The URL can be used to link to this page

Home My WebLink AboutPermit Building 2006-10-19Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01226ISSUED: 1011912006APPLIED: 0912212006EXPIRES: 06/0812007VALUE: $ 101,277.00 SITE ADDRESS: 2720 33RD ST ASSESSOR'S PARCELNO.: 1702193100311 Springfield TYPE OF WORK: Single Family Residence PROJECT DESCRIPTION: Addition to existing single family residence Owner: Address: Contractor Type Architect General Electrical Mechanical Plumbing MICHELLE JOHNSON 2720 N 33RD SPRINGFIELD OR 97477 in OAH 0090 You maY obtain cop calling the center License 08699 26743 Residential bslr-ggg-r+s thetelePhone Notification Expiration Date Phone 541-746-7757 12n8t2006 08t26t2008 541-736-9876 Contractor LUKE DESIGNS,INC. OWNER OWNER GOOD DEAL METAL PRODUCTS INC OWNER BUILDING INFO # 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: Fully Improved Yes Sidewalk Type: Downspouts/Drains: R-3 VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path; snrinkrffiiHgg, Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:nla 6.00 10.60 52.00 17.50 XPIBE IF THE WOHK REQUIRED PARKING overhrCfiMll E N C ED 0ftJ&Afr,f,fl$fl NE ti Fft6tat: # Streeffife( BQOAY PERIQD Handicapped: Paved Drive Rqd: Compact: o/o of Lot Coverage: PUBLIC IMPROVEMENTS Notes: Storm H2O to curb & gutter system.JlP Paee I of4 Curb and Gutter (Note: FIELD Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01226ISSUED: 1011912006 APPLIEDz 0912212006 EXPIRES: 06/0812007VALUE: $ 101,277.00 Description Type of Construction Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0o Administrative Fee + 57o Technology Fee + 87o State Surcharge Building Permit Fire SF Fee - Residential Fixture Not Covered Mechanical Pellet Stove/Insert SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan + l0"h Administrative Fee + 5%o Technology Fee + 87o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid Total Value of Project Date Paid $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Amount Paid $371.90 $10.00 $76.03 $35.46 $s6.73 $s72.1s $s1.15 $s6.00 $4s.00 $30.00 $2.16 $43.13 $6.00 $8.40 $4.20 $6.72 $21.00 $63.00 $1,459.03 Receipt Number 1200600000000001437 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 220060000000000r467 2200600000000001467 2200600000000001467 1200600000000001789 1200600000000001789 1200600000000001789 1200600000000001789 1200600000000001789 9t22t06 10/18/06 10/18/06 10/18/06 10/18/06 10/18/06 10/18/06 10/18/06 t0n8l06 10/r8/06 10/18/06 10/18/06 10/18/06 12t26/06 12t26t06 12t26t06 12t26t06 12t26t06 Fpes Peid Plan Reviews Initial Review Planning Review Public Works Review Public Works Review Structural Review 09t22t2006 10fi8t2006 09t22t2006 10fl7t2006 09t22t2006 09t22t2006 10/18/2006 10n7t2006 10t03t2006 DLM OK APP APP APP NJM TAJ JLP JLP No Planning issues. Storm H2O to curb & gutter system.JLP To Request an inspection call the 24 hour recording at 726-3769. AII 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. Paee 2 of 4 Yafuation Uescri 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: COM2006-01226ISSUED: 1.011912006 APPLIEDz 0912212006 EXPIRES: 06/0812007VALUE: S 101,277.00 Reouired Insnections 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. 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. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Special Inspection: High Strength Bolting Inspection: To be done during construction by a State Certified Special Inspector with approval from the City of Springfield. Copies of inspection results shall be provided to the City of Springfield. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Page 3 of4 Status 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: COM2006-01226ISSUED: 1011912006 APPLIEDz 0912212006 EXPIRES: 06/0812007VALUE: $ 101,277.00 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 certi$ 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 70f .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. /e-)b-o(o Owner or Contractors Date Page 4 of 4 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone C;' - of Springfield Official Receipt L- clopment Services Department Public Works Department RECEIPT #: 1200600000000001789 Date: 1212612006 10:41:42AM Job/Journal Number coM2006-01226 coM2006-01226 co}d2006-01226 coM2006-01226 coM2006-01226 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 57o Technology Fee + 8% State Surcharge + llYo Administrative Fee Amount Due 63.00 21.00 4.20 6.72 8.40 Item Total:$103.32 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check MICHELLE JOHNSON ddk 3 819 In Person $103.32 Payment Total: -5T6ffi cReceint I Page I of I 12t2612006 sPFltruGFlELCl 'il %,',= ZON Li)4 INITIALS DATE I ) IIL,fN-rG 225 FIFTH STREET o SPRINGFIELD,OR 97477 o PH:(541)726-3753 o FAX: (541)726-3689 E LECTRI CAL P ERM IT AP P LI CATI O N City Job Number C,oM a0olo- D \\l n Date IA )Lo - oLo I. LOCATIAN OF INSTALIATIAN:3.COMPLETE FEE SCHEDULE BELOVV LEGAL DESCRIPTION A. Nerv Residential - Single or Multi-Family per dwelling unit' 1*i o).g 3t Octstt JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 daYs. 2. g0NTRACTORTNSTALLATONONLY Electrical Contractor Otpvrn a Address Phone Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or 401 Amps 601 Amps to l@0 AftYlfsr i*s 1 Over 1000 Amps/Volts Reconnect Only 200 Amps or less 201 Amps to 400 AmPs 401 Amps to 600 AmPs the oregnn t ltititflRbfificat'on -non-'lr2-8SC4Eo $37s.00City B. D. E. Supervisor License C. I'emporary Sen'ices or Feeders Installation, Alteration or RelocationExpiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician $ s0.00 $ 69.00 $ 100.00 Owners Name Address City OWNER INSTALLATION The installation is being made on properly I own which is not intended for sale, lease or reqf. Phone q$g-134q Pump or irrigation $ 50.00 Sign/Outline Lighting $ s0.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. SUBTOTALAFABOW g 8% State Surcharge l0% Administrative Fee 5% Technology Fee 103 42Inspection Request: 726'3769 TOTAL Shared Driv(T:)/Building Forms/Electrical Permit Application 8-06.doc OREGON )'t n 34.) souRCEEYt++z/€ $106.00 $ 19.00 .- 200 201 Brancft I4r ir n . M i. [,elle Jclnnsovl \ New Per Panel .oD F Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fa'x 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01226ISSUED: 1011912006 APPLIED| 09t22t2006 EXPIRESz 0411912007VALUE: $ 101,277.00 SITE ADDRESS: 2720 33RD ST ASSESSOR'S PARCEL NO.: 1702193100311 PROJECT DESCRIPTION: Addition to existing single family residence Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PhoneNumber: 541-988-1349 Phone 541-746-7757 Owner: Address: Contractor Type Architect General Electrical