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Home My WebLink AboutPermit Building 2011-8-2 .. www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01759 IVR Number: 811145282601 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676. permitcenler@ci.springfield,or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 08/02/2011 07/15/2011 EXPIRES: VALUE: 01/28/2012 $233,862.39 08/02/2011 SITE ADDRESS: 7045 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702352100700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling OWNER: ADDRESS: THOMPSON IDA JEANINE & ROBERT D 7085 THURSTON RD SPRINGFIELD OR 97478 Phone Number: CONTRACTOR INFORMATION ~ Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone Genera! Contractor OWNER OWNER 0000000 08/12/2025 BUILDING INFORMATION ~ # of Units: # of Stories: 2 Lot Size: Height of Structure: 28 Sq Ft 1 st Floor: 1813 Occupancy Type R-3 Type of Heat: Forced Air Gas Sq Ft2nd Floor: Construction Type Type VB 296 Occupancy Type U Water Type: Gas Sq Ft Basement: Construction Type Type VB Range Type: Gas Sq Ft Garage: 785 Hazmat: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: # of Bedrooms: 3 Municipal! Development Code: Sprinkled Building: No Plumbing Specialty Code Edition: Fire Alarms: Residential Specialty Code Edition: 2008 Energy Path: Path 1A Gas-fired Structural Specialty Code Edition: furnace with min. AFUE of 90% ".--. Site Information ~ Engineered Fill; No Fill Volume: Flood Hazard Area: A~NTION: Oregon law requires you to Land Hazard Area: fol~ rules adopted by the Oregon Utility Retaining Wall: Nottf~ation Center, Those rules are set forth Soils Report Required: In O'AA 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). NOTICE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT. COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. .....;..;. Springfield Building Permit 8/2/2011 1 :27:29PM Page 1 of 6 SP~:~. ;.~~?ij ~<~ ~OREGON www.ci.springfieJd.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01759 IVR Number: 811145282601 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 08/02/2011 ISSUED: APPLIED: 08/02/2011 07/15/2011 EXPIRES: VALUE: 01/28/2012 $233,862.39 SITE ADDRESS: 7045 THURSTON RD, Sprin9field, OR 97478 ASSESOR'S PARCEL NO: 1702352100700 PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: 85 Sideyard Setback: 113 Rearyard Setback: 48 Solar Setback: 0 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential New Single Family Dwelling DEVELOPMENT INFORMATION ~ Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: o Yes 4 28 REQUIRED PARKING Total: 2 Handicapped: Compact: Street Improvements: Storm Sewer: Storm Sewer Available: Special Jnstructon: Subdivision Accepted: Notes: Descriotion R-3 1 & 2 family . U Utility I misc. Springfield Building Permit PUBLIC IMPROVEMENTS ~ Valuation Description Tvee of Construction VB VB Unit Amount Unit Tvee 2,109.00 SqFt 786.00 Sq Ft 8/212011 1:27:29PM Sidewalk Type: Downspout/Drains: ~ Unit Cost 96.83 37.72 Value 204,214.47 29,647.92 233,862.39 Page 2 ofB www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01759 IVR Number: 811145282601 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 petmitcenter@cLspringfieJd. or. us PROJECT STATUS: STATUS DATE: Issued 08/02/2011 ISSUED: APPLIED: 08/02/2011 07/15/2011 EXPIRES: VALUE: 01/28/2012 $233,862.39 SITE ADDRESS: 7045 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702352100700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling FEES PAID I Descriotion Amount Paid Date Paid Structural Plan Review Fee Residential $534.76 07/15/2011 _.W'~__ _"_W ._~'~_'~.W~~'W~ SDC: Total Sewer Administration Fee $346.38 08/02/2011 ~~_ Reim!:>ursement Cost - Sto..'.ll:'..~r~~age _ .__._________. $3.9~8~_____~~02/2011__ SDC: Reimbursement Cost - Local Wastewater $3,520.66 08/02/2011 ~ ~'. -~---~ ------~_._.