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Home My WebLink AboutPermit Electrical 2004-11-4 ::';:'~1-,( ~.4..:..':'~~' <;..0 ._.;:;..4....1~:,;...~ i ,-i.~' . .'/___...:fl.>;f..,' "" ~.4"-..' . .~;"._.~'.'.~ ,,', '''",:' ;. ::"'". ';:'+~'" "<. ;~ ""~' '-"'~' "'" "-},-'Tl'\I' ,,:C)r' S'r .~c r If [ D" ()REt"C))\J ':', 'r-" ' >:~~);'~':):!,~:~(!f: '1\:>:t'..;;,I~,E~ .'> i.~__)':: ,:',1.',,', -\,:, :';: " ,,' ,..:.:-./ ',',' r" ;:-:';", j' ': ',"':\ . ::: .,; i ~ '.: .c;, .' , ".;r 225 ~uIH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-~~~(\).-'!: " .," ELECTRICAL PERMIT APPUCATlON I: I ~,.o:~ :~,;. " City Job Number CO~ ZOO'-\ - 61 68') Date , __ _ , I ( /0 L( W ~ ~/ '?o- ~.o,. ~~ ~ 09:' -" ~ 61 (\) 1. LEGAL DESCRIPTION J'70:S 3'~s I - r1r- 13~9q' JOB DESCRIPTION ~J -Or:\-v...) ~ 0 I +0 (' /l\Qu) 1.'(; OS K. Permits are non-transferable and expire if work is Dot started within 180 days of issuance or if work is Suspended (or 180 days. 2. Electrical Contractor JB Electric, Inc. Address 4685 Isabelle Street City Eugene Phone 687-5770 Supervisor License Number 2708-S Expiration Date 10/1/07 Constr. Contr. Number 37587C Expiration Date 7/1/06 (CCB 104929 3/14/08) Sigct~~~: t Owners Name L(::-s., ' 'SiN t1 7/ iI (L., +- Address 'S: 2. 7 b LA- ~c YI/1.-r:)~'- City t::. u G-&'e Phone OWNER INSTALLATION The installation is being made on property I own which ~ en int~ed for sale, lease or rent. tJ 'MlI SHAll EXPIRE IF THE WORK t~Hb~~L~1JrDNDER THIS PERMIT IS NOT COMMENCED OR I~ ABANDONED FOR ANY 180 OAYPtt\\uD. " Inspection Request: 726-3769 3. Service Included 1000 sq. ft. or less Each additionai 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder B. . (0<1. .00 200 Amps or less $ 63.00 J 201 Amps to 400 Amps "~'_,,,, $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 ' Over 1000~N: Orego~~Z5.00 Reconnecl<01kbyv rules adoPted-bYth~O'~~!D Notifiea regon Utility C. . . . au may obtain COpies of th I · Installati...~...-..R9Io.eation e ru as by ~ruvr. ,nOI8; the teMe Ine 200 AmpptHli\Q,r for tha Oregon I Jtfrity N . I ion 201 Amps to 400~' Is 1-800&2-2344\.69. ) 401 Amps to 600 Amps '~100.00 D. New Alteration or Extension Per Panel , One Circuit Each Additional Circuit or with \ (\ Service or Feeder Permit J $ 43.00 5-.., ,0 (J $ 3.00 1 E. Pump orirrigation $ 50,00 Sign/Outline Lighting $ 50,00 Limited Energy/Residential $ 25,00 Limited Energy/Commercial $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. \ ~ ~ .O(jl cn.<..\O , ~ ~ ~o 140.40 7% State Surcharge 10% Administrative Fee TOTAL r; Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINlj~lELD Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/3012004 EXPIRES: 05/04/2005 VALUE: $ 150,000.00 SITE ADDRESS: 222 S 5th St ASSESSOR'S PARCEL NO.: 1703353113300 Springfield TYPE OF WORK: Restaurant TYPE OF USE: , New Commercial PROJECT DESCRIPTION: Dutch Brothers Coffee ~\QJTICE: THIS PERMIT SHALL EXPIRE IF THF wn~1( Owner: SWAGGART LESTER C & M A AUTHORIZED UNDER THIS PER~fio!n<t NIJihber: 541-686-9357 Address: 3276 LAKEMONT DR EUGENE OR 97~MMENCED OR IS ABANDONED FOR 1I 1\IV 1 Rn nllv p~Qlnn .I CONT&ACTQR INFORMATION 1 License Contractor Type Architect General Electrical Mechanical Plumbing Contractor , RON THIENES DEL J INC , DELJINC HOME COMFORT HEATING & AIR THOMAS E WHITE Expiration Date Phone 541-726-8795 541-476-1387 541-476-1387 541-345-2838 541-726-9778 40432 40432 84164 86252 09/02/2007 09/02/2007 06/25/2007 09/25/2005 I BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: ' B VN 1 23.50 Heat Pump Electric Electric Path 1 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 336 376 I DEVELOPMENT INFORMATION I Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: , ",% of Lot Coverage: 1 '-'utres you to ""'>>" 'Cp-,^t'. "f'c'lnn aw,..."" J"I'\ I PUBLIC IMP~w~oPted by the oregol 5' etlf~rth ose ruleS are 'Notification mer. ~\\'fdllg~~ 952-001- In OAR 952-001-00 ~~~ rules by 0090. You may ObtB~. the te\ep~one caUing the cen~r. ~~ Utility Notification number for the. reg n '232-2344). Center IS 1-80u-v Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: , Notes: Pal!:e 1 of6 REQUIRED PARKING Total: ., Handicapped: Compact: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Use Bid Amount Use Bid Amount Bid Amount Pavinl! Fee Description Plan Review CommlInd/Public + 10% Administrative Fee + 7% State Surcharge Temp Power 200 amps or less -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Addressing Assignment Backflow Device Building Permit Fixture Heat Pump Minimum/Adjustment Mechanical Paving Planning Final Occy Inspection Refund - San Sewer SDC Reimb Refund - Sanitary Admin Refund - Sanitary SDC Improv Refund - Trans Improv SDC Refund - Trans Reimburse SDC Refund - Trans ~eimbui-se SDC Refund - Trans Reimburse SDC Refund - Transportation Admin Sanitary Sewer - 1st 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement. SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Sewer - 1st 50 Feet Storm Sewer Each Addtll00' I Valuation Descriotion I $ Per Sq Ft or multiplier $1.00 $1.00 Amount Paid $473.30 $5.00 $3.50 $50.00 $10.00 , $139.63 $71.80 $31.00 $28.00 $565.65 $196.00 $12.00 $27.00 $370.65 $143.00 $-264.48 $-449.34 $-201.05 $-7,448.95 $-1,688.53 $-1,688.53 $1,688.53 $-30.81 $45.00 $201.05 $264.48 $10.00 $2,779.24 $318.69 $604.74 $30.81 $7,448.95 $1,688.53 $45.00 $42.00 Square Footage or Bid Amount 100,000.00 50,000.00 Total Value of Project ~ Date Paid 8/27/04 11/1/04 , 11/1/04 11/1/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 Pal!e 2 of 6 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/04/2005 VALUE: $ 150,000.00 Value Date Calculated $100,000.00 $50,000.00 $150,000.00 10/0612004 10/06/2004 Receipt Number 2200400000000001103 1200400000000001544 1200400000000001544 1200400000000001544 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Vent Fan Water Line -1st 50 Feet Water Line - Each Addtl100' + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less, Total Amount Paid Fire Department Review 09/07/2004 Initial Review Planninl! Review Public Works Review 08/30/2004 09/07/2004 09/07/2004 Structural Review 09/21/2004 $6.00 $45.00 $14.00 $12.00 $8.40 $57.00 $63.00 $5,727.26 11/2/04 11/2/04 11/2/04 11/4/04 11/4/04 11/4/04 11/4/04 ., I Plan Reviews I 09/2312004 08/30/2004 10/18/2004 10/06/2004 09/21/2004 OK APP LLH APP E~M APP SB WE JMP Pal!e 3 of 6 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/0212004 APPLIED: 08/30/2004 EXPIRES: 05/04/2005 VALUE: $ 150,000.00 2200400000000001360 2200400000000001360 2200400000000001360 1200400000000001571 1200400000000001571 1200400000000001571 1200400000000001571 GRG Plan Review: coffee kiosk. Job #COM2004-01083. Occupancy classification: B. Construction type: V-No Provide address numbers in contrasting color from the background positioned plainly visible and legible from the street or road fronting the property (1998 Oregon Structural Specialty Code 502 and 1997 Springfield Uniform Fire Code 901.4.4). Provide fire extinguishers with a minimum rating of2-A:10-B:C every 75 feet of travel distance. The top of the extinguisher(s) shall be between 3 and 5 feet above finished floor (Springfield Uniform Fire Code 1002.1). SDCs added. DOWNTOWN REDEVELOPMENT DISTRICT- (MWMC ONLY). Connecting to Existing Sanitary sewer stub on NE corner of property. Received fax from Chris Moulds with project changes. Still waiting on other requested items. .seRINGFI:EL.D" . _ '. ~'..r'.-"""_t:1':'.1,.-..'-. j;~",:,I ."''''\<'''~. :-. "...,.. ~ CITY OF SPRINGFIELD' 1 . .~ ~ ,- Building/Combination Permit Status Issued PERMIT NO: COM2004-01083 225 Fifth Street, Springfield, OR ISSUED: 11/02/2004 APPLIED: 08/30/2004 541-726-3753 Phone 'EXPIRES: 05/04/2005 541-726-3676 Fax 541-726-3769 Inspection Line VALUE: $ 150,000.00 Structural Review 09/27/2004 09/27/2004 WE JMP Received from Ronald E. Thienes, Architect the Special Inspection forms, estimated values, energy code forms, and electrical plans E1 and E2. Called Carol Schirmer to remind her that I am still waiting to receive the site work utility drawing! and information. Also contine to wait for the plumbing contractor information. Structural Review 10/05/2004 10/05/2004 WE JMP Received 3 Drawing sets of Ll,;,L6. Called Carol and left message with Amy about missing L2 drawing and asked for plumbing contractor. Structural Review 10/15/2004 10/15/2004 WE JMP Received revised L2 Site Plan. Still waiting on mechanical and plumbing contractor information. Structural Review 10/22/2004 10/22/2004 WE JMP Brian Anderson said to change mechanical contractors from Larry Dean McGinnis to Home Comfort. He said the plumber, Thomas E. White, is in the process of renewing his license. Structural Review 10/25/2004 10/25/2004 10 JMP Still WE for plumbing contractor with current license. Wally with Home Comfort said no gas heat pump, just electric. Just one vent fan to complete mechanical equipment and inspections. Structural Review 10/29/2004 10/29/2004 10 JMP Brian with Double R Products called I to say that Plumber's Bond is being fedexed to Contractor's Board. Told him that as soon as I receive their notice that the license is current, the data base may be updated and the permit issued. Structural Review 11/02/2004 11/02/2004 APP JMP Received fax from Brian Anderson, forwarding fax from CCB showing Gridline Plumbing's license is active. Updated data base. Structural Review 08/30/2004 09/09/2004 WE JMP Received 9/7/2004. See attached fax to Ronald E. Thienes of the structural review. SUB Review 09/27/2004 10/04/2004 APP JF Electrical drawings and energy code forms. SUB Review 09/07/2004 09/17/2004 WE JF JMP left message with Amy for Carol Schirmer, requesting electrical plans and lighting system energy code forms and worksheets. Pal!e 4 of 6 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/04/2005 VALUE: $ 150,000.00 225 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 inspection 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting Temporary Electric: Approval required prior to Utility Company energizing poie. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roofing: Prior to installing any roof covering. Drywall: Prior to taping. Roof Sheathing/Nailing: Before covering sheathing with finish material. Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to placement. Ceiling Grid: After drywall approval but prior to cover. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to City Building Inspector. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Underslab Plumbing: Prior to filling the trench 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. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection. Pa2e 5 of6 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/04/2005 VALUE: $ 150,000.00 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 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 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 remain on the site at all times during construction. Owner or C,ontractors Signature Pae:e 6 of 6 Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 I 083 Payments: Type of Payment Check 11/4/2004 RECEIPT #: Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By JB ELECTRIC r.ty of Springfield Official Receipt 'velopment Services Department ,Public Works Department 1200400000000001571 Date: 11/04/2004 1:42:39PM Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 63.00 57.00 8.40 12.00 $140.40 Amount Paid djb 14879 In Person Payment Total: $140.40 $140.40 Page 1 of I ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)72~681'O~ ;0 ".9 oft., ELECTRICAL PERMIT APPLICATION "'ot-~~" ,,~ City Job Number COVV( ZO 0 Y - () I D 8" ~ Date / (7~" 9 \...O'~::<}tib "'0 "'v,,. -" 7~ 3. COMPLETEFEESClmg~~ L01~}(\)\l'.I'~o~. U>-9,,~.~ 0)'$ ;1'i'1S>0' ~t"" :o@?<>- v)' , ~ -< "1.:<' ,~o A. New Residential- Single or MuIti;,Falbll)C.m dwelI~~J!it. -c ----;:" () '"" ", .. CJ ' "0' 010 I .;;> ...:>0 Service Included ' G-.I'(\') ~1c 1. LOCATION OF INSTALLATION S S:+f-.... 51- 2-2- L LEGAL DESCRIPTION 17033<s:3/ JOB DESCRIPTION , I t::UA f -;:>Ol/ E.fL Permits are non-transferable and expire if work is . not started within 180 days of issuance or if work is Suspended for 180 days. ~3r:::CZJ'JZ';:::::i:;:~:zl;..o 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 2. CONI'RACTOR INSTALLATION ONLY ATT~Tr~1.'Gf~gf)BdawIMEf_8Iyoi.o~Alterations or Relocation: fO~I?W rules adopted by the Oregon Utility Electrical Contractor uf)u/.!J?~ K ,P.Ru 07~catlQO(QmlSrorloose rules are set forth $ 63.00 In OAR 9li~hO..Q~b(44l'or~ OAR 952-001- $ 75.00 Address 9iJ/ -V 0 c ."5'/ C09a..Y0i4<fll~~i~ofthe i'UI8S by $125.00 AJt'. callmg~rM~~hl'o l(6'brat~;j~p t8!8p}~Q1';S $163.00 /' ~ c/, 51// l./7J o\.tmber art e ~1~~iJiIY NJr""I'{.ic':r'Q'l City ~ ~,.o~ / /J5.::::. Phone u / ~ /,) -?11 vet 00 ~ Qlrs u. I. c... , $375.00 ~m~J~t u- 02-2344). $ 50.00 Supervisor License Number 7"/a.3 .5' Expiration Date / 0 - / - {)"1 Constr. Contr. Number 'Y () 0/"-'3 "Z. Expiration Date I' - 2. - () 7 Signature of Supervising Electrician D /' ./? -<- -, /" "" S:W,A-C--G;r-~I Address '327 b LA- tc-e {ItA 0,4' r City (::I.A. &c::7VC-f.hone Owners Name ~s OWNER INSTALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps ( $ 50.00 $ 69.00 $100.00 ~ ---(:::) Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with Service ~ Feeder Permit $ 3.00 ".;""" ~~u.u EV'J'PE If- THE WORK E. !\~~\11r~f-~~~l&ii~[8~f~E!~31~~\Udel6 +tlllh Installa tion '~r' ;"~;:~\I;-cD 0'-,'\ Ie.' A3/\N00l~ED fCiR Pump'mtlfin~drr'_~'u , $ 50.00 Sign/d~t4irlJiHiBJ)Xlth\UD. $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTAL OF ABOVE 5'c:::> 3)0 ')~U Q <)0 ~u--- 7% State Surcharge 10% Administrative Fee TOTAL Shared Dnve(T:)/Building Fonns/Electrical Pennit Application I-03.doc CITY OF SPRINGFIELD', Building/Combination Permit Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2004-01083 ISSUED: APPLIED: EXPIRES: VALUE: SITE ADDRESS: 222 S 5th St ASSESSOR'S PARCEL NO.: 1703353113300 08/3012004 05/0112005 $ 150,000.00 Springfield 'TYPE OF WORK: Restaurant PROJECT DESCRIPTION: Dutch Brothers Coffee Kiosk TYPE OF USE: . s '10Y \~ SW AGGART LESTER C & M A ~~law reqUIre on U\\\\W 3276 LAKE MONT DR ~~~:dk ~p.d'\5'Y tne Qreg ~\ 10ft\; ~1 J - S -:>rloote ~. .\e>!=> are ij _ oAot_ 10\\OW '. ow ,rM~r.' \\lU;:''' :~hCl.I\R"'~G'~~-',. Not\1\ca\\on ~(fW\1:()'F~'J~f~mm.\dFION I \0 OA.R 95'2.- obtaIn (;UI-": tne te\ePlWI,"" ContralijO!JO. '1'ou rna'Yenter. lNote. '\'w NotW~i'c~'Wse RON THIE~'Sng tne Cne oregon UtI \. 344), DEL J INCt\urnber 10r t \s '\ _BOO-33Z-Z 40432 DEL J INC center 40432 HOME COMFORT HEATING & AIR 84164 THOMAS E WHITE 86252 Owner: Address: Contractor Type Architect General Electrical Mechanical Plumbing I BUILDING INFORMATION. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: ' Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: B # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: 1 23.50 Heat Pump Electric Electric Path 1 n/a VN I DEVELOPMENT INFORMATION . New Commercial Phone Number: 541-686-9357 Expiration Date Phone 541-726-8795 541-476-1387 541-476-1387 541-345-2838 541-726-9778 09/0212007 09/0212007 06/25/2007 09/25/2005 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 376 336 , REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees ~ \NGt\'" ~: PltV~"t>'t\t)\e 'R~b\:~ \S ~G1 "O'ne ~~\\ S\-\~%~t~~ffi~rG~ , \\-\\~\:;Q\l~D 'J~D~: ~~f\~DG~t. ~UG~~t.