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Home My WebLink AboutPermit Building 2005-04-15Status Issued 225Bifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00010ISSUED: 0411512005 APPLIED: 01/03/2005EXPIRESz 1112512005VALUE: $ 4,000.00 SITE ADDRESS: 2220 STIJST 2222 Springfield TYPE OF WORIft Duplex ASSESSOR'S PARCEL NO.: 1703262105500 TYPE OF USE: Alteration PROJECT DESCRIPTION: Single Family Home converted to Duplex without permits. Residential Owner: Address: LARSONDAVID 4085 EDDYSTONE PL EUGENE OR 97404 outo o o1 bYContractor Type Electrical Contractor TONY KOTH Expiration Date 05t0412006 Phone 541-688-8996ies # 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 Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqdl o/o of Lot Coverage: Lot Size: Sq Ft lst Ploor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 VN Fully Improved Yes nla Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: 4 Handicapped: Compact: Notes: $ Per Sq Ft or multiplier Curbside 5r Curb and Gutter Square Footage or Bid AmountDescrintion Tvpe of Construction Pase 1 of3 Value Date Calculated , # Valuation Description I lrt v_IrlJLrrryl|,N r rNlluKlvtAllul\ I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line ITY Building/Combination Permit PERMIT NO: COM2005-00010ISSUED: 0411512005APPLIED: 01/0312005 EXPIRESz 1112512005VALUE: $ 4,000.00 Bid Amount Use Bid Amount Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 7oh State Surcharge Addressing Assignment Building Permit Inspections - Hrly Electrical Miscellaneous Mechanical Miscellaneous Plumbing 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 Willamalane Attached (duplex) + l0o/o Administrative Fee + 7%o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid $1.00 4,000.00 Total Value of Project Date Paid $4,000.00 $4,000.00 02nu2005 Amount Paid Receipt Number 1200500000000000180 2200500000000000435 220050000000000043s 2200500000000000435 220050000000000043s 2200500000000000435 2200s0000000000043s 2200500000000000435 2200500000000000435 2200500000000000435 2200500000000000435 2200500000000000435 2200500000000000435 2200s0000000000043s 2200500000000000435 2200s00000000000435 2200500000000000435 2200s0000000000043s 2200500000000000435 1200500000000000666 1200500000000000666 1200500000000000666 1200500000000000666 $39.39 $10.00 $1s.06 $10.s4 $31.00 $60.60 $45.00 $4s.00 $4s.00 $237.64 $312.s2 $10.00 $86s.31 $82.03 $4s.09 $77.67 s772.49 $175.13 $924.00 $4.60 $3.22 $43.00 $3.00 2nu05 4fiit05 4fi5t05 4n5t05 4n5t05 4ltst05 4fi5t0s 4lt5tos 4fi5t05 4n5t05 4n5t05 4fi5t05 4n5t05 4n5t05 4n5t05 4n5t0s 4lt5t05 4n5t05 4n5t05 5tzstos 5t25t05 5125105 5t25t05 $3,857.29 tr'ees Paid Plan Initial Review Planning Review Public Works Review Structural Review 02n4t2005 02n4t200s 02n4t2005 02n4t2005 02n7t2005 02n5t200s 02n4t200s 03/08/2005 APP TCM Meets LDR duplex criteria. SDC Feers for second unit 2/15/2005 CAS Additional permits maybe required depending on inspection results. APP APP APP SKG TAJ 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. Page 2 of3 t L] 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: COM2005-00010ISSUED: 0411512005APPLIED: 01/0312005EXPIRESz 1112512005VALUE: $ 4,000.00 Reouired Insnections Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Drywall: Prior to taping. Firewall: Located and constructed according to plans. Final Building: After all required inspections have been requested and approved and the building is complete. Final Plumbing: When all plumbing work is complete. Final Mechanical: When all mechanical work is complete. Final Electric: When all electrical work is complete. Rough Electric: Prior to Cover By signaturer l 