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Home My WebLink AboutPermit Building 2005-7-13 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRI1'l\.J1<,IELD Building/Combination Permit PERMIT NO: COM2005-00787 ISSUED: 07/13/2005 APPLIED: 06/23/2005 EXPIRES: 01113/2006 VALUE: $ 38,000.00 '\".-' u'h:' Springfield' TYPE OF WORK: Single Family Residence I HI~ PERMIT SHALL EXPIRE IF THE WO AUTHORT-YPEOFIUSE:HISAdditionr IS NRK Residential .. -,."", , ,cnlVII OT COMMENCED OR IS ABANDONED FOR ANY 11ln n6V Dt:Olnn SITE ADDRESS: 2573 GRAND VISTA DR ASSESSOR'S PARCEL NO.: 1703243101900 PROJECT DESCRIPTION: Addition to existing residence Owner: Address: TERRY MATTHEWS 2573 GRAND VISTA DR SPRINGFIELD OR 97477 Contractor Type General Electrical Contractor OWNER OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: 15.00 32.00 Phone Number: 541-746-3694 I CONTRACTOR INFORMATION I License Expiration Date Phone I BUILDING INFORMATION I .R-3 # of Stories: 2 Lot Size: Height of Structure 25.00 Sq Ft 1st Floor, Type of Heat: Forced Air Gas Sq Ft 2nd Floor: 380 Water Type: ATTENTION: Oregon I~ f~~~'~Wtnt: Range Type: follow rules adopted b;{llt~ ,g~'1\W@hazort Energy Path:,otificatl'on CePath lrh Sg Fl tlier: y . oil",. O~Q ru p.~ "rp. ~c: forth Sprinkled Building:, 952 001n1a010 th Occupilnt LOaD: "'~., - -u rouon UAR ~'i'_nnL I DEVELOPMENT iNEORMATIO'N=itarn copies of the rules by - ". (Note: the t'REc;!mRED PARKING . number for the Oregon Utility Notification Overlay Dlst: Center is 1.S00-332-234!ptal: # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: VN I PUBLIC IMPROVEMENTS I Sidewalk Type: DownspoutslDrains: Fully Improved Yes Curbside 5' , Curb and Gutter Notes: Storm drainage piped into existing to curb face 6/27/2005 CAS Pal!e 1 of4 T . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description A.C. - Residen Dwelline:s Tvpe of Construction AC - Residential V Wood Frame Fee Description Plan Review Residential -Mechanical Issuance Fee- -Mechanical Issuance Fee- + 10% Administrative Fee + 10% Administrative Fee + 7% State Surcharge + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Add, Alter, Extend Circ Ea Add Appliance Not Listed Appliance Not Listed Building Permit Building Permit Heat Pump Heat Pump Minimum/Adjustment Mechanical Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing Plan Review Minor - Planning Plan Review Minor - Planning Plan Review Residential Plan .Review Residential Refund - -Mechanical Issuance Refund - + 10% Administrative Refund - + 7% State Surcharge Refund - Add,'Alter, Extend Ci Refund - Add, Alter, Extend CI Refund - Appliance Not Listed Refund - Building Permit Refund - Heat Pump Refund - Minimum/Adjustment Me Refund - Plan Review Minor - P Refund - Plan Review Residenti . \...11 r OF ~rKll'1ut<IELD Building/Combination Permit PERMIT NO: COM2005-00787 ISSUED: 07/13/2005 APPLIED: 06/23/2005 EXPIRES: 01113/2006 VALUE: $ 38,000.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $4.00 $96.00 Square Footage or Bid Amount 380.00 380.00 Value Date Calculated $1,520.00 $36,480.00 $38,000.00 07/05/2005 07/0512005 Total Value of Project Fpp<. PIilLI Amount Paid $172.48 $10.00 $10.00 543.95 $43.95 $30.76 $30.76 $43.00 $43.00 $6.00 $6.00 $9.00 $9.00 $300.45 $300.45 $12.00 $12.00 $24.00 $24.00 $45.00 $59.00 $59.00 $22.81 $22.81 $-Io.oO $-43.95 $-30.76 $-43.00 $-6.00 $-9.00 $-300.45 $-12.00 $-24.00 $-59.00 $-22.81 Date Paid Receipt Number 3200500000000000372 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000915 2200500000000000917 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000916 6/23/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 . 