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Home My WebLink AboutPermit Building 2011-7-13 .. SI"~,.I.,NGFIE..~ ~~\:~ .....~ o i .7-t^ OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01742 IVR Number: 811158809223 www.ci.springfield.or.us 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 07/13/2011 EXPIRES: VALUE: 01108/2012 $1,000,00 SITE ADDRESS: 353 S 43RD ST, Sprin9field, OR 97478 ASSESOR'S PARCEL NO: 1702323403800 SCOPE: Bathroom WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Convert half bath to full bath Phone Number: OWNER: ADDRESS: RUST BRIAN D 353 S 43RD ST SPRINGFIELD OR 97478 CONTRACTOR INFORMATION ~ Contractor Name Lie Type Lie No Lie Exp Phone OWN ER OWNER 0000000 08f12f2025 OWN ER OWNER 0000000 OB/12f2025 OWNER OWNER 0000000 08/12/2025 OWNER OWNER 0000000 08/12/2025 BUILDING INFORMATION ~ Contractor Type General Contractor Mechanical Contractor Plumbing Contractor Electrical Contractor Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: 'res you to "T--' J"':""V....!\I. l....~ClnOn lCiW requl . . p" ,.-,., "Sq'FtCarport:'he Oregon Utility I " \IJ "L \"";: a00pleu I.J)' lIth QuO. I, "" Sq F,t Other:se rules ure set or "." 'atlonG~,I,CI. .". 2 001 . "JLI..v' c 0 -. "'L'''d'h OAR 95 - - , O!l..R 902-0"~cypancy, oa " I b . In ' bt' opies of the ru es y Electrical Specialty Code Edition8090" You may 0 al(~ote: the telephone Springfield Fire Code Edition: calling the chentoer~gon Utility Notltication number lor t e r ) Mechanical Specialty Code Edition:' Center is 1-800-332-2344 . Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: # of Units: o # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Lot Size: 2008 Site Infonnation ~ Engineered Fill: Fill Volume: Flood Hazard Area: land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit 7/1312011 2:18:34PM NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Page 1 of 4 .. www.ci.sprlngfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01742 IVR Number: 811158809223 225 Fifth St Springfteld,OR 97477 Phone: 541.-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perrnitcenter@cLspringfield,or.us PROJECT STATUS: STATUS DATE: 155 ued 07/13/2011 ISSUED: APPLIED: 07/13/2011 07/13/2011 EXPIRES: VALUE: 01/08/2012 $1,000.00 SITE ADDRESS: 353 S 43RD ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702323403800 SCOPE: Bathroom WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Convert half bath to full bath DEVELOPMENT INFORMATION I Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % 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 Descriotion Tvoe of Construction Unit Amount Unit Tvoe Unit Cost Value Springfield Building Permit .7/13/2011 2:18:34PM Page 2 of4 . 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OREGON www.cLspringfleld.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01742 IVR Number: 811158809223 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permi1center@Ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 07/13/2011 ISSUED: APPLIED: 07/13/2011 07/13/2011 EXPIRES: VALUE: 01/08/2012 $1,000.00 SITE ADDRESS: 353 S 43RD ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702323403800 SCOPE: Bathroom WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Convert half bath to full bath FEES PAID I Descriotion ,?DC: Improv:~~~!