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 Pase 3 of3 s -r 225 Fifth Street Springfield, Oregon 97 477 541-726-3'759 Phone City of Springfield Official Receipt ",elopment Services Department Public Works Department RECEIPT #: 1200500000000000666 Date: 0512512005 1:05:53PM Job/Journal Number coM200s-00010 coM2005-00010 coM2005-00010 coM2005-00010 Description + 7% State Surcharge + l0% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Due 3.22 4.60 43.00 3.00 Item Total:$s3.82 Payments: Type of Payment Paid By Check Number Received By Batch Number ffi Number How Received Amount Paid Cireck LITE ELECTRIC SERVICE djb 6753 In Person Payment Total: $s3.82 -sffi 5/25t2005 Page I of I I CitY of SPringfield 225 Fifth Street, Springfield, Ox--97477 541-726-3759 Phone 541-726'3676 Fax January 25,2006 LARSON DAVID 4085 EDDYSTONE PL EUGENE oR 97404 Job Number: Location: coM2005-00010 2220 5THST 2222 Project:Single Family Home converted to Duplex without permits Dear Permit Holder: The Springfield Building Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the permit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at2220 5TH ST 2222 which is set to expire oiztztzoo6. Our records indicate that you have not requested an inspection within the past five (5j months. This letter is written to notify you that your permit(s) will be expiring shortly. If you are i"uay to request an inspection for your project, please phone the inspection line at 541-726-3769- If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project' If you have any questions, please feel free to phone me at 541-726-3790 or David Bowlsby at 541-736-1029 after FebruarY 1,2006. Sincerely, Lisa Hopper Building Safety Supervisor 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 E LECTKI CAL P ERMIT AP P LI CATI ON Ciry JobNumber LorrrlZOO S- OO o ( O Date z 1.3 LZZO E gT LEGAL DESCRIPTION A. o Z6Z () SR)O Service Included JOB DESCRIPTION L Permits are non-transferable and expire if work is r" not started within 180 days of issuance or if work is Suspended for 180 days. ,, ElectricalContractor Ul 1000 sq. ft. or less' . Each additional 500 sq. ft. or ftfi, / fj portion rhereof obtarn $106.00 $ 19.00 B. Utiti'ty $50.00 aBl63.oo $375.00 $ s0.00 $ 43.00 $ 3.00 L 04R Address ("0. pox I lL37 City 6u6*€Phone btt'ffi' Supervisor License Number s Expiration Date 0 o5 Constr. Contr. Number 9ctl vg Expiration Date O Signature of Supervising Electrician Owners Name c Address qoYt gdq S Pc City gttG+tv{Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 or 1000 Volts see "B" above. 20 401 601 Amps to 1000 Over 1000 Amps/Volts Reconnect Only Pump or irrigation Sign/Outline Lighting New Alteration or Extension Per Panel One Circuit I Each Additional Circuit or with Service or Feeder Permit 2, C. D. E. w"e b a0 t Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges Ltb 7%o State Surcharge 10% Administrative Fee TOTAL 32L $ s0-00 $ s0.00 qbo SInspection Request: 726-3769 +) 4. Shared Drive(T:)iBuilding Fonns/Electrical Permit Application l -03.doc 7E5 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: COM2005-00010ISSUED: 0411512005APPLIED: 01/0312005EXPIRES: 10/1512005VALUE: $ 4,000.00 SITE ADDRESS: 2220 5TH ST ASSESSOR'S PARCEL NO.: 1703262105500 PROJECT DESCRIPTION: Springfield TYPE OF WORK: Duplex TYPE OF USE: Alteration Single Family Home converted to Duplex without permits. Residential Owner: Address: LARSONDAVID 4085 EDDYSTONE PL EUGENE OR 97404 Contractor Type Contractor License Expiration Date Phone IMATION # 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: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: R-3 VN Lot Size: Sq Ft lst Floor: on law req u i