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 Pae:e 2 of 4 . . U 1 :f OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00787 ISSUED: 07/13/2005 APPLIED: 06/23/2005 EXPIRES: 01113/2006 . VALUE: $ 38,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Refund - SDC Sanitary/Storm Ad Refund - Storm Drainage Imperv Refund - Storm Sewer - 1st 50 SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - 1st 50 Feet $-3.49 $-69.75 $-45.00 $3.49 $69.75 $45.00 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 7/13/05 Total Amount Paid $778.45 Initial Review Plan nine: Review I Plan Reviews I 06/24/2005 APP 07/12/2005 APP LLH TAJ 06/2412005 06/24/2005 Public Works Review 06/2412005 06/27/2005 APP CAS Structural Review 06/24/2005 06/28/2005 WE JB Structural Review 06/30/2005 07/01/2005 APP JB 2200500000000000916 2200500000000000916 2200500000000000916 2200500000000000915 2200500000000000915 2200500000000000915 Outside floodplain per the Corrected Effective Model for Gateway dated Nov 2003 by David Evans & Assoc and per Mel Oberst. Storm drainage piped into existing to curb face 6/27/2005 CAS Talked to Monty Luke, designer, and there Is only one piece of Info that I'm waiting on (Eng. Trusses); however, they are having the eng. Review an expanded footing that may not be required as designed. Expect resolution in a couple few days. JB Approved as noted on plans 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. ~eollirerUn~nections I Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Sbear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Pae:e30f4 " I . . CITY OF ~rIU1~GFIELD c Status Issued Building/Combination Permit PERMIT NO:COM2005-00787 ISSUED:' 07/13/2005 APPLIED: 06/23/2005 EXPIRES: 01113/2006 VALUE: $ 38,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Building: After all required inspections have been requested and approved and the building is complete. Storm Sewer Line: Prior to filling trench. Underfloor Mechanical. Prior to insulation or decking and including required testing. 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. 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 times during construction. ?1'....,rnn:-:rctt ....:::::,_ -' Owner or ,tontractors Signature 7h-z,/()!; Date I I I I I' I I Pae:e40f4 ,,' , - , C>.' ..k ,: . ," . '!' '." ~ '"1/. r ~,) ," ' ".~' ; '<, . " 4" '. '.,I. ........ '. . ''', '.. ~ ' t, ',. ".J ~ . ., . ~.!~ ~:fil '. ,~_' ,', L. ... ...~"~' ~.--."...- " " .'... "'....~ "..;:-.....;Z' .'- .1.1 ~.'_ '> .'" ,...._ ...: ,,'_~. ^',,:: '}.t .._ J._ .'_' '\....'"-.,Y'~... _"''l~' . ~~'. ",-' SPRIN j:i ~.} !;'J(;;~":" ~ ~ 'b-'r;"o.v." . . FAX: (541)726-368gec\~~",~;,{ I 'J,O\"~~'. ..,,,Q, /)00 Date b-Z.'l~-r_ . ~\'--~~" ^",o.., . ~ -0 - ,o.~1-o'" 3. kC01Yiya:lw2FE1!:;scifflDfJiE~.. B-~"--~Y:('-i.1:~'.!.'I<l "id,~"\\ ~~'i,---,~~",.;,^, v :.....<'",...,."...".~. '~1.:~ .~:~y -~ :0'_1""'~'::""'~":;;:'" .,,~~ .,;\<li 'Q\0 eO. A. e~j,~~;~~1~~~1~f~~~r;ri}1t2 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 ELECTRICAL PERMIT APPLICATION City Job Number ~~ - 00"78 7 1. ~L6€ATjONOE'INsi..ill:'ATION;Wffi.#~q ~.uuu.~_ ., ...."" _"",,,.,~,,, "- .....' "''-''\\1 2S'7> G-r.........cl VI')M. LEGAL DESCRIPTION 1703 zl.f31 01'700 JOB DESCRIPTION \\ 1\ ~ _ JMiliDf\ -\0 ~ Permits are non-transferable and expire if work is ;, nol started within 180 days of issuance or if work is Suspended for 180 days, ~N.i'RAcrOR..tiNSTAJJ1A.::':/iiotl~ !f.i.....~ ~ ~ ..~~.6'A'.t-_""~t'~~i~"~-!\i~1M."'$<,.tL~W. --..' " ,i City Expiration Date OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 'l4 ~, ~ ( Inspection Request: 726-3769 Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or FeedeqnTI~t=. I\JU ~.:... B. ~:.~~t:b~~~ijif~ihlst;lli;.--ti~~ib(iteffii~~~.':f~R. ~16'~iiti~ri;b:,.-~.:.j "r';'ulnUNlt' ';~G'2;:; rAlt~~'~~,;~ol.'ln:-"'.".J 200 Amps,orlessCED OR IS ABANnnNFn $63:00 . . ....., 201 AmjiS't6400IAmpS'ERIOD. $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsIVolts $375.00 Reconnect Only $ 50.00 $50.00 C ~:r-'-';:\.;--~rt't!~.-.~.~.~o/'S~ ..;> ~:"'h."'='':':~'--F'.''''''d~-.~\'C~J~ ?!~...~t:c',*,C:~-,~4_~.' _....~. ~.,j.i.;<,.j.~.,id . - __ .!!!!P.