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HomeMy WebLinkAboutPermit Building 2009-2-10 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone .541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6754 A ST . ASSESSOR'S PARCEL NO.: 1702344106802 PROJECT DESCRIPTION: Garage Owner: Address: CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2009-00189 ISSUED: 02/10/2009 APPLIED: 02/10/2009 EXPIRES: 08/1012009 VALUE: $ 15,851.00 Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential MADDY WAYNE A & JANICE L PO BOX 383 WALTERVILLE OR 97489-0383. Contractor Type General Contractor OWNER # of Units: Primary Occ~pancy Group: U Secondary Occupancy Group: Primary Construction Type VB Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: .~! I cNTfOf\l. ^ J~l'~e0N1iRACrORIINF.QRMATlON I . L"~QI/Dn C ,.~u uy fh ' -~ y.ftJ to ,In OAR 9 enter. Th e Oleon/) I) , . " 0090 \,52-001-0010 oSe rUlJe1seJlse IilltjExplratton Date . IOU ma through 0 ' Set forth CAtlin.... ,. Y Obtt=lin ~_. AR OJ::""l ~_ nUII/~~I}l&fuNF(()RMlirr6~'ll rUle~by'- ., 11~llJl; ~.~Ih l.ienteris 1 ~d 'I tility N;' ,iJ One # of Stonef?:OO-332-2344) fIt/cation ' Height of Structure . Type of Heat: Water Type: , Range Type: Energy Path: Sprinkled Building: Phone n/a Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 476 I DEVELOP~ENT INFORMATION' REQUIRED PARKING Total: 2 Handicapped: Compact: Overlay Dist: Ncti1tE" # Street Trees Rqd: "Paved Drive Rqd: Yes THlH'rfRMIT SHAL108l<cIlIRINli''llIiE WORK 17.20 ~~!~~~~~ ~ND~RTH'S PERMIT IS NOT ANY'180/(D~l\WIW\i~m~ Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Sidewalk Type: Downspouts/Drains: I Valuation Descriotion I $ Per Sq Ft ' or multiplier Sqnare Footage or Bid Amount Value Date Calcnlated Paee I of 3 _.fi1,~,~~~~I!1!~ '11 ,.,' Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00I89 ISSUED: 02110/2009 APPLIED: 02/10/2009 EXPIRES: 08/10/2009 VALUE: $ 15,851.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Estimate . Estimate $1.00 15,851.00 $15,851.00 $15,851.00 02/10/2009 Total Valne of Project I ' ';P,M< r1W Fee Description Amonnt Paid Date Paid Receipt Nnmber + 12% State Surcharge $23.34 2/10/09 1200900000000000090 + 5% Technology Fee $15.68 2/10/09 1200900000000000090 Building Permit $194.50 2/10/09 1200900000000000090 Fire SF Fee - Residential $23.80 2/10/09 1200900000000000090 Plan Review Minor - Planning $119.00 2/10/09 1200900000000000090 Plan Review Residential $126.43 2/10/09 1200900000000000090 SDC Sanitary/Storm Admin $11.13 '2/1 0/09 1200900000000000090 Storm Drainage Impervious Area $222.61 2/1 0/09 1200900000000000090 Total Amount Paid $736.49 I Plan Reviews I Public Works Review 02/10/2009 02/01/2009 APP LKW Storm water to tie i":to existing system Planning Review 02/10/2009 02/10/2009 APP DDK Strnctnral Review . 02/10/2009 02/10/2009 APP CJC 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. . 