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Home My WebLink AboutPermit Building 2007-03-20\*-.] Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2007 -00127ISSUED: 0312012007 APPLIED: 0112512007 EXPIRES: I lll5l2007VALUE: $ 15,552.00 SITE ADDRESS: 829 S 43RD ST ASSESSOR'S PARCEL NO.: 1802052108900 PROJECT DESCRIPTION: Shop addition to"''tf8tl CE TYPE OF WORK: Shop TYPE OF USE: Addition Residential Phone 541-747-1408 License Expiration Date Phone Owner: Address: Contractor Type General Electrical RODELLO GILBERT A 829 S 43RD ST SPRINGFIELD OR 97478 Contractor OWNER OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Fronfyard Setback: Side'l 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:NTIO ies ado N:Oregon la by Sprinkled Building OS 576 To Culvert - Provide Drainage Plan I Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: U VB 14.00 14.00 Overlay Di*eii'?10 # Street TftUJfrm[ Paved Drive Rqd: oh ofLot Coverage: copies the center (Note: th lor the Ore9 on UtilitY Total: Handicapped Compact: Sidewalk Type: DownspoutsiDrains: nf the rules " t*EE8IHBED PARKING ^a oaO-)? Gravel Yes Notes: Storm tied to existing system. Adding new Impervious area only no new DFU's.JLP 2126107 PUBLIC IMPROVEMENTS Page I of3 hk LI.-,N I T(AL I UK T1\I U:lryJ l,U ll,uu\u li\ r (JluYlA I rtrL\ | Load: F 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: COM2007 -00127 ISSUED: 0312012007 APPLIEDz 0112512007 EXPIRES: ll/1512007VALUE: $ 15,552.00 Description Garage Fee Description Plan Review Residential + l0o/o Administrative Fee + 5%o Technology Fee + 87o State Surcharge Building Permit Fire SF Fee - Residential Plan Review Minor - Planning SDC Sanitary/Storm Admin Storm Drainage ImPervious Area Storm Sewer - lst 50 Feet + l0oh Administrative Fee + 57o Technology Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Tvpe of Construction Garage $ Per Sq Ft Square Footage or multiplier or Bid Amount $27.00 576.00 Total Value of Project Amount Paid Date Paid Value $15,552.00 $15,552.00 Receipt Number 1200700000000000072 1200700000000000298 1200700000000000298 I 200700000000000298 1200700000000000298 1200700000000000298 1 200700000000000298 1200700000000000298 1 200700000000000298 1200700000000000298 2200700000000000858 2200700000000000858 2200700000000000858 2200700000000000858 2200700000000000858 Date Calculated 0u2512007 $100.23 $22.80 $1s.s6 $15.94 $r54.20 $28.80 $112.00 $11.98 $239.63 $45.00 $4.60 $2.30 $3.68 $43.00 $3.00 u25t07 3t20101 3t20107 3120107 3t20t07 3t20t07 3120101 3t20t01 3t20t07 3t20t07 st30t07 st30t07 st30t07 st30t07 5t30t07 $802.72 Plan Reviews Initial Review Plannins Review Public Works Review Public Works Review Structural Review 0u26t2007 0u29t2007 0u29t2007 02t26t2007 0u29t2007 03n6t2007 0u29t2007 02t26t2007 0U29t2007 03n9t2007 APP DLM Shop building not to exceed house/garage in square footage or height. Rcvd l/29l2007---Waiting in order PW rcvd for rvw.JLP Storm tied to existing system. Adding new Impervious area only no new DFU's.JLP 2126107 See documents for plan review comments APP APP WI APP LLH TAJ JLP JLP To Request an inspection call the24 hour recording at 726-3769. All inspections 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 of3 I l'ees Paid I Status Issued 225 Fifth Street, SPringfield' OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 InsPection Line Building/C ombination Permit PERMIT NO: COM2007 -00127 ISSUED: 0312012007 APPLIEDz 0112512007 EXPIRES: l111512007VALUE: S 15,552.00 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. