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Home My WebLink AboutPermit Building 2009-7-10 CITY OF SPRINGFIELD I Building/Combination Pertuit I PERMIT NO: COM2009-00707 I ISSUED: 07/10/2009 . APPLIED: 05121/2009 II EXPIRES: 01/10/2010 VALUE: $ 161,841.80 \ I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1230 W Fairview St ASSESSOR'S PARCEL NO.: 1703273107600 Springfield TYPE OF WORK: Single Family Residence PROJECT DESCRIPTION: New Single Family Dwelling TYPE OF USE: New. Residential . i . Sidewalk Type: C b'd] 5' ur Sl e Yes - . ,m,WdspolltsI.IDahl,s:n law requires you to Recomend no connection to storm or sanitary sewer uhlil:conncilfappr~val:i by the Oregon Utility . Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-00:1- 0090. You may obtain copies of the rules ~y calling the center. (Note: the telephonel number for the OregDn Utility NotificatiDn Center is 1-800-332-2344). I I j I Owner: Address: MICHAEL JAMES MAJDIC 34446 KlNSROW #1"02 EUGENE OR 97401 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing License 176016 . 161264 171074 186277 Contractor EQUITY HOME BUILDERS, LLC DML ELECTRIC, INC CROWN HEATING LLC NORTHWEST MECHANICAL LLC BUILDING I~FOR~ATION I . # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: 1 Height of Structure 19.50 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Electric Energy Path: Sprinkled Building: n/a I R-3 VB 3 I DEVELOPMENT INFORMATION I Frootyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: - Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 18.00 5.00 7.00 13.00 14.50 Subdivision Not Accepred Street Improvements: I PUBLIC IMPROVEMENTS I Fully Improved Storm Sewer Available: Speciallnstrnction: NOTICE: Notes: TI~fgr/'1:~rvi~rtSR)\'~r'EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR. ANY 180 DAY PERIOD. Page I of 4 Phone Number: 541-683-7537: I , Expiration Date 05/04/2011 08/27/2010 07/11/2010 04/10/2011 Phone I 541-382-0803 541-923-9897 , 541-420-3307 541-504-1988 Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Fl Basement: Sq Ft Garage/Carport Sq Ft Qther: Occupant Load: I I 4~510 11,500 440 2 Yes 43.00 , ] REQUIRED PARKING I Total: 2 Handicapped: I Compact: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description Garaee/Misc SFlDuplex Tvpe of Construction $ Per Sq Ft or multiplier $37.72 $96.83 _ Square Footage or Bid Amount 440.00 1,500.00 U VB Utility R-3 VB 1&2 Familv Total Value of Project ~ ) I CITY OF SPRINGFIELD I I Building/Combination Permit I PERMIT NO: COM2009-00707 ISSUED: 07/10/2009 APPLIED: OS/2112009 EXPIRES: 01/10/2010 VALUE: $ 161,841.80 Value , I Date Calculated I OS/2112009 OS/21/2009 ! I $16,596.80 $145,245.00 $161,841.80 Fe~ Description Amount Paid Date Paid Receipt Number Plan Review Residential . $624.71 5/21/09 2200900000000000544 + 12% State Surcharge $214.69 7/10/09 2200900000000000778 + 5% Technology Fee $106.55 7/10/09 2200900000000000778 1st Appliance $79.00 7/10/U9 2200900000000000778 2 Baths One or Two Family $337.00 7/10/09 2200900000000000778 Addressing Assignment $38.00 7/10/09 2200900000000000778 Building Permit $961.09 7/10/09 2200900000000000778 Curbcut ~ 2nd Curbcut $-45.00 