_CoS~Loc~1 W.~:.!.~~~~_._ SDC: Total Sewer Administration Fee . . -'... -_.._._._---~~-- Branch circuits without service or feeder - 15t circuit Branch circuits without service or feeder - each additional First Appliance Fee Clothes washer Sink/basin/lavatory Bathtub ~..,?f M!~imum PIU~?!~1 Permit Fees ~~~"I Building P:~~t Fee Stat~,2f Oregon Surcharge (12% of ~pplicable fe.es) Technology fee (5% of permit to.!,al) SDC: Reimbursement Cost - Local Wastewater -.-.- Total Amount Paid Amount Paid Date Paid $198.27 07/13/2011 -"~-----"-~""-"'-'-'~----'_...._------- $30.23 07/13/2011 -~_.,-_.'."'_..-~--------- -. $55.00 07/13/2011 -_._......._..'~ $12.00 07/13/2011 $79.00 07/13/2011 $19.00 07/13/2011 $19.00 07/13/2011 $19.00 07/13/2011 $1.00 07/13/2011 _._--_.- $58.00 07/13/2011 $31.44 07/13/2011 $13.10 07/13/2011 ----..- $406.23 07/13/2011 --~---_.._,- $941.27 Reciot # 2011002020 2011002020 -_.__..._~- 2011002020 2011002020 2011002020 2011002020 2011002020 2011002020 2011002020 2011002020 2011002020 2011002020 2011002020 Plan Review , Deoartment Permit Issuance Received Due Date Comoleted Result 07/13/2011 07/13/2011 07/13/2011 Issued Reviewer David Bowlsby 07/13/2011 07/13/2011 Not Required David Bowlsby Structural Review 07/13/2011 Comments: Over the counter permit ~~:~'e~;fi~&;;el~}~!~~~~~i~5:~, ~"'''~--''' C"~... ..,- .'.jC..-J'..d:c" Public Works Review 07/13/2011 Comments: Over the counter permit 07/.13!20~f1~~0~]:1':t 'Not;Reqllired",. .",:~~_ "[)avid'Bowlsoy ~,~;_":~:;~~r~:~~~~;;;'-~_'::,,~ ,.' l .~. ,,' ~_:~!.j' ,h' ,-~:;.,;~:~~ -'~-v--.-11':'_"");~"~:'jJ7't.;C^'2;~~'" )_ ~\ ~c'~::" :,~:~2: ),~;"t~' '",' 0' '. -. .J 07/13/2011 07/13/2011 Not Required David Bowlsby Springfield Building Permit 7f13/2011 2:18:34PM Page 3 of 4 s;~:~~. G.;:EL~ .;<~ m /'i ",':.' OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01742 IVR Number: 811158809223 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 07/13/2011 EXPIRES: VALUE: 01/08/2012 $1,000,00 SITE ADDRESS: 353 S 43RD ST, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702323403800 SCOPE: Bathroom WORK INVOLVED: Remodel TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Convert half bath to full bath INSPECTIONS REQUIRED ~ Inspections 1260 Framing 1999 Final Building Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Mechanical: Prior to Cover' Final Mechanical: When all mechanical work is complete. Underfloor PI~mbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. 2300 Rough Mechanical 2999 Final Mechanical 3170 Underlloor Plumbing 3500 Rough Plumbing 3999 Final Plumbing 4500 Rough Electrical 4999 Final Electrical Final Plumbing: When all plumbing work is complete. 