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Home My WebLink AboutPermit Building 2009-10-6 r,". :': Status '.~:~ ., .. .f',,:' Issued' 225 Fifth Street, Springfield, OR .: 541-726-3753 Phone' . '" ,.;, , ,f ,. .541-726-3676 Fax...., '.,} ,.,_,:i'!,hr , .' . ,> '- ~"' - , 541-726-3769 Inspection Line'. ,'. >-'; ::.,,'. :/"'.: ': '. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00263 ISSUED: 06/06/2003 APPLIED: 04/11/2003 . EXPIRES: 03/14/2010 VALUE: . $ 262,285.00 .~: ., '- "';".. !"'. ;,\' . " SITE ADDRESS:.,;.J 864 S 67th St. . ..-".' +.,. . .,.' ASSESSOR'S PARCEL NO~: ' 1802031108800' ':~,~ ;-" Springfield TYPE OF WORK: Single Family Residence i;': .' PROJECT DESCRIPTION: Singl~ Family Residence TYPE OF USE: New Owner: Address: . ":,,.,,"." HAAG'GARy'R:&'BA.RBARA F . 878S 67TH ST' I,... , . SPRINGFIELD OR 97478 ~ '~ , CONTI~.ACTOR INFORMATION' License Expiration Date Phone Contractor Type General Electrical Mechanical Plumbing Contractor OWNER. ,~. :' ,i' c DOUG PALMER CORP ,i::..],. if- CRYSTAL CLEAN AIR INC .j .; SHAD CHASAN SURRETT i"'; . ~, 'l'l;:~.:,;. l~ " l' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Constniction. Type: ,1 .. # of Bedrooms: i 'l I ~ 1"\ ~ 1 .' , 1 R-3 U-l ,r.",VN : f :~~'" . '. 4 '-: , , ~! '.; Frontyard Setback: Side 1 Setback: Side 2 Setback::1 .' !, 'r, Rearyard Setback: ji',-:' , . j. . Solar Setbacks:\,' , 65.00 25.00 :1 18.00 , 40.00 60.00 .;. it : ~, " Street Improvements: ., Residential 90725 96878 158295 05/03/2010 02/17/2009 02/14/2010 541-434-5600 541-484.2286 541-741-3553 I, BUILDING INFORMATION I ') # of Stories: 3 Height of StruCture 44.00 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Electric Energy Path: Path 1 Sprinkled Building: n/a Lot ~ize: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupani Load: ',DEVELOPMENT INFORMATION' 20,153 1,793 1,330 163 875 REQUIRED PARKING 2 " O,:erlay Dist: Hillside Total: # Street Trees Rqd: 1 Handicapped: Paved Drive Rqd: Yes Compact: % of Lot Coverag~;rTENTION: 013:99.1 law requires you to follow rules adopted by the Oregon Utility " .,...1____ _..1__ _~_ __.~.f~~U... I PUBLIC IMPROVEMEN;rS:I~52-001-001 0 thro~gh OI\R 952-001- " vv:>v. rOU m~\I obt"1f1 copIes of the rules by Fullv Improved calling theSG~~~J\lk ~rJWi: the telephone Curbside 5' No number forDowiij'p~o-,itsfD~~iHs:"Jotific'Curb and Gutter .) Center is 1-800-332-2344). Storm Sewer Available: . ~i""""('E' SpeclallnstructlOn:I , . THI$ PERMITSHAI1L';EXPIRE IF THE WORK AUlliOltlZED UNDE'R'jHIS PERMIT IS NOT caJ~MENCED OR IS ABANDONED FOR LAN'Uab GAY PERIOD. . i. . ,".' " Notes: "If' .~ .,..... . I :. Paee 1 of5 " ~ ~ . ~L' ,:\ '. .1~' ~'j: -~ . Status IS~:~'~dlHff\;, . " 225 Fifth Street;Sprin'gfield, OR i:'~:~ ~ ~i~~;~;~~~~:~~;t'!"WX \;fi?,1~;,~;, . . 