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Home My WebLink AboutPermit Building 2011-5-12 .. SPRINGfiELD' .~~ :......'f2i...* .-W0A~OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00790 IVR Number: 811147972287 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us permitcenler@ci.springfield,or.us PROJECT STATUS: STATUS DATE: Issued 05/12/2011 ISSUED: APPLIED: 05/12/2011 05/10/2011 EXPIRES: VALUE: 11/07/2011 $5,000,00 SITE ADDRESS: 2258 33RD ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1702193404500 SCOPE: Bathroom WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Half bath and gas FP added without permits by previous owner, current owner wishes to acheve full approval. OWNER: ADDRESS: GAY ROBERT C 1150 DARLENE IN APT 300 EUGENE OR 97401 VICINUS JACKIE l YNN 1150 DARLENE IN APT 300 EUGENE OR 97401 Phone Number: OWNER: ADDRESS: Phone Number: CONTRACTOR INFORMATION Contractor Type Mechanical Contractor Plumbing Contractor Electrical Contractor General Contractor Contractor Name INNOVATIVE AIR INC BAXTER PLUMBING & ROOTER lLC NEW REYNOLDS ELECTRIC INC ARTHUR L DONAGHEY III Lic Type CCB CCB CCB CCB BUilDING INFORMATION ~ "OU to rp'''Ulres, I't" ohat'slze: "I On UtI \ , oN' Oreg the Oreg t 10lto ",-r,ENT1 s adO?te(s!i"'\1Mf<!gQr~e se 001- 10110W lule centel. s'ifFi 2ndi'!l>f.rq, 95'2- b~ "otllication \ -00\ () \l$Uu.,,'. "ll"e lule5 . ~' 0"'1'\ 95'2-00 obtJlR E\;~aSemi\'t'e?nol\e In 90 '(ou may ters,\f-l:Gar~~e: "otilicatlon 00, he cen' \ 'i),IIW " calling \ tl1e oitll3m;~:rt~344). number 01 tel is $<fRCb~er: 0 cen Occupancy Load: # of Units: o # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal J Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: 2008 1\-1E \NOP-\\ Structural Specialty Code" ,\Editfon::', ,\' ""PIP-E II' "I-r IS ~01 " I.l ,,~~ C'\-I,,'-'- <=.1' EP-w"\ , . :f\-\\S PEP-~\1 U~DEP- 1\-11S I' O~ED rOP- <U1\-10P-IIED OP- IS f\$f\~D ~ONl~ENCE~ PEP-IOD- p,N'! ~ 80 \)1"\ Springfield Building ~ermit 5/1212011 10:28:40AM Page 1 of 4 S~:I~N~=~ .::- ;f'~':,,,, OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00790 IVR Number: 811147972287 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pe rmitce nter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 05/12/2011 ISSUED: APPLIED: 05/12/2011 05/10/2011 EXPIRES: VALUE: 11/07/2011 $5,000,00 SITE ADDRESS: 2258 33RD ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1702193404500 SCOPE: Bathroom WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Half bath and gas FP added without permits by previous owner, current owner wishes to acheve full approval. I Site Information I Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: DEVELOPMENT INFORMATION I Overlay Oist: # Street Trees Reqd: , Paved Drive Reqd: 1% of Lot Coverage: Highest point on structure to north property line: REQUIRED PARKING Total: Handicapped: Compact: PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description I Description Bid Tvpe of Construction NA Unit Amount Unit Tvee 5,000.00 Bid Unit Cost 1.00 Value 5,000.00 5,000.00 Springfield Building Permit 5/12/2011 10:28:40AM Page 2 of 4 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00790 IVR Number: 811147972287 