HomeMy WebLinkAboutPermit Building 2008-12-17
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Status
Iss u ed
225 FIfth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lllle
SITE ADDRESS 1646 H St
ASSESSOR'S PARCEL NO 1703362106000
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO. COM2007-01049
ISSUED. 09/1212007
APPLIED 07/16/2007
EXPIRES 06/17/2008
VALUE: $ 7,000.00
Sprlllgfield TYPE OF WORK FoundatIOn
TYPE OF USE AdditIOn ReSIdentIal
PROJECT DESCRIPTION FoundatIOn for moved house - House moved 'rom 3349 Baldy VIew to thIs 10cdtlOn
Owner NEDCO
Address 783 GRANT STREET
EUGENE OR 97402
Phone Number 541-345-0446
I CONTRACTOR INFORMA nON I
Contractor Type
Gener dl
Electncdl
Contractor
RAINBOW VALLEY DESIGN & CONSTR
BUILDERS ELECTRIC INC
License
56107
4296
ExpIratIon Date
04/04/2008
12/10/20 II
Phone
541-342-4871
541-485-0922
BUILDING INFORMATION'
# of UllltS
Pnmary Occupancy Group
Secondary Occupancy Group
Pnmary ConstructIOn Type
Secondary ConstructIOn Type
# of Bedrooms
I
R-3
# of Stones
HeIght of Structure
Type of Heat
Water Type
Range Type
Energy Path
Spnnkled BUlldlllg
VB
4
2 Lot SIZe
Sq Ft 1st Floor
Sq Ft 2nd Floor.
Sq Ft Basement
Sq Ft GaragelCarport
Sq Ft Other
nla Occupant Load
1,258
683
I DEVELOPMENT INFORMATION I
Frontyard Setback
Side I Setback
Side 2 Setback
Rearyard Setback
Solar Setbacks.
2260
840
2480
4600
Overlay D.st
# Street Tree. Rqd
Paved Drive Rqd
% of Lot Coverage
I PUBLIC IMPROVEMENTS'
Street Improvements
Storm Sewer AvaIlable
Special InstructIOn
Notes N[,l't~C~lssues at thiS lime The permIt IS lor foundallon only
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTI-!ORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD
Page I of 4
Hospital Support
2
Yes
1700
REQUIRED PARKING
Total 2
Hdndlcapped
Compact
Sidewalk Type
Downspouts/Drams
ATTENTION Oregon law requires you to
follow rules adopted by tr,e Oregon Utility
Notification Center Those rules are set forth
In OAR 95,'-001-0010 through OAR 952-001-
0090 You may obtain caples of the rules by
calling the center (Note the telephone
number for the Oregon Utility NotifIcation
Center IS 1-800-332-2344).
-iii:itJ
Status
Iss u ed
225 FIfth Street, Sprmgfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
DescrIPtIOn
TYDe of ConstructIOn
FoundatIOn Only Use BId Amount
Fee DescnDtlOn
Plan Review ReSIdentIal
+ 10% Admmlstratlve Fee
+ 5% Technology Fee
+ 8% Stdte Surcharge
Addressmg AssIgnment
FIre SF Fee - ReSIdentIal
FoundatIOn Permit
Moved Structure Plumbmg Conn
Plan Review Mmor - Pldnmng
Samtary Sewer - 1st 50 Feet
Storm Sewer - 1st 50 Feet
Water Lme - 1st 50 Feet
+ 10% Admlmstrahve Fee
+ 5% Technology Fee
+ 8% State Surcharge
Temp Power 200 amps or less
+ 10% AdmmlstratIve Fee
+ 5% Technology Fee
+ 8% State Surcharge
Add, Alter, Extend Clrc Ea Add
Perm ServIFdr 200 amps or less
TOtdl Amount PaId
Imhal RevIew
07/17/2007
Imhal RevIew
07/18/2007
Public Works RevIew
07/18/2007
CITY OF SPRINGl<JJ<.,Lu.
Building/Combination Permit
PERMIT NO
ISSUED.