~--- SDC: Improvement Cost - Local Wastewater $1,718.34 08/02/2011 SDC: Reimbursement - Transportation SDC $510.94 08/02/2011 SDC: Total Transportation Administration Fee $132.51 08/02/2011 SDC: Reimbursement Cost - MWMC Regional Wastewat, $101.97 08/02/2011 SDC: Improvement Cost - MWMC Regional Wastewater ~ $1,333.57 08/02/2011 SDC: Compliance Cost - MWMC Regional Wastewater SI $22.63 08/02/2011 SDC: MWMC Credit - Regional Wastewater SDC $-466.89 08/02/2011 SDC: Administrative Fee - MWMC Regional Wastewater: $10.00 08/02/2011 SDC: Improvement - Transportation SDC $1,862.23 08/02/2011 Residence wiring 1,000 sq. ft. or less $134.00 08/02/2011 Each added 500 sq. ft. or portion $100.00 08/02/2011 First Appliance Fee $79.00 _ 08/o.2j2011 SDC: Improvement Cost - Storm Drai~age $571.46 08/0.2/201 ~__ Sanitary sewer $76.00 08/02/2011 State of Oregon Surchar~e (12% of applicable fees) $9.12 08/02/2011 Technology..!,,-,,- (5% of permit total) $3.80 08/02/2011 !echnologxfee_(5--"!o of permit tot..~______._. $62.71 08j.<??/2011 State of Oregon Surcharge (12% of applicabl<:.!.<:es) $150.50 08/02/2011 Admin fee (10% of applicable fees) $14.47 08/02/2011 Structural Building Permit Fee $1,254.13 08/02/2011 Technoiogy fee (5% of permit total) $-41.14 08/02/2011 State of Oregon Surcharge (12% of applicable fees) $-98.73 08/02/2011 Residential Fire (.05 Per Sq Foot) $1.05 08/02/2011 Tech!:JOlogy fee (5% of permil lotal) $84.69 08/02/2011 State of Oregon Surcharge (12% of applicable fees) $198.69 08/02/2011 TeiTlP services 20.0 amps or iess $63.00 08/02/2011 Planning - Major Review - (;jty $211.00 08/02/2011 Residential Fire (.05 Per Sq Foot) $143.65 08/02/2011 Address Assignment, each new or change $38.00 08/02/2011 Wiil~~;re-;;~ :s;~i;i';-i~;;;i1ide;;;zl1-;;d"-'--' $3,409.00 08/02izOl1' One or Two Family Dwelling'with Two Bath $374.00 08/02/2011 Furnace - greater Ihan 100,000 BTU $20.00 08/02/2011 Ran~" hood/other kitc_h"n'=quipmen~_ ...._._ ... .... .__~.~o.?___~/02/20_'_~__ Reciot # 2011002038 2011002168 2011002168 2011002168 --- 2011002168 --- 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 2011002168 Springfield Building Permit 8/2/2011 1 :27:29PM Page 3 016 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01759 IVR Number: 811145282601 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 08/02/2011 ISSUED: APPLIED: 08/02/2011 07/15/2011 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitce nter@ci.springfield.or.us EXPIRES: VALUE: 01/28/2012 $233,862.39 SITE ADDRESS: 7045 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702352100700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling !:Iu!.':.e."! for water heater or gas fireplace $9.00 08/02/2011 Gas Piping up to 4 outlets $14.00 08/02/2011 ~i;igle-duct exhaust (bathrooms, toilet compartment;~-;'ii~ -- ~2TiiO--"-- -- 08/0ii2iiTi- Total Amount Paid $16,941.33 Plan Review Deoartment Application Acceptance Due Date Comoleted 07/15/2011 07/15/2011 Result Application Accepted Received 07/15/2011 2011002168 2011002168 2011002168 I Reviewer Kip Kaufman Planning Review 07/15/2011 07/15/2011 07/20/2011 Approved Tara Jones Comments: First 18' of driveway needs to be paved. ''':.'.-cr:-'-----..~.~---:-..".'^''''.:,,'.--~-.''._:_- ._ ..~""'~'~"-~~~""'"("'P-Cf'\':'"""1"'":l' .. .....- rUbliC worksRevie.,.;..>- '0.7/15/2011 '07115/201,107/22/2011 ','Approved' ". ' " .' . Todd Singleton . l: Comments:, ,~P'o~~ With'~",~';;/a~PIiCanfbY phon~andhe Gpic~te9:ihat he;WiHa9i!~~sjt~rfi,wat~roi constructingaraingar'!en: S~e ,,'", </_"" plah,s!l6ws~e~stlng;curb,cld!;Jiide~~,..?nd~? feet&f&Qrti;:~lEtpaving;into;~R!QP}Lrty" ::,' . . Structural Review 07/15/2011 07/15/2011 07/25/20n Approved Chris Carpenter < _-'--,.-:--t'~ ; ; "I .