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Home My WebLink AboutPermit Building 2005-05-20Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00387ISSUED: 0512012005APPLIEDz 0410412005 EXPIREST 1112012005VALUE: $ 30,000.00 SITE ADDRESS: 22017TH ST ASSESSOR'S PARCELNO.: 1703363102800 JAMES STRODA 220 N 17TH ST SPRINGFIELD OR 97477 Springlield TYPE OF WORI(: Single Family Residence TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Remodel existing residence add bath tqqllTEltt FEDN: Oregon law requlres YotJ to rules ado the Oregon Utility Owner: Address: N n r. Contractor Type Electrical Contractor C & S ELECTRIC in OAR 952-001-0010 0090. You maY obtain copies olthe rules bY Oregon Utility Notilication is 1-800-332-23441, Expiration Date 09/01/2008 License 3849 t-2182 Phone 541-741-2236 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport ' sq Ft other: Occupant Load: R-3 VN nla REQUIRED PARIilNG Total: Handicapped: Compact: Fully Improved Yes Sidewalk Type: Downspouts/Drains: Curbside 5' Curb and Gutter Notes: $ Per Sq Ft or multiplier Square Footage or Bid Amount DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Description Type of Construction Pase 1 of3 Value Date Calculated mfr* T D U lLrrll\ lJ r.\ r rJr(lvl,q,!!!lNJ Valuation Description I 'ND0 PR}I'IIBFIILD Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Buitding/Combination Permit PERMIT NO: COM2005-00387ISSUED: 0512012005 APPLIEDz 0410412005EXPIRES: 1112012005VALUE: $ 30,000.00 Bid Amount Use Bid Amount Fee Description PIan Review Residential + l0o Administrative Fee + 7oh State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less -Mechanical Issuance Fee- + l0oh Administrative Fee * 7o/o State Surcharge Building Permit Dryer Vent Exhaust Hoods Fixture Minimum/Adj ustment Mechanical Miscellaneous Mechanical Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Paid $1.00 30,000.00 Total Value of Project Date Paid $30,000.00 $30,000.00 04t29t2005 Amount Paid Receipt Number 1200s00000000000544 2200s00000000000s46 2200s00000000000s46 2200500000000000s46 2200500000000000546 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200500000000000231 3200s00000000000231 3200s00000000000231 3200500000000000231 $164.87 $9.30 $6.51 $30.00 $63.00 $10.00 $43.87 $30.71 $253.6s $6.00 $9.00 $140.00 $1s.00 $9.00 $127.96 $168.28 $14.81 $6.00 4t29t05 5t9t05 5t9t05 519t05 5t9t05 5120t05 5t20t05 5t20t05 5t20t05 5120t05 5t20tos 5120t05 5120t05 5l20t0s 5t20t05 st20t05 5t20t05 5120t05 $1,107.96 Fpp,s Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 05t02t2005 0st02t2005 05t02t2005 0510212005 05/03/2005 05/03/2005 0s102t200s 05/18/2005 APP JB No Planning Review required. Storm drainage to existing 51312005 CAS Approved as noted APP APP APP SKG TAJ CAS 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. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Footing: After trenches are excavated. Paee 2 of3 \ Keoutred Inspections I Fnl|letlSD Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2005-00387ISSUED: 05/20/2005 APPLIEDz 04104/2005EXPIRESt 1112012005VALUE: $ 30,000.00 By signature' r state and agree, that I have carefully examined the completed application and do hereby certify that aIIinformation hereon is true and correct, and IJurther certify thaiany ana all work performed shall be done in accordance withthe ordinances of the city of springfield and the Laws of ihe stateLf oreg-oo pe.tiioirgio tne work described herein, andthat No occupANcy-wilt be made of any structure without permission ortn. co-rn,ir5, s1*i.es Division, Building safety.I further certify that only contractors and imptoyees who are in comptiance with oRs 701.005 wiil be used on this project.I further agree to ensure that all required inspeciions """ "uqu".t.d aj the