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Home My WebLink AboutPermit Building 2009-12-8 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01730 ISSUED: 12/08/2009 APPLIED: 12/04/2009 EXPIRES: 06/08/2010 VALUE: $ 191,914,00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1252 W Quinalt St ASSESSOR'S PARCEL NO.: 1703273106700 Springfield TYPE OF WORK: Single Family Residence Owner: Address: TYPE OF USE: New PROJECT DESCRIPTION: Single famm6~I(llN~ ~n\l'ioN~QIM9INJlltll242 W Quinalt follow rules adopted by the Oregon Utility , NUlIIIUC:l.lIUII v~(llt::l. I IIU::itlIUltn:i talU tiUllUIUI NORTHWEST BANK In OAR 952-001-0010 through OAR 952.001. 4900 ;vi EADOWS RD STE fll:1!lo. You may obtain copies of the rules by LAKE OSWEGO OR 97035calling the center. (Note: the telephone Residential IIUIIIU!;;I IVI 1I1~ UltlI!:jUII ,",'~II',!__I'I~UII'WO,",'I , ~111RA'CT\'lM~IO~ . . .-.'" ,~ " Contractor Type Contractor License Ex'piration Date Phone .' " .. ~'.' ...t_:,.._.'i'-"'.,~ ~ BUILDING INFORMA nON. # of Units: Primary Occupancy Group: Secondai.y Occupancy Croup: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: 2 NO~lCE: Height ~f Structure 24.00 THIS \!lERM1T SHLy-,)elg!i'J'I,~~~: lif ~r:stdt,y!l11.~)!ctnc {, ...;Yp """E'" II"W~.\,el;riE~I~".i'"'lRlk1ilnr liS ~~'ectr~c ~\\!!. hUn.", """"Range Type:"" Electnc fi\1""~11 "If''''''iE'''1 ("Ii', "CO .\ ,t, .:,,' "o'''~I\'I~'''' l""'!F\: '11"''''1('''-3'1:'''''>' _'CI ",'rEnergy' Path," "'1:'1'1 11'l!J ANY T8'0 'bAY PESprinkled Building: nla Lot Size: Sq Ft 1 sl Floo r: Sq Fl 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: 9,642 785 1,017 462 I DEVELOPMENT INFORMATION. Front yard Setback: Side I Setback: Side 2 Setback: ,,~ Rearyard Setback:~~).' ,;' Solar Setbacks: . I ]9,00 10,00 10.50 126.00 28.00 Overlay' Dist: # Street Trees Rqd:, Paved Drive Rqd: 0/0 of Lot Coverage, 2 Yes 13.27 REQUIRED PARKING Total: 2 Handicapped: Compact: I PUBLIC IMPROVEMEN~S' Street Improvements: Storm Sewer Available: Spechtl Instruction: FullV Improved Yes Sidewalk Type: DownspoutslDrains: - Curbside 7' Curb and Gutter Notes: Storm water to curb via weep hole I Valuation DescriJ?tion , Description- Type of Construction $ Per Sq Ft or multiplier Square Footage , or Bid Amount Value Date Calculated . ""'~ ,Pa2e i of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Gara1!c/Misc SFlDulllex U VB Utilitv R-3 VB ]&2 Familv Fee Description + 121% State Surcharge + 51Yo Technology Fcc 1st Appliance 3 Baths One & Two Family Addressing Assignment Building Permit Curbcut Permit Dryer Vent Exhanst Hoods Fii'e SF Fee - Residential Plan Review Major - Planning Plan Review Residential PW Disc - 2nd Permit Residence Wiring 1.0.0.0 Sq Ft, Residence Wiring Ea Addtl 5.0.0 Sanitary Sewer - Improvement. Sanitary Sew(.'r - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbnrsement SDC Sanitary/Storm Admin SDC Tran Reimburs-Residential SDC Trans Improvement-Resident SDC Transportation Admin Sidewalk Permit Storm Drainage Impervious Area Temp Power 2.0.0 amps or less Vent Fan Willamalane Single Family Total Amonnt Paid Pnblic Works Review 12/.0412.0.09 Plan nine: Review 12/.0712.0.09 Structnral Review 12/.08/2.0.09 Amount Paid $226:22 $112.11 $79..0.0 $4.02..0.0 $38..0.0 $1,.083.19 $88..0.0 $9,.0.0 $13,.0.0 $113.2.0 $211..0.0 $7.04.07 $-3.0..0.0 $134..0.0 $75..0.0 $573.2.0 $753.82 $1.0..0.0 $],.044,54 $1.01.97 $137.14. $211.21 $931.65 $78,13 $88,.0.0 $679,.04 $63..0.0 $27,.0.0 $2,858..0.0 $1.0,814.49 $37.72 $96.83 CITY OF SPRINGFIELD. I, Building/Combination Permit PERMIT NO: COM2009-01730 ISSUED: 12/08/2009 APPLIED: 12/04/2009 EXPIRES: 06/08/2010 VALUE: $ 191,914,00 462..0.0 1,8.02,.0.0 $17,426.64 $174,487.66 $191,914,3.0 121.07/2.0.09 121.07/2.0.09 Total Value of Project F"", p~ Plan Reviews I 12/.0412.0.09 121.07/2.0.09 121.08/2.0.09 Date Paid, 12/81.09 12/8/.09 12/8109 .. 