The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2007-1-25 . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Corn aoo" - 01 rx ~ SPRINGP'IELD ...---- -T) LJI'L/'!--../.'.j\ '" -.-.., il'P" '1.. I .i. ,', ~~JV "'-... I. I ip0?'I()!" ()~ ~~!~LA.T!9~'"-~"~~'~3 42..1.h tvtfiU.v St- LE\AL07:32:~ O\~cD JOB DESCRIPTION ~ ~~re~-~b;e and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Date J /ZS-/07 , 3. F~~~~L!!:!l!!.kE~~!l.1!DUic~.~EI:O~~~~~~-'~- ~:~:~ A. FNew R;;id;~ilil ~ iiiiigl~ ~;-~flllti-F.niily-p-;:;'d;!,lIin ' unit.' i L__ _ . ~___ ~__ Service Included 1000 sq, ft, or Jess Each .dditional 500 sq, ft, or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106,00 $ ]9,00 $50,00 2. I CON.!RAc;TO~ rNSTAf.LATIf)N ONI;,V,j B. ~Se~\~~ or'F~de;s :::lnstalliitiol1;Alteratio~sor RClocatjo~;"') Electrical Contractor [1, hi'll':> f .Pfl..\.m 21t2.CntLl'200 Amps or less $ 63.00 tn D 201 Amps to 400 Amps $ 75,00 Address ::;vD 5. ('1'l~a V\vL 40] Amps to 600 Amps $125.00 , I 60] Amps to 1000 Amps $163.00 City IiJl.l.JJ- Phone j,,/iy -G,Jlj Over 1000 AmpsNolls $375,00 - -- ) Reconnect Only $ 50,00 New Alteration or Extension Per Panel One Circuit I / ~../ Each Additiona] Circuit or with cYw;;ers Name ~ \J. ~-{U- ~ ServIce or Feeder Permit '. $3.00 Address ~\F. IlA t..fj-t., 'PI.-' E. ~i's~!II~n"!,,!s:(S.e,*i~e/feed~'r n?l !~eI~~ed;':E~~h ,ristallaiion I City ~ Phone' Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidentiaJ $ 25,00 Limited Energy/Commercial 1 $ 45.00 ~OO Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Supervisor License Number Expiration Date Conslr. Conlr, Number OWNER INST ALLA nON The installation is being made on jJIU'p~lli I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 ap 6/' \Ol~ c. fr.:T~lripo~a;:Y:Sen.i~~~ or~Feed~r~: "'~J ',[ Installation, Alteration or Relocation 200 Amps or less 20] Ampsto 400 Amps 40] Amps to 600 Amps Over 600 Amps or ]000 Volts see "B" above. D. ~Jlrinch 'Ci~cui~ . ., , $ 50,00 $ 69,00 $]00.00 ,'.,' ...j $ 43.00 ~" ',. .' " .' . ,.. 4.:~cm1'QTAL.9F ABOVE, "~"_k.~-,_",;", ," ,'," '",' .'~' ?^" _; .'1 , ..I ", t 4-500 ,:J,.h() 4-.$-b 2,..u;; 5i ~~ . ...)- 8% State Surcharge 10% AdJf:nislrative Fee T~fi.L ~ Shared Drive(T:)lBuiJding ForrnslElectrical Pennit Application I.06.doc . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4223 Main St ASSESSOR'S PARCEL NO.: 1702323201900 Springfield PROJECT DESCRIPTION: Remodel Save-A-Lot Grocery Store Owner: DONALD V PFEIFER TRUST Address: 2011 NE 164TH PLACE PORTLAND OR 97230 . CITY OF SPRIl'It.1<H..LD. Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/25/2007 VALUE: $ 691,405.00 TYPE OF WORK: Grocery Store TYPE OF USE: Remodel Commercial Phone Number: 541-683-9001 Phone Number: 516-420-0060 I CONTRACTOR INFORMATION I Contractor Type General Designer Electrical Fire Contractor Low V oUage Electrical Mechanical Plumbing Contractor WESTERN CONSTRUCTION SERVICES WESTERN DESIGN GROUP A C & E ELECTRIC CO. WYATT FIRE PROTECTION INC CHRISTENSON ELECTRIC INC SOURCE REFRIGERATION & HVAC INC R A WARNER PLUMBING CO INC. License 63717 Expiration Date 01/22/2008 591 64077 458 149200 151329 07/21/2008 02101/2008 05/01/2007 10/01/2009, 05/03/2008 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: BUILDING INFORMATION' # 'of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: M IIIB nla I DEVELOPMENT INFORMATION I Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Yes Notes: Pa~e I of6 Phone 360-699-5317 360-699-5317 503-363-230 I 503-684-2928 (503) 419-3300 714-578-2300 360-896-0370 REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: Curbside 5' Curb and Gutter -~; '~..' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Type of Construction Estimate Estimate Pavine; Estimate Estimate Use Bid Amount Fee Description Plan Review Comm/lndlPublic Plan Review Fire & Life Safety -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Building Permit Fixture Furnace - Unit Heater Furnace - up to 100,000 btu Gas Outlets 1-4 Gas Outlets 4+ Miscellaneous Plumbing Paving Plan Review Comm/lndlPublic Plan Review Fire & Life Safety Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC SanitarylStorm Admin Vent Fan + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Perm ServlFdr 200 amps or less Perm ServlFdr 201 to 400 amps Perm ServlFdr 601 to 999 amps + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Water Line - 1st 50 Feet Water Line - Each AddtllOO' + 10% Administrative Fee + 5% Technology Fee . . CITY OF ~t'K11'\jGFIELD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/1212006 EXPIRES: 07/25/2007 VALUE: $ 691,405.00 I Valuation Descriotion I $ Per Sq Ft or multiplier $1.00 $1.00 $1.00 Square Footage or Bid Amount 553,151.00 130,754,00 7,500,00 Value Date Calculated $553,151.00 $130,754.00 $7,500.00 $691,405.00 10/03/2006 01/11/2007 10/03/2006 Total Value of Project FpP:~ PIiILI Amount Paid $1,107.05 $681.26 $10.00 $293.20 $146.60 $227.21 $2,041.15 $630,00 $12.00 $96,00 $4,00 $6,00 $45,00 $91.80 $234.49 $144.30 $712.44 $937.08 $82.48 $6,00 $82.90 $41.45 $66.32 $327.00 $189.00 $150,00 $163,00 $1 1.80 $5,90 $9-44 $90.00 $28.00 $4.50 $2.25 Date Paid Receipt Number 9/12/06 9/12/06 10/30106 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 1112106 1l/2/06 11/2/06 11/2106 11/2/06 1l/2/06 1112/06 12/26/06 12/26/06 12/26/06 12/26/06 12/26/06 1/5/07 1/5/07 1200600000000001405 1200600000000001405 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001748 2200600000000001748 2200600000000001748 2200600000000001748 2200600000000001748 2200700000000000027 2200700000000000027 Paee 2 of6 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line + 8% State Surcharge Low Voltage - Commercial Indus -Mechanical Issuance Fee- + 10% Administrative Fee + 10% Administrative Fee + 5% Technology Fee + 5% Technology Fee + 8% State Surcharge + 8% State Surcharge Air Handling Unit 10,000 & Ovr Boiler/Comm 15-30 HP Building Permit Gas Outlets 4+ Miscellaneous Mechanical Plan Review Comm/lndlPublic Plan Review Fire & Life Safety + 10% Administrative Fee FLS Safety Systems Review + 10% Administrative Fee FLS Safety Systems Review Temp Occy (R1A/A) C & I + 10% Administrative Fee + 5% Technology F,ee + 8% State Surcharge Low Voltage - Commercial Indus Total Amount Paid Fire Department Review . $3.60 $45.00 $10.00 $4.50 $68.64 $2.25 $34.32 $3.60 $54.91 $15.00 $30.00 $666.40 $5.00 $15.00 $433.16 $266.56 $15.04 $150.42 $20.60 $205.95 $100.00 $4.50 $2.25 $3.60 $45.00 $10,884.92 I Plan Reviews I 01/17/2007 01/17/2007 Paee3 of 6 1/5/07 1/5/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/18/07 1/18/07 1/19/07 1/19/07 1/19/07 1/25/07 1/25/07 1/25/07 1/25/07 OK .CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/25/2007 VALUE: $ 691,405.00 2200700000000000027 2200700000000000027 2200700000000000064 2200700000000000064 1200700000000000037 2200700000000000064 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 3200700000000000026 3200700000000000026 220070000000000008\ 220070000000000008\ 2200700000000000085 2200700000000000112 2200700000000000112 2200700000000000112 2200700000000000112 GRG Plans Review: Fire Alarm submittal for water now and tamper monitoring and occupant notification of water now. Job #COM2006-01182. Designer: Wayne Elmore. Contractor: Allied Fire and Security. Plans appear to mcet codc requirements. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fire Department Review Fire Denartment Review Initial Review Initial Review Plan Review Comments Plan Review Comments Plannin~ Review Public Works Review . 01117/2007 09/14/2006 09/1312006 12104/2006 09/14/2006 09/14/2006 0111712007 10123/2006 09/13/2006 1210612006 10/03/2006 10/26/2006 09/17/2006 10/09/2006 OK OK APP APP 10 10 APP APP Paee 4 of6 . CITY OF SPRIr\jl>l'lI'.,LD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/1212006 EXPIRES: 07/25/2007 VALUE: $ 691,405.00 GRG GRG LLH LLH JMP JMP EMM CJS Plans Review: Addition of 38 sprinkler heads to existing systcm for remodel. Job #COM2006-01182. Designer: Eugene Lathan. Contractor: Wyatt Fire Protection, Inc. Plans appear to meet code requirements. Site visit on 1/12/07 noted sprinkler heads too close to vertical obstructions in coolers