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Home My WebLink AboutPermit Building 2009-2-2 Status Issued CITY OF ~rKll"t..I'IELD' Building/Combination Permit PERMIT NO: COM2009-00I53 ISSUED: 02/02/2009 APPLIED: 02/02/2009 EXPIRES: 07/02/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Plione 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1261 PARKER ST ASSESSOR'S PARCEL NO.: 1703264416700 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Add gas service, pilling"firep'lace, On-demand WH and convert range from Ip to nat ~, , "I~ IIUN' Oreao , gas follow rules ~rl"nt-;,,,,nL aw, requires You to '~UtlIH;ar'on Cent OJ "'v vl~yon Uti/it Owner: KLUPENGER JEFFERSON DON~ICD\R 952-001 oe~, Those rules are set for~ Address: PO BOX 70744 0090, You ma - 10 through OAR 952-00 EUGENE OR 97401 calling th Y obtain copies of the rule b1- e centpr Itd....~_." S V "UII1Ut:f Tor the Orpf'I'nl-' 11;:I~~'''''.\.crC'f.mone , CONTJM(1lTcOR:llIN.EORMATION"llcation 'J.. Contractor Type Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER License Expiration Date Phone , BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Constrnction Type Secondary Construction Type: # of Bedrooms: # of Stories: R-3 NOTICE:Height of Structure THIS PERfrlYJi.sltlNel.tEXPIRE IF THE WORK VB AUTHORliWiJtijNlyiifl THIS PERMIT IS NOT cOMMEN!}e[lg@~)\l!I'~BANDONED FOR ANY 180 ~~1:ltIfe~~nding n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION' Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: '# Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: IPUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Speciallnstrnction: Notes: ~<::v (A ~'b'~ ~~ Sidewalk Type: DownspoutslDrains: Page I of3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2009-00153 ISSUED: 02/02/2009 APPLIED: 02/02/2009 EXPIRES: 07/02/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calcnlated Total Value of Project , Fpp, P1W Fee Description + 12% State Surcharge + 5% Technology Fee 1st Appliance Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fixture Gas Outlets 1-4 Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $24.60 $10.25 $79.00 $55.00 $6.00 $19.00 $7.00 $39.00 2/2/09 2/2/09 2/2/09 2/2/09 2/2/09 2/2/09 2/2/09 2/2/09 2200900000000000123 2200900000000000123 2200900000000000123 2200900000000000123 2200900000000000123 2200900000000000123 2200900000000000123 2200900000000000123 Total Amount Paid $239.85 I Plan Reviews I To Request an inspection call the 24 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. ~Iirprllnsnections I Rough Plumhing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not attached to lIn applillnce. Gas Service: After line is installed and line has been connected to a minimum of one appliance iucluding required testing. Presure,test done at this point. Rough Mechanical: Prior to Cove~ Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Pa2e 2 of 3 -~,f;!',~,g~~~.~,~'.:l;~~J"H ~ " . r ' . " Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00I53 ISSUED: 02/0212009 APPLIED: 02/02/2009 EXPIRES: 07/02/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Electric: When all electrical work is complete. By signature, I state and agree, tliat I Iiave 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 tliat NO OCCUPANCY will he made of any structure without permission of the Community Services Division, Building Safety. I further certify tliat only contractors and employees wlio are in compliance with ORS 701.005 will be used on this project. I further agree to ensure tliat 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. <. 2_~ tfl ntractor.