HomeMy WebLinkAboutPermit Building 2009-10-7
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Status
Issued
225 Fifth Street, Springfield, OR
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SITE ADDRESS::;-:-""'1138 S41ST ST
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ASSESSOR'S PARCEL NO.:' - 1802064112900
CITY VI' ~rKll~lJI'1J<.,LD
Building/Combination Permit
PERMIT NO: COM2009-01469
ISSUED: 10/07/2009
APPLIED: 10/06/2009
EXPIRES: 04/0712010
VALUE: $ 176,743.00
Springtield TYPE OF WORK: Single Family Residence
TYPE OF USE: New Residential
PROJECT DESCRIPTION: NEWSING",,, FAMILY DWELLING- LOT 58 FILBERT MEADOWS- SAMEAS
. . 1l~2,~ 40TH'C9-1111
Owner:
Address:
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BRUCE WIECHERT CUSTOM HOMES INC
3073.SKYVIEW LN
EUGENE OR 97405
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I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Mechanical
. Plumbing
Contractor ,-,
BRUCE WIECHERT CUSTOM HOMES lNC
'F~"'~:-"'~~ L & EELECTRlC INC .
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'I "",' COMFORT FLOW
, ',' . STEVE RJOHNSON
License
101717
105475
460
65065
I DEVELOPMENT INFORMATION I
. REQUIRED PARKING
. ATTENTION: Oregon law reqUlr~s yoU.1O
Overlay D.st: follow rules adopted by the 1\10t'!!:m Utility 2
# Street Trees R~~i,tification Center. ~ hose ruIHandicapp'ed:h
Paved Drive Rqd,:,l OAR 952_001_0iY.esthrougteGrnjJact?-001-
% of Lot Covera~"'90. You may 3~!501 copies of the. rules by
calling the center. (Note: the telephone
. r. . H~ _ f"'\~,.........,....... I Hilih, f\lntifir.:::lhnn
I F '2~~~~IC.JMP'H-OVEMENTs(ce~ter is 1-800-332-2344),
Street Improvements: Nflrll'!I'" '" u"(I' 03JN3v\!v\!OJ Sidewalk Type:
tlO:l 03 't..!!. ~ I,IJprove, . in'\!
Storm Sewer Available: ~ll\\;\Jtl]Jd SIHl tl31Yes1 03ZI~OH
Special Instruction: u,N Storm wateJjto.curb'viaiweejiJh'oled SIHl
:. lV1H8M :lH.L :lI:~alu^-' . ,., ~ - :3"'110N
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# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Constr~ction 'fype .:
Secondary Construction Type:
,
# of Bedrooms:,! . "
, "
1
.R-3 .)
.,-:: U
'''' I')'
l~i;;' VB
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3
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Frontyard Setback:
Side 1 Setback:
Side 2 Setback: "!i '- ,., .
Rearyard Setba~k: " . . .
Solar Setbac.ks:',i ;i", "
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u
18.00
"~i2.00 .
.1 _
5.00
21.00 .
0.00
Notes:
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I BUILDING INFORMATION I
# of Stories: 1
Height of Structure 17.00
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Gas
Energy Path:
Sprinkled Building: No
Expiration Date
09/16/2010
03/30/2010
06/27/2011
03/1212010
Phone
541-606-5050
541-933-2653
541-726-0100
541-342-3765
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
6,080
1,650
450
DownspoutslDrains:
Curbside 7'
Curb and Gutter
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Page 1 of 4
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, Status - Issued':":""'.: '>'.' ,,' "-
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'. 225 Fifth Street;'Springfield, OR
'541-726-37531'~!9I!e}::tfj;i';'</ .\
541-726-3676 Fax . i+' . ";,:,,;..!,-.,,,.
541-726-3769In~pection Line ;,,:y ..
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,. Description . ":\'.Tvpe of Construction
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... GaraeelMisc'1rr.;,.u VB UtilitY:... ,1
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SFlDuplex R-3 VB 1&2'Familv
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I f,.ee. Description;r~,;. \i ;'...
'. '.Plan Review Same As '~I,..
+ 12% Staie Surcharge"
+ 5% Technology' Fee
1st Appliance
Addressing Assignment
Appliance VenL .' .
