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Home My WebLink AboutPermit Building 2009-8-21 Status Issued CITY OF SPRINGFIELD' Building/Co~bination Permit PERMIT NO: COM2009-01213 ISSUED: 08/21/2009 APPLIED: 08/20/2009 EXPIRES: 02/21/2010 VALUE: $ 209,829.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: li22 W Qninalt St ASSESSOR'S PARCEL NO.:, 1703273107000 Springfield TYPE OF WORK: Siugle Family Residence Owner: Address: TYPE OF USE: PROJECT DESCRIPTION: New Single Family Dwelling ATTElqTION: Oregon law requires you to .1:_11_... _..1__ _.J__~_..J t.... "l.._ 1'"\.._........... 11+:1:.... . ~ .... ,; Notification Center. Those rules are set forth in OAR 952-001-0010 thro.ugh OAR 952-001- 0090. You may obtain copies of the rules by ,.,,.,11:........ +h..... ...,..,...f....... 11'..1.....+". fhn +...I.........h.....,..,,... Residential NORTHWEST BANK 4900 MEADOWS RD STE 410 LAKE OSWEGO OR 97035 n' m"lh:... f/"\I" tho. tlran'......n Iltilitll hJotification I coN'rRAc;r.OR_lNF.QRMA;r.I()I'/~14), Contrac'tor Type General Electrical Mechanical Plumbing Contractor EQUITY HOME BUILDERS, LLC LAMMERS CROWN HEATING LLC NW MECHANICAL, LLC BH~~~~. INFORMATION I Hii'bf<Stb'/i~n SHALL EXPIRE IF T2'-lE V'LQPMize: Alf1eight:of[slrll~j1i'.feR THIS PERMIT IS~tFT 1st Floor: CL1Yp.~[ij.W~[t:OR IS ABANlli:[ei\\fiQ FO~q Ft 2nd Floor: Ar-..'Yar'JUT~!W PERIOD. Electri~ Sq Ft Basement: Range Type: Electric Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: No Occupant Load: License 176016 Expiration Date 05/04/201 I 171074 07/11/2010 Phone 541-382-0803 541-410-3568 54 I -420-3307 # of Units: Primary Occupaucy Gronp: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 U VB 1,290 690 480 3 I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 26.50 8.00 5.00 109.00 85.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I Yes 18.40 Total: Handicapped: Compact: 2 Subdivision Not Accepted Street Improvements: Storm Sewer Available: , Special Instruction: I PUBLIC IMPROVEMENTS I FullV Improved Yes Storm water to curb via weep hole Sidewalk Type: Downspouts/Drains: Curbside 7' Curb and Gutter Notes: PUBLIC WORKS RECOMENDS NO HOOK UP TO SEWER UNTIL COUNCIL APPROVAL OF SUBDIVISION Page I of4 Status Issued CITYOF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-012I3 ISSUED: 08/21/2009 APPLIED: 08/20/2009 EXPIRES: 02/21/2010 VALUE: $ 209,829.00 225 Fifth Street, Spriugfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation DescriDtion I U VB Utility R-3 VB 1&2 Familv $ Per Sq Ft or multiplier $37.72 $96.83 Square Footage or Bid Amount 480.00 1,980.00 Value Date Calculated Description Garage/Mise SF/Duplex. Tvpe of Construction Total Value of Project $18,105.60 $I91,72~.40 $209,829.00 08/20/2009 08/20/2009 l.Fpp, P~iIU Fee Description Amount Paid Date Paid Receipt Number + 12% State Surcharge $236.09 8/21/09 2200900000000000945 + 5% Technology Fee $116.22 8/21/09 