APPLIED:
EXPIRES:
VALUE
COM2007-01049
09/12/2007
07/16/2007
06/17/2008
$ 7,00000
I Valuahon OescrmtlOn I
$ Per Sq Ft
or mulhp"er
$100
Square Footage
or B,d Amount
7,00000
Value
Date Calculated
Total Value of ProJect
$7,00000
$7,00000
07/1612007
Fpp<, PlWIJ
Amonnt PaId
Date PaId
ReceIpt Number
2200700000000001138
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001438
2200700000000001519
2200700000000001519
2200700000000001519
2200700000000001519
2200700000000001853
2200700000000001853
2200700000000001853
2200700000000001853
2200700000000001853
$60 39
$38 99
$20 45
$23 43
$35 00
$97 05
$92 90
$50 00
$11600
$50 00
$50 00
$50 00
$550
$275
$440
$55 00
$940
$470
$752
$24 00
$70 00
7/16/07
9/12/07
9/12/07
9/12/07
9/12/07
9112/07
9/12/07
9/12/07
9/12107
9/12/07
9/12/07
9/12/07
9/27/07
9/27/07
9/27/07
9/27/07
12/17/07
12/17/07
12/17/07
12/17107
12/17/07
$867 48
I Plan ReYlews I
07/1712007
WE LLH
Floor plan not mcluded m submIttal
Left messdge tor Sandy at Nedco to
fax floor plan
07/18/2007
APP LLH
Received floor pldn Okay to
proceed with revIew
07/27/2007
APP TSS
No PW Issues at thiS time The
permIt IS for foundatIOn only
Paee 2 of 4
_...~..~
IM=
CITY OF SPRINGFIELD.
Building/Combination Permit
Status
Issued
PERMIT NO
ISSUED.
APPLIED.
EXPIRES:
VALUE
COM2007-01049
09/12/2007
07/16/2007
06/17/2008
$ 7,00000
225 FIfth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lllle
Structural Review
07/18/2007
08/01/2007
10 LLH
Forwarded to the Buddlllg
Department for revIew
Plannlll2 RevIew
07/18/2007
08103/2007
APP T AJ
ProvIde 2 off street pdrklllg spaces
2 street trees .Ire required unless
they are already III
Structural ReVIew
08/01/2007
08/06/2007
WE LLH
InformatIOn requested from
NEDCO to complete plan review
Plans are wIth Shdwn Eaton with
the BUlldlllg Department under
contract wIth the CIty 01 Sprlllgfield
Structural ReVIew
08/08/2007
09/04/2007
APP LLH
Pldns revIewed by Shawn Eaton
wIth the buddlllg department under
contract with the CIty of Spnngfield
To Request an mspectlOn call the 24 hour recording at 726-3769. AlllOspectlOns requested before 7:00
a.m. WIll be made the same workmg day, IOspectlOns requested after 7:00 a.m. wIll be made the followlOg
work day.
I ~rnI~<r1~r/I"~
Ufer Electncal Ground Install ground rod at footmg and call fOl IIIspectlOn III conjunctIOn wIth footlllg andlor
foundation mspectlOn
Footlllg After trenches are excavated
FoundatIOn After forms are erected but pnor to concrete placement
Post and Beam Pnor to floor lIIsulatlOn or decklllg
Filial Buddlllg After all reqUIred IIIspectlOns have been requested and approved and the bUlldlllg IS complete
Water Lllle PrIor to filhng trench and mcIudmg requll ed testlllg
Sallltary Sewer Lme Pnor to fillIng trench dnd mcIudmg required testlllg
Storm Sewer Lme Pnor to filling trench
Temporary Electnc Approval reqUIred pnor to Ullllty Company energlzlllg pole
Rough Eleclllc Pnor to Cover
Electnc ServIce Approval requIred pnor to utIlity company energIZIng servIce
Filial Electnc When all electncal work IS complete
Page 3 of 4
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO. COM2007-01049
ISSUED' 09/12/2007
APPLIED 07/16/2007
EXPIRES 06/1712008
VALUE $ 7,000.00
225 Fifth Street, Sprmgfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lllle
