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Home My WebLink AboutPermit Building 2003-04-14Status Issued 225 Fitth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2003-00067ISSUED: 04114t2003APPLIED: 02t06t2003EXPIRESz 10114t2003VALUE: $ 15,967.00 SITE ADDRESS: 384 18TH ST ASSESSOR'SPARCEL NO.: 1703362401603 PROJECT DESCRIPTION: MH with garage Owner: MURpHy DONNA D Address: 384 N 18TH ST SPRINGFIELD OR 97477 Springlield TYPE OF WORK: Manufactured Home w Garage/Carport on Private TYPE OF USE: Netu Residential License Expiration Date Phone 60926 07n2t2003 541-345-2279 Contractor Type Electrical Manuf Home Inst Owner Contractor ARC RAY SHARP CONSTRUCTION INC MURPHY DONNA D CONTRACTOR INFORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special fnstruction: # of Stories: Height of o/o of .{O\} the Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARIflNG 6,000 7 Curbside 5' Curb and Gutter I 432 14.00 23.00 s.00 10.00 5.00 t\s Fullv Improved Yes Storm sewer to street and the ralns: Spoke with Donna Murphy 315103, 'new sewer placed last year and goes to street and she is assuming it will continue to go to streetr. SDC credit given for existing MH. Plans show sidewalk and curbcut existing, no PW permits. INFORMA Notes: Page I of4 L] Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: tha 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: COM2003-00067ISSUED: 0411412003APPLIEDz 0210612003 EXPIRESz 1011412003VALUE: $ 15,967.00 Description Garage Manuf Home Tvpe of Construction Garage Manufactured Home $ Per Sq Ft Square Footase $19.60 432.00 $1.00 45,0oo.oo Total Yalue of Project Date Pai Value s8,467.20 $45,000.00 953,467.20 Date Calculated 02t06t2003 03/05/2003 Fee Description Plan Review Residential + l0Yo Administrative Fee + 1Yo State Surcharge Addressing Assignment Building Permit Manuf Home State Issuance Manufactured llome Connection Manufactured Home Placement Plan Review - Planning Sanitary Sewer - lst 50 Feet SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Water Line - lst 50 Feet Willamalane Manuf Home Private Total Amount Paid Amount Paid Receipt Number 12002000000000006s6 1200200000000001004 1200200000000001004 1200200000000001004 r20020000000000r004 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 r200200000000001004 1200200000000001004 1200200000000001004 $100.23 $49.42 $34.59 $8.00 $154.20 $30.00 $45.00 $160.00 $59.00 $4s.00 $31.64 $632.81 $45.00 $4s.00 $1,000.00 2t6t03 4n4t03 4n4t03 4n4t03 4n4t03 4fi4t03 4lt4t03 4lt4l03 4n4t03 4tr4t03 4n4t03 4n4t03 4n4t03 4n4t03 4fi4t03 $2,439.89 tr'pps Peid Plan Reviews Initial Review Planning Review 02n2t2003 02n2t2003 02n2t2003 02t27t2003 APP APP RJB EMM Waiting for response from contractor regarding sum of setbacks and garage versus lot width. Paving width is 12'. Setback of garage from paving will be 19r. Garage cannot be taller than the manufactured home. Paee 2 of 4 Valuation Descrintion Status Issued 225 Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2003-00067ISSUED: 0411412003 APPLIEDz 0210612003 EXPIRESz 1011412003VALUE: $ 15,967.00 Public Works Review 02n2t2003 03/05/2003 APP VRJ Storm sewer to street and sanitary sewer to west of property. Spoke with Donna Murphy 3/5/03,'new sewer placed last year and storm already goes to street and she is assuming it will continue to go to streetr. SDC credit given for existing MH. Plans show sidewalk and curbcut existing, no PW permits. Structural Review 02n2t2003 03/0s/2003 OK RJB To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. wilt be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. 1 2 3 4 5 6 7 8 9 10 l3 t4 18 t9 11 t2 15 t6 17 Erosion/Grading Inspection: After all erosion measures are in place. 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. Foundation: After forms are erected but prior to concrete placement. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Firewall: Located and constructed according to plans. Masonry: Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. 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. Final Building: After all required inspections have been requested and approved and the building is complete. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. 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. MH Service: Approval required prior to utility company energizing service. Storm Sewer Line: Prior to filling trench. Paee 3 of4 Keouired lnsDectlons I 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: COM2003-00067ISSUED: 0411412003 APPLIEDz 0210612003 EXPIREST 1011412003YALUE: $ 15,967.00 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 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 +/t+/z Owner or "*7--7 Paee 4 of4 4/14/2003 8:27:I2ANI City of Springfield Development Services DePartment Public Works DePartment Oflicial Receipt 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Receipt #: 120020000000000 1 004 Date: 0411412003 Line Items: Amount PaidJob/Journal Number Description coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 Plan Review - Planning Storm Drainage Impervious Area SDC Sanitary/Storm Admin Building Permit Manufactured Home Placement Manuf Home State Issuance Addressing Assignment Willamalane Manuf Home Private Sanitary Sewer - lst 50 Feet Water Line - lst 50 Feet Storm Sewer - lst 50 Feet Manufactured Home Connection + 7o/o State Surcharge + l0% Administrative Fee 59.00 632.81 31.64 154.20 160.00 30.00 8.00 1,000.00 45.00 45.00 45.00 45.00 34.59 49.42 Page 1 of2 Line Item Total:$2,339.66 cReceipt.rpt *Bffi# 4/14/2003 8:27:I2ANI City of Springfield Development Services Department Public Works Department Official Receipt 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Receipt #z 1200200000000001 004 Date: 0411412003 Payments: Type of Payment Paid By Received By Check Number Confirm No How Received Amount Paid Check RAY SHARP CONSTR djb In Person P 2,339.66 Total: Page2 of2 cReceipt.rpt *Bfr*mffir* GITY OF SPRINGFIELD SYSTEMS DEVELOPMEN, WORKSHEET JOURNAL OR JOB NUMBER: Com2003 NAME OR COMPANY:DonnaMumhy LOCATION 384 18th Street TAX LOTNUMBER:1'7033624 tl 1603 DEVELOPMENT TYPE:SINGLE FAMILY RESIDENCE NEW DWELLING LINITS 0 BUTLDTNG SrZE (SFl 0 LOT SrZE (SF): a E] t-loU & E]Fa rI]il 1070 1091 1092 1093 1094 1054 1055 1054 1056 1079 1078 1. STORM DRAINAGE DIRECTRUNOFF TO CITY STORM SYSTEMI rMPERVrous sr. I zzqq.oo x COST PER S.F s0.282 CHARGE $632.81 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F 0.00 x COST PER S.F $0.282 x DISCOLINTRATE 50% DISCOUNT $o.oo ITEM 1 TOTAL - STORM DRAINAGE SDC $632.81 2. SANITARY SEWER- CITY A. REIMBURSEMENTCOST: NUMBER OF DFU's 0 x COST PER DFU s22.09 B. IMPROVEMENT COST: NUMBER OF DFU's 0 x COST PER DFU s 16.79 : I $o.oo ITEM 2 TOTAL - CITY SANITARY SEWER SDC $0.00 3. TRANSPORTATION A. REIMBURSEMENTCOST: ADT TRIP RATE 9.57 x NUMBER OF TINITS 0 x COST PER TRIP $ 16.81 x NEWTRIP FACTOR 1.00 B. IMPROVEMENT COST: ADTTRIP RATE 9.57 x NUMBER OF L]NITS 0 x COST PER TRIP s74.17 x NEWTRIP FACTOR 1.00 ITEM 3 TOTAL - TRANSPORTATION SDC $0.00 4, SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's 0 x = I $0.00 B. IMPROVEMENT COST: NUMBER OF FEU's 0 x = I $0.00 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SD( = = I $o.oo $0.00 COST PER FEU $332.86 COST PER FEU s34.83 SUBTOTAL (ADD ITEMS I,2,3, & 4)$632.81 5. ADMINISTRATIVE FEE: SUBTOTAL s632.81 x ADM. FEE RATE 5o/o CHARGE s3l .64 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: I t.a+ I so.oo Steve Templin 31512003 PREPARED BY DATE TOTAL SDC CHARGES : I $0.00 l-$0.-06- I $664ls DRAINAGE FIXTURE UNIT CALCULATION TABLEl,li'u NUMBER OFNEW FIXTURES x UNIT EQUTVALENT: DRAINAGE FXTURE I.]NITS DRAINAGE FIXTURE I.INITS NO. OF FIXTURES FIXTURE TYPE NEW OLD (NOTE: FORREMODELS, CALCULATE ONLY THE NET ADDITIONAL FXTURES) UNIT EQUIVALENT BATHTUB 0 0 3 0 DRINKING FOLINTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LAUNDRY TUB 0 0 2 0 CLOTHESWASHER / MOP SINK 0 0 3 0 CLoTHESWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION/ ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWER, SINGLE STALL 0 0 2 0 SHOWER, GANG (NUMBER OF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 0 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 1 0 URINAL, STALL / WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 6 0 TOILET, PRIVATE INSTALLATION 0 0 3 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 0 TOTAL DRAINAGE FIXTURE UNITS *EDU ts a toa unit set at 167 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 0 0 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE/ IOOO $0.00 CREDITRATE $4.92x CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $4.92 TOTAL MWMC CREDIT BEFORE 1979 $4.92 1979 $4.92 1980 $4.83 1981 $4.77 1982 $4.64 1983 $4.47 1984 $4.30 1985 $4.09 1986 $3.78 1987 $3.41 1988 $2.98 1989 s2.52 1990 $2.06 1991 $1.64 1992 $1.45 1993 $1.31 1994 $1.13 1995 $0.97 1996 $0.82 1997 $0.63 1998 $0.41 1999 s0.22 2000 $0.04 : I $o.oo = l-1- ! $o.oo 225 FIFTH STREET . SPRINGFIELD, Ox-97477 o PH:(541)726-3753 . FAX: (54I)726-3689 E LECTRICAL P ER]WIT AP P LICATION Ciry Job Number Cqtazoct3 r}O O 6"7 Dat" / {4L LEGAL DESCRIPTIONnD33 6zt O/ &: JOB DESCRIPTION 3fhe tollowing projecf as submitted has the followingdoes not require specific land use ?/: 1. Permits are non-.ble and expire work is not started within 180 days of issuance or if work is Suspended for 180 days. ,, Electrical Contractor A t<c E /e-.+*.-,,c Address 8SZ /t 5ae"rt<' City f,aor-.,,pnone 7/t -a/??{ Supervisor License Number *la / 7S Expiration Date /a 3. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or .l- portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder B. 200 Amps or less 201 Amps to 400 Amps-ffi iffift-qft1$'ht)nuro"u'lio" D. 0 Constr. Contr. Number l/ t//3 s6Y // $106.00 $ 19.00 z $so.oo icc '\:; s 63.00 $ 75.00 $ 125.00 $ 163.00 $3 75.00 $ s0.00 $ 50.00 s 69.00 $100.00 $ 43.00 I $ 3.oo S 7-rt - o/ Name rt? Address Phone OWNER INSTALLATION The installation is being made on propefty I own which is not intended for sale, lease or rent. Owners Signafure: 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. New Alteration or One Circuit ,t9:, Each 7o/o State Surcharge l0% Administrative Fee TOTAL -J Limited Energy/Residential Limited Energy/Commercial Minimum Electric Permit Inspection Fee is $45.00 + Surcharges $ s0.00 $ 50.00 $ 25.00 $ 45.00 4./0) 7'z ( /0)> 4tzc YInspection Request: 726-3769 Shared Drive(T:)/Brrilding Forms/Electical Permit Application l-03.doc WffiWffi €.38G .{t C$JSTftACr{}TT oivr,y l\sw Ercrrr*h €iituit$ ;ftiil[fi!lot Insf*llatib;r irrigation Lighting b\ 3sy /rryc;ryW FTELD Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00067ISSUED: 0411412003APPLIED: 0210612003 EXPIREST '1,012912003 VALUE: $ 53,467.00 SITE ADDRBSS: 38418TH ST ASSESSOR'SPARCELNO.: 1703362401603 PROJECT DESCRIPTION: MH with garage Owner: MURpHy DONNA D Address: 384 N 18TH ST SPRJNGFIELD OR 97477 Contractor Type Electrical Manuf Home Inst Owner Contractor ARC RAY SHARP MURPHY # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Springfield TYPE OF WORK: Manufactured llome w Garage/Carport on Private TYPE OF USE: Netv Residential 10 \)\ Date Phone s4t-741-0494 541-34s-227907n2t2003 I I Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: 6,000 Structure Type of Heat: Water Type: Range Type: Energy Path: Dist: 432 SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: 14.00 23.00 5.00 r0.00 5.00 REQUIRED PAR]flNG Total: 2 Handicapped: Compact: 31.00 0hI Fuily Improved Sidewalk rype: curbside 5' Yes Downspouts/Drains: Curb and Gutter Storm sewer to street and sanitary sewer to west of property. Spoke with Donna Murphy 315103, rnew se\ryer placed last year and storm already goes to street and she is assuming it will continue to go to street'. SDC credit given for existing MH. Plans show sidewalk and curbcut existing, no PW permits. DEVELOPMENT INFORMATION Notes: Pase 1 of4 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: COM2003-00067ISSUED: 0411412003 APPLIEDz 0210612003 EXPIRESz 1012912003VALUE: $ 53,467.00 Description Garage Manuf Home Fee Description Plan Review Residential + l0o/o Administrative Fee + 7o/o State Surcharge Addressing Assignment Building Permit Manuf Home State Issuance Manufactured Home Connection Manufactured Home Placement Plan Review - Planning Sanitary Sewer - lst 50 Feet SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Water