HomeMy WebLinkAboutPermit Building 2010-5-17
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-006I6
ISSUED; 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
VALUE: $ 2,000.00
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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SITE ADDRESS: 1030 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703264410200
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: Addition
PROJECT DESCRIPTION: bathroom addition (BWOP) owner disclosed
Residential
Owner: POLK GWEN M & IVAN B /;"TTENT/ON: Oregon' .
Address: 1030 CENTENNIAL BLVD "".oW rules adopted b aw reqUIres you to
SPRINGFIELD OR 97477' NotIfICation Center Th Y the Oregon Utility
In OAR Q~I') flQ1 e -' . ose rule.~ R"~ ref f..:. II
UU90. Vi I Q, ~ 'nroul~i~1
ca/~W~~q; ~
num~ Ore I"U '" e telephone
Contractor Type Contractor Center is l_~O~n UtIlIty ~ Expiration Date Phone
-332-2344).
BUILDING INFORMA nON ~
# of Units: # of Stories:
Primary Occupancy Group: R-3 Height,of;Structure
Secondary Occupancy Group: ' Typ~ oi'H~at:
Primary Construction Type VB " ,\'\Va:ter Type:
Secondary Construction Typei.10TlCE' ' '~ange Type:
# of Bedrooms: .' Energy Path:
1 ~IS PERMIT SHAL~~~\r~.lfe ""i'A~!\ivORK
'. I run"f..,,........ ,,,.___
. ._........ ",,,,,, n ,......" .....1-
'Jii"iMEfoJCEL D,EY,ELOPMF" ,
",',/ 1,';0 DAY PERICD,- - .._~ . ~..
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd: ,
% of Lot C,overage:
. 0,
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
T
XTION
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
h'e'i 'i; d,':Jl" ~
I V al~~~~;O~'D~~~riPtion ~
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee 1 of 2
i,
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM201O-006I6
ISSUED: 05/17/2010
APPLIED: 05/17/2010
EXPIRES: 11/17/2010
VALUE: $ 2,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid i
,.",l,
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliauce
Building Permit
Inspections - Other Plumbing
Minimum/Adjustment Electrical
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Amount Paid:""
,
'.....~ 'T~"
,~,i,'.." ~ ,,".
. Date Paid
Receipt Number
.'
\\1;"')'
$30.36:"" ';
$12.65
$79.00
$58.00
$58.00
$58.00
.,;:'1
5/17/10
5/17110
5/17/10
5/17110
5/17/10
5/17/10
2201000000000000506
2201000000000000506
2201000000000000506
2201000000000000506
2201000000000000506
2201000000000000506
Total Amount Paid
$296.01
Plan Reviews I
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.
'. \
Final Building: After all required inspectioii(iiav~ib'e~n' requ'~sted and approved and the building is complete.
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Final Plumbing: When all plumbing work isc,'complete:'
I Reauired Insnections ~
'1.~/; ., ..
Final Electric: Wben all electrical work is complete.
Final Mechanical: When all mechanical work is complete.
By signaturc, 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 descrihed herein, and
that NO OCCUPANCY will be made of any structure witboufpermission of the Community Services Division, Building Safety.
I further certify that only contractors and employees' who ar! in compliance with ORS 701.005 will be used on this project.
I further agree to ensure tbat all required inspections arc 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. ., ,
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I t
Date
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
22010l),0{iOOOO0000506
Date: 05/17/2010
10:01:59AM
Job/Journal Number
COM2010-00616
COM20 I 0-00616
COM2010-00616
COM20 I 0-00616
COM2010-00616
COM2010-00616
Payments:
Type of Payment
CreditCard
cReceintl
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Description
Building Permit
Inspections - Other Plumbing
1 sl Appliance
Minimum/Adjustment Electrical
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
GWEN FRAISERPOLK
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Page I of I
Amount Due
58,00
58,00
79,00
58,00
30,36
12,65
$296.01
Amount Paid
04313b In Person
Payment Total:
$2960 I
$296.01
~! [.