2200900000000000945 1 st Appliance $79.00 8/21/09 2200900000000000945 3 Baths One & Two Family $402.00 8/21/09 2200900000000000945 Addressing Assignment $38.00 8/21/09 2200900000000000945 Building Permit $1,156.45 8/21/09 2200900000000000945 Cnrbcut Permit $88.00 8/21/09 2200900000000000945 Dryer Vent $9.00 8/21/09 2200900000000000945 Exhaust Hoods $ 13.00 8/21/09 2200900000000000945 Fire SF Fee. Residential $123.00 8/21/09 2200900000000000945 Plan Review Major. Planning $211.00 8/21/09 2200900000000000945 Plan Review Residential $751.69 8/21/09 2200900000000000945 PW Disc - 2nd Permit $-30.00 8/21/09 2200900000000000945 Residence Wiring 1000 Sq Ft $134.00 8/21/09 2200900000000000945 Resideuce Wiring Ea Addtl 500 $75.00 8121 /09 2200900000000000945 Sanitary Sewer. Improvement $617.30 8/21/09 2200900000000000945 Sanitary Sewer. Reimbursement $811.81 8/21/09 2200900000000000945 SDC MWMC Administration $10.00 8/21/09 2200900000000000945 SDC MWMC Improvement $1,044.54 8/21/09 2200900000000000945 SDC MWMC Reimbursement $101.97 8/21/09 2200900000000000945 SDC Sanitary/Storm Admin $166.94 8/21/09 220?900000000000945 SDC Trau Reimburs-Residential $211.21 8/21/09 2200900000000000945 SDC Trans Improvement.Resident $931.65 8/21/09 2200900000000000945 SDC Transportation Admin $75.08 8/21/09 2200900000000000945 Sidewalk Permit $88.00 8/21/09 2200900000000000945 Storm Drainage Impervious Area $1,111.89 8/21/09 2200900000000000945 Temp Power 200 amps or less $63.00 8/21/09 2200900000000000945 Vent Fan $36.00 8/21/09 2200900000000000945 Willamalane Single Family $2,858.00 8/21/09 2200900000000000945 Total Amount Paid $11,529.84 Page 2 of 4 Status Issued CITYUF SPRINGFIELD Building/Combination Permit PERMIT NO: C0M2009-01213 ISSUED: 08/21/2009 APPLIED: 08/20/2009 EXPIRES: 02/21/2010 VALUE: $ 209,829.00 . 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Plan Reviews I Structural Review 08/20/2009 Plannine Review Public Works Review 08/20/2009 08/20/2009 08/20/2009 08/20/2009 APP APP DDK LKW Approved as shown on plans. PUBLIC ,WORKS RECOMENDS NO HOOK UP TO SEWER UNTIL COUNCIL APPROVAL OF SUBDIVISION/Storm water to curb Structural Review 08/20/2009 08/20/2009 APP KLK I 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. Rp'1~In:,npPt~ Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. " Ufer 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 floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspectiou: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roof Sheathing Drywall: Prior to taping. Hold Dowus Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. , 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 testing. Underfloor Plumbing: Prior to insulation or decking. Undertloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Paee 3 of 4 -~m.