and freezers. Sprinkler heads shall be spaced away from obstructions meeting NFP A 13, Table 8.6.5.1.2. Refer also to Figure 8.6.5.1.2(a). See attached comments for Fire Department Plans Review comments. Plans actually submitted on 11117/06 but misplaced until 12/4/06. I routed them as soon as we located them. WE. Received incomplete respouses to structural comments from Gary Young. JMP called Gary to discuss items 6 & 7 (special inspection signatures and contractor data). WE. Called Gary Young. He said that he will talk to Dean Knuteson who will bring in the missing information. He will also respond to the plumbing comments. No change in use. Discussed permit review timing with Karen from Western Design Group; will try to expedite SDC review CJS 10/06/06 Called Karen (Western Design Group) for information on demo'd drainage fixture units (sinks, toilets, etc.) for SDC credit CJS 10/06106 Called Karen (Western Design Group) to confirm that previous use of property was grocery store 10/09/06 CJS Added SDC's 10/09/06 CJS . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/25/2007 VALUE: $ 691,405.00 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 09/13/2006 09/22/2006 WE JMP Structural Review 12/06/2006 1210712006 WE JMP Structural Review 01102/2007 01111/2007 APP JMP Structural Review 10/2712006 10/27/2006 APP JMP SUB Review 09/14/2006 09/2212006 APP DH See attached documents for 9 structural comments faxed to Gary Young. Called Gary Young with Western Design Group. He will providc documentation on the adcquacy of the roof for the RTU and he will have Source Refrigeration provide the increased valuation for the refrigeration system. Received 6 revised structural drawings and 13 pages of structural calculations and a valuation from Source Refrigeration. Received the missing special inspection form and contrator data. 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. ~ Rpllllirprf 1lIII'llll~tilnl"i.l SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting Footing: After trenches are excavated. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide results to City Buiding Inspector Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to placement. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Pa~e 5 of6 . .CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/25/2007 VALUE: $ 691,405.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. Water Line: Prior to filling trench and including required testing. Low Voltage: Prior to cover. 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 shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the 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. Owner or Contractors Signature Date Pa~e 6 of6 225 FiUh Street Spl'iJigfield, Oregon 97477 541-726-3759 Phone HQFlIll.D , . 1":,"- ','; ~,'" ~,~^ C& of Spriogfield Official Receipt .Iopment Services Department Public Works Department Job/Journal Number COM2006-0 1182 COM2006-0 11 82 COM2006-0 11 82 COM2006-0 II 82 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000000112 Date: 01125/2007 Description Low Voltage. Commercial Indus + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By CHRISTENSON ELECTRIC Item Total: (;heck Number Authorization Received By Batch Number Number How Received ddk 15241 In Person Payment Total: Page 1 of 1 12:26:18PM Amount Due 45,00 2,25 3,60 4.50 $55.35 Amount Paid $55,35 $55.35 1/25/2007 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . iJ~~",.," . Mr'"" 1 .,...._.~,_ _. .:;;.> .....-"._t " .~; Ci,.f Springfield Official Receipt D.opment Services Department Public Works Department RECEIPT #: 3200700000000000026 Date: 01118/2007 8:18:34AM Job/Journal Number COM2006-01182 COM2006-01182 Description FLS Safety Systems Review + 10% Administrative Fee Payments: Type of Payment CreditCard Paid By ROBERT BEARD/ALLIED SECURITY Item Total: Check Number Authorization Received By Batch Number Number How Received njm 026413 In Person Amount Due 150.42 15,04 $165.46 Amount Paid $165.46 Payment Total: $165.46 4d...().~ rY\(l..l...-1..- cReceintl Page 1 of I 1118/2007 6.