The URL can be used to link to this page

Home My WebLink AboutPermit Building 2006-9-29 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01027 ISSUED: 09/29/2006 APPLIED: 08/10/2006 EXPIRES: 03/29/2007 VALUE: $ 45,400.00 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 54] -726-3676 Fax 54]-726-3769 Inspection Line SITE ADDRESS: 55] W CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: ]703274305805 Springfield TYPE OF WORK: Tenant InfilI TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Tenant InfilI - Subway Owner: Address: CENTENNIAL SHOPPING CNTR LLC HIOR~ 783] SE STARK ST STE ]03 . \r I\-\E ~~ PORTLAND OR 972]5~01\CE. "t" (,'\-\I\\..\.. E'J,.P\RE ...oU\\ \S N01 - -O'~~\ I v -\\\" PrnWI 1\\\~ '~" ;i" I ~"f'.\~1) ~U" I\U1\-\ l~e 'f.~IWMRMAnON I COtJ\M ~ E\\\OO. Contractor t..\'l ~ &0 Ol\'i ? License RON BRONN~R 69855 EUGENE ELECTRIC SERVICE INC 90200 COMMERCIAL AIR INC ] ]0075 RA YMIE JASON HOYT ]57734 Expiration Date ] 0/16/2007 03/] 7/2007 ] 2/] 8/2007 ] 1/] 7/2007 Phone 54]-726-9992 54] -344-356] 54]-46] -482] 54] -689-4235 Contractor Type General Electrical Mechanical Plumbing BUILDING INFORMA nON. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: B Lot Size: Sq Ft ]st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/~~~ Sq Ft OQ~S ~ U'\.~'( r-.'f. n/a R~~n~l?9' se\ \0 \ :')0 ~t'e .. ..c'e . ~9:t\0\ I DEVELOPMENT INFORMATfU'~09\06V~~~~flI.~~ ,u\89~' ~\; ~~\(f; ;e~\e~.:~,,~i\O~~NG Overlay Dist: \O\\~ ~\\O~ ~\"OO p}{\cOIi1.tl(f\e~o\\\~ # Street ~rees Rq~o'\.\\\~Q. g'b~ ~'i O'O'tJ ~. ~(}i@.~~:. Paved Dnve Rqd: \~ 01" -~OU <<' c:;e~\e eO~~~ . % of Lot Coverage: 0090. ~\{\O \~ \'(\00' ..eoO" c'l1- toe~ \0'< ~e~ \S '\ ,_/'~ rp.'(Ii I PUBLIC ]MPROVEMENTS . # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: ],627 VB 49 Front yard Setback: Side] Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Yes Sidewalk Type: Downspouts/Drains: Curbside 5' To Storm Sewer Notes: Pa2e ] of 4 Status Issued 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 54]-726-3676 Fax 54] -726-3769 Inspection Line Description Estimate Tvpe of Construction Estimate Fee Description Plan Review Comm/lnd/Public -Mechanical Issuance Fee- + ]0% Administrative Fee + ] 0% Administrative Fee + 5% Technology Fee + 5% Technology Fee + 8% State Surcharge + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Backflow Device Building Permit Exhaust Hoods Fixtu re Miscellaneous Mechanical Plan Review Comm/lnd/Public Plan Review Fire & Life Safety Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Paid Fire Department Review 08/] 1/2006 Initial Review 08/] 1/2006 I Valuation Description I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 45,400.00 Total Value of Project ~ Amount Paid $221.9] $]0.00 $]6.60 $54.63 $8.30 $27,3] $13,28 $43,70 $43.00 $]23.00 $]4.00 $347,25 $9,00 $]40.00 $24.00 $3.80 $138,90 $257.27 $338.39 $]0,00 $],8]9.29 $]73.3] $]29.9] $]2,00 $3,978.85 Date Paid 8/] 0/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 9/29/06 I Plan Reviews I 09/] 5/2006 08/] 1/2006 OK APP SKG Pal!:e 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01027 ISSUED: 09/29/2006 APPLIED: 08/10/2006 EXPIRES: 03/29/2007 VALUE: $ 45,400.00 Value Date Calculated $45,400.00 $45,400.00 09/05/2006 Receipt Number ]20060000000000]239 ]20060000000000]47] ]20060000000000]470 ]20060000000000]47] ]20060000000000]470 ]20060000000000]47] ]20060000000000]470 ]20060000000000]47] 120060000000000]470 ]20060000000000]470 ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000147] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] ]20060000000000]47] GRG See attached Fire Department Comments, mf CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2006-01027 ISSUED: 09/29/2006 APPLIED: 08/10/2006 EXPIRES: 03/29/2007 VALUE: $ 45,400.00 Status Issued 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 54] -726-3676 Fax 54] - 726-3 769 I nspection Line Plan Review Comments 09/05/2006 10 JMP Plan Review Comments 09/21/2006 10 JMP PIannin2 Review Public Works Review 08/] 1/2006 08/] 1/2006 08/15/2006 08/21/2006 APP EMM APP CJS Structural Review 08/1 ] /2006 08/] 6/2006 WE JMP Structural Review SUB Review SUB Review 09/25/2006 09/25/2006 08/] 4/2006 09/25/2006 09/25/2006 08/21/2006 APP JMP APP JF WE JF WE. Received responses to structural comments. Faxed submitted energy code forms to Jach Foster. Ron Bronner will discuss tht ceiling grid issues with the owner and then fax the special inspection forms, WI. Received faxed special inspection forms from Ron Bronner, called SUBWAY corporate office, Wilsonville office, and contractor to get info on existing/new drainage fixtures; spoke to Ron Bronner, contractor, who provided info (see SDC worksheet) 08/2]/06 CJS. Added SDCs. Received 8/]4/2006. See attached documents for 13 structural comments emailed to Richard Proulx, Received final internal approval. See attached documents for JMP's structural comments item 7 for the request for all of the energy code forms. SUB will contact the electrical contractor to resolve the lighting issues, To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~eQlliredJnsnections I Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Fire Department, After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete, Rough Plumbing: Prior to cover and including required testing, Final Plumbing: When all plumbing work is complete, Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete, Rough Electric: Prior to Cover final Electric: When all electrical work is complete, Pa2e 3 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01027 ISSUED: 09/29/2006 APPLIED: 08/10/2006 EXPIRES: 03/29/2007 VALUE: $ 45,400.00 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 54]-726-3676 Fax 54] -726-3769 Inspection Line SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all ';mea::;;ooQ~ 'f ;;'1/07;3 v Owner or Contractors Signature Date Pa2e 4 of 4 C\! 0- CD I'-- (J) ~ CD ~ , ~ r-v City of Sprjn~rJeld C.OIulllUuiry SClVic\)s Diyision 225 FllIh Stn:l:I Sfuil\&field. OR 91477 TeleJlhon~; (541) 726.3759 VII": (541) 726.16R9 f ~fV.' t9t:'()~ ""/0;2-' ~ -7.. 5 - It!) ~ I ULlildillil "emlit N _ f)all: ~.zr I~i/.. S"~-buR~ Pn~~ct Tille ' 55} <!~ L ~. ~~~ (}.<. Project ^dd~5 Sl'e~iallulllcc.ion and Testill&: To npplicftnlS of prajr.(.ts 1'I!f\\lirinC ~reci:\1 ill.1tU1ian nr Itlllng U pel Seclion 17O>i \IL'lh~ OrCj:OIl Structural Spcc;i-'IIl)' Cl1dr, Ple"~e rc~i~w Il1e inlt-Jm;t1iQII br.IQw, Wht:n YOll 11i\\'( tinl~td. IJC.knmvledge an umlcm18J,dinr of lhe In(UlIIlMiun by Sigllill,C IJ.llo\\'. Bnd rcllllR tl1i~ fllfm (0 Ih~ Cil)'. R[PORF.'..