~~,'J,e:~j i1 ' j, ~. " 1( Status Iss u ed CITY OF SPRINGFIELD Ii Building/Combination Permit , . , PERMIT NO: COM2009-01213 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ISSUED: APPLIED: . EXPIRES: VALUE: 08/21/2009 08/20/2009 02/21/2010 ~.r $(209,829.00 II , Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. I Final Plumbing: When aU plumbing work is complete. . Underl100r Mechanical. Prior to irisulation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When aU mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. I' Ufor Electrical Ground: InstaU ground rod at footing and caU for inspection in conjuction ~ith footing and/or foundation inspection. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When aU electrical work is complete. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut. Standard: After forms are erected but prior to placement of concrete. 11 By signature, I state and agree, that I have carefuUy examined the completed application and do h~reby certify that aU 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 wilrk described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Servi'~es 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 aU 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.wih remain on the site at aU " "om ,""., m:z:~ i <62/- or Ow"" mc~ro" ,,~;: Dm' Paee 4 of 4 Structural Permit ApplicatIon 1~~~!iftJ~€l:-!f~s.E'o.~~\(~1 ~t:~ ,:~0rr,yJ)F,iSP.I{Il~GEIEt'6~.OaEt.ON:;J~Jt:~':! .?;'~"';'~ " m-",,~ , ~ ,,-. ""'... ","",., .or,=,,,,- .=,_ ,.",,,,,. ~""<' '~~~ .~ "'"""<t _ ~ ~ "" _ ~ pe.!nitno.: C( -1--~ t:3 I 225 Fifth Street. Springfield, OR 97477 t PH(541)726-3753. FAX(54J)726-3689 This permit is issued under O~R 918-460-0030. Permits expire if work is not started within 118~:~~:~~::--L~k is suspended for 180 days. :1!:Ii.'::tO:CAl'j'G9\tE@MEN'EAi:!p,if6vAiCCj:.':i'~~',1~~ I This project has fimilland-use approval. Signature: Date: I This project has DEQ approval. Signature: Date: I Zoning approval verified: 0 Yes 0 No I i,~;~~;r~~~~~;7;~;~;:~;~~N~f~:~;'ON1&;;;;;,lJ,;; ;il:~j 1"~j::s:~~~t~~~lli:rE~lk~o~;~~@j~'AN[)yJQ~.ifl~~i~~~(t~~: I Job site address: 11.:2..2. h ~-t-~I '!li1o to\. I City: 'l'""T\t"c.~p\~ ! State: DY. I ZIP: I SUbdiViStOn~J+ ~otno.: 4 I Referen.:,e.~~,'1.. .'.."_.. ~.'~.'~. ..,. ."-'.~.'.. '... '. .'.~.;'" ",;,~!,~,t. :, ~~..Wi"" .." .A;.",'r..." itv ."P".' -. ".'!i0,h ";:J'~J~:'!'~~t;1 ~F!RPP~Rrv,;;;()WNI;R~,~;;~~:;;~'~::.~~"l1cGr"~C":~~~ I Name I t'>.I~ and \Aw1 \~t~efn.CUf\ I. I Address: ~"l-l~ ~i\\~ree_~ ~ I City ~'m\1.f'ld I State: 012- I ZII'1~ I PbonefAl-ql4-6L..~ Fax:. I E-mail: This installation is being made or. residential or [ann property owned by me or a member of my immediate family, and.is exempt from licensing requirements under ORS 701.010, Sign bere: I '. rf.r'.~C:()t.ifif~'Cf'9RJlj!lSi)\~t.Afi9N~"~~~ . I BUSiness~ame t: vitv \:VMebJi~, I { c. I I Address \('nJR~~-+, s:.. tf'1 I I City~ 'Statc: f)tI....- I ZIP?(-t~11 I PhoneBlI-SBL..