5117/2010
Structural Permit Application
DEPARTMENT USE ONLY
~'~_ '~_.'P';;pt"'N~~' ~";#t. ';\:fff~. "<:'=~:o;K",~.:~':-Y"'_-h,;j;1. 't'~~'~~~:r:.."f_...;pJ;. ""
~~.{/;;;-,.~I\fr OE;~r&J~*GFJEI;Q~,O_R.EG~9~~A~~*:"'1:;,~{'~ .
'225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
Permit no:tJ 10 - ~! (p
Date: >/17/1tJ
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days odssuance or if work is
suspended for 180 days.
, ',' ,~";,0;;,1.::0i:A~9QV~8N1iii~NT:j~8:Pe~QYAli.1~i!~;;);:lk!i~:j:;[l
This project has final land-use approval.
Signature: Date:
This project has DEQ approval..
Signature: Date:
Zoning approval verified: 0 Yes 0 No
Property is within flood plain: 0 Yes 0 No
~~~~~J~~,f~~tc:AtE'c;'9~X~OfJ1G,0NSjTRl.i(;miQN~~i,\;,"f;~[,g~}~~)
[2(Residential 0 Government 0 Commercial
\i'\\;t~J;;,,:';jQB;;jsltEI.INF.9r{MATI()N*AN'[j~t!.oc:ATI6r-1;;~iz;\iil*E#'.~
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;; ;;'" ::. - "\:':;~":;FEE SCHEijiJL:E""1:;'"
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(a) Job description:
Occupancy
Name:
Construction type:
Square feet:
Cost per square foot:
Other infonnation:
Type of Heat:
Energy Path:
D new alteration
(b) Foundation-only permit?
Total valuation:
D addition
DYes
DNo
Reference:
$
City:
Phone:
E-mail:
This installation is being made on residential or farm properry owned by
me or a member afmy immediate family, and is exempt from licensing
requirements un .010.
(a) Pemlit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
(e) Subtotal of fees above (2a through 2d):
$
$
$
$
Address:
City:
Phone:
E-mail:
CCB license no.:
State:
Fax:
ZIP:
....,. .:' <,'
Business name:
(a) Seismic fee, J% (.OJ x permit fee [2a]);
$
TOTAL fees and surcharges (2e+3c+4a): $ u,7 _
Print name:
Signature:
l~~1:~~:m~:\~:'~;;I~h;!{JsQ,E;i'-:G~NJ;~ACjt9f{I_~tO,RMArIQ~~'j{;~i~ifi~;~3!~tftfg$f['
Name CCB License Number Phone Number
Electrical
Plumbing
Mechanical
, [City of Springfield
,
~ Development Services Department
225 Fifth Street
Springfield, OR 97477
Planning Division Information She~t for Building Permits
Com mercia IJInd ustrial J M u Iti-Fami Iy Residentia I
The Planning Division requires the following information for.9ll building permit submittals on
properties zoned Medium Density Residential, High Density Residential, Commercial, or Industrial,
including new construction, expansions, and changes of use.
New construction, expansions, and changes of use to any building, parking, or development area in"
these zoning districts requires either Minimum Development Standards-MDS review (SDC 5.15-100)
or Site Plan Review (SDC 5.17-100) by the Planning Division. Overlay District Development review
(SDC 3.3-100) may also be required, depending on the site.
NOTE: It is prudent to make sure your use is permitted in the applicable zoning district. Building
Permit, Police or other permit approvals or inspections are not Planning approval.
. . .
ReQuired:_,roiect'Infof,matlOn- - - - ::-::-- ~--==-'~ .'. =--~--:;rAliplicint:coi1liilete. this segio.n)
A licant Name:
Com an :
Phone:
Fax:
Address:
- '.
ASSESSOR'S MAP NO:
TAX LOT NO S
Address:
Description of the proposed work to be completed under this building permit:
Has this development proposal been reviewed by the Planning Division
through an application process (i.e, MDS or Site Plan Review)?
if yes, Case #:
If no, is this a change in use? 0 Yes 0 No
Prior A roved Use: Pro osed Use:
DYes 0 No
'. .