-111' V1' ~rRIr~\.y1'IELD" Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12126/2006 APPLIED: 09/12/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4223 Main St ASSESSOR'S PARCEL NO.: 1702323201900 Springfield TYPE OF WORK: Grocery Store TYPE OF USE: Remodel PROJECT DESCRIPTION: Remodel Save-A-Lot Grocery Store Commercial Owner: DONALD V PFEIFER TRUST Address: 2011 NE 164TH PLACE PORTLAND OR 97230 Phone Number: 541-683-9001 Phone Number: 516-420-0060 Contractor Type General Designer Electrical Use Initials Low Voltage Electrical Mechanical Plumbing I-t!-,. I CONTRXGifORINFORMATION I Ifulif/ . tileS -It.. Contractor 'I) OA.~8tion CeClOCilliie'Iise.", Expiration Date WESTERN CONSTRUCTI'6N~~I}JfVi(:;!j:~T nte637h{iJ.' the' ~'1~lt 01n~2008 WESTERN DESIGN GROUPe//i Ou ma -OOTO ,.OSe rUle regon II ~'" A C & E ELECTRIC CO. ')Ul))b ng the c?' Obtc59,I'nrolJgh s 8rE07l21i2'008 WYATT FIRE PROTECTION INGh,- '/j (JI/ler. 6,4rFi"ttJies ~A,A ~027o'l'tz008 ALLIED FIRE & SECURITY Ce"!~r;~ ~re!JJlj~~I: the 0 the ,gU23/2008 SOURCE REFRIGERATION & HV AC INC-R.')II~?,~OO/tJl ~e/~PhJ~~lf~009 R A WARNER PLUMBING CO INC. 151329P?A OlJtic",Q5/03/2008 . "/. -" # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: .1 BUILDING INFORMATION I "uFI. rHiS l#!i;f Stories: M /jUrH PE~~j::pt, of Structure C} r, (Jf?/Jxp,e ofll'l.<;a]' I1I~ ,,1,., 't!.,~ate~'TrJle: f.'(p './ 7, ' ~cRjjnge Type: 7: IRE IF c" " ",,'. HIS T/J 0'1J'').l'rl1.?''~a,!,'J;.. Pr. 'iEWn Spriitklejl,BUilding:"R .11/r 'Sn/a 'RI( Vv .....VIV/.::" f.' 1.,,,__ ~ -'.- ...., I DEVELOPMENT INFORMATION I Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: Phone 360-699-5317 360-699-5317 503-363-230 I 503-684-2928 503-281-1177 714-578-2300 360-896-0370 REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: " I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Fully Improved Yes Notes: Pa~e I of6 Curbside 5' Curb and Gutter . .ITY VI' ~rK~j"'ljI'JJ<.,LD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/1212006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion , Estimate Estimate Use Bid Amount $ Per Sq Ft or multiplier $1.00 $1.00 $1.00 Square Footage or Bid Amount 553,151.00 130,754.00 7,500.00 Value ' Date Calculated Description Estimate Estimate Pavin~ Tvpe of Construction Total Value of Project $553,151.00 $130,754.00 $7,500.00 $691,405.00 10/03/2006 01/11/2007 10/03/2006 L...fu< P~i<l J Fee Description Amount Paid Date Paid Receipt Number Plan Review Comm/lndlPublic $1,107.05 9/12/06 1200600000000001405 Plan Review Fire & Life Safety $681.26 9/12/06 1200600000000001405 ......Mechanical Issuance Fee- $10.00 10/30/06 2200600000000001519 + 10% Administrative Fee $293.20 10/30/06 2200600000000001519 + 5% Technology Fee $146.60 10/30/06 2200600000000001519 + 8% State Surcharge $227.21 10/30/06 2200600000000001519 Building Permit $2,041.15 10/30/06 2200600000000001519 Fixture $630.00 10/30/06 2200600000000001519 Furnace - Unit Heater $12.00 10/30/06 2200600000000001519 Furnace - up 10 100,000 btu $96.00 10/30/06 2200600000000001519 Gas Outlets 1-4 $4.00 10/30/06 2200600000000001519 Gas Outlets 4+ $6.00 10/30/06 2200600000000001519 Miscellaneous Plumbing $45.00 10/30/06 2200600000000001519 Paving $91.80 10/30/06 2200600000000001519 Plan Review CommllndlPublic $234.49 10/30/06 2200600000000001519 Plan Review Fire & Life Safety $144.30 10/30/06 2200600000000001519 Sanitary Sewer - Improvement $712.44 10/30/06 2200600000000001519 Sanitary Sewer - Reimbursement $937.08 10/30/06 2200600000000001519 SDC SanitarylStorm Admin $82.48 10/30/06 2200600000000001519 Vent Fan $6.00 10/30/06 2200600000000001519 + 10% Administrative Fee $82.90 11/2/06 2200600000000001537 + 5% Technology Fee $41.45 11/2106 2200600000000001537 + 8% State Surcharge $66.32 11/2106 2200600000000001537 Add, Alter, Extend Circ Ea Add $327.00 11/2106 2200600000000001537 Perm ServlFdr 200 amps or less $189.00 11/2106 2200600000000001537 Perm ServlFdr 201 to 400 amps $150.00 11/2106 ,2200600000000001537 Perm ServlFdr 601 to 999 amps $163.00 11/2106" 2200600000000001537 + 10% Administrative Fee $11.80 12126/06 