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 05/12/2011 ISSUED: APPLIED: 05/12/2011 05/10/2011 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us EXPIRES: VALUE: 11/07/2011 $5,000.00 SITE ADDRESS: 2258 33RD ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1702193404500 SCOPE: Bathroom WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Half bath and gas FP added without permits by previous owner, current owner wishes to acheve full approval. I FEES PAID ~ Description ~a~Eing up ~~_~ outlets .?tructuraJ Building Permit Fee _."".""~_ ~al.a _nc~_ ~f ~~j~u~~~~~b~~!;!~~~~i~_~~:,,~ ,,_____.____ Water closet ""~~-_.__...-_. :'-irst ~pp!i"~.Fe~_.,,,,_~~'0_ Branch circuits without service or feeder - 1 st circuit Branch circuits without service or feeder - each additional Sink/basin/lavatory sac: Improvement Cost - Local Wastewater SDC: Reimbursement Cost - Local Wastewater SDC: Total Sewer Administration Fee Technology fee (5% of permit to~.!L__ State of Oregon Surcharge (12% of applicable fees) Single-duct exh~~~t (bathroom~~ toilet compartments, utili Total Amount Paid Amount Paid $7.00 $87.25 -"._._._---~~-~~ $20.00 . -'---'-._~-- $19.00 $79.00 $55.00 $6.00 $19.00 $257.16 . $526.88 $39.20 $15.06 $36.15 .,._----_._._,-_.~ $9.00 $1,175.70 Reciot # 2011000926 2011000926 -"-""2011000926 .,~_._-~~._"",_._- 05/12/2011 2011000926 --_.~,....._~~~--- 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 05/12/2011 2011000926 Date Paid 05/12/2011 05/12/2011 05/12/2011 Plan Review ~ Deoartment Application Acceptance Received Due Date Comoleted Result 05/10/2011 05/10/2011 05/12/2011 Over the Counter Permit Issuance 05/12/2011 05/12/2011 05/12/2011 Issued Reviewer Chris Carpenter Chris Carpenter [PUbliC work~Revi,e~'-.i' ",~"i,~;' -;05/12/2'01-1 .. - ;Corrime-nts:i;: ;O:er-,tMe;'$~lnt~r~p;rnliti~:~:ff~; F;'.C;;:;;:;;;;;;"~~~~,'-?io~...;-':::" Structural Review 05/12/2011 05/12/2011 05/12/2011 Comments: Over the counter permit Not Required Chris Carpenter Springfield Building Permit 5/12/2011 10:28:40AM Page 3 of 4 . ~:... SP,~I\N.G.~~~.. IJ~~ ",,,,,,,,,,'.~. OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00790 IVR Number: 811147972287 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pennitcenter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 05/12/2011 ISSUED: APPLIED: 05/12/2011 05/10/2011 EXPIRES: VALUE: 11/07/2011 $5,000.00 SITE ADDRESS: 2258 33RD ST, Springfield, OR 97477 ASSES OR'S PARCEL NO: 1702193404500 SCOPE: Bathroom WORK INVOLVED: Alteration TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Half bath and gas FP added without permits by previous owner, current owner wishes to acheve full approval. I INSPECTIONS REQUIRED ~ Inspections 1999 Final Building Final Building: After all required inspections have been requested and approved and the building is complete. Wood Stove: After Installation. 