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HomeMy WebLinkAboutPermit Electrical 2009-10-12 . "'~: ~,;;!!!!}t~~%f~!~4f;"..,;.., A,...,..oo. To ',egin Work . ,', 69600- BE L-09-00 181 . E-l!1ailed To: dan@reynoldsetectric,com 10/1212009 4,41 pm App~oval Code, 06555D , :,," " ,t;r;:\'~J;!;j,li~~~:;[,; " ,Check on slalns 01 permil :':~~~r~.~,I:ii':::Vf:-~.~ :"... '; ,.. ~.. 'By Phone: 541-726-3753 or Email: permilcenter@ci.springfield.or.us f,.,::.'. i, '. ~"" :'" . ,;; i~~J~J;!7~J:~~~~lir'P"E~OF.;WORK<m'W~Kt~t.j,~~jJ..;,~'''''f :P$'&':~~;- .~. "D.' ~.~~ ~~~~~~~~;-'ff~!~~g%TW~:'~~~:~it~r~f:~~~~~~~~~~ratiow~PIscemenl 1~~~~l'~~M;1(CAfEGORYRfF:cONsfRucficfN~~~~\'1.",l1r~',l'\: : I D I ,,2 f~ily' d~~'H,~l"q~~~~:ft{jg;J~C~~"'i;':, " DA"","" ,,;, Ij~1ll!fj,~Jfjoe>S1fETiNitoRMXllcjNiANiY1!i5cA.tIONI~ilA ,~t,: ~; .1 JobAddrm:'353,:J?~~#,~.9N'~'~E'RRYRo-'. ....:.:'ii:- ,:1 }:iiylStaltlZIP: SP.~!~BF.IE~~.?R 9747~ "1' "" ," -, ,~, ,Sultelbld&.Iapt,Do,:'-,,:i;.';}', J(,. t....,~'. I',.' '-. ",' " ' , ,', ,~. I<~"~ ,. " " . ProJect Name: 19595.... _ ;.' I Cross Street/directions 10 job site:'Gamefann road; . I,TompJpm'lnn" ilO~ \'7-'\DO~'JDD !!)f~~~_~ESC~1P"TiON:OF;WORKk'::~#bw, New conslructi~n of birthing center :electncal syste~s (, ,; ; I:. ,~. , ,ljt:i.:},~ ..~~ , , ,.I.!YMf:.S""" " '/11 ~.~ .. I Name: Dan Boaz I Phone: 541-343-7297 I [mail: dan@reyiloldselectric.com 1"~i~'~""'-"'.'''-CONTRACTOR'.i[\'.;'c:.-\'; -,"". lti",~.t"~~!~~~~' ...... ,_' " ..,. I Elec lie, no,:C451 'f'.~ ~i .,-~ 'CCBlic.no.: 184921 ~.~ II:Businen Name: NEW{j~'M9L?~ ELECTRIC INC , I -h'~ I~ I! ;:... ,." ~ . Contact:, '...nTIt"C. ,r . i,~:...;";; "'''' I Add""'2175'f!~~:'A~~~~~.~:T SH,^,!lE~PI?~ IF Tur: IMnOIf I CiIy/State/zIP:,~,~?~:~~~::~t~ ~~~~::R THI: ?~~~.~~~ ~'3 fI~0T I Pbon.. '41.343.7297 FO""4I"1<-4'" Gnll-U,/u-II,,...r-n f'\t"l I~ "n ,\ r. ",ll\ltn enD 1 ,. ...,.l',_'l-\.V....u- ...... ..... ,....... ......-.. - ' -,. EmaiJ: Jeremy~er.l~~~I~f~c.'~1J: I r- r'n l'l~n~ .~ I ,...... ,~~._.,\_,.._t., Metro lie, no,:" . '~j":;.':r:;~iIO'" - City.lic,DO.: I Supervi!liDI Electrician's lic."DO,: 'II Fa~::541.34S-4808 f :2l '~".r " 5404s Supervisinc EI<<trid~" Naine:':~ Jeremy Reynolds Number ofirnpectioni'lnc'luded in paid luvite,:, Residential Service:.. '4 t ' '. ''-' Ji:)~ Reconnect Only: } All Other Services: 2 Upon review and approval by, your local jurisdiction, your. Permit will be e-malled or faxed within one business day, with Instructions on how to 11scheduleyour inSp4:tction:!.:'::~f._', .~~::.::~,1~i ;- .,- 11.9":;''''' ..."....' w..-..;Ji... ".. ~~~~~ii:JU~~~~: .'~' :"";: ",--.'