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Home My WebLink AboutPermit Building 2009-2-2 Status Issued 225 Fiftli Street, Springfield, OR 541-726-3753 Plione 541-726-3676 Fax 541-726-3769 Inspection Line' CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00118 ISSUED: 02/02/2009 APPLIED: 01/2612009 EXPIRES: 08/02/2009 VALUE: $ 2,000.00 Springfield TYPE OF WORK: Bedroom SlTE ADDRESS: 890 ALDRIDGE PL ASSESSOR'S PARCEL NO.: 1802061204324 TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Convert portion of garage to bedroom Owner: Address: DANIELS BETTINA L 890 ALDRIDGE PL SPRINGFIELD OR 97478 Contractor Type General Electrical Contractor OWNER OWNER # of Units: Primary Occnpancy Gronp: Secondary Occupancy Gronp: 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 Instrnction: Notes: Phone Number: 541-741-9113 I CONTRACT~~.INFORMATION I License Expiration Date Phone R-3 I_BUILDlNG-INFORMATlO~'ls you to f;;li~v;r'!I~' adDPted by the Oregon Utility , N I'" #(of Stones: Thoce I'ules are set forth Lot SIze: o mea" JjJ\Jt::jIlL~L " . OAR HeIght of,Strncture'gll OAR 952-001- Sq Ft 1st Floor: In ~~)G ..JV! -vv 'v u".......... 0090, Y6~P,~lg~\:!~'1!;n copies of the rules by Sq Ft 2ud Floor: callin~I~~rG!,Y,PJ\:, (Note: the telephone Sq Ft Basement: numb~~~g~i!iyp.Yt:egon Utility Notification Sq Ft Garage/Carport ~Hg~IPI!t~:800-332-2344). Sq Ft Other: Sprinkled Building: n/a Occnpant Load: 156 VB I DEVELOPMENT INFO~MA~ION , REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Rqd: . Paved Drive Rqd: NOTICE. % of Lot Covera&e: . THIS PERMIT SHALL EXPlRt IF THE WORK ^"TU()DI7~n I"'n~p HHC:: P~RMIT Ie:: MOT - - - COM~DP.P~~,m:'~J~FOR . ' ANY 180 DAY PERfJU. Sidewalk Type: Downsponts/Drains: Paee I of 3 _~~l~qlill~t, ~ . _::. ,.' ~,. , ",:,_",-'-";""'V{ Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00118 ISSUED: 02/02/2009 APPLIED: 01126/2009 EXPIRES: 08/02/2009 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Description Tvpe of Constrnction Bid Amonnt Use Bid Amonnt $ Per Sq Ft or mnltiplier $1.00 Sqnare Footage or Bid Amount 2,000.00 Value Date Calcnlated Total Valne of Project $2,000.00 $2,000.00 01129/2009 Fpp~., PiLIIJ Fee Descriotion + 12% State Snrcliarge + 5% Tecbnology Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Bnilding Permit Plan Review Residential Amonnt Paid Date Paid Receipt,Nnmber $15.00 $6.25 $55.00 $12.00 $58.00 $37.70 1/26/09 1/26/09 1/26/09 . 1/26/09 1/26109 1/26109 1200900000000000047 1200900000000000047 1200900000000000047 1200900000000000047 ,1200900000000000047 1200900000000000046 Total Amount Paid $183.95 I Plan Reviews I Initial Review Public Works Review Stl'llctnral Review 01/27/2009 01/30/2009 01130/2009 0113012009 01/30/2009 01/30/2009 OK APP APP LLH ,LKW CJC No new surfacel no new fixtures As noted on plans 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. I Rpnwp<lln<nprt~ Post and Beam: Prior to floor insulat~on or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Walllnsnlation: Prior to cover. Ceiling Insnlation: Prior to cover. Final Bnilding: After all reqnired inspections have been reqnested and approved and the building is complete. Rongh Electric: ~rior to Cover Final Electric: When all electrical work is complete. Paee 2 on Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541"726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00118 ISSUED: 02/02/2009 APPLIED: 01126/2009 EXPIRES: 08/02/2009 VALUE: $ 2,000.00 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 ofthe City of Springfield and the Laws ofthe State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission ofthe 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 tlie permit card is located at the front of the property, and the approved set of plans will remain on the site lit all times d~l'~~~q):~~_,. ( 1C;;:I(_~n' '.f'-/ Owner or Contractors Signature ---.. Paee 3 of3 ;) ~ )--0 / Date Structural Permit Application j~"-";'S;'-"""':::<c'i=<"""'=~"""='::-~"""'~""";",j.iJil1 ~!J,~!1~lt!iM~~~5k,C?mt;if~ 225 Fifth Streel. SpringfieJd,OR 97477. PH(541)726-3753 . FAX(541)726-3689 Permit nO'{J 1/f / f , '." Date: 1/"7-'-'(1)/ This permit is issued nnder OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is snspended for 180 days. I I 1 Zoning approval verified: DYes D No I 11:=~~~~~.it~~~t1.o. O_..d ~.~:.~n~,9,,"..Y. es..... ~~...~~. ..~?J.'.ll'ljil.j:j " n';jf.';'li4'ai1'.!r.J ~:!I:&1!iM.Jilj;i~,~'ful~.g~]i1;c.;9BX~9F;1)1~QN~.iliI'lIJ,gJjI9t:!:~,,,11i'i~ ! 0 Residential ) 0 Government I 0 Commercial .~1:':~~~~'11iN[;5iJR.M],TiQ[f~~!)~:C~TIQt:J~ fJab site address: . I~ 1&- I~ I Subdivision: I Lot no.: I Reference: ! Taxlot: This project has final land-use approval. Signature: This project has DEQ approval. Signature: . Date: Date: 1 Name:'1:--".fr', "'-^ I~.' ~r. ,~....o_b 1 Address '1<"\ [) {\ \ tV {" -;"".l <(f-- 'Q L I City: ~'('" ",~s;.....o\& State nR- 1 ZIP: q-:r~'}Zl I Phone:9-\\-1-,\\- '1\1\'>-, Fax:{f)f-,tHp?();) reI/- 1 E.mail: \'-"."\\\_r,,Q...~',..Js.(li:>~ !AnI, ('/"'t,r,., This installation is. being made on residential or farm property owned by me or a member of my immedi~. mily,'and is exempt from licensing requirements ~nder ORS . 10. ~. ----. Sign here: / ~0i\i1!J"~:~4S""~.,-,~-"-'="c"'''''''''''''lYAT-''-';Y_l\S~'!i1'''ir,,NA''''1 ~~1if~illRiiWt~\2.~1:1~ACIT.Q~~.IN~Y8U:.~:rJ~~~~iJ0~Af~~~~~J;1 1 Business name: f) \A.) Y\ 0_../ 1 1 Address: 1 1 City: 1 'State: 1 ZIP: 1 I Phone: Fax: 1 1 E-mail: 1 I CeB license no.: I I Print n~me: _ I I Signature'-<~~~--'---' I 1~S:OJitQ;~~~~~~~~~?~~~M&(t,;~~:~~~~lE~~1j I Electrical I I Plumbing I I Mechanical I I I I I I 1 I I I I I Total valuation: 1 $')flt!ZJ - 1 r....."'..._"."'..."._-"'w,.m:...'l!."';..'""""'.'*Jt,.'"~-~.'1 '}~:;~.ijJIQJl!gtf.