HomeMy WebLinkAboutPermit Building 2009-12-14
CITY OF SPRINGFIELD
Building/Combination Permit
Status Deferred Payment Agreement
225 Fifth Street, Springfield, OR
54] -726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2009-0I778
ISSUED:
APPLIED:
EXPIRES:
VALUE:
SITE ADDRESS: 3841 EST
ASSESSOR'S PARCEL NO.: FOUMAL SUB E STRE
12/1412009
06/14/2010
$ 179,000.00
SPR1NGF1ETYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Single family residence -DPA
TYPE OF USE: New
Residential
o
"Yes
..,,;~i"\19:l'l()V-~
-,,;";;' "\'I\~'l'l ~O\
. I PUBLIC IMPROVEM~{'\~~S \,~\l\ \) TOY-
.J"\\"(.~'I\~ ';)'.,<'\t.Y- ~~Id~;alk Type'
Fully Improv"",v \,t.P'" \) 'U'''v S \>-'Ql" . Curbside 7'
YeS\'I\\S ~~1.~ )j~()Y- ~ ~. Downspouts/Drains: To Storm Sewer
Roof runoff from Lots 3 ~ofiti ~~li'!I.~~sting city stormwater system through an 8"
stormwater pipe in the joinCllffn i'JlVlh.
\>-~'l
Owner: KLM CAPITAL INC
Address: 97]2SW ALABAMA ST
TUALATlN OR 97062
I CONTRACTOR INFORMA TlON .
Contractor ,j' License
BANYAN CONSTRUCTION LLC ]65147
HARDING ELECTRIC INC ]32089
-- ':";~;
LOW!':S WE-ATHERIZATlON ]76741
T & S PLUMBING INC ]86903
'I ijJJ.u.~~4\ltiATlON ~
, _"'ON: Ofeg~ ese\~~n
# of Units: "T\ ~';Uie8 4dopte 1t\osll tIlISlIJlsz'OO'O 2
Primary Occupancy Grouto"?'" 10rlQote\otll!~~ ~\l\'t8,QY 29.50
Secondary Occupancy GrMIII}f~ 952..001.00 ta\fI c~ ~~1I0~ced Air Electric
Primary Construction TyPl' 0 0 '{OU~'t 0'0 f lN~Q't~'ftw\\\ical1on Electric
Secondary Construction T:All9eai\\flO tile ceot~e9oR:\lIi&~lrM. Electric
# of Bedrooms: cnb8f ,OJ th8 \8 1.&oB~It: '
t\IA C8nt8f Sprinkled Building: n/a
Contractor Type
General
Electrical
Mechanical
Plumhing
I DEVELOPMENT INFORMATlO~
Front yard Setback:
Side] Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
]8.00
5.00
28.00
19.30
29.70
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Pa~e ] of 3
Expiration Date
06/]5/2011
02/01120 I 0
06/] 9/20 II
06/0112011
Phone
54] -434- 1333
541-688-5006
541-485-2282
541-915-]000
Lot Size:
Sq Ft ]st Floor: 668
Sq Ft 2nd Floor: 633
Sq Ft Basement:
Sq Ft Garage/Carport 237
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
,.
CITY OF SPRINGFIELD
Building/Combination Permit
Status Deferred Payment Agreement
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO: COM2009-01778
ISSUED:
APPLIED:
EXPIRES:
VALUE:
12/14/2009
06/1412010
$ 179,000.00
I Valuation Description I
Estimate
Garage/Misc
SF/Duplex
Tvpe of Construction
Estimate
U VB Utility
R-3 VB 1&2 Familv
$ Per Sq Ft
or multiplier
$1.00
$37.72
$96.83
Square Footage
or Bid Amount
179,000.00
237.00
1,301.00
Value
Date Calculated
Description
Total Value of Project
$179,000.00
$8,939.64
$125,975.83
$313,915.47
12/14/2009
12/14/2009
12/14/2009
~
Fee Description
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
Amount Paid
Date Paid
Receipt Number
$10.00
$1,044.54
$101.97
12/16/09
12/16/09
12/16/09
1200900000000001338
1200900000000001338
1200900000000001338
Total Amount Paid
$1,156.51
Planning Review
12/14/2009
Plan Reviews I
APP DDK
Public Works Review
12/14/2009
12/14/2009
APP LKW
Roof runoff from Lots 3 will be
directed to the existing city
stormwater system through an 8"
stormwater pipe in the joint utility
trench.