't~m,ir'p~. In~I'~i't~ Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Framing Inspection: Prior to cover and after all rongh in inspections have been approved. Final Bnilding: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Perimeter Foundation Drains: After gravel and Iilter cloth is installed but prior to backfill. Page 2 of 3' Status Issued 225 Fifth Street, Springfield, OR 54i-726-3753 phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00I89 ISSUED: 02/10/2009 APPLIED: 02/10/2009 EXPIRES: 08/10/2009 VALUE: $ 15,851.00 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 fnrther 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, tbat 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 constrnction. . , VnZ-' 7'J1'h-lk , ,; Owner or ontractors Signature Page 3 01'3 ~ J~ /cJ. :l00 9 Date Structural Permit Application ':!,j5EPARffiMEN'Thi1iSEt0NT!:i(~ \?tfi'1;>.~-"'-"'<;""l!'''':':kt}i;;;'".''~l!;lfll~l~~~~;&.'tiC:-j - CO"" z..oo 7-00/6 '1 Penn it no.: 225 F;jlh Street. Springfield. OR 97477. PH(541)726-3753. FAX(54 1)726-3689 I Date: Z /10/0 7 This permit is issued under OAR 918-460-0030. Permits expire if ;"ork is not started within 180 days of fssnan~e or if. work is suspended for 180 days. 1~~~{G:9E~,8.ij,ME:tlJf;71@B"[~~'C~~~ I ~is project has fin~11and-use approvaL I SIgnature: Date: '/ This project has DEQ approval. I Signature: Date: 1 Zoning approval verified: 0 Yes, 0 No 1 I I Property is within flood plain: 0 Yes 0 No I I, 1._~~l\T~:Q[fiQ~lG~(Ifij~illfilJ.~IrI<[ij~li:p~~1%~~1 I ~.~~~1~ttf~0~~i~i~bJ~~~i!~R_~~11 I Job site address: C '}S''/ A r STReel 1 I I City: ,"I'/);t1J(FIEU I State: o/<: I ZIP: 9!)Y?,r 1 I . . .1/ Energy Path: II'~~~~:::~:;:":S',.,~.. ._~, '"~'-, .~~L~_;~:I~::" :~.~~r~12~f:,-:::,:~JI i (~F::datio~o:~~;~:it? ~ ..' ',;?""""f4#"ii 'F1ROF1ERlC'Ii.%OWNER".",1'1t-'li""",,,.-!'f"-'i!:>'!,'!' =.'-~, . ,Sk,tY/',h" . -,., ..,"')l>"u....s._-'<-.._.h..,.~.."..,__,___,,:,:~~)"j,.,"'~N,~,J)i" '>,dill.n.6<.",.'.' -h""-"l I Total valuation: 1 Name: 'v.!;1 '//Je ..j- .TI9IJ m/ldrl y I 1 Address: ;:; "lS-l/ )(). Sfi2ee.., I I City:.'?jlj);AlI.?,,;Lrl I State:o,f' 1 ZIP:'1I)Y?J I 1 PhoneS'!'! -?26- - '1 G2 y I Fax: 1 I E-mail: 1 This installation is being made on residential or farmproperty'owned.by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. 1;.~~t{~~{R~b~~~~6N~~~{t4$":1*~il ~~~~,~~~"""-:~L'~._"'~______=~'_,~~__,--,- _"_.).t.~.-;ttlYf,,,];f:~)~~~v- I Business name: L",,:;11.4I J IIWtJCt! 1 Address; / I .1 City: I State: 1 ZIP: I 1 Phone: Fax: 1 I E-mail: I CCB license no.; I Print name; I Signature: 1~~S:Q_i:lI\~:i:!~m['gf1F@.Blltil~pJ~Mg:f;i~BF,iit~iijj)B;B~ I Name CCB License Number Phone Number I Electrical /'irS-() 8'6 5"11-(;5'3 -83.2.3 I Plumbing I Mechanical C'--I'1IUt!'E I I I I I I I I I _.....