541-726-3769InspectioifLirie" ",'; "h~fN!;J~;!!~W;:;;~tit:;ij~f";~; .. ,Description :L;Tvpe of Construction i';:J:~:;~~:ti~'; j~;;1~;k~~~aoi!oe~'~:f~j, . - .'" ;-', !W':n:t~~~~;"r~i~j~~, ~ ~, -, i! !. . . ~~e Descri~tio~,i!~;;, ~ ::.., ',:Addressing Ass!gnl\len!< , Plan Review Residen tial . '~"'1"",~ ".. f;' I' -Mechanical Issuance Fee- . + 10% Administrative Fee + 7% State Surcharge 3 Baths One & :rwo Family ~ ',;1. Addressing Ass!g~n.le,'1;!' I. :';1 . '; ";, Annexed 1998 ~ ,..' i' ': . ~ppliance .ve~!h:.;. '._ "i Building Permi!.~ l' ~/ ",.fJ Dryer.v ent " Exhaust Hoods Furnace - up to 100,000 btu _. Gas Outlets 1-4 Gas Outlets 4+ ,. . ~~1}1, Plan Review w ~lan~,inght..,:,~' '.'~ ~;:': Residence Wiri'ng 1000 Sq Ft . Residence Wiri~g Ea Addtl 500 "~-"Sanitary Sewe_r~~"I~provenient , Sanitary Sewer - Reimbursement ; SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin , 'i '" ,h'.. . SDC Transpo 1d'1'i~ .:1.'." ;I, SDC Transpo Improvement SDC Transpo Reimbursement ,. '_, ,1_ ,'1 . Storm Drainage Impervious Area Vent Fan' ." ." Willamalane Single Family + 10% Administrative Fee . + 7% State Surcbarge Sanitary Sewer - Improvement ",J -:Ii Sanitary Sewer, ~ R~,ml?ursemeni;i SDC Sanitary/Storm Admin ',1.;'; . 1-'. , ._; ! : 1'!-, ',' ,~~i;; "1' .,.. " ,~,. 1. j. .... ~ ".... :'1' ';. " . ;,.;. it . '1 '~l' :}' . . " . :1 Valuation Descrintion I . $ Per Sq Ft or multiplier $74.60 $19.60 Square Footage or Bid Amount 3,286.00 875.00 Total Value of Project Fp~< P~\lU Amount Paid $3.00 $712.01 $10.00 $170.24 $119.17 $306.00 $5.00 $-4.41 $6.00 $1,095.40 $6.00 $9.00 $12.00 ,) $4.00 $1.00 $59.00 $106.00 $133.00 $503.70 $662.70 $10.00 $34.83 , $332.86 $136.D4 $48.44 $709.81 $160.87 $1,279.15 $24.00 $1,000.00 $0.60 " $0,42 . $68.84 $90.56 $7.97 Date Paid 4/11/03 4/11/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 5/22/03 8/5/03 8/5/03 8/5/03 8/5/03 8/5/03 Pa2e 2 of5 CITY OF SPRINGFIELD Building/<;=ombination Permit PERMIT NO:COM2003-00263 ISSUED: 06/06/2003 APPLIED: 04/1112003 EXP IRES: 03/14/20 1 0 VALUE: $ 262,285.00 Value Date Calculated . $245,135.60 $17,150.00 $262,285.60 04111/2003 04/11/2003 Receipt Number 2200200000000000741 1200200000000001001 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302 1200200000000001302' 1200200000000001302 1200200000000001302 1200200000000001302 . 1200200000000001302 1200200000000001302 1200200000000001890 1200200000000001890 1200200000000001890 1200200000000001890 1200200000000001890 .' ;;. ..........i:"":'-1-"". ." ," .,,11 , , 4__.'._._...... .. .it"s'ia iu~ ::~1...,~, i~~~:~~~t}~{~i>, ..;;;l~;l,~~,:~i.;:~. ~~: 225 Fiftb Street, Springfield, OR;;:C:;:' 541-726-3753 Ph ODe . . 