7/10/09 2200900000000000778 Curbcut Permit $88.00 7/10/09 2200900000000000778 Dryer Vent $9,00 7/10/09 2200900000000000778 Exhaust Hoods $13.00 7/10/09 2200900000000000778 Fire SF Fee - Residential $97.00 7/10/09 2200900UOOOOOOO0778 Fireplace (Listed) $20.00 7/10/09 2200900000000000778 Gas Outlets 1"4 $7.00 7/10/09 2200900000000000778 Heat Pump $17.00 .7/10/09 2200900000000000778 Perm Serv/Fdr 200 amps or less $81.00 7/10/09 2200900000000000778 Plan Review Major - Planning $211.00 7110lU9 22U0900000000000778 Residence Wiring 1000 Sq Ft $134.00 7/10/09 22U0900000000000778 Residence Wiring Ea Addtl 500 $50.00 7/10/09 2200900000000000778 Sanitary Sewer - Improvement $462.80 7/10/09 2200900000000000778 Sanitary Sewer - Reimbursement $608.63 7/10/09 2200900000000000778 SDC MWMC Administration $10.00 7/10/09 2200900000000000778 SDC MWMC Improvement $1,OU9.17 7/10/09 2200900000000000778 SDC MWMC Reimbursement $97.90 7/10/09 2200900UOOOOOU00778 SDC Sanitary/Storm Admin $116.66 7/10/09 2200900000000000778 SDC Tran Reimburs-Residential $201.54 7/10/09 22009UOOOOOOOOO0778 SDC Trans Improvement-Resident $888.98 7/10/09 2200900000000000778 SDC Transportation Admin $76.68 7/10/09 220090UOOOOOOOO0778 Sidewalk Permit $88.00 7/10/09 22U0900000000000778 Storm DrainageImpervious Area $587.74 7/10/09 2200900000000000778 Temp Power 200 amps or less $63.00 7/10/09 2200900000000000778. Vent Fan $18.00 7/10/09 2200900000000000778 Willamalane Single Family $2,858.00 7/10/09 2200900000000000778 Total Amount Paid . $10,130.14 Paee 2 of4 , ] -~~~:~~,~I~gP l , f CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2009-00707 ISSUED: 07/10/2009 APPLIED: 05/21/2009 EXPIRES: 01/10/2010 VALUE: $ 161,841.80 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Plan Reviews , Structnral Review OS/26/2009 Initial Review OS/22/2009 OS/26/2009 APP LLH Public Works Review OS/26/2009 OS/27/2009 WI BJG There has been no approval for the subdivision with the PIP work done. Waiting on further information. Structural Review OS/27/2009 OS/27/2009 WI KLK Putilic Works Review 06/11/2009 06/11/2009 WE BJG Waining:on final inspection and as-buUts f.or subdivision. Public Works Review OS/26/2009 06/25/2009 APP BJG Storm water to swale Plan nine Review OS/26/2009 06/26/2009 APP DDK Approved as shown on plans. Structural Review 07/02/2009 U7/02/2009 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. I R~ollirrrl In.,np~tinn., I Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Vfer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After'forms are erected but prior to concrete placement. Post and Beam: Prior to noor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. . Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roof Sheathing Final Building: After all required inspections have been requested'and approved and the building is complete. Underground Plumbing: Prior to filling the trench and including required te,sting. Perimeter, Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Paee 3 of 4 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-00707 ISSUED: 07/10/2009 APPLIED: 0512112009 EXPIRES: 0111012010 VALUE: $: 161,841.80 225 Fifth Street, Springfield, OR 541-726-3753 Phone . 