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Home My WebLink AboutPermit Building 2009-9-24 . Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2009-01386 ISSUED: 09/24/2009 APPLIED: 09/18/2009 EXPIRES: 03/24/2010 VALUE: $ 26,987,00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax . 541-726-3769 Inspection Line SITE ADDRESS: 1119 QUlNAL T ST ASSESSOR'S PARCEL NO.: 1703264102600 Springfield TYPE OF WORK: Garage'Conversion TYPE OF USE: Alteration PROJECT DESCRIPTION: Garage Conversion to Sleeping Room and Bathroom Residential Owner: PHILPOTT KIMBERLY A Address: 1119 QUlNALT ST SPRINGFIELD OR 97477 Phone Number: 541'554-1962 I CONTRACTOR INFORMATION' Contractor Type General Electrical Plumbing Contractor FORT ROCK CONSTRUCTION INC LYNNS ELECTRIC FORT ROCK License 140699 102316 Expiration Date 05/29/2011 10/14/2011 Phone 541-767-1611 541-726-7895 BUILDING INFORMATION I VB # of Stories: Heigbt 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 Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 No I DEVELOPMENT INFORMATION' Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: . . es you to Sidewalk Type: . N' Oregon \a\N reCll\\r Utility Storm Sewer Avai\"i?I.e:.NTIO 'rl t d bV the Oregon t th Downspouts/Drains: S . I I . N' '0 e nO e d~'" .,rt opt or . . pecla nstructIOn~\\O\N n ew caq!ort-a ullIonrstorm ",aterdo connect to eXlStlllg~ysteQ1 . Notitication Cenldl. ,,"v;;l\gh OAR 95~-U ,- Nu i!Gl:: . Notes: in OAR 952-001-~g~~hcoPies otthe rUle~:y . THIS PERMIT SHALL EXPIRE IF THE WORK 0090,You ~a:enter. (Note: the tel~i~~~tiOn AUTHORIZED UNDER THIS PERMIT IS NOT calling tth r the Oregon U\llIty N404) COMMENCED OR IS ABANDONED FOR mber 0 0 332-23 . . nu center is 1-80 -. ANY 180 DAY PERIOD.. Paee I of 3 Status Iss u ed CITY OF SPRlj~\.Jl'IELD . Building/Combination Permit PERMIT NO: COM2009-01386 ISSUED: 09/24/2009 APPLIED: 09/1812009 EXPIRES: 03/2412010 VALUE: $ 26,987,00 225 Fifth Street, Springfield, OR 541'726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I y~]ua~ion DescriI)tion , Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Fp.p~, tiIiLI Fee Description Plan Review Residential + 12% State Surcharge + 5% Technology Fee 1st Appliance Add, Alter, Extend Circ Ea Add Building Permit Fixture Perm Serv/Fdr 200 amps or less Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Amount Paid Date Paid Receipt Number $192,98 $66,83 $27.84 . $79.00 $24.00 $296.89 $76.00 $81.00 $132,28 $173,96 $15,31 9/18/09 9/24/09 9/24/09 9/24109 9/24/09 ' 9/24/09 9/24/09 9/24/09 9/24109 9/24/09 9/24/09 2200900000000001066 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 2200900000000001085 Total Amount Paid $1,166.09 I Plan Reviews I Initial Review 09/22/2009 09/22/2009 APP LLH Plan nine Review 09/2212009 09/22/2009 APP DDK Interior work only. No planning issues Public Works Review 09/22/2009 09/23/2009 APP LKW New carport addition storm water t(] connect to existing s~stem Structural Review 09/2212009 09/23/2009 APP CJC As noted 'on plans 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, ~eouiredJnsnections I Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insnlation or decking. Floor Insulation: Prior to decking. Paee 2 of3 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-01386 ISSUED: 09/24/2009 APPLIED: 09/18/2009 EXPIRES: 03/24/2010 VALUE: $ 26,987,00 225 Fifth Street, Springfietd, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Frami'ng Inspection: Prior to cover and after all rough in inspections have been approved, Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover, Drywall: Prior to taping. 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 Electric: Prior to Cover Electric Service: Approval required prior. to utility company energizing service. Final Electric: When all electrical work is complete. By signature, I state and ~gree, 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, Buildiug 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 tbat 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 oUhe property, and the approved set of plans will remain on the site at all times during construction: /f~~..--~ ~-_. ~/2tf/O 9' Date O'r9- or ContractorS"S1gnature Page 3 of 3 Structural Permit Application - 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726~3689 .1;':~;p.~p,ARTM~Niusl$"qNLY;1 Pennit no.:tJ!11"3<Sc::' I Date: all/1/07 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is , suspended)or 180 days. I (a) Permit "fee (use valuation table): I (b) Investigative fee (equal to [2a]): I (c) Re. inspection ($ per hour): (number of hours x fee per hour) I (d)EnterJ2%surcharge(I2x[2a+2b+2c]): $ I (e) Subtotal of fees above (2a tbrougb 2d): $ 1[~:~_RJ~.mi~~:;;If~~:~~1~~1~~I~l::t(~~~~~~~~~l~~ Sign here: - I C., .... "S":"A",,' "0"'" ,< . :".: ",' '.1 1.(a)PlanreVieW(65%Xpermitfee[2a]): $/"12ftE- . ONTRACTOR-AN '" LLATI. N",., ",,:.; ;;., 'ii'..'"..', ',', 1"~~S1ness name. J:;;r+ '~~2 ....I:~~j;.~~f.,;:;.. 'I (b) Fire and life safety (40% x permit fee [2a]) $ I I Address: (7)!J? Pc>.. (3",1( /7 (3 I I (c) Subtotal of fees above (3a aod 3b): $ I I City: (' oil",CK" ~ ('0"<-' I State:ofL I ZIP: "f74z.'1 I I - (a) Seismic fee, 1% (.01 x permit fee [2a]): $ I Phone. 7(r'7 I~l( Fax /4>'7- 30"5'" I I I E~mail: .1 TOTAL fees and s'urcharges (2e+3c+4a): $ I CCB license no.. / '-f () <<79' r I I Print name: :::I'Ll()(J /he" T2cr-- I I Signatu're: d.l:J k ,~_' I ~~j~~~~1JrnWlt:~(ci'~'~Q~N~1f;RAG:t-9iL~MAmfQN1t~~;ffiL~:~'~'1 I Name I CCB License Number Phone Number I I Electrical I I Plumbing I I Mechauical I 1~2J~:f;;~~;~:#~:~~~~'\~GQ~A~:X~-QY~B~'M~~Nft~~B~FiB@,v~~~~~1W:~~~~11 I This project has final [and~use approvaL I I Signature: Date: I ThiS. project has DEQ approvaL I Signature: Date: I Zoning approval verified: 0 Yes 0 No I Property is within flood plain: DYes D No 1~~~lii~~Ri]jj{(:ATE'{;QBY~\.(;)~.!i:~Q@ii~Qcill1Qi!.~t'Kl:ii~~~~~?fii,1 1.5.Residential 1 D Government I D Commercial Ig~~ta4~i~)~~~:;j9'~YLS:I'jf~L:IN.