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Home My WebLink AboutPermit Building 2004-1-15 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3416 C St ASSESSOR'S PARCEL NO.: 1702312410102 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01271 ' ISSUED: 01115/2004 APPLIED: 12/19/2003 EXPIRES: 07/1512004 VALUE: $ 6;41".\10 \~r.\1.... Springfield TYPE OF WORK: Manuf Home w Garage/Carport Private TYPE OF USE: hUinitials PROJECT DESCRIPTION: Manufactured Home Owner: MARLEE STUBBLEFIELD Address: 3410 C ST SPRINGFIELD OR 97478 Contractor Type General Electrical Manuf Home Inst Plumbing Phone Number: 541-726-7390 I CONTRACTOR INFORMATION 1 Contractor ALL GUTTER INC DABO CONSTRUCTION INC PRUITT TRANSFER INC ROBERT STORRS Phone 541-935-8986 541-988-3135 541-451-1795 5416897574 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: ,1 R-3 VN 3 SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.00 '14.00 13.93 16.00 0.00 License 153502 153220 46205 76940 Expiration Date 11/19/2004 10/21/2004 09/11/2004 11/0812005 BUILDING INFORMATION 1 # of Stories: 1 Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: . Sq Ft Garage/Carport Energy Path: Path 1 re~~tJter: AI It::NTION:Oregon law reo qUI bIfl~nliijls, Surface Area: J - _6-..ol,hl' thQ r9Q , , ' I DEVEL~~LI-;~u'e~~reseH~nl ~~hOAR 952~~QUIRED PARKING ) OAR 952-00t-Q01?: ; ,. ",'es of the rul.snr hh'M~Yfij,-,ttnay obtam COP\ the t~ephoneotal: 2 ;zrS~~mn~~d{qdnter. (Note Wty Notificati~ndlcapped: Pa.Y~RtRf~'M8mhe Oregor Ut, " MmA) Compact: nu . 1 BOO-332-2tJ...- . % of Lot c6've?!ge:'~ " - - . '29.50 4,550 1,100 240 I PUBLIC IMPROVEMENTS' Fully Improved Sidewalk Type: Curbside 5' NOl~CE: .' Downspouts/Drains: Curb and Gutter Encroachment ~erTWtsetl~tp~Al~1f!~~rTtWii Ml41R14ew weep hole is needed. AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Street Improvements: Storm Sewer Available: Special Instruction: Notes: Page 1 of3 CITY OF SPRINGFIELD. Building/Combination Permit Status Issued PERMIT NO: COM2003-01271 ISSUED: 01115/2004 APPLIED: 12/19/2003 EXPIRES: 07/15/2004 VALUE: $ 6,412.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation DescriPtion' Description Tvpe of Construction $ Per Sq Ft or multiplier $16.30 $1.00 $1.00 Square Footage or Bid Amount 240.00 2,500.00 7,500.00 Value Date Calculated Carport Carport Foundation Onlv Use Bid Amount Manuf Home Manufactured Home Total Value of Project $3,912.00 $2,500.00 $7,500.00 $13,912.00 12/19/2003 12/19/2003 12/19/2003 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $54.60 12/22/03 220200000000001895 + 10% Administrative Fee $47.70 1/15/04 2200400000000000033 + 7% State Surcharge $33.39 1/15/04 2200400000000000033 Add, Alter, Extend Circ Ea Add $3.00 1/15/04 2200400000000000033 Curbcut Permit $75.00 1/15/04 2200400000000000033 Encroachment Permit $120.00 1/15/04 2200400000000000033 Garage/Carport $84.00 1/15/04 2200400000000000033 Manuf Home State Issuance $30.00 1/15/04 2200400000000000033 Manufactured Home Connection $45.00 1/15/04 2200400000000000033 Manufactured Home Placement $160.00 1/15/04 2200400000000000033 Manufactured Home Service $50.00 1/15/04 2200400000000000033 Plan Review - Planning $59.00 1/15/04 2200400000000000033 Sanitary Sewer - 1st 50 Feet $45.00 1/15/04 2200400000000000033 Sanitary Sewer - Improvement $344.20 1/15/04 2200400000000000033 Sanitary Sewer - Reimbursement $452.80 1/15/04 2200400000000000033 SDC MWMC Administration $10.00 1/15/04 2200400000000000033 SDC MWMC Improvement $214.23 1/15/04 2200400000000000033 SDC MWMC Reimbursement $314.63 1/15/04 2200400000000000033 SDC Sanitary/Storm Admin $80.78 1/15/04 2200400000000000033 SDC Transpo Admin $55.60 1/15/04 2200400000000000033 SDC Transpo Improvement $727.42 1/15/04 2200400000000000033 SDC Transpo Reimbursement $164.89 1/15/04 2200400000000000033 Storm Drainage Impervious Area $499.38 1/15/04 2200400000000000033 Storm Sewer - 1st 50 Feet $45.00 1/15/04 2200400000000000033 Water Line - 1st 50 Feet $45.00 1/15/04 2200400000000000033 Willamalane Manuf Home Private $1,000.00 1/15/04 2200400000000000033 Total Amount Paid $4,760.62 I Plan Reviews I Initial Review Planning Review 12/19/2003 12/19/2003 12/19/2003 01/12/2004 APP RJB APP TAJ Page 2 of3 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2003-01271 ISSUED: 01115/2004 APPLIED: 12/19/2003 EXPIRES: 07/1512004 VALUE: $ 6,412.