Structural Review
12/14/2009
12/15/2009
APP CJC
As noted on plans
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested hefore 7:00
a.m. will be made the same working day, inspections requested after 7;00 a.m. will be made the following
work day.
l..f.eouiretUnsnections I
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
Footing: After trenches are excavated.
Foundation: After forms are erected bnt prior to concrete placement.
Post and Beam: Prior to 1100r insulation or decking.
Page 2 of 3
CITY OF SPRINGFIELD
Building/Combination Permit
Status Deferred Payment Agreement
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541 - 726-3676 Fax
541-726-3769 Inspection Line
','
PERMIT NO: COM2009-01778
ISSUED:
APPLIED:
EXPIRES:
VALUE:
12/14/2009
06/1412010
$ 179,000.00
Floor Insulation: Prior to decking.
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.
Drywall: Prior to taping,
Final Building: After all required inspections have been requested and approved and the building is complete.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Underlloor Plumbing: Prior to insulation or decking,
Underlloor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Sanitary Sewer Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Underlloor Mechanical. Prior to insulation or decking and including required testing.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefnlly 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 prope,rty, and the approved set of plans will remain on the site at all
ti s during construction. ,;,
/;2 - J& - 0 7'
Date
Paee 3 of 3
225 fifth s.treet
Springfield, Oregon 97477
541-726-3759 Phone
aJ~Qm:Q~. ",.".
1rIL. '&f,:i
'liU" " <
_. ~ ..,
,'",.,..~.",..,...,.,.......,... .~' -
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1200900000000001338
Date: 12/16/2009
2:20:54PM
Job/Journal Number
COM2009-0 1778
COM2009-0 1778
COM2009-0 1778
Description
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
Payments:
Type of Payment Paid By
Check . KLM CAPITAL 1NC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 2564 In Person
Payment Total:
Amount Due
101.97
1,044.54
10.00
$1,156,51
Amount Paid
$1,156.51
$1,156.51
';i'
cRcceintl
Page I of 1
12/16/2009
Plumbing Permit Application
" ~~_-:-~ ~ -~' "~,<;.t!ll ,~h.l~tr-1"'Pj}~'lF":::Yl':,7j,,"'r.."'."l"_~"~
: ~. CfT.y~O:F:Sp~iN~flEtIi~:9R'i601{'~:"
-' ..".':.....,.,~ _;:.. -"'; """"-2 . - <"~""~'~'->::"'~I-_ ~r":._ "''t,;;, .".,;>~.~vc.,. ~ :.~"':;'..:~
225 Fifth Street. Spcingfield. OR 97477 . PH(541)726-3753 . FAX(541)726-3689
VI'~'d"<'- ..-......~.,....,....:,......; '. "',''-J'".' .~.., '\.,.....".,.>&.~_'~:'
":: "DEPARTMENtUSE ONL:Y,":,y{
~ . . .;. . " . . ".- -.' : .,", , . . ,', ~,\-
Pennit no.:
Date,
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the wnrk. Permits
expire if work is not started within 180 day,s of issuance or if work is suspended for 180 days.
';:;:;~;;~;; ~rIlOCAL;'GOVERNMENT,i'ApPROV A~'W:7;;:,;:'f'{
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEGOR'COF CONSTRUCTION'
Residential 0 Government 0 Commercial
';;;:ii[;<'[J()B,siftE INF()RMATI()N;fAJilD;;([OCATION:l0~'~!<:'<<
Job site address: 3 '-I .s (}..-~
City:S ,,,- ~vIJ.. ZIP:97Y)~
Reference: Taxlo!.:
;_:~~;~~16f?:jD_ESCl~..IF?JlbN;~;()t~w,O RK:.-.i~~_~n:;lt~if~t~~t~~~~~~}i~
s\
tJe-.O H 0 r>
" .'~
~ PROe:ER1:Y(:bWNER!i!~e?~;~~t~W~,~:~;~';~~l~;~~
. Name: KLm Co.. I h..\ - DtllN:.- tJeA~c^-
Address: 97 J 2. ..s;.J fh.tt ",...
