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Home My WebLink AboutPermit Building 2011-06-10 S:~~~;:Liij .(gt0~ if'0>~:, 'OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01365 IVR Number: 811178395065 225 Fifth St 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: Iss ued ISSUED: APPLIED: 07/13/2011 06/10/2011 EXPIRES: VALUE: 01/08/2012 $140,036.42 07/13/2011 SITE ADDRESS: 4912 HOllY ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1802051108100 PROJECT DESCRIPTION: SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential New Single Family Dwelling Detached Phone Number: OWNER: ADDRESS: JHD3 llC 2464 SW GLACIER Pl REDMOND OR 97756 Contractor Type Electrical Contractor General Contractor Plumbing Contractor Mechanical Contractor CONTRACTOR INFORMATION Contractor Name GARNER ELECTRIC CO HAYDEN HOMES LLC GO PLUMBING & HEATING LLC PACIF!C AIR COMFORT INC Lie Type ceB eeB eeB eeB # of Units: Construction Type Occupancy Comments Occupancy Type Occupancy Comments Occupancy Type Construction Type # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: BUilDING INFORMATION Type VB 1290 s.f. # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: Gas Electric Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: 5532 1691 40 1 18.34 Forced Air Gas R-3 401 s.f. U Type VB 3 No Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: 2008 Path 2B All ducts and air handler within building thermal envelope I Enginee';;d,FiII:N. Oregon law requires yo~to Fill >Niifm~:TIO. ted b the Oregon Utl\Jty Flo60lifa~a'f!lI~~d~P TI~~e rules are set 10rth la~iia?.lJlA?ea6~_~b.;o N?'ough OAR 952-001- Reta;,Q,"ifV',P.fu?-O btain copies 01 the rules by sOi~~oYt-~kll1H~W (Note: ttle telephone calling the ce 1er. Utilitv Notification number lor the. O\~~g~_332-2344). Springfield Building P;'&wter IS Site Information _ _ ~ ,." ';'~.;-'~7!'''' . I~U 11"'-. HE WORK . THIS PERMIT SHAll EXPIRE IF T .':. AUTHORIZED UNDER THIS PERMIT IS NOT, COMMENCED OR IS ABANDONED FOR::; ANY 180 DAY PERIOD. ',. ,; . 7/13/2011 12:01:05PM Page 1 af6 SPRIN.G.FIE L~ . ~;jl. ='~ . A;j~ ,~ \ i.., . OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01365 IVR Number: 811178395065 225 Fifth 51 Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone 541-726-3769 Fax: 541-726-3676 permitce nter@ci.springfield , or. us PROJECT STATUS: STATUS DATE: Issued 07/13/2011 ISSUED: APPLIED: 07/13/2011 06/10/2011 EXPIRES: VALUE: 01/08/2012 $140,036.42 SITE ADDRESS: 4912 HOLLY ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1802051108100 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 14 8.89 10.18 17.88 New Single Family Dwelling Detached DEVELOPMENT INFORMATION ~ Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: 2 REQUIRED PARKING Total: 2 Handicapped: Compact: Yes 18 PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ Descriotion R-3 1 & 2 family U Utility, misc. Tvpe of Construction VB VB Unit Amount Unit Tvoe 1,290.00 Sq Ft 401.00 Sq Ft Unit Cost 96.83 37.72 Value 124,910.70 15,125.72 140,036.42 Springfield Building Permit 7/13/2011 12:01 :05PM Page2of6 www.ci.springfleld.