2200600000000001748 + 5% Technology Fee $5.90 12126/06 2200600000000001748 + 8% State Surcharge $9.44 12126/06 2200600000000001748 Water Line - 1st 50 Feel $90.00 12126/06 2200600000000001748 Water Line - Each AddtllOO' $28.00 12126/06 2200600000000001748 + 10% Administrative Fee $4.50 1/5/07 2200700000000000027 + 5% Technology Fee $2.25 1/5/07 2200700000000000027 Pa~e 2 of6 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line + 8% State Surcharge Low Voltage - Commercial Indus -Mechanical Issuance Fee- + 10% Administrative Fee + 10% Administrative Fee + 5% Technology Fee + 5% Technology Fee + 8% State Surcharge + 8% State Surcharge Air Handling Unit 10,000 & Ovr BoilerlComm 15-30 HP Building Permit Gas Outlets 4+ Miscellaneous Mechanical Plan Review Comm/Ind/Public Plan Review Fire & Life Safety + 10% Administrative Fee FLS Safety Systems Review + 10% Administrative Fee FLS Safety Systems Review Temp Occy (R1A/A) C & I Total Amount Paid Fire Department Review 01/17/2007 Fire Department Review 01/1712007 . $3.60 $45.00 $10.00 $4.50 $68.64 $2.25 $34.32 $3.60 $54.91 $15.00 $30.00 $666.40 $5.00 $15.00 $433.16 $266.56 $15,04 $150.42 $20.60 $205.95 $100.00 1/5/07 1/5/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17107 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/18/07 1/18/07 1/19/07 1/19/07 1/19/07 $10,829.57 , Plan Reviews I 01/17/2007 OK 01/17/2007 OK Pa~e 3 of6 .ITY VI< ~nUNGFIELD ' Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/1812007 VALUE: $ 691,405.00 2200700000000000027 2200700000000000027 2200700000000000064 2200700000000000064 1200700000000000037 2200700000000000064 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 3200700000000000026 3200700000000000026 2200700000000000081 2200700000000000081 2200700000000000085 GRG Plans Review: Fire Alarm submittal for water flow and tamper monitoring and occupant notification of water flow. Job #COM2006-01182. Designer: Wayne Elmore. Contractor: Allied Fire and Security. Plans appear to meet code requirements. Plans Review: Addition of 38 sprinkler heads to existing system for remodel. Job #COM2006-01182. Designer: Eugene Lathan. Contractor: Wyatt Fire Protection, Inc. Plans appear to meet code requirements. GRG Site visit on 1/12/07 noted sprinkler heads too close to vertical obstructions in coolers and freezers. Sprinkler heads shall be spaced away from obstructions meeting NFPA 13, Table 8.6.5.1.2. Refer also to Figure 8.6.5.1.2(a). . 6-11 }' VI' ~rKll~GFIELD " Building/Combination Permit Status Issued PERMIT NO: COM2006-01182 225 Fifth Street, Springfield, OR ISSUED: 12/26/2006 541-726-3753 Phone APPLIED: 09/12/2006 541-726-3676 Fax EXPIRES: 07/18/2007 541-726-3769 Inspection Line VALUE: $ 691,405.00 Fire Department Review 09/14/2006 10/23/2006 OK GRG See attached comments for Fire Department Plans Review comments. Initial Review 09/13/2006 09/13/2006 APP LLH Initial Review 1210412006 12/06/2006 APP LLH Plans actually submitted on 11117106 but misplaced until 12/4/06. I routed them as soon as we located them. Plan Review Comments 10/03/2006 10 JMP WE. Received incomplete responses to structural comments from Gary Young. JMP called Gary to discuss items 6 & 7 (special inspection signatures and contractor data). Plan Review Comments 10/26/2006 10 JMP WE. Called Gary Young. He said that he will talk to Dean Knuteson who will bring in the missing information. He will also respond to the plumbing comments. Plannine: Review 09/14/2006 09/17/2006 APP EMM No change in use. Public Works Review 09/14/2006 10/09/2006 APP CJS Discussed permit review timing with Karen from Western Design Group; will try to expedite SDC review CJS 10/06/06 Called Karen (Western Design Group) for information on demo'd drainage fixture units (sinks, toilets, etc.) for SDC credit CJS 10/06/06 Called Karen (Western Design Group) to confirm that previous use of property was grocery store 10/09/06 CJS Added SDC's 10/09/06 CJS Structural Review 09/13/2006 09/2212006 WE JMP See attached documents for 9 structural comments faxed to Gary Young. Structural Review 12106/2006 12107/2006 WE JMP Called Gary Young with Western Design Group. He will provide documentation on the adequacy of the rooffor the RTU and he will have Source Refrigeration provide the increased valuation for the refrigeration system. Structural Review 01102/2007 01/1112007 APP JMP Received 6 revised structural drawings and 13 pages of structural calculations and a valuation from Source Refrigeration. Pa~e 4 of6 . -lIIIri~,1~.