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Home My WebLink AboutPermit Building 2006-7-21 (2) . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00678 ISSUED: 07/21/2006 APPLIED: 06/02/2006 EXPIRES: 01/21/2007 VALUE: $ 1,100,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PROJECT DESCRIPTION: Addition and renovation. Springfield TYPE OF WORK: Bank ~~II~iKTIV~\~E;)~~r~~)(Plr~..ct?iti~O.qE WORK Com~ercial AUTHORIZED UNDER THIS PERMIT IS NOT J ___ ...-. ,..... ~nA,.H'n"'lcn enD ltUI'JIlIJICI'lIJLU VII IV , ....' ,..- -. ~- ANY 1 SO DAY PERIOD. SITE ADDRESS: 1008 HARLOW RD ASSESSOR'S PARCEL NO.: 1703220002305 Owner: GATEWAY MALL PARTNERS Address: PO BOX 617905 CHICAGO IL 60661-7905 I CONTRACTOR INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Contractor License Expiration Date Phone ROBERTSON/SHERWOOD/ARCHITECTS 541-342-8077 CHAMBERS CONSTRUCTION 114258 05/30/2007 687-9445 BUILDERS ELECTRIC INC 4296 12/10/2007 541-485-0922 COMFORT FLOW 460 06/27/2007 541-726-0100 ROBINSON PLUMBING INC .ATTEI\Hm~n'Q~__' 07/13/2007 541-345-6909 BUILDING INFORMATioNI'doPt~d b~-;I;~"6l1/res you to . -" ~cnter Th regon Utility # of Stories: 'Ono?oAR 952-001-001lJ t~i'to~l~i'i1{lre set forth ~ Youm. u<.,q'}f\nnr.:-,...0 Height ofStructu~e ay c18:00) coSq-Ft Ist'Floor:' 01- ea!/ '-.., I'! lC',....,j.-; Type of Heat: . Ing the celltSi.as;Nol~q,1:~2.n~EFloor:: by Water Type: number for t!Elet.trj~on I~'~ :ft'~ii~e!"ent:3 Range Type: Center is 1-800-3~~'F.~ Giirage/!'=,!l,'Jport Energy Path: Path 1 Sq-Ft'Other: Sprinkled Building: n/a Occupant Load: B 2,182 Contractor Type Architect General Electrical Mechanical Plumbing VB 67 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEl\.....l' I" I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: Page 1 of 5 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Estimate Pavine Estimate Use Bid Amount Fee Description Plan Review Comm/lnd/Public Plan Review Fire & Life Safety -Mechanical Issuance Fee- + 100/0 Administrative Fee + 8% State Surcharge Building Permit Fire SF Fee - Non-Residential Fixture Furnace - up to 100,000 btu Cas Outlets 1-4 Paving Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan Total Amount Paid . . CITY OF ~n~H\it.l'IELD . Building/Combination Permit PERMIT NO: COM2006-00678 ISSUED: 07/2112006 APPLIED: 06/02/2006 EXPIRES: 01/2112007 VALUE: $ 1,100,000.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 1,017,329.00 82,671.00 Value Date Calculated $1,017,329.00 $82,671.00 $1,100,000.00 06/27/2006 06/27/2006 Total Value of Project Fpp<. P~ilIJ Amount Paid Receipt Number Date Paid $2,480.17 $1,526.26 $10.00 $451.47 $303.77 $3,549.15 $218.20 $140.00 $36.00 $4.00 $499.35 $457.58 $601.77 $10.00 $1,186.81 $112.51 $107.50 $285.60 $3,880.85 $879.83 $732.67 $50.00 $18.00 6/2106 6/2106 7/21106 7/21/06 7/21/06 7/21106 7/21/06 7/21/06 