( NOTE: This Authort%aUon'.To Begin Work expires within 180 days If a permit is , 'not obtained. J .f!'::: i" : .! lJt,:'''"' '.,t..' rj~;~L'~~,"_~~' ,. _:.. ~ . The local building depiirbiient inay detennlju~ that an Authorization To Begin WOR Is null and void If It does not meet applicable land use laws and loeal ordinances '. "..,f';! J, . :., . t't'F::1:";' ?~<;~!t~'t-~~!0~\S'RLAN: REVIEW' " ~,;. Pleasc cbcck all that appl)': o A scrvice or feedet begionint:: at 400 Ampswhcretheavailablcfauh currentc>>ceeds 10.000 Amps at 150 Yolts or less to t::found e>>ceeds 14,000 Amps for all other in~a1lations . DHazardouslocations DAserviceorfeedetf1l1edal600 amps or more DFifepumps. o Emergency systems o Additionofanewmolorloadof JOOHPormore DBuildingsmorcthanthreeslories DMarinas and boat yards OFloalingbuildings E]CommerciaJ.use agricullmaJ buildint::s DlnslaJlat,onofa'50KYAorlarger seperatelyderivedsys 1 c';;'jl EJ"A","E".or"I'2" or "1.3" DRecreationalYchideParks DSupp'YVl.lhlllleformorethan600 supplyvohsnumina! 1 1~.0~:~it.i-*:!;:~~l":,:\"t< ,,:;;:rF:EE'SCHEDUL:E- '.!, DSixo,moreresidenlialunitsinone slruclure o Heahbcm'facililies IvucriPtion It;i~n)~~t[,~li~e"!,gy:-~~ IStand.u]one Iimiledencr~y, 1$~i-vkcD~~r.f~ers-_ "" ,;., I Services 200 amps or less ISer.'ices 20\"t0400 limps l Q,y C01l1IllCrC::I~/:'''';'''~ "-;;.-~ "I.l $58,00 J - -~;:~,O'O I . ",'" 'j~". ...., 2) $81.0~"J $]62.001 1 $95.00 $95.00 I .~ 1 ~-% ,,~ ~".. -' '""If: . -:-J",,~:'Pt~f!Jf4:r I Jf.T "'" _",-I",. .:.' "., *fl. , '~5.H:~ I 45 J $6001 $27000 ~ ~~ ~.....:. ;',' $585 o~ I $70,201 $29.251 $684.451 Ell, Total I Brllnch circuits with service or feeder each circuit Itltbhf~ll~er~,ji'Fee; ,,~~.i~"'" ~,~. I Subtotal IStllte surchllTge (12% ofpermillOlal) ITechnology fee (5% of permit tOIaI) ITOTAL PERMIT FEi': c'8-1% 11,0/13101 ~(L ATTENTION: Oregon law lequires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001. 0090, You may obtain copies of the lules by calling the center. (Note: the telephone number for the Olegon Utility Notification ~i'""';' "oo.~~ ~~ t~ \\.\\ This Authorization To:Begin Work must be posted at the job site until replaced by a Permit -=-:-fr. ", ~'j " ,~' . .. .1Z; ~J~ ' ".~"I.T.1Ht'"Ili<'" ,'l'd"i-o!';' ~ ~,gr"" "."T~"':7'- -~;-t;:'"7 ;:',' .":1 J!l,<-;~"'.. ,,. ~l ~~ ~~;'~:'~' 1: .~~, \ " ' .,!'" \ -, :~. ~ ;::~:t~~'~'-4;~':4~1- .~~- ._~1t~ ;~ I.: r l)~~ .,: ! '\~ " .:., CITY OF SPRINGFIELD' Status ' Issued,'. {: , 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax. 541-726-3769 'nspec.!i~~:Lin~' .....' ....!.,. i Building/C~mbination Permit PERMIT NO: C,'OM2008-01502 ISSUED: 06/05/2009 APPLIED: 10/0212008 EXPIRES: 04/02/2010 VALUE: $:417,871.00 II .,",':. ',ii' '; SITE ADDRESS,. ," \, 353 DEADMOND FERRY RD 'I",. . ""'.b.'._..,.'.', .. . 'ASSESSOR'SPAR<OELNO.:' ',WI3154003700 , :': ' .,.....'..,...'.i; i.