2140 Pellet, Gas, Fireplace or Wood Stove 2999 Final Mechanical Final Mechanical: When all mechanical work is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete, 3500 Rough Plumbing 3999 Final Plumbing 4500 Rough Electrical 4999 Final Electrical 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 or 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 t front of the 'operty, and the approved set of plans will remain on the site at all times during construction ' Owner or Contrac Date Springfield Building Permit 5f12f2011 10:28:40AM Page 4 of 4 .... DEPARTMENT, uSE ONLY' " Stru,~trrral Permit Application - 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 Date: (;) This permit is issued under OAR 918-460-0030, Permits expire if work is not started w';thin 180 days suspended for 180 days, 1\,>. .,-,:\ lqCA~ (;QY~I'lt:clMENt;P,;8P'~QYA~f;![grifJtr~';;~~~~] This project has final land-use approval. Signature: Date: This project has DEQ approvaL Signature: Date: Zoning approval verified: DYes D No Property is within flood plain: DYes D No ~:~~WJ,~J,~igl,..tE(;Q~Yd.tqfJi<:::ON!ifRQ"i:jtlQN~'t~~~i~~!V~\~~" o Residential I 0 Government I 0 Commercial j;cV'/iF'iI{@)E3",si:i"~i.-'i@5RMATipN7ij..NpN;QcA1'i9N(~l\(;,;~~H!N:\ Job site address: -:) "1B. 311'-"< t City: S. 'v1Z) /0(:.-89 en State 0 rT I ZIP l.f.1L/ 7? Subdivision: l- Lot no.~ Reference 7 - o.~ ~1C( . ~41 Taxlo! 04-500 . , ',P.ROPERTY oWNER "',i' Name: 'It:J .l ~ L.l€.. {j" U Address: '11 S ;J, 3.1 HI: S I. I City ~"'t. .e.-lrt State Of?-- I z1PQ1<f17 PhoneStlt - ~ . ~3SD Fax: - - E-mail: h(~('j I'VlOM @ ,.r.!, AA . (trill\. This installation is being made on rdidential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. Sign here: " '. CONTRA.cTO~ I~ST:AtLA1]9N;..,,;~.- '.. '1, . ',. ,.; Businessname:1hdJ. .1-"1' ..-P,. (q -, (AlI.1 Address:~14D Wl.ut-P/; . ,":j"lT ht\€ City: CrJ.Jnp y{), State: O/Z-, 1 ZIP:C{1*' \ Phone: <;;CU - g"10 ]WO Fax$lll -!OS gG"g'd--. E-mail: ~, \I '\I~Y\fr ,'];> (W"\fb~ ( .r AlA^ CCB license no: "I-X( l \ I <.... L,~...j Print name: ,11111>,<'- r ~1Q I Signature: -- .-41) / -J I ~ Name Electrical Plumbing Mechanical .R'At;:t()R.'I.NfQR.f>'I.AT!9:N~~;:Ef",;\0A\1i;~ I { qCB License Number Phone Number ill3Qq:l. ~(:1<f\ 7'J,.'l1 {iet 0:;" I" (1 ~1 Permit noSI (- 7t{) 'i" ":"\,;,,,, ':?:~T;"FEE:S.t;HEi5UtE:Y'''c;' f', k~~ "<:;:-.- '::~',:~~y'~'~~"tJp~(i#fotr~a'!~_~'ii)j1~~;~~1iM:;};~!~li~~'Mfr}\:~;1f/f,j~'_d:fAi:"?..~:J:z~i4~ (a) Job description l-I-al.c-- brJ.lil r. ,J 1. Occupancy Construction type: Square feet: Cost per square foot: Other information: Type of Heat: Energy Path: D new ~"'aiteration (b) Foundation-only permit? D addition DYes DNo Total valuation: 'F:~};;tJ,uUijing:J~'~Sl~mF~~~~~~~~jk~i~~k;;~\;\\,t~:~(.,: $ ~OO 0 ;"A ,. i,"'..' ,,._,,,';1.;\,;,'-- $ X']?-'2 $ J 1tt:1 JF. I> (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]): $ it) Lf../ (e)Subtotaloffe~ (a) Plan review (65% x permit fee [2a]): $ (b) Fire and life safety (40% x permit fee [2a]): $ ~s above (3a and 3b): iK[;'" $ IC:fJ;f';.~., (a) Seismic fee, 1 % (.01 x permit fee [2a]): $ TOTAL fees and surcharges (2e+3c+4a): $ J J/. <f'l , ~~ E~ck~ ~MO::t~~M- 08/19/10 THU 16:15 FAX 5417263689 CITY OF SPRINGFIELD 1aJ00l Electrical Permit Ap . DEPARTMEN1"USEONlY ns Fiftb Str..I.Spri.~n"d,OR 97477HH(5411?2S-37SJ.FAX(541)726-3689 BPRINGFlIAoD ez:;::"~ fi .' ...~ ~. l:".1'. <--- ~.,;..._.._.( ~~!~...,,~.