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Home My WebLink AboutPermit Building 2004-6-14 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00558 ISSUED: 06/14/2004 APPLIED: 05/11/2004 EXPIRES: 12/1412004 VALUE: $ 2,000.00 Status 'Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1810 HARBOR DR ASSESSOR'S PARCEL NO.: 1803023302900 Springfield TYPE OF WORK: Manufactured Home on Private Lot New Residential TYPE OF USE: PROJECT DESCRIPTION: M.H. on lot wi covered porch. (In flood zone) Owner: DONALD PACHKOFSKY Address: 85252 MARRIOTT LANE PLEASANT HILL OR 97455 Phone Number: 746-7048 , CONTRACTOR INFORMATION I Contractor Type General Electrical Plumbing Contractor MELVIN E LANGFlELD OWNER OWNER License 66954 Expiration Date OS/29/2005 Phone 541-747-9585 BUILDING INFORMA nON I VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 nla I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 48.00 5.00 21.00 14.00 21.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Floodplain 2 Yes 22.00 REQUIRED PARKING Total: 2 Handicapped: Compact: Notes: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 160 DAY PERIOD. I PUBLIC IMPROVEMENTS I Fully Improved ATTENTIm.i~m~ requires you to Yes follow rulemwii~jilnlis~regon ~ilb' and Gutter SDC credit for existing structure. Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001- 0090. You may Dbtain copies of the rulBS b~ cal\1ng the centBr. (Note: the tBlephone number for the Oregon Utility Notificalion Center Is 1~-2344). Street Improvements: Storm Sewer Available: Special Instruction: Page 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Description Tvpe of Construction . Foundation Onlv Use Bid Amount Manuf Home Manufactured Home Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Foundation Permit Manuf Home State Issuance Manufactured Home Connection Manufactured Home Feeder Manufactured Home Placement Plan Review - Planning Total Amount Paid Planninl! Review Public Works Review Structural Review Structural Review 05/21/2004 05/17/2004 05/12/2004 06/10/2004 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 2,000.00 15,500.00 Total Value of Project Fpp< PIiILI Amount Paid $29.25 $30.00 $21.00 $45.00 $30.00 $45.00 $50.00 $160.00 $71.00 $481.25 Date Paid 5/11/04 6/14/04 6/14/04 6/14/04 6/14/04 6/14/04 6/14/04 6/14/04 6/14/04 I Plan Reviews I 05/21/2004 05/19/2004 05/12/2004 06/14/2004 APP EMM APP VRJ WE DLM APP DLM Pal!e 2 of3 . CITY OF SPRII'ljuNJi.LU Building/Combination Permit PERMIT NO: COM2004-00558 ISSUED: 06/14/2004 APPLIED: 05/1112004 EXPIRES: 12/14/2004 VALUE: $ 2,000.00 Value Date Calculated $2,000.00 $15,500.00 $17,500.00 05/11/2004 05/11/2004 Receipt Numher 1200400000000000709 1200400000000000897 1200400000000000897 1200400000000000897 1200400000000000897 1200400000000000897 1200400000000000897 1200400000000000897 1200400000000000897 FEMA Elevation Certificated Required before occupancy. Anchoring for flood way still needed to be submitted to Don Moore. Floodplain Development approved SHRZ004-00082 SDC credited for existing structure, no fees due. Contacted Mel and storm sewer to go to the street, 5/19/20049:30 am. Need engineered design for tie downs In a flood plain condition. Notified applicant of htis requirement 5/12/2004. dim Received engineering for anchoring system for floodway. See documents for plan review comments. . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00558 ISSUED: 06/14/2004 APPLIED: 05/11/2004 EXPIRES: 12/14/2004 VALUE: $ 2,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line 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. L.R~(lUir~d Insn~ Foundation: After forms are erected but prior to concrete placement. Manuf Home Set Up: When installation of all piers or stands is complete. Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been Installed. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. 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 1 further certify thai 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. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 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. ('-....i_)~~/~ Ow-;'er or Contractors s~re o - (<f~O Y Date Paee 3 of3 e. o 0 . 0 \. ,.: " " " " o 00 . . 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 pennit#:~-mS-S-8 Address: I~/O j/M,ts~ J~, Issued by: ~~ Date: f1~1 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 befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: )2(1. A2. I own, reside in, or will reside in the completed structure. )8( I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is Jff6fYIJ) t4,.uq FieLD " (Name) t (/)~,s-i- (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR D 3B. I will be my own general contractor. If! 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 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 understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side ofthis form. ;(.~ n ~L.L.- .c., IV, <:l </ - (SigiIatufe ?permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property- owner.doc 03/11/03 .~. . Acting. as Y o~r. Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . . 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. Employer Responsibilities 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 foIIo'Ying: 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 a State Business ill number, call the Business Information Center at 503-986-2200. 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.' Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. rf,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 Consumer 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 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns. Code Compliance: As the permit holder for this project, you are responsible for resolVing any failure to meet code requirements that may be brought 10 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. Time: Make sure you hilve sufficient time to supe!"ise your employees. , ~ .~ Expertise: Make sure you have the skills t~ act asyour own general contractor, to coordinate the work of rough-in and finish trades, and to notifY building officials as the appropriate times so they can perform the required inspections. rfyou 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 03/11103 SPRINGFIELD ...-....... .\ 225 F1FfH STREET. SPRINGFIELD, OR 9747; . PH:(541)726-3753 . FAX: (~!1'Y1~~689 ~~' ~ 'If' _ nlnU 'nU *:\1:- ~ ~JI ELECTRICAL PERMIT APPLICATION apPfO. ana rlfO/aCt ,. - Itl 09S /lss City Job Number Date G. - I t..( - 0 <J nOt fa IJbrr,i/t <J <?O . qlJi, eat, _ 'l11<' n'nn_ . e Sf) ti&.th F~"r.;-~C1n1l'.'V~.<wmll'wi. .. ~"" ~.~. tI ~.... 'Y'- '"" >......~~/~... e'()iil~IW.~ 3. VJf.gMPLE'flt.E~b;~t;n : ' ' O~~1:11 ,,?~i!.f;,'cr?':"'ln~'" 'lit~~~. o;l.l~~ '<UY.~~__ '<:;ei..};"/3~lj86..&'* 'Un ,. '.... A. ~~M~il1~lffi~~~re~l~ffi'}~~.~)i~ji~i>~~' ilitt~~ ma~$U1l.:.~~""$",""":Ln~~~~~lQrht~~. ~-~ -'.00.,; ".... \:b:I.~~ 1. fiti;"6cATibN;QIFiNSTAiJLfATroN'l{!~~ifJ ~~~____~~~ :;:'o'T \ / ~ 10 Z>^.hOI/' ;:7)_.'..-.... , LEGAL DESCRIPTION I~(JS ?J 2.. :3 3 /)2/'00 JOB DESCRIPTION >,(cY~??7/3-v7 ~ 11-- Permits are non-transferahle and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. fiooNfRAe;OR.rINST]1;rrr!4TION;oNE~~ ' 2. b'>iIl"".o:l~~tfut/'Y<<";:;f~ll":"..~!.2f2~"W' ;'" '~ Electrical Contractor Address // ./ Phone/ City Supe.rWwill~: taw regulres~to fr.>l1ow rules a ' pted by the Oregon Utility . Expjry..