~ft'~ , " .. -~' . . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 10/27/2006 10/27/2006 APP JMP SUB Review 09/1412006 09/2212006 APP DH .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 Received the missing special inspection form and contrator data. To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 RpnllirprIJn~nection~ I SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting Footing: After trenches are excavated. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide results to City Buiding Inspector Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to placement. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Fiual Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. Water Line: Prior to filling trench and including required testing. Low Voltage: Prior to cover. Paee 5 of6 . 6:ITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09112/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone ' 541-726-3676 Fax 541-726-3769 Inspection Line 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 shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the 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 ';-~"T~'"'AA(AM/ 1-/4 -01 Owner or contr~Signatu\e D~te / Pa~e 6 of6 225 Fifth Street Springfield', Oregon 97477 541-726-3759 Phone . _,'j:,~.."~,,I,L,.. ~._.,'_'" ", llii!i . I .\.~. i ~>,., "'", ,0. ~ ~".,".,. . ~.~ ~'H ~. ... Citiif Springfield Official Receipt D.pment Services Department Public Works Department RECEIPT #: 2200700000000000085 Date: 01119/2007 2:42:20PM Payments: Type of Payment CreditCard Item Total: Check Number Authorization Paid By Received By Batch Number Number How Received WESTERN CONSTRUCTION djb 619114 In Person Payment Total: Amount Due 100,00 $100.00 Job/Journal Number Description COM2006-01182 Temp Occy (RIA/A) C & I Amount Paid $100,00 $100.00 cReceint 1 Page I of I 1/19/2007 ~ll 1" OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 , . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4223 Main St ASSESSOR'S PARCEL NO.: 1702323201900 Springfield TYPE OF WORK: Grocery Store TYPE OF USE: Remodel PROJECT DESCRIPTION: Remodel Save-A-Lot Grocery Store Commercial Owner: Address: DONALD V PFEIFER TRUST 2011 NE 164TH PLACE PORTLAND OR 97230 Phone Number: 541-683-9001 Phone Number: 516-420-0060 I, CONTRACTOR INFORMATION I Contractor Type General Designer Electrical Use Initials Low V oUage Electrical Mechanical Plumbing Contractor WESTERN CONSTRUCTION SERVICES WESTERN DESIGN GROUP A C & E ELECTRIC CO. 591 WYATT FIRE PROTECTION INC 64077 ALLIED FIRE & SECURITY 64465 SOURCE REFRIGERATION & HV AC INC 149200 RAW ARNER PI.;UMBING;CO.IN€:llil law r8I'51329 you tQ folic....... ..~~ . "HH ......,. . .... .. ,.-. ,.-. Hili V\IIUY '. r' Bl,J1I.:DING INFORM", llu"le set fortI Notiu'-_... ' - - 'In OAR 9<;#"-fr'C1.r.01 0 through OAR 952-00'1 L S' - '0 StorIes:.. ot lZe: .-' M0090. YOliieigh't'ilrs1lJ;]ftflPe,es of the rules ~~Sq Ft 1st Floor: calling 1lype:ii(~elit!Note: ,t~e tel~~ho~e Sq Ft 2nd Floor: IIIB numberWate'rtTypf:90n Utility Notification Sq Ft Basement: <Ran"g'ectype!JOO-332-2344). Sq Ft GaragelCarport Energy Path: Sq Ft Other: Sprinkled Building: nla Occupant Load: License 63717 Expiration Date 0112212008 07/21/2008 0210112008 02125/2008 10/0112009 05/03/2008 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 DEVELOPMENT INFORMATION I Phone 360-699-5317 360-699-5317 503-363-2301 503-684-2928 503-281-1177 714-578-2300 360-896-0370 REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: NOo.v.H!~y Dist: TH I ,# StreetJT.jrees RHd: 'p' r cnd'Dv r! <> RH Ad' r EXPIRE IF THE WORK ave rive lJ:- , AUTo/PJfL.\tC~~:,rr.rfe:THIS PERMIT IS NOT ~?