~:.t,." ,:."",.,' .... "<':"'~-f~ ,,,,..iW' 6t;. ,",-~ ~~~~ ~ --~ Pennit no.: Date: This permit is issued under OAR 918-309-tlOOO. Permits are nontransferable. Permits expire It work Is not stllrted within 186 days of Issuance or if work is suspended for 180 days. . LOCAL OClVERNMENT,a.PPROVAI.;' ." "', ':.' ".: '.:/:"""':~;;'i;';\<'Fa:'..'$cHEIWtE::..~;': ':!.'f<';,,<:Y:'(:,t;;'~'..'::' . , Zoning approval verified? DYes DNo .~U~be~'Ofjfl;.j,'.:l!~n~perif<iD1()') <illY; : Cost :::.1 :riYlal :'. '.CATEGORY':'O~ :CQNSTRuc1lON:;/ .... .:ea.':. :l' cost. - '. o . , . \ , .' e:(Residenlial I 0 Government I 0 Commercial RtJidential, per IlnJ~ serVil!fl Included: 1,000 sq. f\. orless (4) $134.00 $. iE, ....~081.SI EI' ORM&:TAW'tl)Kl fIj""?' '<,-E<,:"/;:'. . :;, IT .',' NF. "',IOljl:. .0;, :,0. . .130 . .~;:>'''': ,. Each additi01llll 500 sq. ft. or portioo Job site address: 22-56 o:? (1...1) thereof $ 25.00 $ City: pr t-t-\') , lsU;t~ I ZIP:q)'f'7~ Limited enetgy (2) $ 32.00 $ Reference: IhtJ2.- ..J Cj 7 i-/ I Tl\Xlol.:/Tl." flJO Each manufacturW home or nwdular $ 63.00 $ " 'OESCR!PTlON OF' WORK"...";: :c" dwelling .ervlcc or feeder OJ /H\,(} It. <7 ,/ ~ ,=. Services or feeders: installQriOfl. ~ltel'a.li(Jtl , relocation - f.(4:."I~ T 200 "'"ps or less (2) S 61.00 $ PROPERTY OWNER 201 !1l400 amps (2) $ 95.00 $ Name: li?ATfl~7t--r ~H 40110 600 "'"p' (2) $168.00 $ Address: ;22--)' g;> 37/0> ...1r 60 I to 1,000 "'"p' (2) $206.00 $ City: '6f' FLID I State: -I ZIP: 5'1'11/ Ov", 1,000 lITllP' or volls (2) $466.00 $ Phone: - " I Fax:: - - Reconne<\ only (2) $ 63.00 $ E-mail: Temporary servius or food....: 1...IOllalio alteration. ""ocation. This installation is being made on residential or fmm fuperty 200 amps or I... (2) $ 63.00 $ OWlled by me or a member of my lnunediate fumlly. is 20 I to 400 omps (2) $ 61.00 $ prope~ Is nol intended for sale, exchange, lease, Or rent, OAR 40 IlO 600 amps (2) 479.54 (I) and 479.560(1). . $126.00 $ Signarure: Over 600 amps or 1,000 volts, se. service, r feeders scotion above .CONTRAcrqR 'INSTALLA110N Branch clrcult.fjl new. alteration, txlcnston >IIr pon.1 Business name: r-.('i.V re, ,!"\o\r\J: .e. lec\:{ ~ ( .. Foe for branch circuits with purohllSe of wvlce or feeder fee, Address: 'l.n<, I.Jil.<).. '2.."'" fl..ve.. Each branch circuit I $ 6.00 $ City; ~iJr.?!')L I State: (jR I ZIP: q74o~ b. Pet fer branch circuits without pUTChase f 11 service or fcoder fee: Phone:SJ..j1-Ylb ,ZCj7 I Fax: g.1I- '3J.(J; Lj S<n.~ Pirst branch circuit (2) S 55.00 $.,\~ c:P E-mail: Each additional branch otroul! -i $ 6.00 $ en OJ CCB license no.: \kljClZ.1 I BCD lieense no.: r.. Lt~1 Mlstallaneous f..., "rIIlee or f6<lkr nol. eludod Signing supervisor's license no.: SLjnLi S, Eaeh pump or inigatlo. circle (2) $ 63.00 . $ Print name of signing supervisor: ~e.\Q{'f\\" ,Qu,..,o\o.~ Eaeh sign or '!)ll1in.-lighting (2) $ 63.00 $ Signature of signing supervisor~ -s7, ~. ~ [Sign.rctrcult or alimilcd-energy ponel, $ 83.00 $ altcrelion, or extension (2) , Euth addltio..H..poctl.n: (I) ~. $58.00 $ ',!::?::T1ty{!f}Y:~.)fg;:'!~:~lA~pL1C';I~i:>~: _ ::.:,:.,;,;:::,.:;t;,:.",;;::;,. ':J~J (A) Enter subtotal of above fee, ~ I? ref' (MInimum Permit Foe 558.00) (B) Eoler 12% surcharge (.I2x [A]) 1'5~ 30]: J~ (e) T""hnolo~ Fee (6%ef[A}) $ f!.V TOTAL fees and surcharges (A thrOB 1bC): <.I 7~ ''It 440-2'84-1 (910l'COM) :...