541-726-3676 Fax 541-726-3769 Inspection Line Undert100r Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Undert100r Mechanical. Prior to insulation or decking and including required testing. Undert100r 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 apRliance. Gas Service: After line is installed and line has heen 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. Ufor Electrical Ground: Install ground rod at footing and call for inspection in conjuction with footing and/or foundation inspection. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbellt - Standard: After forms are erected b1;lt prior to placement of concrete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all . information hereon is true and correct, and I further certify that any and all work performed shan:be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community. Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will.be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. I ~lJI)~1C;i).~r~ OC. 'Owner or Contractors Signature tA.()..... mo:Jl \;\'\ f).lf).{f'\ Date Pa2e 4 of 4 Electrical Permit A 1~~:jDEeAR:rM&EN]):lisEYp&NUy}1I~r jjif~fBlii;tM;jlf';'V_Vd:'Cd:Ljk"\%iiJ:"",.","":;,""^",,~,,"~,::-:<:.",::,,fu~,,,.&II' Permit no:: @,-\D\ 225 Fifth Street. Springfield, OR 97477.PH(54~)726.3753.FAX(S41)726-3689 f) (t\ r-v-1 V103gl3\ <Jl\,(:(XJ. Date:' J \j\}'\)./\ This permit.is issued under 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. 1~~_'ilIi\11!0C,,;l!ifG0VERNMENr;j!!ARRROY,,;l211lfillif~J~1 I Zoning approval verified? 0 Yes 0 No I 1;';:'.;;'"fJ'!illt~lICM"EG0RY,!0F:-iC0NSrRUCrIONt%<!"ilIi~i47l1 I I Residentia_l,pcr unit, service includ~d: I -~esidential I D Government I D Commercial 1 11,000 sq. ft. orless (4) 1'1~~ilJ1'J0B~SlrE'\INF:0RMA1i10Nr'ANDiI!0CArI0N!S&3!",J1I~1 I $134.00 $ ("?A > 1 Job site address: 1'L'2i)fi-~,y.\rteuJ I I ~~~~~ritionaI500sq.ft.orportion 0 'l. $ 25.00 $~D 1!~:~~~;~~:::~~~~;;~~lf~~! [~~~:~~~;~~~;~e~~:r(~)OdUIM oj : :::::: I ~~1~~. -~R~IP\ 011 Ir,~~::;::rf~:s~e(~/nsta//ation. alte~at, relo:ot~:~oo $ : l'Jl'4.,,-,'&d;r";'::;:'Jr~_.._,.,~.J.[.,nR0nERC':_,.y.,.Rj.0 WNER'''i0T'iFi~.'.cf4id.>i''.J'l%lfuT'j0riPffd 201 to 400 amps (2) I I $ 95.00 $ 1 "t,X,,$i'~A"''''~","'=_,wF*,",',cr;, ,r:;;.... 'lL.s" .... '" ~}}wn!fZt~=0*,7Jf%,~r- IName:Ml('\t)y~.l VA. " I 40Ito600amps(2) 1$158.00 $ I I Address: 'h~rr ., 1 D? I 601 to 1,000 amps (2) ,I I $205.00 $ I I City: PI A f Y1 e _ State: & ZIP:q-qqt> \ I lOver 1,000 amps or volts (2) I I $469_00 $ I I Phone:ffl f- (O'D~--:P:)%x: 1 I Reconnect only (2) 1 $ 63.00 $ I I E-mail: I [Temp~rary services or feeders: installation, alteration, reloc(ltion I. This installation is being made on residential or fann property . I 200 amps or less (2) \ I $ 63.00 $$l.P?>1 owned b~ me o~ a member of my immediate family. This. I 201 to 400 amps (2) I $ 87.00 l prop~rty IS not Intended for sale, exchange, lease, or rent. OAR I. I 479.540(1) and 479.560(1). 401 to 600 amps (2) I $126.00 $ I Signature: lOver 600 amps or 1,000 volts, see serv'ices or feeders section above I J~J14~~JWifcONm~CJtOR~.INSJ"Ali!