. .
. . .
Zonin TOTZ: Overla
The proposed project requires submittal and approval of the following Planning application
prior to building permit approval:
o DWP Overlay District Development 0 Statement Letter Regarding ,DWP Exemption
o MDS 0 MDS Land Use Compatibility Statement
o Site Plan Review 0 Other:
Reviewed b :
Date:
Mechanical Permit Application
"<,>,,,:,,~',: C;::',.""i'.".:'~f",':~';',,","'.':~:,i.~ ..:,,,,,:-;~, :i:~,,,<;,,:;-,,'t, "., .l:~hC_',;':".\""""~ ,','
.'." DEPARTMEN:rUSEON(Y":"~:
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Peffilitno.:
225 Fifth Street. Springfield. OR 97477. PH(541)J26-3753 . FAX(541)J26,3689
Date:
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.
~u"r'.;i,,'2i'~'CAt~$bR.y~t:qF;?tq.Ni>TROCT'16.N',\;::r(\:':..:.'" !..,:
0Residential 0 Government 0 Commercial
~'!X1f~:~JQj:fi$@E'Tf~i~9RM~'t!P'N,\~ANQli~c!)'Q~J.IQNi;irJJ;','(Wi;
Job site address: 0 ~O . ~1'-'7E'JV',vJ"'l- <-
City: StatetlIL ZIP: C;
Reference:
~
ttf~}I~i0~iff~t~:*:'~tfQggRm~~:Q\j.j.~:~R~~~rifr,~j~i1\~~(it;::~A
Name:
Address:
City:
Phone:
ZIP: "'Jf7l.(,>?
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
Print name:
ZIP:
Signature:
440-2545-J (II/OS/COM)
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~,ij~~J~,~r.~~~)~~:i~'~!~ts~~~~#:~;:!;!r({j:~)t!t:;~.~: .'9~:I~~;,&~~~X!;, .....~otal ....
"~J-f;C'ost'::.;",
First Annliance /f' $79.00 $ f77i
urnace/burner including ducts and vents
Upto lOOk BTUlhr. $17.00 $
Over lOOk BTU/hr. $20.00 $
Heaters/stoves/vents
Unit heater $17.00 $
Wood/pellet/gas stove/flue $38.00 $
Repair/alter/add to heating appliance/
refrigeration unit or cooling systemJ $58.00 $
absorption system
Evaporated cooler $13.00 $
Vent fan with one duct/appliance vent $9.00 $
Hood with exhaust and duct $13.00 $
Floor furnace including vent $58,00 $
Gas piping
One to four outlets $7.00 $
Additional outlets (each) $4.00 $
Air-handling units, including ducts
Upto 10,000 CFM I $11.00 $
Over 10,000 CFM $20.00 $
Co m oresso ria bsorotion svstem/heat OUffiO
Up to 3 hpll OOk BTU $17.00 $
Upto 15 hp/500k BTU $29.00 $
Up to 30 hp/J,OOO BTU $43,00 $
Up to 50 hpll,750 BTU $57.00 $
Over 50 hpll,750 BTU $95.00 $
Incinerators
Domestic incinerator $20.00 $
..'," '/"'.
Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system, etc. $
~rMl~~~~D~f,l~e~~j!~~.~:;:tf~~~t1~~j~1~1~~:1~J~ ~.t~~l ~:~~~:~~~:;~ ~~:~~~~~kiJ '
Reinspection $58.00 $
Specially requested inspections (per hr.) $58.00 $
Regulated equipment (unclassed) $13.00 $
Each additional inspection: (I) $58.00 $
'~""t:~~,~.:ifi~'''~~'''x''~'~'~,'''>-:w_",~",~.,-"t.';~''tl'~"_~"_"'C~~~J!'~~~~~'
~j'B"~0flSA~r:r:t .~~~~,~~,~~P::b(QIV~.fJ;~tUSE;0J~fJ:;,?l~b~gfL,,~'4;~~:j{~1r;Htl;
(A) Enter subtotal of above fees (or enter set '71~
minimum fee of $ 79.00) $
(B) Investigative fee (equal to [A]) $ ~
(C) Enter 12% surcharge (.12 x (A+B]) $ q~o
(D) Seismic fee, 1%(.01 x [A]) $
(E) Technology Fee (5% of[A]) $.h~
TOTAL fees and surcharges (A through E): $ 4'2 4~
-
Plumbing Permit Application
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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~)Y :'STliio'CAL!hGOVERN M EN:r;fApRRqV AIY;;i:~<iBiY,lt:i~21'iiH
Zoning approval verified? 0 Ves 0 No
Sanitation approval verified? 0 Ves 0 No
CATEGOR'(OF CONSTRUCTION
B"Residential D Government D Commercial
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Job site address: It) 0 t!E;v7l:"J.I1V14L-
City: l-I> State: tffL ZIP:
Reference: Taxlo!.:
},$t~:~:.%~-~~"'::~~:':f}1~~\1r\J[)ES_CRI~;rldN~+'O~c~W,O RK;;~~~~~~~~rp',;~tj~~,!:~~
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225 Fifth 5t"et + 5pdngfie]d, OR 97477 + PH(541)726-3753 + FAX(54])726-3689
'.
,: v~ " ..PROPJ=RTY4~rOWN ER'~~~Hp~~~l~~r~W.~~~~~~Wf:~~~~
. Name:
ZIP:
Address:
City:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family, and is
exempt from lie ' quirements er OAR 918-695-0020,
~
Signatu .
'-,.",,{;;_,Il,,':tih. ,"'~'"
CONTRACT.
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
Plumbing license no.:
Print name:
Signature:
ZIP:
BCD license no.:
440-2500-J (] ]/08/COM)
Permit no.: (3/0 v (,. 1 (p
Date:
~ 17 10
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];":'-:,:;,,,j;,:,:,,,:~:~:.,:;:,,,:,:::.,;:"t~"t~:::,,r,,;;;
~ Qtf j Cost".... ;Total",
;.: ".~,,'" - '> ,~,</; ~ ,"~> - - :;;<'--
,.r.;.... ',~",k 0;~_d:.._e_a.~::-,~1:';L'~ ~.o~~ t .1;" ..'.
New residential
] bathroom/I kitchen (includes: first
100 feel of water/sewer lines, hose $238.00 $
bibs. ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms/l kitchen $374.00 $
3 bathroomsll kitchen $439.00 $
Each additional bathroom (over 3) $95.00 $
Each additional kitchen (over I) $95.00 $
Residential fire sprinklers (includes plan review)
o to 2,000 square feet $58.00 $
2,001 to 3,600 square feet $116.00 $
3,601107,200 square feet $174.00 $
7,201 square feet and greater $232.00 $
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and $58.00 $
water supply
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee I I $58.00 I $
Each fixture $19,00 I $
Miscellaneous fees
100' storm, sewer, water line $76.00 $
Each fixture, appurtenance, and piping $19.00 $
Storm water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private storm drainage $19.00 $
systems exceedinp- the first 100 feet
Specialty fixtures $19.00 $
Reinspection (no. of hrs. x fee per hr.) $58.00 $
Special requested inspections (no. of $58.00 $
hrs. x fee per hr.)
Each additional inspection: (1) I $58.00 $ ~
.
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~Me(Jic:il:gai:piping~%i&:'f~'.fJ.;;,::;;;'<;Y~;~?;,;:,' ~i Mi,nimum fee $
\'.,- .....' - ,. --- '".. -" """""-.'. '''''~'' ,',,,,,
Enter value of installation and equipment $
Enter fee based on installation and equipment value. I $
'"~!:;''"iiii;""",,'',"cJffiIn' ."..."!.![..... ~~~..~
K~.t'i;?~\:.t~~4{~ft;Jj,~~f?PIJl~ANrlf;'iLJSE\") ;...__ ~..,,; "~.,, .?~
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $
(8) Investigative fee (equa] to [A]) $
(C) Enter 12% surcharge (.]2 x [A+B]) $ 'f; en
(D) Techno]ogy Fee (5% of [A]) $ 2--~~
TOTAL fees and surcharges (A through D): $ t,'/~
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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DEI!ARTMENTUSE ONLY
. .~':,,: -
Permit no.: (!IO - C, / r;,
Date: s: i7 /0
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.