~~R:MA..tiQ~~J~'~'R!f~Qj::~T!Qr:I:~Jt~~m~~~ I Job site address: 1//1( t(.v,v-..c, 1+ I City: 4~ 1'.',..1.0 I State.df{... I Subdivis;cm: OJ I Lot no.: I Reference: '.. . -",;_,_ "_.tT~,X_I.O~:_...,__._,,_,,,. I::'.:,,' ,," ".:" ~R()pERliY/,QWNE~2/';:f I Name: K."""" DI.,..'I/lo, I Address: I ( /q Cl.J ,yo. "" r I City: <,pI',',.", .c'"lo I ~ Phone:' I I ZIP: I State: Fax. I ZIP' f)~ E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. Ir,:~J~;:~Y}':~:~~fr~f;\l{7\~}~9(J~10:~;i[~:~-~::'~~H'~.RiJ~.~-~?~~,!~~2~':;;~!~'?\~r':.;;/?:7'i~.y'tz I ~i}\;Y~1.~~fl,~,;m'(nfQrJQ~.!~_q~~1\~j~i~;~'t~;'\:~:~*~~J{j}~~it~lY,%~~~*i~!~:i~:;1 I (a) Job description: d~c /'A7J~/(J7t/ I Occupancy 1 I I I 1 II I I I I I Total valuation: ..p, ~ ~ "if? ad> I $ 1'2~B 'Id. ""f' ....>, ~!\>m~'rt'~i;~"r~~!tilr;-f.j ""r ~+-1:'.I!1t , ,.>;'... '''"''k'~' '''. i'''"1 c. Ul mg _e~s~~1'4j>~~..~i':.'!;t1;:;*.r.~"'~;"'~""S.: ~'i.A.4;\~;/I~;~i'r ~)(J~~ ~f,~"J,_~';;L.l' Construction type: Square feet: Cost per square foot: Other information: Type of Heat: Energy Path: o new 0 alteration (b) Foundation-only permit? D addition DYes DNo $ $ $ 225 Fifth Street. Springfield, OR 97477+PH(541)726-3753.FAX(541)726-3689 1~~~fDEPJXRTME!:l1TJe~~YJ~l ",~:".;.'I:i.f-,;,T:'_;'''-'''-'''''i,:;t~;_~,~t'I;;;::~~~~~-i Ipennitno.: (!'1-/ 3. '3k-1 I Date: q 112M 71 Electrical Permi(Application ,. , D 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. I Residential, per unit, service include'd: 11,000 sq. ft, orless (4) $134,00 $ I I Each additional 500 sq. ft. or portion I thereof $ 25.00 $ 1 Limited energy (2) $ 32,00 $ I I Each manufactured home or modular I dwelling service or feeder (2) $ 63.00 $ I Services or feeders: installation, alteration. relocation I I 1 200 amps or less (2) I 1 $ 81.00 $ Xl 1 _3f_~S:'" '-, . ,- """""'W-...,,,..-,,,,~~,,,,..,~- 1201 to 400 amps (2) 1$95,00 $ I ~_';'~""_",~"",P.RPgE_Ri~b~.,"'IE~~j,,kJd";'.,,;,.,~~1'il~~ I Name: f::-//'VI ;O/111~ 1 401 to 600 arnps (2) $158,00 $ I I Address: /1'19 W/t//1-UL--r .1601 to 1,000 amps (2) $206.00 $ 1 .1 City: I State: I ZIP: lOver 1,000 amps or volts (2) $469,00 $ 1 I Phone: I. Fax: I Reconnect only (2) $ 63,00 $ 1 1 E-mail: I Temporary services or feeders: installation, alteration, relocation I This installation is being made on residential or farm property 1 200 amps or less (2) $ 63.00 $ I owned by me or a member of my immediate family. This I 201 t 400 (2) 1 property is not intended for sale, exchange, lease, or rent. OAR 0 amps $ 87.00 $ . 479,540(1) and 479,560(1), I 401 to 600 amps (2) $126.00 $ I Signature: . . .... , ! Ov~r 600 amps or 1,000 volts, see services or feeders section above I ~~~e~l\lm~Qjl(;[Bl!iIl~lSjfr~~IE'J,xl]I.GiN~iij~#1~1 I Branch circnits: new, alteration, extension per panel I I Business name: LH.AJN' s eJf{.....T O;-L- ! I a. Fee for branch circuits with purchase ofa service or feeder fee: I I Address: J30'/. ~ I 1 Each branch circuit Ii.{I $ 6,00 I $ J-'<f 1 I City: fif/ICfZf,~ t. I State: bIZ.. I ZIP: 91ll'~51 I b. Feeforbranch circuits without purchase ofaservice or feeder fee: I I Phone: 5:=<11- '1Z't.-'7~5'1 Fax::)IJ1~7';f-I1!:~"Z---1 1 First branch circuit (2) ~ $ 55.00 $ I I E-mail: lu<r.f.f1/wfS 2 c.