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Home My WebLink AboutPermit Building 2006-6-19 - CITY OF SPRINGFIELD - Building/Combination Permit 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2006-00492 ISSUED: 06/19/2006 APPLIED: 04/26/2006 EXPIRES: 12/19/2006 VALUE: lj;,)8~,\9~.00 \\,v;:) 1 - ._n ,~W reC\UI..... \ \\i\iW __ot"'f'I(l'::-t U\':J",,-, ......" 'Ihe U\\J~-, ~ot tortn f.S:)U 1.....~ ,. ___,.. "'~O~)\.o'-" - ~ _ _ r \\850.\..... - f:1 :"\.- SITE ADDRESS: 6411 FOREST RIDGE DR SPRHiP.F!IEW,yPE Or. ~0RIK}Sing~tli'~,jJ~ltesidence ASSESSOR'S PARCEL NO.: MOUNT AINGA TE PH 3 'O~\~\~a\iO() ~~~~~O~ 0 tnro~g~ ~,tne {u\es '0,/ ~o ()~R S~Jb'.p'E\ OF tlJ\~~O?llNew te\e?nolle Residential PROJECT DESCRIPTION: Single family residence - Mt GatelS"ub~.Jot-<!Q.6,\\a'/ 0'0 (:). ,Note'. tne..\ tl'icatiOIl 009v. . \ tne cellteC Uti\iW r'lO ,.~\\\nn A.onOIl ..'"'^") v-, 'O{ tllv - 3'.:)'--t.-~ IIUII,'oe{ te{ IS ~-80P-lione Number: 541-914-3426 cell . Owner: Address: JEFF PLUEARD 3779 STERLING WOODS DR EUGENE OR 97408 Status Issued I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor PLUEARD CONSTRUCTION LLC SUNSET ELECTRIC INC SUNSET ELECTRIC INC RS PLUMBING CONTRACTING License 167960 158859 158859 103816 Expiration Date 01/09/2008 02/27/2008. 02/27/2008 01/04/2008 Phone 541-683-5140 541-915-4883 541-915-4883 541-461-4714 ,J 1 R-3 U VN I BUILDING INF.o.mtTION I ' WORK U',,,, - \1 SHAll EXPIRE \f THE # of 810,;,,11-\15 PERM UNt~1HI~~T \S NOT Height of sM1nd~\ZED OABA~m6NmlIflOO: Type ofHe(lOMM~~.Q ~q Ft 2nd Floor: Water TypeANY 180 DAY PE b. Sq Ft Base~ent: Range Type: Gas Sq Ft Garage/<;arport Energy Path: ~ Path 1 Sq Ft Other: Sprinkled Building: nla Occupant Load: \ # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 23,288 1,502 1,222 3 1,176 756 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 76.50 17.00 18.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Hillside 4 Yes 22.10 REQUIRED PARKING Total: 2 Handicapped: Compact: 0.00 I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Yes Sidewalk Type: Downspouts/Drains: Curbside 5' To Storm Sewer Notes: No hook-up to City Infrastructure until Public Improvements accepted by the city;storm drainage piped to stub provided 5/12/06 CAS Pa2e 1 of5 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier $4.00 $99.00 $26.00 Square Footage or Bid Amount 2,724.00 3,480.00 1,176.00 A.C. - Residen Dwellin2s Gara2e AC - Residential V Wood Frame Gara2e Total Value of Project ~ CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00492 ISSUED: 06/19/2006 APPLIED: 04/26/2006 EXPIRES: 12/19/2006 VALUE: $ 385,992.00 Value Date Calculated $10,896.00 $344,520.00 $30,576.00 $385,992.00 04/26/2006 04/26/2006 04/26/2006 Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $971.85 4/26/06 1200600000000000551 -Mechanical Issuance Fee- $10.00 6/19/06 1200600000000000898 + 10% Administrative Fee $217.20 6/19/06 1200600000000000898 + 8% State Surcharge $155.13 6/19/06 1200600000000000898 3 Baths One & Two Family $306.00 6/19/06 1200600000000000898 Addressing Assignment $31.00 6/19/06 1200600000000000898 Appliance Vent $12.00 6/19/06 1200600000000000898 Boiler/Comp Up To 100,000 btu $12.00 6/19/06 1200600000000000898 Building Permit $1,495.15 6/19/06 1200600000000000898 Curbcut Permit' $80.00 6/19/06 1200600000000000898 Dryer Vent $6.00 6/19/06 1200600000000000898 Exhaust Hoods $9.00 6/19/06 1200600000000000898 Fire Fee - Residential $232.80 6/19/06 1200600000000000898 Furnace - up to 100,000 btu $12.00 6/19/06 1200600000000000898 Gas Fireplace $15.00 6/19/06 1200600000000000898 Gas Outlets 1-4 $4.00 6/19/06 1200600000000000898 Mountaingate Impervious Area $1,664.10 6/19/06 1200600000000000898 Plan Review Major - Planning $198.00 6/19/06 1200600000000000898 PW Disc - 2nd Permit (Street) $-30.00 6/19/06 1200600000000000898 Sanitary Sewer - Improvement $686.52 6/19/06 1200600000000000898 Sanitary Sewer - Reimbursement $902.52 6/19/06 1200600000000000898 SDC MWMC Administration $10.00 6/19/06 1200600000000000898 SDC MWMC Improvement $865.31 6/19/06 1200600000000000898 SDC MWMC Reimbursement $82.03 6/19/06 1200600000000000898 SDC Sanitary/Storm Admin $199.37 6/19/06 1200600000000000898 SDC Transpo Admin $60.57 6/19/06 1200600000000000898 SDC Transpo Improvement $805.70 6/19/06 1200600000000000898 SDC Transpo Reimbursement $182.69 6/19/06 1200600000000000898 Sidewalk Permit $80.00 6/19/06 1200600000000000898 Temp Power 200 amps or less. $50.00 6/19/06 1200600000000000898 Vent Fan $18.00 6/19/06 1200600000000000898 Willamalane Single Family $1,000.00 6/19/06 1200600000000000898 Total Amount Paid $10,343.94 Pa2e 2 of 5 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00492 ISSUED: 06/19/2006 APPLIED: 04/26/2006 EXPIRES: 12/19/2006 VALUE: $ 385,992.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Plannin2 Review 04/27/2006 06/07/2006 I Plan Reviews I 05/01/2006 APP 06/07/2006 APP LLH TAJ Plannin2 Review OS/24/2006 WE T AJ 05/01/2006 Public Works Review 05/01/2006 APP CAS 05/12/2006 Structural Review 05/01/2006 OS/24/2006 WE RWC Structural Review Structural Review 06/16/2006 06/06/2006 06/16/2006 06/06/2006 OK RWC WE RWC Place orange construction fencing at the rear of the area of disturbance. No construction activity or tree removal allowed in outside the area of disturbance. The clump of big leaf maples marked on the plot plan are to be preserved unless a liscensed arborist indicates that they are unsafe or in danger of dying. Dead branches and trunks may be removed. These tree~ may possibly be counted for one of the required street trees. Contact Mike Risely in PW Maintenance (726-3615) regarding this. A letter was recieved from Kyle King, certified arborist, stating that the trees should be removed. This is approved. tara 6/16/06 On hold until tree information provided. Spoke to Jeff Plueard and will be getting this information in. tara 5/23/06 No hook-up to City Infrasture until Public Improvements accepted by the city; Storm drainage piped to stub provided 5/12/2006 CAS PW cannot review plan until info is made available 5/2/06 CAS need to get second copy of l)truss details 2)beam calc's Need to get an engineered foundation from contractor 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. l...jeouiredJnsnections I 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. Pa2e 3 of 5 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2006-00492 ISSUED: 06/19/2006 APPLIED: 04/26/2006 EXPIRES: 12/19/2006 VALUE: $ 385,992.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Curbcut - Standard: After forms are erected but prior to placement of concrete. 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 but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. 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. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Shower Pan. Prior to covering 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. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Ufor Electrical Ground: Install ground rod at footing and call for inspection in conjuction with footing and/or foundation inspection. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Pa!!:e 4 of5 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00492 ISSUED: 06/19/2006 APPLIED: 04/26/2006 EXPIRES: 12/19/2006 VALUE: $ 385,992.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Low V oItage: Prior to cover. Electric Service: Approval required prior to utility company energizing service. Storm Sewer Line: Prior to filling trench. 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 win 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 win 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 win remain on the site at all times during construction. ~l~X\~ Own\J. o~~6!}actors Signature b -{~-f)b Date Pae:e 5 of 5 CITY OF ~mNGF'ELD SYSTEMS DEVELOPME~~ORKSHEET JOURNAL OR JOB NUMBER: COM2006-00492 NAME OR COMPANY: Plueard Constructicin LOCATION: 64]] Forest Ridge TAX LOT NUMBER: MouyntainGate 1 st Addition Lot] 06 DEVm.oPMENT TYPE: SINGLE FAMILY RESIDENCE NEW I'WELLING UNITS ] BUILDING SIZE (SF' 2634 LOT SIZE (SF): I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S.F. x COST PER S.F. CHARGE 5]52.00 $0323 = $1,664.10 RUNOFF ROUTED TO DRYWELL DESIGNED'AND CONSTRUCTED TO CITY STANDARDS , I IMPERVIOUS S.F. I x I COST PER S.F. x I DISCOUNT RATE I 0.00 I I $0323 I 50% ITEM 1 TOTAL - STORM DRAINAGE SDC 1 $1,664.10 2. SANITARY SEWER - CITY . . A. REIMBURSEMENT COST: NUMBER OF DFU's x 36 B. IMPROVEMENT COST: ' NUMBER OF DFU's x 36 COST PER DFU $25.07 $]9.07 ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE . x NUMBER OF UNITS x I 9.57 1 B. IMPROVEMENT COST: . I ADT TRIP RATE x NUMBER OF UNITS x I 9.57 . . ] ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x COST PER FEU I ] I $82.03 B. IMPROVEMENT COST: INUMBER OF FEU's' x I ] ICOST PER FEU I $8653]' MWMC CREDITlF APPLICABLE (SEE REVERSE) . MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I SUBTOTAL (ADD ITEMS 1,2,3, & 4) = .1 5. ADMINISTRATIVE FEE: SUBTOTAL. . x ADM. FEE RATE $5,198.87 .' 5% . TOTAL SANITARY ADMINISTRATION FEE: . . TOTAL TRANSPORTATION ADMINISTRATION FEE:. 23288 r.rJ P-l Cl o U ~ P-l f-< r/) ...... c:r ~ DISCOUNT $0.00 . I $1,664.10 1070 = I =1 $902.52 ]09] = , $686.52 I 1092 i ~ $1,589.04 COST PER TRIP $]9.09 .x NEW TRIP FACTOR 1.00 $182.69 1093 = , COST PER TRIP $84.19 $988.39 ]094 x NEW TRIP FACTOR l.00 $805.70 = $82.03 1054 = $865.31 ]055 $0.00 ]054 $10.00 [1056 $957.34 $5,198.87 I CHARGE $259.94 199.37 11079 I $60.57 11078 TOTAL SDC CHARGES = , $5,458.81 J Cheryl Slaymaker 5/12/2006 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 1 0 3 = 3 I DRINKING FOUNTAIN 0 0 1 = 0 IFLOORDRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 LAUNDRY TUB 2 0 2 = 4 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3 SHOWER, SINGLE STALL 3 0 2 = 6 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASINIDOUBLE LAVATORY 2 0 2 = 4 SINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1 URINAL, STALL / WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 36 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 OFD's) set at 167 gallons per day - . MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$] ,000 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 $225 $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 $529 o TOTAL MWMC CREDIT $0.00 = Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us pe~U( ~r; - (;~1f~~),!2:;c&8 Address:C:;~/ 1O/Ut-sr j);2J~ I~SUedbY:j1.J Tna,chzt/A/' Date: ~//7/0~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can. be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ')rr 1. o 2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor ifthe structure is sold or offered for sale before or on completion. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be . licensed with the Construction. Contractors Board. OR P 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCBand 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 and do understand the Information Notice to Property Ow~ers about Construction Responsibilities on the reverse side of this form. ~jL~~ ~ -/9-[)b ()......~ ~ ~ignature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 . . . ~ ' '.ActingaS:':):'our .Own General ~Contractor.? . ' INFORMA 1IO(\fNOT!CETO PROPERTY OWNERS ABOUT CONSTRUCTION .RESPONSIBllITIES ' .. ." . ' . 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. _, .____1 If you are acting as your own contractor to con~truct a 'ni~ home or m~ke. a substantial impl ove~eni to an existing structure, you can prevent miriyproblems by being. aware of the folloWing responsibiliti~s and concerns. Employer Re~lP((})IDl.~iibinitlle~ You wiH,in most instanc~s,. .be.ruled to be an "eJ;llployer''< and the, 'iontractor~ YQu~ontr~ct with 'will.be "~mployees" if . '. - - . . you: 4se contractors no~ licensed with the Construction Contr~ctors Board to do laboI: in c~mstruct!!lg or to as~ist in the .' . .. -' . . . " J .... '~. construction or improverpe.nt of a residential ~tructure. As .the employer, YOUl inu~t comply wRjli the following: " c.'~ '- -.:....;. , ": _.~,~! "'.' ,. '- . ...... '. : ',~, ,.- -.... ' . ~ .. , Oregon's Withholdhig Tax' Law:' As an e~pioyei~"yoti must withhold 'income taxes fromemploy~e"wa~es' at the time employees are paid. You will be,liable for t~e tax.payment~ even.if you don.'t actually yrithhold the tax from your. " .1-"" .... 01-' . - O' , .., ~ _' ,> . - . . ,. ',; ".' ' employees. For more information, call the DepartInenf-ofRevenue at 503-378-4988.' . - ' . :. .' , ,-::..-- : - ' - ~" ' . I Unemployment Insmrance Tax: As an employer~ you,afe.reqiIired to.pay a tax for uneinploymehrinsurance purposeS :/ on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. . . , "J . ", . ~ The Oregon . Business Identification Number (BIN) is a combine,d'. number for .,both Oregon Withholding and Unemployment Insurance Tax. To fil~ for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmll for the al'l'lVl'l;ateJorms. , " ., .' ; . ,', . - Workers' Compensation Insurance: As an employer, you ate subject to the Oregon Workers' Compensation Law, and must obtain workers' compensatiqn .i"f.1surance for your emplo?ees. .If y~~ fa~l to o!,>tain workers' compensation insurance; you could be subject to penalties and be liable fot: all claim cO~J~ if one Ofyou.r erppl.oyees is injured on the job. For more mformation; call the Workers' Compensation Division at-the' Department of Consunier and Business Services at 503-947-7815..." . r / U.S. Internal Revenue 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 <it 1-800-829-4933 or visit their web site at w\vw.irs.gov. . . . ':.,Other Re~lPonsibnides 'a~rl{Ai.ea~of. Con~erns :. Code Co~pii~Iice: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements th~.t may be J:>rought to your attention through inspections. '"t" -.. "j.' - ;, I, -,', "-..