City:Tv...\ ,,-\-,.~ State:O,;z ZIP:'170b2.
Phone:Sol gOlf. m..'- 2. Fax:S03-'13- 5 7S
E-mail: n e-b 0>"\ 7$7 e .u,,,,,,. <............
This installation is being made on residential or farm property
owned by me or a member of my immediate family, and is
exempt from licensing requirements under OAR 918-695-0020.
Signature:
. CONTRAC170R JNSTALLA liON.
.;df..,\.''''; .
Businessname:T4'S, P <.I"",b,,,- ,.;
Address: Po Bo "l2.2) Lj
City: liW ""-,1.-C- State: Olt.... ZIP: 97'10'-1
Phone:SlII-<tIs:"-1 () 0 0 Fax:S'-II-s/}f' - S83/
E-mail:'Ts l",,.,b,n .....bo.-.
CCB license no.: ) &10 9 0
Plumbing license no.:
Print name:
Signature:
440-2500-) (1Ii08/COM)
;~ .;~~~~.'~)$tt:; -~~!{.\~~~t7EEt{S:CHEDUlIE?;j;:~(':'!lt\1N/~::fi~m~.:~
.,.r.,;;; ;~~- i,~"""V'~-;\~,:r(,....,\~':~.0',~~,;",-:-;!,~,'T.,.:,~,~,~..i': . C~.C (T -fT;:>r
;'4Descriptioi11,:t~;f;j:~":~i:::::'1&,):,'''1\~~\''<:2j~;'- Qty . ~! . ,.: 9~J\):':" :\. h P ~..'~"
It,ii~'~~Ji'r.-,E1~~' ..<J,~,;,.';fj~-'fqt0:d%t;r,~-&~~~~~;}'~;!~,~~;~N;~ ~,.,:",,:i; ~;Ij~ ~~j'tvh~ (;i:~I:_C.O_s.( 1'1\',)';
New residential
I bathroomll kitchen (includes: first
J 00 feet of water/sewer lines, hose $238.00 $
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathroomsll kitchen $374.00 $
3 bathroomsll kitchen $439.00 $
Each additional bathroom (over 3) $95.00 $
Each additional kitchen (over 1) $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 $
3,601 to 7,200 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 $68.00 I $
Each fixture I $19.00 I $
Miscellaneous fees
100' storm, sewer, water line $76.00 $
Each fixt,ure, 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 $68.00 $
hrs. x fee per hr.)
Each additional inspection: (1) $58.00 $
fM'l~d.;'\+-:;pt.,yit.,;:}.".;,.,;\".-<;;,,-,;tt\''i::"''~:i':;i;:~\~'~;';..' {!;;,."r..;~ Mi.nimum fee $
,: e Ica:gas:plpJ~g~1~;:~,!'i'-:f5'>.:3'~;~!?:if,~. ,d Enter value of installation and equipment $
Enter fee based on installation and equipment value. I $
~;';""'~~~"~~-'.._"'T''''-;..'~l''~J1.''r~~
;,~'1iY'fi".. ."..tk-;. A:pelll<::~NT;!';USEii,~ 'H.~l '. ",.'_.
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $
(B) Investigative fee (equal to [A]) $
(C) Enter 12% surcharge (.12 x [A+B]) $
(D) Technology Fee (5% of[A]) $
TOTAL fees and surcharges (A through D): $
225 Fjfth Street. Springfield, OR 97477+ PH(541)726-3753 +FAX(541)726-3689
-'...., ,,'-',,",' ,...' .", ",
<,' DEPARTMENT USE ONLY,
'.\'..;''',eo' . - .-
CO~ zoo 'f - 0 l 77'3
Pennit no,:
Date: /2- -/6 -0 c;
This permit is issued uuder 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.