-o2l:>3 I Fax5lI-~-l'57.t:; I I E-mail~~Vj~he..nt!.hn:Y..Jt1~.ca.It r CCB license no.: \':\{pt)\\D I I printna.m~ln"'QU I I Signature: : '/tL&t/ I , - I' . . '~:e ;:~,B'lct~;r~R~~:~~i~;:;'~rRII<1AT~~:;~umber I I Electrical [t)lY\L figrlr/C.,Ih<' ~/-,{/().'.;~ : ::::~;~al ~~~.~t:~ 1~~~;~::~::i;~;~~~rri1iitiOri';;f:;; ~i:t\;";:;;;# i:' I Occupancy I I I I I Type of Heat: I Energy Patb: I . 0 new 0 alteration I (b) Foundation-only pennit? I Total valuation: Construction type: Square feet: Cost per square foot: Other information: o a~dition DYes DNo I (a) Permit fee (use valuation table): I (b) Investigative fee (equal to [2a]): 'i (c) Reinspection ($ per hour): (number of hours x fee per hour): (d) Enter 12% surcharge (.12 x [2a+2b+2c]): I (e) Subtotal of fees above (2a tbro~gb l;i~~I>I_a~i-~~;i~~fe.e<s'~T_ ' I (a) Plan review (65% x pennit fee [la)): I.(b) Fire and life safety (40% x penn it fee [2a]): I (c) Subtotal of fees above (3a and 3b): 1~7~~:;~~~"r~:.~~ie~~~~~:~:;~~;,. I TOTAL fees and surcharges (2e+3c+4a): \1 I I I I I I I I I I $ I $ I $ I $ I I I: I I I $ 'cl $ I $ I Electrical Permit APJfication 225 Fifth Street+Springfield, OR 97477+PH(S41)726-3753tFAX(54J)726-3689 . l"::";;:'b~~. "_?'f<1j;:-;p'i 3cBH ~~.-!::'''j-~' -. . ,-,}',.,,~'.'~wx:)1t:1I5 ::' t?t[ft&ftI~.~~~~~J1I~~~E,'.,g~~,~~;~~~ I Pennitno.(''1- J.-2-l-;3 ~ I Date: ~/~/er=r J. This permit is issued under OAR 918~309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days ofl<;suance or if work is suspended for 180 days. I , , I",,," "'''iii1~;''OCA''''';G 0, y' ER'N' M ENT;fA'"nROYA'I!ii(",'~.J ,;;1.3"",.'", ,<::1"....u_,q"-"'~L. ._ .1,.,;,JJl. ... . _ . ;,.~..c_ ,r;; '" '."....j.."-:.~.'.,i;!"L., I Zoning approval verified? 0 Yes 0 No li;irlll!;:T\'IlJa1i!'CATEGORyj)'Ol;,qfCONSmRUCTJON~Mi~(~'r~;;;~ihl' I NResidential I 0 Government I,D Commercial ' 1;1!Ii:)~.:JOBJlSITE~INF,ORMA;r:ION;;:AND,~IlQCATION:g;~'iii~1 I JObsiteaddr;ss:l1~7.Z IA)t~tI~in~Z7L1 I I ~:~~~Po~i$f~11) State, ()K Lot :o~:' 1]f.f".:"~~Jll~8';;DESCRI~tIONiOffS);WOR ~~~~il:'tj'~iii1l'tll . ' a ~I'(]{ilt ,.' I. J.1 v:e.-' ,L :'::;~~~';.":"J.WN'"1&f!F I c;,,:~~~~t I m~NJji Iphon~-DZ$IFax: -'. I E-mail: I This installation is being made on residential or farm property owned by me ora member afmy immediate family. This property is not intended for sale, exchange, lease, or rent. OAR. 479.540(1) and 479.560(1). Signature: l!J!llif,,~.~CONitRJl:CJ.ORiiiNS:rALiI.!'ATION~1i;ii!!~;r~~jiiilil I Business name: TYn L 8ec+n' c. I I Addres.: q . S V t:r?t!. I City: 'I ' State: /)12- I ZIP:Q"Ff511 I Phone:~ -'-IID-?l3lIlll Fax:'i34I-97:2,-f75t'J, I E-mait:-dmleJaYv(I'I'flt?@.C/.olLf'J5wf I I CCB license no.: /(.,1 ;;J.('~ I BCD license no.: q~JIIC. I I Signing supervisor's license no.: tfio S- ~. I I Print name of signing supervisor: .\)I).t\.~ M' ~5 I I Signature of signing supervisor: ~~.-:.. :JI. . '-f. . - ,,-1 '-' ~ t..~4- ~~,,\d'- COV ~~ ~\t 440.2584.J (9/08/COM) . I~:"'t;;. ~,""' g~'r",,~i",_:!