reslF[rtftpd Ftoor: adopted by the Orego Center. Th ose rules are 1-0010 throu gh oAR n copiB&of the Load: Notification Fully Improved yes ALL EXT Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: 4 Handicapped: Compact: Curbside 5' Curb and Gutter $ Per Sq Ft or multiplier Square Footage or Bid Amount Description Type of Construction Page I of3 Value Date Calculated L(rr\ r I(AL I (rI( I r\ r (rt(lvtA I l(J]\ r 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: COM2005-00010ISSUED: 0411512005APPLIED: 01/03/2005EXPIRES: 10/1512005VALUE: $ 4,000.00 Bid Amount Use Bid Amount $1.00 4,000.00 Total Value of Project Date Paid 2ltU05 4lt5t05 4nst0s 4lt5t05 4n5t05 4nst0s 4n5t05 4n5t05 4n5tos 4n5t05 4fi5t0s 4nst0s 4n5t05 4n5105 4lt5t05 4n5t05 4lt5t05 4n5t05 4tr5t05 $4,000.00 $4,ooo.oo 021tu2005 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0o Administrative Fee + 7o State Surcharge Addressing Assignment Building Permit Inspections - Hrly Electrical Miscellaneous Mechanical Miscellaneous Plumbing 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 Willamalane Attached (duplex) Total Amount Paid Amount Paid $39.39 $10.00 $1s.06 $10.54 $31.00 $60.60 $4s.00 $45.00 $45.00 $237.64 $312.52 $10.00 s86s3r $82.03 $4s.09 $77.67 s772.49 $175.13 $924.00 $3,803.47 Receipt Number 1200500000000000180 2200500000000000435 2200500000000000435 2200s0000000000043s 2200s00000000000435 2200500000000000435 2200500000000000435 2200500000000000435 2200500000000000435 2200s0000000000043s 2200500000000000435 220050000000000043s 2200s00000000000435 2200s00000000000435 2200500000000000435 2200500000000000435 2200s00000000000435 2200s00000000000435 2200500000000000435 Fees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 02n4t2005 02n4t2005 02n4t2005 02n412005 02n7t2005 02n51200s 02114t2005 03/08/2005 APP TCM Meets LDR duplex criteria. SDC Fee's for second unit 2/15/2005 CAS Additional permits maybe required depending on inspection results. 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. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Drywall: Prior to taping. Paee 2 of3 Reouired fnsnecfinns L 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: COM2005-00010ISSUED: 0411512005APPLIED: 01/0312005EXPIRES: 10/1512005VALUE: $ 4,000.00 Firewall: Located and constructed according to plans. Final Building: After all required inspections have been requested and approved and the building is complete. Final Plumbing: When all plumbing work is complete. Final Mechanical: When all mechanical work is complete. 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 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 is located at the front of the property, and the approved set of plans will remain on the site at all times LI - r6 -o5 Owner or Contractors Signature Date Paee 3 of3 Construction Contractors Board 700 Summer St IrlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:www.cc$!g!9.g"5 70c oor o &zo s+t^ sF Issued by:\6 Date: '{-/S-of Permit #: Address: 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 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, and either box 3A or 38: fff . 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. 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 VB. I will be my own general confiactor. 