I (A) Entersubtotalofabovefees I lInA N1 \)VY V\. (Minimum Permit Fee $58.00) Th\J1~1 . /\:;&~ I(B)Enter12%surcharge(.I2x[A]) I $!1~J:e, ~ 1 (C) Technology Fee (5% of[A]) I s"1\:1u ~ I TOTAL feesand surcharges (A through C): I ~'~:iB .~ q~'u 440-2584-1 (9/08/COM) c1 , Structural Permit Application 1!1IBD.~p.AR:fMINT{u~Ero~i2.'Y.~'1 ,,"",,'~'.,..= .' "".6k<;.',c",'~' ._~,.1." "*"".':~'~.k",1~.'n=h*.,," CcvflO'o 'j'-oogn Peryrllt no.: r~ 225 Fifth Street. Sprlngfleld, OR 97477 . PH(541 )726-3753 . FAX(541 )726-3689 ~ .." This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 118~::~S ~::::O;if work is snspended for 180 days. i~.,: ':'i!J!'rCi'EYl0~"'SPRll\i(jFIEIID':oliEGON;' (~ ", 't., :;i .~~ A&...h;tt:~~b.' ",r """""""m;,- 'o"";;*,^~,,,;;; Ic,"",-",~;""..~~!"",".,,!' ;:t%:tIfi!K~",,:1'l>"'~" "I ;;:'l;t'i~{S~q~C;A[~GOV-E:R!iM~NTflAP'P'RQ"A~Jll' I This project has finalland~use approval. I Signature: Date: ~,:;I.:his project has DEQ approval. I I Signature: Date: ).Zoning approval verified: DYes D No ",: Proper~:y is within flood plain: 0 Yes D No I '~~~;~:~:~~;C=~~G~~~Y~~~~~~~~~~li~N~:::;:~~~!~ii: %)";J,db~"OB..ii.~lrE:~INI;.QJ~MArION<AIIID2;LOCAI!QI'I7',H;;;;'":;:,.1 1 Job site address: 12:2. t.. ~+ ~n\n? ~ -l- ~ e. I CilY:<:::'':'rt ~ .c.rf\d r State: 1 ZIP: I SUbdivis~n:{ ~ l~\-t-. 'I Lot no.:[\ 1 Reference: 170327:$ ( 1 Taxlot: 07 CfOO IC\-t"' ~;:,,}lW3;l1>_ -'Z;~p. RO'----~~E--"R.TY:'; -''^"''''--.'-::. ia4i'f"'<~: ;,: "'/.' ~~~~..q;, ~.t-i;l4*"",,___- __~______,__,_,_....;OVVNER~'~:;;kR.:r..:. 1 Name:ct>...+t>y VLNl'll ~a.V'fI.W\" ~Jf..?:o \ I . I Address: l'1-'LQ U""'~ tl-II'€.. . I I City: ~~ I Slate: OR 1 ZIP:~~O\ I Phone:~ ~-I()I~ Fax: - - , , 1 E-mail: This installation is being made on residential or fann property owned by ~ me or a member afmy immediate family, and,is exempt from licensing requirements un. d/.f1 ORS 701.010. __----.- ',. 6!:2- -.. I..- _- Sign here: -- r IBt"J"";!\. :!t9t";\.C;bNTRAC'rOR';jNSTA[[fATjONl1l'i~"!l::l).A :;:~7.~:t' 'I M_'ik~''''1.'''~_4''''_''_~'_'''4'''''__~~_'___c_,_ . _________;;~~"_._._ ,'" .,. ~_,__.^' ,._.".__,""i1F!~>J~'\;,ffif'l__ S0-"],,~:,d,,.bw j: I Business name: t=-A lJitv. Hctncbu,. J:j~ Lill 1 :_1 Address:I/~:?> MJl!. wdU <:.tYt'~r I Sfc- r I I City: ?r.M I State:O'L. I ZIP: '71701 I Phonemt ~~~2--~~ 1 Fax5L-I--~~~-15'Z5 1 ,I E-mail:a~V~i.N P- IIVL.CloW\. 1 1 CCB license no.: J Tlpt) \ lJ 1 \ I ~' 1 ~' ,Print name: .f\t-'r.lJ i.7!d.s;goature -'/1.N;j./ I I 1"7i,':a~J;7""i.tlJlBIco'NTRAc::TOR,IN"QRIVIAtl()N';5;:" ,,.~ [ Name t CCB License Number Phone Num. ber I Electrical ~-llol~ ~I.(/fr?"~ I I Plumbing ~Im- t~Iot.