The URL can be used to link to this page

Home My WebLink AboutPermit Curb Cut 2006-12-19 " Status Issued , CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2006-01539 ISSUED: 12/19/2006 APPLIED: 12/01/2006 EXPIRES: 06/19/2007 VALUE: $ 84,980.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1959 15th Street ASSESSOR'S PARCEL NO.: 1703252303400 Springfield TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New Residential PROJECT DESCRIPTION: New Manufactured home and garage Owner: OWENS ROGER & DONNA Address: 1955 15TH ST SPRINGFIELD OR 97477 Phone Number: 913-3801 I CONTRACTOR INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Contractor OWNER 41fi OWNER l"N,Vl)/y EUGENESUPERSALESC~TER~~' OWNER D~. ~'1~~~If~,- '" -/1,,1(1.. IT/... , / _ I BtJl1-DING0INF.QaM1\~ION I /6'0 <(,f'O UIJIO <.<. f:. # of St~9V OJ? / ~J?:f'~ 1 Lot Size: . Height of stf!t~Ull~ 4: 1'018 J9f' ~ Sq Ft 1st Floor: Type of Heat: l'@ue~1}t?l~~i?ijf' Sq Ft 2nd Floor: VB Water Type: . -~)G~t~ftl" Is&Ft Basement: " ~l).;. Range Type: EfAA)e /S ;P)J~f'Garage/carport M Oqo ~t1;~nergy Path: 0-1> sq)Ft Other: It>. OObi}c. ~I'tth ~kled Building: n/a Occupant Load: f'l A. "ill. (9,,,, .~ c.v -'1" I ~c 1 r ,.' f). '00. h1~ltE~Qh~~tr~FORMA TION , -?G>: ~~~ (j IJ). V07.. fi)r, h by ~ 1'6- 1JJ6el'~/~6 Ciy OBOqlrJi~~f:~& Q 90i-&. 5'(~}~ Ol'!.? 061}/9.r~e~b.ets~gft~O IS' YOtt 34.0U"'''/~ i9 O~ 1'alre{f~I~~~,. ~ U. to 1000 i"'<t (jJGrVtfl~t~~C1A~.&~ ~4t. . ,~ l:)tJ ,~/~w'd'A~J'&. 6/F; r:y 5.00 "0. ~~ /16 " ~6 3'~a O/{'I- 't'i'~ .':,' '", 6~'l /)1&.. t"l;, . I PUBLIC iivI~V~~.! . 70" Sidewalk Type: Fully Improved Yes License Expiration Date Phone Contractor Type General Electrical Manuf Home Inst Plumbing 133809 02/24/2007 541-341-1215 1 R-3 1,326 480 REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 2 Yes 17.70 Total: Handicapped: Compact: 2 Street Improvements: Storm Sewer Available: Special Instruction: Downspouts/Drains: Curbside 5' Curb and Gutter Notes: Storm H20 must be installed per site plan specs. J.LP Pal!e 1 of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01539 ISSUED: 12/19/2006 APPLIED: 12/01/2006 EXPIRES: 06/19/2007 VALUE: $ 84,980.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Tvpe of Construction $ Per Sq Ft or multiplier $1.00 $26.00 $1.00 Square Footage or Bid Amount 2,500.00 480.00 70,000.00 Value Date Calculated Total Value of Project $2,500.00 $12,480.00 $70,000.00 $84,980.00 12/0112006 12/0112006 12/07/2006 Foundation Onlv Use Bid Amount Garal!e Garal!e Manuf Home Manufactured Home ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $95.16 12/1/06 2200600000000001646 + 10% Administrative Fee $69.57 12/19/06 2200600000000001724 + 5% Technology Fee $30.27 12/19/06 2200600000000001724 + 8% State Surcharge $48.43 12/19/06 2200600000000001724 Add, Alter, Extend Circ Ea Add $6.00 12/19/06 2200600000000001724 Addressing Assignment $31.00 12/19/06 2200600000000001724 Curbcut Permit $80.00 12/19/06 2200600000000001724 Encroachment Permit $130.00 12/19/06 2200600000000001724 Fire SF Fee - Residential $90.30 12/19/06 2200600000000001724 Garage/Carport $146.40 12/19/06 2200600000000001724 Manuf Home State Issuance $30.00 12/19/06 2200600000000001724 Manufactured Home Conn - Plmb $45.00 12/19/06 2200600000000001724 Manufactured Home Feeder $50.00 12/19/06 2200600000000001724 Manufactured Home Placement $160.00 12/19/06 2200600000000001724 Perm Serv/Fdr 200 amps or less $63.00 12/19/06 2200600000000001724 Plan Review Major - Planning $198.00 12/19/06 2200600000000001724 PW Disc - 2nd Permit $-30.00 12/19/06 2200600000000001724 Sanitary Sewer - 1st 50 Feet $45.00 12/19/06 2200600000000001724 Sanitary Sewer - Improvement $474.97 12/19/06 2200600000000001724 Sanitary Sewer - Reimbursement $624.64 12/19/06 2200600000000001724 SDC MWMC Administration $10.00 12/19/06 2200600000000001724 SDC MWMC Improvement $961.52 12/19/06 2200600000000001724 SDC MWMC Reimbursement $91.61 12/19/06 2200600000000001724 SDC Sanitary/Storm Admin $121.53 12/19/06 2200600000000001724 SDC Transpo Admin $70.88 12/19/06 2200600000000001724 SDC Transpo Improvement $836.32 12/19/06 2200600000000001724 SDC Transpo Reimbursement $189.58 12/19/06 2200600000000001724 Sidewalk Permit $80.00 12/19/06 2200600000000001724 Storm Drainage Impervious Area $659.55 12/19/06 2200600000000001724 