~f.P~~~ROVEMENTSI f\~'{ '\ ceO \J Sidewalk Type: Downspouts/Drains: Pae:e 1 of5 CITY OF SPRINGFIELD Building/Combination Permit Status Pending 225 Fifth Street) Springfield, OR 541-726-3753 Phone 541-726-3676 FJx 541-726-3769 lrispection Line I PERMIT NO: COM2004-01083 ISSUED: APPLIED: EXPIRES: VALUE: 08/30/2004 05/0112005 $ 150,000.00 I Valuation Descriotion I Bid Amount Pavinl! Tvpe of Construction Use Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 100,000.00 50,000.00 Value Date Calculated Description Total Value of Project $100,000.00 $50,000.00 $150,000.00 10/06/2004 10/06/2004 J' ~ Fee Description, Amount Paid Date Paid Receipt Number Plan Review Comm/Ind/Public $473.30 8/27/04 2200400000000001103 I + 10% Administrative Fee $5.00 11/1/04 1200400000000001544 I $3.50 11/1/04 1200400000000001544 + 7% State Surcharge I Temp Power 200 amps or less $50.00 11/1/04 1200400000000001544 I I Total Amount Paid $531.80 I I Plan Reviews I I Fire Department Review 09/07/2004 09/23/2004 OK GRG Plan Review: coffee kiosk. Job I #COM2004-01083. Occupancy I I' classification: B. Construction type: I V-No I Provide address numbers in I contrasting color from the background positioned plainly visible and legible from the street or road fronting the property (1998 Oregon Structural Specialty Cod~ 502 and 1997 Springfield Uniform Fire Code 901.4.4). Provide fire extinguishers'with a minimum rating of2-A:I0-B:C every 75 feet of travel distance. The top of the extinguisher(s) shall be between 3 and 5 feet above finished floor (Springfield Uniform Fire Initial Revie~ Code 1002.1). 08/3012004 08/30/2004 APP LLH Planninl! Review 09/07/2004 10/18/2004 APP EMM I I I ! I Pal!e 2 of5 I I ~~aJu~~'!~r~\:""''''''''''''''1 Ii ~! Status Pehding I 225 Fifth Street; Springfield, OR 541-726-3753 Phone 541-726-3676 FJx 541-726-3769 I~spection Line , Public Works Review I I I Structural Review I I Structural Review Structural Re~iew I I I I I. Structural RevIew I I Structural ReJiew I I I Structural Re~iew I I I I Structural Re~iew I Structural Review SUB Review 09/07/2004 09/21/2004 09/27/2004 10/05/2004 10/15/2004 10/22/2004 10/25/2004 10/29/2004 08/30/2004 09/27/2004 10/06/2004 09/21/2004 09/27/2004 10/05/2004 10/15/2004 10/22/2004 10/25/2004 10/29/2004 09/09/2004 10/04/2004 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: APPLIED: EXPIRES: VALUE: 08/30/2004 05/0112005 $ 150,000.00 APP SB SDCs added. DOWNTOWN REDEVELOPMENT DISTRICT- (MWMC ONLY). Connecting to Existing Sanitary sewer stub on NE corner of property. Received fax from Chris Moulds with project changes. Still waiting on other requested items. Received from Ronald E. Thienes, Architect the Special Inspection forms, estimated values, energy code forms, and electrical plans El and E2. Called Carol Schirmer to remind her that I am still waiting to receive the site work utility drawing! and information. Also contine to wait for the plumbing contractor information. Received 3 Drawing sets ofL1-L6. Called Carol and left message with Amy about missing L2 drawing and asked for plumbing contractor. Received revised L2 Site Plan. Still waiting on mechanical and plumbing contractor information. Brian Anderson said to change mechanical contractors from Larry Dean McGinnis to Home Comfort. He said the plumber, Thomas E. White, is in the process of renewing his license. Still WE for plumbing contractor with current license. Wally with Home Comfort said no gas heat pump, just electric. Just one vent fan to complete mechanical equipment and inspections. Brian with Double R Products called to say that Plumber's Bond is being fedexed to Contractor's Board. Told him that as soon as I receive their notice that the license is current, the data base may be updated and the permit issued. Received 9/7 /2004~ See attached fax to Ronald E. Thienes of the structural review. Electrical drawings and energy code forms. WE JMP WE JMP WE JMP WE JMP WE JMP 10 JMP 10 JMP WE JMP APP JF Pa2e 3 of5 CITY OF SPRINGFIELD. Building/Combination Permit Status Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2004-01083 ISSUED: APPLIED: EXPIRES: VALUE: 08/30/2004 05/0112005 $ 150,000.00 SUB Review 09/07/2004 09/17/2004 WE JF JMP left message with Amy for Carol Schirmer, requesting electrical plans and lighting system energy code forms and worksheets. To Request an inspection c'all the 24 hour recording at 726-3769. All inspection 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting Temporary Electric: Approval required prior to Utility Company energizing pole. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roofing: Prior to installing any roof covering. Drywall: Prior to taping. Roof Sheathing/Nailing: Before covering sheathing with finish material. Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to , placement. Ceiling Grid: After drywall approval but prior to cover. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to City Building Inspector. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Underslab Plumbing: Prior to filling the trench 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. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection. Pal!e 4 of 5 Status' Pending 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726;,3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: APPLIED: EXPIRES: VALUE: 08/30/2004 05/0112005 $ 150,000.00 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 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 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 remain on the site at all times during. construction. Owner or Contractors Signature Pal!e 5 of 5 Date , 225 Fifth Street Spr.ingfieid, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-0 I 083 COM2004-0 1 083 COM2004-0 1083 Payments: Type of Payment CreditCard 11/1/2004 RECEIPT #: ,,-.ity of Springfield Official Receipt ,evelopment Services Department Public Works Department 1200400000000001544 Date: 11/0112004 Description + 7,% State Surcharge + 10% Administrative Fee Temp Power 200 amps or less Paid By DOUBLE R PRODUCTS Item Total: ' Check Number Authorization Received By Batch Number Number How Received djb 001604 In Person Payment Total: Page I of I 11:16:25AM Amount Due 3.50 5.00 50.00 $58.50 Amount Paid $58.50 $58.50 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/02/2005 VALUE: $ 150,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 222 S 5th St ASSESSOR'S PARCEL NO.: 1703353113300 Springfield TYPE OF WORK: Restaurant TYPE OF USE: New Commercial PROJECT DESCRIPTION: Dutch Brothers Coffee Kiosk Owner: SW AGGART LESTER C & M A Address: 3276 LAKE MONT DR EUGENE OR 97408 PhoneN umber: 541-686-9357 I CONTRACTOR INFORMATION I Contractor Type Contractor License Expiration Date Phone Architect RON THIENES 541-726-8795 General DEL J INC 40432 09/0212007 541-476-1387 Electrical DEL J INC A0432 09/02/2007 541-476-1387 Mechanical HOME COMFORT HEATING & AIR 84164 06/25/2007 541-345-2838 Plumbing THOMAS E WHITE 86252 09/25/2005 541-726-9778 ~~ I ,oB;UILDING INFORMATION I &-~- ~v ".' # of Units: ~ '\~ ~ {:>.Q~ of Stories: . ~O Lot Size: Primary Occupancy Group: , ~~ ~~~ ~ ~\JlIeight of Str!l..ctore ~~~ .~fl Ft 1st Floor: Secondary Occupancy Group: \,."t-\~:. ';J~~ Type of~e.at: H~~,^~~-";:<..'~~t 2nd Floor: Primary Construction Type ,:?-\"'\'" "'~ ~~ Water Type: \e(S. fCtrisC";)~~'1-~ ~~Basement: Secondary constr~tiOn{S:te:$;)\"~ ~<o~ Range Type: ''b-~ ~e ~ftl~ C!) *F~ Garage/Carport # ofBedroomsK\~ ,~'*' ~ '\J~ ~ {:> ';J<V' Energy Path::, ~o~ 'O~~ 0 '~1.~~e <; ~(l:i\S~ther: '~\.~ c.. <<\: ().'Vv~ <~ \J ~~ SprinkIt;d B~in~,\~O~ ov~~O' \.e>~~pant Load: '\' ,\~J f'.~ C-'--' ,Q t~~ ~C'\\l- V\<; ,0 o. ~~ ., ~~'\~~<o~ <V~' I DEVELO~~'~~~~~~~!<let"'~""'\ ~~~. ,,\J _\ ,<0 ,..' ~' ~. R) ~" 0 2;C(,; REQUIRED PARKING ~' ~O. ~O fJ:(S ~ 0 ~e" ~O~ r;o"-> Front yard Setback: ~ oWr~~St? ~ ~'O- ve0 0,0 ~\)\) Side 1 Setback: # Stt~eo~retWR~ ~e.f.>'" Side 2 Setback: Pav~e~tb"o' ~e' ," Rearyard Setback: % of Lot (f~~t'age:ve Solar Setbacks: ' ~~ 376 336 Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS. Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: Pae:e 1 of5 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone ' 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Use Bid Amount Use Bid Amount Bid Amount Pavinl! Fee Description. Plan Review CommlInd/Public + 10% Administrative Fee + 7% State Surcharge Temp Power 200 amps or less -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Addressing Assignment Backflow Device Building Permit Fixture Heat Pump Minimum/Adjustment Mechanical Paving Planning Final Occy Inspection Refund - San Sewer SDC Reimb Refund - Sanitary Admin Refund - Sanitary SDC Improv Refund - Trans Improv SDC Refund - Trans Reimburse SDC Refund - Trans Reimburse SDC Refund - Trans Reimburse SDC Refund - Transportation Admin Sanitary Sewer - 1st 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Sewer - 1st 50 Feet Storm Sewer Each Addtl100' I Valuation Descriotion ~ $ Per Sq Ft or multiplier $1.00 $1.00 ' Square Footage or Bid Amount 100,~00.00 50,000.00- , Total Value of Project ~., Amount Paid $473.30 $5.00 $3.50 $50.00 $10.00 $139.63 $71.80 $31.00 $28.00 $565.65 $196.00 $12.00 $27.00 $370.65 $143.00 $-264.48 $-449.34 $-201.05 $-7,448.95 $-1,688.53 $-1,688.53 $1,688.53 $-30.81 $45.00 $201.05 $264.48 $10.00 $2,779.24 $318.69 $604.74 $30.81 $7,448.95 $1,688.53 $45.00 $42.00 Date Paid 8/27/04 11/1/04 11/1/04 11/1/04 11/2/04 11/2/04 11/2/04 11/2/04 11i2l04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 , 11/2/04 11/2/04 11/2/04 11/2/04 11/2/04 Pal!e 2 of 5 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/02/2005 VALUE: $ 150,000.00 Value Date Calculated $100,000.00 $50,000.00 $150,000.00 10/06/2004 10/06/2004 Receipt Number 2200400000000001103 1200400000000001544 1200400000000001544 1200400000000001544 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 , 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 2200400000000001360 ~W1r<ii";~~~=" :' '.! ._".' - '" ~ . .,,0-* ",'. _ ' ......~....,,-~,."';'l')',", ,."._.