Mechanical Plumbing MICHELLE JOHNSON 2720 N 33RD SPRINGFIELD OR 97477 Contractor LUKE DESIGNS,INC. OWNER OWNER OWNER OWNER )R INFORMATION # 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: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy ,32- IS Sidewalk Type: Downspouts/Drains: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport ABANDON RK T ED FOR REQUIRED PARKING Total: Handicapped: Compact: R-3 VN Fully Improved Yes t E. Sprinkled IT ShfILL 6.00 10.60 52.00 17.50 COM Overlay Dist:n,U.i]l#lqgg. # Street Trees Rqd: Paved Drive Rqd: oh oILot Coverage: PUBLIC IMPROVEMENTS Notes: Storm H2O to curb & gutter system.JlP Paee 1 of3 Curb and Gutter Status 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: COM2006-01226ISSUED: 1011912006 APPLIEDz 0912212006 EXPIRESz 0411912007VALUE: $ 101,277.00 Description Dwellines Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0o/o Administrative Fee + 57o Technology Fee + 87o State Surcharge Building Permit Fire SF Fee - Residential Fixture Not Covered Mechanical Pellet Stove/Insert SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan Total Amount Paid Type of Construction V Wood Frame $ Per Sq Ft Square Footage or multiplier or Bid Amount $99.00 1,023.00 Total Value of Project Amount Paid Date Paid Value $101,277.00 $101,277.00 Date Calculated 09t2212006 $371.90 $10.00 $76.03 $3s.46 $56.73 $s72.1s $s1.1s $s6.00 $4s.00 $30.00 $2.16 $43.13 $6.00 $1,355.71 9t22t06 10/18/06 10/18/06 10/18/06 10/18/06 10/18/06 10/18/06 r0/18/06 r0/18/06 10/18/06 l0/18/06 10/18/06 10/18/06 Receipt Number 1200600000000001437 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 2200600000000001467 Fpps Peid Plan Reviews Initial Review Planning Review Public Works Review Public Works Review Structural Review 09t22t2006 10/r8/2006 09t22t2006 10n7t2006 09t22t2006 09t22t2006 10n8t2006 t0/17t2006 10t03t2006 DLM OK APP APP APP NJM TAJ JLP JLP No Planning issues. Storm H2O to curb & gutter system.JLP 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Paee 2 of3 Ronrrired fnsnecfinns Valuation Descrintion I OF Building/Combination Permit PERMIT NO: COM2006-01226ISSUED: 1011912006APPLIED: 09/2212006EXPIRES: 0411912007VALUE: $ 101,277.00 LD Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line Floor Insulation: Prior to decking. 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. Hold Downs Installed: Special Inspection performed prior to placement of concrete, Provide report to City Building Inspector. Special Inspection: High Strength Bolting Inspection: To be done during construction by a State Certified Special Inspector with approval from the City of Springfield. Copies of inspection results shall be provided to the City of Springfield. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. 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 correcto 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 Safefy. 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. lo-p -o Lo Owner or Contractors Page 3 of3 Date Construction Contractors Board permita.tDwlZt "6 OI LZ6 Address: ?