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax .541-726-3769 Inspection Line Public Works Review, 12/19/2003 01105/2004 APP VRJ Encroachment permit fee included in permit fees for new tap to sanitary sewer, submit conpleted ' application to PW's prior to any work within the PUE or ROW. If new weephole is needed, include in Encroachment permit application. See documents forplaD review comments for carport - Rlan review comments for M.H. is staIidard form in file. Structural Review 12/19/2003 01105/2004 APP DLM 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. LReauired'TInsoections 1 1 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 2 Footing: After trenches are excavated. 3 Foundation: After forms are erected but prior to concrete placement. 4 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 5 Manuf Home Set Up: When installation of all piers or stands is complete. 6 Final ManufHome Set Up: After all required inspections are requested and approved and porches, skirting, d_ecks, venting, street address numbers, trees, driveway, etc., have been installed. 7 Final Building: After all required inspections have been requested and approved and the building is complete. 8 Water Line: Prior to filling trench and including required testing. 9 Sanitary Sewer Line: Prior to filling trench and including required testing. 10 Storm Sewer Line:, Prior to filling trench. 11 Manuf Home Plumbing: After home has been connected to water and sewer. 12 Curbcut - Standard: After forms are erected but prior to placement of concrete. 13 MH Service: Approval required prior to utility company energizing service. 14 Rough Electric: Prior to Cover 15 Final Electric: When all electrical work is complete. 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 ~eS,;j:::i~J:pJ ~~r ;r Contractors Sig~at~re ~ / ) - '- V Page30f3 /J'I/s/d! Dati { 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-0 1271 COM2003-01271 COM2003-0 1271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 COM2003-01271 Payments: Type of Payment CreditCard Receipt #: 2200400000000000033 Description Garage/Carport Willamalane ManufHome Private Manufactured Home Placement Sanitary Sewer - 1st 50 Feet Water Line - 1st 50 Feet Storm Sewer - 1st 50 Feet Manufactured Home Connection Curbcut Permit Encroachment Permit Storm Drainage Impervious Area Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Transpo Admin Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin ManufHome State Issuance Plan Review - Planning Manufactured Home Service Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By ZETT A STUBBLEFIELD Received By djb Check Number Batch Number Authorization Number 000276 015264 City of Springfield Official Receipt Development Services Department . Public Works Department Date: 01115/2004 1:09:22PM Amount Paid 84.00 1,000.00 160.00 45.00 45.00 45.00 45.00 75.00 120.00 499.38 344.20 164.89 727.42 314.63 214.23 10.00 55.60 452.80 80.78 30.00 59.00 50.00 3.00 33.39 47.70 $4,706.02 Item Total: How Received In Person Payment Total: Amount Paid $4,706.02 $4,706.02 Issued by: 5 Lfl b ~tS: . -0\2...7 ( C'S'.f-' Construction C,ontractors Board 700 Summer St NE Suite 300 PO Box14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: C.OlM ZOC Address: Date: J-I ~-O'1 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 be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: .. .. ~ 1. ~,2. I own, reside in, or