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01365 IVR Number: 811178395065 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/13/2011 ISSUED: APPLIED: 07/13/2011 06/10/2011 EXPIRES: VALUE: 01/08/2012 $140,036.42 SITE ADDRESS: 4912 HOLLY ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1802051108100 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling Detached FEES PAID ~ Descriotion Amount Paid Date Paid Reciot # Structural Plan Review Fee Residential $569.15 06/10/2011 2011001519 Multiple -P;r~TtDis~~'~u;t(M-~-2)--~"- ---~_.--_.~ - __n_$_3-ioo -----6711 312011--- 2611"60201'3 SDC:~~;nbu~~e;n;;ic~~: Storm Drainage --'$S1-W' 07/13/2011 2011002013 SDC: Improvement Cost - Storm Drainage $754.88 07/13/2011 2011002013 SDC: Reimbursement - Transportation SDC $497.07 07/13/2011 2011002013 SDC: Improvement - Transportation SDC $1,811.51 07/13/2011 2011002013 SDC: Reimbursement Cost - Local Wastewater $3,161.28 07/13/2011 2011002013 _~_0 _ ~DC: Improvement Cost - Local Wastewater $1,542.96 07/13/2011 2011002013 SDC:~~~.~~~ost - MWMC,Regional Wastewat. $101.97 07/13/20~1.. ... 2011002013 SDC: Improvement Cos~C Regional Wastew,:t:~_.-12:333.57 07/13/2011 2011002013 Structu!al Building ,=~.,:",it Fee _~_ _.._~__ . $_8~.~~.___ 07/13/2011 2011002013 SD~~~ative Fee - MWMC Regional Wastew~ _. _ __$:.~~~___ ..._.__ 07/13/2011 2011002013 Admin fee (10% of applicable fees) $8.66 07/13/2011 2011002013 SDC:'Total Sewer Administration Fee '-~---$351~85 -~_. oiii3/20i1--------io11002013. __n_ ______..__.____,__,__,_____ SDC: Total Transportation Administration Fee $135.88 07/13/2011 2011002013 !:lesidential Fire (.05 Per Sq Foot) $86.55 .-0lii3i201.1-----.---.2011ii620i3 Slne or Two Fa.rnily Dwelling with Two Bath $~74.00 07/13/2011 2011002013 Furnace - up ~o 120,000 BTU ._._____.._____!2.7,00 07/13/2011 2011002013 Ra~e hood/other kitchen equipment $13.00 07/13/2011 2011002013 Sing!::~uct exhaust (bathrooms, toilet compartments, utili $36.00 07/1_~!2011 2011002013 First Appliance Fee $79.00 07/13/2011 2011002013 Residence wiring 1,000 sq. ft. or less_____~:=- $1~-- 07/13/2011 2011002013 Each_"-d~e.cJ.500 sq. ft. or portion __..!5.o.00 07/13/2011 2011002013 !,lann~2~_Major ~eview - City $211.00 07/13/2011 2011002013 Gas Piping up to 4 outlets $28.00 07/13/2011 2011002013 State.ofOregon Surcharge (12% of applicable fees) ._....:)192-:79:----. 07/13/2011.------- '..'" -2ii1iOO2Oi3-- Technology fe:.i5% of permit total) ..____.._~.9_'_~~__ 07/13/2011 2011002013 ~u~CutlDriveway 1st Cut $88.0.l!........ 07/13/2011 2011002013 Sidewalk up though 90 Feet $88,00 07/13/2011 2011002013 Willamalane fees - Single family detached $3.409.00 07/13/2011 2011002013 Address Assignment, each new or change $38.00 07/13/2011 2011002013 SDC: Compliance Cost - MWMC Regional Wastewater SI $22.63 07/13/2011 2011002013 Total Amount Paid $16,599.73 Springfield Building Permit 7f13f2011 12:01:05PM Page 3of6 SPRINGFIElD ~l' ~,.