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 about Construction Responsibilities on the reverse side of this form. 1/t 5t (Signature of permit applicant) @ate) (White copy to issuing agency peffnitfile, pink copy to appltcant.) Property_owner.doc 06-0 I -04 D a\ Acting as tour Own General Ctrhtract6r?' INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NaTE: This lnformatian N*tice to Property Owners aioul Constructian Rasponsibilities was developed by the Construction Contractors Board in accordance with ORS 7A1.055(5i, passed by the 1989 aregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problans by being aware of the following respoasibilities and'concerns. Employer Responsibilities You will, in most instances, be ruled to b9 an o'employer" and &e contractors you contract with wiil be "employees" if you.use conhactors not licensed with the Construction Contractors Board to do labor in constucting or to assisl in the consfruction or improvement of a resideirtial structure. As the employer, you must comply with the following: Oregou's \ilithhotding Tax Law; As an employer, you must withhold income taxes ftom employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more informatiq:n, call the Department of Revenue at 503-378-4988. Unemployment I*surance Tax: As an employer, you are required to pay a tax for unemployment iflsurance purpolis on the wage$ of all emnlo;.,1: U* more information, call the Oregon Employment Department at 503 fa7-1488. -'-=. The Oregon Business ,J*rnr*rron Nurnber (BnD is a combined number fff.,botlx.Oregon Witklrolding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or yww.dor.state.or.uslformspay.htrnll for the appropriate forms. lVorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and rnust obtain workers' compensation insurance for yow employees. If you fail to obtain workers' compensation insurance, you could be subjeci to penalties and be liable for all claim costs if one'of your emptoyeed is injured on the job. For more informafion, call the Wr:rkers' Compensatio,n Dvision at the Department of Consutner and Business Services at 5A3-947 -7 815 . U.S. Internal Revenue Service; As an employer, you must withhold federal income tax {iorn erniiloy€es"wage}i- You will be liable for the tax payrnent even if you didn't acrually withhoid the tax. For a Federai EIN number, call the IRS at l-800-829-4933 or visit their web site at lytgu;ttggv. Other Responsibilities and Areas of Concerns Code Compliance: As the pen*it holder for this praject, you are responsible for resolving any failure to meet code requirements lhat may be brought to your attention through inspections. Liability ancl Property Tlam*ge Insurnnce: C'ontact your insurance agent to see if you hat'e adequate instrrance coverage lbr ilccid*nts an<J ornissions s*ch as fulling t*o1s, paint over spray, u.,ater damage from pipe punctures, fire or work that must be redone. Time: Make sure youhave sufficient time to supervise your employeeE. Expertise: Make sure you have the skills to act as your own'general ccnfractor, to eoorilinate the work of rough-in and linish frades, and to noti{y building officials as the appr$priate times so they can perform the required inspections. If you have additional questions call the Construction Conkactors Board (503-3784621) ar write the agency at PO Box 14.140, Salern, OR q7309-5052. . - ,., ;,,.,n ..., Property*ovrner.doc 06-0 1 -04 CIry OF SF. ,GFIELD SYSTEMS DEVELOPMEN. 'RKSHEETJOURNAL OR JOB NUMBER: COM2005-00010R NAME ORCOMPANY:Larsen LOCATION 2220 5thst TAX LOTNUMBER:170326210ss00 DEVELOPMENT TYPE:SINGLE FAMILY RESIDENCE NEW DWELLING TINITS DTRECT RLINOFF TO CIry STORM SYSTEM BLTTLDTNG SIZE (SFl 0 LOT SZE (SF): CHARGE $0.00 0 RLINOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CIry STANDARDS I- rMPERVrous s-tr xI oro COST PER S.F. $0.3 r 0 COST PER S.F $0.310 COST PER DFU $24.04 $ 18.28 NUMBER OF L]NITS I NUMBER OF TINITS I ADM. FEE RATE 5010 IMPERVIOUS S.F 0.00 NLII\4BER OF DFU's l3 B. IMPROVEMENT COST: NUMBER OF DFU's l3 ADTTRIP RATE 9.57 B. IMPROVEMENT COST: ADTTRIP