\;'. , '"::~ -,,", . PROJECT DESCRIPTION: New medical office / birthing center Ii SPRINGFIETYPE OF WORK: Medical Office i: TYPE OF USE: New} " Commercial , Owner: Address: , :J~g1~~~g:~B;H,~;t;';"~'" EUGENE OR 97440 " ." '~br\!di.;~:,2,~~7. I CONTRACTOR INFORMATION. Contractor Type Contractor License Expiration Date Phone " Architect ANDERSON DABROWSKI ARCHITECTS 503-239-7377 General ANSLOW & DEGENEAL T 484-0070 " Electrical ,~: 1:1. ti, . :- REYNOLDS ELECTRIC 184921 01/02/2011 541-343- 7297 " ~ ,. I Mechanical " 'i ". MARSHALLS INC 25790 12/23/2009 541-747-7445 I. I Plumbing 1- ~ J- , ABSOLUTE PLUMBING SERVICES INC 67664 07/11/2011 541-345-3055 Sewer l! , BRAUNEXCAVATINGINC 101388 10/17/2011 (541) 935-5940 . .1~; . ;1 ,BUILDING INFORMATIONi # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Constr.~c!i'!,nll)pe Secondary Construction Type: .. # of Bedrooms: i;r"",~\" , :- , .[.",.jl', ,,: ii, Lot Size: Sq Ft I,st Floor: Sq Ft 2:nd Floor: Sq Ft Basement: Sq Ft Garage/Carport, Path 1 Sq Ft Other: . An~,nION: @~Sl!e#.n:t.l\-,o,a,jl~uires yiJu to . .~,", ... .... _ _ _ ''-'-''':L.. I\! OTil;I::: .. L ~pELOPMENT INFORMAi'IO'N~'ii~~C;~t;r:vTh~~~' ;~I;~ "a~~set forth THIS PERMIT SHALL EXPIRE I., /, --", -.". in OAR 952-001-001 o ittREQJ,lfJRED 'p)(RIm\[G 61 )THORIZED UNDER THIS PERMIT IS NOT, 0090 You may obtain '-oniAs of the rules by F~ontyardA~1,~ac~N:CEn OR IS. A. S'A' NDONED FO~verlay D.st: all"n the center, (' ~r.~~~I\he telephone S.de 1 SetlJack:iylc " u. '# Street Trees Rqd: c I g Handlcalmed:' t' , "'" i'SO'DAY PERIOD" , number for the Oregol< u""'y "u,,,lca Ion SIde 2 Setbacl{:" , .: ' Paved Dnve Rqd: Center is 1"80S:-'H!)!!".f~~4). Rearyard Setback: , % of Lot Coverage: , Solar Setbacks:ii, :, Ii ' l ' " B 1-);.'1!), .', " ',VA # of Stories: Height of Structure Type of Heat: WaterType: Range Type: Energy Path: Sprinkled Building: 1 23.58 47,699 4,057 49 " I PUBLIC IMPROVEMENTS I I Si?ewalk Type: ,i . DownspoutslDra'ins: Street Improvemen'ts: Storm Sewer Available: Special Instruction: ';, ',:' ~ f" ,; '.-;. .",', 'n--'--' .: .f-.. Notes: I' I I ~f, ,i, ,I "tgll'/~<i~ "Yl, ./ Paee 1 of 5 ,) .'. ,1~ . ')'_: i, i ii I. "'-.--.-.-.---- ., ~. , Status IssJ~~;~;>' .;~/;d(;)~t<( 225 Fifth Street;iSpr}J.ii:!ield;pR:!y;.j[:;' 541-726-3753 Phone;:"~; . " , 541-726-3676 F~x ~_ :' "; . , ., "j" -, ' ~"., ' .. . 'f 541'726-3769Iii~PfC,~?~~,p~e,:":ii ;; ,,~, :.: .. ".. ,- , : . ';<;;\:::,:~~~' 'Description . };::T;,'oe.of Consd~~li~n .:t;'::~r:~i.;;~';. ..", ".. '\ Medical Offices:' :'V I-Hour , ,"'''{:~l,jr(;h;&;j ," Fee Description , " ,. .', ..