will reside in the completed structure. I understand that I must b.ecome licensed as a constniction contractor if the structure is sold or , offered for sale before or on completion. , ~ 3A.My general contractor is A I f ~ t-_ o-IL . (Name) ISsS-OZ (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR D 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed' with the Construction Contractors Board. If I changeiny 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 thi~ building permit ofthe ' name ofthe contractor. ' I hereby certify thatthe above information is correct aJ1'4hat I have read and do understand the Inforination Notice to Property flwners abt'?t onstrucyon ReSPj,ibib!'es on the reverse side ofthis form. ' /2J/lltoJlr '}__ ftJd h~;/!f ' Ot!/~q \0 (Sl~ature of permit applicant) / // ' ( (Dale) , , ", (White copy to issuing ~cy'permit file, pink copy to applicant.) " Property _ owner. doc 03/11/03 \ J Act~~g as Y Qur Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to properly 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 substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract withwill be, "employees" if you use contractors not licensed vvith the Construction Contractors Board to do labor in conSf;rtJcting or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the 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 a State Business ill number, call the.Business Information Centf;r at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For mote information, call the Oregon Employment Department at 503-947-1488. Workers' Compensation Insurance: As an employer, you are subject to, the Oregon Workers' Compensation Law, al)dmtlst obtain workers' compensation, insurance for YOUl' employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all 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. Internal Revenue Service: As an employer, you must withhoid 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 nwnber, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas 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 through inspections. : Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as fallin'g toOls, paint over spray, water damage from pipe punctures, fire or work that must be redone:" ,,' ' Time:, Make~ure y<;>U,have,sl!fficienttime to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate 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 03/11/03 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENfttORKSHEET JOURNAL OR JOB NUMBER: Com2003-01271 NAME OR COMPANY: Marlee Stubblefield LOCATION: 3416 C Streeet TAX LOT NUMBER: 17023124 t1 10102 DEVELOPMENT TYPE: SINGLE F AMIL Y RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF: LOT SIZE (SF): 4536 I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM' IMPERVIOUS S,F, x I COST PER S.F. CHARGE 1722.00 I $0.290 = I $499.38 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. x COST PER S.F. x DISCOUNT RATE I DISCOUNT 0.00 $0.290 50% = I $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's x I COST PER DFU I 20 I $22.64 B. IMPROVEMENT COST: I NUMBER OF DFU's x I 20 COST PER DFU $17.21 ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x NUMBER OF UNITS x I 9.57 I B. IMPROVEMENT COST: ADT TRIP RATE 9.57 x I NUMBER OF UNITS I I x I I = I ITEM 3 TOTAL - TRANSPORTATION SDC $499.38 $499.38 C/) W ~ o u ~ W E-< C/) - Cl ~ 11070 1091 1092 I COST PER TRIP I x NEW TRIP FACTOR $17,23 1.00 = , $164.89 1093 COST PER TRIP x I NEW TRIP FACTOR $76,01 , 1.00 $727.42 1094 $892.31 = $314.63 $452.80 $344.20 = , $797.00 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU',s x ICOST PER FEU I I $314,63 B. IMPROVEMENT COST: I NUMBER ,OF FEU's I I x ICOST PER FEU I $214,23 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE. ITEM 4 TOTAL - MWMC SANITARY SEWER SD< = , SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , 5. ADMINISTRATIVE