~~J~~TziwiV0~1Alhr~Jij;~:.,,:hr~fft#j~f7l~~~gJ1~~g~JllHt' (a) Permit fee (use valuation table): $ 1 1 (b) Investigative fee (equal to [2a]): $ I I (0) Reinspection ($ per hour): I (number of hours x fee per hour) $ 1 (d) Enter 12% surcharge (,12 x [2a+2b+2c]): $ 1 1 (e) Subtotal of fees above (2a through 2d): $ I r7~~~~~;~~~;::~~~J I (b) Fire and life safety (40% x permit fee [2a]): $ I I (c) Subtotal of fees ahove (3a and 3b): $ I (a) Job description: Oc~upancy 1 1 I I 1 I . Type of Heat: I I 0 new 0 alteration' I (b) Foundation-only permit? Construction type: Square feet: Cost per square foot: Other information: Energy Path: D addition DYes DNo 1 (al Seismicfee.I%(,OI x permit fee [2a]): 1$ I TOTAL fees and surcharges (2e+3c+4a): $ 225 Fifth Street. Springfield, OR 97477.PH(541)726-375HFAX(541)726-3689 Iti~DE8ARTMENT1GSEmNlliY.'J.."'.'1 ~:Z:;';~:j."";;!:"FYi/:"':;"'.ki&,:':;;Zc'!j\>1~'m:'i:7t~AiiG'.si~,"., I Permit no.:/' CJ - II ,.( I' I Date: I / :J-{j, 10 't I I Electrical Permit Application Tliis permit is issued under OAR 918c309-0000. Permits are nontransferable. Permits expire if work is not started witliin 180 days ofissnance or if work is snspended for 180 days. liilir~l\l1!:0.C]l;I!IG("jgEBN.ME:Nif"~ee~o.v]l;~~~fil I Zoning approval verified? DYes D No 1~~li.€M:EGQ8YI1Q.~~9~O'N$j1'8l!JGjl]IO'N~1!tJt~l'!Il 1~~:~~~JIPElfN~~~~;';;~~~ND~~~€~%7~~;~il : ~~~;::ti;I,:,el:S:~:; service inclnded: $: I 1 I Each additional 500 sq, ft, or portion $ I Job site address: thereof . CitY: I State: I ZIP: I 1 Limited energy (2) $ 1 I'~~~~_ ..-_. ..... ....~ .... ~ JLot.,:;;...""i'1,"",'''''''c I ~~~~l~:ns~~~~~~~ ~~~:r (~)odular $ I f~Q!';~~lJ!D.ES9RlBml!:1flljl!:1F..\WOR~~~-,ill,""t"1'?Sfj I I I Services or feeders: installation, a(teration, relocation \ I, I 1 200 amps or less (2) $ 81.00 $ 1 11~~.iiIi_,llrtJll'~RQ~ElhtY;[0YvNE:Rj~1:~~_~i~\j1'i1~1 1 201 to 400 amps (2) $ 95,00 $ I I Name: ~D~~')~'^^ \ 121 '> 1 1401 to 600 amps (2) $,158.00 $ 1 I Address: <6"\ \l ~ \\N: -r'":..(l\SI2 OL' 1 I 601 to (000 amps (2) $205,00 $ 1 1 City:Slfi\\~~"'\ 1 State:<J(')Q 1 ZIP:~}~ 1-15 lOver 1,000 amps or volts (2) $469.00 $ I I Phone: SZjI- +~~~ 'II ") 1 Fax: _ _ 1 Reconnect only (2), $ 63,00 $ 1 I E-mail: .b.e...-\\.~\~~itA\ol~@a{)(.co ~ 1.1 Temporary ser,vices or feeders: installation, alteration, relocation I This installation is being made on residential or farm property' I 200 amps or less (2) $ 63,00 $ I owned by me or a member of my immediate family, This 1 201 to 400 amps (2) $ 87,00 $ I property is not intended for sale, exchange, lease, or rent. OAR 1 479,540(1)~ji0(1)~ ~ _' 1 401 to 600 amps (2) $126.00 $ Signature: <......~ Over 600 amps or 1,000 volts, see services or feeders section above I '=~~?:~7~~~:;;~~~m'QN~~~~k~' :,r::::':::::~:ir:::~i::t:i::::r:::s:s~~na~~~:;e~:,::dlr ;ee. i f' City: i State: I ZIP: I b. Fee for branch circuits without purchase ofa servi,ce or feeder fee: I 1 Phone: 1 Fax: -. I First branch circuit (2) $ 55,00 ' $ 5"") 1 E-mail: 1 Each additional branch circuit 2-- $ 6.00 $ J:2-- 1 CCB license no.: I BCD license no.: J Miscellaneous fees: service or feeder not included I Signing sup_ervisor's license no.: I Each,pump or irr.igation circle (2) $ 63.00 $ I 1 Print name of signing supervisor: I Each sign or outline lighting (2) $ 63.00 $ I I Signature of signing supervisor: \ j;/~-\ " I Signal circuit or a limited-energy panel, $ 63.00 $ I <l{ ~ h) ..