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Storm Sewer Line: Prior to filling trench. Final Building: After all required inspections have been requested and approved and the building 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 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 properfy, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Paee 3 of3 Required lnsoecttons I 225 Fifth Street Springlield, Oregon 97 477 541-726-3759 Phone CiF' of Springfield Official Receipt D'-+lopment Services Department Public Works Department RECEIPT #: 2200700000000000858 Date: 0513012007 tz07:42PM Job/Journal Number coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5olo Technology Fee + 8% State Surcharge + 10o/o Administrative Fee Amount Due 43.00 3.00 2.30 3.68 4.60 Item Total:$56.58 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check GILBERT A RODELLO ddk 692 In Person $56.58 Payment Total : -5565-[- cReceint I Page I of I s130t2007 *F*H*Ftft.!l SPFTINGFIELE, r:ili'i;''t4:. I:. t ,1' , -', , ""ii '. Q4fr'' ""';:' ZON INITIALS DATE SOURCE225 FIF-rH STREET o SPRINGFIELD, OR97477 . PH:(541)726-3753 o FAX: (541)72G3689 ELECTRICAL City Job Number Date A i,2@ 3. COLTPLETE FEE SCHEDLLE BELO\+' A. Nerv ll.esidential'Single or l\'lulti-Family pcr dwelling unit' Service Included I LOCATION OF INSTALIATION : .)S q3^t ,T 5 t-e /</ JOB DESCzuPTION: SH <) p /t oo tTtoil Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 daYs. 1000 sq. ft. or less Each additional 500 sq' ft. or 200 Amps or less 201 Amps to 400 AmPs 401 Amps to 600 AmPs 601 Amps to 1000 AmPs Over 1000 Amps/Volts Reconnect OnlY Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial s 106.00 $ 19.00 B. t0D Contractor Address Supervisor License Expiration Date Constr umber Date S of Supervising Electrician C. Temporary Services or Feeders $ $ Cily 75.00 s 125 .00 $163.00 $375.00 $ s0.00 s 50.00 $ s0.00 s 2s.00 $ 4s.00 UIIOS !0U tt:, e8 rego n utilir nter. Those $ 50.00 zolSntrt 10 through4)A8 $ 69.00 401 Amps to 600 AmPs $ 100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circttits' ' ' New Alteration or Extension Per Panel one circuit s 43'oo Each Additional Circuit or with Service or Feeder Permit / $ 3'oo Lz*t/3'' Owners Name G,/berf A. [?./.l/rt Address 8a g s. +3 r'l S{E. N,[iscellaneorrs (Service/feeder not included) -Each Installation City kl Phone <-q/'"{7- /'/Og3rte OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent.Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. SL-BTOTAL OF ABOW 8% State Surcharge l0% Administrative Fee 5% Technology Fee 0t) 56.-Sg A="u- Inspection Request: 726-37 69 'zzl TOTAL Shared Driv(T:/Building Forms/Electrical Permit Application 8-06.doc portion thereof Jlfg T:!lt 7HE IICE: Each Modular r sH4 Feeder Owners Sisnature: , EJL{/'oLm Building/C ombination Permit coM2007-00127 0312012007 0u2512007 0912012007 $ 15,552.00 PERMIT NO: NSUED: APPLIED: EXPIRES: VALUE: Status Issued 225 Fifth Street, SPringfield' OR 541-726-3753 Phone 541-126-3676 Ftx 541-7 26'37 69 InsPection Line SITE ADDRESS:829 S 43RD ST ASSESSOR'S PARCEL NO.:18020s2108900 PROJECT DESCRIPTION: Shop addition Residential Owner: Address: RODELLO GILBERT A 829 S 43RD ST SPRINGFIELD OR 97478 Contractor OWNER OWNER Springfield # 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: TYPE OF WORK: ShoP TYPE OF USE: Addition PhoneNumber: 541-147'1408 License Expiration Date Phone Contractor TYPe General Electrical # 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: I Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/CarPort Sq Ft Other: Occupant Load: U VB 14.00 nla 576 REQUIRED PARKING