The URL can be used to link to this page

Home My WebLink AboutPermit Building 2005-01-20Status: Issued 225 Fifth Street, Springfield, OR 541-:726-3753 Phone 541-7263676Fax 541:7 2637 69 Inspection Line CITY O Buildin g/Co mbin ation Permit PERMIT NO: COM2005-00013ISSUED: 0112012005APPLIED: 01/04/2005E)PIRES: 0212512006VALUE: $ 38,264.00 SITE ADDRESS: 868 6TH ST ASSESSOR'S PARCEL NO.: 1703352101200 Springfield TYPE OF TYPE OF USE: Single Family Residence Addition Residential PROJECT DESCRIPTION: Addition to existing single family residence ' Owner: Address: LESLIE BELL 534 7TH ST SPRINGFIELD OR 97477 PhoneNumber: 541-744-9385 Date PhoneContractor Type General Electrical Mechanical Contractor OWNER owhrER OWNER OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Primary Construction Type Secondary Construction # of Bedrooms: Frontyard Setbrck Side l Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: YN # ofStories: Height of Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Overlay Dist: # Street Trees Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 418 Setback 5' , Curb and Gutter 2 22.00 Wall Heat Electric Electric Path 1 nlz 16.00 14.00 68.00 24.00 I REQUIRED PARKING Total: Handicapped: Compact: 29.00 Sidewalk Type: DownspoutVDrains DEVELOPMENTINF( Notes: Storm drainage piped to curb face 1/7/2005 CAS l of 4 t I LJ ate Fullv Improved Yes D Buildin g/Co mbination Permit Status: Issued 225 Fifth Street, Springfield, OR 541:726-3753 Phone 541-726-3676Fax 541:7 26-37 69 I ns pe ction Line PERMIT NO: COM2005-00013ISSUED: 0112012005APPLIED: 01/04/2005E)PIRESt 0212512006VALUE: $ 38,264.00 Description Dwellings Tvpe of Construction V Wood Frame $ Per Sq Ft Square Footage or multiplier or Bid Amount $92.40 418.00 Total Value of Project Amount Paid Date Paid Value $38,623.20 $38,623.20 Date Calculated 0111912005 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 7Yo State Surcharge Building Permit ' Dryer Vent Exhaust Hoods Fixture Minimum/Adj ustment Mechanical Plan Review Minor - Planning Plan Review Residential Sanitary Sewer - Reimbursement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Vent Fan + l0o/o Administrative Fee + 7%o State Surcharge Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Total Amount $180.08 $10.00 $50.83 $35.58 $306.30 $6.00 $9.00 $112.00 $6.00 $59.00 $19.02 $182.80 $240.40 $27.64 $129.58 $4s.00 $24.00 $12.s0 $8.7s $106.00 $19.00 $1,589.48 y4105 u20t0s u20t05 1t20t05 u20t0s u20t0s u20t05 u20t05 u20t05 u20t0s u20t0s u20t05 u20t05 u20t05 u20t0s u20t05 u20t05 8t25t05 8t2stos 8t25tos 8t25tos Receipt Number 1200500000000000017 1200500000000000082 r200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200s00000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200s00000000001241 1200500000000001241 1200500000000001241 r200500000000001241 Plan Reviews Initial Review Planning Review Public Works Review Structural Review 0u06t2005 0u06t2005 01/06/2005 0u06t200s 0u06t200s 0u19t2005 0u07t2005 0u19t2005 APP APP APP APP RJB EMM CAS DLM To be built as per Historic Review DRC2004-00053 Storm drainage piped to curb face 1/7/2005 CAS See documents for plan review comments. 2of4 ,T Yaluation Description I rees raro CITY OF SPRINGFIELD Buildin g/Combination Permit Status: Issued 225 Fifth Street, Springfield, OR 541:7263753 Phone 541-726-3676Fax 541:7 26-37 69 I ns pe ction Line PERMIT NO: COM2005-00013ISSUED: 0112012005 APPLIED: 01/04/2005E)GIRESz 0212512006VALUE: $ 38,264.00 To Request an inspection call the24 hour recording at 72G3769. 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. 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. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover 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. Storm Sewer Line: Prior to filling trench. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Reou 3 of 4 L Status: Issued 225 Fifth Street, Springfield, OR 541:7263753 Phone 541-726-3676Fax 541:7 26-37 69 Inspe ction Line OF Buildin g/Co mbin atio n Permit PERMIT NO: COM2005-00013ISSUED: 0112012005APPLIED: 01/04/2005E)CIRESz 0212512006VALUE: $ 38,264.00 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 certiff 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 certiS 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 4of4 qI 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 ELECTRICAL P ERMIT APPLI CATTON 8-to*t zoos - r^tc)O ( 3 Date LEGAL DEilao 1. LACA'TIONOFINSTAITA'TION 8 bg 61L 5l 3. COMPLEIE }EE A. t .t'* New Residential - Single or l\{ulti-F to\\ow inO drn'elling unit.'t'T\rr b(LOO Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or thereof Each Manufact'd Home or Modular Dwelling Feeder C. Temporary Services or Feeders $ r 06.00 $ re.00 I ? /oCJOB DESCRIPTION D-ernroe zo 6**? 