7/21106 7/21/06 7/21/06 7/21/06 7/21/06 7/21/06 7/21/06 7/21/06 7/21106 7/21106 7/21/06 7/21106 7/21/06 7/21106 7/21/06 2200600000000000723 2200600000000000723 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 1200600000000001124 $17,541.49 I Plan Reviews I Paee 2 of 5 ~iir' . . CITY OF ~rK.1j'\it.t<IELD ,..".... Building/Combination Permit Status Issued PERMIT NO: COM2006-00678 225 Fifth Street, Springfield, OR ISSUED: 07/21/2006 54 I -726-3753 Phone APPLIED: 06/0212006 54 I -726-3676 Fax EXPIRES: 01/2112007 541-726-3769 Inspection Line VALUE: $ 1,100,000.00 Fire Department Review 06/08/2006 07/12/2006 OK GRG Plans Review: Addition and remodel. Job #COM2006-00678. Occupancy Classification: B. Construction Type: V-B. 5191 square feet. Occupant load: 67. Fire extinguishers shown on Plans Sheet A I.I and described in project manual page 23 Section 10522. Will verify on inspection, Exit lights shown on Builders Electric Plan Sheet E2. Will verify in inspection. Emergency egress lighting shown on Builders Electric Plan Sheet E2. WiII verify in inspection. Above the main exit door, provide sign stating "THIS DOOR MUST REMAIN UNLOCKED DURING BUSINESS HOURS" ifkey locking hardware is employed (2004 OSSC 1008.1.8.3, exception 2.2). Initial Review 06/08/2006 06/08/2006 APP SKG Plan Review Comments 06/27/2006 10 JMP WI. Received structural response from Lana Sadler. Plan nine Review 06/08/2006 07/03/2006 APP EMM Development Agreement signed 7/3/06. Public Works Review 06/08/2006 06/28/2006 WE SB LDAP Ready to issue. Please issue LDAP before this permit. Still holding for transprotation numbers from client. Public Works Review 06/30/2006 07/18/2006 APP SB 'Ldap issued 6/30/06. Ready to issue. SDCs added. Ready to issue. Structural Review 06/08/2006 06/16/2006 WE JMP Received with 3 projects on 6/12/2006. See attached documents for 8 structural comments faxed to James M. Robertson. Structural Review 07/19/2006 07/19/2006 APP JMP Received final internal approval. SUB Review 06/12/2006 06/21/2006 WE JF JMP left a voice mail message for Lana Sadler requesting the BE and Lighting energy code forms and worksbeets, SUB Review 07/10/2006 07/10/2006 APP JF Paee 3 of 5 . . CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2006-00678 ISSUED: 07121/2006 APPLIED: 06/02/2006 EXPIRES: 01/21/2007 VALUE: $ 1,100,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection 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. IRpn~ Site Inspection: To be made after excavation but prior to setting forms. Erusion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. . Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection. 