~1- ~HI5-~ I Moehaoical CT~- r::l-I ()-=t41 ef-ll-,,(ZO -~':t I~i~)~ ~lu[tiQP'~into~~~~~oQ't:~;F~)~ I (a) Job description: I Occupancy I I I Cost per square foot: 1 1 I I . ~new 0 alteration I (b) Foundation-only permit? I Total valuation: I 1 I I I 1 I I 1 [J No I $ 1 1 $ $ $ I $ ) I $ Construction type: Square feel: Other information: Type of Heat: t:;JQ C; Energy Path: .S D addition DYes (a) Pennit fee (use valuation table): I (b) Investigative fee (equal to [2a]): I (e) Reinspection ($ per hour): (number of hours x fee per hour) I (d) Enter 12% surcharge (.12 x [2a+2b+2e]): 1 (e) Subtotal of fees above (2a tbrough 2d): I (a) Plan review (65% x permit fee [2aD: 1 (b) Fire and life safety (40% x pennit fee [2a]): I (c) Subtotal of fees above (3a and 3b): $ 1,{4.~M,~~t~!!,~,~~~us1i~,es'l'_f:r:E;i~iitr.;;.~~~~~~~~t'1 I (a) Seismic fee, 1% (.01 x permit fee [2a]): $ I TOTAL fees and surcharges. (2e+3c+4a): S I J I I \9~SLo. ~"? Q. \5)' , . -\ ~ 'd- Ssrr _~ <SP ~ l\ 'iF; 1& \q, ~Cl..o... ~ ~ /y~ fO-0" ~f\$'j \ . 'S 1? I),.- ~ O"\~~ C\ Plumbing Permit Application 225 fifth Street + Springfield, OR 97477 . PH(541 )72.6-3753 . FAX(541)726-3689 ~~ I' DEPARTMENTUSEONLY I Permit no.: I Date: This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire jf work is not started within 180 days of issuance or if work is suspended for 180 days. :".1 1 I I 1 I 1 Job site address: 1~7".:",+ 'CWll'\C..h- f\-v-L I I City~--r\l'\C~1 State ~ r ZIP: 1 I Subdivision: ~ \ -\- I Lot no.: B I. I :DESCRIPTION 'OF,WORK"! :." .J_, , I JJp4) r~-ttlJC'"\-~v'\ <;).f\((\e.. \-&milll (r"<:.....~e - "u ~ I P"ROPERTY. OWNER ;~ _ ' I I Name'Ye-oh"f \le.rce.\J ~~;"'_~\ I 1 Address: \'1-'2..<::\ UnV\pf" Av~ 1 I City:OlQf>V\f' I State: b~ I ZIP:'l1-'-tbl I 1 Phone:5~ -q';'j:z,- }~Fax: 1 I.E-mail: I 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: I . .. CONTRACTOR'INSTALLATION!" .. ;...1 I Business name: tu\..) Mec.~\('",\ I Uc.. 1 I Address '1l5 SlAl'/qrnrar.t.k}o.flSf-e 1.Q~~zzl 1 City:'\4zdmt')nt/ I State: ~ -J ZIP:(jr=1S1.::1 I Phone&l-l-g'<fJ-3116~ I Fax: ff/I- FJtH-lJt352. '1 E-mail:nwml!..c!ltmitolllr.€hilfwbU.(.tJ!IA I CCB license no.: Jf5to'2;:J--:r1 BCD license no.; I . : ::~~7:::~f!:jjfjl/fl. : . I Signature!JlttA/7 ~ I I LOCAL .GOVERNMENT.APPROVAL.."". I Zoning approval verified? DYes D No 1 Sanitation approval verified? DYes D No I CA TEGORY.,OF. CONSTRUCTION. I ~esidential lD Government I D Commercial I' JOB.SITE..INFORMA TIONAND .LOCATION I', 440.2500.) (11/0S/COM) I". .,. IbescriPtion I New residential I bathroom!l kitchen (includes:firsl 100 feet of water/sewer lines, hose bibs, ice maker, underjloor low-point drains and rain-drain packages) I 2 bathroomsll kitchen $374.00 I 3 bathroomsll kitchen $439.00 I Each additional bathroom (over 3) $95.00 I I Each additional kitchen (nver I) I I $95.00 I Residential fire sprinklers (includes Dlsn review) I 0 to 2,000 square feet $58.00 I I 2,001 to 3,600 squareree' $116.00 I I 3,601 to 7,200 squarereet $174.00 I I 7,20 I square feet and greater I I $232.00 I I Manufactured dwelling or pre-fab (circle one) I Connections to building sewer and I I $5800 