~.,m~...,.,-."'W' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . Vent Fan Water Line - 1st 50 Feet Water Line - Each Addtl100' Total Amount Paid Fire Department Review Initial Review Plan nine Review Public Works Review Structural Review Structural Review 09/07/2004 08/30/2004 09/07/2004 09/07/2004 09/21/2004 09/27/2004 $6.00 $45.00 $14.00 $5,586.86 I Plan Reviews I 09/23/2004 08/30/2004 10/18/2004 10/06/2004 09/21/2004 09/27/2004 OK APP APP APP WE WE Pal!e 3 ,of 5 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/02/2005 VALUE: $ 150,000.00 11/2/04 11/2/04 11/2/04 2200400000000001360 2200400000000001360 2200400000000001360 GRG Plan Review: coffee kiosk. Job #COM2004-01083. Occupancy classification: B. Construction type: V-No Provide address numbers in contrasting color from the background positioned plainly visible and legible from the street or road fronting the property (1998 . Oregon Structural Specialty Code 502 and 1997 Springfield Uniform Fire Code 901.4.4). Provide fire extinguishers with a minimum rating of2-A:I0-B:C every 75 feet of travel distance. The top ~f the extinguisher(s) shall be between 3 and 5 feet above finished floor (Springfield Uniform Fire Code 1002.1). LLH EMM SB SDCs added. DOWNTOWN REDEVELOPMENT DISTRICT- (MWMC ONLY). Connecting to Existing Sanitary sewer stub on NE corner of property. Received fax from Chris Moulds with project changes. Still waiting on other requested items. Received from Ronald E. Thienes, Architect the Special Inspection forms, estimated values, energy code forms, and electrical plans El and E2. Called Carol Schirmer to remind her tha't I am still waiting to receive the site work utility drawing! and information. Also contine to wait for the plumbing contractor information. JMP JMP Building/Combination Permit PERMIT NO: COM2004-01083 ISSUED: 11/02/2004 APPLIED: 08/30/2004 EXPIRES: 05/02/2005 VALUE: $ 150,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 10/0512004 10/05/2004 WE JMP Structural Review 10/15/2004 10/15/2004 W.E JMP Structural Review 10/2212004 10/22/2004 WE JMP Structural Review 10/25/2004 10/25/2004 10 JMP Structural Review 10/29/2004 10/29/2004 10 JMP Structural Review 11/0212004 11/0212004 APP JMP Structural Review 08/30/2004 09/09/2004 WE JMP SUB Review 09/27/2004 10/0412004 APP JF SUB Review 09/07/2004 09/17/2004 WE JF CITY OF SPRINGFIELD' Received 3 Drawing sets ofL1-L6. Called Carol and left message with Amy about missing L2 drawing and asked for plumbing contractor. Received revised L2 Site Plan. Still waiting on mechanical and plumbing contractor information. Brian Anderson said to change mechanical contractors from Larry Dean McGinnis to Home Comfort. He said the plumber, Thomas E. White, is in the process of renewing his license. Still WE for plumbing contractor with current license. Wally with Home Comfort said no gas heat pump, just electric. Just one vent fan to complete mechanical equipment and inspections. Brian with Double R Products called to say that Plumber's Bond is being fedexed to Contractor's Board. Told him that as soon as I receive their notice that the license is current, the data base may be updated and the permit issued. Received fax from Brian Anderson, forwarding fax from CCB showing Gridline Plumbing's license is active. Updated data base. Received 9/7/2004. See attached fax to Ronald E. Thienes of the structural review. Electrical drawings and energy code forms. JMP left message with Amy for Carol Schirmer, requesting electrical plans and lighting system energy code forms and worksheets. To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. ~eouiredJnsnect!ons . Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. SUB Final: After all required energy inspections have been requested and approved. Pa2e 4 of 5 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2004-01083 , ISSUED: 11/02/2004 APPLIED: 08/30/2004 , EXPIRES: 05/02/2005 VALUE: $ 150,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting Temporary Electric: Approval required prior to Utility Company energizing pole. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. ' Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved~ Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Roofing: Prior to installing any roof covering. Drywall: Prior to taping. Roof Sheathing/Nailing: Before covering sheathing with finish material. , Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to placement. Ceiling Grid: After drywall approval but prior to cover. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to City Building Inspector. ' Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Underslab Plumbing: Prior to filling the trench 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. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection. By signature, I state and ~gree, 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 wiil be made of any structure without 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 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 remain on the site at all times during construction. f ku~ ~}~~ 11-02 --0,/ / Owner or Contractors Signature Date Pal!e 5 of 5 ...