\ Springfield Building Permit 81212011 1:27:29PM Page4of6 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01759 IVR Number: 811145282601 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 08/02/2011 ISSUED: APPLIED: 08/02/2011 07/15/2011 EXPIRES: VALUE: 01/28/2012 $233,862.39 SITE ADDRESS: 7045 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702352100700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling INSPECTIONS REQUIRED , Inspections 1020 Zoning/setbacks 1110 Footing 1120 Foundation Footing: After trenches are excavated. 1160 UFER Ground Foundation: After forms are erected but prior to concrete placement. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 1220 Underlloor framing 1260 Framing Framing Inspection: Prior to 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 1520 Interior Shearwall Ceiling Insulation: Prior to cover. Shear Wall Nailing: Before covering sheathing with finish materials. 1530 Exterior Shearwall 1540 Gypsum Board/LathlDrywall 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. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. 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. Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. 1999 Final Building 2200 Underlloor Mechanical 2210 Underfloor Gas 2260 Gas Service 2300 Rough Mechanical 2310 Rough Gas 2995 Final Gas 2999 Final Mechanical 3130 Footing/Foundation Drains 3170 Underfloor Plumbing 3200 Sanitary Sewer Underfloor Plumbing: Prior to insulation or decking. Sanitary Sewer Line: Prior to filling trench and including required testing. 8/2/2011 1:27:29PM Page 5 of6 Springfield Building Permit www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01759 IVR Number: 811145282601 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 08/02/2011 ISSUED: APPLIED: 08/02/2011 07/15/2011 EXPIRES: VALUE: 01/28/2012 $233,862.39 SITE ADDRESS: 7045 THURSTON RD, Springfield, OR 97478 ASSESOR'S PARCEL NO: 1702352100700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New Single Family Dwelling 3315 Water Line 3400 Storm Sewer Storm Sewer Une: Prior to filling trench. Rough Plumbing: Prior to cover and including required testing. Final Plumbi.ng: When all plumbing work is complete. 3500 Rough Plumbing 3999 Final Plumbing 4000 Temporary Power Service 4120 UFER Ground 4225 Service or Feeder 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, 1 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 ~"""rAi d A~. Owner Contractor Signature ~ W~II Springfield Building Permit Bf2/2011 1 :27:29PM Page 6 of6 www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2011-01759 7045 THURSTON RD CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 permilcenter@ci.springfield.or,us r.;P~YIViEN~TIYPEF~~',PXYORli.cAsilIER"DB6wLSB\';:'ic'; 1,'-; Check troy wilson 352509 RECEIPT NO: 2011002168 RECORD NO: 811-SPR2011-01759 DATE: 08/02/2011 lQfSCRjl'!.tl()N'~51.",<t ';'''4,;''4.c.:,,:~;';' li ii ,;'f~~',,>'Ji:'J;A'C:COI.JNj';C:ODE': ',""fe,":"; ":AMoIrNT~DUEJ i.i! .. ;,. 'I Address Assignment, each new or change 224-00000-425602 38.00 Admin fee (10% of applicable fees) 224-00000-426605 14.47, Each added 500 sq. ft. or portion 224-00000-426102 100,00 First Appliance Fee 224-00000-425604 79.00 __Flue ven.tforwater heater or gas fireplace 224-00000-425604 9.00 __, ~"'!'E,,-:.~reater than 100,000 BTU _______~24-00000-425604 20.00 _.9a~~ipin~_up_t.o~..ou~~_. __"'__' 224-00000-425604 .___ 14.00 _____ One ?r Tw~!amily E:"elling with,T.::v.o Ba!'...., 224-00000-425603 374.00 ~~~ng - M~~eview - City 100-00000-425002 211.00 ~flge hood/other 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 144.70 SDC: Administrative Fee - MWMC Regional Wastewater SDC 611-00000-426604 10.00 SDC: Compliance Cost - MWMC Regional Wastewater SDC 444-00000-426607 22.63 SDC: Imyrovement - Transportation SDC 447-00000-448027 1,862.23 _ __ ~DC~ECovement Cost - Local W,::,tewater 443-00000-448025 1,718.34 SDC: Improvement Cost - MWMC Re~ional Wastewater SDC 445-000_00-44~25 1,333.57 _ _ SD~.:.!."2provelT1ent Cos!.