~ alteration, or extension (2) .,;x-,/- 1 Each additional inspection: (I) . ~"';;'!"\"':i~-!'j"E-E- "'S""-H-E-DtJ' 'lE' """'_{iW""~~a!?'-,,, t.1~tJf11..~'b~~'i~~~lim___~_ .~;.... _"_I.:!~~~:~.i.'~~~ "_Z~'''~~1_~':''&:'l'1''!!!(:'''''''kl'II''''CI''Ji!{E:::"'''''li ",'.' ,~ ~Numb"erAdf::iQjpectiO,",'plfJtem,(,):rji Qty:: l~.:Q~~ r,!p.ta~, t~'~$:!l:'~.;::~~.-JiL:&ilfilllli'AI;~d~;1<,",,,lli:$!'tf~o':d>;;"ii _; l);-,;;,;;;-'!.l iElIl{~;l-";iil~ ~ .. ,~9-~~11l $134,00 $ 25.00 $ 32.00 $ 63.00 $58.00 I (A) Enter subtotal of above fees " (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (,12 x [AD 1 1 (C)Technology Fee (5% of [AD I TOTAL fees and snrcharges (A through C): $ w7 i I $ ~ OL-- I $3~ .1 $ '7fZ-'C I 440-2584-J (9/08/COM) -' , , , , , , . . . ". ..' C6nStI~uc~ion Contractors Board. 700Summer,.St NE Suite 300 'PO Box 14140 '; . Salem OR 97309-5052 . Phone: '503-37,8-4621 Web Address: wwW.ccb.state.or.ns' 'Permit#: &'1-:- .I/~ "., .. .- . . ;" Address: 57lJ AiJ)/Z./ zx,6'f , Is~ued by: Grz:- .. Date: !/3?) .' , " , 'Statement: Information NQtice toP'ro,pertyOwners'" .. About Construction Responsibilities . . Note: Oregon Law" ORS 701.055(4) requires residential construction permit applicants whoare not l(cense.d with the Construction Contrac,tors B6ardJo sign the followingstatementbefore a building . permit can be issued.' This statement is required for residential building, iilectrical, mechanical and ' . '. . " -! plumbing permits, Licensedarchitect andeligineer applicants"exempt from licensing under' . ORS 701,010(7), neeclnot 's.ubmi~ this, state1J!ent. This sta~ement will be fil~d with t~e pe;mi!., '. I ~ .~,u m2,ili..'::::::::::1::,:':,:;~:~:":;3Ad, . '.~ I understand that'lmus! become licensed as,a c<?nstruction contractor ifthestructureis sold or offered for sale before 6ro~ completion. " . . D JA. My general contractor is, . . (Name) (CCB #) ;; .".,,' . . . I will,instruct my g~neralcontrictorthat all subcontractors who work on th~ sh1.!clli!e ml,lst be licensed with the Construction Contractors Board. " ' A"1~ OR, ' '.:' ~ 3B. I will cerny own ge~era.I contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board: If) 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 building permit of the name of the contractor. ' . . ,. . Ihereby certify thatthe above info,rm'atic:m.is correct and that.! have read and do un~erstand the Informati~n N~W ';~t~oomc.~roct'.. h'=lliU~" ffi, ,~_ u,;:;;:: ? ,---=-'" Si ature of permit applicant) (Date) " (White copy to issuing agency permitfile, pink copy to applicant.) PropertL owner.doc 06.01-04 ;-.- ~..---. . _. ~.. -.... - - .' - -..:.. .... ~..~ r;-, Acting as '-:Y:our'~@wn'General'Contractor?,.'y' - ....."../. ""-r, \.!,_, _"\ .~~ ." .""