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. compliance with ORS 701.005 will be used on this project. J further agree to ensure that all required inspections are requ at the proper time, that each address is readable from the street, that the permit card is located at the front of the R , and the approved set of plans will remain on the site at all times during constructio 7-( 3-1 I Date Springfield Building Permit 7/13/2011 2:18:34PM Page 4 of 4 I '. "~' Property Owner Statement Regarding Construction Responsibilities Oregon Law 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. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: W I own, reside in, or will reside in the completed structure and my general contractor is: pR Name CCB# Expiration Date D' I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or l2?J I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If' change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 7-(3-/ I Date . . Permit #: Issued by: Date: Address: This Copy for Permit Offices ;.. t; Structural Permit Application ,'~ ' ',~'~'~',.-- :-" "D~.O\'.~; "-;-~X;'~i1_ .. :\~ -'': .." -.' .. . -.... . '- .. .. =".. >', " .." 225 Fifth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541)726-3689 DEPARTMENT USE ONLY Pennit no::.$ ( ( - !7 'f 2.... Date: II This pc.'mit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of ssuance or if wOl'k is suspended for 180 days. LOCAL GOVERNMENT APPROVAL This project has linal land-use approval. Signahlre: Date: This project lms DEQ approval. Signature: Date: Zoning approval verified; 0 Yes 0 No Property is within flood plain: 0 Yes 0 No CATEGORY OF CONSTRUCTION Cj)<esidcntial I 0 Government I 0 Commercial JOB SITE INFORMATION AND LOCATION Jobs;te add,ess: ~<;::.::; $. ~ :<,f'(-\. S-t. City: ~~ 'VI. ~ lh=\ c\ I Slale(')!2 I zllq'7t(?~1>' Subdivi~ion: -J' I Lot no.; Reference: 1'102 S;J:S 19faxlot: cJ 5trt:!) C PROPERTY OWNER Name: ,I ""~:- A. '" l/ V (,-r Addcess3S".-J ~3 'q~rc'( .ct' .,. C;ty: . c;"" ~ :r;~p \ ,.\. State: 0;(/ I ZIP: '1'7'I~ Phoneslll _M 0". SI S-9t1.!i "Fax: _ _ E-ma;l: n'/4-e~u~./d, r aho&. ~ This insbllution is ~ing made'e.n-.re"Side~tial or far ro~erty}wned by me or a member afmy immediate family, and' . pt ~ ~ensing requirements u~6RS 701.0JO. Signhere:,;{ ).d~~ ~/ "" t/ r;;ldNTRACTOR di(S'r ALLA l0'N ~ nus;ness name: (')I.J V\.clf Address: City: Phone: E-mail: CCB license no.: I State: I Fax: I ZIP: Print name: Signature; SUB-CONTRACTOR INFORMATION Name CCU License Number Phone Number Electrical Plumbing M~dumiCllI FEE SCHEDULE 1. Valuation information (a) Jnh deseript;on: 1'>'-(,+- II ~AA...11 !')f-L Occupancy Constnlction type: Square feet: Cost per square foot: Other information: Typr of Heat: l!:llergy Palh: o new 0 alteration (b) Foundation-only permit? Totul valuation: 2. Building fees (<I) Permit fee (use valuation table): (b) Investigative fee (equal to [2a}): (c) Reinspection ($ per hour): (number of hours x fee per hour) o odd it ion DYes DNa $ /00 $ ~r:> $ $ (d) Enter 12% surcharge (.12 x f2a+2b+2cl): -(c) Subtotal of fees above (2)> through 2d): 3. Plan review fees (a) Plan review (65% x pemlit fee [2a]): (b) foire and life safely (40% x permit fee [2a]): (c) Subtotal offccs above (3a and 31l): 4. Miscellaneous fees (a) Seismic fee, 1% (.01 ), permit fee pal): TOTAL fees and surcharges (2e+3c+4a): $~~ $ $ $ $ 2-~~ I s Cl a>(. Electrical Permit Application D 225 Fifth SlreeHSpringfield, OR 97477+PH(541)726-3753+FAX(541)726-3689 cf;;....;y:;;::')X;:LCcP< .