HomeMy WebLinkAboutPermit Building 2010-2-9
CITY OF SPRINGFIELD
Building/Combination. Permit
PERMIT NO: COM2010-00171
ISSUED: 02/19/2010
APPLIED: 02/09/2010
EXPIRES: 08/19/2010
VALUE: $ 146,000.00
Status
Issued
225 Fifth Streei, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5794 ORCHID LN
ASSESSOR'S PARCEL NO.: 1802033305100
SPRINGFIETYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Single family residence
TYPE OF USE: New
Residential
Owner: HA YDEN HOMES LLC
Address: 2464 SW GLACIER PL STE 110
REDMOND OR 97756
I CONTRACTOR INFORMATION ~
Contractor Type
General
Electrical
Mechanical
Plnmbing
Contractor
HA YDEN ENTERPRISES
TOP NOTCH ELECTRIC INC
PACIFIC AIR COMFORT INC
STUTZMAN SERVICES INC
License
92208
172366
39237
31747
# of Units:
Primary Occnpancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Secondary Constrnction Type:
# of Bedrooms:
BUILDING INFORMA TlON ~
II of Stories: I
Height ol)tructu..e 14.50
'Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path:
Sprinkled Building: nla
I
R-3
U
VB
2
I DEVELOPMENT INFORMATION ~
Frontyard Setback:
Side I Setback: .
Side 2 Setback:
Rearyard Setback:
Sola'i Setbacks:
10.73
12.00
10.73
10.00
15.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Expiration Date
07/29/201 I
09/29/2010
03/25/2010
05/1212010
Phone
541-228-6935
541-317-1998
541-672-9510
541-928-8942
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
5,414
832
560
REQUIRED PARKING
3
Yes
25.70
Total:
Handicapped:
Compact:
2
Subdivision Not Accepted I PUBLIC IMPROVEMEN'M iENTION: Oregon law requires you to
IUIIJN rules adopted by the Oregon Utility
Street Improvements: Notificatio~ieW\WI.1iJtRl'~e rules are set forth
Storm Sewe,' AY?!Hb)f:E: . ORK In OAR 95frOO~sQ,~WstIYP.IW!1 OAR 952-001-
Special Instruct\~?,'3 PERf~~T ,8t!ii.%1!r<fj(jfillf.r.~~IJtt1~}~J'\.'l'M't is the '@~Rrm'(ql.'f-~&~Ip'BRE.ItI~q~~~(~~~fYhe City
'\ ITHORrfl~l\.li'lt:\1liW1\& ~~J\r~'1h\h be made Rl\JYIlGJIlD.l1flfllll fn rJn)!, j!.Js IllbklW
Notes: Storm';'"ater tocLC i>d!liontilm~[j)<fi~ouncil". nurril:leddr lhe. Oregon t 0't11l I
COMNitl~ Utf'I~ 1\" '/ " ' Center IS 1-800-332-2344).
ANY 180 DAY PERIOD. . "
Pa~e 1 01'4
-~..~
. ..... ,.....-."..,. N" '" __d,;i"
Status
Issued
225 Fifth Street, Springfield, OR
54f-726-3753 Phone
541-726-3676 Fax
54 J -726-3769 Inspection Line
Description Tvpe of Constrnction
Bid Amount Use Bid Amount
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
I Bath One & Two Family
1st Appliance
Addressing Assignment
Appliance Vent
Building Permit
Curbcut Permit
Dryer V en t
Exhaust Hoods
Fire SF Fee - Residential
Gas Outlets 1-4
Plan Review Major - Planning
Plan Review Residential
PW Disc - 2nd Permit
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Compliance Charge
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Reimbursement
SDC Transportation Admin
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
Wmamalane Single Family
Total Amount Paid
I V aluation Descri~tion ~
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
146,000.00
,.',;;. I'
, Total Vitlue of Project
~
Amonnt Paid
$176.76
$91.50
$220.00
$79.00
$38.00
$9.00
$895.97
$88.00 "
$9,00
$\3,00
$69.60
$7.00
$2 I 1.00
$582.38
$-30.00
$\34.00 "
$25.00 "
"
$352.74
$463.89
$10.00 '
$22.63
$1,333.57
$101.97
$118.03
$211.21
$22.17
$88.00
$307.98
$63.00
$18.00
$2,858.00
$8,590.40
Date Paid
./" ,
. .,',
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/1 0
2/19/1 0
2/19/10
2/19/1 0
2/19/10
2/19/10
2/19/10
. 2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
2/19/10
Pa2e 2 of 4
"
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM201O-00171
ISSUED: 02/19/2010
APPLIED: 02/09/2010
EXPIRES: 08/19/2010
VALUE: $ 146,000.00
Value
Date Calculated
$146,000.00
$146,000.00
02/09/20 I 0
Receipt Number
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
1201000000000000152
120ioOOOOOOOOOOOl52
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review
Planllilll! Review
02/09/20 I 0
02/09/20 I 0
I Plan Reviews ,
02/09/2010 OK
02/09/20 I 0 APP
Structural Review
02/09/2010
02/09/20 I 0 WE
Puhlic Works Review
02/0912010
02/10/2010 .