--- -~ SPRINGFIELD' -CaM zoo4l' 01085 Building Permit #l $:=JQ:04 Date 'VI '(0 ,,"0 , I o \0 I o ~ o ~ '~::iuJ;;P:f~E E5 th :m,s.eT : Project Addres3 City of Springfield _t7U..TCH COln:~u~iE:Y s~~;~'!"~ Oi"!=::iif ns Fifth Sneel Springfield. OR 97471 Telephone: (541) 726~3759 , f'ax: (541) 726-3689 Special Inspection And Testing '. I .. 2~-2. ~A :5PF1? I-' W 1J To applicants of projecu requiring special insPection or lesting as per Seelion 170 I.S of the Oregon Smacrurlil SpecialCY Code, Please review.the information below. When you have finished, acknowledge an understanding of the inCoonation by signing below, and return this fonn to the Cicy. DEFORE A PERMIT CAN BE ISSUED: The owner or owner's representative, on the advice of the responsible Project Engineer or Arcbitect. shall complete, sign, and submit 10 the City for review and approval this form completed on both the nont and back. The Owner and Oeneral Contraclor, where applieable. shall also acknowledge the following conditions applicable 10 Speciallnspecrion and/or Testing. I. Contractor is responsible for proper notification for tne lnspution or Testing of items listed. 2. Testing laboratory shall lake appropriate samples and transport them to their laboratory for proper evaluation or testing. · Copies of all laboratory reports and inspections are to be sent to the City by Ibe Testing Agency. J. SpeCllllll'lspCdioll Agency is 10 submil names and qualifications of on-site Speciallnspcclors to the City for approval. 4. Spcciallnlipeclor shlill provide inspection n:ports to the building offICial of alllnspecrioo activides. 5. Contractor is responsible to review the City approved prans for addicional inspection or testinc requirements that may be nOled, BEFORE A CERTIFICATE OF OCCUPANCY WILL BE ISSUED: The Special Inspection Agency shall submit to tho Building Official a statement that all items requiring inspection have been fuffjUed and reported and were to the best of the Inspector', knowledge, in confonnanc:e with the approved plans, specifications and applicable workmanship provisions. Those items not tested andlor inspected sball be noted h the statement. The report is to be submitted to the City prior to a request for flr.al iru;pections. ~~.~ aenal Conlr8Clor ignature , \ i 11 . ~~.cyRep~ \" ,Jl..J -.. 0 Building Offic:ial Signillure t1l ACKNOWLEDGMENTS cP/tlj ,fffP/JlJ?; ,/;;t~.J)~ Owner Name (Printed) OW/,j~Urt - !fq;;4Li/ 1',. ":7.iH'.Allf_ ~Pd ~~ Engineer or Architect Firm (Printed) Ell8ineer or Archilect Signature oJ. .ofJU(JL6' ~LJU~l:..S- Gen. Contra<:tor Firfu Name (Printed) l' rz ~CL Speciafl~i9R A!efley w~printed) , ..... ~ ~,' ~ J~c. \ ,,^<C \...) \ BUilding Official 'Name (Printed) , Testing Laboratory Name (Printed) Testing Laboratory Rtp Signature - " Reinforced COllcrete, ClInUe, Grout and Mortar: ~~ _.G\lmte (koUl__ __Mmlli ----- -----+ Pri!casllPre-stressed Concrete: ....fikL-1~:ThnL Prr.-1tnL..Qaill!.ing SMOKE CONTROL: Leakage testing Control verification ROOFING Insulation il1stallationJR-valuc* Test strips/scams SPl~CIAL INSPECTION AND TESTING SCHEDVLE "------ . A~gregate Test of Mix Design Reinforcing Test Mix Design- WeishmstT Cerr,. Reinfodng Placement c.Qntinu.o!.li.D.atd.PJant.lne:!'1 I DJDC':ct Plilfi.nJ! CaSl~es %u:nples (Pickup/Delivered) ColUJlftSSiwl..Iesl. GRADING, l..:XCAVATION, AND it'lLL Acceptance tests · PSF Establisb final grade Fill placement inspection/continuous Soil Density STRucruR At. STEELJWELnIN(;; Sample and test (list specific members below) Shop material identification (mill cert) Weld inspection X Shop Ultrasonic inspcction Shop High strength bolting Shop A325 N X A490 N X Metal deck welding inspeclion Reinforcing Steel welding inspection Reinforcing steel mill certificnte Metal stud welding inspection Concrete insert welding inspection Moment resisting steel frames ~ Field Field Fidtl F f A egregate..T.ests Reinforcing Tests Tendon Te$t Mix Design... Reinforcing Placement lnsert Placement Concrete Batchinr CQngetc Placement Installation Inspection Cast Samples Pick-up Sample!!: Compression Teste: STIWCTURAL WOOD: Shear wall nailing inspection Shear wall anchors Inspection ofGlu-lam fab. '!' TIC psi (nspecti(ln of lruss joist fab. Sample and test components Fabrication welding of steel accessories FIREPROOFING: Placement inspection Density Tests Thickness lests Inspect hatching MASONRY: Special inspection stresses Ilsed.. rm rg Preliminary acceptance lests (masonry uni13, wall prisms) Subsequent tests (mortar, groul, field wall prisms) Placement inspection of units, :111(1 rcillforccmcnl Musonary, monar, grout, and reinforcing s!eel certificates ADDIT10NAI.I INSTRUCTIONS. OTHER TEST, & INSPECTIONS: Form rompleled by: Date-'_26 "pnovmE STRENGTH REQUIRED BY ARCHlTECTOn. ENGINEER OR CONTRACT DOCUMF-NT LOCATION OF VALUES "iI! m '0 I o 1.0 I o -Ilo o -Ilo I--' -Ilo -0 -0 o 0\ ATTACHMENT A CITY {Jii~iiuNGFIELp SYSTEMS DEVELOPMENT CHARGE KSHEET JOURNAL OR JOB NUMBER C0M2004-01083 NAME OR COMPANY: DUTCH BROS LOCATION: 222 South 5th St MAP & TAX LOT NUMBER: 17 03 35 31 13300 DEVELOPMENT TYPE: COFFEE KIOSK NEW DEVELOPED AREA (S.F.): 372.00 ITE: 934 EXISTING DEVELOPED AREA (S.F.): ITE: TOTAL IMPERVIOUS SURFACE (S.F.): 5,000 LOT SIZE (S.F.): L STORM DRAINAGE IMPERVIOUS SQ. IT. $ 0.310 PER SF x TOTAL STORM DRAINAGE SDq ;2. SANITARY SEWER-CITY A. REIMBURSEMENT COST: NUMBER OF DFU's ] 1 B. IMPROVEMENT COST: NUMBER OF DFU's 11 (SEE REVERSE SIDE) DOWNTOWN REDEVELOPMENT CREDIT x $ 24.04 PER DFU x $ ]8.28 PER DFU TOTAL WCAL WASTEWATER SDC:I $ 3 TRANSPORTATION BLDG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR NEW A. REIMBURSEMENT COST: 0.372 x 496.12 x $ 18,30 PER TRIP x 0,5 NTF 1$ 1,688.53 I B. IMPROVEMENT COST: 0.372 x 496,12 x $ 80.72 PER TRIP x 0.5 NTF 1$ 7,448.95 , EXISTING A. REIMBURSEMENT COST: 0.000 x 0 x $ 18.30 PER TRIP x 0 NTF 1$ B. IMPROVEMENT COST: 0.000 x 0 x $ 80.72 PER TRIP x 0 NTF 1$ TOTAL TRANSPORTATION REIMBURSEMENT SDC:- $ TOTAL TRANSPORTATION IMPROVEMENT SDC: $ DOWNTOWN REDEVEWPMENT CREDIT 4, SANITARY SEWER - MWMC NEW: A. REIMBURSEMENT COST: NUMBER OF FEU's 0.372 B, IMPROVEMENT COST: NUMBER OF FEU's 0.372 TOTAL TRANSPORTATION SDC:' $ '$ '$ 318.69 , 2,779.24 I x $856.69 PER FEU x $7,471.08 PER FEU EXISTING: A. REIMBURSEMENT COST: NUMBER OF FEU's B. IMPROVEMENT COST: NUMBER OF FEU's I I $ TOTAL MWMC REIMBURSEMENT FEE: $ TOTAL MWMC IMPROVEMENT FEE:' $ MWMC ADMINISTRATIVE FEE: $ TOTALMWMCSDC:I $ 3,107.931 $ SUBTOTAL (ADD ITEMS ],2,3, & 4) , $ 3,107.931 $0,00 PER FEU '$ 0.000 x $0.00 PER FEU 1$ 0.000 x MWMC CREDIT IF APPLICABLE (SEE REVERSE) 5, ADMINISTRATIVE FEES: BASE CHARGE (SUBTOTAL ABOVE) $ 3,107.93 x 5% $ 155.40 TOTAL TRANSPORTATION ADMINISTRATION FEE: $ TOTAL SEWER ADMINISTRATION FEE: I $ stevev.- w. B.eclUvll"ij B.Clrv.-es. C\5l5i200~llJi~ros-Main st.xls 10/6/2004 DATE TOTAL SDC CHARGES 1 $ 1 $ , $ 3,263.331 1 JULY 2004 DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT = DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TIIE NET AuUJ !!ONAL FIXTIJRES) - DUTCH BROS FIXTURE TYPE BATHTUB DRINKlNG FOUNTAIN FLOOR DRAIN INTERCEPTORS FOR GREASElOIUSOLIDSIETC. INTERCEPTORS FOR SAND/AUTO WASHlETC. LAUNDRY TUB CLOTIffiS W ASHER/MOP SINK CLOTIffiS WASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (1 PER TRAILER) RECEPTOR FOR REFRIGERA TOR/W A TER ST A TIONIETC. RECEPTOR FOR COMMERCIAL SINK! DISHWASHERlETC. SHOWER, SINGLE STALL SHOWER, GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTIAL KITCHEN SINK: COMMERCIAL BAR SINK: WASH BASIN/DOUBLE LAVATORY SINK: SINGLE LAVATORY /RESIDENTIAL BAR URlNAL, STALUW ALL TOILET, PUBLIC INSTALLATION TOILET, PRIVATE INSTALLATION MISCELLANEOUS: NUMBER OF EDU'S* FIXTURES NEW OLD UNIT EQUIVALENT 3 1 3 3 6 2 3 6 12 1 3 2 2 3 2 2 1 5 6 3 ' o o o o 1 o 1 o 1 TOTAL DRAINAGE FIXTURE UNITS= '"EnU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwellin~ (20,~ry2:~et at 167 gallons per day DRAINAGE FIXTURE UNITS o o o o o o o o o 1 o o o 3 o o 1 o 6 o 11 o o 11 CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY YEAR ANNEXED 1979 or before 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 RATE PER $1,000 ASSESSED VALUE $5.29 $5.19 $5.12, $4.98 $4.80 $4.63 ,$4.40 '$4.07 $3.67 $3.22 $2.73 $2.25 $1.80 CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE IMPROVEMENT (IF AFTER ANNEXA TION DATE) COM2DD4-D1D83, dutch bros-Main st.xls YEAR ANNEXED 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 RATE PER $1,000 ASSESSED VALUE $1.59 $1.45 , $1.25 " ,$1..09 $0:92' $0.72 $0.48 . $0.28 . $0.09 $0.05 $0.00 $0.00 $0:00, x X CREDIT TOTAL $0.00 $0.00 $0.00 1 JULY 20.0.4 . . 225 F:ifth Street Springfield, Oregon 97477 541-726-3759 Phone ~ity of Springfield Official Receipt Jevelopment Services Department Public Works Department Job/Journal Number COM2004-0 1 083 COM2004-0 I 083 COM2004-0 1083 COM2004-0 1083 COM2004-0 1083 COM2004-0 I 083 COM2004-0 1083 COM2004-0 1 083 COM2004-0 1083 , COM2004-01083 COM2004-01083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1083 COM2004-0 1083 COM2004-0 1083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-0 1 083 COM2004-01083 , COM2004-0 1083 Payments: Type of Payment Check 11/2/2004 RECEIPT #: 2200400000000001360 Date: 11/02/2004 Description Addressing Assignment Building Permit Paving Fixture Sanitary Sewer - 1st 50 Feet Water Line - 1st 50 Feet Water Line - Each Addtl 100' Storm Sewer - 1st 50 Feet Storm Sewer Each Addtl 100' Backflow Device Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin Refund - San Sewer SDC Reimb Refund - Sanitary SDC Improv Refund - Trans Reimburse SDC Refund - Trans Improv SDC Refund - Trans Reimburse SDC Refund - Trans Reimburse SDC Refund - Sanitary Admin Refund - Transportation Admin Planning Final Occy Inspection Vent Fan Heat Pump Minimum! 1\djustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Paid By STEW ART & SONS ENTERPRISES Item Total: Check Number Authorization Received By Batch Number Number How Received 2227 In Person Jmp Payment Total: Page 1 of 1 10:01:00AM Amount Due 31.00 565.65 370.65 196.00 45.00 45.00 14.00 45.00 42.00 28.00 264.48 201.05 1,688.53 7,448.95 318.69 2,779.24 10.00 604.74 30.81 (264.48) (201,05) 1,688.53 (7,448.95) (1,688.53) (1,688.53) (449.34) (30.81 ) 143.00 6.00 12.00 27.00 10.00 71.80 139.63 $5,055.06 Amount Paid $5,055.06 $5,055.06