\1 /'S 6 ~ I /VOlVo:.. Construction type: s71'ot:- I3vt-(r Squarefeet: 7'9 {, Cost per square fool:'%.13,30 Other information: Type of Heat: NJ:VL o addition DYes ONo I 1 I 1 I (e) Subtotal offee, above (2a through 2d): $ I 1!f3~~lfmr~~ilWft&~~~~~~!E@~~~~~,:1 .~_._......._.....,,_.._.~_.9~~~,"'~...lij......_iii!i;g~___.Jilj_ I (a) Plan review (65% x permit fee [2a]): $ I Z b l(l_ I (b) Fire and life safety (40% x permit fee [2a]): $ 1 (c) Subtotal of fees above (3a and 3b): $ I (a) Permit fee (use valuation table): 1 (b) Investigative fee (equal to [2a]): I (e) Reinspection ($ per hour): (number of hours x fee per hour) I (d) Enter 12';' surcharge (,12 x [2a+2b+2c]): $ $ $ $ I (a) Seismic fee, 1 % (.01 x pennit fee [2a]): I $ TOTAL fees and surcharges (2e+ 3c+4a): 1 $ CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F.I CHARGE I I 624.00 I $0.357 I = I $222.61 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS ,I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I I 0.00 I $0.357 I 50% I ~ ITEM I TOTAL-STORM DRAINAGE SDC ,.$222.61 2. SANITARY SEWER - CITY JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS L STORM DRAINAGE A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 0 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 0 I COM2009-00189 Wa"!'e & Jane Maddv 6754 A Street 1702344106802 Single Family Residence o BUILDING SIZE (SF: COST PER DFU $27.67 COST PER DFU $21.04 3. TRANSPORTATION ITEM 2 TOTAL- CITY SANITARY SEWER SDC A. REIMBURSEMENT COST: 1 ADT TRIP RATE I x I 9.57 I I NUMBER OF UNITS I x I I 0 I I B. IMPROVEMENT COST: I ADT TRJP RATE 1 x I NUMBER OF UNITS I x I 9.57 I I 0 1 1 ITEM3TOTAL-TRANSPORTATlONSDC = I 4 SANITARY SEWER - MWMC A. REIMBURSEMENT COST: [NUMBER OF FEU's 1 x I 0 I B. IMPROVEMENT COST: INUMBER OF FEU's I ' I 0 , ICOST PER FEU I $97.90 x ICOST PER FEU I $1,009.17 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM4TOTAL-MWMCSANITARYSEWERSDC ~ I SUBTOTAL (ADD ITEMS 1.2,3, & 4) ~ , 5. ADMINISTRATIVE FEE: I SUBTOTAL x ADM. FEE RATE I~ I $222.61 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: 476 en W Cl o U 0:: W f- en - O. ~ LOT SIZE (SF): 10454 DISCOUNT $0.00 $222.61 11070 $0.00 1091 $0.00 I 11092 I ~ , $0.00 COST PER TRIP 21.06 x INEW TRIP FACTORI i 1.00 I $0.00 1'1093 I $0.00 1 1094 I ~_nl $0.00 1 1054 I COST PER TRIP $92.89 $0.00 x, INEW TRIP FACTORI I 1.00 1 = = $0.00 1 JOSS $0.00 I 1054 $0.00 11056 $0.00 I $222.6 I I I CHARGE $11.13 I 11.13 11079 ..J $0.00 11078 TOTAL SDC CHARGES =, $233.74 1 .".---.. - - Kaye Wilson PREPARED BY - 2/] 0/2009 DATE DRAINAGE FIXTURE UNIT (DFU) CALCULA TION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXl1JRE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES UNIT FIXTURE TYPE NEW OLD EQUIVALENT I BATHTUB 0 0 .3 = DRINKING FOUNTAIN 0 0 1 = I FLOOR DRAIN 0 0 3 = 1 INTERCEPTORS FOR GREASE 1 OIL 1 SOLIDS 1 ETC. 0 0 3 = I INTERCEPTORS FOR SAND 1 AUTO WASH 1 ETC. 0 0 6 = I LAUNDRY TUB 0 0 2 = 1 CLOTHESW ASHER 1 MOP SINK 0 0 3 = ICLOTHESWASHER - 3 OR MORE (EA) 0' 0 6 = IMOBILE HOME PARK TRAP (I.PER TRAILER) 0 0 12 = IRECEPTOR FOR REFRIG 1 WATER STATION 1 ETC. 0 0 1 = RECEPTOR FOR'COM. SINK 1 DISHWASHER 1 ETC. 0 0 3 = SHOWER., SINGLE STALL 0 0 2 = SHOWER., GANG (NUMBER OF HEADSl. 