Storm Sewer - 1st 50 Feet $45.00 12/19/06 2200600000000001724 Water Line - 1st 50 Feet $45.00 12/19/06 2200600000000001724 Willamalane Manuf Home Private $1,000.00 12/19/06 2200600000000001724 Total Amount Paid $6,498.73 Pal!e 2 of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Planninl! Review 12/11/2006 12/11/2006 Public Works Review 12/1112006 Public Works Review 12/13/2006 Structural Review 12/11/2006 I Plan Reviews, 12/11/2006 APP 12/13/2006 APP 12/12/2006 WE 12/13/2006 APP 12/12/2006 APP Pal!e 3 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01539 ISSUED: 12/19/2006 APPLIED: 12/01/2006 EXPIRES: 06/19/2007 VALUE: $ 84,980.00 LLH TAJ Placement of this MH is approved through Site Plan Review DRC2006-00065. There are 4 occupancy conditions: Condition 9: The decorative monuments located within the 15th St frontage shall be removed and affected portions of the planter strip. sidewalk and curb shall be repaired to the satisfaction of the PW Director. Condtion 10: 2 street trees shall be planted along the 15th St frontage as shown on the plot plan. Condition 11: The applicant shall post "No Parking - Fire Lane" along the access drive as shown on the plot plan. Condition 13: A wood screening fence shall be installed along the north property line in accordance wi SDC 16.090(I)(a) and 31.160(1)(f). The wood fence shall be 6' in height behind the required front yard setback as shown on the plot plan. To meet conditions of approval, owner must fill out Encroachment permit application & Asphalt deposit requirements must be received from Maint. Dept. prior to release. ( Encroachment permit fee has been added to fee's inside this case type) Tlkd w/owner by phone today @ 2:52pm he said will be in wed 12/13 to complete application. File given to Tara, she will return when she has completed her review. Storm H20 must be installed per site plan specs. JLP Application for Encroachment permit received.JLP PUsed standard plan review comments for M.H. & Garage with additional notes on plans. JLP JLP DLM CITY OF SPRINGFIELD - Building/Combination Permit Status Issued PERMIT NO: COM2006-01539 ISSUED: 12/19/2006 APPLIED: 12/01/2006 EXPIRES: 06/19/2007 VALUE: $ 84,980.00 225 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. I Reouired Insoections I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Foundation: After forms are erected but prior to concrete placement. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. 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. ManufHome Plumbing: After home has been connected to water and sewer. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. Manuf Home Set Up: When installation of all piers or stands is complete. Final ManufHome Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to 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 will be made ofany 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. ~~::a~g.q~ /2-1 o;~b Date Pal!e 4 of 4 "' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Addr'ess: www.ccb;state.or.1i.s 'Permit #: a, - 6) ~5,31 AddJ:ess: /951 It) 7J.. SG ' 'be D~te: /2 li9/b '~ ;I Issued by: , ~tatement.:: Information Notice to Property Owners . About Construction ResponsibUities . . Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construct~on Contractors Board to sign the following statement before a building . perin it can' be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicanis, exempt from licensing under ORS !01.010(7), need not submit this statement: This statem~nt will be filed with the permit.. . ,. . . Fill in the appropriate blanks and initial poxes 1 and 2, and either box 3A or 3B: ~ 1. ~..n 2. I o~, reside in, or will reside in the completed structure. . I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My general contractoris (Name) (CCB #) , .' I will instruct my general contractor that all subcontractors who work on the structure m~st be .licensed, wIth the Constniction Contractors Board. . OR ~ 3B. I will be my own general contractor. If! hire subcontractors, I Will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. , I hereby certify that the above information is correct and that I have read,anddo understand the Information Notice to Property Owners about Construction Responsibilities. on the reyerse side of this form. V ~\2rA-- UJ {)/lJM/I/l- /2-IQ-00 /-' , ~ ~: (Signature of permit applicant) (Date) (White copy to issuing agency jJ~rmit file, pink 'copy to applicant.) Property_owner. doc 06~Ol-04' Acting as,Your'Own General Contractor? . - INFORMATION NOTICE TO PROPERTY OWNERS' ABQ.UT CONSTRUCTION 'RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantIa] improvement to an existing structure, you can prevent many problems by be*g aware of the folloWing responSibilitie;; apd concerns. Employe~ Responsibilities You will, in most instances, be,ruled to be an "employer",and the c~ntractors you.contractwit?