~ *,7 ~, , \ OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01365 IVR Number: 811178395065 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us permitcenter@ci,springfield , or. us PROJECT STATUS: STATUS DATE: Issued 07/13/2011 ISSUED: APPLIED: 07/13/2011 06/10/2011 EXPIRES: VALUE: 01/08/2012 $140,036.42 SITE ADDRESS: 4912 HOllY ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1802051108100 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling Detached Plan Review I Deoartment Initial Review Received 06/13/2011 Due Date 06/13/2011 ComDleted 06/13/2011 Result Approved Reviewer Chris Carpenter Public Works Review 06/13/2011 06/1712011 Approved Kaye Wilson 06/13/2011 Comments: Stormwater to tap r?trLicWral'~eviewI -: -. ----~,.o6/13720H,-.:o~13@~y1 ; ,,'06{20/201t ;:" "Wait(f)g'lrterfiar:r-:--'''~'.~T!<ip K~ufman t- ", . - ." . _ ,.- '-',,' .'"..4'" _~';'\ ;h,.""""',,;,,,'- i"" !"comments: Rlanmng','1;,i'.l ," ,.,;'''~',v", '>"~'\' 'f' ',' '" "t , "". -'_<'", __ '.. ._ -I'.r,_""".._~_,2. .~ '_"""'-~""';;,'~"".;",..,,.. ~_ '~';"-i"t;;-r.,i;~,,,":::4':,:;,........, __^n-__'~." Planning Review 06/13/2011 06/13/2011 07/05/2011 Approved Tara Jones Comments: *3' walkway is required. *Front elevations are site specific and contain required design elements. Inspectors wilJ field check that actual elevations match submitted designs as shown on the approved set of plans. *Covered porch must extend 4' in front of garage. 'lstructural Revi~~,,' ': ..~.';"~,- '~'^!1r ":.P~':1 ~(2912,~~:,?~~'1~/:~g1 '1~O~29;t1()C"f~RPt2'~ r ~ ,,~ """ , "~':w," ': -;~" .>" :::~~:'$;/'"7',14?Z;::}~;YZ':Lt ;~~!~~OI~;Jt;EL~:'1.~j" k"~':;}~;~ / Permit Issuance 07/06/2011 07/06/2011 07/13/2011 Issued '~~~r;--~~-:--l , j David Bowlsby Springfield Building Permit 7/13/2011 12:01:05PM Page 4 of6 S~~~NG.:~L~ ,,@Ji '{-'. OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01365 IVR Number: 811178395065 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/13/2011 ISSUED: APPLIED: 07/13/2011 06/10/2011 EXPIRES: VALUE: 01/08/2012 $140,036.42 SITE ADDRESS: 4912 HOllY ST, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1802051108100 SCOPE: Single Family Residence WORK INVOlVEO: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling Detached INSPECTIONS REQUIRED ~ Inspections 1110 Footing 1118 Footing Drain 1120 Foundation Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. 1150 Slab/Fiatwork Slab: To be made after all inslab bUilding service equipment, conduit piping and other equipment items are in place but prior to concrete. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 1160 UFER Ground 1220 Underfloor framing 1260 Framing Framing Inspection: Prior t~ cover and after all rough in inspections have been approved. 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling 1450 Insulation Duct Ceiling Insulation: Prior to cover. 1520 Interior Shearwall 1530 Exterior Shearwall 1540 Gypsum Board/Lath/Orywall Shear Wall Nailing: Before covering sheathing with finish materials. 1630 Roof Sheathing 1999 Final Building Drywall: Prior to taping. Lath/Plaster: To be made after all lathing and gypsum board, interior and exterior are in place, but prior to plastering. Roof Sheathing Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. 