~:<:, . :.."'1 I;' --1- ". . ,~,.. ;J.o..:; Plan ReVIew ComiriZIndlPuhhc :.: '';, Plan Review CqmhJi;;dIPublic ' .' Plan Review Fi~e '&,Lif~ Safety i "Plan Review Fire &, Life Safety , Reversal - Plan Review Comm/In Reversal - Plan Review Fire & . _ ***+ 100/0 Administrative Fee*** -Mech Iss'2+ Appliances- + 12% State Surcharge , + 5% Technology iee:~ _' '-_ ~-"l'"~"','-, Appliance Vent 'i , Boiler/Comp 3-15 HP '. <> ., . , Building Permit II ,i[ ~. Fire SF Fee - Non-Residential Fixture Furnace - up to 100,000 btu Gas Outlets 1-4 Sanitary Sewer - 1st 50Feet ,~,:1;., Sanitary Sewei.:'Rein(b~ursemeiii '];''' ~ Sanitary Sewer;Each Addtll00' SDC MWMC Administration SDC MWMC Impr~ve';'ent SDC MWMC Reimbursement SDC Transpo Improvement SDC Transpo Reimbnrsement SDC Transportation Admin SDC Transportation AdmiJi.,.~.:i: Storm Sewer.-:'lst~5'ttF~~t ..,ltlUl.Il;:t ,,, ,. ~ -'.. t Storm Sewer Each AddtI 100' Vent Fan , "1'" ~ . I 'j' .,r.~ .1 ... Water Line - 1st 50'Feet'., . , Water Line - Each Addtll00' + 12% State Surcharge + 5% Technology Fee Add, Aller, Extend Circ Ea Add Low V ollage - Commercial Indus .:1;. l' . '~:ll'.'~;".i.l~""," ..~::,,:..'-~ .. . ~ .' f.,' . .... .~.~'.!i~, ".. ... r-:' 1. . 1~' ~;,.} ," II I: CITY OF SPRINGFIELD I' Ii 'Building/Cqmbination Permit " PERMIT NO: COM2008-01502 ISSUED: 06/05/2009 APPLIED: 10/02/2008 EXPIRES: 04/02/2010 VALUE: $! 417,871.00 ", "-;' ,_I Valuation, Descriotion I ',' $ Per Sq Ft or multiplier $103.00 ~.i Amount Paid '- $1,183.08 $1,183.08 $728.05 $728.05 $-1,183.08 $-728.05 , $280.21 ,) $42.00 $317.54 $132.31 $16.00 $52.00 $1,820.13 $156.00 $425,00 $30,00 , $6.00 $52.00 $1,549.25 $34.00 $10.00 $1,761.43 $170.88 $9,720.05 $2,203.63 '$201.05 , $666.04 $52.00 $17.00 $56.00 $52.00 $34.00 $70.20 $29,25 $270.00 $58,00 .", ~ ; Square Footage or Bid Amount 4,057.00 Value " , Date Calculated $417,871.00 $417,871.00 <: 10/0212008 Total Value of Project Fee~ Paid' Date Paid , j~ Receirt Number 1200800000000001030 1200800000000001032 1200800000000001030 1200800000000001032 1200800000000001031 1200800000000001031 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615. 2200900000000000615 2200900000000000615 2209900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 2200900000000000615 1200900000000001]36 ]200900000000001136 1200900000000001136 1200900000000001136 10/2/08 10/2/08 ]0/2/08 10/2/08 1012/08 10/2/08 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5109 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 10/13/09 10/13/09 10/13109 10/13/09 Page 2 of 5 '1!;';' r ,::,~:1:. if,..;.,!';, : Status CITY OF SPRIN~nJ!,LD II Building/Combination Permit Ii PERMIT NO: COM2008-01502 ISSUED: 06/05/2009 APPLIED: 10/02/2008 EXPIRES: 04/02/2010 VALUE: $1:417,871.00 ...::}.": -' , . :"225 Fifth Streei;'SPr.!nglield, O,R'~ '541-726-3753 ptione,:Yi'~" ,i'\':::;:~~. 