\ PI7.RMIT C'....N BE ISSUED: n\l! owner or GWnI:l"S n:Iln:sllnl:mVC. lll1lhe ad~'ice ul tin: raponsiIJlc PrOFcI [lIl1iuccr "I A'chilcd. shnll ~(lnlplt.1e. ~ie-ll. :lnd ~llh1n;l.to the uty fnr lr'Jicw end epprov3l1lli:!l furm c.omptl:wu on bOlh the rron~l\Ild bDtk. The n"'fItr and General Cnnuaclor. where applh:abh:. ~hall also atknowL:dSl: the ro'lu\\'itl~ 'oodiriIlH$ olllllli,;ahl~ 1<.> S1,~ill!llISpl'cJjo'J ~J\d/or 'I'~~'int_ I. COnlrnCIl'lr i~ R5~onsjblt for proper nodlit;Jlit'll for .he lnsp::(liun or T.:.slinS of il~IIl$li1Icd. z. . Telllin~ laburatory slla/llake appr(ll'riilll! Namples and fr.1nsporll11em 10 1I1clrlaIK'/a1lJr, fllr Vlll~tr (:v~'uiltioll or resting. . Copies of nlllnt.nrl\1lNy rermll~ 311d in.'ipctllons arB It) bE Still 10 111c Cily by lite Testilli Alcne)'. J. Specinlln:tpcClion Agcnq is 10 submit II:ll1lB~ :md qvallfic.allons of OIHile Specilll InspeC:UmllO t~ I:' (:ill' rill' iIl'llru~l1l. 4. Sflecialln!l'cctDr shIll pra"itk inspcl:liol1 reports to tlle buildini: IImei:.1 a I' all inGIJIl"ioll atti\'ilies, S, C(1hrrat:rru l~ re.~rnn~illle in J't\-ie.y Ihe Ory apprO\'ed phlnS lor OOlJilionar DllpectitPI m lulilll ICllllircllIlI:lIls ,I'Alllla)' he ""I~d_ B~~IlORE ^ CERTifiCATE OJ" Q(;CUI'ANC\' WiLl. RF. 1!;~lW.D: The Sptd~1 JnSflClClion ;\~l!Il\;Y shllll submiHo lht: Building Ollici."ll ~ ~t31tmm1lhilll1l1 iltlr:'~ h:'1l1irillg inspectiOn have brell fillfillrd ~lId n:polll!11 nnd wtre(4\!he be.~1 ofll1t illSpc:clllr's k'luwlcdJ:,\:. in ,onfonU3I1tC: wilh o-.c UJlIIIl)'-l:d plans. spt<:illcilliol\s and i1ppli~&bk Wl'rklMI\llhip provisions. .1110SC itC:IRJ nol tC!llcd Dlld'ne i~cpt~l~d Ahall he JlOled 11'1 m.e Slalem~n\. The rcporl is 10 b~ ~Uh\1lLllfd lu the Cily prior tn a rCllllclll til, I\n:ll inspectiolls. . {1t.-t ~ ~ :f,&"''''d~- <l.~J AJ.. Owner Signature Gell. Conlrae/or flirtn NlUnc (Prillt!:d) (j\;HCIlIl C~ign..t'lrc FU1:'~~ ~_ .~~_ ._~"c~ial'n.cPCdlCm~enC)I~(Pr~ .~. _ \..... ~_\..~.& V.... ,,\ \' A RuildingOfliciOlI Naltle (Print.-:d)' BL1~1 slgfla(u~ ..... '- lD r;:: r;:: E co r;:: o 0::: A.Q<NOWI.F.DGP.MENTS _ KreJ.".RJ/ R~tX O-wnc:1' NaJ\1C: (I'rintl:d) EflU;l1ur or Archilect Firl1l{l'rinkd) 11l ('f) N Ci ..- Fff. Ten N6.. 4JJe.sP. Tl"-Sling tllburlltOI)' Name ("rinted) CD o ..- N 0- lD (f) Engi"eer or Archilt'ct Sigllol11re ~t!::;;:Rep- Sign~l"ul (. ~i ( ~ ~ - S '"' :8 m IC i ~ ~ o -<D ... ~~ ~~ ~t -<D < .. en ... , f ~ f\) N a. <0 r- 0> q> <0 N r- I ~ ... m c c e al c o 0::: co C') C') o ..- <0 o ..- N a. m (/) Reinfurced Concrete, (;unite. Groul Imu Mortnr: Concrete Gunitc Grout Mortar .1 I'rcci:lsVf're-stressed COllcretll: I Piles Post-Tens Pre-Tens I I Cladding SMOKE CONTROL: Leakage testing Control Verilication ROOFING: Insulation installation/It-Vulue' Test strips/seams I , Aggrcf~atc Test orMix Design Reilltoreing Test Mix Design-Weighmaster Cert.... Rcinforcin~ Phll.:elllcllt Continuous Hutch Plant Inspect. InSIJeet Placing Cast SnlUllles Samples (Pickup/ncliven:u) Compression Test'" <:!.o 1'7"\ ;;1 ()O (9 - olO;? 7 S- til3t.-V 111..( " 5'""5 _; e..cl:~IVJY't L GRAOING, EXCAVATION, AND FILL Acceptnnce tests ... F.stahlish tinal grade Pill placcment inspection/continuous Soil Dcnsil)' SPECIAL INSPECTION AND TESTING St.:ill;DULE I'SF 1 STRUCT1JRAL STEEUWELDlNG: Sample and test (list spcdfic memhers belo\Vj Shop matcrial identilicutioll(lIli1l cert) WclcJ inspectiun SIlOI) . Jield . 