B 'Id' P 't' 'f ."
Ul 109 ermt. ,,':.i;t;;;-;,
Credit- SDC Storm'Improv
Curbcut permit' -' .: -"
C', ",., . '. _~. ,"" .. _~' ,.
I DryerVent ',~t'_~I,'! -'~~',;
Exhaust Hoods '
Fire SF Fee - Residential
Gas Outlets 1-4
Overwidth Application Fee
Piau Review Major - Planning '-.',
PW Disc - 3rd Perll!.it:,"" 'i' :'~,,:ii'
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
.1 ~ l" .l'~"'" ...
. Sanitary Sewer'" Improvement,
Sanitary Sewer - Reimbursement .
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin -: ;',
SDC Tran Rei.iibu;s:ResidentiaJ' .~
SDC Trans Improv~ment-Resident
SDC Transportation Admin
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Sidewalk Permit., " ", .
Storm' Drainage Impervio'us Area .
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
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Total All!ount Paid
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I Valuation DescriDtion I
$ Per Sq Ft
or multiplier
$37.72
$96.83
Square Footage
or Bid Amount
450.00
1,650.00
Total Value of Project
I1pp~ pqU;LJ
Amount Paid
.
$250.00
$172.58
$90.51
$79.00
" $38.00
$9.00
$1,022.14
$-1,384.82
$88.00
$9.00
$13.00
$105.00
$7.00
" $45.00
$211.00
$-60.00
$134.00
$75.00
$507.07
$666.84
$10.00
$1,044.54
, $101.97
$87.99
$211.21
$931.65
$85.67
$88.00
$1,384.82
$63.00
$27.00
$2,858.00
$8,971.17
Date Paid
10/6/09
10/7/09
"10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
10/7/09
Paee 2 of 4
CITY VI< ~rKll""\.JFIELD
Building/Combination Permit
PERMIT NO: COM2009-01469
ISSUED: 10/07/2009
APPLIED: 10/06/2009
EXPIRES: 04/07/2010
VALUE: $ 176,743.00
Value
Date Calculated
$16,974.00
$159,769.50
$176,743.50
10/06/2009
10/06/2009
Receipt Number
1200900000000001114
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
2200900000000001145
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Ul}' OF SPRINGFIELD
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Building/Combination Permit
:~tatus,\~~~~~d:,;, .
, 225 Fifth Street; Springf!eld, OR':. .:
541-726-3753 Phone" ", ".0 ";'
541-726-3676 Fax'
541-726-3769 Inspection Line
PERMIT NO: COM2009-01469
ISSUED: 10/07/2009
APPLIED: .10/06/2009
EXPIRES: 04/07/2010
VALUE: $ 176,743.00
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Plan Reviews I
1 0/06/2009 APP
DDK
Required street trees as shown on
street tree plan attached to permit:
species as shown. 2" caliper, leave
name tag on until approved.
Storm water to curb via weep hole
As noted on plans
': ..Plannine Review:, .\.' "
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1,0/06/2009
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Public Works Review
Structural Review
10/06/2009
10/06/2009 '-'
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10/06/2009 APP
10/06/2009 APP
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To Request an inspection call the 24 hour recording at 726-3769, All inspections requested before 7:00
. :i.m, will be m'ade. the same working day, inspections requested after 7:00 a.m. will be made the following
'1'" "';"W~;'.ll"d';. ,
work day. I '1,.- ,'. I .';'.1:" . ':
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Ufer Electrical Ground: I~stall ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
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Footing:; After trenches are excavated.
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Foundation: :~f~r fOt~S ~r~.erected but prior to concrete placement.
Post and Beam: Prior to floor insulation or decking.
Floor Insulation: Prior to decking.
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Shear Wall Nailing: Befor~ ~overing sheathing with finish materials.
Framing.Inspection: Prior to' cover and after all rough in inspections have been' approved.
~ 14" I
WalllnsiIlation: . Prior to cover.
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Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.., r
Final Building: After all required inspections have been requested and approved and the building is complete.
, ,
Underfloor Plumbing: Priodo insulation or decking.