~;rIONmit~si01ik;'~A1fi I Branch circuits: new, alteration, exte,!sion per panel I I Business name: J'iY\.l F-\-e ~ i ~ _ I ttr _ I I a. Fee for branch circuits with purchase of a service or feeder fee: 'I I Address: 9la l -UW ~JY"I~JI.G_r.e I I Each branch circuit ,I I $ 6_00 I $ I I city:LZec\MDM -;11 State: 012.-. I ZIP:~ I b. Fee for'branch circuits' without purchase ofaservice or feeder fee:, I I Phone.6L!J...!jn'r ;S'5lo~1 Fax;ff-{f 'iZA-'3~r~ I fjc;t branch circuit (2) I I $ 55.00 I ~ I I E-mail: rll.hlele.(.;t-riC!..L(\(l.(<J.cu51.(.(jV\- I Each additional branch circuit I I $ 6.00 $ I -I CCB license no.: l (0 I 2i.oL./ I BCD license no.: 1,,'3. f I c.. 1 1 Miscellaneous fees: service or feeder ~Ol included I I Signing supervisor's license no.: 5/05"<> I I Each pump or irrigation circle (2) 'I $ 63.00 $ I 'I Print name of signing supervisor: ~11<A-tJ ~u,.~> I I Each sign or outline lighting (2) $ 63.00 $ I I Signature of signing supervisor: ~ ~ ..A. ___ I I Signal circuit or a limited-energy panei, I $ 63.00 $ I V- r \ ____", alteration, or extension (2) V , I Each,additional inspection: (1) 1 "" Q-, ~ I (A) Enter sUbtota. 1 of above f~es \Y f\ \0 (Minimum Permit Fee $58.00) ~.V . ,() . I (B) Enter 12% surchMge (.12 x [A]) . - ~\V".6\ 1 (C) Technology Fee (5% of [A]) . I[ . . --,\.<0 ~I TOTAL fees and surcharges (A tbrough C): ~ $58.00 $ . $Q.~1 $ '1.'t.lA' $/2.38 ~ l.fflJa! 440-2584-J (9/08/COM) Mechanical Permit Application 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541 )726-3689 ~~ DEPARTMENT USE ONLY I Permit no.: I Date: This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. I : I ~eSid-~nti~r .. " " '1 Qty.l. ~~~t I First Appliance I $79.00 /Furnace/burner including ducts and vents 1 Up to lOOk BTU/hr. lOver lOOk BTU/hr. I Heaters/stoves/vents I Unit heater Wood/pellet/gas stove/flue . Repair/alter/add to heating appliance! refrigeration unit or cooling system! absorption system I Evaporated cooler I Vent fan with one duct/appliance vent I Hood with exhaust and duct I Floor furnace including vent I Gas piping lOne to four outlets I 1 Additional outlets (each) I J Air-handling units, including ducts 1 Up to iO,OOO CFM I I $11.00 1 $ lOver 10,000 CFM $20.00 I $ I Comvressor/absorDtion svstem/h'eat DumD I Upt03hp/100kBTU $17_001 $ 1 Up to ]5 hp/500k BTU $29.00 I $ 1 Up t030 hp/I,OOO BTU $43.00 $ I Up to 50 hp/t,750 BTU $57.00 I $ I Phone54-1-'f?D -.~':lf::L'J. 1 Fax:f5L(/-g,~ ..:::JoZ/ lOver 50 hpll.750 BTU $9S.00 I $ 1 E-mail:c:m'')V1Y1f'C~-'\@~~dlx.rJd.Q; I Incinerators I CCB license no . /'/ /'(j7 ~ 't\f Domestic incinerator $20.00 1 $ IC6mmerciai"';'. ..' ..., J Print name: ~ -~ c-y I Enter total valuation of mechanical system 1 J1I"""7A~ and installation costs $_ Signature: _ - /,r ~ . I 1 , Enter fee based on valuation of mechanical system, etc. . $ 1~~Wi~el~a~e6.~sJees.: " . ,..llte"!~ ~~~t I ~~~~I I Reinspection I $58.00 I $ I Specially requested inspections (per hr.) f $58.00 $ I Regulated equipment (unclassed) $13.00 I $ r Each additional inspection: (1) J $58.00 $ )~?~~;!~~:-;Y~i'v)in~~jiJ~,::ARPllICANT~dsE[r.