541-726-3676 Fax' . ,'" ':;, 541-726-3769 Inspection Line Perm ServlFdr,200~mps or,l~ss;;~'(:\~( ',"': ,'$162.00 ,Perm ServlFdr,201,t0400 amp",,:,;;,.::.:, '$95.00 , ,<Y~j;~~,,:;t~1~~..., ";', '~\ 'l.;~:, Total,Anionnt Paid '$22,452,10 ", -t . Plan nine Review, , .. .' ...- ,i~;" ~ ~j~',~'~ . .~l~ !;! -' ' ;, I' .. ~ .~:t .'M ." ~~ , Fire Depa~tmehiR~~ie~, ,.. W/02/2008 I t IJ' ., r ""~ .'!~.;~1r~1~:~';>,lr Initial Review , PuhlicWorks Re~iJ';#F" i ~ t :1", \. " 1.S,~~ucturaIJte\1e~ )\.:;; i' 1.1, - . , ~lrtr'~,t ~~~~, ~, SUB Review Planning: Revie,w !, ~;. : :r i r 1. (. ~; ~ \,". 1r.;~1 ~j ,.. t ' 10/13/09 10/13/09 Plan Reviews I 10103/2008 APP LLH 1200900000000001136 1200900000000001136 II I, I Ii II Sent lett~r to Anslow and DeGeneault requesting energy forms. See attached documents. Waiting 'I'or details as requested in attached:iplan review letter (Reply recievedi.10/23/08) 10/27/08i:waiting for fire approval (APP 11;04/08) . '. Andy Lilnbird Planner - waiting on DEQ W~.II injection permit in order to sign I!evelopment Agreement Ii See attached document for Fire Department Plans Review comments. .' Andy re~eived DA on 1/26/08. To be built pe~i approved Final Site Plan Review,bRC2008-00042, Calf Andy Lifubird at 726-3784 for Final Site Inspection before Final Building and Occupancy. , " To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested before 7:00 a.m. will be ~ade the same working day, inspections requested after 7:00 a.m. will' be made the following .. ., , work day. i" j' , , . , i. \ b:' ' lr.., 1'1;"',, J ' 10/02/2008 .. D .' .... 10/02/2008 10/02/2008 ,. " ...11" ';: U 10/02/2008 " , '. 10/07/2008 APP CTM ,; r Erosi';n/Grading Inspection: Prior to ground disturbance and after erosion measures arei~stalled. Vfer Electrical Ground:, I~stall ground rod at footing and call for inspection in conjunctio~ with footing andlor foundation inspection. ',t,:~, - '~, ~. ~,. - , .. 1': Footing:i'After trenches are excavated. : " Foundatinn: After forms are erected but prior to concrete placement. ,'\, ~! ,;; ,. ;1,] 11 .~: Paee 3 of 5 I 10/13/2008 APP CJC 11/03/2008 WE EMM 11/04/2008 APP GRG 10/03/2008 u 1112012008 APP JF 01/28/2009 APP EMM 01/28/2009 , I; :f , . I;, \,_ I .~eH~!re1 r n~tlections I " Status biu'id- -. ; 225 Fifth StreethipAngheld,'OR,: . 541-726-3753 Phone" .:' . ..~,,:,,:,:;'t.~,i ,. .,,'.., -.1' 541-726-3676 Fax' 541-726-37691nspection Line .. .. 'd! ; "1' ,~", 'i, " v CITY OF SPRINGFIELD Ii .~ :'~ Building/C1mbination Permit PERMIT NO: COM2008-01502 ISSUED: 06/05/2009 APPLIED: 10/02/2008 EXPIRES: 04/02/2010 VALUE: $1:417,871.00 ,0 " ". ..., ;;', ':,. ':':", .:~;;-:,~.~:t;:. '" : . Post and:Beam:':Prior to 'floof insulation or decking. , r.':.i. -"', ':' ~};f'~~.