y,c." "EOCAL::GO"ERNMENT"AP,I!~OVAJ.')i:v~:t'\j'fj'W<'i
Zoning approval verified? 0 Yes 0 No
;l',:!;f:;;'.:,:,e.CATEGORY;~()F?CONSTRUCTION?:'R":'''' ...
ciResidential D Government D Commercial
~~21t1()Bi$lmE[HNI7:()~MA;rloNf:AND[;li.().CA'liION~~~~~l1
Job site address: C61VTC/V,lVI~
City: State:tTll. ZIP: 1?Lf?1
Taxlot.:
"DESCRIPTION.OF- WORK:::;": .:'
At> tv ('
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Name:
Address:
City:
Phone:
Fax:
Business name:
Address :
ZIP:
City:
Phone:
E-mail:
CCB license no.:
Fax:
BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-J (9/08/COM)
:? ;'~:',~!i~~~{;y~.~\i::'~~~~~~~~~iI;EE~S'CH ~DQ ~Ef:)i~~nWf~~f~~t~~~~,fif~
.. .." " ... -, " ,",,~ -.. ,- .....-.. .. '", ,-,- . ' '-;".~~,' : " Cost Total
i.~.u~~er Q.[:i~_sp~~#o_n~.pe[.lt~-D,1i(.)',f/': Qty.' .i':"'ea~~; ., ,'.'cost.
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Residential, per unit, service included:
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)
S~rvjces 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) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per pane!
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder ':lot included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection:'(1) t $58.00 $("K
:~;;:;:~(<<{:t~~~~ijiB'Yh?jij,;;t~~i:%1}A'RP[IC'ANt4.0S'Ef,i';;~"ft'!'t'\~i';~Jr';\ftfr~>"r., ~>~~:~: ';
.1i:,~",f'\<<:;}"^,,",,,,,:::,%k_,,,ift,__::ti' )'~: , ," ,. ,,' '~", ,,/l(f,,\',,_"f~:_;i;:1k~:'i;'.,ct:.: ;Ok! :''::
(A) Enter subtotal of above fees 5J1tO
(Minimum Permit Fee $58.00) $
(B) Enter 12% surcharge (.12 x [AD $ 3<; :r
(C) Technology Fee (5% of [AD $ J. '1'"
TOTAL fees and surcharges (A through C): $ (/7 ~
Rx OatelTime MR~-13-2010(THU) 00:48
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4685.lsabelle Street. Eugene, 0,egoo.97402
john~jbelectricinc,oom ,. CC8.# 1 04g~9
541.687.5770' Fax 541.302.8296
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ROBINSON PWMBING,INC.
City of Springfield
225 5th Street
Springfield, OR 97477
IlthMay2010
REF: 1030 Centennial Boulevard, Sprinl!field OR 97477
To whom it may concern,
With reference to the above address and the bathroom remodel, we find that
all plumbing and fixtures are compliant with the Plumbing Code Standards.
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Brian Robinson
Robinson Plumbing
PO Box 23753.4775 Pacific Ave. . Eugene. OR 97402. Phone: 541-345-6909 . Fax: 541-345-6903
May 12, 2010
City 0 Springfield - Building Department
225 5th Street
Springfield, OR 97477
RE: 1030 Centennial Blvd., Springfield, OR
To Whom It May Concern:
Gwen Polk, owner of 1030 Centennial Blvd., asked me to review and inspect the
bathroom remodel she completed on the second floor of her home. I certify that
this addition is fully compliant with all applicable statues and codes as of 2004,
the year it was built.
RespectfullYl
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Douglas A. lee
President
Lee Construction Company
P.O. Box 10367 · Eugene, Oregon 97440 . (541)683.'3607 Q. FAX (541) 485.1344
CCB #63579
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