~~ '. I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) I (B) Investigative fee (equal to [A]) 1 (C) Enter 12% surcharge (.12 x (A+B]) .I (D) Seismic fee, 1% (.01 x [A]) 1 (E) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A through E): CATEGORY OF CONSTRUCTION . ~esidential I 0 Government I 0 Commercial .JOB SITE.'NFORMATIOIll.AND LOCATION 'I Job site address: I ~.{'2.., () H"-.j y- V I e0 I City:~--r\f\A.\4f>ld r State:O'K. I ZIP: , I Subdivision: t)h'iVlCl \ t- I Lot no.: \ D 1 . DESCRllmON, (jF.WO~~" - ~\~1f~~!N:R:\~I~ - ,-" -..,.... -... . I Name:{Y\ir\'lQf J -:\Q.m,e.c;. m I Address:^~\o t..i - r - I City: 6.x:t)"\I"\e. State: (<Q.. I Phone:ffi ~~ lD9,-;,-~~ Fax: . - I E-mail: 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 701.0 I O. . Signature: ,. '\"-'. ,. _ C0NTRACTOR.I/IlSTAtl!ATION.,' . ,-:.",,'1 I Business name: II fQJt'I ~/o1A. ,_L(. c. I 1 Address: /f}CJ 7- ).HJ CCKdn. tUtf!.1. 1 I City: ~K~ 1- St:rte: OT? 121Pq-:r-=:ro11 440-2545-) (I 1/08/COM) FEE SCHEDULE. I I I I I I I I I I : $17_00 I $ $20.00 $ $17.00 . $38.00 $58.00 $13.00 I $ $9.00 $ $13.00 I $ $58.00 I $ $7_00 I $ $4.00 $ $ $ $ $ $ $ Total cost I I I I I I I I I $ $ $ $ Structural Permit Application - 225 Fifth Street. Springfleld, OR 97477. PH(541}726-3753. FAX{541)726':~689 m~w;DEj;ARi'MENT~USEONifY<KI ~,:-~.~.~-,=~..~<..,,"" -,- ".~,.~: ,',,_.~.~'"' ,.;;" -,,~.,.~_._,~".. ._...."..~.-~-.~~--~_._.._._-" ...."._~,,- -'.".'~" ~.~ _.'<"..- perIj1itno.:C'1-7-:&+ I Dat,: S -"2----1 --e-<7 . Th.is permit is issued under, OAR 918-460-0030. Permits expire if work is not started within 180 da'ys of issuance or if work is suspended for 180 days. ;, "~.i.-"'JY;:0.:tt.t'J.'fJ:,' ':-, --~.".... '" :,~'S'--'M" "'-'''''E' ,- R'o --.N"....'M... -'E'.---."-T';.--.u ..,- -'--"-:Q":",.'Wr;i;i[j.kf&a,,~'ft1 :e::T,?l",,:;:\1\-4l:QCAU.GOV. . NT:!f~p,P.R()V~L;.\'h!:f::i::. ''2',,";., I Date: !Date: DNo DNo This project has final land-use approvaL Signature: I This project has DEQ approval. '; Signature: . I Zoning approval verified: 0 Yes T1nJperty is \>,'ithin flood plain: 0 Yes I (a) Job description: 1Je.w Q,~"tnJI'~ i., Occupancy 5'i.n.~le. fulY'\~I~ ~td:e,.,r~ I Construction type: '-' f 11,,~e;;~~~ti~14_ .., I[]~o:e,?,,?,:~~ ...... .L[]"::~~:;Ci~.~..'".'II: ~~~~:e:es:~are \:co ~;;v:i'l0'\:'!''''i~()I3;.SFrE'i-JN.~().RM~Tlo.N'~IIID~t!O<:HIOIII_~'''_i. I Other information: I JObsiteadd:essl'2-?'~trview (w.) I 1 Type of Heat: .r\-VA-c.. I City:~~,(\aTte _ _ I State: O~ I ZIP: I I EnergyPath: 5 I Subd]vISlon:~) ~t I Lot no.~. 10 I 1 "" 0 . I I nJ'~!li ':.t I 1 rn - I ""new alteratIOn 0 addition Reference: ~ I~ ~ Taxlot: ~ / _, I :.., "fi1',,'~i"ii~:"'''Z"-'';;.R':':O'P-'>E'R'-iY"'O:.~W-.N."E..R-.~q;l;;;~::zi.~'l;1ii:iJt,\ ''!Qil I (b) F oundation,only permit? 0 Yes Iil7No 1~'::::';n';~}.1~\(j~~~ m::~~i ,.,_:.'::11"""""'."1 I Total valuation: I AddresF 3~1 1 I rL. JI I (a) Pennit fee (use, valuation table): City .~'" ._.1.. State: () I I ZIP:'1 r</()'I c.- I (b) Investigative fee (equal to [2a]): I Phone / - P>~:'~~ Fax. I I - I (c) Reinspection ($ per hour): E-mail: - I (number of hours x fee per hour) This installation is being made on residential or farrnproperty owned by I d) E 12"' (12 [2 b ) ( nte, r '" surchar, ge. x a,+ 2 +.. 