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Home My WebLink AboutPermit Building 2010-1-5 ..." CITY OF SPRINGFIELD Building/Combination Permit , - Status Issued PERMIT NO: COM2009-01831 ISSUED: 01105/2010 APPLIED: 12/23/2009 EXPIREs: 07/05/2010 VALUE: $ 13,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax' 541-726-3769 Inspection Line SITE ADDRESS: 253 W CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703274401301 Springfield TYPE OF WORK: Bathroom TYPE OF USE: Alteration PROJECT DESCRIPTION: Add bath - encroaching on existing garage space Residential Owner: HUFFMAN STEPHEN K & MARIA E Address: 253 W CENTENNIAL BLVD SPRINGFIELD OR 97477 Phone Number: 541-747-0544 Contractor Type General Electrical Mechanical Plnmbing I. CONTRACTOR INFORMATION I Contractor License OWNER FIRST LIGHT ELECTRIC INC 179416 OWNER EUGENE EXCA V A nON & PLUMBING INC 138003 I. BUILDING INFOR~ATIO~ I Expiration Date Phone 11/27/2011 541-726-2961 07/06/2011 541-988-0868 # of Units: Primary Occnpancy Group: Secondary Occnpancy Gronp: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # of Stories: Height of Structure Type of Heat: aseboard Electric Water Type: Range Type: Energy Path: '.l.,:,:.:.~pr~.n1<.led Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occnpant Load: ]]6 R-3 n/a UC;"'If''''F. ~His 'PE~RMIT SHAll EX\-'I~E1to/P{+ffi~t IN~ORMA TION I AUTHORIZED UNDER THIS h[.f'i'fll I Iv .lfU r. . Front yard SetbroMMENCED OR IS ~.~ANDONEI{,~~t~\.yDlst: Side 1 Setback: ANY 180 DAY PERIOD. ..,.#$treetTrees Rqd: Side 2 Setback: . Paved Drive Rqd: ....~ 1.,. Rearyard Setback: . okm Lot Coverage: Solar Setbacks: REQUIRED PARKING Total: Handicapped: Compact: . .- ~.""8"Yl.ae ~1I.tf\ AI I E:I....I IVI'4. _I~~...../ n... _ .u. . follow rules adopted IltJBtel0IJI9IlR9'fI!~ENTS I Street Improvements: Notification Center. Tl,u;:Iti l~h'.O"AR'" . 95~iOo1. . ' In OAR 952-001-0010 thr~~g . Storm Sewer A vailabl'\)090. YO.U m~y obttllnCoples of the rules by Speciallnstrnction: calIl\1Vthet01fl\efe ,(I\\ilQ;~~tItf1l&::' , numbel' for the Oregon utility NOt Notes: Center 18 HI0Q-332-2344). Sidewalk Type: Downspouts/Drains: ......;,,;....._n.:'... Page 1 of 3 ~"'I\!~l!'!""'iIIl:I!:l1 ;.I :~ ~~ Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-0]83] ISSUED: 01105/2010 APPLIED: ]2/23/2009 EXPIRES: 07/05/20]0 VALUE: $ 13,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541.726.3769 Inspection Line I V ~Iuation Descrilltion .1 Estimate Tvpe of Construction Estimate . $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 13,000.00 Value Date Calculated Description Total Value of Project $13,000.00 $13,000.00 12/23/2009 Fr<;' P~i11 $107.41 $53.55 $22.31 $79.00 $55.00 . $24.00 $165.25. $114.00 $132.28 $173.96 $15.31 $9.00 , < 12123/09 1/5/10 1/5/10 1/5/10 1/5/10 1/5/10 1/5/10 1/5/10 1/5/10 1/5110 1/5/10 1/5/10 Receipt Nnmber 1200900000000001358 1201000000000000004. 