RATE 9.57 SUBTOTAL s2,45s.12 x x x x x x x x DISCOLTNT RATE 5OYo $0.00 DISCOT'NT $0.00 ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBT]RSEMENT COST: $550.I6 COST PER TRIP $r 8.30 COST PER TzuP $80.72 s947.62 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 xx xx ITEM 3 TOTAL. TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBT]RSEMENT COST: NUMBER OF FEU's I B. IMPROVEMENT COST: NUMBER OF FEU's I a\ €MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SAMTARY SEWER SDC SUBToTAL (ADD rTEMS 1,2, 3, & 4) 5. ADMINISTRATIVE FEE: $9s7.34 CHARGE s122.76 x TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINI STRATION FEE: CherylSlaymaker 311012005 COST PER FEU $82.03 $312.52 .64 $175.13 $82.03 $0.00 45. $2,577.88 1070 1091 1092 I 093 1094 1055 I 056 079 078 ar!n () trlFa o rrl& II@T -w COST PER FEU $865.31 455.12 PREPARED BY DATE TOTAL SDC CHARGES DRAINAGE FIXTURE UNIT IS LAND ELGIBLE FORANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) CALCULATION TABLE NUMBER OF NEW FD{TIJRES X UNIT EQUIVALENT: DRAINAGE FXTURE UNITS FOR CALCLILATE ONLY THE NET ADDITIONAL NO. OF FIXTURES UNIT FIXTURE TYPE NEW OLD ALENT MISCELLANEOUS DFU TYPE NUMBER OF EDU'S TOTAL DRAINAGE FD(TURE UNITS lsa toa mit set at 1 67 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE DRAINAGE FIXTLIRE 0 2 2 1979 *EDU BEFORE 1979 1979 1980 l98l I 982 1 983 I 984 1985 I 986 1987 1988 I 989 1990 l99l 1992 I 993 1994 t 995 1996 1997 I 998 1999 $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4"40 $a.oz $3.67 $3.22 $2.73 $2.25 $1.80 VALUE / IOOO $0.00 CREDIT RATE $5.29x CREDIT FOR IMPROVEMENT (lF AFTER ANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $5.29 TOTAL MWMC CREDIT$1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 3 310BATI]TUB 0 0 1 0DRINKING FOLINTAIN 3 000FLOOR DRAIN 0 3 00INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0006INTERCEPTORS FOR SAND / AUTO WASH / ETC, 2 000LAI.INDRY TUB 0 3 31CLOTFIESWASTIER / MOP SINK 0006CLOTHESWASHER- 3 OR MORE (EA) 00012MOBILE HOME PARK TRAP (I PER TRAILER) 0 1 00RECEPTOR FOR REFRIG / WATER STATION / ETC. 0003RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0002SHOWE& SINGLE STALL 0 2 00SHOWER, GANG (NT'MBER OF HEADS) 3103SINK: COMMERCIAL/RESIDENTIAL KITCMN 2 000SINK: COMMERCIAL BAR 0 2 00SINK: WASH BASIN/DOUBLE LAVATORY 1 0 1 1SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0005URINAL, STALL/WALL 6 000TOILET, PUBLIC INSTALLATION 1 0 3 3TOILET, PRIVATE INSTALLATION l3 CREDIT RATE/$I,OOO ASSESSED VALUE YEAR ANNEXED 0 2000 rI@El 2001 20 I 225 Fifth Street Sprirrgfieid, Oregon 97 477 541-726-3759 Phone city of Springfield Official Receipt 'elopment Services Department Public Works Department RECEIPT #: 2200500000000000435 Date: 0411512005 9:08:46AM Job/Journal Number coM2005-00010 coM200s-00010 coM2005-00010 coM200s-00010 coM2005-00010 coM2005-00010 coM200s-00010 coM200s-00010 coM2005-00010 coM2005-00010 coM2005-00010 coM2005-00010 coM2005-00010 coM2005-00010 coM2005-00010 coM200s-00010 coM2005-00010 ibuzoos-oooro Description Addressing Assignment Willamalane Attached (duplex) Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration Building Permit Miscellaneous Plumbing Miscellaneous Mechanical -Mechanical Issuance Fee- Inspections - Hrly Electrical + 7%o State Surcharge + l0% Administrative Fee SDC Sanitary/Storm Admin SDC Transpo Admin Amount Due 31.00 924.00 312.52 23',t.64 175.13 772.49 82.03 865.31 10.00 60.60 45.00 45.00 10.00 45.00 10.54 15.06 45.09 77.67 Item Total:$3,764.08 Payments: Tipe of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check LARSON & LARSON njm 601 In Person Payment Total: $3,764.08 -$764TF t 4lt5l200s Page I of I TPFII{GFI€!D -I