-'-7LO 33 ua 5 + Issued by:Date Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensedwith the Constructton Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engtneer applicants, exemptfrom 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 38 700 Summer St IrlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress: www.ccb.stgtg@ 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. b, $z 3A. My ge,neral contractor is (Name)(ccB #) If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a conkactor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. (Signature of applicant) (White copy to issuing agency perunit file, pink copy to applicant.) Property_owner.doc 06-0 I -04 I will instruct my general confiactor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR K:r. I will be my own general contractor. to-n-ob (Date) Ac**mS e$ Yc*r $wn Gexxeral Cantraetor? lrxroxnq*fisN NsTr*E Y* plqspxffi,yy *wNffi&s ,&B*UT **hlSTRUfiTlON Rm&p*zuSlBILlTlxs fVOIs; Tkis ln{*rrnaflon A/ofic* t* Fr*p*rty O*vners a}cu{ Sonstru*ti*n Resporisl&ilffie$ lvas deiveloped by the Consfrxcfior: **ntra*d*rs Eoard in accardance wifh ORS V01.055{5J, passed }y f*e 1989 *regan d-*grdsfafl;re, nf y*u are a*ting Es y*ur *r*x c**traet*r to co*sh"*et a nsw hl:me or rrak* * sul:stnnfiatr irxpr*v*ment t* an *xi*ting strueture, y$nr r*ir pr*v*::rt many problerns by ireing aware of the follorving responsibili:ies and c*ncei:rs. ffi mp&*yffi x' &*$Bmms ih* *t$es Y*u rrill, in nxlst inst*r:ces, be ruIed to be ax 'uenrplsyer" anstr the cor:lra*l*rs you c*ntract wrth wrll be "'e:npluy***" if, y{:u use conkactci{s $<lt licefised wipb t}:e Canstrl}cti$x C**tract*rs Board tt: d* lah*r in s*n**xcting or t& assist in th* ccmsxrueti&x: *r impr*v*rne::t erf a residenti*tr *truc*:re. Ax {he emptr<lyer, ymu rnust **mp}y with t}ra fol}tlx,ixg: {}reg*xt's Witlx*roldixrg ?'ax {-awr A* an *rnployer, y#l;l rxust ivit}rh*}d inco;:::e t*x*s fr*m enpl*yee weg*$ at the tims empl*y*es ar* paid" Y*u w'iil l:e iiabl* fbr tl:* taN pa3me*ts *:,,*n if y*u <3**'t a*t*ally ir",it}:3?*ld the tax fr*n: y*ur *rnplcye*s. F*r rnr:re {nf?:rxvratiqm, eall the l}epa*rnent *f Keven*e at $03-3?8-4$88. Unemptroymemt Inslrram*e Taxr "A"s an emptroyer, you are required to pay a tax ior *nenrployment insurance purpo$€Br- on the wages of all *xnpl*yees. F*r mere inf<xmati*n, *alX the Sregon firrpl*yme*t Oepartment at 5*3-947-1488. The ft*gcn Susi*ess Xds:tifieaticn }durnber (IIIN) is * c*ntbined number lor both Oregon Withholding and Unemtrl0ymgntInsur*,ne*Tax.Tcfi1eforaBIN,**i}5*3.$45.8s91or}Yx1y*Miorthe appropriate forms. Wcrkers' Car*p*msmti*rnx Imsursn*e: As ax *mp}*y*r, you ar* sui:r.ject 1* the Greg*n trVrrkers' C*xrpensati$t: 3-aw, and rnust clbtsi* w*rkers' *omprnsatiqln ins*rance *"or y*ur *rmpi*yee*. If y*Ll fail t* obtain worker$' comper:salion insurancc" y*u *auld be x*bj**t to penalties and be liable for all clairn costs if *ne *f,your emptroyees is injrxed CIn the job. F*r rn*r* infurmati*n, eall the W*rkers' Colxpens*ti*n *ivisi** at the Oeparln:e*t slf Cortsurner and Business $erviees at 503-947-78 1 5. f,i,S, trntenxlnX Kev*nu* Servicel As ax *nrpleryer, y*u rxu$t rvitl:hr:ld fu*J*ral incorne tax fi'orn empl*3rees' *ug**)-- Y*u wil} be }i;ibic l*r *t* tax payxlerlt evcn if y*r: didn't a*tu*trly ivithh*ld the tax. F'cr a Federal SI}{ *ul*b*r, catrl the IRS at X-BSS-829-4933 nr visit their rveb site at.UXx,U&g{ty" $*her Kesp*nsibilities and Arem$ $f'Con*erns C*de C*raEpl*xxre*: As th* per:xit hnlder fcrr this pr*;eet, )re:rl aro resp*nsihl* Jclr r*so!'"'tng any farlure to r*e*t e*de requir*n:ents