I water supply . I Commerc.iall industrial, and dwellings other than one- or two-familv ' I Minimum fee I I $58.00 I I Each fixlure $19.00 I l\'liscellaneous fees 1100' stann, sewer, \....ater line I I I Each fixture, appurtenance, and piping I Stann water retention/detention facility I' II I Irrigation systems I Piping or private stonn drainage I I systems exceedine. the first 100 feet I Specialty fixtures I I Reinspection (no. ofhrs, x fee per hr.) I I Special requested inspections (no. of hrs. x fee per hr.) r Each additional inspection: (1) $58,00 $ I' Medicalg'as plping!{:" '''...: I Minimum fee $ I I Enter value of installation and equipment $ _' 1 I Enter fee based on installation and equipment value. $ I :.:t;t;:",\'iI";!APRLICANT,.USE",' '" . ... ... ~: ,:' . . " I I (A) Enter subtotal of above fees I $ I (Minimum Permit Fee S58.00) I (B) Investigalivc fee (equal to [All I $ I I (C) Enter 12%surcharge(.12x IA+llll I $ I I (D) Technology Fee (5% of [All I $ I I TOTAL rees and surcharges (A through D): I $ I .-....., , ./FEESCHEDUl:E' . . . I Qty. I Cost >, ea. $238.00 $76.00 I $19.00 $19.00 $19.00 $19.00 $19.00 $58.00 $58.00 Total cost $ $ I $ I $ I $ I I $ I $ I $ I $ I I $ I I $ I $ I I $ I $ I $ I $ I $ I $ I $ $ Mechanical Permit Application DEPARTMENT USE ONLY Permit no~: I Date: 225 Fifth Street. Springfield, QR 97477 . PH(541)726*3753 . FAX(541)726-3689 This permit is issued under OAR ~18-440-0050. Permits expire if work is not started within 180 days of issuance or if work is snspended for 180 days. CATEGORY OF CONSTRUCTION .. . .' ::.1 I,'. FEE ,SCHEDULE . ; I 18l1Residential I 0 Government I 0 Commercial I II 'FR1'r~sSt':Aido'~o.'rl'lta.ln'ac'el.:," ,. :;.1 QtY'I.$. 7C9c.~0~Ot I.JOB SITE';INI:.oRMATIOt-!,AND,I,.OCATION . ..1 I Job site address: l'7,b~ )~-\- n. '\\nc..\ t-A\le hrnacc/burncr inclnding dncts andvcn!s I <<: ~--r I ;K. ~ I Up tolOOkBTUlhr I I City,. '1AtIl\O . ' State: b . ZIP: lOver lOOk BTUfllf. I Subdivision<1:-.,'ftflrJ:\- r Lot no.: E> I .1)lJ I Heaters/stoves/vents I . DESCRIPTION:'OF.;WO~K;' ,. .,.' I Unit heater I 1~~:~:';~w~~~:~;:~:;J i ~~g~~~~l~::ii~;;ga~:;;:~ve/:: I I Name:9&Y \/e{"r"'eU~\ciMM\I ~ \t'.'1011 1 Evaporated cooler I I Address: 1":T-'Z.. G L\ l'Iopd I4-ve I I Vent fan with one duct/appliance vent I Hood with exhaust and duct I I City: ~rllje I State: 01Z... I ZIP: 174 ()II I Floor furnace including vent I I Phone: P)~ -q,:>, -J()I~ I Fax: . - I I Gas piping I E.mail: I lOne to four outlets I I This installation is being made on property owned by me or a 1 Additional oUllets (each) member of my- immediate family l and is exempt from licensing I Air-handling units, including ducts requirements under ORS 701.0 I O. ' 1 Up to 10,000 CFM " I I $11.00 I. Signature: lOver 10,000 CFM $20.00 .. .,;. GONTRACTORjrilSTALt)l.TIClN;:"J'~.'