Underfloor Drain: Prior to cover or placement of concrete.
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Rough Pl~mliing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
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Sanitary Sewer Line: Prior i.o filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all.plumbing'work is complete.
Underfloor,Mechanical. Prior to insulation or decking and including required testing.
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Underflo.~~ Gas: After line is installed and required testing and capped if not attached to an appliance.
Rough,c;:;",~:,~~\t Iin:~is.\ns!!,lIed and required testing and capped if not attached to an appliance.
Paee 3 of 4
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CITY OF SPRINGFIELD
'. "
Building/Combination Permit
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Status Issued, .'
225 Fifth Street, Springfield, OR. <
541-726-3753 Phone . :-\)1,:.:
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541-726-3676 Fax. ',,-,.:,',. :'.,,",,-"H""-"
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541-726-3769 1~~pe~ti~~'Lirie " "'f
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PERMIT NO: COM2009-01469
ISSUED: 10/07/2009
APPLIED: 10/06/2009
EXPIRES: 04/07/2010
VALUE: $ 176,743.00
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".,... Gas,ServiceqAfter line is installed and line has been connected to a minimum of one appliance including required
. testing. 'Pres'ur~:test d~~e~.at_ihis point. .
;'.'-;'--i'
Rough Mechanical: Prior to Cover ".
"11
,
Final Ga~: When all gas w~~<~ is complete.
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Final M~.chllnica!; W_~_~n:llll~",echanical work is complete.
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Rongh Eiedrlc::Prior to Cover
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Tempor~1-y Electric: Approval required prior to Utility Company energizing pole.
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Electric Service: Approval required prior to utility company energizing service.
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Final Electric:. When all 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.
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Curbcut{ Standard: After forms are erected but prior to placement of concrete.
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By signatu;e, I ~tate:and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is trueand correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances Qf 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 Commuoity Services Divisioo, 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 per~ii card is iocated at the 'front of the property, alld the approved set of plans will remaill 011 the site at all
times during constr.{ctioll. '.
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1- Date / I
Owner or Contractors Signature
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Page 4 of 4
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S.. P AINOPIIU.D ~ ZON .
~ft . . INITIALS
.6!.' DATE
, ~ SOURCE
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-J7SJ . FAX: (S41)726-3689
ELECTRJCAL)7}l!MIT APPU~-1,TION
City Job Number ( 'Lf - 0/ L/@ I.J
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1. lidCAnONOFlNSTALUTION:-,
113"~ 5..~;S~' .~~-..
LEG~Cr~4 \
VLCV:O
JOB DESCRIPTION:
SFr?.---
Permits a re non-transferable and expire if work is
not started within 180 days of issuance or irwork is
Suspended for 180 days.
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Electrical Contractor L +- c
Address q Z. -g s 3
ACl'eS
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City 'S,o (C \ 6
PhoneSLJ' '119l
Supervisor License Number L{ 17 'i - S-
3r/-ro IZ/io/ II
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Constr. Contr. Number I b S- '--/ 7 y-
3)10
Expiration Date
Expiration Date
SigOa~ of Supervising Electrician
( rQ \~,OlAnL
Owners Name ~'r lICe LJ I "",ked
C.lSbl"
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110 1'" S
Address ~ \:) 7 3
City € lJ S:-"'<.-
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OWNER INSTALLATION
The installatioo is being made 00 property [ own which
. is not intended for sale, lease or rent.
Owoers Signature: ~
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Inspection Request: 726-3769
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Date
/0/&/0'7
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3. - COMPLETE FEE SCHEDULE BELOW . .
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A. "~~ew-.Re~id"~~n~ial__:_.~:i~~)e ~r:~lultkFamily per dwelliril~n.it~ /~--;
-p y~ cr-J" . o-V
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Service Included
!
1000 sq. ft. or less
Each additional 500 sq. ft. or
portioo thereof
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Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$57.00
:-':-:~~-.,.<I: '-~" .....-"'-~"-~"'---_. '~--"',------::-~~' ------:- ---.. '-1
B. ~...Si~iie~'o'r Fee~e-is"~ Inst:fllatio~;Alier3ii6~j'o~ R~iocatio~:,:I,!'1
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200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNohs
Reconnect Only
$ 73.00
$ 86.00
$143.00
$186.00
$426.00
$ 57.00
'c. . T~~po.rary seiv!~~'~ or F~~ders
.... ." - . - -.