FEE: I SUBTOTAL x I ADM. FEE RATE 1= I $2,727,55 , 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Virginia Jurasevich PREPARED BY 1/2/2004 DATE = $214.23 $0.00 $10.00 $538.86 $2,727.55 CHARGE $136.38 80.78 $55,60 TOTAL SDC CHARGES = J $2,863.93 1054 , lOSS " 11054 105(i 1079 " 1078 DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE '" NUMBER OF NEW FIXTURES x UNIT EQUN 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 BATHTUB 2 0 3 = 6 DRINKING FOUNTAIN 0 0 1 = 0 . FLOOR DRAIN 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 0 0 2 = 0 ICLOTHESWASHER/MOP SINK 1 0 3 = 3 CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (l PER-TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0 SHOWER, SINGLE STALL 0 0 2 = 0 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 2 0 1 = 2 URINAL, STALL / WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 ,TOILET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFUTYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 20 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDIT RA TE/$1 ,000 ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 0 BEFORE 1979 $5.04 (Enter 1 for Yes, 2 fOJ: No) 1979 $5.04 IS IMPROVEMENT ELGI~LE FOR ANNEX. CREDIT? 0 1980 $4,95 (Enter 1 for Yes, 2 for,No) 1981 $4.88 BASE YEAR 1979 1982, $4,75 1983 $4.58 CREDIT FOR LAND (IF APPLICABLE) 1984 $4.41 VALUE / 1000 CREDIT RATE 1985 $4.20 $0.00 x $5.04 = , $0.00 1986 $3,88 1987 $3.50 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) 1988 $3,07 VALUE / 1000 CREDIT RATE 1989 $2,60 $0.00 x $5.04 0 1990 $2,14 1991 $\.71 ]I 1992 $1.52 TOTAL MWMC CREDIT = $0,00 1993 $1.38 1994 $L19 1995 $1.03 1996 $0,87 1997 $0.68 1998 $0.46 1999 $0.27 2000 $0,09 2001 $0,04 SIPAe....GFiIELIO ~,.""'.~~ DEVELOPMENT SERViCES DEPARTMENT 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 MANUFACTURED HOME LAND USE AGREEMENT As required by the City of Springfield Development Code, I agree that witl} the approval of the attached permits, one of the following manufactured homes will be placed at ~ 4/(, C ~ T; , Springfield, Oregon, City Job Number CtlH2!24,lj -tJ!Zl/ - I - ~ Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch 00 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thennal envelope meeting perfonnance standards which reduce heat loss to levels equivalent to the perfonnaIlce standards required of single family dwellings constructed under the State Specialty Codes. Type II Manufactured Home. A unit of not less than 12 feet in width with an enclosed floor area of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width and that has no bare metal siding or roofmg. The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of the enclosing material exposed above grade. I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60 days of the date offssuance of the manufactured home set up pennit. These requirements may include, but are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on your approved set up plans and/or pennit and your partition approval if applicable: . Street Trees . Paving Driveway . Minimum 32 square foot storage structure . Completion of partition approval . Removal of any existing structures as noted on your partition approval . Signing and recording of any required partition, easement, improvement agreements, etc. . Fmallot grading . City Sidewalk and curbcut installation . Any outside agency approval as required i.e., Division of State Land approval. By my signa""e below, 17"" to oomPh"0 mentioned land use'eqnrrements, lk1Jia ~wJ/Jlf rv /J5-/orf- Vwne< Signature V' ' ffJi-i I Contractor Signature Date 3. eJn~BUO!S peZpOlnn'Q' ,'t\d=> \ -rO-0!-\ ',-'..., 'OU!UOZ ?)"-l.., 'IB^OJddB esn pUB I ::J!