~,..- ,- ,r, ':';..._.)o;):if;i:i-';;>" <.., _<+f'0"-U'; ~i7iDE"ARTMENHUSE ONEV;;, ",."'",::l\:a:'TIJUJ............_.._.:'_hj.;;;;;t?,,"'..:;..: .. >:.... 't-..>:,-,_";.'.":; - (7'f 2- Date: 7 This permit is issned nnder OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. s"lt':::'i,IiocACGOVERNMENt-.. APf!ROVAlii...... Zoning approval verified? DYes D No '\i';;~i-;. ./cA'TEGORY'OF'CONSTRl.JCJION ",'ii;" , esidential 0 Government 0 Commercial , ""JoBlisITE~INF,ORMATIONIAN[).1..0CA'TION;f~;'ii; $, q3 S;-t, Name: ."', ":L"('FEE1SCHEDULcE ..;;".;.",.".;. ;N';mj,~-~o~~iispe~Jions\>'ei-if~i(j' IQtY':i<;'~~t. .~~~li'; Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) SeITices or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 60110 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary seITices or feeders: installation, alteration, relocation '^'^ farm property 200 amps or less (2) $ 63.00 $ ily. This 201 to 400 amps (2) $ 87.00 $ AR-- 40 I to 600 amps (2) $126.00 $ N' Address: ZIP: City: Phone: E-mail: CCB license no.: BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: '~tV~ /\: ~6) ~ 440-2584-) (9108/COM) Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit I $ 55.00 $ 55 2. $6.00 $/2. Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited-energy panel, alteration, or extension (2) Each additional inspection: (1) ~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [A]) (C) Technology Fee (5% of[A]) TOTAL fees and snrcharges (A throngh C): $ 63.00 $ $ 63.00 $ $ 63.00 $ $58.00 $ . ~.~. :.t~ $ ~?Oj) $S;~ $ .7:U" $ '7 "0:31- This permit is issued uuder .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. '>:,;,~;;~';.;~;IfO()Al; 'GOVERNIVIENT,.API'R()VAfrjffiis<~~tif4:i;:.' Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION'. l2rResidential I 0 Government I 0 Commercial ,.:'!i,.'JJOBSI'J]: 'INF()RMA"llON:iAND;JiOcATJON~{);Ti;.".. Job site address: ~~ ) S, q ~d $rt City:.Sn~o. rl<:""lc\ I State: 0 ? I ZIP:q7Lj~ ~ Referen~e: \n~~~.... Taxlotg:~,.. 1./';' '?" ',.i:;,;,:,~.DESCRII?TION"QF;i;vv.ORK"":h;)';;(;:(.\;I.;\j)';Ie;: t t2:E./.-".o 0 if j'S'''''''t+ 117 77:l Fuu-) / Plumbing Permit Application 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 ., .PROPERTY.;OWNEI{'"i""; . Name: j 'S"'t'7. '^ rK' '-.I S'--' Address 3 s-:J 45, ~ '3 r.d_ .s"t City: Q---,JI~1'\O\ha::. \ c\ I State/) I? I ZIP: q?~' I> Phone;sz.)(-Sr5:.-~'?' '--J C Fax: - - E-mail:;?......1e.... a;w c-rf~ ( ~ I, r (" a v'^-- This installation is 15eing made~ entiaQ or farm property owned by me or a member ofrgyfll11 d~family, and is exempt from}icensingrequir:ements \'. - 95.0020, Signatur"')~ ~ ~ "'" '-.?/ jX)NTRA,c-rOR~ll:;ttTt6N.. ".'" ,'., Business name: ;?')A, J \I\..~ Address: City: Phone: E-mail: CCB license no.: I State: Fax: I ZIP: I BCD license no.: Plumbing license no.: Print name: Signature: 440-2500.J (l1/08/COM) '-':"".-',;'.'''.c,:-~..,:".:,:",_,c, ;,,_'..'," ;"'.'i,'!";;: "'_.f<>"'H",';;"',~,-"";" "''?'DEPARTMENT USE ONL y,\,~'i, ., . -. "-'. 