APP TSS
Structural Review
02/18/2010
02/18/20 I 0
ACC CJC
Structural Review
02/1812010
02/18/2010
APP CJC
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00171
ISSUED: 02/19/2010
APPLIED: 02/09/2010
EXPIRES: 08/19/2010
VALUE: $ 146,000.00
DJB
DDK
Access restricted to I driveway/lot.
Follow street tree plan.
The 40' long garage does not meet
prescriptive wall hracing
requirements of R602.IO. The
applicant has heen contacted and
advised to provide engineering or to
revise the plans to show a garage
wall length no greater than 35'.
CJC
For this parcel in Jasper Me"dows,
it is the recommendation to the
Building Division, hy the City
Engineer: "that no connections shall
he made to sanitary or storm H20
systems, until the subdivision is
accepted by City Council".
Stormwater to curh and gutter
unless storm tap is provided.
Revieved engineering for wall
bracing for review
As noted on plans
To Request an inspection call1he 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.
l....Jl.eo lIi~eCU nsnections I
Site Inspection: To he made after excavatioil'but prior to setting forms.
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
Footing,: After trenches arc excavated.
Found"tion: After forms arc erected but prior to concrete placement.
Post and Beam: Prior to noor insul"tion or decking.
Floor Insul"tion: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials.
Paee30f4
-G:;~'D.'..iiJ';
~-~
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fa,
541-726-3769 Inspection Line
':'
,.. !;
PERMIT NO: COM2010-00]7]
ISSUED: 02/] 9/20] 0
APPLIED: 02/09/2010
EXPIRES: 08/19/20] 0
VALUE: $ ]46,000.00
Framing Inspection: Prior to cover and after all rough in inspections have been app~oved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Final Building: After all required 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.
Vnderfloor Plumbing: Prior to insulation Or decking.
,
UndertlooJ'Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Sanitary Sewer Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
\;. .t,
Rough Gas: After line is installed and required'testing'and capped ifnot attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
Rough Mechanical: Prior to Cover
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
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 wiII be made of any structure,without permission of the Community Services Division, Building Safety.
I further certify that only contractors and empIoyees'1:vho are'in compliance with ORS 701.005 wiII be used on this project.
1 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 wiII remain ou the site at all
times during construction.
--~.~~~~
'--;/-/<7-/0
.
Owner or Contractors Signature
Date
Page 4 of 4
-Z/9 /0
I
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
Electrical Permit Application
. I I
225 Fifth Street+Springfield, OR 97477. PH(541)726-3753+FA.X(541)726-3689
~i~ii[qfiil'J.1~i..@~~R&MEN~~~Fig:8.:QYi~_[f~~~~~
Zoning approval verified? 0 Yes 0 No
. ~~it~~i~~ill~:G:~~if~Q~1{9'@)1~$l]BJU~~IUf>JJ1~~~~t~~
o Residential 0 Goverrunent 0 Commercial
~~1iJlf~1;~fiiE}fjLr:jR~i[M~if:I,Qt~~.~P~~Q~Q~%(QN1~~ti;;;#~!
579lf OfLtfl
City: ZIP: '1Nn'
"
/8020:S:S 0 S to c:::,
~~~T_~~RJtQg~~:1i'(~~W~:~~I!?i1r~1~~~~~~-I~~~fl~~
Name: \-L, d,,,,
Address: '-/ t..