~!::Jads ElJ!nbeJ ~OU seop pUB 'OU!UOZ 5U!MOHO~ aLlI SBlI pemwqns sa j::le!oJd 6u!MOIlO~ elli CO~MPLETE J."'EE SCHEDULE BELOW' , e~Ba 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)lkO-.H)l5~ ELECTRICAL PERMIT APPLICATION City Job Number UWI z.c o3'-C 127 I Date I-i S- -0 L{ "5 IrA. "5tJLtfi tt-~ <;::,. +- E. IVIiscr~~ ~~e/feeder not included) -Each Installation. .' \". N:ocegOil Ha.W oragon u\\htY \ ,~n~N \ \0 daptat.PCM~to~i111gag~ set tort $ 50.00 lo\\a;.rv r,UH:l~~"ter. ~~JHW~~.oo~ $ 50.00 OWNER INST ALLA nON . \ot\i\Ce.tl~~~QO'\ ~OO ~ <l~J.~~i~e~r~~l\:. $ 25.00 The installation is being made on propertt Pt~:';:;~!llna.'.{ obt~lrii1~~?wt{g~Q\m~lral $ 45.00 . . oOEtu. '{~ iC\utar.-(N'O. . . .1\.l~\ilcat\On IS not mtended for sale, lease or rent. ~a\\\nQ the Cwuere~~~"tclPl! It Inspection Fee is $45.00 + Surcharges .J ber ~or the \ ru\".'),~2..2344, - Owners Signature: tlllm . "........",,4\C ~fjJHJVTAL OF ABOVE 5 '3 <~1( 7% State Surcharge ./ 10% Administrative Fee S'7.-'D 1. LOCATION OF INSTALLATION S+ 34/b L LEGAL DESCRIPTION 170 'Zoo 3/ Z Lf JOB DESCRIPTION I/J1 JI 5EtLv l ~ t/ Cl ~~ '\- I Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. IDIOL 2. CONTRACT'ORINSTALLATION ONLY Electrical Contractor 1)tQi] (![)/Clr' Addressffl bUB \-{ I (, ill City ~'?PLO Phonq~'~i3S Supervisor License Number 4''?54I:; S Expiration Date \ C) -a2cb- 0/\ \ '/~--:: '2._'1...:.r- j' Constr. Contr. Number ~ J _,- v-~ t (rJ .-.2..1 - C) 4- Expiration Date a~lP;~ " Owners Name j/II/ r1 ~ '34/0 C Address City S'\' I~() Phone Inspection Request: 726-3769 A. New Residential- Single or Multi-Family per dwelling unit. 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 $106.00 $ 19.00 )( $50.00 S{)~- B. Services or Feeders - Installation, Alterations or Relocation: $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only NOTI.C .. . i{(fj-S PBrttp.orary Services or Feeders . AU7:IRM1T Sf/I; COM Dii@JlJNtj ~Rflelocation ANy 1 'fi~@rf~~R THIS PI;: THE M'nh. $ 50,00 2 1 ~p IJ..~DQ MIT ~ $ 69.00 401 Amps ~ tpAmps WED F()f! '.01 $100.00 . Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 ~ $ 3.00 ~io[) TOTAL ~~()I -- Shared Dlive(T:)/Building Fonns/Electrical Pennit Application 1-03.doc ., 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 www.ci.springfield.or.us MANUFACTURED HOME SET-UP AGREEMENT As required by the City of Springfield Development Code, I understand and agree that with the approval of . the attached permits, one of the following manufactured homes will be placed at . 3 -11 6 \, c... I. ~+ , Springfield, Oregon, City Job Number a:,w,?.;:io '3 - 0fZ;I. / Type I Manufactured Home: A multi sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thermal envelope meeting perfOlmance standards which reduce heat loss to levels equival~tQ the p,erformance standards required for single family dwellings at the time of construction. r ?/M ~ initials ' , r Type II Manufactured Home: A unit of not less than 12 feet in width enclosin minimum floor area of 500 square feet, that has a nominal roof pitch of 2 feet in height for eac 2 feet in width, that has no bare metal siding or roofing, and that has been'certified by the manufa rer to have an exterior thermal envelope meeting performance standards which reduce heat loss to Ie s equivalent to the performance standards required for single family dwellings at the time of con 1.Iction. initials I further state, by my signature below, that I have been provided with the following information: Manufactured Home Blocking, Water Line Conilection, Street Tree Standards, Sanitary Sewer Connection, , Electrical Connection, and Minimum requirements for permanent steps. I also understand that the manufactured home shall be placed on an excavated and backfilled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure, enclosed at the perimeter with stone, brick or other concrete or masonry materials approved by the Building Official and with no more than 24 inches of the enclosing material exposed above grade. . ) 11: [4'2 ~p ,~/ Lfl-W:J/2 _~~0{ _ /......, / / , /,,/ a/;~Ioy Date l - (