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. 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 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. 2020 Underground Gas 2200 Underfloor Mechanical 2210 Underfloor Gas 2260 Gas Service 2300 Rough Mechanical 2310 Rough Gas Springfield Building Permit 7f13f2011 12:01:05PM Page 5 of 6 . SP~:::<:i1 ~"~~,~ 4~.~,,,,, OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01365 IVR Number: 811178395065 225 Fifth SI Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perrnitce nter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/13/2011 ISSUED: APPLIED: 07/13/2011 06/10/2011 EXPIRES: VALUE: 01/08/2012 $140,036,42 SITE ADDRESS: 4912 HOllY ST, Springfield, OR 97477 ~:t,,\>~ ASSESOR'S PARCEL NO: 1802'051108100 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling Detached 2995 Final Gas 2999 Final Mechanical Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. 3130 Footing/Foundation Drains 3170 Underlloor Plumbing 3200 Sanitary Sewer 3315 Water Line Underfloor Plumbing: Prior to insulation or decking. Sanitary Sewer Line: Prior to filling trench and including required testing. 3400 Storm Sewer Storm Sewer Line: Prior to filling trench. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. 3500 Rough Plumbing 3999 Final Plumbing 4120 UFER Ground 4220 Electrical Service Electric Service: Approval required prior to utility company energizing service. 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover 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 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 the front of the property, and the approved set of plans will remain on the site at all times during constructi~. 1 .~ '-::r- 13- I \ Owner or Contractor Signature Date Springfield Building Permit 7/13/2011 12:01:05PM Page 6 of6 .. . . TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 www.ci.springfield.or.U5 811-5PR2011-01365 4912 HOLLY 5T permitcenter@ci.springfield:or.us RECEIPT NO: 2011002013 RECORD NO: 811-SPR2011-01365 DATE: 07/13/2011 lDESCRfP..TION..%,,i,'S.' OJ''' 'f '--"-J,--~.ii.li:_",;i:t,,~.^:":~ACC()DNt;C()DEU.,, " ;AM()UNt...D.lJE~... ',.J Address Assignment, each new or change 224-00000-425602 38.00 ~min fee (10% of applicable fees) 224-00000-426605 8.66 Curb CuUOriveway 1st Cut 201-00000-428060 88.00 Each added 500 sq. ft. or portion 224-00000-426102 50.00 .___!:irst Appliance Fee 224-00000-425604 79.00 _--..!:.~rn~.~p.to 100,000 BTU____ 224-00000-425604 17.00 _~~~iping up t5'..4 ?..'::!!~._ ___ h___._ ___ _._. ... ..3?~~,9E_9E~56_04 .__________ _.....3~~_____. . _~~tipl~ ~."2':~~sc.9unt (rv1."!_3L.______ _ ______~01-9E()()~~?~06~,,__,____,_ _.___:~O.:.I!CJ..__.. _ One or T":'_~~':.m!2'.E'::':':!I!~~."'i!!' Twoy--"..!i:'____., . 224-00()~0-4..2_~6()~_,_._.______________~!~()~... ..