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 SUB Exterior Lighting Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Shear 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. Roofing: Prior to installing any roof covering. Masonry: Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Roof SheathinglNailing: Before covering sheathing with finish material. Ceiling Grid: After drywall approval but prior to cover. Pa2e 4 of5 . . CITY OF SPRU\jld'lJ!,LD' Building/Combination Permit PERMIT NO: COM2006-00678 ISSUED: 07/21/2006 APPLIED: 06/02/2006 EXPIRES: 01/21/2007 VALUE: $ 1,100,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54 I -726-3676 Fax 541-726-3769 Inspection Line Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Epoxy Anchors: To be done by Certified Spciallnspector. Provide Inspection results to City Building Inspector. High Strength Bolting: To be done during construction by a State Certified Special Inspector. Provide inspection results to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to Ci.ty Building Inspector. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections bave been requested and approved and the building is complete. Rough Grading: After gravel is in place but prior to placing concrete. Final Paving: After paving is complete. Underslab Plumbing: Prior to filling the trench and including required testing. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. By signature, I state and agree, tbat I bave carefully examined the completed application and do hereby certify that all information bereon is true and correct, and I further certify that any and all work performed shall be done in accordance witb the Ordinances of tbe City of Springfield and the Laws of tbe 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. . fjL?1~/?~Y 8~ 7-2(- oC. Owner or Contractors Signature Date Paee 5 of5 . . ATfACHMENT A CITY OF SPRINGFIELD SYSTEMS DEVEWPMENT CHARGE WORKSHEET JOURNAL OR JOB NUMBER C0M2OO6-00678 NAME OR COMPANY: Liberty Bank LOCATION: 1008 HarlowRd MAP & TAX WT NUMBER: 17 03 22 00 02305 DEVEWPMENT TYPE: Addition to Drive thro Bank NEW DEVEWPED AREA (S.F.): 2.182.00 EXISTING DEVEWPED AREA (S.F.): TOTAL IMPERVIOUS SURFACE (S.F.): STORM DRAINM1<; ITE: ITE: WT SIZE (S.F.): 912 .-fl~ I.lll is III 8 cl u:lo 0;:l ~ tJJ' O:::lc:.r S732.67. S732.67 11<78 IMPERVIOUS SQ. FT. x S 0.323 PER SF 2.266 TOTAL STORM DRAINAGE SDC:' 2 SANITARY SEWER-CITY. A. REIMBURSEMENT COST: NUMBER OF DFIJ's B. IMPROVEMENT COST: NUMBER OF DFIJ's (SEE REVERSE SIDE) 24 x S 25.07 PER DFU 24 x S 19.07 PER DFU S 44.14 TOTAL LOCAL WASTEWATER SDq SI,059.35 I 3 TRANSPORTATION Per Dew study, verified by Gary McKenney 7/18106 BLOG AREA roSF x TRJP RATE x COST PER ADT x NEW TRJP FACTOR NEW A. REIMBURSEMENT COST: 2.18 x 38.41 B. IMPROVEMENT COST: 2.18 x 38.41 EXISTING A REIMBURSEMENT COST: 0.00 x 0 B. IMPROVEMENT COST: 0.00 x x S 19.09 PER TRJP x 0.55 NTF $879,83 ~ S3.880.85 ~ x S 84.t9 PER TRJP x 0.55 NTF x S 19.09 PER TRJP x o NTF SO.OO I SO.OO I o S 84.19 PER TRJP S 103.28 