By sIgnature, I state and agree, that I have carefully exammed the completed applicatIOn and do hereby cerlIfy that all
mformatlOn hereon IS true and correct, and I further certIty that any and all work performed shall be done III dccordance WIth
the Ordmances of the CIty of Spnngfield and the Laws of the State of Oregon pertalllmg to the WOI k descrIbed herem, and
that NO OCCUPANCY wIll be made of dny structure WIthout permissIOn of the Commulllty ServIces DIvIsIOn, Buddmg Safety
I further cerllfy that only contractors and employees who are m compliance WIth ORS 701 005 WIll be used on thIs proJect
I further agree to ensure thdt all reqUIred IIIspectlOns are requested at the proper lIme, 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 pldns Will remalll on the sIte at all
tImes dUflOg constructIOn
Owner or Contractors SIgnature
Date
Page 4 of 4
. CIty of Sprmgfield
ElectrIcal AuthorIzatIon To Begm Work
E-maded To kelly@bUlJderseJectrK com
ReceIpt # .EC52266~
12/17/2007 J 53 17 PM
7~
W;:
By Phone
Check on status of permit
(541)726-3753 or Em',1 permltcenter@cl spnngfield or us
TYPE OF WORK
10 New construction
o Addition/alteration/replacement
CATEGORX OF CONSTRUCTION
I 0 1 or 2 family dwellmg [XJ Multl family D Commercial/Industrial
1 ~ JOB SITE INFORMATION AND LOCATION
IJobno 07.95% s IJQbaddres~ 1646 11 ST
I City/State/ZIP SPRINGfiELD OR 97477
I SUltc/bldg lapt no
I Project name Rambow Valley
Cross strect/dlreltlons to Job slle
I SubdiVIsIOn I Lot no
Ilax map/pdreel no 1703362106000
DESCRIPTION OF WORK--
Service and 6 ClrcUlts for IIghtmg
- SITE CONTACT
I Ndme mel mannmg
] Phone
I Emall
I",
CONTRACTOR-10 _
ICCBhc no
jUhcno 2012C
I Busmess I\ame BUILDERS ELfc,CTRIC INC
I Contact K.elly Q'SneD
IAddre!>s ] 95 MADISON ST
I City/State/ZIP EUGI::NE OR 97402
I Phone (54/ )4850922
I Ern'lll kelly@bUllderselettnc"om
I Metro hc no
ISupcnlsmg electrician's hc 110 5275S
I Supervlsmg elletncldn'!> name RUS~ELL R ROBBINS
4296
".. (541 )4854055
I City hc no
Upon review and approval by your local JUrisdiction, your
permIt wJJI be e mailed or faxed wlthm one bus mess day,
With mstructlons on how to schedule your mspectlon
NOTE This AuthOrization To Begm Work expires wlthm 180
days If a permit IS not obtamed
The local bUlldmg department may determme that an
AuthOrization To Begin Work IS null and VOid If It does not
meet applicable land use laws and local ordmances
II
II Dt.!>cnptlOn Qt} la Total
I ReSident!!,' S~NGLE. OR multi-fauul} d\\elhng UllIt includes
dttalhcd gdr.tge
11,000 sq ft or le~s
I [a addl 500 sq ft or portIon
I Lumted energy reSIdential
(\\llh above so ft)
I LllTIlted wergy multltamdy
resldwtml (wlth above Sq fl)
I Se~IS~s~ OR feeders IIIstallatlon, alteration, AND/OR r~locahon
1200 amps or less II $7000 $7000 I
1201 amps to 400 amps I I
401 amps to 599 amps 1
TEMPORARYscrvlcc!> OR reedlt'!l mstaJJ!ll!on,~alt~ratlon, I
AND/OR relocatlOu '%
1 200 amps or less 1
1201 amps to 400 amps 1
1401 amps to 599 amps I
1 Branch CirCUit.. - Nl W, alteration, OR o..tenslOlI, per punel I
I A Fee for branch melllts With 6 $400 $2400 I
above servIce or feeder fee
each branch CIrCUlI
I B fee for branch ClfCUltS I
\'dthout servIce or feeder fee
first branch CirCUlI.