:" c': ;, ';" ',',l3'OCAL"'GOVERNMENT: ApPROVA.lf'i'.;*,~"';'(1iin!\1
'. ,', ._ ..,. _'."... . ....'......., c....,
Zoning approval veri tied? DYes D No
;~,.!':~h.\:;S.CATEGORv::i0I7;;tC()NSTRUCTION~10)',; ",1;"":"
Residential 0 Government 0 Commercial
[({f>il:i,W'JoBE$mE~INJ;()RMA"flolill:AN[jl1UObJl.;r,I()N@;1f.;t~:13
Job site address: 3 gLf ( E c;
City: S 'fF Q. State:0<2.- ZIP:
Reference,fi>.-..4-( S\Ab E: 'SoT Taxlot.:S.LO~
,,' :DESCRIRTION; OF'WORKqfi",:,'iOi",:W'!:1;'
'^~e- Wlvtc 7/;".",1'
Name:
L
sr
97062-
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family, This
property is not intended for sale, exchange, lease, or rent. OAR
479540(1) and 479,560(1).
Signature:
ZIP: 971102-
-S11- (g53 -9/30
E-mail:
CCB license no,: /3,;:(() '( 9
Signing supervisor's license no.:
. Print name of signing supervisor:
Signature of signing supervisor:'~d
~
r,~.\\)
~t~
~
440-2584-J (9/08/COM)
C1::~;t:,":'f:'~:i~;\~1f~r~f~;\i('FEE-j#5CHE[jUI!lE*'1:1j~%:~t:~'hAV:}1}~~S\i"Wtrrt1J;C
,-.' ,..",t'''"u:.;,.-''''.;,..'o'...../i'.:;,,{ ,;';. ......". ,. - .. ,. . .,K-.-'".-\~-":,i'ob"'~il'~..lt..~ "(!<<t~"'~,,,::
:-;N ~~ ~el ~f}~.sp'~~ii'~tri~ :p~r)4,~."~( ,)..~.f,--~'"I,(~H~,' . Cost 'Total'
" '~'..' ~ c.,. .,' , _", , '.', , .,,_,ft. .'.., '." . \ v..' '.... '". .' ,," _", j .~~a.':,'" .' '_t:.osL i.
Residential, per unit, service included:
1,000 sq. ft, or less (4) I $134.00 $ 13Y
Each additional 500 sq, ft. or portion l. $ 25.00 $ 50
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, aLteration, reLocation
200 amps or less (2) $ 61.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $156.00 $
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) I $ 63.00 $h?.
201 to 400 amps (2) $ 67.00 $ 1
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 panel
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 orfeeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a Iimitedwenergy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $56.00 $
&!~~~~t~\~\~~~~ARe11icA~Ntt~tJS-E~r?~:~fj,~$f;r~~j~~~~{1a~;if::i";f~
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $ 247
(B) Enter 12% surcharge (.12 x [A]) $ z9~
(C) Technology Fee (5% of [AD $ 12 'I~-
TOTAL fees and surcharges (A through C): $ ZB8.
ct,
j
Structural Permit Application
.. ~;:~Bi['"~ .: ~4,:.1t,,1:f!"4~. P~~E'~~I 'pj;~~. ~~~~;~dj;~~'7~:f'{"j;t:~
. ..,<-: (3ITY:;OFiSBRINGFIEED~'OREGONff~~~1i.~',,~y~; '"'_ ',r~-
~ _"'":"_ _" '" _ . _.,.... ,h_~""" "'~" >. "". . " .,,;.rl ""
'DEPARTMENT.USE ON!-Y
Co...... zoo if. C 177
Permit no.:
225 Fifth Street. Springfield, OR 97477. PH(54 1)726-3753 . FAX(541)726-3689
Date: Z-(<(-O'
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days.
;~ .'.LOC'AL:GOVERNMENT.!:ARRROV Ai!'~::;;j':r\',;~~ ;~~~2j;
. _.. _ ,_ . _._""._ ___.' _. _.__..____' _ _ .. ..."~, .,'__...'.. ..... c_, "'..,.;~,.. "'_,
This project has finalland~use approval.
Signature:
This project has DEQ approval..