2c 1 : me or a member of my immediate family, and is exempt from licensing , requirements under ORS 701.0 I O. (e) Subtotal of fees above (2a through 2d): I $ $ $ $ $ S Sign here: I I City: State: zIP:9rlO/1 PhonefJ.{l-hg'7-oPJt)3 Fax:/5'11-1Jf1.2,-l"Jz..c:, 1 E:mail.a.mye1tJify ~ (y.hrJhr/N?d fV41d~ i",CCB liceuse no.: ~~ {O I printnam~eacl I J'S;~nature ~.&? /~ I $'GIJ::--' z:i"~",J':J:;;:kJ~:;~Ir ' - ;'CoNTRACTOR\iNF:dRMArlON::>;ry;lG,%14L,*J0l'&%~l i':,~~.::;"if:\~~:~;";~ I,,;,;:~;:~l ^ '" Q at'" I Plumbing \9,((l2.:=I-j 1~1-5l~-~ "'\' .. ~ I Mechanical /-:/ 10-'11 Itill ~"W~ -} \.:V\VClUOc;.0"'" \\t()~r '-\SOJ. . b.... f~::/\) \. c.e< Irfi'j'S..tL/' I (a) Plan review (65% x pennit fee [2a]): 1 (b) Fire and life safety (40% x peffilit fee.[2a]): r (c) Subtotal of fees abo,:e (3a and ~b): I $~2-4-,rL I I $ I I $ I I (a) Seismic fee, 1% (.01 x peffilit fee [2a]): I $ I TOTAL fees and surcharges (2e+ 3c+4a):$ ~ \q.5 Plum bing Permit Application I DEPARTMENT USE ONLY This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expi~e if work is not started within 180 days of issuance or if work is suspended for 180 days. 1 LOCAL GOVERNMENT .APPROVAl .1 I Zoning approval verified? DYes D No I I Sanitation approval verified? ~ Yes D No I _I CATEGORY,. OF CONSTRUCTION,_, , .1 Illt\Residential 1 D Government 1 D Commercial 1 i --JOBSITE.INFORMATION..AND LOCATION 1 -I lob site address. Iz..oo FC...\'("IHeW 1 I City~"')r\DA.+teld r State: & 1 ZIP: I I Subd]vislOn. G\')\l'\ql+- I_Lot no.: \ b . I ~~\/:~;E~O~~~.~<(;'~! : Name:m~:~;rE~~;~R\ , c.~'~"'1 1 Address ~'-f4('; U~'("l,)W A-f\~ I I City: ~.l 'Cr f>.lfl e. I State: 0 f.2.. 1 ZIP:Ci,-=t<-I;Ql. 1 Phone~'2, -~:itFax: I 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 CONTRAC.TORINS.TALLATION,;':_", .;1 1 Business name: L c.. I I Address: q /5 ~ I rLV')~ 1iJtl1A~ ~ State: Of2..~~ Phone 'jj.J1-5~-1<i6c;.1 Fax:~"/-!5dI~ 09>57- _I E-mail jUni~\IJ~lH1..(lllm^-< I 1 CCB license no.: ~~ z.::r 1t ItCD license no.: I I Plumbing license no.: I - I Print nameiTil/'JtAf.f{- 9!I~1/f// 1 I Signature'[fZ71'Hvt' /'0. I 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 440-2500-) (IIID8/COM) ,- I, -. - IDescri_plio~~' New residential I bathroomll kitchen (includes:first J 00 feet of water/sewer lines, hose bibs, ice maker, underfloorlow-point drains and rain-drain packages) 1 2 baihroomsll kitchen $374.00 $ 1 3 baihroomsll kitchen $439.00 $ 1 Each additional batllroom (over 3) $95.00 1 $ I Each additional kitchen (over 1) $95.00 1 $ Residential fire sprinklers (includes plan review) o 10 2,000 square feet $58_00 2.001 to 3,600 square feet $116.00 3.60i to 7.200 square feet $174.00 7,201 square feet and greater $232.00 Manufactured dwelling or pre-fab (circle one) Connections to building sewer and I I $5800 I $ water supply . Comm~rcial, industrial, and dwellings other than one- or two-family Minimum fee Miscellaneous fees 100' stann, sewer, water line Each fixture, appurtenance, and piping Storm water retention/detention facility Irrigation systems Piping or private stonn drainage svstems exceeding the first 100 feet Specialty fixtures 1 Reinspection (no. ofhrs. x fee per hr.) I Special requested inspections (no. of hrs. x fee per hr.) I.Each a~ditional inspection: (I) $58.00 I i\'1c'diCargas'pipirii(;~',;.'