<. I Compressor/absorption system/heat onmo I BUSinessname.L"~&~~~~ I LC I Upto)hp/IOOkBTU I I $17.00 I , - I Up to 15 hp/500k BTU 1 1 $29.00 I Addr<:SS~ r- I Up to 30 hp/I,OOO BTU I I $43.00 I City. ./'S. . . State: <1 ZIP:q::;-:;01 I I Up to 50 hp/I,750 BTU I $57.00 I Phone:'3JI-l./2(J ~"f-I Fax: 911--3'glJ -"::fDZJ. lOver 50 hplI,750 BTU I $95.00 I I E.mail:('Y1';tJJ1hadi~€ beM hrmd !l:J;rl. tYJl~!nerators, I 1'1)omestlc inCInerator $20.00 .I CCB license no.: I 7/ () ~ . 'Commercia!>l''',. Print name: S~~ ar-~ I Entertotalvaluati;n~'fmechanicalsystem I ~ q I and installation costs $ . Signature: . ~. I ." # Enter fee based on valuation of mechanical system, etc. $ i'~l,:;~~~~:eousfe~s':\ :,.; IItC~"" ::l!oo $~~~~I I Specially requested inspections (per hr.) I $58.00 I $ 1 Regulated equipment (unclassed) : I $13.00 I $ Each additional inspcction: (1) I $58.00 $ $17.00 I $20.00 $17.00 I $38.00 1 $58.00 I I I I $13.00 $9.00 $13.00 $58.00 1 Total I .cost $ I $ 1 $ I I $ I $ 1 $ I $ I $ I $ I $ I I $ I $ I I $ 1 $ I I $ I $ 1 $ I $ 1 $ $ .:., .1 I $7.001 $4.00 I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) ,I $ I (B) Investigativefec (equal to [AJ) , $ 1 (C) Enter 12% surcharge (.12 x [A+BJ)' $ I (0) Seismicfee, 1% (.0 I x [A j) I $ 1 (E) Technology Fee (5% of [AJ)" I. $ I TOTAL fees and surcharges (A through E): I $ 440.2545.J (11/08/eOM) CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET .._--~-_._~- JOURNAL OR JOB NUMBER: C0m2009-00817 NAME OR COMPANY: Northwestbank LOCATION: 1223 WQilinalt TAX LOT NUMBER: 1703273107400 DEVELOPMENT TYPE: Sinide Family Residence NEW DWELLING UNITS I BUILDING SIZE (SF 1980 LOT SIZE (SF): L STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. J. CHARGE I 1948.50 I $0.357 . I = I $695.12 , RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I I 0.00 I I $0.357 I I 50% ~ I ITEM I TOTAL - STORM DRAINAGE SDC 2 SANITARY SEWER - (:JTY -' DISCOUNT $0.00 $695.12 6534 $695.12 r-- 1m 11:l 10 I~ 1U1 It;; 5 .U1 ~ 1070 A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 30 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 30 I COST PER DFU $27.67 COST PER DFU . $21.04 ITEM 2 TOTAL - CITY SANITARY SEWER SDC , ~ , 3. TRANSPORTATION. A. REIMBURSEMENT COST: I ADT TRIP RATE I x I 9.57 I I NUMBER OF UNITS I x I I I I I B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I I . 9.57 . I I I ITEM 3 TOTAL- TRANSPORTATION SDC $1,461.05 II ,. $829.96 $631.1 0 $201.54 $888.98 1091 1092 ,I 11093 11094 .4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x I, I I I COST PER FEU I $97.90 B. IMPROVEMENT COST: [NUMBER OF FEU's I I I I x.ICOST PER FEU. $1,009.17 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRA TIVEFEE ITEM 4 TOTALc.MWMC SANITARY SEWERSDC ~ , SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ , 5. ADMINISTRATIVE FEE: I SUBTOTAL x ADM. FEE RATE I~ I $4,363.76 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: COST PER TRIP 21.06 x I NEW TRIP FACTORI I 1.001 x I I ~, COST PER TRIP. $92.89 $1,090.52 x INEW TRIP FACTORI I 1.00 I , !: $1,117.07 ='1 $97.90 11054 = , $1,009.17 1055 , $0.00 1054 ,. $10.00 I 1056 I I I Kaye Wilson PREPARED BY DATE $4,363.76 CHARGE $218.19 I 144.90 11079 $73.29 11078 =, $4,581.95 II 6/23/2009 TOTAL SDC CHARGES DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUl\.ffiER OF NEW FIXTURES x UNIT EQUN ALENT = DRAINAGE FIXTURE UNITS (NOlE: FOR REMODELS, CALCULATE ONLY TIlE NET ADDITJONAL FIXTURES) NO. OF FIXTURES I .DRAINAGE FIXTURE UNITS 6 0 0 0 0 0 3 0 0 I 0 I 3 I 2 I 0 I 3 I 0 I 2 I 2 I 0 I 0 I 9 ,I 0 I , 30 II ~''EDU (EQuiValent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFLrs) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE; BASED ON COUNTY ASSESSED VALUE YEAR l' ANNEXED IS LAND ELGIBLE FOR ANNEXATION CREDIT? .2 I BEFORE 1979 (Enter I for Yes, 2 for No) I 1 ]979 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2 I 1980 (Enter I for Yes, 2 for No) I ~ : 1981 BASE YEAR 2006 i 1982 II I 1983 CREDIT FOR LAND (IF APPLICABLE) I 1984 VALUE /1000 CREDIT RATE . 1985 $0.00 x $0.00 ~ , $0.00 I 1986 . I 1987 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) 1988 VALUE /1000 CREDIT RATE 1 1989 $0.00 x $0.00 ~ I 0 I 1990 I 1991 1 1992 TOTAL MWMC CREDIT = $0.00 I 1993 I: 1994 1995 I ]996 I 1997 . 1998 1999 '2000 2001 225 Fift.h Street Springfield, Oregon 97477 541-726-3759 Phone i(~ Job/Journal Number COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 .COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-008 I 7 COM2009-008 I 7 COM2009-008 I 7 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 COM2009-00817 Payments: Type of Payment Check cReceintl RECEIPT #: 2200900000000000757 Description Fire SF Fee - Residential Willamalane Single Family Addressing Assignment Plan Review Residential Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit Sto.rm Drainage Impervious Area Sanitary Sewer - Reimbursernent . Sanitary Sewer - Improvement SDC Tran Reimburs-Residential 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 Penn it 3 Baths One & Two Family 1 st Appliance Vent Fan . Exhaust Hoods Dryer Vent Gas Outlets 1-4 Heat Pump Temp Power 200 amps or less Perm Serv/Fdr 200 amps or less + 5% Technology Fee + 12% State Surcharge Paid By EQUITY HOMEBUILDERS LLC Check Number Batch Number Received By djb Page 1 of 1 City of Springfield Official Receipt Developmert Services Department Public Works Department " , Date: 07/06/2009 Item Total: Authorization Number " How1 Received I n Herson 3633 Paym~ot Total: 1O:16:31AM Amount Due 127.60 2,858.00 38.00 145.50 134.00 100.00 88.00 88.00 (30.00) 695.12 829.96 631.10 201.54 888.98 97.90 1,009.17 10.00 ]44.90 73.29 211.00 1,172.73 402.00 79.00 27.00 13.00 9.00 7.00 17.00 63.00 81.00 123.09 252.57 $10,588.45 Amount Paid $ I 0,588.45 $10,588.45 7/6/2009