Signature:
Zoning approval verified: DYes D No
Property is within flood plain: DYes D No
i.~~'1~{~"i'i[iiCATEG.bR.~OI'.I.:.(;.bN~lRUCfr10N:;uil~jl'.~.:':3,~;
Residential D Government D Commercial
"'.\,;'iifh,'iJ9BlSI;[E', iNf.ORMAfi9NYANI?!'LO:CAtlc5Nf:lb,,;,'7;i~;
Job site address: 38 Lj I E: &&re.cJr-
City S (', "- S-,.1..l
Subdivision:(1)~o....-t- ~
Reference: i 7 -0 z. -3 I -13
: , P.ROPERTYOWNER
Name: j(Lm . ~\ - .D,,~ l\.I-<,;\~".-
Address: 97/2 $w Pr A A ~~
City:!,),,-- ".:~ ~ State: O~ ZIP:'!")Ob...
Phone:$"03-80 .. 0 2.'- 2.. Fax:511J-Z/:!.- s-87S
E-mail: il ~ ~_o.~........
This installation is being made on residential or farm property owned by
me or a mem~Of my immediate family, and is exempt from licensing
requirement u . er OR 701.01 .
Sign here:
,:.~
Date:
Date:
ZIP:'17'i 1 if
3
01 ZOe::>
Business name: 13u..,.,. D.h'\.. Co/l ~ L~,-
Address:J'il'l V/~ J)A-Ivc-
City: ~ State: Ot!. ZIP:97yo.r
Phone: ~-1IJ+'-13 J3 FaxS'fI-'''3- 'iS9o
E-mail: . "" _ 3 j) e hoh,..,..1 . ...0....
CCB license no.: ) (.. $1 '-/ 7
Print name: f!r"",,,- 80.l ~ Cc:L,-ch""
Signature:
;::?~~~;,~. .;, J;~.t;..t;:s-u ~;.G0~J:BAC:r9f(I_~ 170R..MA1tQN~~'t{~~f~~:i~fl~
Name CCB License Number Phone Number
Electrical /32--069 t.SIf -So 0("
Plumbing J(J1u 90 J 9/.r- / " " <>
Mechanical /?I.. 7'-"/ '/J,r-z-U z..
'FEESCHEOiJLE'1;!"
, ~ ',". . ',-
-.>t. "
"'i~V aC~~'~ti.o~"/ipf6rm~!j(lD,',f1~!fj~~~~~~:~lr!~}~1
(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot:
Other infonnation:
Type offleat: Z e:r. ~
Energy Path: Z
new 0 alteration 0 addition
(b) Foundation-only permit? DYes
.......
-
Total valuation:
)2_::. B,~ Vd i Ii g"J eet~::~~ ~:1.~~~~:.~~~j_i ~~:":,~~ ~;,f:~~~:;_~-~'
(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
(e) Subtotal of fees above (2a through 2d):
$
$
$
$
$
1'~;:.~J~~{!e~.i~Wlf~~t~~t~1.~~~?11-.~~1F-~~8~~~~f>~r~gu~:-~..~:~~~:7-';' 8
(a) Plan review (65% x permit fee [2a]): $
(b) Fire and life safety (40% x permit fee [2a]): $
(c) Subtotal of fees above (3a and 3b): $
~'~~);~J~cell_a'rleq~u~:f~~~:'fE~r~I;'~' ~'i.\;;tf;~~-':;(,:\(,
",.::., '~'."
(aJ Seismic fee, 1% (.01 x pennit fee [2a]):
$
TOTAL fees and surcharges (2e+3c+4a): $
t[)~'1 1IfV1/li""
.~
7') q / $'[/0
'l;'~'-Al.."
Mechanical Permit Application
.
'';' ;\;-.,~ k,~~",,'t<.' . :',......'7,,.""~"L" ""~l';' ;'::-.::'~~"'r~,>,,~:-':':~'
,~,,,,,\pE>PA~TME,NJ:;!Jl?E Qf\jLY..'::'i1
,'.' ". ~":", -Y." . ~ - ",,, ",'... '.. "!~N '._:.!!<."~ Y"
Permit no.:
Date:
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days,
",,",';V''-''''''''''''C'A'T''E'G''O''R'',i''O' 'E"'C'O' 'N'''ST:R'''U''''C' "T"'IO-N'''M,,:i, ',,,, "W.,
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esidentia! 0 Government 0 Commercial
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Job site address:3&Y
City:S
Reference: 1J-02--31 -)3 Taxlot.:
DESCRIPTibf{'OF WpRI(.' ".'.... w,
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726.3689
New & I
0........