~f ", '. .', '-i. Floor 1n'c?latiori:' Prior to decking. Shear Waii,Nailing: Before covering sheathing with finish materials. . :;:\; :::' '.~~ ,', . :i.. .:: ;: ' ~'":' Framing tnspecti~ri: "Pri~~~ t~cover and after all rough in inspections have heen approved. Wall Insubition: Prior to cover:' Ceiling Insulation: Prior to cover. ," -~. '. .'",:.',.~", '. ,.,. , . Drywall:. Prior to taping.', !,. ~. ' t::: . . 'i_ Roof SheathinglNailing: Before covering sheathing with finish material. Ceiling qf,I~:k1!s~~r dryw~1I approval hut prior to cover. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Building Inspector. ' Provide report to City , Ii 'Final Building: After all required inspections have been requested and approved and the huilding is complete. Underground Plumbing: Prior to filling the trench and iucluding required testing, ::~, 1 .l, . .. . - .~ ,Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.., '; 1. :: Underfloor Plumbing: Prior to insulation or decking, . ,,:' , " ..:~.,......: ...",.l-:" .... Underfloor'D'rain: Prior t? cover or placement of concrete. i', "\-'. . Rough Plumbing: Prior to c.lver and including required testing. Shower Pan. Prior to covering and i!Jcluding required testing. - "I'. Water Line: Prior to filling trench and including required testing. _..: '-1 'I' .,.r~" ,;. '-":1.' Sanitary i;ew';r Line: 'Prior to filling trench and including required testing. ~,. i . Storm Sewer ~in~: Prior to filling trench, ,rN, t(hl.r4~1;;.J., ~, Drywell, "Engineered Drywell is Required. Final Plumbing: 'When all pl~mbing work is complete. Underfloor Gas: After line is install~~ and required testing and capped if not attached to an appliance. Rough Gas: After line is iiisi~lIed and required testing and capped if not attached to an appliance. .. .",;,~. ~_'l,.fa, ". "~Hl.i~; i Gas Servic,:.' iA~ter Ihie isinstalied and line has been connected to a minimum of one appliapce including required testing. Presore test done at this point. , :I,!!. '1 Rough Mechanic,al: Prior to Cover , " . :, . ,. ::'. Final Gas: When all gas work is complete. Final Mechani~al: When all mechanical work is complete. Rough Electric: Prior to Cover '"J , i., , , . .. : r~ ':"0 , Electric ~ervi~e: ;Api'roval required prior to utility company energizing service. .:~..~~H; ..<~ , ' ~ Final E1e~tric: When all electrical work is complete. ,1'j.' . . ~ .". " !:, ~. ~,I .;. II ' I J t.. . ,: ~.~ ;.. ~.;; ;' " , Pa2e 4 of5 ,.." : ~,:,; 225 Fifth Street, Springfield, OR 541-726-3753 Phone ,'., , ,~.,'.:. 541-726-3676F~x ';', ',;." ;;":;;\, . 541-726-3769 Insp~Ction~'Line' ::':jJfo;f.'..: ;, .: ),ii'€'~'-\. " .' ~ " " CITY OF SPRINGFIELD , Ii Building/Cqmbination Permit PERMIT NO: COM2008-01502 ISSUED: 06/05/2009 APPLIED: 10/02/2008 EXPIRES: 0~/02/20IO . VALUE: $,!417,871.00 'I : :':: , ,.