o NTF x x TOTAL TRANSPORTATION REIMBURSEMENT SDq TOTAL TRANSPORTATION IMPROVEMENT SDC:' TOTAL TRANSPORTATION SDC:, S 4,760,68 I 4 SANITARY SRWER - MWMC NEW: A. REIMBURSEMENT COST: NUMBER OF FEU's 2.18 x S51.56 PER FEU S1l2.511 B. IMPROVEMENT COST: NUMBER OF FEU's 2.18 x S543.9t PER FEU SI,186.81 , EXISTING: A. REIMBURSEMENT COST: NUMBER OF FEU's 0.00 x SO.OO PER FEU . so.oo I B. IMPROVEMENT COST: NUMBER OF FEU's 0.00 x SO.OO PER FEU SO,OO I MWMC CREDIT IF APPUCABLE (SEE REVERSE) TOTAL MWMC REIMBURSEMENT FEE: TOTAL MWMC IMPROVEMENT FEE: MWMC ADMINISTRATIVE FEE: TOTALMWMCSDC:, S 1,309.32 SUBTOTAL (ADD ITEMS 1,2,3. & 4) S7,862.02 I 5 ADMINISTRATIVE FEES' BASE CHARGE (SUBTOTAL ABOVE) S 7,862.02 x 5% , S393.1O TOTAL TRANSPORTATION ADMINISTRATION FEE: S TOTAL SEWER ADMINISTRATION FEE: S Sl>... @. ~ e.- SDC COORDINATOR 7/1812006 DATE TOTAL SDC CHARGES COM2006~00678, Uberty Bank, 1008 Hanow Rd.xts S601. 77 $457.58 SI,059.35 S879.83 S3.880.85 $4.760.68 SO.OO S112.51 St,186.81 S10.00 5t.309.32 - 285.60 I 107.50 H90 58...55.12 1 JULY 2004 . . DRAINAGE FIXTIJRE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUN ALENT ~ DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TIlE NET ADDmONAL FIXTURES) Addition to Drive lhru Bank FIXTIJRE TYPE BA TIITUB DRlNKING FOUNTAIN FLOOR DRAIN, FLOOR SINK INTERCEPTORS FOR GREASElOIUSOLIDSlETC. INTERCEPTORS FOR SAND/AUTO W ASIllETC. LAUNDRY TUB CWTIIES WASHERlMOP SINK CWTIIES WASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (1 PER TRAILER) RECEPTOR FOR REFRIGERA TORIW A TER ST A TIONIETC. RECEPTOR FOR COMMERCIAL SINKJ DlSHW ASHERlETC. SHOWER, SINGLE STAlL SHOWER. GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTIAL KITCHEN SINK: COMMERCIAL BAR SINK: WASH BASINIDOUBLE LAVATORY SINK: SINGLE LA VA TORY /RESIDENTIAL BAK URINAL, ST ALllW AlL TOILET, PUBLIC INSTALLATION TOILET, PRIVATE INSTALLATION MISCELLANEOUS: NUMBER OF EDll'S" FIXTIJRES UNIT NEW OLD EQUN ALENT 3 1 3 3 6 2 3 6 12 1 3 2 2 3 2 2 2 1 5 2 6 3 TOTAL DRAINAGE FIXTIJRE UNITS~ "EDU CEauivalcat Dwelling Unit) is a discIlarge eauivalcnt to a sin2le familv dwellino (20 DM set at 167 ..nons per day CREDIT CALCULA TION TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFfER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY YEAR ANNEXED 1979 or before 1980 198t t982 1983 1984 1985 1986 1987 1988 t989 1990 199t RATE PER SI,OOO ASSESSED VALUE ':1,-::,$5.29.:' ~'$5.19j \'$~:-12,~' : S4:9~: ::,S4.80, ';),~::~:: ',S41)'i :1:,$).67,: ;<'-$322 ? i'" $2.73: . -$2:25i Si.80:: YEAR AJ'Ilu:.A..r.D RATE PER SI,OOO ASSESSED VALUE 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE IMPROVEMENT (IF AFfER ANNEXATION DATE) C0M200fH)0678, Liberty Bank, 1008 Hartow Rd.xts ..."..,,_":;",Y;c;::J;"":':::,:':f:::'i\ ':,~;i~::,:~:!, ~:~J~:;~r~~:~ .... ' "';". .S1.09 .