1218/.09 12/8/.09 1218/.09 1218/.09 12181.09 i 12/8/.09 1218/.09 1218/.09 , 1218/.09 12/8/.09 . 1218109 12/8/.09 ' 12/8/.09 12/8/.09, 1218i,09 12181.09 . 1218/.09 12/8/.09 :: 12181.09 " 1218/.09 12181.09 ' 12/8/.09 12/8/.09 1218/.09 ] 2181.09 12/8/.09 Receipt Number 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.0]355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.0]355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.0]355 22.0.09.0.0.0.0.0.0.0.0.0.0]355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 22.0.09.0.0.0.0.0.0.0.0.0.01355 APP LKW Storm water to curb via weep hole APP DDK APP CJC As noted nn plans Paee 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-01730 ISSUED: 12/08/2009 APPLIED: 12/04/2009 EXPIRES: 06/08/2010 VALUE: $ 191,914.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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, R~r,~irprl Infnp~-.J 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 ~Iaccment uf concrete, Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction witb footing and/or founda~ion inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: P~'ior to floor insulation or decking. "Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in i'nspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover, Drywall: Prior to taping, Final Building: After all reqnired inspections have been requested and approved and the building is complete. Undcl'gl'ound Plumbing: Prior to filling the trench and incJuding required testing. Perimeter Foundation Drains: After grllvel and filter cloth is installed but prior to backfill. Underfloor Plumbing: Prior to insul~tion or decking. Undertloor Drain: Prior to cover or placement of concrete. Rough Plumhing: Prior to cover and inclnding reqnired testing. Water Line; Prior to filling trench and including required testing. Sanillll'y Sewer Line: Prior to filling trench'and including required testing, Storm Sewer Line: Prior to tilling trench, Final Plnmbing: When all plumbing work is complete, ( Undertloor Mechanical. Prior to insulation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Pace30f4 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2009-01730 ISSUED: 12/08/2009 APPLIED: 12/04/2009 EXPIRES: 06/0812010 VALUE: $ 191,914,00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54] -726-3676 Fax 54] -726-3769 Inspection Line 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 aud agree, that I have carefully examined the completed applicatiou 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 strncture withont permission of the Community Services 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 all required inspec'tions 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 will remain on the site at all times during construction. L~ ~ner or Contractors Signature I V/6;S0 , Date , .,.", Paee 4 of 4 Residential Energy Additional Measure Selection Department of Consumer and Business Services Building Codes Division 1535 Edgewater NW, Salem, Oregon' Mailing address: P.O, Box 14470, Salem, OR 97309-0404 503-373-1268. Fax: 503-378-2322 Web: bcd.oregon.gov RESIDENTIAL INFORMATION ~ Date: Building pennit number: lJL( - {7'3D Owner's name: \ 1011\ (:'. c:A ~ 70_ \ t" -:;z. Job address: ~7 \^ )-P<;;.