(2 Iks,u J"dW1 I I Each additional branch circuit $ 6,00 $ 1 1 CCB license no.: 8 ;, -Z 1,/ ~ 'I BCD license no,: Zo- n I-C- 1 Miscellaneous fees: service or feeder not included 1 I Signing supervisor's license no.: :J sS 1- S I Each pump o~ irrigation circle (2) . I $ 63,00 $ 1 I Print name of signing supervisor: L.., IV IJ P ~ 1 Each sign or outline lighting (2) $ 63,00 $ I I Signature of signing supervisor: ~' f) II I I Signal circuit. or a limited-energy panel'l $ 6300 $ I . '. _ ~ ttA ~~ alteratlOn, or extenSIOn (2) . . '. ~Eachadditinnal inspection: (I) I' I $58,00 $ I ~ '"",'""," _i"_W"o'Di~I"r.,"A\-N"1r"'iri'S""E~"""!;t\~JK-'-"'*''''''_1 . . ...,,~~~i~t;\:_~~l.;:;~'~_,_~I,~~~__._~~t~!,{~~~~~~~~ \S)~t).,rf'- . (A) Enter suhtoml of above fees . I (\~.~ ~'D" (Minimnm Permit Fee $58.00) $ fa (' \j ,~\,~ '!:ttY.<}-. 1 (B) Enter 12% surcharge (.12 x [A]) $ ;2-".' I ~ ~'I (C) Technology Fee (5% of [A]) $ 'j',!;' \Y 1 TOTAL fees and surcharges (A through C): $ j't2-!.l-' ~~~9:G..~~G:Cil)ME~~ME"NjJ"jl~~.li1.:lilxr.fi.!~~1 I Zoning approval verified? 0 Yes 0 No . ~ '''''. . *~:~''fGAmEGlil~"'iI0- 13(;)NSffiROemjo~'. ';".-k '. ~"~~~"=~~u ....lI!.I7I. . y,__~.~~~~~ o Residential I 0 Government 1 0 Commercial ,~t:[~][s"I]f~JINf5.~RM~mIi;jfiJiW~fi[o~I!Q.~~lfJ\\jJi~.~* I Job site address: 1/; "1 d)rAll\//iVlL/ I City: S'P~ I State: CJ7L 1 ZIP: <JIlf'!} I ~~-'~:>::;,~, jt')ct1il."~~JL~t~~ , 1ll'''''''''''''''''''''''''"'~'*t;Jt:'''''R.Ie,lil.0Niil0.~l(;W0R~~~ ~~~~~_.__."__.~_,__.=.,.'-..,_ _ _ '!;"",,_._,"."_,..!i~~~;;i~.&~~i e.,,/I..I2-Il-u~ I}JrJVi:!J2J71)rJ 440.2584-J(9/08/C()~ Mechanical Permit Application r;~"~€iDE;P,'ARliMEN:wsEfoN'11:Ycm~1 Ik!;~~J:_';""":4i'r;n_:&,,,~:t'''''3fir'')''';;~"(::;A~$J~~t:-': I Permit no.: lkj- I J X-~ I IDU~ I 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 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. ~~~~V~~~!;~]tS.f8.~.P:Wi!E iliR'0Yii(~?F""t''''';'I'I!f;~!ii~r,..\i'"!*"j)\(i'';\1l;I'Q,e'1l\ ~i<~,,~,~t~,,;Etf)~1;l;f!(i~i1'"*1fi~A~~tfl;!j:1~1{:;}~; \:,1.Y..~ I First Appliance . \ '$79.00 Wurnace/burner including ducts and vents 1 Up to lOOk BTU/hr. I I lOver lOOk BTUlhr. 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 1 Evaporated cooler I I Vent fan with one duct/appliance vent I 1 Hood with exhaust and duct I Floor furnace including vent '1 I Gas piping 1 lane tn four outlets I I 1 Additional outlets (each) I Air"handling units, includin~ ducts I Up to 10,000 CFM I I $11.00 I $ laver 10,000 CFM $20.00 $ I Compressor/absorption system/heat pump 1 Up to 3 hp/JOOk BTU 1 1 $17.00 I $ 1 Up to 15 hp/500k BTU 1 1 $29,00 $ I Up to 30 hp/J;OOO BTU 1 '1$43,00 1 $ 1 Up to 50 hp/J,750 BTU I I $57,00 1 $ laver 50 hp/I,750 BTU $95,00 1 $ I Incinerators Domestic incinerator 1"~9e,]~9]5B~~QJ'lSif:!fl!lf:ii1W~~~ I,aResidential I D Government 1 D Commercial \lii~$!I1'i!i0B?rSI1ifEJjfN-FbRI\i1l1.mION~~AN~lE0c'AmioNii';;~~J,\lJ '~.~L.'~'''''''''''~'M~...,"'._.:Ii1._.,".-,~>."..u."",_=:J..--,--,-"".."-~.~~b..u.~_.