^1""'t''''~''''''''1.''''''''''''>' .. .... ..-. 'Y""O'W"E' 'R"?;;;.iW~""'~~'~\'I\~.M'
~~~~~;jJl>>~~~~.s~tfi'f.?_~~,~,E.R.J}:..,~L'., . _~__'_' ~;\,;,i4i:30~~~,R>,,'i,~~~1'~
Name: )eL - Oa.-('f!.. ~:'D_
Address: "t 7/ 2. . -SvJ fuf)'l1 " ~.....
City:TvA.\....-\-. _ State: Od.. ZIP: 9"/0(.,"2-
Phone: 503- 80 '1- ol-(.2. Fax: 503- ZJ 3 - 5g7 S
E-mail: JneJ 0>'"\ 757 e. ~J, 00. c.....
This installation is being made on property owned by me or a
member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
Signature:
~~~~~({6i-.1:rF{~<;::t:0R-~IN$TAllG~tI0.N!~k~f,f~i(;,f!2t"k';(i,'!i
Business name: .L tJCAJI.. e.r, Q
Address: (lo "8".,.. -z.j 337
City: ftv. State:O.l! ZIP:''}7'102.
Phone::sY/-f"J';: zUl i!...
E-mail:
CCB license no.: ] 7 i. "7 '1
Print name:
Signature:
440.2545.) (II/OB/COM)
",', ~-. ,": ..... :"'FEE . SCHEDULE ",: . "
~~~~Jd.~i_!~t~~~Ji~1~~~it~i~~4Wjki:' ,9!r," ~.': 'Cost' . ,,;.Total.
t~1;.ea;',>:,~~;; ~:~cost ,;~!,
First Aooliance $79.00 $
Furnace/burner including ducts and vents
Up to lOOk BTUlhr. $17.00 $
Over lOOk BTUlhr. $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 system! $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
Up 10 10,000 CFM I I $11.00 I $
Over 10.000 CFM I I $20.00 I $
Comnressor/absorotion svstem/heat numn
Up to 3 hp/100k BTU $17.00 $
Upto 15 hp/500k BTU $29.00 $
Up to 30 hpll ,000 BTU $43.00 $
Up to 50 hpll,750 BTU $57.00 $
Over 50 hp/I,750 BTU $95.00 $
Incinerators
Domestic incinerator $20.00 $
';c:c)mm'ercial~~11,\~i:i~:}~K~~!~;t~~~~J;~~~>~(~ .~~~tf;;riL~~!I~i~Tr(J_z;.;/eq
Enter total valuation. of mechanical sy~tem
and installation costs $
Enter fee based on valuation of mechanical system, etc. $
. f!.'~'3..."o:.,\':.~'''':;::.t :,...1i,';ib~W~~>f~"'}fl,.r. '~:::$~t\;;;;:.. i:t'"-'.J{; ~Ciistlp, "'..Tj)tal\'il
~M Iscellaneous~ fees \ 1;-~"""~~.'J.:'~;~~' Items
,t -. C';"~ :-.,.rc..,._,..'t<..,....,:',\~:!':,.o., ~-r.'--. .,.1"t'S!,:,,:~\,_ " ' .i.'<<.i'~ ;;.;; -: ea:f--~~ :1!<:COSE' ..;
Reinspection $58.00 $
Specially requested inspections (per hr.) $58.00 $
Regulated equipment (unclassed) $13.00 $
Each additional inspection: (I) $58.00 $
~f'1~D~~':~\r!~:A-~_~~I~~_f~jj~;tQ_S'E~~i>'ii~~;~~
. .