~~.::-~\'),;i:j' :~:~,; ~5:\E~' . ,. ',SO.OO x x CREDIT TOTAL DRAINAGE FIXTIJRE UNITS o o o o o o 3 o o 1 3 o o 3 o o 2 o 12 o o o o 24 SO.OO SO.OO SO.OO 1 JULY 2004 .... '" lSl g .... ,~ .., .-9 QI ~ CO o..:LI'il "'" en C> en =-~ == =' ~ g-l "'" rn ... <- 10 ="" "'" .. ...., = ..0 ....., ..... :>> 3:t: HZ mO ll.. <> CD :;; l:i ~ ~.. "" Um ='" " I....U~ a ~= " =-1 .. '" " =-1 " ~- .. -;:: . ~~~ ~<'l ...:> -= ~ aJ'Z ._;::: ... -l:z ~ "'-' "'= ? -i" ::E Ul ~~ ~~ ~ ~-- ~~ ......,~ C7'>~p., ~fi1i <::>..-4 ..0 <:::> ~:> C"J 10 "...{D 6lSJ ~~ ","'0 .~~ ;; C1\ ':I --;>~~ '" .... "'''' " ( ( ( 0 .." .... c: ... .~ 0 .... .~ 0 ."' -'" Ji;:; ,,= 0 " '" 11:; .. '" .. .. ..c ~ ~.. ~ ~, .. co i-' ... ~ .. ... ~ en ... ~. '" . CIIOO CjlyoIlfJIT~eltt . ColllJl1l1nily'ScoviRS Division 22S YiIDl SlRd Spriosfield, 011.91477 TIi./, ,..(S<lI)JU..37S9 'III: (S4I) 11.6-3689 " COM 2oolo -Colo-lfl i,(IS /a(p lIulldVig P\:nn1l II Dille -L.~b-k.~~~ G.J~ l)~rdi - . -- - <..> PlVjecllUe V ioo8 tbyleW lLoC\J PmJDd At!dm7 8pedJlltJJpa:trollaJlll TelllDg Te IlJlIIloIl1Io .rP!\PlS~ SpaUl mlj?dn cr lcotiD&... Fir smJaa UD4 o(llPI l!Rg0ll SItIanlTIII]Irdally.nw. I'In>E reY~ lu llfo:matlaWoJ... Mltil yau lol... IiIllJl!I!.~1l'l1lldi:Gllaili1ll'1It fa!lItmIiuo br&liOOibellil;; IRIlJtllmImIlnm In Ih<Cily. BDII&II:A PEtiIlTCAN BIISSI/Ul: ~D'_lI'_'.. '...., .;J ,,_ .nlhclllYillellfllm ""Il....Jol'mjod.&gllleOrorAm.ilcCl.D!ltlllllplclc-.t\'il.lIl.hiilllllllodr. Clil' hRlh:n>1IIIl!''ll911Walllds limn "'II"'" pold IIdulII IIdIlll:t. . 1\:m'llmllllGIIIIIIIIC......, "'" \II1cnoGjllkQG:,dm!laIsll...o . .\.!,'.,lhdlllJ~arG6iial!lWbirJ.tlilJaiol~014'<<'I"oIliir. L ColIrt:!cr b... ~. 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S. ~i1t"JllIllliblo Io~e.eary~..~ 6lrddiliollll~""."IIlli"8Rl\"",__'IIuIOlI}' llclllll1:4 BEillllEA CIIlJtPxCAT80rOcCuJ.ANCVWlLLBB ISSlJEDt ncSpr.r:lJl rll!pCllioa~ mil ~~.!.llJrBuildlDJ OIIlcialu__bld ~~ ~"l\d....fiIIlllIal4llll'<lIDlk<i1Bll_I.lbo:lialorl1loinSjlldoi'..,:~ ..;;.';'._mClllolGmlwiolritli-Ile.." """'JlhJo. sPidIlcJ1loIlJN"lIIka!lI. """.' ....1:.11 ."" :;...... ThlUIlJmu0I1lll1eIIIOIUotilll,"'''',,",GbcDJlcd I. Em~ ThlnplrlillD"'5l11IiIitl:d.~arypriorlD UIIXPlWfOfIilall-,...J_..J. A.;A.... .R.EDGEl."..'IO L;~.w?-..l"k.. ()wm:t~al1ld) ~-r'f ~1oA.~""- E~8rAIdrkmfinllll'riDl6d) %\ T~r..:l.~, ''', Nme(Pribl<4) SPECIAL INSPECTION AND TESTING SCHEDULE I Reinforced Concrete. Gunitc, Grout and Mortar: I Concrete Gunite Grout Mortar I I I I I I I X I 'Ii I I I frecnst/Pre~stn:ss.:d Concrete: I Pile, Post-Ten, Pre-Tens I I I I I x r Ag~reeate Test OfA'Iix Desi~n Rejnforcin~ Test },,[jx Desi~- Weidunastcr Cert * Reinforcinl! Plac~menl Continuous Batch PlanllnsDet't. InsDecl Placing Cast Saml!les SamDles CPickuolDeliveretll l Comuression Test. Claddin2 A e..gre~le T esls Reintorcine Tests Tendon Test Mix DesiRns. Reinforcing Placement Insert P 'ac~menl Com:rete Batching Concrete Placement lnstallation lmoection C"'l Somales Pick-Ilo SrnnDles Compression Tests SMOKE CONTROL: FfREPROOFING: Leakage testing Control Vedfication Placement insptclion Den.ily tests Thickness tesls Inspect botching ROOFING: Jnsulation jnslaLJ<JtionlR~V81ue. Test .'Itdps/seams ADDITIONAL INSRUCTIONS, OTHER TEST, & INSPECTIONS: AOOrTION.AL TIO:ST $ )1J:::'PEc..T\C:HJ~C.O"-IC.lLE"E C.C"-lC.