541-726-3676 Fax 541-726-3769 In~pection.une. , .. ~ ',. .' . ';<, " Vent Fan . '~,;t'~~~:,:l~~~\'\' "~'~, -t 10% Administrative Fee ;;,:7: .7% State SII#har.ge > ...." .... 'Residence Wii-ing'IOOO'Sq F,t\,{;.;> Residence Wiring Ea Addtl 500:,"!--)' + 12% State Snrcharge ". '. + 5% Tecbnology Fee ,. Residence Wiring 1000 Sq Ft . ,,'r',.>:.:;: '. .' . '>'.... "^~ . . Residence Wiring.Ea Addtr500.>~.<,''' .- -r-' ~~"~\.';.' ',~..~~I:r., , . i . Total Amount Paid '!""'" '.,. , rlT . ;iL)'t-ji ~ +,~ '';)':\'fi - 'f Initial Review . 04/14/2003 " . ,t', ;j;i,;r, '~j' ,l:l~ ~ ; i " . 1- L ~ ~t:.~~.\ ,:;. T Plan nine RevIew" -:jl ,..\,' , .0" 04/14/2003 " . . $6.00 $20.10 $14.07 $106.00 .$95.00 $37.08 .. $15.45 . :$134.00 . $175.00 $8,425.90 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00263 ISSUED: . 06/06/2003 APPLIED: 04/11/2003 EXPIRES: 03/14/2010 VALUE: $ 262,285.00 8/5103 11/18/05 11118/05 11118/05 11118/05. 10/6/09 10/6/09 10/6/09 10/6/09 I Plan Reviews I 04/14/2003 c 04/21/2003 ,J .~~ ~L', ~;:'. ';\'~I; :'i31:\..,1~ )~~" 'i' '1 , I Public Works Review' . 04/14/2003 ,'f', .\. " . '/-, 'l . Structural Review'!!~~I'W' :' I '>.~ Structural Rev~ew t! ;'.I.n:, .lll . I . 1! . ~ , r' l' 1. \'t. \, ~l .,. .\ ...,~ 'I: , .;L t!.;;~ wL' . .' ~i ~ 'In ;,~,l< . .. .t,....\! Structural Review " ." , ~ '1' L . 'i ~t,' \ 'It,, ,!~~: ...~. 04/14/2003 ,-'-=1:; -'-,. ., . ~ ',- 11> ~ :,} 05/07/2003 , r , I'{' .:~~'f~: : I OS/20/2003 . ".1 04/23/2003 05/06/2003 ,) 05/08/2003 1;) OS/20/2003 " APP LLH APP AJD APP DJW WE DLM WE DLM APP DLM Paee 3 of 5 1200200000000001890 2200500000000001601 2200500000000001601 2200500000000001601 2200500000000001601 2200900000000001139 2200900000000001139 2200900000000001139 2200900000000001139 Addressing assignment fee divided due to plan check fee overpaid by $3.00. Instead of processing a refuod for $3.00, applied the $3.00 to addressing assignment. $5.00 still due for addressing. Called applicant 4-21-03 to request information clarifying the grade change. Grade cbanges more than 10-ft. Height determined to be 26-ft. per definitiou of building height in Article 2 of tbe SDC. Please have Steve Graham check, pipedstormwater runoff over existing retaining wall onto ueighboring property. See Asbley for more details. Owner submitted design package fOI vertical loads. Called designer tbis a.m. He has no prepared analysis for lateral loads. Called owner and requested that a lateral load analysis be prepared by a professional engineer for submittal to this ofti.:e before plan review can be completed. dim See document and construction documents for plan review comments. Check storm water runoff at neighboring property. j":" \!~ ~t~, ~ c. CITY OF SrK11~GFIELD ' Building/Combination Permit .Status -~ Iss~ed:! ,!"- ---..- . . ..