~M_E_N9ED OR IS ABANDONED FOR Total: Handicapped: Compact: 1 PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Yes Sidewalk Type: Downspoutsffirains: Notes: Pa~e 1 of6 Curbside 5' Curb and Gutter Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Descrintion Type of Construction Estimate Estimate Pavine: Estimate Estimate Use Bid Amount Fee Descrintion Plan Review Comm/lndlPublic Plan Review Fire & Life Safety .....Mechanical Issuance Fee..... + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Building Permit Fixture Furnace - Unit Heater Furnace - up to 100,000 btu Gas Outlets 1-4 Gas Outlets 4+ Miscellaneous Plumbing Paving Plan Review Comm/lnd/Public Plan Review Fire & Life Safety Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC SanitarylStorm Admin Vent Fan + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Ea Add Perm ServlFdr 200 amps or less Perm ServlFdr 201 to 400 amps Perm ServlFdr 601 to 999 amps + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Water Line - 1st 50 Feet Water Line - Each AddtllOO' + 10% Administrative Fee + 5% Technology Fee . 6:ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 I ValuaJ1'inr Descriotion I III 1111 111111 $ Per Sq Ft or multiplier $1.00 $1.00 $1.00 Square Footage or Bid Amount 553,151.00 130,754.00 7,500.00 Value Date Calculated $553,151.00 $130,754.00 $7,500.00 $691,405.00 10/03/2006 01/11/2007 10/03/2006 Total Value of Project Fpp< P~iIiLI Amount Paid $1,107.05 $681.26 $10.00 $293.20 $146.60 $227.21 $2,041.15 $630.00 $12.00 $96.00 $4.00 $6.00 $45.00 $91.80 $234.49 $144.30 $712.44 $937.08 $82.48 $6.00 $82.90 $41.45 $66.32 $327.00 $189.00 $150.00 $163.00 $11.80 $5.90 $9.44 $90.00 $28.00 $4.50 $2.25 Date Paid Receipt Number 1200600000000001405 1200600000000001405 220060000000000t519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001519 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001537 2200600000000001748 2200600000000001748 2200600000000001748 2200600000000001748 2200600000000001748 2200700000000000027 2200700000000000027 9/12/06 9/12/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 10/30/06 1l/2/06 11/2/06 1l/2106 11/2/06 11/2/06 1l/2/06 11/2/06 12/26/06 12126/06 12126/06 12126/06 12/26/06 1/5/07 1/5/07 Pa~e 2 of6 -~~!!'!@,,!I~~; - ~.' . , "': , . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line + 8% State Surcharge Low Voltage - Commercial Indus -Mechanical Issuance Fee- + 10% Administrative Fee + 10% Administrative Fee + 5% Technology Fee + 5% Technology Fee + 8% State Surcharge + 8% State Surcharge Air Handling Unit 10,000 & Ovr BoilerlComm 15-30 HP Building Permit Gas Outlets 4+ Miscellaneous Mechanical Plan Review CommlInd/Public Plan Review Fire & Life Safety + 10% Administrative Fee FLS Safety Systems Review + 10% Administrative Fee FLS Safety Systems Review Total Amount Paid Fire Department Review Fire Department Review 01/17/2007 . $3.60 $45.00 $10.00 $4.50 $68.64 $2.25 $34.32 $3.60 $54.91 $15.00 $30.00 $666.40 $5.00 $15.00 $433.16 $266.56 $15.04 $150.42 $20.60 $205.95 1/5/07 1/5/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17107 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/17/07 1/18/07 1/18/07 1/19/07 1/19/07 $10,729.57 01/17/2007 I Plan Reviews I 01/17/2007 OK 01/17/2007 OK Pa~e 3 of6 6:ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/1212006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 2200700000000000027 2200700000000000027 2200700000000000064 2200700000000000064 1200700000000000037 2200700000000000064 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 2200700000000000064 1200700000000000037 1200700000000000037 3200700000000000026 3200700000000000026 2200700000000000081 2200700000000000081 GRG Plans Review: Fire Alarm submittal for water flow and tamper monitoring and occupant notification of water flow. Job #COM2006-01182. Designer: Wayne Elmore. Contractor: Allied Fire and Security. Plans appear to meet code requirements. Plans Review: Addition of 38 sprinkler heads to existing system for remodel. Job #COM2006-01182. Designer: Eugene Lathan. Contractor: Wyatt Fire Protection, Inc. Plans