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 1201000000000000004 Fee Des.criotion Plan Review Residential + 12% State Surcharge + 5% Techoology Fee . 1st Appliance Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Fixtnre Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Amonnt Paid Date Paid Total Amount Paid $951.07 I Plan Reviews I Structural Review 12/24/2009 Initial Review 12/24/2009 . 12/24/2009 OK DJB Planning: Review 12/24/2009 12130/2009 APP DDK No planning issnes. Pnblic Works Review 12/30/2009 12/31/2009 APP LKW Structural Review 01/04/2010 01/04/2010 APP KLK . . 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. . . RI~llllir.prl 'n~np('tioaJ Post and Beam: Prior to floor insnlation or decking. Paee 2 oD CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-01831 ISSUED: 01/05/2010 APPLIED: 12/23/2009 EXPIRES: 07/05/2010 VALUE: $ 13,000.00 225 Fifth Street, Springfield, OR .541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Floor Insulation: Prior to decking. , Framing Inspection: Prior to cover and after ~II rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulatiori: Prior to cover. Drywall: Prior to taping: Final Building: After all required inspections have been requested and approved and the building is complete. Undernoor Plumbing: Prior to insulation or decking. Rough Plumbing:. Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete; Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, 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, Building Safety. I further ccrtify that only contractors and employees .whoare 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 permit card 'is located at the front of the property, and the approved set of plans will rcmain on the site at all times during construction. a;/It- '?fA/1~ Owner or Coitactors Sign at re . I /t?6h D Date I - I ,".", ,t'. ". ".., Page 3 of 3 111\ 225 Fifth Street. Springfield, O~ 97477. PH(54 1)726-3753 . FAX(54I)726-3689 1,:";D~P,ARTM,ENTU~E'QN~y":1 fe~~ZOO ? - 0 '8'"f I I Date: /2.- Z >~ 0 ~ I 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, 1~':'~;';,:kl;iJ;~;)~,j'li:;:_[Q~G.AWY~QY'~BJff~i(gl~IJ~-~Jfi:{p:y'~,~T~i~:~~~~~i~I~~~1 '~~~~~~;e~ct has final land-use approval. Date: I t;~~-:t<;_~,E:r.,f:~RYi_\r~;;f\::~~n.~~g-i;"~~-'{~QUIJ~1]:'q_r~~~:":i;~?)~:~-~~;::r~:-~,:~>;;2~1 I T~is project has DEQ approval.. I ::ri3:~YaJ~~~H~~Ii~f~flI{~Hp~Q;&t~4~}i;~f;1r~W:t~l~rt~~~~j~t~~~~}l;if~1;t~~'w~\~;~{,:1 Signature: Date: (a) Job description: Ad&! )>",~"......I'tl r",ou.r.:.- "til. r", r&>o>"'" I 6-1 In""III....",, "'V'I(..fi~"~'l"'&Q,r'::'f1t'~ I Zoning approval verified: 0 Yes 0 No I I Occupancy i< ~3> - - - I I Property is within flood plain: 0 Yes 0 No I I Construction type: wOilj-fhun e...