Installation, Alteration or Relocation
I
$ 57.00
$ 79.00
$114.00
/--., ~
IV ..5 -
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over ,60? Am!'.s?r 1009 yolts see "8;' above.
D. ; '8ranchCfrc~liis<", -, :-- :-.-"., ~...- .'
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 50.00
$ 5.00
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l\1.isc~~I.iil~e_€!us (Se!""ice/r~der ~ot includ~l) ~~acl! Installatio~~1
- , '.- .. . -
Pump or irrigation $ 57.00
. Sign/Outline Lighting $ 57.00
Limited Energy/Residential $ 29.00
Limited Energy/Commercial $ 52.00
Minimum Electric Permit Inspection Fee is $52.00 + Surcharges
4.si;l1;j'O'I14.f- biABo\rE'" ." . ..' ;;) 72- 0--0
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12% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL
Shared Drive(T:YBuilding FonnslElectricaJ Pennit Application 7-08.doc
2~Willamala~e
t Park & Recreation District
/11-!'-((/1
Job. No.' (".-
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009
NAME: ~Jfa M~4::~r . PHONE: r::;-~ "Jv.>F.
ADDRESS:'O?:? S1::Y1II~-W ulCITYB1c~t-- STATE:~ZIP: 'l'J$'tJJ""
. LOCATION OF PROPOSED BUILDING SITE:
Street Address: ( I Jd 5 'l{( fT
Plat Name: Tax Lot Number: /J'{)Z t'u Lt'1 /j.<;/Jo
. .
. .
1. .DEVELOPMENT ,TYPE (Check appropriate dwelling(s). Dwelling type definitions are ori. the
back.)'
A. Sinole-Familv Detached
NO. OF UNITS
\ . X $2,858 per unit =
$ 2.if rf'
. 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 $1.,550 per unit =
'$
WflLAMALANE SDC $
2.. SDC CREDIT (lfaP~licable) SDC p~yer ';'ust fumish ~roof Dr'
Willamalane Credit approval.) $ .
3.. TOTAL WILLAMALANE NET SDC A~SESSED
(if SDC reduced for Credit)
$
;2.,rF
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. -Date' "..' - -. . - . .
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-- Development Services Department
CitY of Springfield
SI4fY1<
Structural Permit Application-
AS /Is- Z
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;'!"''''','::;;;,;~...GITY~OF SPRINGFIELD,.. N ~,~;<,'<l';;c,,;~'f",?:i::r,i'~_'"
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(54i)726-3689
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pennitno.:t!'1-/t;~ 7
.... , I Date: /O/C//o 'j
. This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days o!issuance or if work is
suspended for 180 days.
r;:~e!l'fiii[:"'Mi\~1fiffc"il'rG'0i1ERNMEN:F~~JrIiRcivAiEl~"",;;Wifl~ii!ti1
I~""-,~____~,~,,_,",,,,~.__.I.:.:.._-,,^__,__~__...<tr.~.m''--'''',"~'_'M'_ ..,."~,,~.~iS,...'it,..,~,v
I This project has final land-use approval. 1 I", "j'C->"""!;;.~!I!,m:-\1!"lli"&-,~.",.,.^,.,....;:t;;---~,!~,"",,,':l"': I
Signature: . . Date: ~~t;~~~~rr;~45~E",~PJ1~IJ.lJ.!;~E.\?:~~~~~;',
I 1 :~1~,v;rillt;t1ontr.ri6~ri,~ht}nr.11~.t~~~~~~~~~~}:l~'
. ~;:~;:ct has DEQ approval. Date: (a;;~b~;;~ri;;i~~~~~;O-";Sf'D'it~~'1llI=Jl.."rel_..~.