Total: Handicapped: Compact:14.00 Sidewalk TYPe:Street ImProvements: Gravel Storm Sewer Available: Yes Downspouts/Drains: To Culvert - Provide Speciat Instruction: - Drainage Plan Notes: Storm tied to existing system. Adding new Impervious area only no new DFU's.JLP 2126/07 Page I of3 m : Plan Building/Combination Permit PERMIT NO: COM2007-0012issunut o3l2ol2oo1Status Issued 225 Fifth Street, SPringfield' OR 541-726-3753 Phone 541-726-3676 Fax S4l -7 26-37 69 InsPection Line 7 0y2s12007 0912012007 $ 15,552.00 Value $15,552.00 s15,552.00 Date Calculated 0112512001 ReceiPt Number 1200700000000000072 1200700000000000298 1200700000000000298 1200700000000000298 1200700000000000298 1200700000000000298 1200700000000000298 1200700000000000298 1200700000000000298 r200700000000000298 Shop building not to exceed house/garage in square footage or height. Rcvd 1/29l2007--Waiting in order PW rcvd for rvw.JLP Storm tied to existing sYstem. Adding new Impervious area onlY no new DFU's.JLP 2126107 See documents for Plan review comments APPLIED: EXPIRES: VALUE: DescriPtion Garage Tvpe of Construction Garage $ Per Sq Ft Square Footage or multiPlier or Bid Amount $27.00 s76'00 Total Value of Project Fee DescriPtion Plan Review Residential + l}oh Administrative Fee + 57o TechnologY Fee + 87o State Surcharge Building Permit Fire SF Fee - Residential Plan Review Minor - Planning SDC Sanitary/Storm Admin Storm Drainage ImPervious Area Storm Sewer - lst 50 Feet Total Amount Paid Initial Review Planning Review Public Works Review Public Works Review Structural Review JLP 03n912007 APP DLM Amount Paid $100.23 $22.80 $15.56 $15.94 $154.20 $28.80 $112.00 $11.98 $239.63 $45.00 Date Paid u25107 3t20107 3t20107 3t20107 3120107 3120107 3120107 3120107 3120107 3120107 $746.14 0u2612007 0il2912007 0u2912001 0212612007 0u2912001 0u2912007 0311612007 0y2912007 0212612007 APP APP LLH TAJ JLPWI APP To Request an inspection call the 24 hour recording at 726-3769. All inspections requested a.-. rrill be made the same working day, inspections requested after 7:00 a.m. will be made work day. before 7:00 the following Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Reouired fnsneefi Paee 2 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax S4l-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2007 -00127ISSUED: 0312012007 APPLIEDz 0112512007 EXPIRES: 0912012007VALUE: $ 15,552.00 Footing: After trenches are excavated. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Storm Sewer Line: Prior to filling trench. Final Building: After all required inspections have been requested and approved and the building 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 shalt 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, tnat ttre 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. fu/,--/a /-r/<4 'W//-1 ?o- 247 Owner or Contractors Signature Date Page 3 of3 --:IT il Construction Contractors Board 700 Summer St I{E Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:!!ry4fu]g!4 Permit #:(t-Q ' ,.A0 Address Issued by:L^rrn out.,5'?DU Statement: lnformation Notice to Property Owners About Gonstruction Responsibi Iities 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 building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer 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, md either box 3A or 38: 1. 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 instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 38. 