-\- <(7:))\\1\D \:-\- .Pnr-c > City: ~\ \'l\~~~ State: 612- ( "- INSTRUCTIONS ZIP: ct':fLi::r-i- From the list on Page 2 (Table NI,I 01.1 (2)), select one of the nine items for additional energy conservation, in addition to the standard requirements specified in Table NIIOl.1(I). Selected item number: 5 Within each item, select the sub-item under "requirements" you are intending to use, where options are noted. Applicant's si Print name: : I You must.submit this form to Building Codes Division before the plan review and permit issuance. If this form is not submitted along with the original permit application, the file wiD be placed on hold pending receipt of this information. l' DEPARTMENT OF I' CONSUMER ~~ .(' ..BUSINESS \,)lSERVICES 440-4854 (8/09/COM) Page 1 , - c; I Measri're ' Description 1 High-efficiency HV AC system: Select one' o Gas-fired furnace or boiler with minimum AFUE of90 percent (a), or o Air-source heat pump with minimum HSPF of 8.5, or o Closed-loop ground source heat pump with minimum COP of3.0 Select one: o Certified performance tested duct systems (b) or o All ducts and air handler are contained within building envelope (a) o Replace corresponding Table N 110 1.1 (I) components with all of the following: Wall insulation-above grade - U-O,047/R-24; Vaulted ceilings - U-0.033/R-30A (c) (d); Flat ceilings - U-O,025/R-49; and Windows - U-0.32 Select one: 0 Zonal electric AND select one of the following: o 75 percent of permanently installed lighting fixtures as CFL or linear fluorescent or a minimum efficacy of 40 lumens per watt; or o Windows ~ U-0.32; or o Flat ceilings - U-0.025/R-49 and vaulted ceilings - U-0.033/R-30A; or n Exterior walls - U-0.047/R-24 High-efficiency .m Replace corresponding Table Nil 0 1.1 (1) components with all of the following: ceilings and N Vaulted ceilings - U-0.033/R-30A (c) (d); windowsflighting/ Flat ceilings - U-O,025/R-49; Windows - U-0.32; and . 75 percent of permanently installed lighting fixtures as CFL or linear fluorescent or a min efficacy of 40 lumens per watt o Replace corresponding Table NIIOI.I(I) components with all of the following: Vaulted ceilings - U-0.033/R-30A (c) (d); Flat ceilings - U-0.025/R-49; Windows - U-0.32; and ' Natural gas/propane, on-demand water heating with min EF of 0.80 o Natural gas/propane; on-demand water heating with min EF of 0.80; and 75 percentof permanently installed lighting fixtures as CFL or linear fluorescent or a minimum efficacy of 40 lumens per watt o Minimum I wattlsq, ft. conditioned floor space (e) 2 High-efficiency duct system: TABLE NllOl.l(2) Requirements o Ductless furnace or o Ductless heat pump 3 High-efficiency building envelope: High-efficiency water heating! lighting: Solar photovoltaic: Solar water heating: a, Furnaces located within the building envelope shall have sealed combustion air installed, Combustion air shall be ducted directly from the outdoors. b, Documentation of Performance Tested Ductwork shall be submitted to the Building Official upon completion of work. This work shall be performed by a contractor that is certified by the Oregon Department of Energy's (ODOE) Residential , Energy Tax Credit program and documentation shall be provided that work demonstrates conformance to ODOE duct p...