1 Zoning approval verified: 0 Yes 0 No 1 I Occupancy (L / II\..
f;;;ii;~~1l;'i~ffijl9~~~~ij~l'~U~;!9NTI~~1~)f;lEi:i'!L~ t. ~:::7;:~~:n::~ O~ ~-o I
11&';;;:~~~'~:""'.l ~..?.':~:~me~~_~.....,_~_~,:.""~;~~~!,,.~.;. I Cost per square foot I
, .. ,,' '~",,",i!.Q.~],~!J:Fm~~Q~M.~,!]QNt~NPl1!'.0~AT1QN~"'f.:;w:..!'fi I Other information: 1
I Job site address: ,/!~"3 <; I..{J 51' I TypeofHeat:!;;f"A I
I city:<;9'-; '''If:,,-I.i I State:" IL I ZIP: 9 7n7] I I I
I Subdivision:F:lh",o\: (l\l&J-UIoJ':' I Lotno.:5'b I I .--.rE9<rgypaoth: I/tk . I
, 1 Il!J new a teratlOn 0 addition
II'j~~;~~~:~;;::"~i";[$-~.-.,.._.._J,~~I.~~~~~,,}?".t::t.~.,/J,~,~~.", I (b) Foundation-only permit? O.Yes 0 No 1
l, '. .""""''' "","".d.. ,iPR0P"R'R{',0WNER:.1':"i'N"i':.":.,..Vi'~i!'.I'-"":,,,, 1
.fi:. .. ~t1t__\ ".""!~J\'.'''.!1..'~_''-o''''''.,.J<,~.,,___.ol>.,...)"___,-.,.__,~,lc'_.._~..,J ("""",,,'-' '''''''''''''"'''''1 I Total valuation: ~ l s
I Name: Q. {Ill (. IV" c.h. ,t C V "'~"- ~"'o.> :t N c.. 1 1'2" B""ld"''''''~''''''''"'j",,,,,,c.mFe'':': "".."".,,,,,,..,,,c,,~,,,,.... "';,=.m;""",e., '1
:. .' UI lDg';J.eeSj,"';;;~~'1~.:.'.ri(;-.,- ...~":: ::~':~~l'f:"~l-i' .-;., ~"rW;t}~:~':;:!
I Address:~071 Sr....view L-N . '. . ..... ,.....,<"...,~,-_..,..~........, ,. .,..",,~. "~_,,,",,,~"""'J'.'
I r 'I I" 7 -- 1 I (a) Permit fee (use valu.ation table): $
City: < V',(,,-,- Statej) JI.- ZIP" yo,
I ~ , b tr ""6' I (b) Investigative fee (equal to [2a]): $
Phone: -b~ - '1 '1'> E Fax: -, -::>> '"' .'
I (c) RelOspectlon ($ per hour):'
I E-mail: W;Cc..hN~~C.....-SQ.CO.~U.S1.Ne. \' (number of hours x fee per hour)
This installation is being made. on residential o~ farm property owned by I (d) Enter 12% surcharge (.12 x [2a+2b+2c]):
me or a member of my Immediate family, and IS exempt from IIcensmg
requirements under ORS 701.010. I (e) Subtotal of fees above (2a through 2d): $
1~.:j?;pj~1f,1-'m'i~W'i'~l?F~!!!'d>;'!ffi;~]"'l.tl?,.w~~;i:J;b.W'>k!1~"jfJ~
"___,,__._,,,___..._._..!!t.._~_~.-6~X!l~~,.....sr.<~.-~~~",~~:~:
I (a) Plan review (65% x permit fee [2a]): $ I
L<b) Fire and life safety (40% x permit fee [2a]): $ 1
r (c) Subtotal offees above (3a and 3b): $ 1
1:;'.~;:.ly(i~;~~Jrr;1te:~!f.~ff~~fl~jJt1.\~Yi~',::~:?~;;;~~;?i_~l~~t~\~~ii~~~~::'l
1 (a) Seismic fee, 1% (.01 x permit fee [2a]): I $ 1
I TOTAL fees and su~eharges (2e+3c+40): $ 1
$
$
Sign here:
I~' ""'."'" Iili' ~~""'--"~'~-'-.'-'.--'-'.. '-"',"'-'''''~' "~""""~..'."'''c' ,~.'
\ '''l''''':''. ,,,lIf,C0NifRACTOR,,INS1'AI1l!AlI0N;. '-,<"""I,,,~'~f<';\'i:;.1lf,l.