(A) Enter subtotal of above fees (or enterset
minimum fee of $ 79.00) $
(B) Investigative fee (equal to [A]) $
(C) Enter 12% surcharge (.12 x [A+B]) $
(D) Seismic fee, 1%(.01 x [A]) $
(E) Technology Fee (5% of[A]) $
TOTAL fees and surcharges (A through E): $
~ ~ Willamalane
t'W Park & Recreation District
Job. No. C1- /7 '1 F
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009
NAME: ,kL-M.~1 711'- . PHONE:~::J. {ft!J'f 9 I "'~.2~:L.
ADDRESS:9?1:J... Sv.i~~1f-~r ~1f't-1!rt5E:~IP:o,l>kt7;"
. LOCATION OF PROPOSED BUILDING SITE:
Street Address:."5E'i1 E. . ~ r
Plat Name:
Tax Lot Number:/702- ;?/:! /:zU.v
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the
back.)
2. SDC CREDIT (If applicable) SDC payer must fumish proof of
Willamalane Credit approval.) $'
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
~
Development Services Department
City of Springfield
$ "JF~%
_IJ .' ..) I J'
Da\D .lQ.. \D \J~\~.
. 5
SP~~:~..FIEL~
a,,~
~"", OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
COM2009-01778
3841 EST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield, OR 97477
541-726-3753
permilcenter@ci,springfield,or.us
RECEIPT NO: 2010000549 RECORD NO: COM2009-0I778 DATE: 10/12/2010
WE.SCRIf'Tf6r.E'l; jj;f;i):;'~"<- j'';:'';-~7'ji:.t :':.t,.,~l ;:T~;;;'[i:~/MJPPJjt>l-r:CQI)E'3>E""~'::J-:.~l'ito~uEfDu.J;i',c;'" ;.- Tel .,1
Building Permit 224-00000-425602 $1,030.28
Storm Drainage Impervious Area 440-00000-448028 $635.58
Residence Wiring Ea Addtl500 224-00000-426102 $50,00
3 Baths One & Two FamiI~ 224-00000-425603 $402.00
1st Appliance 224-00000-425604 $79,00
Exhaust Hoods 224-00000-425604 $13,00
-----.
Dry-"rlJe~t 224-00000:.~______ $9,00
Addressing Assignment 224-00000-425602 $38.00
Willa~Ia_~ Single Family" _._~21-00000-2!5023 $2,85~~
.~_13Y.'.~tate Surchar.g,,__. 821-00000-215004 .-221687
SDC:Ir-".~portation Ad",in 719:00000-4~6604 $78.08
SDC Tran Reimburs-Residential 446-00000-448026 $211.21
,sanita,ry Sewe!. - Reimbursement 442-00000-448024 $782,81
!?anitary Sewer - Improvement 443-00000-448025 $595.25
SDC Sanitary/Storm Admin 719-00000-426604 $137,57
Plan Review Major - Planning 100-00000-425002 $211,00
+ 5% Technology Fee 100-00000-425605 $100.91
Fire SF Fee - Residential 100-00000-424005 $80.05
~p Power 200 amps or less _~---324-00000-4261 02 $63,00
Fan 224-00000.425604 $27.00
Plan Review Residential 224-00000-425602 $669.68
_"_'_'___ _____.n .~.._~~.____""._"",..,__"_.__,..._~_..."._._~__."__.".,,.__
SDC T~ns Improv"ment-Resident 447-00000-448027 $931.65
Residence WirinS.1 000 Sq Ft 224-00000-426102 $134,00
TOTAL DUE: $9,353.94
kP'PAYMENt.,;r",pE.-T:"-PAYOR~-CASHiER1DBOWLSi'-Y;4;"'~:t::()MME.NTS-i.:lJ'-,JJ-'!I;.!i-'(;-"~'''';''''''';:--ic;;; AMo'UNT-i>AI" ::,~,,,,,.i-:_' _;~l
-_ .~ ~,,'" -,._...._,.."..... ':"]'"'' ...__.....~.............................~"..~~.,~..... . ..,..,,~ ~._~ ...... ~~0~"""'.-;"..~
Check
2880
klm capital inc
pay outstanding dpa amount due
$9,353,94
$9,353.94
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