-~i11 be "employees" if you use contractors riot licensed with the Constrpction Contractors Board to do labor in constructing <:>.f to assist in the construction or improv~ment of a residential structure. As the ,(m~ployer, you must comply wit.h t~e following: Oregon's Withholding Tax Law: As an employer, you must 'Withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of-Revenue at 503-378-4988: ,', . Unemployment Insurance Tax: As an employer, you are required topay a tax for unc,111ployment insurance purPoses on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon l;3usiness Identification Number (BIN) is a combined number for both Oregon Withholding and . .. Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVlupensation Law, and must obtain wo~kers' compensation insurance for your eIl!ployees. If you fail to obtain workers' cOlHpensation insurance, yoticould be subject to penalties and be liable for ~11 claim costs if one of your employees IS injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. hiternalRevenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at-l:..800-829-4933 or visit their web site at w\vwjrs.!!oy. Other Responsibilities ;andAreas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention th-r:ough inspections. , . , Liability' and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. .. 4" , '''':~'... ~ \ Time: Make sure you have sufficient time to supervise your employees. , . . \ . . . . Expertise: Make sure you have the skills to' act" as your own geliefal contractor, to coordimite the work of rough-in ' and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner.doc 06-01-04 CITY OF S~GFIELD SYSTEMS DEVELOPMEN"I~RKSHEET JOURNAL OR JOB NUMBER: C0M2006-01539 NAME OR COMPANY: Donna Rogers LOCATION: 1959 15th Street TAX LOT NUMBER: ] 703252303400 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS ] BUILDING SIZE (SF: 1811.2 LOT SIZE (SF): 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x COST PER S.F. CHARGE I . 1 ]965.20 $0.336 = 1 $659.55 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. x I COST PER S.F. x I DISCOUNT RATE I I I 0.00 I $0.336 , 50% I = I' ITEM 1 TOTAL - STORM DRAINAGE SDC '$659.55 1 NUMBER OF UNITS x I COST PER TRIP ] I $19.81 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's x' COST PER DFU I 24 $26.03 B. IMPROVEMENT COST: I NUMBER OF DFU's x I 24 $19.79 ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x I 9.57 B. IMPROVEMENT COST: I ADT TRIP RATE I 9.57 NUMBER OF UNITS I x I 1 I i = , x ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INU. . MBER OF FEU's 'I x 1 . 1 ICOST PER FEU I $91.61 B. IMPROVEMENT COST: INUMBER OF FEU's x I ] leOST PER FEU I $961.52 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC . = , SUBTOTAL (A])D ITEMS 1; 2,3, & 4) = 1 5. ADMINISTRATIVE FEE: I SUBTOTAL x I ADM. FEE RATE 1= I $3,848.19 I 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: o rn. ~ Q I~ ~ rn ...... c:; ga DISCOUNT $0.00 11070 $659.55 $624.64 109] $474.97 11092 I =1 $1,099.61" x INEW TRIP FACTORI I. . 1.00. I $189.58 1093 COST PER TRIP x INEWTRIPFACTOR $87.39 I' 1.00 $1,025.901 $836.32 ]094 = $91.61 1054 = $961.52 1055 $0.00 1054 $10.00 11056 $1,063.13 I $3,848.19 _1 CHARGE $192.4] ]21.53 1079 $70.88 11078 TOTAL SDC CHARGES =, $4,040.60 I I Jeff Prociw 12/12/2006 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATIlTUB 2 0 3 = 6 IDRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 !INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER / MOP SINK 1 0 3 = 3 ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 IRECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3 ISHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 ISINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1 URINAL, STALL/WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFD's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE $5.29 $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. $1.59 '.. $1.45 $1.25 $1.09 $0.92 .' $0.72 $0.48 $0.28 $0.09 $0.05 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE /1000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $5.29 o = $0.00 TOTAL MWMC CREDIT 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number C~~ -OIS39 Date \'").