~i'- 225 Fifth Street, Springfield, OR: <' 541-726-3753 Phone ... .., : 541-726-3676 Fax . .", 541-726-3769 Inspection Line, ,) ,;,i[ii: ;.., -i;" ~:. ::' ..':_~.,~., :-".;:':i~,:.. {:.::::,.-.:., , '.) PERMIT NO: COM2003-00263 ISSUED: 06/0612003 APPLIED: 04/11/2003 EXPIRES: 03/14/2010 VALUE: $ 262,285.00 "r-:' I . -','- ;j To Request:an'in~pijction call the 24 hour recording at 726-3769. All inspections requested before 7:00 ., ....' - I'. .,.,'.........~, '-0..,,,__ '''. 'q., ,;' a.m. will be madeti1.~ sain~\yo,rtdng day; inspections requested after 7:00 a.m, will be made the following work day. . . . .f'.".'.' . :,'.c.':", ' :":'1, Rpnnirp:rlJnsnectinns I ~~,..:'~~, .~;l~.:. ~ ::'?~t:i:i.:/~{?it~!<.. " . urer Ei~~trical'Gr~uiid;iii~t;1I ground rod at footing and call for inspection in conjunction with footing and/or , foundatio,~ insp~ction. Fooling:'!!Aitir t;'~nches are excavated. ~. VI ' .." , , ;1. ,~ -'dl ,. Foundation: After forms are erected but prior to concrete placement. , Post and Beam: Prior to floor insulation or decking. I. ~) Floor Insulation: Prior to decking. . ". Shear Wall Nailing: .Beforeh';,vering sheathing with finish materials. ~~ ';~ ';! ': ~ ... c Framing'lnspection: Prior to cover and after all rough in.inspections have been approved. ., .,.t. Wall Ins~'ati9n_: ;I:'ri~r to ,cover. Ceiling Insulation: 'Prior to cover. Drywall: Prior to taping. Hold Downs Installed: Special Inspe~tion performed prior to placement of concrete. Provide report to City Building Inspector. 1,. C .;j- "1' ; .1 ~~ ')" 'r . . , .i-.t Final Buhdin~: 'After all r~quired inspections have been requested and approved and the building is complete. \ . . Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. .) fr:-; \r ? " . .. Underl100r Plumbing: Prior to insulation or decking. . Underfloor.Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and, including required testing. " e Shower Pan. ...P~ior to .covering and including required testing. rt., ,tli'l'~f!;; ...1 ... . Water Line: :Prior to filling trench and including required testing. , I, j. Sanitary. Sewer Line: Prior to filling trench and including required testing. .~ ~. ';r. t;'l . iI' ,;.~ Is ....: Storm Sewer Lin'e: .Prior to filling trench. : ./1 ';'; Final Plumbing: When all plumbing work is complete. Underf100r Mechanical. Prior to insulation or decking and including required testing. Rough Gas: After line is in~~alledand required testing and capped if not attached to an appliance. . ni,....;,.j;t~.., "i';:" .:,'\'1 . . Gas Service:"[After line is installed and line has been connected to a minimum of one appliance includingrequired testing.' ~resure test done at this point. ;. \" . Rou~hM~~h~nic~l: Prior to Cover .. I I; Paee 4 of5 , ~~'i. 