~ ..toJ~~.. _ 't" -1,." l.' I f_,,_,vz~ INFORMATION~NOTICE TO PROPERTY OWNERS (i,,',. '; " ABOUT CONSTRUCTlON:RESPONSIBILlTlES . i, ~~,:.~ ~.t -:-:" .,,:,.,.,> 'j" .','''''' ~ ..... ".~..;-';.c~:, " "t, ...... .. . ~.~.._' " .' , '- ., " " '.,- .~- ." ~ . .~, " r:'-..\ ~'f '. . t. ~... : , . 1..- - . ~ :.... l' . .~ +.,' -~ ,.' NOTE: This Information Notice to Property Owners about Construction'Responsib/lities was developed by the Construction Contractors.Board in accordance with ORS. 701,055(5), passed by the 1989 Oregon Legislature. , . ~ .~,-, '~' r~_ ~'....:.' ~:+.... .': ..4.1. :.c ':/ ;(',J ".'-;' ,;7,' ,,' ::~. -", --J" ,- .::'. ;'''}T.: ~.-," -",'&..': If you are acting as yf,)ur f,)Wl1 <;ontr!lctq~ to constru9t a new home or make a substantial improvement to an existing structure, you can pr~vent:maiiy .problems by being,aware,ofthefo]]owing responsibilities and 'concerns. , ' Employer Responsibilities ,"'~ . ~'~ ,.,-". :.',';, .~:,". "'CO', ".,,', 'to ;\.," "\ -.,., .....,,~ q '::"1.:.' " ...:~.... ',.,.... ... ~ , '.(".1.; You wj}l; in,1TIost insta,nce~,,-b.e,,,~le~ t~ p~ .,ljl1 ~'emploY~:'lan~J:2e;cgr1ra9~~rs Y.~l!,con?:a~t..~th,wii! ,~~ ."~n:pJ<?yees" if you use contractors n'ot licensed with the:Construction ContJ;actors "Board to do labor, in constructing or to assist in the ," ,._,.." ':. ,~--, t. ;0., :-",:.--\.r..lq.~"'..,;.. .-... +~"\..'''''. ,~." "01". > '. ;.~ '"."" ../ .'....1. ._'.:-4:',.':",....1 ">., ,\,-' construction ,qr jll)p!,oye!"(1en( oJ a,~esi?el1li!llstrucf).tre. AsJI!~<e.lpp~oy~r,. you plU~t .!=oIllP!Y wi~1! t\1e f~lIowing: ....... _..'_ 'j'_ ~': ....y\,c' ...',....... ,~. I.... J.~, ._' . ':.1. '!" ....... _ ' . '.~" "_' , ,-,1.' ~ 1 ....,. ,-' , Oregon's WWhhoidi~~ f~i Lii~':"A.s '{Ii ~in~lo'Yet"'youtfuust ~J;hb.bj\l'ificorrle' iax'esfr~fi1efu~lo~i-:"e\~ag'es'arfuetime employecs ar!, paid, You will be liable 19r the, tax.pay.ment~ ~ven if you don't a.ctually withhold. the tax from YO'c'f empioyees. For more informati6n,c'al}:the .b~~;;' ;.:;etitdf."jteveilue"at 503-378-4'988: -'.'. .\1"'.;, :,.o.~", ,,;' < :' ...,-': , .' '., --f' ,', U oemploymenHnsur'ance Tax: As an employerl'youiakrequitedto pay a tali for i.memploylnent insurance purpose~ f! on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. ' ,) , ~: ',.,'> -,_~ !"" _ ~~',lT:~'i- flt: . ~ I. Jj:.';: :fJifi-... " r~.' 'n) .....~, ft'.~ ~.3... ',_: - )[1 ~ "j-~; --o-:J::" r ! '" ;, ---:;'1~.\6'~(,,-.. -. ~ \.....:~. ~ The Oregon Businessldentificatiqn Number <BIN) is a cOll)binesll1u1J!!>~r. fQT both:QregOlf ~it~oiding- and' Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor,state.oLus/fonnsoav_htmll for the al-'y.vy~:~te!"~~~.__._ . __~_. . _ .... ._ ___+__ _ ,,__ _, _ _ ~ _ . ,;1 . '.' :,.:-.-" ~..~'.'~.::.' ~ t .(.:: ;~ 1 . ~~,- ))_ ..' '':'':.~~.'.'.'.'_ 1 . Workers' Compensation Insurance: As an employcr, you are subject to the Oregon Workers' CompensatIOn Law; and must,obtain workers' compensation insurance for your employ,ees. If you fail to obtain worker~', compensation iilsurancg, '96ti c6iilH ifc'~i.1Bj~d?6'pel)~I~i~s aM be''iiabr~'for ~Il'chlim 'C.o#5 if orie'6f:yo'1i!