__ Planning - Major Review - City 100-00000-425002 211.00 Range hood/othe~kitchen equipment 224-00000-425604 13.00 Residence wiring 1,000 sq. ft. or less 224-00000-426102 134.00 Residential Fire (.05 Per Sq Foot) 100-00000-424005 86.55 SOC: Administrative Fee - MWMC Regional Wastewater SOC 611-00000-426604 10.00 SOC: Compliance Cost - MWMC Regional Wastewater SOC 444-00000-426607 22.63 SOC: Improvement - Transportation SOC 447-00000-448027 1,811.51 ___ SOC~lmproveme~t Cost - Local Wastewater 443-00000-448025 1,542.96 _____.SI?C, ~mJ'.rov."_ment Cas!.,: MWM~ Region~~as!.":va~r:..~OC__~5-00000~~8025 ____.__,." 1 ,333.57 ____~~rn~r.!'''_''_~'2t... Co~:_s.t()':.'!' OralO,a~." __ __. _. _. ____ ___440:QOO_~-448~2!!...____ ___ _' _ 754.88 SOC: Reimbursement - Transportation SOE.._ _______ __. _. 44~~.~~-4480~______ _... __ __.~97.~_, _ SOC: Reimbursement Cost - Local Wastewater ..___. _..__~3__0~000-448024 3,161.28 SOC: Reimbursement Cost - MWMC Re9ional Wastewater SOC 444-00000-448024 101.97 __SOC: Reimbursement Cost - Storm Orainag.e 441-00000-448029 518.83 SOC: Total Sewer Administration Fee 719-00000-426604 351.85 SOC: Total Transportation Administration Fee 719-00000-426604 135.88 ~dewalk up though 90 Feet 201'00000-428060 88.00 Single-duct exhaust (bathrooms, toilet compartments, utilittroor 224-00000-425604 36.00 State of .oregon SurCharge (12% of applicable fees) 821-00000-215004 192.79 Structural Buildin9 Permit Fee 224-00000-42_~~()~_ _~75c~__.__ _.~echnology fee (5~ of permit to~~____~._ 100-00000-425605 89.53 ___,,~~::malane fe."~2~~~le family ~e_tached 821-00000-215023 3,409.00.. _ TOTAL DUE: 16,030.58 EPAYIVIENT,l'YPE';' ." PAY,OR~",3.,{;'C;':~HIER' OElqwC'l)3Y~V'C()IVIMEN"'S';~{i;i!':J::;",,'.;L; ",AMO\.JNtPAIDs!.?'".. " ..: i Check HAYOEN HOMES LLC $16,030.58 177 TOTAL PAID: $16,030.58 St1~ING.":~~ .~;:J."q I!$ 'C" ..... Y'< , . OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Frtth 81 Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811'SPR2011-01365 4912 HOllY ST permitcenler@ci.springfield.or.us RECORD NO: 811-SPR2011-01365 DATE: 06/10/2011 " " "'~i~:~""f!;:i.' ::T'ACJj,0tJNTlC.d6E'J'::>t~,->:r~:~:f " AMQUN;T1Hj,UE. ~ -- --v~,~~~:D 224-00000-425602 569.15 TOTAL DUE: 569.15 lLJJAY~t~_~iTLtyp~~1~:~:-~~pij.YOR~SHiEFf;KKAdF~MAN:~F~:~~~c~QNUVt~~~L&~~"%~ :~/ '" .,~-'~':(;J AMOUNr-PAfQ\~~-_-~-___'~~_~c'_,~".,';"~ Credit Card Hayden Homes 569.15 038098 RECEIPT NO: 2011001519 LeESe RilitI0-N-t_c4~ j' :+;,~ ;o:t,'/~::~~ry~_~1>}f Structural Plan Review Fee Residential TOTAL PAID: 569.15 " Electril.~al Permit Application '(I I . SPRINClFIE'LD DEPARTMENT USE ONt Y Permit no S 7l . / :JuS 225 Fifth Stree.tt Springfield, OR 97477. PH{S41)726-3753. FA..X(S41)7'J ~, Dare: This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is no(started within 180- .. days of issuance or if worl\. is suspended for 180 days. lOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No .CA TEGORVdFCONSTRUCTlON . iZi-Residential~" I D Government I D Commercial " JOB SITE INFORMATIOr'r ANDJ.:OcAtioN.,; Job site address:. 1../9/1.... foLL'! City: )\'l'-I""':,~\"''-D State: Va.. 1 ZIP: q.....("t-'l3 Reference~\ \ . .1 Taxlot.~\/Y") , DESCRiPTION OF WOR '_'1U\F1'\w \ ,-..... in )0" \\rR\~ a '--\ PROPl: RTY OWNER' Name: i+~'N !