\LE TE C.Oi"1 Pl2...ES~lal...l: 1.5o~P~\ GRADING, EXCAVATION,AND PILL AJ;;ceptance tests" PSF Establish final grade FiJI placement inspection/continuous Soil Density STRUCTURAL STEEUWELDING: Sample and test (list specific members below) Shop rnalcri~1 idenlitication (mill cert) X Weld inspeclion ~Shop ~field :x Ultrasonic inspection ~Shop ~t'ield High Strength Bolting_Shop _field A325 _N _X A490 _N _X Metal dt:ck welding inspection Reinforcing Stt:d welding illspection Reinforcing sted mill ceTtiticatc ~Ictal stuc.l \....dding impeclion Concrete inserl v...elding inspection MomenL resisting steel frames _F _F STRUCTURAL WOOD: X. Shear \,,'a]l nailing inspection X Shear wall ancho.. Inspection of Glu-Iwn fab. .. T/C psi Inspection of truss joist rub. Sample and test compiments )( Fabrication welding of sleet accessories ~'IASONRY Special inspection stresses used" r m f g Preliminary accept3J1ce tests (masonry units, wall prisms) Subscquenllests (monar, grout. tield wall prisms) Placement inspection of units, and reintorcement Masonry, morlar, grour, and rdnforcing steel certificates FonuComplet'dbY~ ~ Dat_l..,/r'//DV> TEMPEfLATOlLE~ <tAIR.... COl-..ITEI-.JT. 'PROVIDE STRENGTH REQUIRED BY ARCHITECT OR ENGINEER OR CONTRACT DOCUMEN1' LOCATION 01' VALUES "" en "- .... en "- tV "" "" en .... .p. w ..., ..., tV en w . en ..., en () .... --l < III Ul " ;0 .~ .... '" r <:> " 1> Gl '" "" ..., 225 FifUJ Street " " SP!ingfield, Qregon 97477 541-726-3759 Pbooe . -n:Q:;~ u.... _. . ~. .... of Spriogfield Official Receipt _elopmeot Services Department Public Works Departmeot Job/Journal Number COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 COM2006-00678 Payments: Type of Payment Check cReceintl RECEIPT #: 1200600000000001124 Date: 07/21/2006 Description Fire SF Fee - Non-Residential Temp Power 200 amps or less Furnace - up to 100,000 btu Vent Fan Gas Outlets 1-4 -Mechanical Issuance Fee- Fixture Building Permit Paving + 8% State Surcharge + 10% Administrative Fee Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin Paid By LIBERTY BANK Item Total: . l:heck Number Authorization Received By Batch Number Number How Received ddk 9970037 In Person Payment Total: Page I of I II :35:29AM Amount Due 218.20 50.00 36,00 18,00 4.00 10.00 140,00 3,549,15 499.35 303.77 451.47 732.67 601.77 457,58 879,83 3,880.85 112.51 1,186,81 10,00 107,50 285.60 $13,535,06 Amount Paid $13,535.06 $13,535,06 7/2112006