~~Ft;, ,i~,~, ~..,:.., . ,., 0 II . By signatu~e, I state',aiId agr~e, t~~~'I have carefully examined the completed application and do h~reby certify that all information hereon is true and corr~ct, and I further certify that any and all work performed shal! be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and e'inployees who are in compliance with ORS 701.005 will be used on this project. I further agree to~n~ureJhat aIL~eqU:ired inspections are req'!ested at the proper time, that each address is readable from the street, that,the p,erinic~rd i~'locaie~ at the front of the property, and the approved set of plans will remain on the site at all times during constru:ction. 'I , \ f '" 1 ,;, ,f., J, ,c . .1;<.{1' i!. Owner or Contractors Signature .... ~. ... J\. . ~o ,01 :.: ,....;;:.. ''t '~..,~ .', ..:" ~ _1,:1 ' ~, J .:1~': :. l,: '. ;f ' .I: , , -. -~, ~~ ~~1'.'." , ':..., t"' . > ~ ," , j~1:;\ 'Ii, --;~:~I . ii. ~. ~: .t': " .',., . ';1'}~:. " ~: ~ , . , ". o. '" ~ ;,'", ;~ "i1li:lf:' !1rij';~h. '.,' 1 . ; ~i ,~.. . '. ., , "1 , ; '{'" 1~ . ....: '., ~: _:,,:r. 1: ~ ~ ;; ~7:-', '11,1," 1 . i , li . .:1 l'r' ~,' .s, . , ... 'j' , o-:-:,f:i' .:::'.' .o,~ .::;:.' " . ...: " r ....:;.., f: ~l' '.~~ t \ 1 ' . 0'; ;~.. . T, " , (1';"t .,: ;. u u -.... . ~ " " Page 5 01'5 Date . Ii , ;::r~ '- .2~5;Fifth Street';:;-, \:-'" , "...' , '. .".""',-,,... .":" ", .... Springfield, 'Oregoil'97 47.70; hi,:; 541-726-3759 Phon~' "~"~i' ,'. .,~ ;:' " ,RECEI~1,'/#: City of Springfield Official Receipt . Developm~nt Services Department Public Works Department 1! '1200900000000001136 Ii Date: 10/13/2009 I: Amount Due 162,00 95,00 270.00 58.00 29.25 70,20 $684.45 9:19:53AM Job/Journal N umbe~:i~~~~.; j,.~~~.~~iP,tiO'~': -~~;':!};i;i2;' ~.'. C0M2008-0 1502ii.,~;! :'!Pet'm Serv/Fdr 200 amps or less CONl2008-01502, ::k:,PeI.;TI Serv/Fdr 201 to 400 amps COM2008-01502 ':;~r:'{tAdil,Alter,J';xtend'Circ Ea Add , .-', " '" ..,.'.. ~,' COM2008-0 1502 . Low V olta:g~}Sommefciallndus COM2008-01502 + 5% Technology Fee COM2008-0 1502 . + 12% State Surcharge , ~0; ;.~). \r\:l:N:;::::' -~:UI.::';'f':;fjW(7 , }~ald,.By '.', ':, . ,ZONLINE PERMIT CHGS ': "'}f;::;\t1;:\;:~ '... '-~' Payments: Type of Payment ONLINE CHGS '" "'; iP-:' , .,,~ "I ..~, " T,';~li':',,2 .'; ,. n'. i' ': ' ~r ,;!~ 1'1 ':. .jt ~: " ;; .:'..., "".,;., ~"; -,.. .,i 'jo. , '(~'~t'''' ,it; t I i . ,~\ i [ii. ~i:~ '{;;: 1 , , , , ;1. 't ![d , .':.' ;;'.' " " " " i" ~ . ~~ .' \\ {' H j, " " '1 ~ :1";;' r , , I', 0\ ,'." .:; ~ !! cReceintl .. .. ; !1 ! I; ,: , :.: .1 'fl. " " ,~ Item Total: Check N umber Authorization Received By Batch Number Number How::Received Amount Paid $684.45 $684.45 " " Page 1 of I 10/13/2009