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. O0NTRACTOR TNSTALTATION ONLY B. City Electrical Contractor Address Supervisor License Expiration Date Constr. Contr ,ber $37s.00 $ s0.00 $ s0.00 $ s0.00 $ 2s.00 $ 45.00 Expiration Address 53tt 1 Sh E. City SP i\pno"" 7t{\-?3ff OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent' Installation, Alteration or Relocation $ 50.00200 Amps or less 201 Amps to 400 Amps $ 69.00 401 Amps to 600 AmPS $100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel $ 3.00 not included) -Each lnstallation Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited EnergY/Commercial Minimum Electric Permit Inspection Fee is $45'00 * Surcharges 4- SwrorAL oF ABovE I Z { 7o StateSurcharge l0% Administrative Fee TOTAL of Supervising Electrician Owners Name ES v (E ?ta lz so I,T6 ZS 0em0 Inspection Request: 726'3169 Shared Drive{T: )/Building Fonns/Electrical Pennit Application l -03'doc s City Job Number il .: , 1 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone .-.Crty of Springfield Official Receipt- 'elopment Services Department Public Works Department RECEIPT #: 1200500000000001241 Date: 08/2512005 10:31:19AM Job/Journal Number coM2005-00013 coM2005-00013 coM200s-00013 coM200s-00013 Description + 7o/o State Surcharge + l0% Administrative Fee Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Amount Due 8.75 t2.50 106.00 19.00 Item Total:$146.25 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard ROBERT BELL djb 090616 In Person $146.25 PaymentTotal: -ffi .i t( 'l 81251200s 1of1 lfilffiI ( i F G 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: COM2005-00013ISSUED: 0112012005APPLIED: 0l/04/2005 EXPIRESz 0712012005VALUE: $ 38,264.00 SITE ADDRESS: 868 6TH ST ASSESSOR'SPARCELNO.: 1703352101200 PROJECT DESCRIPTION: Addition to existing single family residence Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PhoneNumber: 541-744-9385 License Expiration Date Phone Owner: Address: Contractor Type General Electrical Mechanical Plumbing LESLIE BELL 534 7TH ST SPRINGFIELD OR 97477 Contractor OWNER OWNER OWNER OWNER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories:on law Height of Structure the Type of Heat:Those Water -00 10 throu Range obtain copl (N ote: UtilftYt Size: et €fitflt lst Floor: fft 2nd Floor: Basement: Garage/Carport Other: Load: REQUIRED PARI(NG Total: Handicapped: Compact: 29.00 P\RE \I1HE 418 VN n UtrlitYlf$ 16.00 14.00 68.00 24.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo ofLot Coverage: 1 AL rs uorI Fully Improved yes 'tH\S PER iHont,t N M\1 S EDU D t0R Setback 5' Curb and Gutter AU ED OH A\ PEcu Notes: Storm drainage piped to curb face 1/7/2005 CAS {Y 18u Page I of3 R\OD \ lrull:l-rll\ (r lI\I (TI(IYIA I l(Jl\ | 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: COM2005-00013ISSUED: 0112012005 APPLIEDz 0110412005EXPIRES: 0712012005VALUE: $ 38,264.00 Description Dwellings Type of Construction V Wood Frame $ Per Sq Ft Square Footage or multiplier or Bid Amount $92.40 418.00 Total Value of Project Amount Paid Date Paid Value $38,623.20 $38,623.20 Date Calculated 0ut9t200s Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7%o State Surcharge Building Permit Dryer Vent Exhaust Hoods Fixture Minimum/Adj ustment Mechanical Plan Review Minor - Planning Plan Review Residential Sanitary Sewer - Reimbursement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Vent Fan Total Amount Paid $180.08 $10.00 $s0.83 $3s.s8 $306.30 $6.00 $9.00 $112.00 $6.00 $s9.00 $19.02 $182.80 $240.40 $27.64 $129.58 $45.00 $24.00 u4t05 u20t05 u20t05 u20t05 y20105 u20t05 u20t05 u20t0s u20105 u20t05 u20t0s u20t05 u20t05 u20t05 u20t0s u20t05 u20t05 Receipt Number r200s00000000000017 1200500000000000082 1200500000000000082 1200s00000000000082 r200500000000000082 1200s00000000000082 1200500000000000082 1200500000000000082 1200500000000000082 1200s00000000000082 r200500000000000082 1200500000000000082 r200500000000000082 1200s00000000000082 r200s00000000000082 1200s00000000000082 1200500000000000082 $1,443.23 Fees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 0u06t2005 01/06/2005 0U06t2005 0u06t2005 0l/06/2005 0u19t2005 0u07t2005 0y19t2004 RJB EMM CAS DLM OK APP APP APP To be built as per Historic Review DRC2004-00053 Storm drainage piped to curb face 1/7/2005 CAS See documents for plan review comments. 