(FEE'_ SCHEDULE ,,,,,\?;t:r;-~-;',;.' ';:';;;;;;~,,,,.i",~,'1 ::"'-~~." _ .^":;Wl,,,,,,,,,.,._,~.. ,.... _ .. . ._.. - __~....~..._.~._:;'~:._~'t..~n~4.: ,.;;~:,-~~~~;t,;"~'~~~iii:,<t:::;'SJi,c$'Br4kl';i0;::~.,,.-,4Im'i~'.'I~'C'.- -- .'t""~...~':l'O'.."t-" I" I .~'N:: :-'ij'-. ,. f.=w.'w~li..._:J<<-,","'1).:'0' ,\..,: ' ,Ill" . l"r.illf OS ;,1'\' '",%', a" :~ urn ero 'Ins ec ODS: er,ltero. t .,'.. ; -', --I.'~I~":. _n-';'.~., -' '1t:Mj}t01:fJ;~;Mfq";f,_Pr/l<m!ij;!t*,j!'0?]j0'l';:m,JJ:",' 8+~i ml:!.f~1:l. ,:,"\'tf; ~'l.C:Q:~,tjr,~'1 Residential, per unit, service included: 1,000 sq. fl. or less (4) $134.00 $ I Each additional 500 sq. ft. or portio~ $ 25.00 $ thereof ,: I Limited energy (2) $ 32.00 $ I Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Ii [ Services or feeders: installation, alteration, relocation I 200 amps or less (2) $ 81.00 $ , I 201 to 400 amps (2) $ 95.00 $ I 401 to 600 amps (2) $158.00 S I 601 to 1,000 amps (2) $205.00 $ lOver 1,000 amps or volts (2) $469.00 S Reconnect only (2) $ 63.00 $ I I I I I I I I I I I I I I , I I Each branch circuit I S 6.00 I $ I b. Fee for branch circuits without pur.chase of a service or feeder fee: I I I I Temporary services or feeders: insfaflation, alteration, relocation 200 amps or less (2) $ 63.00 $ $ $ '201 to 400 amps (2) 401 to 600 amps (2) $ 87.00 $126.00 Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extf!nsion per panel a. Fee for branch circuits with purchase 'of a service or feeder fee: First branch circuit (2) I S 55.00 I $ Each additional branch circuit I S 6.00 I $ / Miscellaneous fees: service or feede~ not included I E~ch pump or irrigation circle (2) $ 63.00 I $ I Each sign or outline lighting (2) I $ 63.00 I $ I Signal circuit or a limited-energy panel, I $ 63.00 I s alteration, or extension (2) I Each additional inspection: (l) I $58.00 I $ I (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (.12 x [A]) I (C) Technology Fee (5% of [A]) I TOTAL fees and surcharges (A through C): $ $ $ $ I.' DEP~RTMENT U.SE ONLY Permit no.f'}'f - t 2- 1-. ? Date: l!/~/rl Plumbing Permit Application 225 Fifth Street + Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started withi~ 180 days of issuance or if work is suspended for 180 days. 1 LOCAL, GOVERNMENT ApPROVAL:" ' I' '- ". .'. I Zoning approval verified? 0 Yes 0 No I 'Oescripiio';' I Sanitation approval verified? 0 Yes 0 No 1 New residential I CATEGORY."OFCONSTRUCTION. ',:;' I bathroom!1 kitchen (includes:flrst I """ I I 100 feet of water/sewer lines, hose uv,\.esidential 0 Government 0 Commercial bibs, ice maker, underfloor low-point '" .JOB.SITE,'INFORMATION.ANI;l:LOCATION ,,' ",1 drains and rain-drain packages) I Job site address: J 2.1.... ~ (jlJ/rIalt 12 bathrooms!1 kitchen $374.00 1 I <<::: I ., '-i 0"'/ 1 11 ":Ll{-:iO I 3 bathroomsll kitchen $439.00 I City::-"- p U State: IC. ZIP:,? 