<!:r:~ry~ >!ryIc~s _ ~_t:;. ~e. ers r" -'~-7' ;:X,'tl4E.}k: i _ w~_:'<fli'~_,)~ - "~-~...~, Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 D~~~_:' E hAdd'''A "IG' nit 'ib .n-.~ -." "rUI8S 'Co" OD ac . !.",!!".I.~up,=.e1i~l\". {NO('L..!he t$k3-00' )",0 /I..~ ServIce or 1i5'il\5 '1>erIDlth 0 . ,.. , ~ 'II &"f-.iUI L e regun uwny r,."t'flL.{.i,.Yl ;"'-"'l~~.~""i-)'Ji'!: '''"(''j1{VCli\Cl'. 'j;JT:'OifJ{J~>f'~:::f;'~~~'f1"'-"'-'w.- "V_~r";';'~, ~'~' '.1 E. .~MiSc~n~.!t~~s.<~,~m~o;IJ!,-e:!!er,.no.t.iI1~l~de~);"'!,.a$~",1.n}~Il,~ tio'!J Pump or inigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 MiI1imum Electric Permit Inspection Fee is $45.00 + Surcharges .'. ,t!'$i';.' ...,';"urt"-"v.~.;,';!'!-',_" "i.-''''.:.n;.,,' "". - '~.'~."'.'.".1;..."":1.-..: :i.'k."X;f?~., ""1"'.,.'--.:;' "~'. 4. :SUB.TpTALPF.'ABOl{E;;;',~'J<! ~!';"~E;~f~;'''~.$, ''\IV,f'''"'' f!9 ,~..-,!,1,,;: ->!,. !::':.,'W'-h>....... " ,): -""..'y&"'.-.~ !!""'", ,,.b.,, 4-q~ .3~ 4,'-'\0 S\.~ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)IBuilding Fonns/Electrical Pennit Application 1..(I3.doc -. . . . . '. .' . .. .~ . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us permit#:C0W1z.c!S-007&-7'' -" Address: ZS:7'J G O\V\-~ \1.'&4. ISSUedby:}>r.R Pl~ Date: 7/Y;/OS Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) 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. 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. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: Qrl. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~ 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl change my mind and hire a general contractor, I will contract with a contractor who is, licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do nnderstand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~ ~/~ los- t (Signature-of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 ". . AdJirrn~rm~ 1{@Ullr (fJ)W1ID Gerrnermll C\!])ll1l1trmd@r? INFORMATION'NOTICE TO PROPERTY OWNERS ABOUT.Cqi1STRUCTION RESPONSIBILITIES ~ " , i NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. .' " lEmpnoyer JRespol!ll.silbmties You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined nwnber for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmlI for the app.......t'I.~ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Conswner and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the ' IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov. Otlbler JResjplollllsilbfillities ami! Areas of COllllcerlllls Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. -"':-_ O. \ _~_"" \ .~ , " . . Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your oWn general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the 3pp.vp,;ate ti~es so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner .doc 06-01-04 .' JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS I. STORM DRAINAGE . . .. . CITY OF J1rRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET COM2005-00787 . T ecry Mathews . 2573 Grand Vista Dr 1703243101900 SINGLE FAMILY RESIDENCE o BUILDING SIZE (SF' 329 LOT SIZE (SF): 20138 DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. . x I COST PER S.F. I CHARGE I 0.00 I $0.3 10 = I, $0.00 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I ! I 0.00 I I $0.310 I 50% I = I ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 0 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I $0.00 3 TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP I 9.57 I o I $18.30 B. IMPROVEMENT COST: I ADTTRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP I 9.57 I o I I $80.72 ITEM 3 TOTAL - TRANSPORTATION SnC = , $0.00 A. REIMBURSEMENT COST: :NUMBER ~FFEU'S I x B. IMPROVEMENT COST: INUMBER OOF FEU's I x ICOST PER FEU I $865.31 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = , SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , 5. ADMINISTRATIVE FEE: I SUBTOTAL x I ADM. FEE RATE 1= I $0.00 