~.l,~;,;"u","d,,,,,~fA""!,~ 1 Job site address: II / r qy he;; I t~ /71,')( 1 I City: 5Pr'.\r.'J (:.,'e/ f\ 1 State: .0 tZ- 1 ZIP: 1 1 Subdivi;ion: - 1 Lot no.: 1~2Y~"':~r"--"~ .Ul'I7'-""-"----;MM~"'!~~~' e.1r~,~"'_!!DJ;~.f~ll3mlgN"O~vy,O,RIS"h~,;~_'v_cffi!li,~ _ "', 1 &0/'''''')''' CO('.. V( ('5.b~ - 1 1 Name: K.r.".-. O~!I f)/')T 1 Address: (II,,! tQJ,y'\(,/t o/' 1 City: 7ft ,k f:<!b:J 1 State: 0(2 'ZIP: 1 Phone:&-! /-53-4 / 'I C, l. 1 Fax: 1 E-mail: This instaJlation 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: 1~\l>!l'1l/~0NmRAeT0R~iNS;ijA~I!Ami0N~'l!I~~ti\'l!'i~!1 ~~J!D~EEh~,,,,,-,..J.+..;. +..,.--'''-~ .,.31, .__._......^',~,.._."u_._~.~A,...,__,__'l;;ffi;'jRfj2fftg4t;;~Z1l!'Xh,_", I Business name: For t ((Ot./( CfY\s+e.l/cI-.'i)/\ Ji'tc. I I Address: fp .f30t1 /7 I'} 1 1 City: tt>iI~J ( Jfo ,(.. 1 State: of! 1 ZIP;'17'-/ U-j 1 1 Phone:9ft -7&;7 - IC / I 1 Fax::5i/(- 7~'"l 3005- I E-mail: I CCB license no.: / Lj() (, '1Q 1 Print name: ~.o..o r>1,..", 7-<. ...v- . I Signature: ~ t..-~ _' , tJ CJ 440-2545-J (1l/08/COM) $17.00 I $ $20.00 $ $17.00 I $ $38.00 $ $58.00 $13,00 $ $9,00 $ $13.00 1 $ $58.00 1 $ $7.00 I $ $4.00 $ ~!'ii1~1~~ ';r~costilI~\ $ 0'1 I 1 I , I I I I 1 1 1 1 I I I I I I I I 1 I I I \ $ I Enter total valu.atian of mechanical system and installation costs $._ $ I Enter fee based on valuation of mechanical system, etc. I $ I ~Mi~I1'1i~~~tr~f~1f~'If'F'C~~li~~~~=I!!I~ost~'I!il!I'.iita~~1 W-Y'-0<+?:"""'S:T;n=~,,*,,~:t.<l~"'ft'~f;S'.<~~~ -Y.f~! ;;~e:n~ i{;1ifcostz;(~ 1 Reinspection I $58.00 $ 1 Specially requested inspections (per hr.) $58.00 $ I i Regulated equipment (unc1assed) I $13.00 $ I I Each additional inspection: (I) I $58.00 $ I I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) I (B) Investigative fee (equal to [AD 1 (C) Enter 12% surcharge (.12 x [MBD I (D) Seismic fee, 1% (.01 x [AD I (E) Technology Fee (5% of [AD I TOTAL fees. and surcharges (A through E): $ I $ I $ q~ I $ I $~'l) I $ "I2--~ I Plumbing Permit Application 1t:~~~~r~~~T:~~~l{f-g~~~8Hi!y~' Pennit no. 01- I:J gr,,:, Date: -'] / ( '010 'i 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 within 180 days of issuance or if work is suspended for 180 days. I'~~"-''''''NY ".,.-. .. N ENT"" ""itS """""'1 I""""",,,,,,,,,,,,,.,.,".F'..'", .", ,.- "1"'~""'"""''!.'2f'~'''''''~1 ~fYfik,l&~~'1!f;',fU;(D"G'A4tEG'G~E~ .....M..._::ft'/f.P"RROVAl!,;ii1&,~\%~~<}L~~;;1~-~;% i~,~~,:'r:'-fA;';h;~-{f:.i\)1~A;1f~it~~.~R I;_Ej(S.C,R ED,11_IlEr"rL?f'(~I~'iJ;1;~rir~'~~JS~.'{1f~i':$ I Zoning approval verified? D.y ~s 0 No I If~B~1~:6iiiitiij~~~~fJ~~;t~\*t@~f~~~f~9\~~~IQf~~I~ts;~'~N~~:I~tE)'t~.!;]~1 l1i"{1'"!%'~"MS~\\<;Ft:,';'.&~Wl{t1h1t%ji1f~~~~H?r?c,~!~,gJ e",_::.~: .yl~...~~~.'ir"xtt3 ~(~~.~~ttri]~ I Sanitation approval verified? 0 Yes 0 No I 1 New residential I I . CATEG.OR.'COF,CONSTRl:JCTION ;',', ", I I bathroom/I kitchen (includes. firs/ ~~~~"~~~~ITiE';IN~~R.~A~7;~~~ND~1&~C~~l~~~;~~,~1 fff!n~~~~~~Z:~?5:~fi:!;;'f~int $238.00 $ I Job site address: /lIq Q,) h""lr O/' I 12bathrooms/l'kitchen $374.00 I ~ I I I 1 3 bathrooms/l kitchen $439.00 City: ~((ir-'l t..'