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. Paee 2 of3 L Valuation Descrintion Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Buildin g/Combination Permit PERMIT NO: COM2005-00013ISSUED: 0112012005APPLIEDz 0110412005 EXPIRESz 0712012005VALUE: $ 38,264.00 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. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover 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. Storm Sewer Line: Prior to filling trench. 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. i /zo/ af Owner or Contractors Signature Date Page 3 of3 Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress: www.cc[,!!g!4g perrrit XiCS r,*Z-clt>-5 O O<), 3 Address:a58 6+L sf Issued by:\6 Date: /^ z<> 'o r 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: E-r. lEl- z. &- 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. tr 3A. My general contractor is (Narne)(ccB #) I will instruct my general contractor that all subconfractors who work on the stnrcture 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 nirme 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) (White copy to issuing agenq perunitfile, pink copy to applicant') @ate) Property_owner.doc 06-0 I -04 Acting asYoirr Own General tdntractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT SON$TRUCTION RESPONSIBILITIES i: r3 Ifyou are acting as your own contractor to consfuct a new home or make a substantiirl improvement to an existing skucture, you can prevent many problems by being aware of the following responsibilifies and concerns. Employer Responsibilities You will, in rnost instances, be ruled to be an "employer" and the confractors you conEact rrith wrll be "employees" if you use contractors not licensed with the Conskuction Contractors Board to do labor in qonstructing or to assist in the construcfion or improvement of a residential structure. As the employer, you must comirly with the following: Oregon's Yt/ithholding Tax Law: As an employei-, you must withhold income taxes from employee wages *i the time employees are paid. You wili be liable for the tax payments even if you don't actually withhold the tax from your employees" For more information, call the Departmant of Rsvenue at 503-378-4988. : Uaemployment Insurance Tax: As an employer, you are required to pay a tax for tlnarrploynmrt inssrance purposd({ on the wages of all employees. For more information, call the Oregon Employment Department at503-947-1488.< The Oregon Business Identification Number (BII.U is a combined number for .both Oregon Witttholding ,rdi Unemployment lnsurance Tax. To file for a BlN, call 503-945-8091 or wwrv.dor.state.or.us/formspay.htmll for the appropriate forms. Workers' Compensation fnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must, qbtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation iRsurance, you bould be subject to penalties and be liable for all claim costs if one ofyour er4ptolees is injured on the job. For more information, call the Workers' Compensatibn Division at the Deparrme*'bf Cdnsunrer dnd Business U.S. Intern*l Revenxe Service: As an employer, you must withhold feddral iireO*re tax fram-e*qplbyees"tdagiill You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at l-800-8294933 or visit their web site at ttruvtl$gry :r(:. . !,, ,.. :Other Responsibilities and Areas of Concerns : Code Compliance; As the permit holder for this project, you are responsible for r6[btvin['any'fat'ureto?neet code requirementsthatmaybebroughttoyourattentionthroughiuspections i. 1:r,. i.r , :! ;.:: , , ".i: ri-:,:r..".i . Liability aud Property Damage fnsr:rance: Cantact yourinsurance agent to sde tfj'bri trrivejhCequate insurarree'l coyerage fcr accidents ancl omissions sucil as falling lools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient lirne tn supervise your employees. Expertise: Make sure you havd the skills to act as your own geiidralconl"actor,tt6(iooreinui" the workof rough-in and finish trades. and 1o notify building officrals as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) ar