1 TC 1 Each additional bathroom (over 3) $95.00 1 I SubdiVIsion: t +-- I Lot no.: " I I Each additional kitchen (over I) I 1 $95.00 1 I ) (1~~Es,C/RIp'~I~I'}-,~W~~~"'~ ;~.~" .,..1., 1 Residential fire sprinklers (includes plan review) ~ Vc:t.UT f ,ff '""l i~ I 0 to 2.000 squarc feet I: I I $58.00 1 2.001 to 3,600 square feel 1 $116.00 , PROPERTY. OWNER.'" "', . .: I 1 3,601 to 7,200 square feet I I $174.00 LeSJ-e" I \ 'A ~. It/IM' I 7,201 square feet and greater 1 $232.00 Name: =. VI OnfJ I'lUI ~- ~- I Manufactured dwelling or pre-fab (circle one) I Address:UI (J7B ~ I Connections to building sewer and Ii I I $58.00 I It' I I CI ::J.lJJI: water supply ,I City:~ - State: f) ZIP: - f -, 7 ICl I Commercial, industrial, and dwellin.gs other Ihan one- or I Phone,. J ~ - 02. &:f{ I Fax: two.family I I E-mail: 1 Minimum fee I I $58.00 1 I Each fixture $19.00 1 This installation is being made on residential or farm property owned by me or a member afmy immediate family, and is I Miscellaneous fees exempt from licensing requirements under OAR 918-695-0020, 1100. stann, sewer, \vater line I Signature: [ Each fixture, appurtenance, and piping I CONTRACTOR'INSTALLA TION' . ",.'. ,.,- ",1 1 Stonn watcr retention/detention facility 1 1 I Business na~ne: fJJf;fhUJ1Il>.tll J Ie I I Irrigation systems _ I I q / _ 1/' , I Plplllg or pnvate storm dramage I Address: . c') IiJ1r.Oc..f- ~_ 2l>h$ltz svstems exc'eedin. the first 100 fe et , ~mazd I State: tJK... IP:CJ'T:j!ju, I Specialty fixtures 1 1 I j} ?IL- J' .c.'l/. _~,." A&-- 1 RemspectlOn (no. ofhrs. x fec per hr.) I I Phone:5....,1-81!7-UtVi7~ ,Fax: J' -;:;xn-:-~2 I Special requested inspections (no. of" I I E.maiIMIJ1YIt.C'htii1IP.ufllcfiJ.hnhntuZ &1111 hrs. x fee per hr.) $58.00 I CCB license no,:/tfbt9-7f:1 BCD license no.: I I Each addit;onal inspeetion: (I) I $58.00 I [ Plumbing licenlie no.: I I' h:iedical ~'as-pipjn'g .'~' I Minimum fee I I P , -'I I 1 Enter value of installation and cquipme. ot $ . nnt nam?;l/l ' - I . . I J Enter fee based 0"_ inst.allation a~d eq~ip_~ent ~a]ue. Signature. , L .~"., ".APPLICANT!USE" . , I (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) 1 (8) Investigative fee (equal to [AD I (C) Enter 12%surcharge(.12x [A+BD I (D) Technology Fee (5% of [AD 1 TOTAL fees and surcharges (A through D): "FEE SCHEDULE. " I Ot;. I ~~~t ./ '.-> $238.00 $76.00 $19.00 $19.00 $19.00 $19.00 I $19.00 $58.00 440.2500.J (II/DB/COM) Total cost $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ I $ I $ I $ I $ I $ I $ I $ 1 I $ I $ $ $ $ $ Mechanical Permit Afjplication 1",",""'~>Z!N';~""';_hH;f,~'ili''iO c,,; ..ir"-'''!f',HtJ)~.j:_-1S,''<Hf'4''-lli? . ~g':~OEI'!ARIMENr,OsE'oNI!!~?";':ijj'c~ ~\fI""''0'''E:w!t,\M1j:t'#N$,,",.;%;,',th~-.1F0WJm%""i'~-8lh~1(~;;W I Permit no.: ra - t 2- t '3 '" , I Date: R ~ 2-0---&1 I' This permit is issued under OAR 918-440-0050. Permits expire if work is not started witbin 180 days of issuance or jfwork is suspellded for 180 days., 1;rr:l'\,\;\ll!i!ll~KG~f;i;13.Q~~ItQI',;[QQ~~ltR(,jQ][QNi!t;!