\\\l!l:.Ii!l!ll:l enter. Those rules are set forth in OAR 95 -001-0010 through OAR 952.()O1. Corisb9G:on JJIIl1~abtain copies 01 the iules by , cal' 9 the center. (NotB: the telepnone Expil:at' ,nt~teJr the Oregon Utility Notification. Center is 1-800-332-2344). Signature of SuperVising Electrician Owners Name ~"'J Address %<. <S' 2. ~ 2.-. ~,.~kJ24- W1A-vo.."",.. If (-0 City fLe.",~.......1 ,/, (( Phone 9/L ~ 36/ '17<(77 OWNER lNST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~C~~~ ..., / r' Inspection Request: {26-3769 Service Included , 1000 sq. ft. or less Each additional 500 sq. ft. or , portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $ 19.00 I $50.00 c:f) ,0-0 ~tl?t".~'Y!J.:'ll-:~r',~;.;;{.('~'tr.~'::~.wtf'~~lif!r~~~"..;p,4'11.vi~'I'!""'-f~.i~lt,(,~~~~ B. ~~~~tt~~~~~~r~:i:a~~~~~~i\~~~jL~~~~lie~~.!!~~~ 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/V oIlS Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. ~lfeinj.;;po1-a~ry; IS~r~f~;'OfJF~~W~ftt~?J~~~~~f,:i~~rtt;H",~. ~t9. ~ti-;Z#P~1t1 ~,,\_,__,.,'_w -'--'-.",'~-~u.::.~~' ~,"j'... ",,~::nvl1;~<Ai~'~~ Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps, $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 VollS see "Boo above. D ~B', .!lih"'fC":~,r"". '?n'lti,^"'~"''''ili>'~.t':f<'I!,'::''~' ' "};,,,,~",~.'''''' ....j . .:' ~~m~c , !rCuh.~, ~- "~~'r#!~~l~~'~v;'"\;(~ \:l~',:n'/r~~;~~'" New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Pennit $ 43.00 $ 3.00 E. Mir, ~rn:~~~~(Sr#r~~;-ie~d'Wli,'ti:i1f~l~a)ftE~i~~iri~t,kiittii>iii1 , . ~~~~.tl:i").;;;~-.....~;.r~",,,":":OAI~""H"_""'_""~ Pump or irrigation $ 50.00 SignlOutlVltPJ$~Wll '~, ~i~~OW~pl(- , Limited En,..~~lte'ilt\aj)Hi\LL t"l'~h':;~mlflqS MnT Limited E~~W1~'efti~\NDER '!'tl?,~~.sJa.qtbP MnlP~D OR 1~l\b"I...."I' Minimum EIectflQMl'II\It'Iiist~~'I\\O{1. is $45.00 + Surcharges , ~,"", '."''''''', <.' "M\N-;('1;lll..Q;&(foJ-:L"!"?~"l"",,\,.,,.I1~IG:,~ : 4. :SUBT01'AL:{OF1ABOVE,V..-":,-....~".~,""1J.,, ~ 0-0 ~:::""'.'1-~'i'!:t..W~4'tf;::~""'-"!.~.("f1;'"'\:... ,....'.,:);-~. 't,- t'>,;,r~~~,l,~,,"'1'i . ) D 4 . 3,)0 )~ r- ~ j'7'i::i ;-) 19. 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Forms/Electrical Pennit Application 1.Q3.doc CITY OF S!NGFIELD SYSTEMS DEVELOPMEN_ORKSHEET --, JOURNAL OR JOB NUMBER: Com2004-00558 NAME OR COMPANY: Donald Pachkosky LOCATION: 1810 Harbor Drive TAX LOT NUMBER: 18030233 t12900 DEVELOPMENT TYPE: SFD - Credit for exisitng MH NEW DWELLING UNITS 0 BUILDING SIZE (SF' 0 LOT SIZE (SF): I. STORM DRAINAG~ DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I 0.00 I $0.290 I = 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 DISCOUNT I 0,00 I I $0.290 I I 50% I = I $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I COST PER DFU I 0 I I $22.64 B. IMPROVEMENT COST: I NUMBER OF DFU's I x COST PER DFU I 0 I $17.21 ITEM 2 TOTAL - CITY SANITARV SEWER SDC =, $0.00 ), TRANSPORTATION A. REIMBURSEM ENT COST: I ADTTRIPRATE I x I NUMBER OF UNITS I x I I 9,57 I I 0 I I 8. IMPROVEMENT COST: I ADTTRIPRATE I x I NUMBER OF UNITS I x I I 9.57 I I 0 I ITEM 3 TOTAL-TRANSPORTATION SDC = , 4: SANITARY SFWFR . MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I i $314.63 8. IMPROVEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I $214.23 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SD< = , SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , 5, ADMINISTRATIVE FEE: ISUBTOTAL 1 x I ADM. FEE RATE 1= I $0.00 I 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Virginia Jurasevich 5/19/2004 PREPARED BY DATE 'r- 1[2 "J~ , '" G ~ $0.00 SO.OO 1070 SO.OO 1091 SO.OO 1092 COST PER TRIP SI7,23 x INEW TRIP FACTORI I 1.00 I 11093 I SO.OO COST PER TRIP $76,01 SO.OO x INEW TRIP FACTORI I 1.00 I t094 SO.OO = SO.OO 11054 = SO.OO 1055 SO.OO 1054 SO.OO 1056 SO.OO SO.OO I , CHARGE I $0.00 #DIV/O! 1079 I #DIV/O! 1078 - TOTAL SDC CHARGES = $0.00 - . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT' DRAINAGE FIXTURE UNITS l, (NOTE, FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO, OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 0 0 3 = 0 IDRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 IiNTERCEPTORS FOR GREASE lOlL! SOLIDS I ETC. 0 0 3 = 0 IiNTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 ILAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER I MOP SINK 0 0 3 = 0 ICLOTHESW ASHER. 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAPJI PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRIGI WATER STATION I ETC. 0 0 1 = 0 IRECEPTOR FOR COM, SINK I DISHWASHER I ETC. 0 0 3 = 0 ISHOWER, SINGLE STALL 0 0 2 = 0 ISHOWER, GANG (NUMBER OF HEADSt 0 0 2 = 0 ISINK: COMMERCIAURESIDENTIAL KITCHEN 0 0 3 = 0 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LA V ATORY 0 0 2 = 0 ISINK: SINGLE LA VATORY/RESIDENTIAL BAR 0 0 1 = 0 IURINAL, STALL! WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 ITOILET. PRIVATE INSTALLATION 0 0 3 = 0 I MISCELLANEOUS DFU TYPE NUMBER OF EDU'S I 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 J .EDU (Equivalent Dwellin~ Unit) is a dischar~e eQuivalent to a sin,,!e family dwe\lin~ unit (20 DFU's) set at ]67 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDIT RA TE/$I ,000 ANNEXED ASSESSED VALUE BEFORE 1979 S5,04 1979 $5,04 1980 $4,95 I 1981 $4,88 I 1982 14.75 i 1983 54.58 I 1984 $4.41 I 1985 $4.20 I 1986 $3.88 i 1987 $350 I 1988 53.07 I 1989 S2,60 I 1990 52.14 I 1991 $1.71 I 1992 $1.S2 I 1993 $Ll8 I 1994 $L19 I: 1995 $1.03 1996 $0,87 I 1997 $O,6S I 1998 $0.46 I 1999 $0.27 I 2000 $0,09 I 2001 $0.04 IS LAND ELGIBLE FOR ANNEXATION CREDIT! 0 (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT! 0 (Enter I for Yes, 2 for No) BASE YEAR 1979 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDIT RATE $0.00 x $5.04 o I I I I I I II CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE $0,00 x $5,04 = , $0.00 TOTAL MWMC CREDIT = $0.00 I ,I ~....... Cou~t 1SE --:-~ Publk \\boo . . ~: '1,.- , . . 'r '.''i'':~e I,.} M J P/U3' ,/:' . / . . . \ ' , ' '.. f.~~ty - SANITATION AUTHORIZATION NOTICE. FOR SP047121 , Permit Sub-Type: AUTHSITE Application Date: 04/28/2004 Proposed activity: AUTHORIZATION WITH FIELD VISIT Job Address: 1810 HARBOR DR SPIt Applicant: Owner: PACHKOFSKYDONALD S FEDERAL NATIONAL MORTGAGE ASSOCIATION 85252 MARRIOTT LN % FIRST AMERICAN TITLE INSURANCE COMPANY PLEASANT HILL OR 400 COUNTRYWIDE WAY SV-35 97455 SIMI VALLEY CA 93065 Parcel #: 18-03-02-33-02900 Discussion: Authorized?: Y SYSTEM FUNCTIONING PROPERLY AT THIS TIME.MANTAINREPLACMENT AREA. Y=Yes N=No , Inspection, By: WM Inspection Date: 04/30/2004 Inspector Signature: Date: ~/tr;L 225 Fifth Street Sprlngfield, Oregon 97477 541-726-3759 Phone . .j:~~:~ WiL " , City of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number COM2004-00558 COM2004-00558 COM2004-00558 COM2004-00558 COM2004-00558 COM2004-00558 COM2004-00558 COM2004-00558 RECEIPT #: 1200400000000000897 Date: 06/14/2004 Description Foundation Permit Manufactured Home Placement Manuf Home State Issuance Manufactured Home Connection Manufactured Home Feeder + 7% Slate Surcharge + 10% Administrative Fee Plan Review - Planning Payments: Type of Payment Paid By Item Total: Check Number AuthorIzation Received By Batch Number Numher How Received Check 6/14/2004 DONALD S PACHKOFSKY dim 1622 In Person Payment Total: Page 1 of 1 11:19:53AM Amount Due 45.00 160.00 30.00 45.00 50.00 21.00 30.00 71.00 $452.00 Amount Paid $452.00 $452.00