I 5% TOTAL SANITARY ADMINISTRATION FEE: }OTAL TRANSPORTATION ADMINISTRATION FEE: B. IMPROVEMENT COST: I NUMBER OF DFU's I x 101 4. SANITARY SEWER - MWMC ~5l'~",~" PREPARED BY DISCOUNT $0.00 $0.00 $0.00 COST PER DFU $24.04 $0.00 $18.28 $0.00 x INEWTRIPFACTORI I 1.00 $0.00 x INEW TRIP FACTORI I 1.00 $0.00 ICOST PER FEU I $82.03 . - $0.00 = I $0.00 I $0.00 = 1 $0.00 $0.00 $0.00 CHARGE $0.00 I rJl ~ Cl o U ~ ~ f-< rJl - o ~ ~ 1070 I i 1091 I 11092 1093 1094 1054 , I 1055 1054 , 1056 I =1 I #DIV/O! 11079 #DIV/O! J 1078 I 7/13/2005 =, TOTAL SDC CHARGES $0.00 DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS (NOTE: 'FOR REMODELS. CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 0 0 3 - 0 IDRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE lOlL I SOLIDS I ETC. 0 0 3 = 0 INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER I MOP SINK 0 0 3 = 0 CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG I WATER STATION I ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK I DISHWASHER I ETC. 0 0 3 = 0 SHOWER, SINGLE STALL 0 0 2 = 0 SHOWER. GANG (NUMBER OF HEADS\. 0 0 2 = '0 ISINK: COMMERCIAURESIDENTIAL KITCHEN 0 0 3 = 0 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 0 0 1 = 0 IURINAL. STALL I WALL 0 0 5 = 0 ITOILET, PUBLIC INST ALLA TION 0 0 6 = 0 ITOILET. PRIVATE INST ALLA nON 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 ~ .EDU (Equivalent Dwel1in~ Unit) is a dischar~ equivalent to a simde family dwelling unit (20 DFU's) set at 1671!;D..11ons Der day 'I YEAR ANNEXED I ~ BEFORE 1979 1979 1980 r 1981 I 1982 I 1983 I 1984 I 1985 I 1986 I 1987 I 1988 I 1989 I 1990 1 1991 1992 I 1993 L 1994 I 1995 I 1996 I 1997 I 1998 I 1999 I 2000 I 2001 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE I CREDITRATE/$I,OOO J 1_ ASSESSED VALUE 1:$,?.29 '~il ;;h, l;$s!i ,t-~ ';1 ~':$5'19 t~1 1,{$~Ai :~] 4.98 "'" #'"'8""0' ~12i .'"'' .' """F~"" ""'_. ,..,,": .",", r'~-~~,~X{$4;63'- .; ,'"'j:'* "!'" _1,';;.1- ,~ .., "~," ,.: ,il '';'''''O:':~:-$440~,r~:;t',,,,"" r~ J~~~/~':07T'?f::~~ t~ ~."t~'. '., ~" ,,,-~-,( '<,f t"- ~--;";::",J}($316ir-i'\>'L">:;t (':::-:'~~_" " '~r'/',,:~$ rt :~;;:;t",'~.~~.~,~:~"i":"'p',r~? IL:',., '$2.73 " .:' ~f; \~i~I'''~~'$2[2~f '~?;l;"':V ~t ~.::~". ~;, <'- -? ,;:~~,- ~~ j;t,~'~'.2',>$1".80,..:"~'_?' ;) 1*:i:,(:~'.J:,~J ~,~.~'., ~:;.t,i> ,,:' "'.:,......$145..!~.'., " r",~ .',-., '~;'$'1-' 25"'>\""t~:. ::', "'l ~\~~:~~{~:S~ $0:72" """ '", $0:48 ,;::,,:; .i~ ',,' "." ,:,:.1:;1';" \;%!-,o'/'~ ' $0.28"''':';'1,., ,,'.: ',-$O:69;&'il.j:.~):i:l.t:~ . ';$"'00'5"f~"4~:r.~;j ,t':._'&"':"_.~''':t<:;;:1";.,!~\;l" IS LAND ELGlBLE FOR ANNEXATION CREDIT'? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT'? (Enter I for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE 11000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT = $0.00 T ' I I . 22~.Fifth Street . Springfield, Oregon 97477 541-726-3759 Phone . ~~~R~"!'EU>._'."...,,_" ..'_.' 1 MiL, ........ \ ,- I, . _ _ r ! Job/Journal Number COM2005-00787 COM2005-00787 COM2005-00787 ., COM2005-00787 COM2005-00787 COM2005-00787 COM2005-00787 , COM2005-00787 \ COM2005-00787 COM2005-00787 . COM2005-00787 COM2005-00787 Payments: Type of Payment CreditCard <' 7/13/2005 RECEIPT #: 2200500000000000917 Description Plan Review Residential Building Permit Minimum! Adjustment Plumbing Heat Pump Appliance Not Listed Minimum! Adjustment Mechanical -Mechanical Issuance F ee- Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Plan Review Minor - Planning + 7% State Surcharge + 10% Administrative Pee PaId By TERRY MATHEWS (,;beck Number Batcb Number Received By 'ddk Page 1 of I ~ity of Springfield Official Receipt Wevelopment Services Department Public Works Department Date: 07/13/2005 Item Total: Autbortzallon Number How Received 138107 In Person Payment Total: 11:44:20AM Amount Due 22.81 300.45 45.00 12.00 9.00 24.00 10.00 43.00 6.00 59.00 30.76 43.95 $605.97 Amount PaId $605.97 $605.97