City: I< ",o! VVlCV< .vi
Phone: 59/- .2.13" (0<)"55.
E-mail:'
("'c '"
State: 6 P. ZIP: '1775'0.
Fax:5?//-7'II" ,;757:? .
This installatiou is being made ou residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560Q).
. ~.
Address:
City: &
Phone: 51 ,/- 311.I9Q<?
E-mail:
CCB license no.: -;
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor.
ZIP:
440.2584.) (9/08/COM)
~f~ip~R4R~@:~~i]t~~l9,:~~&fA~~
CO ~ Zc) l" - 0 cJ I 7{
Permit no.:
Date:
1,000 sq. ft. or less (4) $134.00
Each additional 500 sq. ft. or portion ( $ 25.00
thereof-
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00
dwelling service or feeder (2) $
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
40 I to 600 amps (2)
I $ 63.00 $ b
$ 87.00 $
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase ofa service or feeder fee:
Each branch circuit
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited~energy panel,
alteration, or extension (2)
$ 63.00
$ 63.00
$
$
$ 63.00 $
Each additional inspection: (1) $58.00 $
'-J;~'~~''''''''fffi! \H'ffi~I''8;''~N''ffii~W;'S<~E.F!!If,,;, .'!!),,;(j!''''''',1\)fj''0.
;~~4~~;' ""!*~~I~;,t,, '~<8,~9.t;LJ.!1S~H~ . :JJ.:~~~~~;a~-k~t~~~.~~~:'t>;,
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
'(B) Enter 12% surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
TOTAL rees and surcharges (A through C):
''':.......
JOURNAL OR JOB NUMBER: COM201O-00171 <n
NAME OR COMPANY: Havden W
LOCATION: 5794 Orchid 0
0
TAX LOT NUMBER: 1802033305100 U
DEVELOPMENT TYPE: Single Familv Residence <>::
NEW DWELLING UNITS I BUILDING SIZE (SF; 0 LOT SIZE (SF): 0 W
I-<
<n
I. STORM DRAINAGE -
0
DIRECT RUNOFF TO CITY STORM SYSTEM ~
I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I
I 823.75 $0.374 = $307.98
RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. , x I COST PER S.F. I x DISCOUNT RATE ~I DISCOUNT I
r 0.00 I $0.374 50% $0.00
ITEM I TOTAL - STORM DRAINAGE SDC $307.98 I $307.98 1070
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
r NUMBER OF DFU'sl x I COST PER DFU I
, 16 , I $28.99 I ~ I $463.89 1091
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x , COST PER DFU , ,
I 16 , I $22.05 I ~ I $352.74 1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC ~I $816.63 I
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRJP RATE I x I NUMBERIOF UNITS I x I COST PER TRJP I x INEW TRJP FACTOR'
9.57 22.07 , 1.00 , = I $211.21 1093
B. IMPROVEMENT COST:
I ADT TRJP RATE I x I NUMBER OOF UNITS I x I COST PER TRJP I x [NEW TRIP FACTORI
9.57 $97.35 , 1.00 , ~ I $0.00 1094
ITEM 3 TOTAL- TRANSPORTATION SDC = I $211.21 I
4. SANITARY SEWER -MWMC
A. REIMBURSEMENT COST:
INUMBER ~F FEU's I x I COST PER FEU I
I $101.97 , = I $101.97 1054
B. IMPROVEMENT COST:
INUMBER?F FEU's I x ICOST PER FEU I
I . $1,333.57 , = I $1,333.57 1055
C. COMPLIANCE COST:
INUMBER?F FEU's I x ICOST PER FEU I
I $22.63 I = $22.63
MWMC CREDIT IF APPLICABLE (SEE REVERSE) ~ $0.00 1054
MWMC ADMINISTRATIVE FEE = $10.00 1056
ITEM 4 TOTAL - MWMC SANITARY SEWE.R SDC ~ I $1,468.17 I
SUBTOTAL (ADD ITEMS I, 2, 3, & 4) I $2,803.99 I
5. ADMINISTRATIVE FEE:
I SUBTOTAL I x I ADM. FEE RATE 1= I CHARGE I
r $2,803.99 I 5% $140.20
TOTAL SANITARY ADMINISTRATION FEE: I 118.03 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: I $22.17 1078
Todd Singleton 2/10/2010 TOTAL SDC CHARGES -I $2,944,19
PREPARED BY DATE
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUlV ALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONt Y THE NET ADDITIONAL HXTIJRES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 1 0 3 - 3
DRINKING FOUNTAIN 0 0 1 = 0
FLOOR DRAIN 0 0 3 - 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 - 0
INTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 - 0
LAUNDRY TUB 0 0 2 - 0
CLOTHESWASHER / MOP SINK 1 0 3 3
CLOTHESWASHER - 3 OR MORE lEA) 0 0 6 0 I
MOBILE HOME PARK TRAP II PER TRAILER) 0 0 12 0 I
RECEPTOR FOR REFRIG / WATER STATION / ETe. 0 0 1 - 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. I 1 0 3 = 3
SHOWER, SINGLE STALL 0 0 2 = 0
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 - 0
SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 - 3
SINK: COMMERCIAL BAR 0 0 2 - 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 - 0
SINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 - 1
URINAL, STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
TOILET, PRIVATE INST ALLA TION 1 0 3 = 3
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS I 16
*EDU (Equivalent Dwelling Unit) is a dischar~e enuivalent to a sinple familv dwellinp unit (20 DFU's) set at 167 pallons per day
.........