1 Jltra.<;onic inspection. __Shop field High Strength Bulting Shup Field A325 _N_X At\90 . .N _X Mellll deck welcJing inspectiun ReinfOldng Steel welding inspedillll Reinforcing steel mill certilic<lte Metal stud wdding in~pection Concrete insert wdding inspe\:tion MOlnenl resisting steelli'urnes F F I AJ.:gl'e,eatc Tests Reinforcirlg Tests Tendon Test Mix Designs. Reinforcing Placement Insert PI,lcctnent Concrete Batching Concn:tc Plucement Installation Inspection Cust Samples Pick-up ~al11ples Compression Tests STRUCTURAL WOOD: Shear wallnuiling inspection Shear wall anchors . Inspection orGill-lam fah. · Inspection of truss joist fuh, Sample and test components Fahrication welding or steel accessories T/C psi FIREPROOFING: l'lul.:ement inspection Density tesLs Thickness tests Inspect batching MASONRY Snecial inspection stresses used. I'm fg Preliminary ,\cceptance tests (masonl)' units, wall prisms) Subsequent (eslS (mortar, grout, tield \\'all prisms) . Placement inspection of units, ,uul reintorccment Masonry, mortar, grout, and reintorcing steel ccrtiticates Form Cumpleted by: ~,..:} \3~ ,vi'd~.. Date -e'J - .;;J../-tJ b A nDlTIONAL INSTU1CTIONS, OTHER TP.:ST, & INSPECTIONS: , ee /L.,,^-,,, ... (~!~: J' "'PROVIDE STRENGTH HEQUIREIl BY ARCHITECT OR ENGINEER OR CONTRACT DOCUMENT LOCATION m'VALUES ATTACHMENT A CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET JOURNAL OR JOB NUMBER C0M2006-01027 NAME OR COMPANY: SUBWAY #7 (Store #40092) LOCATION: 551 W. Centennial Blvd MAP & TAX LOT NUMBER: 17 03 27 43 05805 DEVELOPMENT TYPE: Fast food restaurant with minimal food prep, in shopping center NEW DEVELOPED AREA (S.F.): 1,657.00 Shop, Ctrt lTE: NEW DEVELOPED AREA (S.F,): 1,657.00 Rest EXISTING DEVELOPED AREA (S,F.): 1,657,00 Shop Ctr TOTAL IMPERVIOUS SURFACE (S.F.): J. STORM DRAINAGE lTE: LOT SIZE (S.F.): 822 937 822 IMPERVIOUS SQ, FT. $ 0.336 PER SF x TOTAL STORM DRAINAGE SDC:l 2. SANITARY SEWER-CITY: A. REIMBURSEMENT COST: NUMBER OF DFU's B. IMPROVEMENT COST: NUMBER OF DFU's (SEE REVERSE SIDE) 13 x $ 26.03 PER DFU 13 x $ 19.79 PERDFU $ 45.82 TOTAL LOCAL W ASTEW A TER SDC:' $595.66 I 3. TRANSPORTATION BLDG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR NEW A. REIMBURSEMENT COST: 1.66 x 67,91 B. IMPROVEMENT COST: 1.66 x 67.91 EXISTING A. REIMBURSEMENT COST: -1.66 x 67.91 B. IMPROVEMENT COST: -1.66 x 67.91 0.45 NTF $1,003,121 0.45 NTF $4,425.18 1 0.45 NTF ($1,003.12)1 0,45 NTF ($4,425.18)1 x $ 19.81 PER TRIP x x $ 87.39 PER TRIP x x $ 19.81 PER TRIP x x $ 87.39 PER TRIP $ 107.20 x TOTAL TRANSPORTATION REIMBURSEMENT SDe: TOTAL TRANSPORTATION IMPROVEMENT SDC: TOTAL TRANSPORTATION SDC:I $ :4. SANITARY SEWER - MWMC NEW: A. REIMBURSEMENT COST: NUMBER OF FEU's 1.66 x $157,05 PER FEU $260.23 I B, IMPROVEMENT COST: NUMBER OF FEU's 1.66 x $1,648.32 PER FEU $2,731.27 I EXISTING: A. REIMBURSEMENT COST: NUMBER OF FEU's -1.66 x $52.46 PER FEU ($86,93)1 B. IMPROVEMENT COST: NUMBER OF FEU's -1.66 x $550.38 PER FEU ($911.98)1 MWMC CREDIT IF APPLICABLE (SEE REVERSE) ~. ADMINISTRATIVE FEES: BASE CHARGE (SUBTOTAL ABOVE) TOTAL MWMC REIMBURSEMENT FEE: TOTAL MWMC IMPROVEMENT FEE: MWMC ADMINISTRATIVE FEE: TOTAL MWMC SDC:' $ 2,002.59 _ SUBTOTAL ~~.!"