~B::~~es:' n~:'~:\J:"W~,~;~.~:~"'-'C-'~"~'~':'.-"fi'_~;~~~~';;;:-'r~
I Address: '3 073 S IL~ vi~..J '-v"-
I City, of: U) ,,~ I State,O<L . I ZIP, q 7~D'-
I Phone, -Mb c1"/57 Fax: . ::s'i'f-?)3bl
I E-mail: W; eGo>-"'- \ ",0,,,-,, S @ CO"" ct..5-\ ~ .-.Jc..T
I CCB license no.: . 1011 ( -,
I Printn~e~~ e-J....~vlt: Wc-~\-c';"/
I Signature: W W~..
.,
1~'''''''i'''''i;!SUi31CONffil!l!' 'RAC;tOR1IN~ORMAtION'll!~"""i;;cI{':,"
~~~';;..j[;~_.___~~__,,__. .__._____"-'"~__...__.!..:'-,_~_,_~..,,'_...,,'_ c.,~__."l:&'~...u_<;.J,;~_.
Name .' CCB License Number' Phone Number
1 Electrical J....r:: 105'17.<;' 5tl'iI'l1>
I Plumhing.5tc-~i p lu,.Ji.,< b50f,~ ., 1l-3' "S-
Mechanical CF J-l " "b l> 72.6- 0 I 00
5A-fYl<
Structural Permit Application_ c'7 .- / I I /
_ ...'N..,...
.~"~~""","9 },~,"-,' '"'-ij.~'C)~>''I-''''' .-'-'.... "," ,
225 Fifth Stteel. Springfield. OR 97477. PH(541)726-3753. FAX(54i)726-3689 ~
AS
11s-2
5,-/01-1.. f)
1~,!:,DEel~~~lf;tiQ~~2~.~~lil
perrnitno.:{!Cj_/!ft? 7
I Date /O/{,/o '7
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days o!issuance or if work is
suspended for 180 days.
l"li("''IiI1;1!e~~1T6CAIT.rG'0VERNME"N:fI,fAPifROVAE~""".;ri'''';f''''l'''~i:?1
_.h~:!'!>I. _.._.....it....,................... "....,..... ..,.... ..~.1llW.i'}t'il!\l1liJ
This project has finalland.use approval. 1 :WIK".'lil!,i:L~:m!1t'if~~~....T~.'....~..,..."..,"'y.>1<!\.;f>W;Wdllr.:,,:i'll;'...I
Signature: Date: ~+"~1~~:at!~~R~g~~-9Ji.~~.u..~~Ja'~~~~~iS~~~[
~~~~~;e~ct has DEQ approval. Date I. I \~;~~~t~~::~~~'~i~~~~~~~~'
I Zoning approval verified: D Yes D No I I Occupancy fL.1 V\..
I Property is within flood plain: DYes D No 1 I. Construction t'fte: J '&
1..,.,~;-f'ifiIj':"tti1;11!'CAfE(i0RY,~'OI'!~NS1iRUCTioN;;~~W4ii~i.it!1iJ:1\<I:11
~"lli!l!~.",':!Mc............. ..iiL <0'-- ..... .,... ............"............... ,..q;'. I Square feet: ([, <;0/4.<0
11~'~~~:~!~~_"_,,l.q.?~.,;~.~~t..,..~J_'?:.~lIl~;~:.,.,~~,) I Cost per square foot:
"""1~M&:-'I~..Q.I;l,:(~IJJ;~INF.9.~fIII~T!QNt"~MQ~L:Qc:;AII9N'\!~.x~;.I,ljl I Other infonnation:
IJobsiteaddress: /Irs S VIS/' I I Type of Heat:!; (A
I City:<;o .,..; "~ C : c..1.I I State: 0 d. I ZIP: q 7)7 7 I I E!lergy Path: ~ A-
I Subdivision:F; IhM-I: (y\tA1av'> I Lot no.: 5'0 I I ..".. D .