- Storm Drain~".__,_.. 440-00000-448028 571.46 SDC: MWMC Credit - Regional Wastewater SDC 445-00000-448025 -466.89 SDC: Reimbursement - Transportation SDC 446-00000-448026 510.94 SDC: Reimbursement Cost - Local Wastewater 442-00000-448024 3,520.66 SDC: Reimbursement Cost - MWMC .R."gional Wastewater SDC 444-00000-448024 101.97 SDC: Reimbursement Cost - Storm Drainage 441-00000-448029 392.83 SDC: Total Sewer Administration Fee 719-00000-426604 346.38 SDC: Total Transportation Administration Fee 719-00000-426604 132.51 Sanitary sewer 224-00000-425603 76.00 Single-duct exhaust (bathrooms, toilet compartments, utility roor 224-00000-425604 27.00 ___Stat,,- of Orego"-!?.':'!-"-I1a!g,eJ~~% of aPE'i"able fees) 821-00000-215004 259.58 ___2~ct'!':~~ Building..!ermit Fee ___, 224-00000-425602 1,254.13 ~c.t:'nology feeJ5% of permit total) 100-00000-425605 110.06 Temp services 200 amps or less 224-00000-42~102 63.00 Willamalane fees - Single family detached 821-00000-215023 3,409.00 TOTAL DUE: 16,406.57 ,COMMENTS' "" ",i<rd:.'..", ~ ,jAII'I(j~t--IJ:g~lDJ.+,jl;;e:",... , ,; , 16,406,57 TOTAL PAID: 16,406.57 .--:"" Structural Permit Application F~,;j":t~t."J~~~l!;~~~1'l ~-:i"OI'~ ~~1f1~:~j 2::!.5 Fillh Streel. Springfield, OR 97477. PI-I(541 )726-3753. FAX(541)726.36S9 ,"P;lINOJ'IItI.D'1:&12/{;:;!4."'. U" ,/.Jl 11.,'&,h'iZE!"'X.^""Y,,',:! ,"", ~'... ~"\!'Z "i'; . L;:Z;/",'-. ~ DE,PARTMENT USE ONLY 8 { (- 'P- 2# J.L Permit no,: J-7-5i Date:' ~ }5- 1-1 This permit is issued under OAn 9]8-460-0030. Permits expire ifwol'k is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL This project h~\s finalland-wiC approval. Signnhlrc: Dale: This project hns DEQ approvnl. Sigllafure: Dati:: Zoning approval verified: 0 Yes DNa pfi)pcrty is within nood plain: DYes 0 No CATEGORY OF CONSTRUCTION Residential o GOVClllment o Commercial E~m<lil: -- ( <."1"" This installation is being made on residential or farm property owned by me or a member of 1)' immediate t:1mily, and is exempt from licensing reqllirements \.Jnder RS 7 I 10. Sign It CO Business name: SUB-CONTRACTOR tNFORMA TION Name Electrical Plumbing Mechanical I'flouc Number ceo Licensc Numhcr I FEE SCHEDULE I. Valuation information (a) Job description: 5;- tr Occupancy R.:- Construction type: Square feel: I 2 Cost per square foot: Other in formation: .J~c.e; _ Type of IIcat: Energy Puth: I A new D alteration (I>) Foundation-only permit? Tollll valuation: ~ 2. Building fees (a) Permit Ice (use valtmllon table): (b) JnvestJgalivc fee (Cql!llJ 10 pul): (e) Rcinspcction ($ per hour): (number of hours x fee per hour) "-"N D nddition DYes DNo $ $ $ Cd) Entcr 12% surcharge (.12 x 12a+2b+2c]): (e) Suhtotal of fees above (211 fhrough 2d): 3. Plan review fees (a) Plan review (65% x permit fee [2a)): (b) Fire and life safety (40% x pemlil fce [2a]): (e) Subtotal uffccs above (3u and3h): 4. Miscellaneous fees (a) Seismic fee, 1% ~.Ol x permit fee [2aD: $ $ $ $ TUTAL fecs and surchargcli (2c+3c+4a): $ -....- .... 225 Fiftb Street+Springfield, OR 97477+PH(541)726-3753+ FAX(541)726-3689 '1O('><>';~,_mW'_"T:C"~_ ~>:".,_,:,~-<,,>,;~,,_.,) '., ' ,"':C'",' ,;p;!j\,~DEPARTMENTUSEiONLY ..,L ':",;:;i>"",:L--: :"" "/',""'''',""w~__,' ,-- ',Wii'J:"::"Y:, " ":'",,'-:-:;;,: pi},.<< ;:5PR- 28t---1- -$1 Date: 7- - j 5 -u Electrical Permit Application ;~!a:~~El!i:iy;NG~ij~lJ~~~:O~GOI~ ~# Tbis permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days. Address: City: Phone: E-mail: CCB license no.: ZIP: '<,<': ',:. ",;; ,,' .' ." sFEE'SCHEDUI..E . ;;i:,' z.,:""" 0 Nt.hbe,.