-sig;;"ature ---...... Date Paee 3 of 3 ' . ',Mechanical Permit Application CITY OF SPRINGFIELD, OREGON 225 Fifth Street tSpringfield, OR 97477 . PH(541 )726-3753 . FAX(541 )726-3689 ---..... TOR INSTALLATION '" I Busines I Address: I City: I Phone: I E-mail: I ees license no.: I Print name: I Signatu"re: I State: I Fax: I ZIP: 440-2545-.1 (II/OS/COM) ~~ I DEPARTMENT USE ONLY I Permituo,: (J(1-/)':) I Date: 1'7-/0 I I I I FEE SCHEDULE I Qty. I Cost ea. I First Appliance ( $79;00 Wurnace/burner including ducts an~ vents I Up to lOOk BTUA,r. I I lOver lOOk BTU/hr. I Heaters/stoves/vents I Unit heater Wood/pellet/gas stove/flue ,- . Repair/alter/add to heating appliance/ refrigeration unit or cooling system! absorption system Evaporated cooler Vent fan \vith one duct/appliance vent Hood with exhaust and duct Residential Floor furnace including vent Gas pipine One to four outlets - I \ I Additional outlets (each) , Air-handling units, includin~ ducts Up to 10,000 CFM I I $11,00 I $ Over 10,000 CFM $20,00 $ Comoressor/absorotion svstem/heat oumo Upt03hp/100kBTU I $17,00 I $ Up to I; hp/;OOk BTU , $29,00 1 $ Up to 30 hp/LOOO BTU 1 $43,00 I $ Up to 50 hp/L7;O BTU 1 $57,00 I $ Over;O hp/L7;O BTU 1 $95.00 I $ Incinerators Domestic incinerator 1 Commercial I Ellte: total v~luation of mechanical system and installation costs$ _ ' I Enter fee based on valuation of mechanical system, etc. I Miscellaneous fees ' Iltemsl'-Cost ea. I Reinspection $58.00 $ I Specially requested inspections (per hr.) $58.00 $ I Regulated equipment (unclassed) $13.00 $ I Each additional inspection: (I) $58,001 $ I APPLICANT USE I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) I (B) Investigative fee (equal to [AD I (C) Enter 12% surcharge (,12 x [A+BD I (D) Seismic fee, 1%(,01 x [AD I (E) Technology Fcc (5% orrAD I TOTAL fees and surcharges (A through E): I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I 1 I $ I Total I cost I- I I I 1 I I I I $ if ' :5 I $ I tlo .;;.::.1 Total cost $.'7 '1 $17,00 I $ $20,00 $ $17.00 I $ $38,00 $ $58,00 $ This permit is issued under O~R 918-440-0050. Permits expire if work is not'started wit~in 180 days of issuance or if work is suspended for 180 days. I CATEGORY OF CONSTRUCTION I 00.- Residential J 0 Governmint I 0 Commercial I JOB SITE INFORMATION AND ~OCATION I lob site address: 1;\"'\ yc:;,\(pr ~ I City:5.or-i.I\<~-L-\d I State: D~ I ZIP:'17417 I Subdivis'on: U I-Lot no.: I . DESCRIPTION OF WORK ~t-djijjC}J{h - 4T~t-~1d,:"r J=':;,n::\ Q;Z --> I 1 PROPERTY OWNER I Name: ~ \~\\I^.dJ'C"'.r I Address:~'?)b~ :-l;b-q-44 I I City ~~,^"bo \J I State 0)1< I ZlPCf7l{DL I Phone: 1-.q)'1~~'3t..l-~1 Fax: - -, I E-mail: \-<(\I..I.o.e::..\~/@./'.i\l"'ifl>lS't; r'lef- I This installation 1s bemg made on property owned by me or a member of my immediate family, and is exempt from licensing requireme ts under .010. $13,00 1 $ $9,001 $ $13.00 I $ $58,00 I $ $7,001 $4,001 $ '7 $ $20.00 I $ $ 'i~ $ $ 10 ;.)-- $ 225 Fifth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541)726-3689 -iii' ,... ..;. )c .:- ~. ' I Pennitno,:G ;1-1 ~3 I Date: J-!2-/I} I' DEPARTMENT USE ONLY Electrical Permit Application CITY OF SPRINGFIELD, OREGON This permit is issued under OAR918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. I LOCAL GOVERNMENT APPROVAL I FEE SCHEDULE I Zoning approval verified? 0 Yes 0 No I I Number of inspections per item ( ) IQty.1 Cost I CATEGORY OF CONSTRUCTION I ea. I HI I I I I Residential, per un'it, sendee included: W Residential' D Government 0 Commercial I' - JOB SITE INFORMA.TION AND LOCATION I 11,000 sq, ft, or less (4) , I I':;' I ( I ~ V _ .-.. ~ L I I Each additional 500 sq. ft. or portion job site address: ~b, r4.f"L-LV 1">, ' thereof I City: srr;^"~t e.Jd I State: r)K I ZIP:S? Vb I I I Limited energy (2)' I Subdivision: J 1 Lot no.: I Each manufactured home or modular I DESCRIPTION 9F WORK I dwelliog service or feeder (2) I ntevt4 10D DtfHe.