'f-:i _ ',":X~;::.I,<;:::81$~-r~;~r~~i"'::-EEE{fs_cH EPU ILE2Ct~r',::;~"-~;t~t~:~i::;:':;L.~~;;~;~,Yf.\I{', , " ,. ',iBti;;;,Z;/;g'i.., .p.;;'. /,;;;;.'. ~,;'I.Q,ty':I:'CtiSf; ..LTota]" ~ ~;,.. ::.-,~I~~';;7,~,e::l.,~;\:ii: :?'~".!::.c.o_~t:-~<: New residential 1 bathroomll kitchen (includes: first J 00 feet of water/sewer lines, hose bibs, ice maker, under floor low-point drains and rain-drain packages) 2 bathroomslI kitchen $374.00 3 bathroomsll kitchen $439.00 Each additional bathroom (over 3) $95.00 Each additional kitchen (over I) $95.00 Residential fire sprinklers (includes plan review) o to 2,000 square feet $58.00 2,001 to 3,600 square feet $116.00 3,601 to 7,200 square feet $174.00 7,201 square feet and greater $232.00 Manufactured dwelling or pre-fab (circle one) Connections to building sewer and water supply Commercial, industrial, and dwellings other than one- or two-family Minimum fee $23B.00 $ $ $ $ $ $ $ $ $ $5B.00 $ Each fixture Miscellaneous fees ] 00' storm, sewer, water line Each fixture, appurtenance, and piping Storm water retention/det'ention facility Irrigation systems Piping or private storm drainage systems exceedinp- the first 100 feet Sp'ecialty fixtures Reinspection (no. ofhrs. x fee per hr.) Special requested inspections (no. of hrs. x fee per hr.) Each additional inspection: (I) --:;:: $5B.00 $19.00 $ $"::;, $76.00 $ $19.00 $ $19.00 $ $19.00 $ $19.00 $ $19.00 $ $5B.00 $ $5B.00 $ . $5B.00 $ t~~i'~'i~~i~g~;~pr~i~~g~D~~0'~~;~~~K~}::{t~~~~T;$,;' Mjnimum fee $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ "'"~C,,,,_~,,,,,,iw~ili'!.'niil"I'C"'A'N-""Yi"S'~"E"w""'''''''_j,~,-~~"" ~\%-,>!":t~~~~~~~,,I'::\~,fi,L::._,' _-~___jt~U,,_,_,~~!lmic~'2'~ (A) Enter subtotal of above fees (Minimum Permit ~$58,O~ (B) Investigative fee ~afio [A]) (el Enter 12% surcharge (.12 x [A+B]) (D) Technology Fee (5% of [A]) TOTAL rees and surcharges (A through DJ: $S;-6 $ $~~ $ z.-~ $ t:.7~Y Mechanical Permit Application ,_, 4!"- ,r.~ _ " '" ;:-!: ':+' ~. ' ~ . _"/:.' "' --"~~";-,I : ..... , ~'::;!;\)Glff~kOF:~SPR1NGFIE'L:D"{OREG'ON~::'~' "Z.~""~" ~'>4..Jt"~"4-"~' ,"""~"i"'"'' -.""'r_...."_ '"',..,,, '>~"'-d-7.._f~~ _ 'w",-:""" 225 Fifth Street. Springfield, OR 97477 . PH(54])726-3753 . FAX(541)726-3689 ....'>".;;-': +':'~~_".c. .:.~;-,c, ";"""'__,' ,'"., ...-~,....,_,._. - ';. " ,~:''''';':,,'':' ..." ' i;<OEPARTMENT'USE ONLY:';! , ., ; ... f,_ . ',_,_. - This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. '. ';':i'_c:At~G6R:i'r;'0.F;Fc:bNstROc:tibN)~.:" esidentia! 0 Government o Commercial 'It;;r;Vi,jOB~$ifEH!\If: O:RMft..trICir\lFAN[j;;~bGA;tiQ N~~~'i; "!:'i Job site address: . 1-( '3 CityS l'\~ t~~~~k~~'~~~t>\~:~~~{~i~'P"RQ,Ft~BTY:!1lQW.N.~~;'f~iliL~~:f~rji~;ti;;{~~~Gi!tI::ltjt;'~~j Name: Address: City: Phone: E-mail: CCB license no.: Print name: ZIP: Signature: 440-2545-J (J1/08/COM) .'1" FEE SC:HEDULE ~;~~~J9:~~~!.~~fw!~\;~~::~~~,~;,~~~\...:.;'::!~:~t~~,;:!~;~;~~ ' . I""')~?