- I 1~!~~~fi"iticl&jlfG.ATE't;'G[YI!1i:)Fcl!J::.QNs;fi'flrcj;I9_~1~;jg~~f~1$1 I Square feet II (" I , 0Residential I 0 Govemment I 0 Commercial I I Cost per square foot: 11 2. . 1~{~:r~;~~};~~~~g'ijt'i~It$lT~~9fi~_A-T~Q~lAtip'~~~:'-G~T[Q:N-~~~J~~f~~~;~ I Other information: I I Job site address: 2t;:~ W. /1t1Jt1:AIWt~AI 5/pti. I Type of Heat: ~I<.<:-t(i", kyho>;}f;J r.,-"""I~ ,<:.0, I I City ~ I'll tAGt -Cr~J r) I State 0 R.. I ZIP'j 7+17 I I Energy Path: / I I SubdiVISion: .sUtlt,l/t;.If~J... I Lot no: ? I I 0 "'" . I I I I I' new l.!!I alteratIOn 0 addition Reference /7,ogZJ7.44- Taxlot: 0/301 .. 1:(.:, :. (, p,R6PE_R'6{'9WN~R):'.? .,\.~\ ':..'.,1 : (b) Foundallon-only permit? 0 Yes 0 No I ! ~~"~~;~~rf:~~~:"A7~~ i'f~i~~\~~~~UPI~~~~ I (c) Reinspection ($ per hour): I I I E-mail: st(ChevtkhlA.ft.iI>-li!1f\ ~_ a Q J. c..o/lV1 I (number of hours x fee per hour) $ This installation is being made on residential or farm property owned by (d) Enter 12% surcharge (.12 x [2a+ 2b+ 2c]): I $ .2.. :;. ,41 me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. /..-d Iq~0;i~~~~t=I,~:r,~;'~~~;~;;~~~~:~:;~~~~~~i>b:.~~~~::,11 V SIgn here ,---- 1::/~K I /t4 ~ ,_~_._.j:},..aJhr~:n~~t~~~s~J~,t>~:gi;;Yt.fi,W;;L~'~.'~,~~...ri .~~t,,"f1;iti~~'.'&..~~'k~\:&.,jf& tll L:'", " : i::N~AC;tjO}~I@;J,ALLATI~L.:"..;;\;:,:-",;;): ..,i;;:.J (aJ Plan review (65% x permit fee [2a]): I $ 1,~,"l1 fa 7 - I Business name: ;r. d '3. H /JI+MAN ,,-,O;.j<;7:': t'.o I (b) Fire and life safety (40% x permit fee [2a]): I $ 4oz. "10 I i ~:::i~~~dtl.l::~~M ~,; 414 711 i~~~~~i~~~f~~~~I_~~~~~i ~ I ~",I' k'" rI 'I I TOTAL fees and surcharges (2e+3c+4a): $ "''''.-''',''121- E-mail: '.~'c.rVlr"" r1u"i"'la"1 '!!E I1nl. ("'1M .;>" i' I CCB license no.: :Y' 2- 'Zfp I I Print name ::;:; t'ephevt k, Hi.J.ft:W1.t1 tI\ I Signature ....~,' ....... /V?~ h~~~~~;\:tf:fr~l~tr;fl~~{j~.~~'~G~fiw~'~GI9R,~I.NJT,9R~:tIQ~W~~f:\~i}~~r!-l I Name I CCB License Number Phone Number I I Electri~al I fiAt FIU_ 541- 7?t,-Z'Jhl -"f/r<:>r 1.Je,4t ~/et.trrc... (w~>1e Syll,'4'i~t-'lII.) . I PlumhIng I Ot,J FI/.Ir S<'/t-4{,l-IQ()4. ..;>!Mv>'\e PY(t",,/;ltY1~ "'''\':'d~')\.,''vafioY\.. I Mechanical 2IIz.:z.t& ~~1'7<17.717~ -?<r6.~ 1itJ~YI4";' . 225 Fifth Street. Springfield, OR 97477. PH(S41)726-3753' FAX(541)726-3689 ~\Vflf;~,~~~~J,ro:~~~i![~J;_ P;-~t::ZOC? -01 S"3{ I Date: 12..-23- Or I Electrical Permit Application This permit is issued under OAR 918-309-0000. Permits are nontransferahIe. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 1_!!:Q.GI,\j..~GQ:Il~@Mt;Nif;i@J;>;BKQWk:I!.~1't;EElfs~e8ED1iJl!!E~~"i~,!"'1~,,- .",_._._".