{VHUance standards, , c. A=advanced frame construction, which shall provide full required ceiling insulation value to the outside of exterior walls. d, The maximum vaulted ceiling surface area shall not be greater than 50 percent of the total heated space floor area unless vaulted area has a U-factor no greater than U-0.026, e, Solar electric system size shall include documentation indicating that Total Solar Resource Fraction is not less than 75 percent. f. Solar water heating panels shall be Solar Rating and Certification Corporation (SRCC) Standard OG-300 certified and labeled, with documentation indicating that Total Solar Resource Fraction is not less than 75 percent. 4 Zonal electric, ductless furnace, or ductless heat pumps: 6 High-efficiency ceilings and windows/water heating: 7 8 9 440-4854 (8109/COMl D---Minim~m of 40 ft. of gross collector area (1) Page 2 ~ ~ Willamalane . . t-w . Park & Recreation District Job, No, t! 7 - J')]' 0 SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: COli/ z ~ "=-2 PHONE: 'S'19 i - / LJ ,;;] . ' ADDRESS: ! tlf Iqr( Jr- CIl:V s,oFL/} . "-'STATE~IP: '7'7y?? . LOCATION OFPROPOSED-BUILDING SITE: Street Address:l2\" ;2- . ~ c9tA'/;o/Yf1A-~r 'Plat Name: Tax Lot Number:/17-'7 7 "2 ') r / 0 c; ,/00 . , ...., 1, 'DEVELOPMENT TYPE (Check appropriate dwelling(s), Dwelling type definitions are on the back.).,.... ' . ...c....., , A. Sinale-Familv Detached NO, OF UNITS / X $2,858 per unit =.. $ '2,Fj I , ' " 8, Sinale~Familv Attached NO, OF UNITS ";. .: ,"'.",., . ... X $3,100p~r unit = ~ C, Multi-Familv Aoartment NO. OF UNITS X $2,641 per uriit = $ 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 .', Willamalarie Credit approvaL) $ 3, TOTAL WILLAMALANE NET SDC ASSESSED , (if SDC reduced for Credit) /J/~dA - Dev1it6Pment Services Department City of Sprin~field . . $ 0)-[" 4'-J /2;." f , 0'7 Date . . . \~(0{01 5 Structural Permit Application .5J1-Wl~ AS /z,cJ,'l... CCII^-'-z:,oo" - 00703 e,.) a",;...,Lll- li~ilDERARTMENi:msEidNi];.',7",.',';1 ). ~.("_;"1.7'."'-,"""h ,.- """,-,"','AA'<_-E._.'~ .r."". .'R~)l",,~...1' CO..,.v\ 200? - 0, 7 J (:J Permit no.: 225 Fifth Street. Springfield, OR 97477 . PH(54] )726~3753 . FAX(541)726-3689 ~. ;,;.:=.~ ~~ 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 for 180 days, , ~-'l'J.f;[OCAGtGOVEFiNMENt.i;A'p'PR()ijAL." .:';jf~1"',.:,;;i,;"z:1 .".'i.",_X'-md?;;~," ,.__',___.j_.. ',.,', ",' _. ....__~__~__.._....,_"'__=____". .~..._ ,_,', __."'.... .t:.y.>n0,w.il.!ftf1t -"-""; I This project has final land-use approval. I I Signature: Date: I This project has DEQ approval. I I Signature: Date: I Zoning approval verified: 0 Yes 0 No l~ii~~~~~~~i~~~~lO~~~~N~I~U~flQH!'i~~w1f!Sili;:s~t'jkl~ I 5ZJ Residential I 0 Government I 0 Commercial 1[~:li~;~i:~;~:l~~Ti;liE~:;~&~~~~f~i~~JJ,:ll: I City<;:yr\l[\ ~\i~ 1 S, late: 01L I ZIP:1'~ 1- t 1 Subdivision: Gl~ \.+- I Lot no,: \ I I Reference: 170 ~ Z 73. IfTaxlot: 0 I; 7 0 e:. ;~'-"'lT:'~~~t,.~~-~f.7f,-p R-O.'P-"~E'R TY' ,', '"'-O--W~'~N.E"R":~;.a&~;:;.;-'1;. -'_;~I-'~:~~,J~\f;#gL, . ._~________i. ;;, '.___n_ "::'~..:-i:._,:~-~,;;';" I, Name, -.')l,!-cp'\ c., (~f)Y\~\e.?