--- 3'7 y- Plumbing Permit Application 225 Fifth Street . Spri~gfield. OR 97477 . PH(541)726-3753 . FAX(541)726-3689 . ":"!"DEPARTMENTusE'6'N[y;if~f ?Efo This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. "'?~";)~;; ';i:i!!QCAL'. 'GOVERN M ENr.AF> Ii'R;cjVAIYW!?;::;~'~i'l'J;('iW Zoning approval verified? DYes D No Sanitation approval verified? DYes D No CATEGORY OF CONSTRUCTION !i;~;r~~~;~:;~\).:~,'Xt;~t~i ~' Name: City: Phone: E-mail: Signature:' . CONTRACTOR INSrALLArlON Business name: .,,;'.,. "," Address: City: Phone: E-mail: CCB license no.: Plumbing license no.: Print name: ZIP: Fax: BCD license no.: Signature: 440-2500-J (l1/08/COM) :f~;:~:.' ,;~,;riiiV~.~:~;~t~~fi:~~~fEE:;'/S_CR EQLJ EEHi:~':~;;"~:;"~;f~f~~:X:~\~'~;'~~~ft;,}~:t ~;1'R~~:9~det~~,:h%t{t1~~t~~'~.i\;::1.)~};;:;~~~!~;)ii.i~i B.~';' i:~:~\}~;E:~~{ :{t!.:}.~j~:1~t': New residential I bathroomll kitchen (includes.' first . J 00 feet of water/sewer lines, hose bibs, ice maker. under floor Jow~point drains and rain-drain packages) 2 bathroomsll kitchen $374.00 3 bathraomsll kitchen $439.00 Each additional bathroom (over 3) $95.00 Each additional kitchen (over I) $95.00 Residential fire sDrinklers (includes Dlan 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) C9nnections to building sewer and water supply Commercial, industrial, and dwellings other than one- or two-family Minimum fee $238.00 $ $ $ $ $ $ $ $ $ $58.00 $ Each fixture Miscellaneous fees 100' storm, sewer, water line Each fixture, appurtenance, and piping Storm water retention/detention facility Irrigation systems Piping or private storm drainage systems exceedina the first 100 feet Specialiy fixtures Reinspection (no. ofhrs. x fee per hr.) Special requested inspections (no. of hrs. x fee per hr.) Each additional inspection: (1) I I~I $58.00 $ $19.00 I $~"'~.W $76.00 $ $19.00 $ $19.00 $ $19.00 $ $19.00 .$ $19.00 $ $58.00 $ $58.00 $ $58.00 $ KM~-d'i~~l~g~~:s:~p'pi'(1g~t;~:~tJ~Wt!~j?~}'.i~~WA~f;~: Minimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. I $ ~~~t~~~~~It~^~ij_ij'iGcANI~U~~J;~~_m (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): $ -z;2" pO $ g $ ~ 7'. $ ;an $11'1 0/, ~ IV I" Mechanical Permit Application . .'Y;:6~PA~T'ME~:fysKq~LW;:'\'!f! Pennit no.: JI (- 'nO r: 10 /( 225 F;fth Street. Spr;ngfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 Date: This permitis 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. . .';':!'CAi"EGORV!7QF/COr-jSTRUCTION?, , . '"", This installation is being made n property owned by me or a member of my immediate family, and is exempt ITom licensing requirements under ORS 701.010. Signature: ~~t~~i1t~~,\Miig9~;rRAc.:jf6R0Rr\($TAiitAtIQriijj.,:;;:;:} ,;~.." ,; Business name: (/vI/Oc/r4I7//E Address: ZIP: City: Phone: E-mail: CCB license no,: (u l f) '-I <-- Print name: Signature: 440-2545-) (1II08/COM) '7 .. .. , FEE SCHEDULE ., , Residential"'''i ,-" ", , "-l_:Y},( ;i\~ SIP:, ,~>:..costLi ",T~~I.-" ~) 1 _'.~ 1"'" ""~~~'!<;0l~f:.>'.:;.", '<~;~;!'ea;::'~; c'.;_ "vireos ':!~.' First Annliance a~ ( $79.00 $'10\ .