~~.\:jl.l!~!1l!1 i~~~~~$~~if;~~IN~~R~~t:~~AN~IT~~c:~;J~~~~;f:Mtl I Job site add~ess: \1:21.. \ 0r"~ ~)\Y\u It I I city:~Ii}lA~ield I State: 1JlL. I ZIP: I I SUbdivisionubt(ll'{lt . <-.] Lot no.: If . I 1,;,,"""l!E1'~':.'.,>n;DESCRII'!;T1c5N~O,;'''WORK<''if'':''''';l:'~'''' "'''I ~~ J ;,:,:\:i:~~~~~'~'''{;,,'''T_____; _~,,_,_..A..._,__.__ _ .1,,_.... ~~;". d_ m_>.j~:, ";::;;,;. ".:_m:;w=.." J>-o' ,:":; ~~fh),(lc ill I. ~~)A.1 ee- I ~~;iitt~'i~~it~~1.:~~9)f~~.ty~QW:~~.R:~1itti:~~j?,~~{4~1~1' I Name: IA)/~pn I Address:?, -=r J C I City:Sd)r' I Phone&-/ 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 701.010. Signature: .4'."."..'......UliE. . ..'.....'........"'.... .._--. ...'" . .........'''...$'..-.'. .....,' """'''~'' "'." "I l'r";~bj~j;.~.ON:tfY\!.CI.O.R~il.NS:r~J!I!A"TIQN~ji!'~'iJC:"J; I Business name:('-YrWVl ft~~ I I Address: IfYf?- JJC. (by; I I City: WM ] StateD I ZIP. II I Phonemt-ll1D- ~y;,1-1 Fax:5i{/-'b,7,{)-7DZ/ I I E-mail: ~Ya..JVJhfb..+~pJ1dhr/J4dfAHd,flt( I CCB license no,: IT I 0 I Print name:5ttht'J1. Ar~ I I Signature: 'Q~ " I 225 Fiftb Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 440.2545-1 (I 1/08/COM) Irtl1,~",q:l.~'''''t1!i21!'ii0:F:EE1''S''CFtEDi.)UE;i'l\!j\f('~~~li';l':':'<I81!~.,,~ ~^jLJ':ti10~m*n2'Jf:1hi<*E?r!;.,,, _._.,!f;,._^,,",_, ".'A,""._,jll\\l,\,',",'W4:Ii0$'i.l.:,di7'j)0@il~~:f,1@f,' 12" '-"%L.:-:'rx!f't.J~+'. ".;f'"'~,?it"'~{{.0~~....):j'~,;-'~\i!1->.?:.:; 1t'.~'1i'~I'?f'-'~!;.~_I-;~1iCOS.t.:%~~ ~';S'F.. <ofa.'!'.r':: .Resldentlal;,~",., "':'~*""~.'~Qty ],,~,.-~ " " -~, .1,'" r'"~,,,.,....,,,,,,,:;::,,,,.... ~,.iL#~~,~~.-I'/I;;-;,..^t~J\~';'~,~,~i :,.,_.J, ;,,'l"fea.::;v_; '!.. ;:{costt:~,: First Aooliance I $79.00 I ~ I furnace/burner including ducts and vents I I Up to lOOk BTUIhr. I $17.00 [$ I lOver lOOk BTUlhr, I $20.00 I $ I I Heaters/stoves/vents l I Unit healer I $17.00 I $ , I Wood/pellet/gas stove/flue I I $38.00 I $ I Repair/alter/add to heating appliance./ I I I refrigeration unit or cooling system!' $58.00 $ . absorption system I Evaporated cooler ,. 'I $13.00 I $ I Vent fan with one duct/appliance vent $9.00 I $ I Hood with exhaust and duct I I $13.00 I $ I Floor furnace including vent I, I $58.00 I $ I Gas piping lOne to four outlets . I I Additional outlets (each) "I I Air-handlin2 units, incIudin~ ducts Up to 10,000 CFM, I . $11.00 I $ lOver 10,000 CFM I I $20.00 $ I Compressor/absorption system/heat pnmp I Up to 3 hpil OOk BTU I I $17.00 I $ I Up to 15 hp/500k BTU $29.00 I $ I Up to 30 hpil ,000 BTU I. I $43.00 I $ I Up to 50 hp/I,750 BTU I' $57.00 $ lOver 50 hp/I. 750 BTU I I $95.00 I $ I Incinerators I Domestic incinera,tor $7.00 I $ $4.00 $ $20.00 I $ I I I I I Enter total valuation of mechanical system and installation costs $ _ . Enter fee based on valuation of mectlanical system, ete, I ,Reinspection I I Specially requested inspections (per ~r.) I I Regulated equipment (unclassed) Eacb additional inspection: (1) I .,,'''f'llil'ooc; ~"""'~t.'i:\1 cas 'if:" $58.00 S I $58.00 I $ I $13.00 I $ I $58.00 I $ I $ I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) I (B) Investigative fee (equal to [A]) I (C) Enter 12% surcharge (.12 x [A+B]) r (0) Seismic fee, 1% (.01 x [A]) I (E) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A through E): $ $ $ $ $ $ 2~ Willamalane t\ij Park & Recreation District Job. No. Cq-\Q\~ I SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME:~ll im Rolf ilL PHONE:. , . . ADDRESS: AAa) tJ\~fft~~$wer18"ATE:_ZIP: C\~O'nS LOCATION OF PROPOSED BUILDING SITE: Street Address: \ 'L'L'2.. LV (QDif\tL\ t Plat Name: (QlJim Lb Tax Lot Number: 1.,00'2., ":2.. \ cncvo 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type d~finitions are on the back.) A. Sinale-Familv Detached NO. OF UNITS X $2,858 per unit = 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 Dwellina Unit NO. OF UNiTS X $1,550 per unit = WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer must furnish proof of Willamalane Credit approval.) 3. TOTAL WILLAMALANENET SDC ASSESSED ~ (if SDc reduced for Credit) $" 'l$5S~ Ie $ :' $ $' $ $' .2658.(;0 $i: g $~.tXJ 5 It \ / CA Date 5 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ~,LA;QF1l1~d---' ..,....." ... 1IIIr. .. , ~., " . /. -, ; . -,--,- ...-. -'-"'-'.._._'-'- - - Job/Journal Number COM2009-0 1213 COM2009-0 1213 COM2009-01213 COM2009-0 1213 COM2009-01213 COM2009-01213 COM2009-01213 COM2009-0 1213 COM2009-0 1213 COM2009-01213 COM2009-0 1213 COM2009-01213 COM2009.0 1213 COM2009-0l213 COM2009-0 1213 COM2009-0 1213 COM2009-01213 COM2009-01213 COM2009-0 1213 COM2009-01213 COM2009-01213 COM2009-01213 COM2009-0l2l3 COM2009-01213 COM2009-01213 COM2009-0 1213 COM2009-01213 COM2009-0 1213 COM2009-0 1213 Payments: Type of Payment Check cReceintl RECEIPT #: 2200900000000000945 Description Plan Review Residential Fire SF Fee - Residential Plan Review Major - Planning Building Permit Addressing Assignment Willamalane Single Family 3 Baths One & Two Family I st Appliance Vent Fan Exhaust Hoods Dryer Vent Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit Stoml 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 + 5% Technology Fee + 12% State Surcharge Paid By EQUITY HOME BUILDERS Received By njm Check Number Batch Number Page I of I City of Springfield Official Receipt Development Services Department , Public Works Department Date: 08121/2009 Item Total: Authorization Number 3828 " How Received In Person . Payment Total: 8:14:18AM Amount Due 751,69 123.00 211.00 1,156.45 38.00 2,858.00 402.00 79.00 36.00 13.00 9,00 134.00 75,00 63,00 88.00 88.00 (30.00) 1,111.89 811.81 617.30 211.21 931.65 101.97 1,044.54 10,00 166,94 75.08 116.22 236,09 $1 1,529.84 Amount Paid $11,529.84 $11,529.84 8/21/2009