-k",,0:,. Address: 7'fIJ-I ~'" G.L.A<-\""'- (>1.. ,p. /f0 City: ~>.lt> State: 012.. I ZIP: 'rn.,,-(o PI;one: o/{{ Q\~ -51Q,;" - I Fax: - - E-mail: f.{.....bD.{cl..-~sJtZfD 1{P>(1)c?V-H0Kc:5 .<.01-'- 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 _4~9:540(1);w. ~79.5~(1).. -.- Slgnature:? 7[". --.... -"- CONTRACTOR INSTAllATION. Business name: G QR\{'\"~ t:..l.Q..--\ R.,C- AddressQ9)...\:> "S<~. ~\<.~<'.)\<...\.>.i'-n~o..\.l<2... City: \-\' \\ 'Sb ~ ~'-\:> State: C) ~'- I ZIP: q '''Wl.", Phone:S::>"'3-- (.4-......$5:>...1 Fax:S,,:;> - ('-\,':l.'ll1.S E-mail: <:\ I::. (b C\.~,,<,... '<:--.F>Le:a: \"-:<"- _ <;: "'" CCB license no.: \--::L' \ 'S" I BCD license no.: "3",.,~S r:... Signing supervisor's license nO.: -~ rr~ ~ ~ Print name of signing supervisO~#o.<2"""" '?_ Signmure of signing supervi~ ~ ~~ 4.10.2;&4.) (910B/COM) FEE SCHEDULF"",,,:,:.,., ,'; .....- Cost Totol' Qty, eo, cost Number of inspcctio"ns per item () Residcntinl, per unit, scnicc included: \- -$1J4:00--$\'..~.li2 .- -2. $ ~5,00 $ y:;{FP' - 1,000 sq. fi. or less (4)' Each additional 500 sq. ft. or portion thereof Limited energy (2) Each manufactured home or modular dwelling service or feeder (2) $ 32.00 $ $ 63.00 $ Scn'ices or feeders: insfallalion, ollerolion. relocatioll 200 amps or less (2) 20110400 amps (2) 40 I to 600 amps (2) 601101,000 amps (2) Over 1,000 amps or volts (2) Reconnect only (2) . - - $ 61.00 $ $ 95.00 $ $158.00 $ $205.00 $ $469.00 $ $ 63.00 S TcmporufY services or [eeders: installalioll, afteration, relocatloll 200 amps or less (2) $ 63.00 $ 201 10400 amps (2) $ 87.00 $ 40110600 amps (2) $126.00 $ Over 600 amps Df 1,000 volls, see services or feeders section above Brnnch circuits: new, ai/era/ion, exrensionper panel a. Fee for branch circuits with purchase orn service or feeder ree; Each brnnch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of n service or feeder fee: First branch circuit (2) EDen additional branch circuit $ 55.00 $ $ 6.00 $ Misc:elhmcous fees: service or feeder /lot inclu.ded Elleh pump or irrigation drde (2) $ 63.00 $ $ $ $ 63.00 Each sign or outline lighting (2). Signal circuit or II. limiLed-energy panel. allerlllion, or extension (2) Each additional inspection: (1) .\.' : ,,:.' ,";', '.' APplicANT' USE .... $ 63.00 $58.00 $ (A) Enter subtotal or above fees (Minimum Permit Fcc. $58.00) (B) Enter 12% surcharge (.12 x [AD (e) Technology Fee (5% of [A]) TOTAL fees and surcharges (A through C): $WAp' $ ~.~~ $ V, 7L ...... 'n t;. ,. 9> ~ Structural Permit Application DEPARTMENT USE ONLY ~;jJ;i;:~iiif 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 This permit is issued under OAR 9] 8-460-0030. Permits expire if work is not started within 180 days of issuance or if ","'ork is suspended for 180 days. , -,. , ,.,,,~ c' ... . _ - ,'-, n.' _ . '. lqCAI, C;QYE~"ME:NTAPpR0VAt:,. This project has final land-use approval. Signature: Date: This project has DEQ approvaL Signature: Date: Zoning approval verified: Property is within flood plain: 0 Yes i[~~~;g~~:(;~~~#'GAttE.GQtiy.4~Qf~;.G.ON~TF.