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. (Signature of permit applicant) @ate) (lYhite copy to issuing agency permitfile, pink copy to applicant.) Property_owner. doc 06-0 I -04 2aafYlao/ Acting as'tour Own General Contractor? INtrORMATION NOTIEE TO PROPER?Y OWNERS ABOUT CON$TRUCTION RE$PON$IBII-ITIES If you are acting as your own conkactor to constrmt a new home or make a substantial improvement to an existing skucture, you can prevent mriny problerns by being aware of"the following responsibilities and concerns. Ernpl*yer Responsibilities You will, in nrBqr instances, bp ruled to be an ';.*ploy"r" and the consacto:s you ponfagt with will be:'employees" if you use conbactors nct iicensed with the Construction Contractors Boal{ to do labor in constructing.or to assiqt in the construction oi improvement of a residential structure. As th* employeq, you must c.amply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employe** are paid. You will be liable for tl:e tax pa3.rnents even if you don't actually withhold the tax &om your employees. For more information; call &e Deparhnent of Revenue at 503-3?8-4988. : l';--,' Unemploymert Insuranee Tax: As an employer, you are required to pay a tdx for unemploymerrt insurance purposd, on the wages of all employees. For more information, call the Oregon Employment Departrnent at 503-947-1488. \ l:.i The Oregon Business Identification Number (BnD is a combined number for both Oregon Withholding and Unemp1oymentInsuran*eTax.TofilefaraEIN,call503.945-80910rwguLMforthe appropriate forms. -i Workere' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation l-aw, and must obtain workers' compensation insurance fo1 yorg employees. If you fail to abtain workers' cornpensation insuranc'e. you could be subjecl to p'enllties and be iiaUie fof all claim costs lf one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Departnient of Consumff:&nd Busiaess Services at 503-947-78 X5. U.$. Interxal lLevenxe ficrvice: As an empl*yer, yo* must withhold federal income tax from ernployees' wages.ty: You will be liable for the tax paymefit cven rf you didn't actually withhold lhe tax. For a Federai EIN number, call tl19 ", IRS at t j800-8294933 0r visit their web site at,!qrvw.irs.s0v. . i Other Responsibilities and Areas of Concerns Code Compliance: A.s rhe permit holder tbr this project, you are responsible for resolving any {ai'lure to meet c*de requlrements that may bu l:piisgfi1 10 your attcntion through iitspcctions. ,: Li*bility and Fropertp' Damage Insurance: Contact your lrisuranoe agent to see if you have adequate ifisurance coverage {br acci<3er"rts ::nd crnissio:rs such as thlling tor:ls, p*in1 over spray. water rlamage from pipe punctures, fire or Tirne: Make sure you have sufficient time to supcrvise your cnrployees. \ Expertise: Make sure you have the skills to act as your olvn general conkactor, to c,:ordinate the work r:f,r<lugh*in and finish trades, anrl t* nnti*, buikling cf{i*ials a$ the appro;:ri*l* times s* they can perf*rn"i th* required insp*ctlo:rs. If you have additionai questions call the Cr:nstruction Contractors B*ard (503-37846?1) *r write the agency at PO Box 14140, $alem, OR 97309-5052. ,,. u ,,.i Property_owner.doc 06-0 i -04 lnfarmatianff,,b toNaticeNOTE:Autners Constructionabout was thePropertyResponstiililiesdevelopedby CoslracforsConstruction m witltaccardance 70oRs 1 1055{5),bypassed Oregon Legislature. OR NUMBER: NAMEORCOMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING TINITS DIRECT RUNOFFTO CITY STORM SYSTEM CITY OF Sl -r.lc FIELDSYSTEMSDEVELOPMEN1 JRKSHEET Gilbert Rodello 829 S 43rd St I 8020521 FAMILY 0 BUILDING SIZE (sF. 0 LoT SZE (SF):0 I nPERvIous sr.l-I zt+.oo x TO