I J I ~ new alteratIOn 0 addition
I_R;:::.,~..~:;""""!1..,"~~".........~..".~~~I.~:[~O':-....c,~~~~!r,.,L:~,~~~". '''"11 (b) Foundation-only pennit? D'Yes D No
". ''''#.<:i''''\''lt''''~l!'. iP,ROP.ER'EY~OWNER-.~.".,;,""'Y"'-'ih""':..;..:.:,, "'.,,\;
y.. -, ~-'~<'tt,I<."".UJ~<'_(I;~ ...__..,_,_..._"m"~__'!I.".__,__.,_,'-~,.___!.,_..,_~~JI_~,_'. ..".....,''8.. .,,'-'.....-'" I Total valuation: ~ I $ I
I Name. e, ,\1 C<. kJ \, d,. ,t CvSK\I"- ~""'> J:'l\l(. 1"2" B' ...'I.d..:h=(.'''.'''',;H'''.'-':'''~'<.-$.,y.:'.i\:'i1.'.....,,'''-''...~. .,~" .' ""''''''.'1
I.". I '., UI Ing-lleesT,:-_..:<"';'~iL~... *,",,\ ';1:", .,' ~<; :..,r.-4-'':.l:l~rn. .... ...' -. ~~'-~~
Address:.:lO,'3 St:\4\1\~W L-N .. . ..".. ..-.... -...~:..".._... _,'..l..-_ .. .,,'-' -.......... ._._...._.'~,.h..._,......
I . C I I" 7 -- I I (a) Pennit fee (use valuation table): I $ I
CIty: < '-"re"" State;) '" ZIP: f Y D>
I " b b v tq ."., , 1 I (b) Investigative fee (equal to [2a]): I $ I
Phone' .1,9'1'>0 Fax' -){.-:::nbv
'. . I (c) Reinspection ($ per hour):' I I
I E-mail:W;(che.J~...-0.....-SQco.~u.S1 . Ne.f' I (number of hours x fee per hour) $ .
This installation is bein~ made. on resi~ential o~ farm property~wne~ by I (d) Enter 12% surcharge (.12 x [2a+2b+2c)): I $ I
me or a member of my Immediate famIly, and IS exempt from hcensmg
requirements under ORS 701.010. I (e) Subtotal offe.. above (2a through 2d): I $ I
I" ".._."'-~~,.~"~.~:!iM(~'l"'}~"'f.'~.;<Jrifli!l11fr'tli~,."\.1
!i.~!~.~~.~_~.i:i:~)'j~~lf~!~_~~li1t0.ff!r';it~...,:{,~~'t:tB"i&t<f~a~~~jw,..k}':!il
I (a) Plan review (65% x penn it fee [2a]): $ I
I (b) Fire and life safety (40% x pennit ree [2a]): $ I
I (c) Subtotal of fees above (3a and 3b): S I
1.14;}\'i~~~it~Re.9~;rsJi~~ri*ff.l.~~j~.;i:;~~~?:-.~jT\lt~~l~!!~~~M~~-Th~~~;1
1 (a) Seismic fee. 1% (.Ot x pennit fee [2a]): $
I
Sign here:
,..,,~;~'\\t~1I1'!'$11':CONiIRACf6Rli<iNSTALli.!AfiCjNI~:"~.I.'il'4B,;'S!~"l!i;
~.~,,~~I*i,.._.._"~,'~_,.._~..._"__t.."'__..,_._......~.h____~...1.~~'g!w",~t1"i!..,-\ ..",l""
1 Business name: 't,'{vu, ~;ed,,~, C",b...... I>c,-..Q\ J:1vc..
I Address: '3 07 3 <;; It~ .; <:.w /..V'
I City: or") e,...... I StateP.(t. I ZIP:'17~"l
I Phone: -6J'& cf") 5 ? Fax: -3'1'1- 33 b z I
I E.mail:W;eL-ke.\ ""0,,-,, €2 co""u..54~v.Jc.\ I
I CCBlicenseno.: {OI/(7 I
I Printn~e:~-e...,....~.:.-IC Wt.)\-o.Jv
I Signature: W W ...________.
r;~~~~i~SQ~}fPc~t~~~~~~~~;;t'~;t;~~:;~~~;';J~~il
!Electrical/..+--C I /05'17<:. 15/../YI'i& I
I Plumbing5Jr-vr, p~v'~""< b.5l7b~ I> 1l-3, b., I
I Mechanical C f HI" " b V I 7 Z. b - 0 I 00 I
TOTAL fees and surcharg.. (2<+ 3c+4a): S
"C';,', ,". ::X~ ,;;
.,':':
Wla~.,,~, ;
:.~~;
, ."~ .~,., ~,,' .'.. I n
City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street' ,.