I edch addl branch CirCUit I
I Mlscelldncous~- - 1
I ServIce reconnect only 1
leach mdllufactured or modular I
dwellrng servIce and/or feeder
I Pump or IrrigatIOn Circle 1
I
I
I
FEE SCHEDULE
I
I
I
I
I
I
I
I
I
II
II
I:
I'
I * CIty Of Sprmglleld
I
Sign or outlme Ilghtmg
~Igna] clrcull(s) or I united
energv pdnel alLerdllon or
extlnslon
not offued onlme at thiS JUTlSdlcllon
ELECTRICAL PERMIT FEES
SubtoWl I $9400 I
State Surcharge (8% ofpenmt fee) $752 I
City OfSpnngfield fees *1 $1410 I
IOl<'\LPFRMlTrFF $11562 I
10% Local AdmIn Fee 5% Local1edmology fee
1
PROC
/\
I )
U
-
ThiS Authorlzallon To Begin Work must be posted at the Job site until replaced by a Permit
225 FIfth Street
Sprfngfield, Oregon 97477
541-726-3759 Phone
rA'NQFlEU> 4ij
~J.'" -
IIii:
CIty of Sprmgfield OffiCIal ReceIpt
Deyelopment ServIces Department
Public Works Department
Job/Journal Number
COM2007-01049
COM2007-01049
COM2007-0 I 049
COM2007-01049
COM2007-0 I 049
Payments
Type of Payment
ONLINE CHGS
cRecelOtl
RECEIPT #.
2200700000000001853
Date. 12/17/2007
DeSCriptIOn
Perm ServlFdr 200 amps or less
Add, Alter, Extend CIrC Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Admmlstratlve Fee
PaId By
ONLINE PERMIT CHGS
Item Total
Check Number AuthorizatIOn
Received By Batch Number Number How Received
NJM
ONLINE BUILDERS Onlme
Payment Total
Page 1 of 1
221 29PM
Amount Due
7000
2400
470
752
940
$11562
Amount PaId
$11562
$115 62
12/17/2007
Status
Issued
225 FIfth Street, Sprmglield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIon Lme
SITE ADDRESS 1646 H St
ASSESSOR'S PARCEL NO 1703362106000
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO' COM2007-01049
ISSUED' 09/12/2007
APPLIED: 07/16/2007
EXPIRES: 06/1712008
VALUE: $ 7,00000
Sprmglield TYPE OF WORK FoundatIon
TYPE OF USE AddItIon ResldentIdl
PROJECT DESCRIPTION FoundatIOn for moved house - House moved flom 3349 Baldy V,ew to thIs locatIOn
Owner NEDCO
Address 783 GRANT STREET
EUGENE OR 97402
Phone Number 541-345-0446
I CONTRACTOR INFORMATION I
Contractol Type
General
Electncal
Contractor
RAINBOW V ALLEY DESIGN & CONSTR
BUILDERS ELECTRIC INC
LIcense
56107
4296
EXpiratIOn Date
04/04/2008
12110/2011
Phone
541-342-4871
541-485-0922
BUILDING INFORMATION'
# of UlIlts
Pnmary Occupancy Group
Secondary Occupancy Group
Pnmary ConstructIOn Type
Secondary ConstructIOn Type
# of Bedrooms
I
R-3
# of Stones
Height of Structure
Type of Heat
Water Type
Range Type
Energy Path
Sprmkled BUlldmg
VB
4
2 Lot SIze
Sq Ft I st Floor
Sq Ft 2nd FloOl
Sq Ft Basement
Sq Ft Garage/Car port
Sq Ft Other
nla Occupant Load
1,258
683
., _ _, ."~'r.\.requllt:::i yvu \....
I DEVELOPMEJN:fiIlIIF0RM\<\.'oT-rON "e Oregon Utility
101I()" IL."" J,J~~ .-r- h 'se ~ules are set forfl:i:QUIRED PARKING
NoliflC'atlon Center 0 52 001.
Ove~lut9!'!$:'2-001-0P\ilPItiOISiI'P{)lft~ 9 - ;f.9tal 2
# s~r,'!1oTryMJIM~ obtain copies of ~e rules 'i'fandlcapped
PaveJdarnml~9.center. (Note thiV11~hhO~~ffompact
% of MMb~Y<foo$he Oregon UtI1\W 0 I ca
Center IS 1-600-332:2: ).