\lQ\ 1. LOCATION OF INSTALLATION: }7S1 JS-/!!., 'ST. 3. COMPLETE FEE SCHEDULE BELOlV ZON~ INITIALS ik) . tv} DATE IL>lOJ.-CLz- SOURCE~~ L~ A. New Residential- Single or Multi-Family per dwelling unit. LEGAL DESCRIPTION: J 703 ?);2..3 LJ~401J JOB DESCRIPTION: a fl ; 4~c;'e Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $106.00 $ 19.00 I $50.00 q),tKJ 2. CONTRACTOR INSTALLATION ONLY B. Services or l<eeders - Installation, Alterations or Relocation: Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits. OU'~O , u.' r(3~ ~r . . "1'" ". ~\ ' ,,"Uh, .... \, ,,/1 J')\.~W. ~lf~~.:,a~I~'Jf;~nl.\JJ~I~~Per Panel :~{ \ ~ .\' ",';'}'~iJ&:\G;I}Hif"..? "'\'~ ;;0\ .vltr , ',1\ , I ~t'''') ". -v. GJ" " t.,ni ~O\\0\1\' 'J\'~~. nt~~cp~umtib'n,hY,t;i\~iV:~~h'. CTO ~~ LA ~""C::;'\.~l;- C/d. ::'Sel\~f:r~ijdl1'~mrt~":{'5 0\ b $ 3.00 0. Owners Name 'Z:A /J" 1; ~ ';"' ,,''''\_'\JUll - ,..,.: t"J en... ;:' c...J\. f'( /l _,,, c C\~i:"vu. ,.. ,. "" - - 1(1 Ut'l . - ,,;"";0.vn iOn.:. Address -19 5,) / '5 7.h.- ,fT, (\f\4U. '[:)\'-: ~"T\a~~'t~f~\~$i~ ~tmtl;n not included) -Each Installation - "" ?fiiilpff'.'l'd "t~>l. n U\iM'i ,$./JrlJ Phone C} J 3 ... ~"~;:J{,.'\~f~~~~gi5r.~~i3A4) $ 50.00 , C'?ntefSfgn/~utline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4'~ wo Ie; /1S- TOTAL } +~.37 Shared Drive(T:)lBuilding Fonns/Electrical Pennit Applbtibn 8-06,doc Electrical Contractor 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only o..~:"i> .. ..1\1E\NORK ',' ; _'I~r" ~ ""IT r.,\-\i\ll E:d'IPfe~p.orwY,~~mes or Feeders \ r\~~ \ \...' "." . _ --uIS PERM\ \ Iv . . ._ DllcO \l\\\OER \ n . cC\Cl , . I\UI.\-\Or\ L_' ,.... Ie' AB~~~~~ti@I,\MteratlOnorRelocatJon '. . \,. \("'U Ol~ .:; .'..... C U ,'ll \'; C \' v ~ 100 200 Amps or less \. ,,,'V ~ RO OAY PER 201 Amps to 400 Amps , h\,". '_"-. 401 Amps to 600 Amps Address \ \ Supervisor License Num~\ '., City Phone Expiration Date Constr. Contf. Number Expiration Date Signature of Supervising Electrician City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ;<::~~:ru!L/O~ 4. SUBTOTAL OF ABOVE 8% State Surcharge 10% Administrative Fee 5% Technology Fee Inspection Request: 726-3769 I ~3~ $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100,00 $ 43.00 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone c: 1f Springfield Official Receipt v~ .Jopment Services Department Public Works Department Job/Journal Number COM2006-01539 COM2006-0 1539 COM2006-01539 COM2006-0 1539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-0 1539 COM2006-0 1539 COM2006-01539 COM2006-0 1539 COM2006-01539 COM2006-01539 COM2006-0 1539 COM2006-0 1539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-0 1539 COM2006-0 1539 COM2006-0] 539 COM2006-0 1539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-01539 COM2006-01539 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 2200600000000001724 Date: 12/19/2006 Description Addressing Assignment WilIamalane ManufHome Private Fire SF Fee - Residential Garage/Carport Manufactured Home Placement ManufHome State Issuance Sanitary Sewer - ] st 50 Feet Water Line - ] st 50 Feet Storm Sewer - ] st 50 Feet Manufactured Home Conn - Plmb Manufactured Home Feeder Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Sidewalk Permit Curb cut Permit PW Disc - 2nd Permit Encroachment Permit Storm Drainage Impervious Area 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 Plan Review Major - Planning Item Total: Paid By ROGER OWENS Check Number Authorization Received By Batch Number Number How Received djb 019513 In Person Payment Total: Page 1 of] 2:57:59PM Amount Due 31.00 ] ,000.00 90.30 146.40 ]60.00 30.00 45.00 45.00 45.00 45.00 50.00 63.00 6.00 30.27 48.43 69.57 80.00 80.00 (30.00) ] 30.00 659.55 624.64 474.97 189.58 836.32 91.6] 961.52 10.00 121.53 70.88 ] 98.00 $6,403.57 Amount Paid $6,403.57 $6,403.57 ]2/] 9/2006