~1 State:OZ- ZiP: 1 Each additional bathroom (over 3) $95,00 I Reference: -- I Taxlot.:, I I Each additional kitchen (over \) $95.00 iR:t11i'i&7::;::'~t~DESC;:~:~~0R.k~~~~f~~(;i~~'5,!r~~$laj i E;~~,~:~~::~:s!:;n:::s (includes plan reT::~568~000 I 3,601 to 7,200"squarefeet 1 $174.00 I 7,201 square feet and greater 1 $232.00 I Manufactured dwelling or pre-fab (circle one) Connections to building sewer and I I $58.00 I $ water supply Commercial, industrial, and dwellings other than one- or two-family . I Minimum fee I Each fixture I MiscellaneousJees 1100' storm, se'?ler, water line Signature: I Each fixture, appurtenance, and piping I ,,; _,CONTRACT:0R,INST:AllA1;ION::'i;j';~,;i;;",j~';:i:;: .,,;"'1 I Storm water retention/detention facility I Irrigation systems Piping or private storm drainage systems exceeding: the first 100 feet Specialty fixtures Reinspcction (no. ofhrs. x fee per hr.) Special requested inspections (no. of hrs. x fee per hr.) 1 I I 1 1 I I I I I I 1 1 1 I I 1 1 I 1 1 I I 1 1 I Enter fee based on installation and equipment value. I $ I 1~~Ji~~E'Ag~ill(;;'ANjf.ti!fsE~'t~~2~~1 I (,A) Enter subtotal of above fees $ ih 1_ I (Minimum Permit Fee $58.00) - I ~ I (B) Investigative fee (equal to [AJ) $ I . 1 (C) Enter 12% surcharge (.12 x [A+BJ) $ 1 I (D) Technology Fee (5% of[AJ) $ I 1 TOTAL fees and surcharges (A through D): $ I -" .., 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 . ;: BROgERr:~J$o,^,NE~il.~~1~fJ~,~~J:\l~j:~;t~}f~~::'~~ K.VA Dh.:t foT I Address: If 1<( G.J,'/\a/ r I City: Lj1(!W;[-r I.{) I State:Ov'2-- I Phone: i1I-5.J;;. I'f? <- .1 Fax: 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 9 I 8-695-0020, I N~me: I ZIP: I Business name: eel )f('JvV' P/<.M-..b ,(A"j Address: City: I Phone: State: I Fax: I ZIP: E-mail: CCB license no.: Plumbing license no.: Print name: I BCD license no.: Signature: 440-2500-1 (1l/08/COM) I 'f I $58.00 I $19.00 $76.00 $19.00 $19.00 $19.00 $19.00 $19.00 $58.00 $58.00 Each addition:al inspection: (l) $58.00 $ $ ?,."\";"i:r~~~II']j1fhJ'J<''if''''..'<i.'''':;''':;je'''f:'fl'r.':'O:'":>C-i:~""'itQ;'''F'--q'1 $I\1edicaJlga~;p'ipil.lgWii~~i.~~t{~itii~3&~'i Mi.nimum fee I Enter value of installation and equipment $ _" $ $ $ $ $ $ $ $ $ $?(, $ $ $ $ $ $ $ $ City of Springfield Official Receipt Development Services Department Public Works Departmeut 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number. COM2009-01386 COM2009-0 13 86 COM2009-0 13 86 COM2009-0 13 86 COM2009-0 1386 COM2009-0 1386 COM2009-01386 COM2009-01386 COM2009-01386 COM2009-0 13 86 Payments: Type of Paymenl CreditCard cReceintl RECEIPT #: 2200900000000001085 Date: 09/24/2009 8:29:22AM Description . Building Pennit. Fixture 1st Appliance Penn Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Stonn Admin Amount Due 296.89 76.00 79.00 81.00 24.00 27.84 66.83 173.96 132.28 15.31 $973.11 Paid By FORT ROCK CONST/ Item Total: Check Number Authorization Received By Batch Number Number How Received nlm 070402 In Person Payment Total: $973. II $973.11 Amount Paid Page 1 of 1 9/24/2009