Frontyard Setback
Side I Setback
S,de 2 Setoack
Rearyard Setback
Solar Setbacks
2260
840
2480
4600
I PUBLIC IMPROVEMENTS I
Street Improvements
Storm Sewer AvaIlable
Specllll InstructIOn
S,dewalk Type
Downspouts/Drams
The pel mIl IS for founddtIon only NOTICE: E WORK
THIS PERMIT SHAll EXPIRE If TH NOT
AUTHORIZED UNDER THIS PERMIT IS
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Notes
No PW Issues at thiS tIme
Page I of 4
-Wlc~";D ~
,~_ I
Ii'
_ """ i
Status
Issued
CITY OF SPRINt.1<I~LD
Building/Combination Permit
PERMIT NO: COM2007-01049
ISSUED 09/12/2007
APPLIED 07/16/2007
EXPIRES' 06/17/2008
VALUE $ 7,00000
225 Fifth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lllle
I ValuatIOn DescrmtlOn I
DescrlotlOn
Type of ConstructIOn
$ Pel Sq Ft
or multIplier
$100
Square Footage
or BId Amount
7,00000
Value
Date Cdlculated
FoundatlOlI Onlv Use BId Amount
Total Value ot Project
$7,00000
$7,00000
07/16/2007
L-F"'" PiW,J
Fee DescrIPtIOn Amount PaId Date Paid ReceIpt Number
Plan RevIew Resldenhal $6039 7/16/07 2200700000000001138
+ 10% Admllllstrahve Fee $38 99 9/12/07 2200700000000001438
+ 5% Technology Fee $20 45 9/12/07 2200700000000001438
+ 8% State Surcharge $23 43 9/12/07 2200700000000001438
Addresslllg AssIgnment $3500 9/12/07 2200700000000001438
FIre SF Fee - ReSIdential $97 05 9/12/07 2200700000000001438
FoundatIOn PermIt $92 90 9/12/07 2200700000000001438
Moved Structnre Plumblllg Conn $50 00 9/12/07 2200700000000001438
Plan RevIew Mlllor - Plannlllg $11600 9/12/07 2200700000000001438
Sallltal y Sewer - 1st 50 Feet $50 00 9/12/07 2200700000000001438
Storm Sewer - 1st 50 Feet $50 00 9/12/07 2200700000000001438
Water Lllle - 1st 50 Feet $50 00 9/12/07 2200700000000001438
+ 10% Admllllstrahve Fee $550 9/27/07 2200700000000001519
+ 5% Techuology Fee $275 9/27/07 2200700000000001519
+ 8% State Surcharge $440 9/27/07 2200700000000001519
Temp Power 200 amps 01 less $55 00 9/27/07 2200700000000001519
+ 10% Admllllstratlve Fee $800 12/17/07 2200700000000001855
+ ]00/0 AdmmlstrdtlVe Fee $940 J2/J7/07 2200700000000001853
+ 5% Technology Fee $400 12/17/07 2200700000000001855
+ 5% Technology Fee $470 12/17/07 2200700000000001853
+ 8% Stdte Surcharge $640 12/17/07 2200700000000001855
+ 8% State Surcharge $752 12/17/07 2200700000000001853
Add, Alter, Extend Clrc Ea Add $24 00 12/17/07 2200700000000001853
Fixture $80 00 12/17/07 2200700000000001855
Perm Serv/Fd. 200 amps or less $70 00 12/17/07 2200700000000001853
Total Amount PaId $965 88
I Plan Reviews I
IlIIhal ReView
07/17/2007
07/17/2007
WE LLH
Floor plan not lIIe1uded III submIttal
Left message fOI Sandy at Nedco to
fax 11001 plan
IlIItllll ReView
07/18/2007
07/18/2007
APP LLH
Received lloor plan OkdY to
proceed With review
Page 2 01 4
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01049
ISSUED: 09/12/2007
APPLIED. 07/16/2007
EXPIRES: 06/17/2008
VALUE $ 7,00000
_~~.,u"'"''
Status
Issued
225 Fifth Stl eet, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
Public Works Review
07/27/2007
APP TSS
07/18/2007
Structnral RevIew
08/01/2007
10 LLH
07/1812007
Planum!!: Review
08/03/2007
APP TAJ
07/1812007
Structural RevIew
08/0612007
WE LLH
08/01/2007
Structural RevIew
09/04/2007
APP LLH
08/08/2007
No PW Issues at thiS tIme The
permit IS for foundatIOn only