write the agency at PO Box 14140, salem, oR 97309-5052' ;.i .,- .; -s:2r; ;,., .. (a Propeny-owner"doc 06-0 I -04 NOfE: This lnformatian Notice to Praperty Awnerc about Construction Rbsponsrbildr'es was developed bythe Construction Contractars Eoard in accordance with ARS 701.065f5J, passed by the 't989 aregon Legislature. CITY OF SPn .iFlELD SYSTEMS DEVELOPMEN'r RKSHEET JOURNALORJOBNUMBER: COM2005-00013 NAME OR COMPANY:Bob Rell LOCATION:868 6th St TAX LOTNTIMBER:1703352101200 DEVELOPMENT TYPE: NEWDWELLINGT]NITS 0 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM BUTLDTNG SrZE (SF) 418 LOT SZE (SF): CHARGE $129.58 0 IMPERVIOUS S.F x 418.00 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F 0.00 NUMBEROFDFU's l0 B. IMPROVEMENT COST: NUMBEROFDFU's 10 ADTTRIPRATE 9.57 B.IMPROVEMENT COST: ADT TRIP RATE 9.57 STIBTOTAL $ss2.78 COST PER S.F s0.310 COST PER S.F $0.3 l0 COSTPERDFU $24.04 $r8.28 NTIMBER OF UMTS 0 NT]MBER OF TINITS 0 ADM. FEE RATE 5o/o DISCOT]NT RATE 50% $129.s8 DISCOUNT $0.00 x x x x x x x x ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBURSEMENTCOST: ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENTCOST: $423.20 COST PER TRIP $18.30 COST PER TRIP $80.72 $0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 xx xx ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NI]MBER OF FEU'S 0 B. IMPROVEMENT COST: NUMBEROFFEU'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. ADMINISTRATTVEFEE: $0.00 $552.78 CHARGE $27.64 TOTAL SANITARY ADMINISTRATION FEE TOTAL TRANSPORTATION Cheryl Slaymaker FEE: 11712005 COST PER FEU $82.03 $240.40 $r82.80 $0.00 $0.00 27.64 s580.42 1070 1091 1092 1093 1094 1 055 1056 1079 1078 a E]ooO &rI]FO o rI]& -E COST PER FEU $86s.31 PREPAREDBY DATE TOTAL SDC CHARGES x DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OFNEWFD(TURES x UNIT EQUIVALENT:DRAINAGE FXTURE UMTS FORREMODELS,ONLY TIIE NET ADDITIONAL NO. OF FXTURES TiNIT DRAINAGE FIXTURE T]NITS 0 2 r979 FD(TURE TYPE NEW OLD MISCELLANEOUS DFU TYPE NUMBER OF EDU'S TOTAL DRAINAGE FD(TT]RE T]NITS lsa toa unit set il 167 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE *EDU 21979 BEFORE 1979 $5.29 $5.29 $5.19 $5.12 $4.98 $4,80 $4.63 $4.40 $4.07 $3.67 $3-22 $2.73 $2.25 $1.80----T1se $1,45 $1.25 $1.09 $0.92 $o.72 $0.48 $0,28 $0.09 $0.05 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) 1980 l98l 1982 1983 1984 x1985 r 986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 VALTIE / IOOO $0.00 CREDITRATE $s.29 CREDIT FOR IMPROVEMENT (IF AFTERANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $5.29 TOTAL MWMC CREDIT 0 0 3 0BATHTUB 0 0 1 0DRINKING FOIINTAIN 3 0FLOORDRAIN00 0 0 3 0INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 6 0INTERCEPTORS FOR SAND / AUTO WASH i ETC. 0 2 0LAUNDRY TUB 0 0 0 3 0CLOTI{ESWASTIER / MOP SINK CLOT}IESWASMR - 3 OR MORE (EA)0 0 6 0 12 0MOBILE HOME PARK TRAP (1 PER TRAILER)0 0 0 0 1 0RECEPTOR FORREFRIG/ WATER STATION /ETC. RECEPTOR FOR COM. SINK / DISHWASIMR / ETC.0 0 3 0 2 2SHOWE& SINGLE STALL 1 0 0 0 2 0SHOWER, GANG (NT]MBEROF HEADS) SINK: COMMERCIAL/RESIDENTTAL KITCIIEN 0 0 3 0 SINK: COMMERCIALBAR 0 0 2 0 0 0 2 0SINK: WASH BASIN/DOLIBLE LAVATORY SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 2 I.]RINAL, STALL/WALL 0 0 5 0 0 0 b 0TOILET, PUBLIC INSTALLATION TOILET. PRIVATE INSTALLATION 2 0 3 6 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 00 2000 20 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone 'ity of Springfield Official Receipt elopment Services Department Public Works Department RECEIPT #: 1200500000000000082 Date: 0112012005 10:37:49AM Job/Journal Number coM2005-00013 coM200s-00013 coM2005-00013 coM2005-00013 coM2005-00013 coM200s-00013 coM2005-00013 coM2005-00013 coM200s-00013 coM2005-00013 coM2005-00013 coM2005-00013 coM200s-00013 coM2005-00013 coM2005-00013 coM2005-00013 Description Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Plan Review Minor - Planning Building Permit Fixture Vent Fan Exhaust Hoods Dryer Vent Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Plan Review Residential Storm Sewer - lst 50 Feet + 7o/o State Surcharge + l0% Administrative Fee Amount Due 129.58 240.40 182.80 27.64 s9.00 306.30 l12.00 24.00 9.00 6.00 6.00 10.00 19.02 45.00 35.58 50.83 Item Total:$1,263.15 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard ROBERT BELL djb 054232 In Person $1,263.15 Payment Total: -51ffi U20/2005 Page I of I 5I