- I Address \ 9-4 \q-w-. ~+-. . I CitY~\{lo..,~e..\.d.. I State: OR 1 ZIP~::t.(-1~- I Phon~'P- l~ 1 Fax: - - 1 I E-mail: 1 This installation is being made on residential or fann property owned by me or a member of my immediate family, and.is exempt from licensing requirements under ORS 701.010. Sign here: f;;:li:I~:i!;;;;-'f.,1li1:,'iC:ON1fRACT,.-,OR11INSfAti!fiiATio'N"lr'#I';;,;.;;liI~i,,1il;'.',;.;:,.1 . ,,,c ':';::ii ,;;a4~,,,,,,-. ,,_~~____'.v_. .,......... .....'n.'..h;....._ ....,,__. _;_~..,..,.. . .....~",jOO,'S'"d5i'i.~_ "'''.0'~'''_ . ~.,..... Business name: c:.'7\Ur-t-~ .~L\..i.'d.-e.vs UC I 1 Address \ \ 33 ~ \D~ oS+-, , ';)k I --.J 1 City: -,~ I State: ~ I ZIP~'r=Fl(>\1 I Phone54~~~2.. -O~ F"",9JI-?'~~-lSZ.s 1 1 E--mai[C\.'M.~e,!.III~@ ~~d.C'O/I^J 1 CCB jicensc no,: l-=tloD lLD I I Printname:Q..Y>\.\.~~lV\.~ I I Sigoatur . . '/./ I S!JBlltONTR.o;cToR'INI'ORMAl'ION' [ Name CCB License Number Phone Number I Electric'q:~'{~,!t:,..l.1b \ "2J.p 4 fiL{ I 41 b -: ~~ I Plumbin!L~ r 'b ~+6 <)<-1 i -LjICl-llO't}Sl I Mechanicalt~ \+\ n-=!-'-l 15<-(1-'iZ6-~~1 I Date: /L-'-(-O ? :}~;>XalR~(!on~i'iif;r~.~.tio_iii~I\~~';, (a) Job description: Occupancy 'S\'(\.u.\ e. -Km \ \u... Construction type: i7 ~l6.t.V\'\- t 1:0. Square feel: I'?D'L.. Cost per square foot: Other information: Type of Heat: Energy Path: . 0 new 0 alteration (b) Foundation-only permit? D addition DYes DNo Total valuation: $ I (a) Permit fee (use valuation table): I $ 1 (b) Investigative fee (equal to [2a]): $ I (e) Reinspection ($ per hour): $ (number of hours x fee per hour) I '(d) Enter j2%surcharge (,12 x [2a+2b+2c]): 1 $ I (e) Subtotal of fees above (2a tbrougb 2d): 1 $ i~f~~::~~::\~~~:~:;~:~:~~~~~'~:~Jr: . I (e) Subtotal of fees above (38 aDd 3b): I S I (a) Seismic fee, 1%(.01 x permit fee [2a]): $ I TOTAL fees and surcharges (2e+3c+4a): S 00.::> r;;1UP~ \ I"" \'. 0'03 --.J \ '2- eP "2- 5A\ .1 I I I -I I I I I 1 I 1 1 ,I I 225 FiftJI Streett Springfield, OR97477t PH(541)726-3753t F~(541)726-3689 I Permit no.: I D~te: Electrical Permit Application This permit is issued under-OAR 918-309-0000.. Permits are nO,ntransferable. Permits expire if work is not started within 180 days ofiiSuance or if work is snspended for 180 days, lillIIIi'~.:[C>C~LiljjfGQSlE~NMENjfi!f~F1R~o"SlAl.illIIIlIlllll!nl:!mlf 1 Zoni;;-g approvai verified? DYes D No - IlIllIillIIIlll\\llI!.lf'JllCAffiE(O'oijYJ[0f'A!CotJISffir{QcjfIONillll\illIII:IlS _ _ I Residential, per unit, service included: I~Residential , I 0 Government J 0 Commercial I j,OOO sq. ft, odess (4) 1~__'~OBf!.S.lffiE!liIN~ORM/!.ffiJ,ON'IANDllL!QCM'I!:l.N_lI!1 I Job site address: 11..5 2. I! \~ r ~l')'t~ \ C ~ I ~~~~:fdditjOnal 500 sq, ft, or portion $ 25,00 $ I Citr'i-:. \~l:\d I State: D'\2.. I ZIPq-:j;Lft 1- I Limited energy (2) $ 32.00 $ J SUbdi~i~ion:?Jt>,~y\(A\t"",:, "",JLotno::,I, I J~~~I~:IJs~~i~r~~Pe~~:r(~)odular I $ 63.00 $ 1!~~~:~~~7~"-1 I ~::':;s02::,e;;; installation. alterat'j'on. relo:at~:~oo S .i~~~=r;R-nt{~b~~~~.jll!~1!;s.Il:!lllllll'120j to 400 amps.(2) $ 95.00 $ 1 Name:\1JCt.V\ (2., P1 bV\?-_Y.. tt'. t I 401 to 600 amps (2) 1 $158,00 S 1 Address'\~l\.' \ ~+\r. 5t;-., 1601 to 1,000 amps (2) 1 $205,00 $ I City:"\~\(\V\c...~eld I State: 6\2,. 