~___,_..,. '_~h._:Jf~.i1~M&1%fu'~;z-~ 1 Zoning approval verified? DYes . D No Q':~ll!Il'!iilQ!t~llto.!ll~*i =;~~]E:GjR~~~~7~:~mRQ~ff80~~~~~~ II Residential, per unit, service included: ,,,,gr,,, ~?;~, '.l:.Q~tl1l!!11 ~::~~;:I~E~~~MijO~~~~;~~I~~ d I ~~~o;~i:~::II~S~O(:~ ft. or portion :1::::::.1 1 City: S P.f'.i 1 State:~ 1 ZIP:77C(7, I Limited energy (2) $ 32.00 $ 1 .1~~~~~~~ti~;O~lI~E~W~~~~~~~ I ~~~~I::nS~~~~r~~~~~:r(~)odular $ 63.00 $ I I A-dl7,4-~~ ~ c.lrc.V\.~~ - ISerVi~esorfeederS:jnstallation,a!terationJrelocation I 1~~~'eROeER~i!QWNERfo'~<~Y~""""f;~';~,~ i ~:~ ~:~oo::: ;:~ ~ ::::: ~ : 1 N:me: ;;~;' '" <;;;A-~A~3;;::'1!;;:;;:"'-"'" I 401 to 600 amps (2) $158.00 $ . 1 1 Address: ZS3. J. Ce-4e-...",,'.4-! 1?J1I.!. I 601 to 1,000 amps (2) $205.00 $ 1 I City: > f'r .d.. 1 State: o<L I ZIP:') 7 4 ., 7 lOver 1,000 amps or volts (2) $469.00 $ I 1 Phone: ':)14. I - 747 - OS\(t( Fax: I Reconnect only (2) $ 63.00 $ 1 ! E-mail: ~ ~~ \l..J.,,,,,,",,,,",,,,,,,,,," L 4(l)( .l":~~ I Temporary services or feeders: installation, aiteration, relocation I This installalito is being made on residential or farm property I 200 amps or less (2) $ 63.00 $ I owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 67.00 $ I property is not intended for sale, exchange, lease, or reot. OAR I 1 1 I 479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $ Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I . 1~~C.oNm@iCil1"t:)~1'lINsJf,~I!I!~m[ot;j"S~~'ffl*,'}Jij I Branch circuits: new, alteration, extension per panel 1 1 Business name: r-:;'4.. <; 't- L;"j;1't- "F/;. ./14 ;c.:J::,/ t: I a. Fee for branch circuits with purchase of a service or feeder fee: I 1 Address: r;-g..z:r7 7 ~I ';6 /f- ~ ov.-L' 1 Each branch circuit 1 1 $ 6.00 1 $ I 1 CityGyO,.(";~j1::;..~ 1 State:O"<:' r ZIP: 97'/),ifl b. Fee for branch circuits without purchase ofa service or feeder fee : I I PhondY/,rr.b-7'ZA..3YLF~.yf )Z~-02.96/ 1 First branch circuit (2) I $ 55.00 $SS"'I 1 E-mail: 0/ ~ >,!~;{J,": 7-'(3 ~.-<--" cp,;...,j. Each additional branch circuit l-{ $ . 6.00 $ 2-4 I I CCB license no.: / '7 9'0// h I BCD license no.: C -",- .?~ A 1 MIScellaneous fees: service orfeeder not included 1 I Signing superviso~'s license no.: ty"JI.yO -S . I 1 Each pump or irrigation circle (2) . 1 $ 63.00 $ . 1 I PrintnameOfSigningSUpervisor:~:z: e /YJ '~-~~~{' _.i3JOl>signoroutImelighting(2) I $ 63.00 $ 1 I Signature of signing supervisor: A ./2,y Signal CIrCUIt or a lImited-energy panel, $ 63 00 $ I ~ 4n-""7'./':1~ _ alteration, or extenSIOn (2) . ,rt \ ~ V v ~ v 1 Ea~h a~~tiona~ ,insp:~t:,~: (!L..... I.... . ~:B:~O__~ . 1 ~ &:J.J'<:iJ~--. \ ~~~~1\:~P,l!tGP;.Njli3llliS~~~~ \ (\ ~ . \ (A) Enter subtotal of above fees \\. 'c:t' ,(\ I (Minimum Permit Fee$58.00) $ 7 't \\\\\\v \\' 1 (B) Enter 12% surcharge (.12 x [A]). $ Q /.161 '\::tY'v\i. ~ 1 (C) Technology Fee (5% of [A]) I $ 31 97 \ l.tj.. 1 TOTAL fees and surcha;ges (A through C): - $ 9 2 ~.. '~~ 440-2584-J (9/08/COM) . Plumbing Permit Application IC.