<- furnace/burner including ducts and vents Up to lOOk BTUlhr. $17.00 $ Over lOOk BTU/hr, $20.00 $ Heaters/stoves/vents Unit heater $17,00 $ Wood/pellet/gas stoye/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 I $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 to 10,000 CFM $11.00 I $ Over 10.000 CFM I I $20.00 I $ Comoressor/absorotion svstem/beat oumo Up to 3 hp!l OOk BTU $17.00 $ Upto 15 hp/500k BTU $29.00 $ Up to 30 hp!l,OOO BTU $43.00 $ Upto 50 hp!l, 750 BTU $57.00 $ Over 50 hp/I,750 BTU $95.00 $ Incinerators Domestic incinerator I I $20.00 I $ ~C"8mrtie.tClaJ~ti:~:'~;'r:t~:;:i':~i~i:~~'t~f?f~:;. '{':~'T~'~>';"i'~?~i:i;:~\:[~';'?r:\t~',~.i'~'0;~!:~ ~:','i;'i~.;~;' Enter total valuation of mechanical system and installation costs $ Enter fee based on valuation of mechanical system, etc. $ ~~~J~p:~n~'p,~9.~~~I,r~~,~~f~t~;{1:}::,~:~1~~i)~i~'~~ ~>;~~~tt~:~ '-,c..Total,., \"?co'st\;,": Reinspection . $58.00 $ Specially requested inspections (per hr.) $58.00 $ Regulated equipment (unclassed) $13.00 $ Each additional inspection: (I) $58,00 $ ~~~~1~~~1hit~fr~J.A~:F?:~ic~NIq[d,s-~~~~~i1&R~f~';f.~~; (A) Enter subtotal of above fees (or enter set $ '1Q.ct: ) minimum fee of $ 79.00) (B) Investigative fee (equal to [A]) $ y- (C) Enter 12% surcharge (.12 x [A+B]) $Ci',AA (D) Seismic fee. 1%(.01 x [A]) $ ~ (E) Technology Fee (5% of [A]) $I).,.q~ TOT AL rees and surcharges (A through E): (To A.'~ \I.... \ 8/'\ A 14 (Fin) (Upper) \ 14 (4~ ~ ~6j\.4~ Sr P (~ rJ 1624046 OMP (@) 22 I 12 L13 ~. ~d08 ~ ~ ~r~~~ O~ ~~f7 54! Q10 ?,~( -, ,2.5r7-<<.6 4 . 42 1 s Fr .c @ 34.5 Fr G 20 Slab \ (f~4) ,/ .........12.5 2/ Cone (ff"fJ 10.5--. .-11.5- 4 6 2 a.....-12--.J 16' ~ I TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 81 Springfield, OR 97477 541-726-3753 www.ci.springfield.or.us 811-5PR2011-00790 2258 33RD 5T perm itcenler@ci.springfield.or"us RECEIPT NO: 2011000926 ibESCRIP.,TION' ';~~:'i:." ~~7;~':r!i''''t:''0~0~' Balance of Minimum Plumbing Permit Fees Branch circuits without service or feeder - 1 sf circuit Branch circuits without service or feeder - each additional RECORD NO: 811-SPR2011-00790 DATE: 05/12/2011 '-<,7.- /C:i::~;i":ACcoUNj~cobE ..~?;'. - ". "},:AMOONT"DUE ,".' '-'j 224-00000-425603 20.00 224-00000-426102 55.00 224-00000-426102 6.00 224-00000-425604 79.00 224-00000-425604 7.00 _._------~~- 443-00000-448025 257.16 442-00000.448024 526.88 "___.,___'w,__.*_,___,._____---r-_____ _ 719-00000-426604 39.20 ___,__..._,._,~,_.,,"_,,_._w_____._..__.__ ... 224-00000-425604 9.00 ______w._w__.~____'''~___ 224-00000-425603 19.00 821-00000-215004 36.15 224-00000-425602 87.25 100-00000-425605 15.06 224-00000-425603 19.00 TOTAL DUE: 1,175.70 ~~~yMENf"('(pE'~::~~Y_()R"'CAS;;,E~itCA~PEri!E~?P.:..';T. 'C.oJIIIIII1~NJ.S:;Xi;';):~:;: ;;~.,:;' :"~Ar@UNTI;'AID _ _ . .._ Credit Card Jackie Lynn Gay 1,175.70 203913 First Appliance Fee ~~ipin~ to 4 outlets _~EE:_lmpro~err:~nt Cost. Local Waste~~:~~ SDC: Reimbursement Cost - Local Wastewater ,~' --- ,~-~_.. -~ SDC: Total Sewer Administration Fee -- ,.--.--> - -~- Single-duct exhaust (bathrooms, toilet compartments, utilittroor Sink/basl~/lavatory State of Oregon Surcharge (12% of applicable fees) Structural Building Permit Fee Technology fee (5% of permit total) Water closet . 0.] TOTAL PAID: 1,175.70