. '. '. ,." . [Minimum fee I Enter value of installation and equipment $_" I Enter fee based on installation and equipment value. li~:t;;;:';'r:':::,:"~~~jA.:,.,:f,b:;iA..P P.L IC-A.N..T'~U.SE-:''i::. "..-:, 'C""'"j"~"~..libr0",,~,i'.',,,"~'.~'(L;'",, ,,",\, ~:'?,,"'i:c .1 (A) Enter subtotal of above fees (Minimum Permit Fee S58.00) I (B) Investigative fee (equal to [A]) I (Cl Enter 12% surcharge (.I2x [A+B]) I (D) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A through Dj: I Permit no.-: I Date: : FEE SCHEDUlE ,. "-IQ!y.1 Each fixture I I Cost ea_ $238.00 $58.00 I $ $19.00 $ $76.00 $19.00 $19_00 $19.00 $19_00 $19.00 $58.00 I $58.00 .I ,I;' """ $ $ $ $ $ Total cost $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ '.~ -,.. ,.f:.. , Job. No. Cf1,101 SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: . ~\~_ ~id\(! PHONE: IJlj3- 153-' . ADljRESS~\P ~\W;..~mD'1- 6tl~STATEQbIP: tIw l . .. I LOCATION OF PROPOSED BUILDING SITE: . Street Address: 1'1.50 lD. t6irVlW Plat Name: ~lJ\(\~.. Tax Lot Number: 1'70311'&' cr\~ . . 1; DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the . back.) A. Sinale-Familv Detached NO. OF UNITS l X $2,858 per unit = $~pv B. Sinale-Familv Attached NO. OF UNITS X $3,100 per unit = $ C_ Multi-Familv Aoartmimt 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 = $ $ '2RJ!:fJ.t:O 1) $ WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer must fumish proof of Willamalane Credit approvaL) 3. TOTAL WILLAMALANE NET SDC ASSESSED .(if SDC reduced for Credit) Development Servi e ~ City of Springfield . $J~.oc) ~ LcIOq Date 5 City of Spl'ingfield Official Receipt Development Services Department Public Works Department. 225 Fift:11 Street Springfield, Oregon 97477 541-726-3759 Phone Job/JovrnalNumber COM2009-.1l0707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009"00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 .C:O~009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 COM2009-00707 Payments: Type of Payment Check cReceint 1 RECEIPT #: Date: 07il012009 8:03:04AM 2200900000000000778 Description Addressing Assignment Willamalane Single Family Fire SF Fee - Residential Building Pennit 2 Baths One or Two Family .1 st Appliance. Vent Fan Exhaust Hoods Dryer Vent Gas Outlets 1-4 Fireplace (Listed) Residence Wiring 1000 Sq Ft R~sidence Wiring Ea Addtl 500 Temp Power 200 .amps or less Penn Serv/Fdr 200 amps or less Sidewalk Pennit Curbcut Pennit Curbcut - 2nd Curbcut Storm Drainage Impervious Area Sanitary Sewer - Reimbursement 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 Heat Pump + 5% Techriology Fee + 12% State Surcharge Amount Due 38.00 2,858.00 97.00 961.09 337.00 79.00 18.00 13.00 9.00 7.00 20.00 13400 50.00 63.00 81.00 88.00 88.00 (45.00) 587.74 608.63 462.8.0 201.54 888.98 97.90 1,009.17 10.00 116.66 76.68 211.00 L7.00 106.55 214.69 $9,5U5.43 P~id By - EQUITY HOMEBUILDERS Itein Total; Check Number Authorization Received S-y Batch Ntimber.Niitnber How Received Amount Paid IIh 3644 In Person Payment Total: $9,505.43 $9,5U5.43 Page I of I 7/1 0/2009