'r:;,..nf . '" CITY OF SPRINGFIELD Building/Combination Permit Status Issued .. ,)' PERMIT NO: COM2003-00263 ISSUED: 06/06/2003 APPLIED: 04/11/2003 EXPIRES: 03/14/201 0 VALUE: $ 262,285.00 225 Fifth Street, Springfield, OR . 541-726-3753 Phone.... '." .::;-::;... 541 ~ 726-3676 F~~.> ~:'.:1~~~1~t:;':: :;:i~f(:~:~W(WI~'\;~; 541-726-3769:I~~pec!i?h Line" '. ., .:f,.; .~;;f.~~'.;;; .,_:~'...:, FiDlil Ga's::;Whe~,aJl,gas work is complete. . .' I'" ...,T-. . "S:.:: ';~(:'.:' Final Mechanical: When a<Il,mechanical work is complete. . '. I" . Rough Electric: Prior to Cov'er, c' ':::.Cl . Electric Service: Appr~vaJr~quired prior to utility company energizing service. ~.;,..' ':. ;.;;i .._;-: ;;,'..;. . ~J.'?'J~ :At;:i:~?:~"(', Final EI~:~t~i~f.$h~n'allelec!ricalwork is complete. f; i ~;,; ;,' , ' ' : By signature, I ~tate:and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is trueand.correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services ~ivision, Building Safety. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required i~~pections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front or'the property, and the approved set of plans will remain on the site at all . .' "..~~.... "d_,~... ~ / times during con'struction. . ~< /~.-' ~'". / ~~ . -'1 __ ./.1~" . '. O. '?"'? ~~~/Y' ::!0 V /0 .6 ('2 / . /.' . atu..,{.- I / Owner or ;ontrl\:':tor~ Sign;7-" , Oat L_--~ " ~~ I !.l '" ....t;$i_. -,~;l:,,j!rca. , ; .; 1~' i.' '1;1 \ ", ~1' ...) _'- j' st'I',!~'ll ';':,,1. I~l. 1: 'I~f: .."1 . f~";' ,:-',il';:~ ", !, ,It 'f . " P ~ ':'J , !" \, ,,;:. .;;~, ,ll.!.;.iL,.,:.j1: . .:-t.. "tlo '~!/l ~. .. 'I ' . t""" c. . .:: :: ~' 1 ~ J \', ,.), "; l!1 _-. \' ~~.,~~,jl.~r~~\ . . '-' , ~';' . ~'/ '}f :;:~;~, . . :h ,~"i~"~r - 1.'," ,: ,. ;,. " ,- '.Ji.:: . ,tl:{l~ir.,;';.h.: :~! ; ;1 .I' . ", "1:': ~.~ '~~~. .# ':1. ',. '. ,.1 ." ~!. ]';"Jl ,,~>- , " , ,-} 1, Page 5 of5 " . 'l! " .f" 225,Fifth Street>'.,; . " .,.. .. Springfield, Or~~0-'19.'Z477;:~\ '!:\\,'" .)( 5~1 ~ 726-3 7 5? r~?~~M?jri!!l'';t{;!:t;;'2~;;':':'' ,,';' ;{;'.;;!~(J;t&t'\.R.E<:;Elr,~'#:. J~jb'/Journal Num~ed::~':{ij~~~r.ipti~W:(?~;~:S~~~':',':.( '.': ~,- , COM2003-00263)',; 'Re'sidence-Wiring fOOOSq Ft F.. '." ...' '.. COM2003-00263 ':-':--Residence Wiring Ea Addtl 500 .t. '. , . ,.... . COM2003-00263 ..... "+5%TechnologyFee ., ". , ~ : . .1 . ,~~ <' . ". '."' . COM2003-00263' '", ., -:+'12%,State,~urcharge) '''. . .', ':~'%;~~':~~r;\~}i:(~,r::;",y';'}:"::' :~:/ :,:;/ . PaYl11ents: . . ,')....{.;,..i,'-. Typ.:ofPayment." ';;;'f~idBY:Y, . .',.'\...... ,....... .......-..,,,.....'.".,,1; '..... Check'.GARYHAAGVh~3.>.,' CreditCard;iJk:HAEL iipITrNO" '. . ~~'~- , "'.-' ,.,'. ':. . . "~~;":':".,' -:.... ,.-. ',: '....~-....;~>,_.. "... '.'.,l Job/Journal Number,..