~" ......Total '. ~~, a;:.:.oi'( {:-{,3,iiCOsf f~~'i' First Annliance I I $7i.OO $ 7'l urnace/burner including ducts and v.wt~ Up to lOOk BTUlhr. $17,00 $ Over lOOk BTU/hr, $20,00 $ Heaters/stoves/vents Unit heater $17.00 $ Wood/pellet/gas stovelflue $38.00 $ Repair/alter/add to heating appliance/ refrigeration unit or cooling system! $58,00 $ absorption system Evaporated cooler $13,00 $ Vent fan with one duct/appliance vent $9.00 $ Hood with exhaust and duct $13,00 $ Floor furnace including vent $58.00 $ Gas piping One to four outlets $7,00 $ Additional outlets (each). I $4,001 $ Air-handling units, including ducts Up to 10,000 CFM $11.00 $ Over 10,000 CFM $20.00 $ Comnressor/absorption system/heat pump Up to 3 hp/1 OOk BTU $17,00 $ Upto 15 hp/500k BTU $29,00 $ Up to 30 hpll,OOO BTU $43.00 $ Up to 50 hp/1 ,750 BTU $57.00 $ Over 50 hpll,750 BTU $95.00 $ Incinerators Dome~,:, I I $20.00 I $ ;',/i.::'i.;;:.'."" <,- Enter total valuation of mechanical system and installation costs $ Enter fee based on valuation of mechanical system, etc. $ r-;~)~:4Jn~~~,~9.~~r,~~!J~fj:ri~tt~~:~~;~~;,~t~N~ F~~~ ,~/Cost.'.. " ':>,~~~~~,:\,,:;, ~-~!14'ea;~t~:;>; Reinspection . $58.00 $ Specially requested inspections (per hr.) $58.00 $ Regulated equipment (unclassed) $13.00 $ Each additional inspection: (1) $58.00 $ ;'~lWZ~~~~~~,t!l~~_~@~J~J~.Rijlc~Nill;10SE~l~fArT!%~~m~~~l!li (A) Enter subtotal of above fees (or enter set 7"-- minimum fee of $ 79.00) $ (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ Cf ct.J. (D) Seismic fee, 1%(.0] x [A]) $ (E) Technology Fee (5% of [A]) $ '? ~~ TOTAL fees and surcharges (A through E): $ 7'2"1 ~ ST~G.=;;ij L~~ ~OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth SI Springfield, OR 97477 541-726~3753 www.ci.springfield.or.us 811-SPR2011-01742 353 S 43RD ST permilcenter@ci.springfield.or.us RECEIPT NO: 2011002020 RECORD NO: 811-SPR2011-01742 DATE: 07/13/2011 lDESCRIP,.tiorF ;'0\"~""" 'L~;'\t.f~vf~,;" " :'~--.,)k;",-~,~' ';'!i.'Cc;'OUr-lJ,'C:OOE':" -.'4 :." - '\AMOUNTJD.UE. ' '-'., '"" 'j; j _.___~~~~~f Minimum p'lumbing Permit Fees _ __..... 224.00000-425603 1.00 Bathtub 224-00000-425603 19.00 .> -_.- - ----~ .------.---. - .._--"-" .~-'_._---- Branch circuits without service or feeder - 1 st circuit 224-00000-426102 55.00 .-.__._~---_. --- -_..-......"''''--*. --~--~----~...~. Branch circuits without service or feeder - each additional 224-QOOOOA26102 12.00 -'--~-~"---'------- Clothes washer 224-00000-425603 19.00 First Appliance Fee 224-00000-425604 79.00 SOC: Improvement Cost - Local Wastewater 443-00000-448025 198.27 SOC: Reimbursement Cost - Local Wastewater 442-00000-448024 406.23 SOC: Total Sewer Administration Fee 719-00000-426604 30.23 Sinklbasinllavatory 224-00000-425603 19.00 __.State of <?r~on Surcharge (12% of applicable fees) 821-00000-215004 31 .44 .__ Structura.!.~uildin9 Permit Fee 224-00000-425602 58.00 ._ H_ :r.".c~~~logJ fee (5% '~!.eer.m.itJ."-~ 1 00-00000-425605 13.10_____ TOTAL DUE: 941.27 -PAYMENT TYPE; i.. PAYOR",. 'cAsHIER"oBOWLSBy"''':iic6MMENTS; . :'';''_ P',;." .... ,.' AMOUNT'PAiO; .;. ;'.', ' _ '- ____.__.._ __'"~____'__ .~_~_ _~_._ _....._"'___._,......_.~('>.....h._.f':__..."-_~~__.,___"._,__.\,;_.__.;,.--...______.. .-'-_..___J.~._____,,_...__"'~...__..._.... Check RUST BRIAN 0 $941.27 1787 TOTAL PAID: $941.27