(Ci:tDE#ARTME'NT'uSE;ON~y:~~.:fj;1 " -,- '.+.' '. 1- ',,', """"':"::':-:" I Pennitno.: C"f -J-t?3J I ID~: 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. 1.;":dfiC'J?i:r"0fl!OQAL:GQVERNI\IIENl',,ApPR0VAl!i~~WJPD*;~,:II I Zoning approval verified? 0 Yes 0 No I I Sanitation approval verified? 0 Yes 0 No I I . . CATEGORY'OF.CONSTRUCTI0N I I a;(Residential I D Government I D Commercial I 1:,;UiP:;JOEliSiJE .IN FORMf!.t:lQN:ANP;';L0QAl'ION:'J)l\',j~Cim Job site address: ?-t:;-; Ill. t.v-.ft...",,'a/ aNti. I City !:f:;f'I'r-.o.~,'eJrI I State: 0fL I ZIP: Cf71/.17 I I Reference~ li-o; 2.1- '1'1 1 Taxlo!.: I so} I 1,';"';'.i';~;,\;;';'.))f';,;:'DESc::RII;'TION."OF.::W.0RK;;"t~j';:;;,\::~i;"lY*(i:;1 I 4cltl baf4too,.,/re!au.fe.lJ.hllz, nfflf by ,;,MI. I I illc, l"1/d,~ qm~t a~ ' I I '\H' , . , ;. I PROPERTY;!OWNERT'~:i I Name: S1i"~tivfd tf1dn6. ItI./f+Wlo.Y\ I I Address: ~'6~ W' ~te4f""A-/ 13/l1li. I I City: 5,tJrll1~fle.Jal I State: oe I ZIP: &11411 I I Phone::7'1t -?f7-dt;'f1f I Fax: I E-mail: "5,replt,e>'\kklJ~~~ ~ aal. LoW! This installation 'is being made on residential or rann property owned by me or a member of my immediate. family, and is exempt frO~g r~~ire~~. nts. der OAR 918-695-002. O. Signature: ~IIW~ I. ., . . . N"'ItACT0RJNSTAtlA'tION '.1 I Business name: &;w:,eVIR T?llttotlb,'>1c.' h.ca(J~h8<t IAcl I Address: ~2..1-4 A<<oWt1eaol 1?tJ' I I I City: ~~",..,..._. I State: oR I ZIP: '17tJ04. I I Phone:&A1 !<tr- '&;0+ I Fax: ; I I E-mail: I I CCB license no.: I BCD license no.: I I Plumbing license no.: .1 I Print name: I I. Signature: I 225 Fifth Street + Springfield, OR 97477 + PH(541)726-3753+ FA.X(541)726-3689 ,'~'t1 frt ~ '- 440-2500-J (11/08/COM) 1;~~:i:~~:;<,_\~,:P;:';;:7:V:,~.j~j0:i;t%J;;:+1:.t:F'E-E ~is:bR E t), U Et:;:i~'~\: ';._~~::':~~~\~+:~"IY:~"!~i:Wj?Tf~~{: I IliR,~~5~l~Es~jl~~);~iy:1:~~~::;;i;\iilti;;~~121%1;.!.:~~R~f,ll~l\.~~WI:0I. I New residential I I bathroomll kitchen (includes: first J 00 feet of water/sewer lines, hose bibs, ice maker, under floor low-point drains and rain~drain packages) 1 2 bathroomsll kitchen $374.00 $ I 3 bathrooms/l kitchen $439.00 1 $ 1 Each additional bathroom (over 3) $95.00 1 $ 1 Each additional kitchen (over I) $95.00 1 $ I 'Residential fire sprinklers (includes' plan review) I 0 to 2,000 square feet $58.00 1 $ 2,001 to 3,600 square feet $t16.00 $ 1 3,601 to 7,200 square feet $174.00 $ I 7,201 square feet and greater $232.00 $ I Manufactured dwellin~ or pre-fab (circle one) I Connections tabuilding sewer and I I $5800 I $ water supply . I Commercial, industrial, and dwellings other than one- or two-familv I Minimum fee I I $58.00 I $ I Each fixture $19.00 $ I Miscellaneous fees 1100' stonn, sewer, water line I I Each fixture, appurtenance, and piping I b I Storm water retentioi1/detention facility Irrigation systems . Piping or private storm drainage svstems exceedine: the first IOO.feet I Specialty fixtures Reinspection (no. ofhrs. x fee per hr.) Special requested inspections (no. of hrs. x fee pe~ hr.) . Each additional inspection: (1) $238.00 $ 1 1 1 I 1 I I 1 I I 1 I I 1 I $ I $1\4_"" $ $ $ $ $ $ $76.00 I $19.00 $19.00 1 $19.00 1 $19.00 1 $19.00 1 $58.00 1 $58.00 I $58.00 $ 1 I I .1 KMi'ij'i~~lr~~~s:n~f~l~"li'~t~~~~:~i~~?i!Y~M~~~;;:l Minimum fee $ I Enter value of installatlon and equipment $ _" I Enter fee based on installation and equipment value. I $ 1~,~~~"~~g~iEi:G'~Njj';{iJ.S:~~~ I (A) Enter subtotal of above fees $ (Minimum Permit Fee $58.00) n foP 1 (B) Investigative fee (equal to [A]) $ 1'1 I..j.QOI I (e) Enter 12% surcharge (12 x [A+B]) $ '-;'%1 1 (D) Technology Fee (5% o[[A]) $ C, '10 I TOTAL fees and surcharges (A througb D): $ 2~ t.~l Mechanical Permit Application 1,;j!;;i8~'r;~RJ~~1iIQ~~:;,QNBX:~'!j~~ I Permit no.: C'J - l-K';l I ID.~ I 225 Fifth Sireet . Springfield, OR 97477 . PH(541)726-J753 . FAX(541)726-J6B9 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. 1~)~":St;F:?{:~CAJ~G6RYA'QFj;1C;Qr'I~IRUGtI6N~\'::::':;.,';';,'.'.' ;":1 I [!I'Residential I 0 Government I 0 Commercial I ~~q1l*1;;:tQEl%~lm~'IN;~9RM)fi[[QNK~Nt:iJ;WQ'(;;~]jQN~,:F:::;~n;1 Job site address: '2t7~U). CUtf.€.W1laJ ~lvtl, I I City S pr,'flAf;e/e/ I State: O~ I ZIP: q14n 1 I Reference: 17':io,?>- 27-'/11 I Taxlo!.: I?oJ I I ..'OESCRiI'TiON OF WqRK .. ;.1 I Adct b4'1hrfJO.... / reJJCCttr:. utility TcOfPI I;;q /~(-I1I;)r1 I fJ.~i'i.f1n~ f1():{d,ge~~. 1"',;>;,.,;;":i!\''''',;G:,!#'''t.P.R....o':nE.~R.:ry'liO.:..W~ .'N..E...R...:!f'~:;~'if)J~"'''''';''';l'~'' ;t\~!f<'i~:~.;;'t1~~:;'~;:,'\~~~.ty~, ,.:C.",..,,};L, ,.";'!L~::',~~,:,.,,,,,~, ,~,"" "~_ ;)f~/!"L,;Hi,~~~\~.A\;;l$1!f'h;.,-,;:.,;;! I Name .ste~e ().vld MD.rra 11M f.(1fV/fM. I Address 2.5~ W. ffJNltplliJ}iJ./ J!,/.t,.J, City 5pri ..,c,{jc.!e{ , I State: OR.. 'I ZIP: q70 771 Phone'5If1-717-"~r;# I Fax: - I I E-mail: s:kp~e'lkku~M tfl! oof /fJPIA I This installation is being made on property owned by me or a member of my immediate family, and is exempt ITom licensing requirements under~RS 701.010. . Signature: ~ I.""",,, ,'0:.'. ,. ..... ."'.", .Y;.. '-;, ...- ""","i". '.""".x;,,',i,,, c,. ~'"!"Jli,",,,,..J~".U. N,r, ACm0R.,1 .. Att'~",,,, ~.,"J;;l'i..3;;:~)","=t'O."," ,_." ___,~_ :. _ ~ ,.~. ".. ..'.. "'_..> _1;,,:_ ..j"_h_' ._....%. _. _. _ .~_.t.. 1 .. _ ,_ _'_..'. .h"'O!;.; .,.c~".,.". \ ,,::.;,"':".'.