0 0 2 = ISINK: COMMERCIAI.JRESIDENTIAL KITCHEN 0 0 3 = I SINK: COMMERCIAL BAR 0 0 2 = ISINK: WASHBASIN/DOUBLE LAVATORY 0 0 2 = ISINK: SINGLE LA V ATORY/RESIDENTIAL BAR 0 0 1 = IURINAL. STALL/WALL 0 0 5 = ITOILET. PUBLIC INSTALLATION 0 0 6 = ITOILET. PRIVATE INSTALLATION 0 0 3 = MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = TOTAL DRAINAGE FIXTURE UNITS :EDU (Equivalent Dwelling Unit) is a discharge equivale:nt to a single family dwelling unit (20 DFlfs) set at 167 gallons per day DRAINAGE FIXTURE UNITS o o o o o o o o o o o o o o o o o o o o o o MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE r--- YEAR l ANNEXED 1 BEFORE 1979 I 1979 1 1980 1981 1982 1983 1984 198~ 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 '::'[[::,L]!!,;':'" ;t:IL ;"i'(i.-";:, ": I , ~;o ~-".,. . $3.67 L. .$322".". .. ,: 'I. $2': ~~'~;.!;.i~:!~::~1 $2.2'('_ '~. $1.80~ $1.59 '$1.4 $1.2 i,~$1.0~li~:\,i;i;,I' $O.92',*"1~:!c!!!!'i :.,' $0 72c:l::_ ' $0.48~- , $0.28" , .. $00'9''"-''''''''1''','' . .~t"~;;I:I;,.:~i;: ....,~""'~". I $0.05_~- I. r IS LAND ELGIBLE FOR ANNEXA nON CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) VALUE 1 1000 CREDIT RATE $0.00 x $5.29 CREDIT FOR IMPROVEMENT (IF AnER ANNEXATION) VALUE 1 1000 CREDIT RATE $0.00 x $5.29 ., TOTAL MWMC CREDIT ~ , = 1979 $0.00 $0.00 . 01 , . I I. I 1 I I I I I I I. I 1 1 I I ~ 2 -I I I I 1 I 2 o 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number C0M2009-00 189 COM2009-00 189 COM2009-00 189 COM2009-00 189 COM2009-00 189 COM2009-00 189 COM2009-00 189 COM2009-00 189 Payments: Type of Payment CreditCard cReceintl RECEIPT #: City of Springfield Official Receipt Development Services Department Public Works Department, 1200900000000000090 Date: 02110/2009 Description ' Plan Review Residential Plan Review Minor - Planning Building Pennit Stonn Drainage Impervious Area SDC SanitarylStorm Admin Fire SF Fee - Residential + 5% Technology Fee + 12% State Surcharge Paid By WAYNE MADDY Item Total: L:heck Number Authorization Received By Batch Number Number How Received djb 06093c In Person Payment Total: Page I of I 2:07:25PM . Amount Due 126.43 119.00 194,50 222.61 11.13 23.80 15.68 23.34 $736.49 Amount Paid $736.49 $736.49 2/10/2009 Status Issued CITY OF ~J:"KINlJl< lELD Building/Combination Permit PERMIT NO: COM2009-00189 ISSUED: 02/10/2009 APPLIED: 02/10/2009 EXPIRES: 10/27/2009 VALUE: $ 15,851.00 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6754 A ST ASSESSOR'S PARCEL NO,: 1702344106802 Springlield TYPE OF WORK: Garage TYPE OF USE: New Residential PROJECT DESCRIPTION: Garage Owner: MADDY WAYNE A & JANICE L Address: PO BOX 383 W AL TERVILLE OR 97489-0383 Phone Number: 541-726-9624 t. CONTRACTOR INFORMATION I Contractor Type General Electrical Contractor OWNER LMi ELECTRIC LLC License Expiration Date' Phone 185086 01/09/2011 541,729,8727 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I BUILDING INFORMATION' 'Ore 011 law reqUire:> j U" t.o ATTENTION# of S~o"ie" the Oregon Utility iJlloW rules H~\gh't~f~t.