1 ZIPq-=/L\-:rt Over 1,000 amps or vojts (2) ! $469.00 $ I Phone8-l\- 5'61 -lti t,~1 Fax: I Reconnect only (2) , I $ 63,00 I $ I E-mail: I I Temporary services or feeders: installation, alteration, relocation Tbis installation is being made on residential or farm property r 200 amps or less (2) $ 63.00 $ owned by me ora member afmy immediate family, This 1201 to 400 amps (2) $ 87,00 $ property is not intencjed for sale, exchange, lease, or ~ent. OAR . 479.540(1) and 479560(1), ,I 401 to 600 amps (2) I 1 $126.00 I '$ , Signature: lOver 600 amps or 1,000 volts, s'ee services or feeders section above '~_1\1f'Silllll.c:0'IIIjfl'&(3mORllllNSjf,4;IJ[I!A'ljJ0Ni1:iIlfiR:'B1\1f'''1 'I Brancheircu!ts: new, alteration, extension per pqnel I Business name: 1)M L F\ e.c..--t-r- t eo. \V\f', I I a. Fee for branch circuits with purchase of a service or feeder fee: Address: q \ 0 LtJ \J f>r~ 11.C~e 'D\QCe I I Eacb branch circuit 1 I $ 6,00 1 S CltY.~~ State: DK I ZIP:'1.::f~ I b. Fee for branch circuits without purchaBe of a service or feeder fee: I Phane4-l-1-4 \ b -;~h(o ~ Fax:B+I-q 23 :~~;:t:;;;j 1 First branch circujt (2) I I $ 55,00 I $ IE-mail:r-\IM\.p\t:.l~tf'~<:,,~,Qabl'~11 Eachadditionalbmnchcjrcuit $ 6.00 $ , CCB license no.: j~/:.2b '-I I BCD license no.: Q"'3{.i.C I MisceUaneou,s fees: service or feeder not included I Signing supervisor's license no.: 5/D55 I I E?-ch pump,or inig.ation circle (2) $ 63.00 I Print name of signing supervisor: .b~ ITJ\." fA I ~f' I 'I Each sign or outline lighting (2) I $ 63.00 I S. . ... . '. f\. . ~A _ ~~ I I Signal circuit or a limited-energy panel, I $ 63.00 19nature of slgnmg supervisor. ~ W{' V ________.__ -.... . alteration, or extension (2) I Each additional inspection: (1) J $58.00 $134,00 $ I I I I I I 1 'I $ $ I I I I ~tQJ\ .~~ . \~ I (A) Enter s. ubtotal of above fees (Minimum. Permit Fee $58.00) 1 (B) Enter j2% surcharge (.12 x [A]) I (C) Technology Fee (5% of [A]) I TOTAL fees and surcharges (A throngh C): $ $ $ $ 440-2584-1 (9/08/COM) 225 Fifth Street Springfield, Oregon 97477 541- 726-3'759 Phone ~~'RINaP.I.U~~ d :. - A... - . EIti . City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 I 730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 J 730 COM2009-0 J 730 COM2009-0 J 730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-01730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 COM2009-01730 COM2009-0 1730 COM2009-0 1730 COM2009-0 1730 Payments: Type or Payment Check cRcceintl , RECEIPT #: Date: 12/08/2009 2200900000000001355 Description PW Disc - 2nd Penn it Curbcut Penn it Sidewalk Penn it Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary SeVt'cr - Improvement SDC Tran Reimburs-Residential SDC Trans Improvement-Resident SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Stann Admin SDC Transportation Admin Plan Review Major - Planning Plan Review Residential Building Permit Addressing Assignment Willamalane Single Family 3 Baths One & Two Family 1st Appliance Vent Fan Exhaust Hoods Dryer Vent Temp Power 200 amps or less Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Fire SF Fee - Residential + 5% Technology Fee + 12% State Surcharge Paid By EQUITY HOMEBUILDERS Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received cjc 4231 In Person Payment Total: Page I of I 9:31 :44AM Amount Due (30.00) 88,00 88,00 67904 753,82 573,20 211.21 931,65 101.97 1,044,54 10,00 137,14 78,13 211.00 704,07 1,083,19 38,00 2,858,00 402,00 79,00 21.00 13,00 9.00 63,00 134,00 75,00 113,20 112,11 226,22 $10,814.49 Amount Paid $10,814.49 $10,814.49 12/8/2009