Line - lst 50 Feet Willamalane Manuf Home Private + l0o/o Administrative Fee + 77o State Surcharge Add, Alter, Extend Circ Ea Add Manufactured Home Feeder Manufactured Home Service Total Amount Paid Type of Construction Garage Manufactured Home $ Per Sq Ft Square Footase $19.60 432.00 $1.00 45,000.00 Total Value of Project Date Pai Value $8,467.20 $45,000.00 $53,467.20 Date Calculated 02t0612003 03/05/2003 Amount Paid Receipt Number 12002000000000006s6 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 r200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 1200200000000001004 120020000000000r004 r200200000000001004 1200200000000001004 1200200000000001004 1200200000000001 103 1200200000000001 103 r200200000000001103 1200200000000001103 1200200000000001103 $100.23 $49.42 $34.59 $8.00 $154.20 $30.00 $45.00 $160.00 $s9.00 $45.00 $3r.64 $632.81 $4s.00 $4s.00 $1,000.00 $10.30 $7.21 $3.00 $s0.00 $50.00 2t6t03 4n4t03 4n4t03 4n4t03 4n4t03 4n4t03 4n4103 4n4t03 4n4t03 4fi4103 4n4t03 4fl4t03 4tr4t03 4tr4t03 4n4t03 4t30t03 4t30t03 4t30t03 4t30t03 4t30t03 $2,560.40 tr'ees Pe Plan Reviews Initial Review Planning Review 02n2t2003 02n2t2003 02t1212003 02t27t2003 APP APP RJB EMM Waiting for response from contractor regarding sum of setbacks and garage versus lot width. Paving width is 12'. Setback of garage from paving will be 19'. Garage cannot be taller than the manufactured home. Pase? of 4 t Valuation Descrintion I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00067ISSUED: 0411412003APPLIEDz 0210612003 EXPIRESz 1012912003VALUE: $ 53,467.00 Public Works Review Structural Review 02n2t2003 03/05/2003 APP \rRJ 02n2t2003 03/05/2003 0K RJB Storm sewer to street and sanitary sewer to west of property. Spoke with Donna Murphy 3/5/03, 'new sewer placed last year and storm already goes to street and she is assuming it will continue to go to streetr. SDC credit given for existing MH. Plans show sidewalk and curbcut existing, no PW permits. To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. wilt be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Erosion/Grading Inspection: After all erosion measures are in place. 2 lJfer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 3 Footing: After trenches are excavated. 4 Foundation: After forms are erected but prior to concrete placement. 5 SIab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. 6 Framing Inspection: Prior to cover and after all rough in inspections have been approved. 7 Drywall: Prior to taping. 8 Firewall: Located and constructed according to plans. 9 Masonry: 10 Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. 11 Manuf Home Set Up: When installation of all piers or stands is complete. 12 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. 13 Final Building: After all required inspections have been requested and approved and the building is complete. 14 Water Line: Prior to filling trench and including required testing. 15 Sanitary Sewer Line: Prior to filling trench and including required testing. 16 Manuf Home Plumbing: After home has been connected to water and sewer. 17 MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. 18 MH Service: Approval required prior to utility company energizing service. 19 Storm Sewer Line: Prior to filling trench. red Insneefions Pase 3 of4 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: COM2003-00067ISSUED: 0411412003APPLIED: 0210612003 EXPIREST 1012912003VALUE: $ 53,467.00 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 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 Date Paee 4 of4 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Development Services Department Public Works Department Oflicial Receipt Receipt #: 1200200000000001103 Drte:04/302003 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 coM2003-00067 Manufactured Home Feeder Manufactured Home Service Add, Alter, Extend Circ Ea Add + 1Yo State Surcharge + llYo Administrative Fee 50.00 50.00 3.00 7.21 10.30 Item Total:$120.51 Check ARC ELECTRIC djb In Person Payment Total: 120.51 $120.51 4t3012003 l:18:l3PM Page I of I cReceipt.rpt ltrffill*"n (