Forwarded to the BUlldmg
Department 101 reVIeW
PrOVIde 2 011 Stl eet parkmg spaces
2 street trees are reqUIred unless
they are already m
InformatIOn I equested f, om
NEDCO to complete pldn revIew
Plans al e With Shdwn Edton WIth
the BUlldmg Department under
contract With the CIty of Spnngfield
Plans revIewed by Shawn Eaton
WIth the bUlldmg department under
contract With the City 01 Spnngfield
To Request an mspectlOn call the 24 hour recordmg at 726-3769 All mspectlOns requested before 7'00
a m. wIll be made the same working day, IOspectlOns requested after 7.00 a.m. WIll be made the followmg
work day
~eolflred.Jn~nectionft I
Ufer Electncal Ground Install ground rod at footmg and call for mspectlOn m conJunctIOn WIth footmg andlor
foundatIOn mspectlOn
Footmg After trenches are excavated
FoundatIOn After forms are erected but pnor to concrete placement
Post and Beam Pnor to floor lDsulatlOn or deckmg
Fmal BUlldmg After dn reqUIred mspectlOns have been requested and approved and the buIldmg IS complete
Water Lme PnOl to filling trench and mcludmg reqUIred testmg
Samtary Sewer Lme Pnor to filling trench and mcludmg reqUIred testmg
Storm Sewer Lme Pnor to filhng trench
Tempo. dry Electnc Approval requIred prIOr to UtIlity Company energlzmg pole
Rough Electnc PI \Or to Cover
Electnc ServIce Approval required pnor to utIlity company enel glZlng servIce
Fmal Electnc When dn electncal work IS complete
Paee 3 of 4
CITY OF SPRINGFIELD.
Building/Combination Permit
Status
Issued
PERMIT NO' COM2007-01049
ISSUED 09/12/2007
APPLIED 07/16/2007
EXPIRES 06/17/2008
VALUE: $ 7,000.00
225 FIfth Street, Spnngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
By sIgnature, I state and agree, that I have carefully exammed the completed appllcdtlOn and do hereby certify that all
mformatlOn he, eon IS tI ue and conect, dnd I further certIfy that any and all work perf OJ med .haIl be done m accol dance with
the Ordmances of the CIty of Spnngfield and the Laws of the State of Oregon pertammg to the work descnbed he, em, dnd
that NO OCCUPANCY WIll be made of any structure wlthont pel miSSIOn of the Commulllty Services DIVIsIOn, BUlldmg Safety
I further certlly that only contractors and employees who are m compliance wIth ORS 701 005 wIll be used on thiS project
I fnrther agree to ensure that all reqUIred mspectlOns are I eqnested at the proper tIme, that each address IS readable from the
street, that the permit card IS located at the front 01 the property, and the approved set of plans Will I emam on the site at all
times dunng constructIOn
~ I:un 01
Owner or Contractors Slgnatur
Ddle
Paee 4 of 4
225 FIfth Street
Sprmgfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-0 I 049
COM2007-01049
COM2007-01049
COM2007-0 I 049
Payments
Type of Payment
Check
cRecemtJ
RECEIPT #
DescnptlOn
Fixture
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Admllllstratlve Fee
CIty of Sprmgfield OfficIal ReceIpt
Deyelopment ServIces Department
Public Works Department
2200700000000001855
Date' 12/17/2007
Item Total
<;heck Number AuthorizatIOn
Paid By Received By Batch Number Number How Received
RAINBOW VALLEY DESIGN dJb 6752 In Person
Payment Total
Page I of I
2 48 40PM
Amount Due
8000
400
640
800
$98 4U
Amount Paid
$98 40
$98 4U
12117/2007