proper time, that each address is readable from theH""::'r#:li:rrrflfrffi;d is located at the front of the property, and trre approveJ..i ripr"rs wilr remain oo tn. site at alr Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. shear wall Nailing: Before covering sheathing with linish 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. Dryrvall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: prior to insulation or decking. Rough Plumbing: prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Rough Mechanical: prior to Cover Final Mechanical: When all mechanical work is complete. 44 uaE Owner or Contractors Signature Date Pase 3 of3 JOURNAL OR JOB NUMBER: NAMEORCOMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING TIMTS I. STORM DRAINAGE DIRECT RLTNOFF TO CITY STORM SYSTEM CITY OF SF^TNGFIELD SYSTEMS DEVELOPMEN] 'TORKSHEET coM2005-00387 Susan Stroda 22017thSt 1 703363 I 02800 SINGLE FAMILY RESIDENCE 0 BUILDING SIZE (SF, O LOT SIZE (SF):0 0.00 RT]NOFF ROUTED DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F NLII\4BER OF DFU's 7 B. IMPROVEMENT COST: NUMBER OF DFU's 7 ADTTRIP RATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 SUBTOTAL $296.24 COST PER S.F $0.3 r 0 COST PER S.F $0.3 l0 COST PER DFU $24.04 $ 18.28 NUMBER OF LTNITS 0 NLMBER OF I.INITS 0 ADM. FEE RATE 5Yo CHARGE $0.00 DISCOL]NT RATE 50% $0.00 DISCOTINT $0.00 x x x x x x x x x x ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CIry A. REIMBI]RSEMENT COST: ITEM 2 TOTAL. CITY SAI\IITARY SEWER SDC 3. TRANSPORTATION A REIMBT]RSEMENTCOST: s296.24 COST PER TRIP $r 8.30 COST PER TRIP $80.72 $0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 xx xx ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU'S 0 B. IMPROVEMENT COST: NLIMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBToTAL (ADD ITEMS t,2,3, & 4) 5. ADMINISTRATME FEE: $0.00 s296.24 CHARGE $ r 4.81 TOTAL SANITARY ADMIMSTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Cheryl Slaymaker 51312005 IMPERVIOUS S.F 0.00 COST PER FEU $82.03 $0.00 $0.00 $0.00 $0.00 $0.00 14.81 $311.05 1070 1091 1092 I 093 1094 1054 I 055 I 056 079 078 0 E] t-.1o O E]F0 frld COST PER FEU $865.31 PREPARED BY DATE TOTAL SDC CHARGES DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FXTURES x UMT EQUIVALENT = DRAINAGE FXTURE UNITS FOR CAICULATE ONLY TFIE NET ADDITIONAL NO. OF FXTURES LINIT FIXTURE TYPE NEW OLD ALENT MISCELLANEOUS DFU TYPE NUMBER OF EDU'S TOTAL DRAINAGE FD(TURE TINITS tsa toa mil set at I 67 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE DRAINAGE FIXTURE UNITS 2 2 1979 +EDU REFORE 1979 1979 I 980 1981 1982 I 983 1984 1985 I 986 1987 1988 1989 t990 1992 1993 1994 I 995 I 996 1997 r 998 I 999 $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $+.+o $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 VALUE/ 1000 $0.00 CREDIT RATE ss.29 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FORANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR CRED]T FOR LAND (IF APPI-ICABLE) x CREDIT FOR IMPROVEMENT OF AFTER ANNEXATION) VALI]E / IOOO CREDIT RATE $0.00 x $5.29 TOTAL I},IWMC CREDIT 1991 $1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0,28 $0.09 $0.05 0003BATIITUB 0 1 0DRINKING FOTINTAIN 0 0 0 3 0FLOOR DRAIN 0003INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 6 0INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 0 2 0LALINDRY TUB 0 0 3 0CLOTFIESWASHER / MOP SINK b 000CLOTIIESWASHER- 3 ORMORE (EA) 0 0 12 0MOBILE []OME PARK TRAP (1 PER TRAILER) 000IRECEPTOR FOR REFRIG / WATER STATION / ETC 0 3 00RECEPTOR FOR COM. SINK / DISHWASHER / ETC. I 0 2 2SHOWE& SINGLE STALL 0SHOWER GANC TNTUMBER OF T{EADS)0 0 2 0 3 0SINK: COMMERCIAL/RESIDENTIAL KITC}IEN 0 0 0 2 0SINK: COMMERCIAL BAR 2102SINK: WASH BASIN/DOUBLE LAVATORY 0 1 0SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 0 5 0URINAL, STALL / WALL 0006TOILET, PL]BLIC INSTALLATION 1 0 3 3TOILET, PRIVATE INSTALLATION YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE s0.00 2000 200'l 20 Permit #:7Construction Contractors Board 700 Summer St flE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: rvww.ccb.state.or.us raoress:Jf,o /*-5 Issued Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a buildtng permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licenstng 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, md either box 3A or 38: M l. I own, reside in, or will reside in the completed structure. 2 I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will instnrct my general contractor that all subcontractors who work on the structure must be licensed with the Constnrction Contactors Board. OR M 3B. I will be my own general contractor. If I 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 notiff 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 of this form. 'hta" 2t, AS (Signature of permit applicant) (White copy to issuing agency perrnitfile, pink copy to applicant.) Property_owner.doc 06-0 1 -04 da{;'n 225 Fifth Street Springfietil, Oregon 97 477 541-726-3759 Phone -levelopment Services Department Public Works Department RECEIPT #: 3200500000000000231 Date: 0512012005 1:39:32PM Job/Journal Number coM2005-00387 coM2005-00387 coM200s-00387 coM200s-00387 coM2005-00387 coM2005-00387 coM200s-00387 coM2005-00387 coM200s-00387 coM2005-00387 coM2005-00387 coM2005-00387 coM200s-00387 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture Vent Fan Exhaust Hoods Dryer Vent Miscellaneous Mechanical Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 7Yo State Surcharge + l0% Adminishative Fee Amount Due t68.28 127.96 14.81 2s3.6s 140.00 6.00 9.00 6.00 9.00 15.00 10.00 30.7r 43.87 Item Total:$834.28 Payments: Type ofPayment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check JAMES/SUSAN STRODA nJm 8445 In Person Payment Total: $834.28 -SM:ts- ,t :( s12012005 Page I of I 5t Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2005-00387ISSUED: 05/09/2005APPLIED: 0410412005EXPIRES: 11/0912005YALUE: $ 30,000.00 SITE ADDRESS: 220 17TH ST Springfield TYPE OF WORK: Single Family Residence ASSESSOR'S PARCEL NO.: 1703363102800 TYPE OF USE: Addition Residential PROJECT DESCRJPTION: Remodel existing residence add bath to 2nd floor Owner: Address: Contractor Type Electrical JAMES STRODA 220 N 17TH ST SPRINGFIELD OR 97477 Phone Number: 541-741-2182 Contractor C & S ELECTRIC License 3849 Expiration Date 09/01/2008 Phone 541-741-2236 CONTRACTOR INFORMATION PUBLIC yTATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Vo ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 VN nla Fullv Improved yes R"EQUIRED PARKING Total: Handicapped: Compact: law requires Yo uto Notes:tU run $ Per Sq Ft or multiplier Square Footage or Bid Amount DEVELOPMENT INFORMATION Description Tvpe of Construction Page I of2 Value Date Calculated .L Valuation Description I Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2005-00387ISSUED: 05/09/2005APPLIED: 0410412005EXPIRES: 11/0912005VALUE: $ 30,000.00 Bid Amount Use Bid Amount Fee Description Plan Review Residential + lOoh Administrative Fee + 77o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid $1.00 30,000.00 Total Value of Project Date Paid 4t29t05 stgt0s 5t9t05 519105 519l0s Receipt Number r200500000000000s44 2200500000000000546 2200s00000000000546 2200500000000000546 2200500000000000546 $30,000.00 $30,000.00 04t29t2005 Amount Paid $164.87 $9.30 $6.51 $30.00 $63.00 $273.68 ees Paid Initial Review Planning Review Public Works Review Structural Review 0st02t2005 05t02t2005 0st02t200s 05t02t2005 05t02t2005 05/03/2005 05/03/2005 APP APP APP SKG TAJ cAs No Planning Review required. Storm drainage to existing 5/3/2005 CAS To Request an inspection call the24 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. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Reouired Insnections 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. Owner or Contractors Signature Paee2 of2 Date 5 Fifth Street pringlield, Oregon 97 477 ll-726-3759 Phone eity of Springfield Official Receipt velopment Services Department Public Works DePartment RECEIPT#: 2200500000000000546 Date:05/09/2005 7z54l24LM Job/Journal Number coM2005-00387 coM2005-00387 coM2005-00387 coM200s-00387 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7% State Surcharge + l0%o Adminishative Fee Amount Due 63.00 30.00 6.51 9.30 Item Total:$r0E.81Payments: Type of Payment Check Paid By C & S ELECTRIC Received By Batch Number Number How Received lth t1567 By Mail Payment Total: Amount Paid $ 108.81 - $108.81 Check Number s/9/2005 Page I ofl trDtlloflD Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00387ISSUED: 0510912005APPLIEDz 04104/2005EXPIRES: 1110912005VALUE: $ 30,000.00 SITE ADDRESS: 22017TH ST ASSESSOR'S PARCEL NO.: 1703363102800 TYPE OF USE: Addition PROJECT DESCRIPTION: Remodel existing residence add bath to 2nd floor Springfield TYPE OF WORK: Single Family Residence Residential PhoneNumber: 541-741-2182Owner: Address: Contractor Type Electrical JAMES STRODA 220 N 17TH ST SPRINGF'IELD OR 97477 Contractor C & S ELECTRIC License 3849 Expiration Date 09/01/2008 Phone 541-741-2236 CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available; Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARIilNG Total: Handicapped: Compact: R-3 VN nla Fully Improved yes Curbside 5' and Gutter $ Per Sq Ft or multiplier Square Footage or Bid Amount DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Description Tvpe of Construction Page I of2 Value Date Calculated t^ |, U rrrrrtl\ (, II\ I t,K1Yr,q.!.[lN_] trVD 'ur 1 AIn..,V RIZED UNDER I ENCED OR IS AI GFIELD Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00387ISSUED: 05/09/2005APPLIED: 0410412005 EXPIRESz 1110912005VALUE: $ 30,000.00 Bid Amount Use Bid Amount Fee Description Plan Review Residential + l0o Administrative Fee + 7%o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid $1.00 30,000.00 Total Value of Project Date Paid Receipt Number 1200500000000000544 2200s00000000000s46 2200s00000000000546 2200s00000000000546 2200500000000000s46 $30,000.00 $30,000.00 04t29t2005 Amount Paid $164.87 $9.30 $6.s1 $30.00 $63.00 $273.68 4t29t0s st9t05 5t9105 5t9t05 st9tos tr'ees Paid Plan Reviews Initial Review Planning Review Public Works Review 05t02t200s 05t02t2005 05t02t200s No Planning Review required. Storm drainage to existing 51312005 CAS Structural Review 0510212005 To Request an inspection call the24 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. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 0st02t200s 05/03/2005 0s/03/200s APP APP APP SKG TAJ CAS Reouired Insnections 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. Owner or Contractors Signature Pa;ee2 of2 Date BTljD, T 225 Fifth Street Sfiringfield, Oregon 97 47 7 541-726-3759 Phone City of Springlield Oflicial Receipt rvelopment Services Department Public Works Department RECEIPT #: 2200500000000000546 Date:05/09/2005 7:54:24AM Job/Journal Number coM2005-00387 coM200s-00387 coM2005-00387 coM2005-00387 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7Yo State Surcharge + l0% Administrative Fee Amount Due 63.00 30.00 6.51 9.30 Item Total:$108.81 Payments: Type of Payment Paid By checl(Number Authorization Received By Batch Number Number How Received Amount Paid Check C & S ELECTRIC llh 1t567 By Mail Payment Total: $108.81 -siit5:Er 5191200s Page I of I atamtlSD