~'", ".DescrlptIon ,<;'.:\i__>::~ ,'~:~', .\,<;: _ ., C0l\:12003 -00263':dj;::;!}~~sidefl!o~;:Wiri!ig:loo'6 Sq Ft COM2003-00263 r ,.Residence Wiring Ea Addtl 500 C0M2003-00263 i " + 5% Technology Fee' . ..t . CO~2003-00263. i ,~h;i,iit,)?r% State ,Sw;charge . ',;' Payments: Type of Payment Check CreditCard Paid By GARY HAAG v MICHAEL TlPITJN0 ... -. ... i; : ~;'~+l: "'1;' ;~: .i ; ;.... ',; :>'\;1. .r;! f .;f~ .:.:; . .,J,rr ~" i.,J "j' ;' ':",-). K~ h ,;l".l,'::.l;i.. ,. j....w.\ ~i "-idH ~.~. . .l ']';-' , , .l) .: J}~ ;I.~<', ..! , '\.:; . ;.~.~: \. ;.. ,i,j,ii .-' )'''~'i;,.~~r~ -;. ~h.~: t:t ....,,- " . ,.}:, l'~ ~. .r 'I":" l ii' ,,:,;~,~., ;: ..,~;:,. . f~' ~ l.~~'~~Y" : ~a) ~~.~; ...\'; .!f",l, .".... j, .' ,f '. .'i.' I .j, .:':-_ ~~1 ;l~ "' ,. "'I ~. ,. Ii." .~, ~t '.: ~i:'1i', :r ~ : ~ tl"~,. ' ; . l~ ~ ~ I ,--:: l~; ,.~. _1:/ ~t '1: -r:; '. ! ~, "- ,If ,qt ',. "~ 1- ~ ,. , , cReceintl .,', City of Springfield Official Receipt DevelopJi.ent Services Department ~ublic Works Department 2200900000000001139 Date: 10/06/2009 Received By Item Total: Check Number Authorization Batch Number Number How Received llh .llh 7847 In Person 6770 In. Person Payment Total: Item Total: Check Number Authorization Received By Batch Number Number How Received llh 7847 In Person llh 6770 In Person Payment Total: ,J .l ,j Page I of 1 ,.J 12:52:37PM , Amount Due 134.00 . 175.00 15.45 37.08 $361.53 Amount Pa'id $309.00 $52.53 $361.53 . Amount Due 134.00 17500 15.45 37.08 $361.53 Amount Paid $309 00 $52.53 $361.53 10/6/2009 This permit is issued under OAR 918-309.0000. Permitsare nontransferable.'Permitsexpire if ';'ork is no't started witbin 180 d~ys of issuance ~r if work is suspe~ded f~r..180 d.ays.. . .' ". . " .. "/ ~ ~ I. :,' . ." LOCALi:GOVERNMENr,APPROVAl.: ". ': .., II.' ','.. ',,' "F;ElVsCHMuLE,' ;.,.~~:.. ,., ::> ';-:'1 I ZO, n ,ing "a,PPf,o, va_l ver,~fi,'e,d,,',?", ',' ,0 Y,es .. _ _ _ _ D. N,O' I ~~~~~~~~'f~~~~~C,.'~i,~~S',~(; it~';'itj. : IQfY, I ' '~!~_("",' "',T ~~a~4 I ."CATEGORY'OF.'CONSTRUCTION; '.- {.... I ...., . . '1'" '.: .' :' . L 1\ / .' . 'I' . '1 >" - I" Residential, per unit, sFrvice included:'. . . ,.:@jR~.si,~ential _. D Govemrnt;nt . ,0 Commercial .,... '. : --/. ,'... ,I:;."'-;JOB',SITE :INFORMATION"AND.LOCATION'. ,"'1, 1,000 sq. It ortess (4) . ,.' 1.$134.00 .$, :J1 .' I. =- --A . >:1 ...-..-J 1 Each additional 500 sq n.-or portion 7" $' , 1,- . '/) reJO Job site address: l:'A~. s... l Q " "'<"'. thereof"'., .25.00: . .. 1,1-.).'. I City: \/11;7,.f.!t,V" '"., ,] State:(,1i'-" I Z,n4,1.117~, '.' I Limitedene;gy (2): ,$ 32", ,( $ ,r.r-? I ~~~~ren~e:/\I~(J}/)O\\' .ITaXlo~:.:~1 ~:671~;nS~~~~~~~~e~W~:(2) '~oo P2,)7 ' I. ',.. .' ,DESCRIPTIONOF,..