~ili~16y~~s;is 'inJo/ed on tlie job, For more'inforffiation, call the Workers' Compensation DiViSTon'at.the'Depaiiment'olC6risu'mei and Business Services at 503,947-7815, nl '. '_ '-\' , U.s, Internal Reven'ue ,Service: ',As an employer, you must withhold'federa],.inconieclax'froni errlpl6yees' :Wages~;!-..."'J You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRSat'10800'S294933'oT,visiitheir\vebsiteatwww.irsi!!ov. j.. " ,," ,', ",'..' ...',t.... :" 'I'. j , . .' ...t."~' . '-'''!;-"'.:.....-t',:.. ~.f .',;,.';'t,.':. ._.~.t. : . .?,','r .!_j .".'.r, _I .', '~'tt . . " I'. . , ' ,,:, '1 ',~' = ,'0tber'-R-esp()nsibilities ~~,d,At:~~,~Qf.lf;()n~e.rl,~ .;,'1' ',", .' , Code Compliance: As the perniit holder for this' project, y.ou are responsible for res6]viri~'ar\.y'fuilure to meet code requirements that may be brought to your attention through inspections. ' " .~~vS-r,(;L"~" ._.-__~.:...-:, ..A.;-?-..-.~;-~.~........;;;,~._~l.O::-"",;,_,,::;-'_,,~ ~:'~~:';'-:~:i.t'-"1~:'-~'-~ :-1";;:-. -'~, LiabilityandProperry ,Dalt;iige-'fnsur:ince: .. C6ntac(y'oUr insurance ~ge'hi to see' if you ~~Ve aqe'quate'insirrancb : . coverage for accidents and omissions such as fal1ing tools, paint over spray, water damage from pipe 'p~tures,Jire or k h b dr', -'-"".....)' " wor t atmust. ere one',;- ,\ ' - -. ___,___--,,-I.<~,-:., .. ~~ \ \) - , .. '. ' -- ,\ - " < .." .\ _...........I~ \ .._____ _..:.\,....~, -~.."-,~_. Time: Make sure you-have sufficient time to supervise your employees: ",' ;:. " ". ,;1" ..I.~,J _:.',' Expertise: Make qure you fiave th~ skiiId6 act ~s;ou+'o~n gen~nilcontracior;'t6 'coofainhte the work of rough-in and finish trades, and to notify building officials as the appropriate 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. . ',~ - ..' ..:- 1 Propcrty_owncr.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/JournaJ Number COM2009-00118 COM2009-00118 COM2009-00 118 COM2009-00 118 COM2009-00 118 Payments: Type of Payment Check cReceintl RECEIPT #: 1200900000000000047 Date: 01/26/2009 Description , Bnilding Permit Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge Paid By BETTINA DANIELS Item Total: Check Number Authorization Received By Batch Number Number How Received cjc 5954 In Person Payment Total: Paee 1 of I I :55:47PM . Amount Due 58,00 55,00 12,00 6,25 15,00 $146.25 Amount Paid $146.25 $146.25 1/26/2009 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-00 118 Payments: Type of Payment Check cReccintl RECEIPT #: Description Plan Review Residential Paid By BETTINA DANIELS City of Springfield Official Receipt Development Services Department Public Works Department 1200900000000000046 1:42:50PM Date: 01/26/2009 Item Total: t.:hcck N umber Authorization Received By Batch Number Number How Received Amount Due 37,70 $37.70 Amount Paid CJC 5952 In Person Payment Total: " $37,70 $37.70 Page I of 1 1/26/2009