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
]992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RA TE/$I ,000
ASSESSED VALUE
$5.29
$5.29 , I
$5.19
$5.12
$4'98
$4c80
$4.63
$4.40
$4.07
$3.67 ..
$3:22
$2'73
$2.25
$1.80
$1.59
$1:45
$1:25
$1.09
$Oc92
$0.72
$0.48
$0.28
$0.09
$005
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
2
2
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE /1000 CREDIT RATE
$0.00 x $5.29
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE /1000 CREDIT RATE
$0.00 x $5.29
o
$0.00
TOTAL MWMC CREDIT
=
$0.00
2~ willamalane
. t\it Park and Recreation District
Job. No.. (tID - 1'7 I
SYSTEM DEVELOPMENT CHARGE WORKSHEET
January 1-June 30, 2010
NAME: H-A-'I.DE'" ~QMES PHONE: 911.;1.ZF.6 "iJ'.S"
ADDRESS:2V~l/ SW IL/tl.1DZ-. CITY~M~b STATE:JL ZIP: q??rt,
LOCATION OF PROPOSED BUILDING SITE:
Street Address:5"7t7~ Q/2C /II /)
/' . /
""',-.~V
Plat Name:
Tax Lot Number:
1. DEVELOPMENT TYPE .(Check appropriate dwelling(s). Dwelling type definitions are on the
back.)
A. Sinqlei-Family Detached
NO. OF UNITS
J X $2,858 per unit =
,
$ ;;26'" \%
B. Sinqle-Family Attached
NO. OF UNITS
X $3,100 per unit =
$
C. Multi-Family Apartment
NO. OF UNITS
X $2,641 per unit =
$
D. Sinqle Room Occupancy
NO. OF UNITS
X $1,321 per unit =
$
E. Accessory Dwellinq Unit
NO. OF UNITS
X $1,550 per unit =
$
WILLAMALANE SDC $
2. SDC CREDIT (If applicable) SDC payer must furnish proof of
Willamalane Credit approval.) $
.. . .,__n_ n. ....
. .
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
$ :J-rJd
"2-t 1\Si IQ
Date ~
(9
~
Development Services Department
City of Springfield .
5
itii
...^............................