~<-.'''::;~ I Busin~ss name: S ~ c:; ffUFF M>4~ tbt>\s.r. Co. I Address: 2'7-; W CU/Lte<-tYlIc.J i3/Vq. I I City: '>;;.JI>If',yte,Qe./d I State: ~ I ZIP: qN77 I I Phone:S1I-7<1-t 717t/ I Fax:<;VI-7l/}iJ7f I I E-mail: ~ill-te..vtI<LAlA<<."l-liUA~)l1oJ{..;)-W.I1 CCB license ~o'.:' 'Z,Cf'2.U - 1 stefh~ k, rtuAAMtJiA I -~~~-0tWw~ I Print name: I Signature: 440-2545-) (lI/OBICOM) I" . .". . .." FEE SCHEDULE' .., i~~~!,~~~:~;1f=~;?;\'(~~1'9ri:,IQ';:~~~;tJ~,I%;1~;, Wurnace/burne'r including ducts and vents 1 Up to lOOk BTU/hr. I I lOver lOOk BTU/hr. I Heaters/stoves/vents 1 Unit heater Wood/pelletlgas stove/flue Repair/alter/add to heating appliance! refrigeration unit or cooling system! absorption system . I Evaporated cooler I Ven! fan with one duct/appliance vent ! Hood with exhaust and duct I Floor furnace including vent I Gas piping lane to four outlets I I I Additional outlets (each) I Air-handling units, including ducts I Up to 10,000 CFM I I $11.00 I $ lOver 10,000 CFM $20.00 $ I Compressor/absorption system/heat pump I Up to 3 hpllOOk BTU I $17.00 I Up to 15 hp/500k BTU . $29.00 I Upt030hpll,000BTU .1 $43.00 I Up to 50 hpll, 750 BTU 1 $57.00 I Over 50 hp/I ,750 BTU 1 $95,00 I Incinerators I Domestic incinerator I .1 $20.00 I $ 1~.COmmercl.aJ:~;/~i~(~\ :~~\1f::~'~:~{;:E~~~~~~?~-\\:?:.i:~:,;~~~T~'.tP,:t~j,:'?~g;r:?{~t:;~:~;;.t:~'l I Enter total valuation of mechanical sys.tem and installation costs $ "'"""'""---- . Enter fee based on valuation of mechanical system, etc. $ ~~J~~~~J!E:~~~<~1:!~~,~4r~~W,(M~~i1JT~1~!!"?~~~I~,;;~1~~t{~~] ;~?\~~'~~~{,iJ; .1 Reinspection $58.00 $ 1 Specially requested inspections (per hr.) $58.00 $ 1 Regulated equipment (unclassed) $13.00 $ 1 Each additional inspection: (I) 1 $58.00 $ , I'>-~'~-"'."t'~-"'"'''~''flr...,..~=..~.~._..,.".__.''''~~-'''''''''."",-"",~,. l~,~~f~~f;~~,;'~~~~~~;,:1t1\~H:l;tGANI~J.:lSE~,Bk~~~?ITj~~?:~~'f1&~~~11 I (A) Enter suhtotal of above fees (or enter set 88.tJt!J- minimum fee of $ 79.00). $ ~ I (B) Investigative fee (equal to [A]) $ ~ I (C) Enter 12% surcharge (.12 x [A+B]) $ ~. I (D) Seismic fee, 1% (.01 x [A]) $ ....::H!- I (E) Technology Fee (5% of [A]) $ ~ I TOTAL fees and surcharges (A through E): $ I~- $17.00 I $ $20.00 $ $17.00 $38;00 $ $ $58.00 $ $13.00 $9.00 $13.00 $58.00 $ $q. "D $ $ $7.00 I $ $4.00 $ $ $ $ $ $ 225 F:ifth.Street Sp~ingfield, Orego'n 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-0 1831 COM2009-0 1831 COM2009-0 183 I COM2009-0 1831 COM2009-0 1831 COM2009-0 1831 COM2009-0 1831 COM2009-0 183 I COM2009-0 1831 COM2009-0 1831 COM2009-0 1831 Payments: Type of Payment Check cReceil1tl RECEIPT #: 1201000000000000004 Date: 01/05/2010 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture 1st Appliance Ven! Fan Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 12% State Surcharge + 5% Technology Fee Paid By J AND S HUFFMAN CONSTR CO Item Total: Check Number Authorization. Received By Batch Number Number How Received D18 7367 In Person Payment Total: ~. :'. 01':, Page I of I 10:33:45AM Amount Due 173.96 132.28 15.31 165.25 114.00 79.00 9.00 55.00 24.00 53.55 22.31 $843.66 Amount Paid $84366 $843.66 1/5/20 I 0