~~S 1,2,3, & 4) , $2,598.25 I $ 2,598.25 x 5% I $129.91 TOTAL TRANSPORTATION ADMINISTRATION FEE: $ TOTAL SEWER ADMINISTRATION FEE: $ c?..ud ~:.~."" Eng, Tech. III 8/21/2006 DATE TOTAL SDC CHARGES COM2006-01027, SUBWAY#7, 551 W. Centennial ~.'-".'A';"'-"; \~~I-,~~~,';,_~~~A ,_3~!_~_k"._",')_,!<<_. 129.91 1 JULY 2004 DRAINAGE FIXTURE UNIT (DFU) CALCULAT]ON TABLE NUMBER OF NEW FIXTURES x UNIT EQUlV ALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) Fast food restaurant with minimaI food prep, in shopping center FIXTURE TYPE BA TH11JB DRINKING FOUNTAIN FLOOR DRAIN, FLOOR SINK INTERChY I ORS FOR GREASE/OIUSOLIDS/ETC. INTERCEPTORS FOR SAND/AUTO WASHlETC. LAUNDRY TUB CWTHES W ASHER/MOP SINK CWTHES WASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (1 PER TRAILER) RECEPTOR FOR REFR1GERA TOR/W A TER ST A TION/ETC, RECEPTOR FOR COMMERCIAL SINKI DISHW ASHER/ETC. SHOWER, SINGLE STALL SHOWER, GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTIAL KITCHEN SINK: COMMERCIAL BAR SINK: WASH BASINIDOUBLE LAVATORY SINK: SINGLE LA V A TORY /RESIDENTIAL BAR URINAL, STALUWALL TOILET, PUBLIC INSTALLAT]ON TOILET, PRIVATE INSTALLATION MISCELLANEOUS: NUMBER OF EDD'S* FIXTURES NEW OLD 2 0 2 0 2 ] 2 2 2 2 o UNIT EQUlV ALENT 3 ] 3 3 6 2 3 6 12 1 3 2 2 3 2 2 1 5 6 3 TOTAL DRAINAGE FIXTURE UNlTS= *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling (20 DFU) set at 167 gallons per day CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED N- I hK. ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY YEAR ANNEXED 1979 or before' 1980 1981 1982 1983 1984 ]985 1986 1987 1988 1989 1990 1991 RATE PER $1,000 ASSESSED VALUE $5.29 $5.19 $5,12 $4.,98 $4.80 $4.63 $4 .40 $4.07 $3,67 $3.22 $2,73 $2,25 $1.80 CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE IMPROVEMENT (IF N-IhK.ANNEXATION DATE) COM2006-o1 027 , SUBWAY#7. 551 W. Centennial YEAR ANNEXED 1992 1993 1994 1995 1996 1997 1998 1999 2000 200] 2002 2003 2004 x x RATE PER $1,000 ASSESSED VALUE $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0,09 $0.05 $0,00 $0,00 $0.00 CREDIT TOTAL DRAINAGE FIXTURE UNITS o o o 3 o o o o o 2 o o o 6 o 2 o o o o o o o 13 $0.00 $0,00 $0.00 1 JULY 2004 225 fifth. S.treet Springfield, Oregon 97477 541-726-3759 Phone C;~' of Springfield Official Receipt L Jopment Services Department Public Works Department Job/Journal Number COM2006-0 I 027 COM2006-0 I 027 COM2006-0 1 027 COM2006-0 I 027 COM2006-0 1027 COM2006-0 I 027 COM2006-0 I 027 COM2006-0 I 027 COM2006-0 I 027 COM2006-0 I 027 COM2006-0 1 027 COM2006-0 I 027 COM2006-0 I 027 COM2006-0 1027 CO M2006-0 I 027 CO M2006-0 1027 COM2006-0 I 027 COM2006-0 I 027 Payments: Type of Payment Check cReceinll RECEIPT #: Date: 09/29/2006 1200600000000001471 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin Plan Review Comm/lnd/Public Plan Review Fire & Life Safety Building Permit Fixture Backflow Device Vent Fan Exhaust Hoods Miscellaneous Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By RICHARD PROULX DBA SUBWAY Item Total: Check Number Authorization Received By Batch Number Number How Received djb 511 In Person Payment Total: Page I of I 2:57:43PM Amount Due 338.39 257,27 173.31 1,819,29 10,00 129,91 3,80 138,90 347,25 140,00 14.00 12,00 9,00 24,00 10,00 27,31 43,70 54.63 $3,552.76 Amount Paid $3,552,76 $3,552,76 9/29/2006