-ts I Services or feeders: installation, alteration, relocation I ^ -r:::- \ ,. --- If I" I I I 200 amps or less (2) $ 81,00 $ (, Jill.!> _ t i) .p.'f-eJ)1C,1ltL.- - ()v\P _ t /) k l1e<ie(' I ,_ P~pPERTY OWNER I 201 to 400 amps (2) $ 95,00 $ I Name: ~e:W ~\l.lDel\<\eJ I 401 to 600 amps (2) $158.00 $ I Addr~ss: ,,:?ODo'l<. 7CS-1t4LJ I I 601 to 1,000 amps (2) $205,00 $ I City: ~\x'eAe_ J State: DR. I ZIP:'17Y/Y{ I I Over 1,000 amps or volts (2) I $469,00 I $ I Phone: .) );"/)1-'3'34 Rt Fax: - - J I I Reconnect only (2) I $ 63,00 I $ I E-mail: t<lU~2A.e...r-@...(J~;11(.-.5.s+..v1~t- I Temporary senrices or feeders: /l1<;tallatlOn, altelatlOn. relocatIOn Th" II' 'b'\l'\ d 'd' I c I 200 amps or less (2) $ IS msta atlO IS ~ ma e on reSl entia or larm property . 63.00 $ owned b~ me 0; a member of my immediate family, This "I 201 to 400 amps (2) $ 87.00 $ property IS not Intended for sale, exchange, lease, or rent. OAR 'I 479,540(I)a~, 401 to 600 amps (2) '$126,00 $ Signature:<;/' \~/,. ,/:.;)-- ---. lOver 600 amps or 1,000 volts, see services or feeders section above I ( CC\~OR INSTALLATION I Branch circuits: new, alteration, extension per panel I Business ~J I a. Fee for branch circuits with purchase of a service or feeder fee: I Address: I Each branch circuit - I ~_$-6;oo-1-$-r--". I City: I State: .] ZIP: I b. Fee for branch circuits without purchase-of a service or feeder fee: I Phone: I Fax: I I First branch ci'cuit (2) I I $ 5500 I $'S S- I I E-mail: I I Each additional branch circuit l $ 6.00 rQ~tp.-. J I ees license no.: I BCD license no.: I I Miscellaneous fccs: service orfeeder no/ included I I Signing supervisor's license no.: J Each pump or irrigation circle (2) J $ 63.00 $ I I Print name of signing supervisor: I I Each sign or outline lighting (2) $ 63.00 $ I I Signature of signing supervisor: I I' Signal circuit or a limited-energy paneL $ 63.00 $ I alteration, or extension (2) I Each additional inspection: (I) $58.00 $ I I APPLICANT USE j I (A) Enter subtotal of above fees $ ~ \ I (Minimum Permit Fee $58.00) I (B)EnterI2%surcharge(.12x[Al) $ '7::;:, I I (e) Technology Fee (5% offAl) $ 'i 0: I I TOTAL fees and surcharges (A through C): $ '7t~J- I Total cost $134,00 $ $ 25,00 $ $ 32.00 $ $ 63,00 $ 440-2584-J (9/08/COM) Plumbing Per~it Application CITY OF SPRINGFIELD, OREGON 225 Fifth Street. Springfield. OR 97477 . PH(54] )726~3753 . FAX(541 )726-3689 I DEPARTMENT USE ONLY -~ ~ I Permit no.('?'7 (..J"3 I Date J./1Ldi II This permit is issued under OAR918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. I LOCAL GOVERNMENT APPROVAL I Zoning approval verified? 0 Yes 0 No I Sanitation approval verified? 0 Yes 0 No I CATEGORY OF CONSTRUCTION I if Residential I D Government ) D Commercial I JOB SITE INFORMATION AND LOC,ATION I Job site address: I D '" \ Va.r-\(.o f S-<T- I City SPr;"S\::RJc\. r State: rl\'\.. I ZIP:Sfit1"1 I Subdivisio'n: - 1 Lot no;: I . DESC~~P!ION O,F y!O.RL- I ~vtd Slst,,,,, tb+-1t1t;ldC to tJeW ~l'lne5/ i-k t"WA'if ~,.ch'r I PROp,ERTY OWNER I Name: ~ v-.~At''\? r I Address: t>D&x. 't6i1L./.~J I City: >C:v<;-e?U.- r State: Di< I ZIP: <)7'1d1 I Phone ' - "" -.60 I <33I.fgFax: - -I ^ I E-mail: KJuiJeIlQer@'-&Yi1cr;Si,Yle..V- This installation'is beirrg' made on residential or fann property owned by me or a membe~ of my immediate family, and is e~empt from ':e~rements 8-695-0020, Slgnatu, ,( - /___ I \'. -TRACTOR INSTALLATION I Busines~ame: I Address: '-../ I City: I Phone: I E.mail: I CCB license no.: I Plumbing license no.: I Print name: I Signature: I State: I Fax: I ZlP: I BCD license no.: 440-2500-) (II/OS/COM) I I Description I New residential I bathroomll kitchen (includes: first 100 fiet of water/sewer