\WORK ..' ''-' '. -,,"" I -'.. I - . ./ I .. --" I Se~icesorfeed~;s:-l~talldtio~,alte;.ation'relocatio'; . )-1-0<" /J:/AJC/\ 1./1' ,.' .1,,{j r./j{p j .' '. I .(/ t:./ (' <.--J ju en i I 200 amps or less (2) ..' $81.00 $ I ~a:e:' 2'~.;J~~~;;/WNER" , "'~>i ~~: :::~~:::~~;~1::::: I ~ I Address: P7&' <:' ''G'') -fA-, I 1601 to i,ooo amps (2) $205.00 $ I Cily;5;J,?d d .. I State:1)t1J I ZIP:Sf'7Y7F'1 lOver \,000 amps or~olts (2) $469.00 $ .IPhonl I ' '1 Fax:' / I I Reconnect only (2) $ 63.00 $ jE-mail: ~-C-----","-_~._ / / I .11 :~:porary ~'ervi(~e)s or feeders: installation, alteration, reio~atjon This. installation is b,eing made on residential or #rm property . - amps or ess -, $ 63.00 $ owned by me or a member of my immediate family, This I 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). I 401 to 600 amps (2) $126.00 $ Signature: lOver 600 amps or I ,OOO'volts, see services or feeders section above I CONTRACTOR INSTALLATION I Branch circuits: new. al/eration, ex/ensionper panel I Bus~ness name: TL;flIL t.J..ti..T.~..L I I a. Fee rorbranch circuits with purchase ora service or feeder tee: I Address: Po 5ut lfytf I I Each branch circuit I $ 6.00 I $ I City: EvC~ I State: I ZIP: I I b.Feeforbranchcircuitswithoutpurchaseofascrviceorfeederfee: -- I Phone: S'/(- 2]2> ( 2t L I Fax: I I Firsl branch eircuil (2) I $ 55.00 $ I E-mail: /l1lo(f-l)f"t.-:I..I<.-a...Ll-li D (c)~ I I Each addilional branch circuil $ 6,00. $ I CCB lic~nseno.: IS-Y 3.lG I BCD license no.:;2..0 '-j-tuc l. ! Miscellaneous fees: service or feeder not included I Signing supervisor's license no.: 53 r2. ~ I I Each pump or irrigation circle (2) $ 63.00 "I Print name of signing supervisor: S7C'liv,.,.x;'/?1;~ I', i Each sign oroulline Iighting(2) . $ 63.00 1 ,,'" ~ ------ 1 1- Signal circuit or a 'limited-energy panel, Signature-of signing supervisor: ~ - - alteration, or extension (2) $ 63.00 $ . ~~I ~ - " 1 Each additional inspection: (1) $58.00 $ , Q'( ," I APPLICANT USE .\r,~ "'~ a /ltf1J /V;OA &-- I (A) Enter subtotal of above fees ~ '0 C . .(Minimum Permit Fee $58.00) ~ <? /~:7 / .>... /Jm ~ I (8) Enter t2%surcharge (.12 x [A]) {)V7 -J ~ oj I I (C) Technology Fee (5% of [A]) , )./ ' I TOTAL fees a~d surcharges (A fhrough C): '.?1IUf ,,0,(, 471-)7~;. ~ ~ ~'~ . ~,- , , f VI,J c/o 'OJ I /1~0 /. -- -- ~_.'( V /II. "'.' ; [)EPARTMENT uSE-6i\,II-,Y , BPA:CF:O ~. ,,,. .... ,. -"., ,. ~ I .. C'.2' iJ(1 J/ ,'- ~_ P~~itno::" ~-~l,~~~ . D: '1."'" ',. / /\ /0 f,>!/; Ci,. . . . Date: , I V J (" U I ..' . Electrical Permit Application ,,:. CITyOOF SPRINGFfELD, OREGO~J , 225 Fifth'S,treet.Spr~ng~eld, ~~ 97477+PH{?41)726-3753+ F~(541)'7i6-3689 ,. . ,", ., -. "... "'... , , .1 I I I I I I I I I I I I- I I I I .1 I . I $ -sdj,1 SO $ ~,cf . qjlo $ \0 ,~S $?i II 5"3. -. , ~,.., 440.2584.) (9/08/COM) $ $ J