DRYWELLDESIGNED AND CONSTRUCTED TO CIry x x DISCOLINTRATE 50o/o ITEM 1 TOTAL. STORM DRAINAGE SDC $239.63 2. SANITARY SEWER- CITY A COST: COST PER DFU $26.03 B.IMPROVEMENT x $19.79 ITEM 2 TOTAL - CITY SANTTARY SEWER SDC $0.00 3. TRANSPORTATION A REIMBT]RSEMENT COST: COST PER S.F $0.336 COST PER S.F $0.336 NUMBER OF LINITS 0 NUMBER OF UMTS 0 ADM. FEE RATE 5Yo CHARGE $239.63 x B. ADT TRIP RATE 9-s7 COST: SUBTOTAL s239.63 xx xx COST PER TRIP $19.81 COST PER TRIP $87.39 $0.00 NEW TRIP FACTOR 1.00 x ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A REIMBI.]RSEMENT COST: NUMBER OF FEU's 0 B.COST: MWMC CREDIT tr APPLICABLE (SEE REVERSE) MWMC ADMIMSTRATIVE FEE TEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) 5. ADMIMSTRATIVE FEE; x x x $0.00 $239.63 CHARGE $r r.98 TOTAL SANITARY ADMIMSTRATION FEE: TOTAL TRANSPORTATION Jeff Prociw 2/26t2007 IMPERVIOUS S.F 0.00 DISCOLINT $0.00 NLIMBER OF DFU's 0 $0.00 $0.00 $0.00 $0.00 I1.98 $251.61 1070 1091 1092 1 093 t094 1055 1054 1056 1079 l 078 a trloo O &r!FU) rq& NUMBEROFDFU'S 0 ADT TRIP RATE 9.57 1.00 COST PER FEU $91.61 NLIMBER OF FEU's 0 COST PER FEU $961.52 PREPARED BY DATE TOTAL SDC CIIARGES x DRAINAGE FIXTT]RE []NIT CALCULATION TABLE NUMBM OFNEWFD(TURES x UNTTEQIJIVA]-ENT = DRAINAGEFXTURE LINITS FOR CAI'UI.A.TE ONLY TTIE NET ADDMONAI NO. OF FXTURES UMT DRAINAGE FDflURE LINITSFXTURE TYPE MISCELLANEOUS DFU TYPE TOTAL DRAINAGE FXTURE TJNITS *mu lsa BEF'ORE 1979 NUMBER OF EDU'S NEW OLD mit set al 167 CREDIT FOR I.-AND (IF APPLICABLE) a MWMC CREDIT CALCULATION TABLE: BASED ON COTINTY ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 1979 1980 1981 1982 1983 1984 x1985 1986 1987 1988 1989 1990 1993 1994 t99s 1996 1991 1998 1999 $5-29 $5.19 2 1979 VALUE/ IOOO $0.00 CREDIT RATE s5.29 l99l 1992 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALTIE/ IOOO CREDITRATE $0.00 x $5.29 TOTAL MWMC CREDIT$1.59 $1,45 $1.2s $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 BATTIfl.-IB 0 0 3 0 DRINKING FOTINTAIN 0 0 1 0 FLOORDRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 0 0INTERCEPTORS FOR SAND /AUTO WASH /ETC.6 0 LAUNDRY TIIB 0 0 2 0 CLOTI{ESWASHER / MOP SINK 0 0 3 0 CLOTHESWASTIER - 3 OR MORE (EA)0 0 b 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISI{WASI{ER / ETC.0 0 3 0 SHOWE& SINGLE STAIL 0 0 2 0 0 0 2 0SHOWER, GANG CNUMBER OF HEADS) SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 0 SINK: COMMERCIAL BAR 0 0 2 0 0 0 2 0SINK: WASH BASIN/DOTIBLE LAVATORY 0 0 1 0SINK: SINGLE LAVATORY/RESIDENTIAL BAR I]RINAL. STALL / WALL 0 0 5 0 0 6 0TOILET, PLIBLIC INSTALLATION 0 0 0 3 0TOILET, PRryATE INSTALLATION CREDM RATE/$I,OOO ASSESSED VALUE YEAR ANNEXED 00 0 2000 IIIL 2001 l 20 $5.12 $4.98 $4.80 $4.63 $+.+o $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 225 Fifth Street Springfield, Oregon 97 477 541.,726,3159 Phone Cir-' of Springfield Official Receipt L ;lopment Services Department Public Works Department RECEIPT #: 1200700000000000298 Date: 0312012007 10:16:l5AM Job/Journal Number co,I|y{2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 coM2007-00127 Description Fire SF Fee - Residential Storm Drainage Impervious Area SDC Sanitary/Storm Admin Plan Review Minor - Planning Building Permit Storm Sewer - 1st 50 Feet + 5%o Technology Fee + 8% State Surcharge + l|Yo Administrative Fee Amount Due 28.80 239.63 I 1.98 I 12.00 154.20 45.00 I 5.56 15.94 22.80 Item Total:$645.91 Payments: Type ofPayment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check GILBERT RODELLO llh 664 In Person $645.91 Payment Total: -561IEDT- cReceint I Page I of I 3/2012007 dGnrHffiIk