lines, hose bibs, ice maker, under floor low-point drains and rain-drain packages) , I 2 bathrooms!1 kitchen $374.00 I 3 bathroomsll kitchen $439.00 I Each additional bathroom (over 3) $95.00 I Each additional kitchen (over I) $95.00 i Residential fire sprinklers (includes'plan review) I 0 to 2,000 square' feet $58,00 I 2,00 I to 3.600 squarefeet $116,00 I 3.60 I to 7.200 square feet $174,00 I 7,201 square feet and greater $232.00 I Manufactured dwelline or pre-fab (circle one) I Connections to building sewer and I I $5800 I $ water supply . . I Commercial, industrial, and dwellings other than one- or two-family I Minimum fee I I $58,00 I I Each lixture $19,00 I I Miscellaneous fees 1100; storm, sewer, water line I ! Each fixture, appurtenance. and piping- I Storm water retention/detention facility I I Irrigation systems I Piping or private storm drainage svstems cxceedinl! the first 100 feet \ Specialty fixtures I Reinspection (no. ofhrs. x fee per hr.) I Special requested inspections (no. of hrs. x fee per hr.) I Each additional inspection: (1) $58.00 $ II\:lediclll ~as piping I Minimum fee $ ) Enter value of installation and equipment $_. I Enter fee based on installation and equiprnent value. I APPLICANT USE I (A) Enter su~total of above fees (Minimum Permit Fee S58.00) - I (B) Investigative fee (equal to IA]) I (C) Enter 12% surcharge (,12.x [A+B]) I ([)) Technology Fec (5% of [A]) I TOTAL rees and surcharges (A through D): FEE SCHEDULE IQty.1 Cost ea~ $238,00 $76,00 $19,00 $19,00 $19,00 $19,00 $19.00 $58,00 $58,00 Total cost $ $ $ $ $ $ $ $ $ $ $, ( $ $ $ $ $ $ $ $ $ (;?i<- .z.......fo:..u -. , , . , , . , , ", ." " .' , , - Construction Contractors Board 700 Sunimer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Plione: 503-378-4621 Web Address: www.ccb.state.or;us Pennit #: Address:' 19.bl ~l'\(p~d .' :> Issued by: '--""..? . Date: 2( ~/{)7 . ;~.' Statement: Information Notice to ,Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board t6 sign the fo{lowing statement before a b~ilding permit can be issued. This~statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement.' This statement will befiled with the permit. . . . . .~. ~ Fill in the appropriate bianks and initial boxes I and 2, and either box 3A or 3B: .:~ I ~l. ~2. 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 oron completion. ' , , . D '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 ~B. I will be my own general contractor. , IfI 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 notifY the office issuing this b!lilding permit of the name of the contractor. I hereby certify that the above informationis corre~t and tha't I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. '.' .- .~ \j-- , , - ~h ____ [), --t:M : n '1 (Signature of permit applicant) , (Date) (White copy to issuing a?ency permit file, pink copy to applica,!i.) PropertLowner.doc 06-01-04 r' - ... .- - ~ ',~' I, \ ~ ", -h Acting as X o,ur Own- Gener;al Contractor? - - '~NFOR~A f.ldN\ ~'bTICE TO ,PROPERTY OWNERS ,~,-' ABOUT CONSTRUPIO!'l'RESPONSIBILlTIES ';. j " .~.. t ,,',' - :- " c ~.~ NOTE: This Information Notice to Property Owners about Construction Respo~sibilfties was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. . ~ 1,_ "-. '" " '['. :;;",' 0' + I' '"..... '. '. "", ~- '. ,-.. '" ".. - If you are acting as your own contractor to constiuct a new home or malfe a substantial improvement to an existing structure, you can prevent many problems'by beipg aware of.thlf6llowing responsibilities and concerns. Employer Responsibilit~es .- ,;' ...' .'~ '. , ..i.' 'I ~ -; " . -'... . _'\. ). . _ . You .will, in mo~t in~Fance_s, ,be. ruled !g-be"al!,:',e.!11pl~Ye.t'.?nd.the cRntract!Jrs,yoll contrac,~~th will !