lh*t sxay b* br*reght to y*:*r atl*nti*e thr*:ug}: i::*p*ctions. X,iahility amei Sr*p*rfy Ilamagc lnsuranc*; C*:rta*t y*xr i*:sur*nc* agent to ste if you have adequate insura*ce $*verege f*r aer:i<irl:ts arxd firni*sru:ns surh as fbtrl{ng tor}u, paint {:}n/*r $pray} w*t*r damag* {r*m pip* p*:*rures, fire sr w*rk that rxust b* red*n*" ?ime: &{ak* sur* y*u h*ve sutlleient tirn* tt supervise your empl*yees. XNpertise: &{ak* sllr* y*u k*ve thr ski}ls to act a.s your t:w"rr geneml contractor, ln *o*rdjnate th* w*rk cf rcugh-in a:rd flnish #ad*s, xn*i x* notify building *fficixls as tl"le appr*;:r"iate n:im*s s* th*y *x* p*rf<rrn"l the rrquired inspe*ti*ns. If you have additionatr questions call t}'re Consfruction Contractors Board (503-3784621) or write the agency at PO Box 14140, $alem, OR 97309-5CI52. ,.i_ ,.,. r.1i,. . Properfy-ownr.doc 06-0 1 -0 4 JOI.IRNAI OR JOB NUMBER: NAME ORCOMPANY: LOCATION: TAX LOTNI.IMBER: DEVELOPMENT TYPE: NEWDWELLINGUMTS I. STORM DRAINAGE DIRECT RI]NOFF TO CITY STORM SYSTEM CITY OF SPRTNGFIELD SYSTEMS DEVELOPMENT WORKSHEET coM2006-01226 Brian & Michell Johnson 2720 33rd Street r 702193 1003 1 I SINGLE FAMILY RESIDENCE 0 BUTLDTNG SIZE (SFl 128.5 LOT SZE (SF):0 IMPEMOUS S.F. x r28.50 RIJNOFF ROU'TED TO DRYWELL DESIGNED AND IMPERVIOUS S.F 0.00 NLIMBER OF DFU's 0 B. IMPRO\EMENT COST: NTIMBER OF DFU's 0 ADT TRIP RATE 9.5',1 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 S1'BTOTAL $43.1 3 COST PER S.F $0.336 COST PER S.F s0.336 COST PER DFU $26.03 $r 9.79 NT]MBER OF LINITS 0 NUMBER OF ITN]TS 0 ADM. FEE RATE 5% TO CIry STANDARDS DISCOUNT RATE 50v, $43.13 DISCOLINT $0.00 x x x x x x x ITEM 1 TOTAL - STOR]VI DRAINAGE SDC 2. SANITARY SEWER - CIry A. REIMBTJRSEMENT COST: ITEM 2 TOTAL - CITY SAMTARY SEWER SDC $0.00 3. TRANSPORTATION A. REIMB{,R.SEMENT COST: xxCOST PER TRIP $r 9.8 r COST PER ]-RIP $87.39 $0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 xx ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU'S 0 B. IMPROVEMENT COST: NUMBER OF FEU'S 0 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: $0.00 $43.13 CTTARGE $2.r6 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMIMSTRATION FEE: Jeff Prociw 10t17 /2006 CHARGE $43.13 COST PER FEIJ $9r.6r $43.13 $0.00 $0.00 $0.00 $0.00 2.16 $0.00 $45.29 I 070 I 091 1092 1093 to94 1 054 I 055 1054 r 056 1079 r 078 a El IJcO !..1Fa rI] COST PER FEU s961 .52 PREPARED BY DATE TOTAL SDC CIIARGES x 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone C;' of Springfield Official Receipt D- ;lopment Services Department Public Works Department RECEIPT #: 2200600000000001467 Date: 10/18/2006 2:53:lePM Job/Journal Number coM2006-0r226 coM2006-01226 coM2006-01226 coM2006-01226 coM2006-01226 coM2006-01226 col|/'2006-01226 col|,42006-01226 coM2006-01226 coM2006-01226 coM2006-01226 coM2006-01226 Description Fire SF Fee - Residential Building Permit Fixture Vent Fan Pellet Stove/Insert -Mechanical Issuance Fee- Not Covered Mechanical + 570 Technology Fee + 8% State Surcharge + l0oh Administrative Fee Storm Drainage Impervious Area SDC Sanitary/Storm Admin Amount Due 5l.r5 572.15 56.00 6.00 30.00 10.00 45.00 35.46 56.73 76.03 43.13 2.16 Item Total:$983.81 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check MICHELLE JOHNSON njm 3742 ln Person Payment Total: $983.81 -SffiBT cReceint I Page I of I t0/1912006