appear to meet code requirements. GRG Site visit on 1/12/07 noted sprinkler heads too close to vertical obstructions in coolers and freezers. Sprinkler heads shall be spaced away from obstructions meeting NFPA 13, Table 8.6.5.1.2. Refer also to Figure 8.6.5.1.2(a). . .ITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2006-01182 225 Fifth Street, Springfield, OR ISSUED: 12/26/2006 541-726-3753 Phone APPLIED: 09/12/2006 541-726-3676 Fax EXPIRES: 07/18/2007 541-726-3769 Inspection Line VALUE: $ 691,405.00 Fire Department Review 09/14/2006 10/23/2006 OK GRG See attached comments for Fire Department Plans Review comments. Initial Review 09/1312006 09/13/2006 APP LLH Initial Review 12/04/2006 12/06/2006 APP LLH Plans actually submitted on 11/17/06 but misplaced until 1214/06. I routed them as soon as we located them. Plan Review Comments 10/03/2006 10 JMP WE. Received incomplete responses to structural comments from Gary Young. JMP called Gary to discuss items 6 & 7 (special inspection signatures and contractor data). Plan Review Comments 10/26/2006 10 JMP WE. Called Gary Young. He said that he will talk to Dean Knuteson who will bring in the missing information. He will also respond to the plumbing comments. Planoine Review 09/14/2006 09/17/2006 APP EMM No change in use. Public Works Review 09/14/2006 10/09/2006 APP CJS Discussed permit review timing with Karen from Western Design Group; will try to expedite SDC review CJS 10/06/06 Called Karen (Western Design Group) for information on demo'd drainage fixture units (sinks, toilets, etc.) for SDC credit CJS 10/06/06 Called Karen (Western Design Group) to confirm that previous use of property was grocery store 10/09/06 CJS Added SDC's 10/09/06 CJS Structural Review 09/13/2006 09/2212006 WE JMP See attached documents for 9 structural comments faxed to Gary Young. Structural Review 12106/2006 12107/2006 WE JMP Called Gary Young with Western Design Group. He will provide documentation on the adequacy of the rooffor the RTU and he will have Source Refrigeration provide the increased valuation for the' refrigeration system. Structural Review 01/02/2007 01/11/2007 APP JMP Received 6 revised structural drawings and 13 pages of structural calculations and a valuation from Source Refrigeration. Pa~e 4 of6 . .ITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2006-01182 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 10/27/2006 10/27/2006 APP JMP Received the missing special inspection form and contrator data. SUB Review 09/14/2006 09/22/2006 APP DH To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 1;' n;ro.J Tn<no~';..n< . ,rr~ SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting Footing: After trenches are excavated. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide results to City Buiding Inspector Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to placement. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. Water Line: Prior to filling trench and including required testing. Low Voltage: Prior to cover. Paee 5 of6 . 6:ITY OF SPRiNGFIELD' Building/Combination Permit PERMIT NO: COM2006-01l82 ISSUED: 12/26/2006 APPLIED: 09/12/2006 EXPIRES: 07/18/2007 VALUE: $ 691,405.00 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and ' that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used ou 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.&!)'a-fl ~frn'I~ 1-/1.()'T Date Pa~e 6 of6 225 Fifth.Street Springfield, Oregon 97477 541-'726-3759 Phone . j]:~~~ ',.. '" i Wi:';,..- ",I it ".: ......~,'"____ =.J~J" ... Ci_f Springfield Official Receipt D.pment Services Department Public Works Department RECEIPT #: 2200700000000000081 Date: 01119/2007 II :09:09AM Job/Journal Number COM2006-0 1182 COM2006-0 1182 Description FLS Safety Systems Review + 10% Administrative Fee Payments: Type of Payment Check Paid By WYATT FIRE PROTECTION Item Total: l:'heck Number Authorization Received By Batch Number Number How Received Amount Due 205,95 20.60 $226.55 Amount Paid djb 9372 In Person Payment Total: $226,55 $226.55 cReceint 1 Page I of I 1/19/2007