(~G~TlQN1~i.~i1~~-Y"~: d;j~ _:!{.~I~~i' esidential 0 Government 0 Commercial li,,';'i;t'\;i:iu~~;;.sI;j:E' .1@O~.MAfl'6N."AND.{L6pAiI0Nhy.;'r'::(':1 Job site address: l-/q (2. /<!..cu.'( .57- City: S\'UN(<::\c-L~ CL Subdivision:l;,)(;-S1"t....9t~ ~~ Reference: J I- " P,ROPERTYOWNER Name: ~O~..J 140''-'-0;~ Address: ZL/&l{ ':>c":' (1,-,\<:.,,07_ 110 City: ;;:-t-,0'--Oi'.l';\ State 0 ZIP: Cf7-7Slc Phone: 5'1! -5-:-olJo -51-':\(0 Fax:o/l{ - . '0'-1- (fl~L, E-mail: CH;:,......>;\Q.).<:..i:4 .r':', If-wo,,-,,--,'- t-k,'--'C;"b.0.[) This installation is being made on residential or farm property owned by me or a member afmy immediate family, and is exempt from licensing requirements, under ~s 701.010. Sign here: [. -:7'(. . . CON1;RA9I()~ /N$TALLMIQN, . Business name: t\,,'C~~ N-o\"'L.~ Address; . '~-', ':: -- . -. City: Phone: State: Fax: ZIP: E-mail: CCB license no.: If 252Lo Print name: t;..L\' J-.(..e-:~{\Q.I...L~. -;-~ Signature: c..~ ~ ;t-;>,;,:;-T' '..'!'e~~~~SCJ:E1'.c:0r{t~A:c:J:()R'IN F.()RMAfIQN~~',;f,~i!:~,2,~;:, ,":;',,), , Name CCB License Number Phone Number Electrical \''-1 \ ">'1 C-. ......-"> s-o_ Plumbing I 'i '3 <",,'" Mechanical ') DO_>";} ~%..- A\.~ . ',. . .,:'.:,':"'FEE. SCHI:PULE ' , ,;r~:~:.v.~i~~iip ~~i~-ro'r'!lraYi.9R:,::S{:;~~~-;i'~~:il~~f:;!~;': (a) Job description: S~D Occupancy ILL\.- ~ Construction type: 5 ~~ Square feet: '" It.. 0 Cost per square foot: Lt ~ Other information: Type' of Heat: ('-t Energy Path: 'l ~ new 0 alteration (b) FoundationRonly permit? Total valuation: (a) Permit fee (use va]uati9n table): (b) Investigative fee (equal to [2a]): (c) Reinspection ($ per hour): (number of hours x fee per hour) (d) Enter 12% surcharge (.]2 x [2a+2b+2c]): (e) Subtotal of fees above (23 through 2d): $ $ $ $ ;," (a) Seismic fee, 1% (.01 x permit fee [2a]): $ TOTAL fees and surcharges (2e+3c+4a): $ (;,0 ()~I.JC" ~ . ~?;.willamalane tlJ Park and Recreation District . Job. No. S'/( 13bS PARK AND RECREATION SYSTEM DEVElOPMENT CHARGE WORKSHEET January,1-December 31, 2011 NAME: f1!t'1 1>ub tJt-fD:yV\cS AD~RESS]i~'1 S"w ~~I'/~ &-71- C1TY:,~7:>M-a>tv/) " '_ PHONE: 5S-iJ7 -!:f( )~ STATE:I)/LZIP: 977J"Z ~ LQCATION:QF ERQJ'QSED!,lLlILDING SITE: . s~~e~t Add;ess:A::li 2-"1~6Li y ',:5TiEiT PlatName:\UQ"t:tOlf~-~ ' Tax Lot Number:, 19C)~e SH~e0 1. DEVELOPMENT TYPE (Refer to develop'ment type definitions on the reverse.) , . , A Single-Family Det~ched NO. OF UNITS ' , ,{ X $3,409 perunit= . $ 310/ , ' B. /'Single-Family Attached NO. OF UNITS X $3,404 per unit =' ' $ c. . Multi-Family Apartment, NO. OF UNITS X $2,800 per unit = $ . D.Single Room Occupa'ncy '- NO. OF UNITS , X $1,400perunit;= '. $ , .... ... E.' Accessorv Dwellin'g Unit , ,. NO. OF UNITS , X $1,70Sper unit = $ --2:- SDC CREDIT (If applicable, SDCpayer must furnish proof of' credit approval.) , - ._ .._~_..__'.._ ,n_, __._'~~_'_.__ .. .. . ~. ". - - ($ u'f3 " $u~-Z(ot ------ ) . '3. TOTAL PARK AND RECREATIONSDC ASSESSED ~~~ . CitY of pringfleld b~ City of Springfield t, I ).~ I n Date of building permit submittal '71~ / I Date'of building permit issuance