Springfield, Oregon: 97477. ,
541- 726-3759 P~~ne.: , ",~,:'.M~~~':;..
}. ';,:RECEIPT#: . 2200900000000001145
Date: 10/07/2009
8:39:38AM
. . ~.~.. .
Job/JOIJrnal Number,f.,{i:De'safpti~n, ":;"~ ., '.
"' . ;'. '. ;~,{,.~,:,~;:.,t .~:..';"'o.:;..~:'.'.;'i'":;:..;- .',
COM2009-.01469 './.:.,BUJldmgl)eI1TIft.::,:..
,.' ,'., -.......<......-, .
COM2009-01469 ".' {,\ddressing Ass}gmnent..'
COM2009-01469 . WillamalaneSingle Family.
COM2009-01469 . )stAppliaoce.A:,.: ,.
COM2009-0 1469 ,'i;,:,jY;!)iF'lfl):!~)\:~;L{ '"
COM2009"0 1469 :.:;;':,;.',,AppliailceV ehe .'.
".":"""". '. ... . f
COM2009-0 1469 ",5<;:, "'Exhaust Hoods'
COM2009-01469!ei:.;oryer Vent ,
~,: .....: ,'" ~,. '. ,:....,..., ,.',~:,i,... .~~.; ~" ", '. <;.
COM2009-01469 "::,,;i(}GaSOutletslc'l" ,
COM2009-01469\"Re;ide';~~'wij:iiigiooO Sq Ft
,. .' .'
COM2009-0 1469 Residence Wiring Ea Addtl 500
COM2009-01469 .T,emp Powe9qOarnps ~J les~ ..
COM2009-01469 . Fire SF Fee "Residential'
>
C0M2009-0 1469.. '. ,Sidewalk Permit
" -
COM2009-0 1469 ',' : ;'Cui'bcut Permit "
COM2009-01469 ,:;c ,Overwidth Application Fee
. '1 ' '.
COM2009-01469di'''IJPW Disc - 3rd Permit
. ". ,
COM2009-0 1469 Storm Drainage Impervious Area
COM2009-01469 Credit- SDC Stclrm Improv
COM2009-0 1469 Sanitary Sewer.- Reimbursement
COM2009-0 1469 Sanitary Sewer - Improvement
COM2009-0 1469 SDC Tran Reimburs-Residential
-t. r' . .,
COM2009-01469 j'SDC Trans Impr.ovement-Resident
COM2009-01469 ' 'SDC MWMC Reimbursement
COM2009-01469 !: . ;SDC MWMC Improvement
COM2009-01469 ,>" "SDC MWMC Admioistration
COM2009-01469 SDC Sanitary/Storm Admin
COM2009-0 1469 SDC Transportation Admin
COM2009-0 1469 Plan Review Major - Planning
COM2009-01469 + 5% Technology Fee
COM2009-0 1469 .:,'. iff. }2% State sur, charge
; . ,1. .. . .
; . I
,. . "
Received By
ojm
[tern Total:
Check Number Authorization
Batch Number Number How Received'
Amount Due
1,022.14
38.00
2,858.00
79.00
27.00
9.00
13.00
9.00
7.00
134.00
75.00
63.00
105.00
88.00
88.00
45.00
(60.00)
1,384.82
(I,384.82)
666.84
507.07
211.21
931.65
101.97
1,044.54
10.00
87.99
85.67
211.00.
90.51
172.58
$8,721.17
Payments: ,
Type'of Payment.
CreditCard
~l . ;.
'Paid By n
Amount Paid
BRUCE WEICHERT CUSTOM
HOMES
03599c In Person
$8,721.17
"
Payment Total:
$8,72 I.I 7
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Page I of I
10/7/2009