~fil1s~e~tioniperite\rt()L.'" QfYtC!isp 'I;Toial:~ .,:.:'. " ",.\'_ ',_'". "'Y",:,:,-" ';"'--">:",- ' ' . :'",'~:~ ",/iCost""{ Residential, per unit, service included: ercial $( '37 N;'; 1,000 sq, ft, or less (4) ( $134.00 Each additional 500 sq, ft. or portion .t.(. , thereof $ 25.00 $!t:JD , 1<I1R- Limited energy (2) $ 32.00 $ .., Each manufactured home or modular $ $ ';- dwelling service or feeder (2) 63.00 "~;,::~1S'j-'J.; ~ Services or feeders: installation, alteration, relocation 200 amps or less (2) p "'l; .Jl1l00 ...!: 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ 17<17r- Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation operty 200 amps or less (2) J $ 63.00 $ &, ~ is 201 to 400 amps (2) $ 87.00 $ t.OAR 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above ,,,It',, Branch circuits: new, alteration, extension per panel a Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit I $ 6.00 I $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 55.00 $ Each additional branch circuit $ 6.00 $ Mjscellaneous fees: service or feeder not included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (1) $58.00 $ '~:'J. (NT 'C:. n+-i. (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $..29? I Q I$,)-'~nter 12% surcharge (.12 x [A])..". $ ~<;lj.j ~\ ~11 ~(SJ;1i,%n1v"&Y1IL"l'~5YO;~!iB\]] IF THE WORK $ ('\.{ Xj.. ?O' ~~IIT@'T~I!e~ ii~3iil~1>~>5lej;'[~fI1flullL (ij)3T $ ?'17'ri. 'h.'~ !' 'i~~ENCED OR IS ABANDONED FOR ~ 'y 180 DAY PERIOD. . jI1.OcAI...' GOVERNMENT APPROVAU Zoning approval verified? 0 Yes 0 N .iii/of- .::.... CATEGORY.OF CONSTRU.CTION:: i2f1{esidential 0 Government 0 Comm JOB-SITE'iNFORMATION'.AND..lOCATIO Job site address: 70 7~ c:L city:"~9 'Ltl ZIP' Reference: 7 - ~z.- 3"" - Taxlot.: "'1 :i:::,' :J"::;':::.;',JDESCRIPTION::.oF06WORK.~;l:;: ,J v' o...:J o Fax: E-mail: S-"l"tJ A- -r-r. N<.-r This installation is eing ma e on residential or fann pr owned by me or a member of my immediate family. Th property is not intended for sale, exchange, lease, or ren 479.540(1) and 4 9.56 (I). BCD license no.: Signing supervisor's license no.: Print name of signing supetvisor: Signature of signing supetvisor: ATTENTION' 0 , . follow rul . regon aw reqUires you to Notificatio~~:~ftrte1h boYsethrueloreg~on Utility . OAR . es ar set forth ~n090 )':952-001-001 0 throu!L~'~;' 952-001- '. ou may obtain cOPI~)llhe rules b calling the center (Note' the t I h Y b '. e ep one ~ num er for the. Oregon Utility Notification Center IS 1-800-332-2344). 440-2584.) (9/08/COM) R-~willamalane t-w Park and Recreation District ," Job. No. SIf - !,/~q PARK AND RECREATION SYSTEM DEVELOPMENT CHARGE WORKSHEET January i-December 31, 2011 NAME: W fL.-CD ~, 'AD~~RESS: '7cJj777.j-it~rtITY:C;?F,--f) P.HON E: STATE:d~ZIP:q?t..N 6" LOCATION OF PROPOSED BUILDING SiTE: Street Address: 769)" 771vt .4.STO.N /Lv Plat Name: , Tax Lot Number: ';bc:l 1. DEVELOPMENT TYPE (Refer to development type definitions on the reverse.) )6' City of Springfield 7 / / )/ II Date of building permit submittal ~ City of Springfield -<b' / 1,/" I Date of building permit issuance I - J' ". 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, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: ~ I own, reside in, or will reside in the completed structure and my general contractor is: 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 ~ I will be performing work on property lawn, 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 I 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. I 'l.(,.... 1": W \ LS".. ) Print Name of Permit Applicant -~~~ Signat of Pennit A pJieant ~ rc,115' /201( Date I I Permit #: $.11.,. g>L ~II- 11S1 Address: 1tTqs- THu /lS7D /J P-tJ-IrJ;> spaJJCi-jj::6CP.~ 'i71'1ll '''''';;;' Issued by: }/Q , Date: (f/"2-/ II " This Copy for Permit Offices