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Puhlic Works Department
RECEIPT#:
1201000000000000152
Date: 02/19/2010
9:21:56AM
Job/Journal Number
COM20 I 0-00 171
COM20 I 0-00 171
COM201O-00171
COM20 I 0-00 171
COM20 I 0-00 171
COM20 I 0-00 171
COM20 1 0-00 1 71
COM20 1 0-00 171
COM20 1 0-00 171
COM20 1 0-00 171
COM20 I 0-00 17 J
COM20]0-00171
COM20 1 0-00 171
COM2010-00171
COM2010-00171
COM2010-00171
COM20 I 0-00 171
COM2010-00171
COM20 I 0-00 171
COM20 10-00 171
COM20 1 0-00 171
COM20 I 0-00 171
COM20 I 0-00 171
COM2010-00171
COM20 1 0-00 171
COM2010-00171
COM20 I 0-00 171
COM20 I 0-00 171
COM20 I 0-00 171
COM20 I 0-00 171
COM20 1 0-00 171
Payments:
Type of Payment
CreditCard
cReccioll
Description
Plan Review Residential
Building Permit
Addressing Assignment
Willamalane Single Family
Fire SF Fee - Residential
1 Bath One & Two Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
I st Appliance
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
+ 12% State Surcharge
- Plan Review Major - Planning
Sidewalk Permit
Curb cut Pem,it
PW Disc - 2nd Permit
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC MWMC Compliance Charge
SDC Transportation Admin
+ 5% Technology Fee
"
Amount Due
58238
895_97
38_00
2,858.00
69.60
220.00
134_00
25_00
63.00
79.00
18.00
9.00
13_00
9_00
7.00
176.76
211.00
88.00
88.00
(3000)
307_98
463_89
352.74
2]1.21
101.97
1,333.57
10.00
118.03
22.63
22.17
91.50
$8,590-40
Paid By
HA YDEN HOMES/TIM
Item Total:
Check Number Authorization
Rece-jved By Batch Number Number How Received
Amount Paid
012481 In Person
Pay~ent Total:
$8,590.40
$8,590-40
nJm
Page I of 1
2/19/20 I 0
~'1; ,
~
, Permit Application
-
Strut
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FA.X(S41)726-3689
)7'15' (V\.litero.- \ ~'tJ.
SPF!INGFIELD ,';'.'}~"
DEPARTMENT USE ONLY
C~Z()/O. CO (( (
Pemllt no.: .
b-
::'~~ir~tr
Date: 2
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of ISSU
suspended for 180 days.
t:OCAI..GQYERNr!1ENT.ARPRQvAti, '0'</';"/'
This project has fmal land~use approval.
Signature:
This project has DEQ approval.
Signature:
Zoning approval verified: DYes D No
Property is within flood plain: DYes 0 No
~!S;~>!iji!5~WKt';ATE:G9RY.:\9Fk~.(j.N $.* RUGft(0.~t;\"ii:~i;i.t~.[: :i;.:: i
Residential- 0 Government 0 Commercial
.::':'WQ:i.l':$I:[E:. iNNOR.MAIf!D'N:)A~(j):i:iqli;.WT(;lH;:;f0f.W:i:',y::
5 'i4 () '01. '
Date:
Date:
CO>
.' <<'.<
.,.;"."
", .'
oQ
E-mail:
This installation is being made on residential or farm property owned by
me or a member ormy immediate family, and is exempt from licensing
requirements under ORS 701.010.
Sig'n here:
LATIQN;.,.c....
E-mail:
eca license no.: 0
Print name:
Signature:
:::~~.',!::_:0:.:S'::;'?T?;:~}1\[;$W.$.\G,~'t{iii3_~'QJ!9R>iN'"F,QR.,M,~~[qfNfL*:i~f;;,\:srr~:~t~ii;f~iX~
Name CCB License Number Phone Number
Electrical I 7.1) U,
Plumbing 31747
Mechanical 3'1,;1. 31
" c ..,FEESCH'EDULE
:i>Yai\iatrcihi~formiiti6;'{; i}: ",.'
(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot:
Other information:
Type of Heat:
Energy Path:
!Xl new 0 alteration
(b) Foundation-only perinit?
D addition
DYes
)a1'ro
("
Total valuation:
:f~~f~1l,m14:~p.g)t~:e.~};t.;~{~i;~;d:.tJ;$i~S~.ih~!~{~:~.'}i.~jJ~t~::rri::.~:::. :,
(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
. (c) Reinspection ($ per hour):
(number of hours x fee per hour)
(d) Enter ]2% surcharge (.12 x [2a+2b+2c]):
(e) Subtotal of fees above (23 through 2d):
$
$
$.
$
$
~~~~m~!R~Y}~~~f~~~~~J~~1{;~~~~~~~{{it1$%~~~~i~~~~iG~Jtt~1!l%~~~E~~~~
(a) Plan review (65% x permit fee [2a]): $ 5SZ. e
(b) Fire and life safety (40% x permit fee [2a]): $
(c) Subtotat of fees above (3a and 3b): $
$
TOTAL fees and surcharges"(2e+3c+4a): $