>~,':e!Jlployees" iI you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the ", . '"." ", . I., ;.:~." ....\. . '." t... '.. . .... construction ?~ impro,:,~me?t of~ resi~~ntial.~n,J,9!M.{~...;AsJ.~e;e~pl~yer, you, "lus~ comply ~ith ~he !oIlo,wing: Oregon's Withhoidhig Tax t'aw':As'an eID~l(iyer:yJu'hlUk~ith~oldinco'ri1e t~es fr~ffi' empioyeewages '~t the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your '.' . '."~: "-. J,":' ~; ',--' {, ~.... ~ ~^ '". . ? ~ . ',' - '-... ~ . .. . employees. FormoremformatlOn,calJ-theDepartmentofRev'enu'eat503-378-4988.' " '-'~' ,/. c;. . J", . . .' . -.-1' Unemployment Insurance Tax: As an employei'; fou'are'required to pay,a tax.for unemployment,insurance purposes r) on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. ~' The ~~~~~. ~~s~~~~~'j;~~~ti~c~:i~~" ~~e/~~';s a4 c~~~;ned:'~~~b~r,tf~;..'b~t~;~egO~::~itJ$o;din~' an~~ Unemployment Insurance Tax. To file fora BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htrnll for the a..... vp' :ate forms. I ~ 1 .. ~. '" !.. .:., ': " ,~'.~ . .... --. l.... " Workers' Compensation Insurance: As an employer; yo~ are subject to the Oregon Workers' Compensation Law, and must obtain workers' cv...p"..sation insurance for your employees. If you fail to obtain workers' compensation , ~.; .... ..{ -.-. , \, . , .'.. ; . i ..... . ,. l'" . ~ ., . . '.. ,.' . .. insurance, you could be subjecrto penalties and be liable for all claim costs if one of your employees is injured on the job, For more information, call tlieWorkers' Compellsa'ti()I; Division at the'Department of'Consumer arid Business Services at 503-947-7815, , . . ----;- U.S. Internal Revenue Service: As an employer, you must withhold federal income"tax. from employees' w'ages.' " You will be liable for the tax payment even if you didn't actually withhold the tax, For a Federal EIN number, call ilie . IRS at lCSOO'829'4933'or.visit,their.web site atwww.irs'l!ov. . ' :.'..., " ,(',,;. ,-~"d " 1 ,',-i";.:~";.~" .~: ,...,.....' f.. J,,' 'T....., '). , "If.., " ~r :. .,,,rh'J-. ,'j.:. ":' ,', , !,' Other Responsibi.liti~s,:md AreasofConc_erns , ~ ._,; 6,_ :-1 Code Compliance: As the permit hoider for this project, you are responsible for resolving anyfail..rre to meet code requ,irements .that may be bro1,1gh! to. your attention thmugh inspections. r. ~ ..4'. .'. '. , ~ . >7, . -... " ~ .,J-i!' '. _' .~ -. ,'. .' ~ "'~ , .7 . '\ "'" Liability and Property D:;;rlage Insurance: 'Corttactyour Inslira~c~-igerit to see ;if YOlxh<ive' adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punptures, fire or workthatmu~b.eredone,---1_, \'\ '''--'__~, . -. .;:--,.', _..I J. US.t 'r. _:-> h ".-i, Time: Make sure you have sufficient time to supervise your employees,;,. , ' i; 1 ,c"':1 . ~ ! I . . 'Expertise: Make sure y~'u have' the skins to ac(as.'your'~~' gebbialco~tractor, to coordinate the work of rough-ih and finish trades, and to notify building officials as the 6P".V...:ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. -,. ~. -,..... ,''";'(. Property_owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-00153 COM2009-00153 COM2009-00153 COM2009-00 153 COM2009-00t53 COM2009-00 153 COM2009-00 153 COM2009-00 153 Payments: Type of Payment CreditCard cRcceintl RECEIPT #: 2200900000000000123 Date: 02/02/2009 Description Fixture Minimum/Adjustment Plumbing I st Appliance Gas Outlets 1-4 Add, Alter, Exteud Circ Add;Alter, Exteud Circ Ea Add + 5% Technology Fee + 12% Stale Surcharge Paid By JEFF KLUPENGER Item Total: t:heck Number Authorization Received By Batch Number Number How Received cJc 41202a In Person Paymcnt Total: . Page I of I , 12:13:34PM Amount Due 19,00 39,00 79,00 7,00 55,00 6,00 10,25 24,60 $239.85 Amount Paid $239,85 $239.H5 / 2/2/2009