-.' '.II " .' ".' , Liability and p'rope~tY'Dainage Ins'urimce:Contact your insudnce '~gentto see if )rcm have 'adequate 'U;su'rance ,. coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone... . \ "':::'_\\- J 4" _ ~ - ---- - . . Time: . Make sure you have sufficient time to supervise your employees. '.~ : ;'.'.. ~ . ~ ~ I . _ f';._':',~'" '/ . . ' Expertise':' Make sure you ha~~ th~' skills to ~ct~s'ybUi 'o~ ieii~~a{co~~actor;to' c~ordi~at~ the work ofrough:'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, ~alem, OR 97309-5052. ...( . ';;'--. I ~ -;: '. ,:'r PropertLowner.doc 06-01-04 . n(l ~v toCf> sPR~ll~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689~..? ELECTRICAL PERMIT APPLICATION / /i //q f - - City Job Number fu.. ~ 1.". Date .lY , Owners Name (\e(K~l~ ,?\~ Address 2>"'\""\ q .. s'rer\ {~3 E. City WJ~~ Phone 1tL~.-N....1i) - Pump or irrigation $ 50.00 \ Sign/Outline Lighting $ 50.00 OWNER INST ALLA TION Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. r;o rV ~,,/)D ~40{) '?:Jq.tXJ 1. LOCA1I0N OF INSTAL +i1(ps \- l 04-\ \ LEGAL DESCRIPTION I ~~S~~~ ::~~~~ta~I~I~~ not started within 180 days of issuance or if work is Suspended for 180 days. \ 7 Supervisor Licen~~umb~7/ \/ cr\ City Expiration Date The installation is being made on property I own which is not intended for sale, lease or rent. ~rtu" =?L~J u \JfC)~l - - Inspection Request: 726-3769 3. A. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portionJhereof . ~. Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 B. $50.00 ,." '.;!~~.):g~ to tioii~'1'lJi\!liW~ti(}n : - c; (r'e set forth 200 Amp$ or less , C$ 63-\00:::\2-001- 201 Amps(to 400 Amps cr, ,::3 0$ ~5Q)OJ:8S by 401 Amps tor600 Amps" (f<~lE:: ti'!l:sii2l5;lJ010ne 601 Amps to"lOOO Arllps ~. ,.:.: U:i:itYi1!&3~b@ation Over 1000 AmpsNdUs,"vl is H3~(j-0J~-L~7~:00 Reconnect Only $ 50.00 c. Installation, Alteration or Relocation \ .i ~ .00 200 Amps or less $ 50.00 ~ ~ 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 I Volts see "B" abpr\\t. \f lHE WORK D. ,. SH~ H\5 PERM\J IS NOl New Altera~<<tY1qtt~t~.v~Ji. a~~~NDONEO fOR One Circuit COMMENCED OR \ "\[\ $ 43.00 Each Additio'i\'lJlyi~"BO <ij~tJh1E.Rtu . Service or Feeder Permit $ 3.00 ~ ed) -Each Installation 8% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 1-06.doc 2~5 Fifth Street Springfield, Or~gon 97477 541-726-3759 Phone Job/Journal Number COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 COM2006-00492 Payments: Type of Payment CreditCard Check cReceintl RECEIPT #: Description Addressing Assignment Willamalane Single Family Fire Fee - Residential Sidewalk Permit Curbcut Permit PW Disc - 2nd Permit (Street) Mountaingate 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 Building Permit 3 Baths One & Two Family Furnace - up to 100,000 btu Boiler/Comp Up To 100,000 btu Vent Fan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace ~Mechanicallssuance Fee- Temp Power 200 amps or less + 8% State Surcharge + 10% Administrative Fee Paid By JEFFREY J PLUEARD JEFFREY J PLUEARD c:..... of Springfield Official Receipt ... elopment Services Department Public Works Department 1200600000000000898 Date: 06/19/2006 Item Total: Check Number Authorization Received By Batch Number Number How Received njm 099469 In Person njm 1001 In Person Payment Total: Page 1 of2 10:05:15AM Amount Due 31.00 1,000.00 232.80 80.00 80.00 (30.00) 1,664.10 902.52 686.52 182.69 805.70 82.03 865.31 10.00 199.37 60.57 198.00 1,495.15 306.00 12.00 12.00 18.00 12.00 9.00 6.00 4.00 15.00 10.00 50.00 155.13 217.20 $9,372.09 Amount Paid $8,000.00 $1,372.09 $9,372.09 611 9/2006