<ncture are set forth NotificatlOn.C~r'~e:,o,f:if~at':J9h OAR 952,001- vaOAR 952 OW,,<!pni!!Mp.e>pies olthe rules by 0090, you rnJra~ ve TJ(i>i!.te: the telephone calling the "'v, ~--.. 1,1l',Utility Notification b r lor"ne."" ",a , ) nurn e ~ "~;'~L-l ij-,n'\., ,,"?2344., / Certtllr.,.,.,. e ""'HOlOg, n a Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 476 1 DEVELOPMENT INFORMATION ,I REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: , Rearyard Setback: Solar Setbacks: 5,00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Yes 17,20 Total: Handicapped: . Compact: 2 , 10,00 6,80 Street Improvements: Storm Sewer Available: Special Instruction: , 1 PUBLIC IMPROVEMENTS I ' \"3e1 ^'<JO oca~ ^N~ . QOo ~~j~~O~ oetNtNdgl"t!'D ~1i\'tl0\-\1.(\\I 'cIOj 03\11 S\\-\~~tl(V{,l\~c'\: S\\-\1. Adding 1.5 feet no increased SDC10\ll S\ 1I~'tl3e1 'tllel)(3 "rW\-\S t ';13\10" )\'tlON\ 3\-\1. j\ :I ' Notes: .-...~' ,~~ Paee I of 3 ._~8;~1~,q.~~.'~b~>"'!I'!~!'~!'J.,~llt, , Status Issued 225 Fifth Street, Springt1eld, OR 541,726,3753 Phone 541-726,3676 Fax 54].726-3769 Inspection Line Description Tvpe of Construction Estimate Estimate Fee Description + 12% State Surcharge + 5% Technology Fcc Fire SF Fee - Residential Garage/Carport Plan Review Minor. Planning Plan Review Residential SDC Sanitary/Storm Admin Storm Drainage Impervious Area + ]2% State Surcharge + 5% Technology Fee Add, Alter, Extend CiJ'c Ea Add Perm SeJ'v/Fdr 200 amps or less + 12% State Surcharge + 5% Technology Fcc Storlll Sewer - ]st ]00' CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2009-00189 ISSUED: 02/10/2009 APPLIED: 02/10/2009 EXPIRES: 10/27/2009 VALUE: $ 15,851.00 I Valuation Descriotion I $ Per Sq Ft ' or multiplier $1.00 Square Footage or Bid Amount ]5,851.00 Value Date Calculated Total Value of Project $]5,851.00 $]5,851.00 02/10/2009 ,F~PJ P1WJ Amount Paid Receipt Number Date Paid $23,34 $]5,68 $23,80 $194,50 $]]9,00 $126.43 $] I.13 $222,61 $] 1.88 $4,95 $18,00 $81.00 $9,12 $3,80 $76,00 2/10/09 2/10/09 2/1 0/09 2/10/09 2/1 0/09 2/] 0/09 2/10/09 2/10/09 4/22/09 4/22/09 4/22/09 4/22/09 4/28/09 4/28/09 4/28/09 1200900000000000090 1200900000000000090 1200900000000000090 ]200900000000000090 ]200900000000000090 1200900000000000090 ]200900000000000090 1200900000000000090 22009000000000004]3 22009000000000004]3 2200900000000000413 22009000000000004]3 2200900000000000447 2200900000000000447 2200900000000000447 Total Amount Paid $941.24 I Plan Reviews .1 Public Works Review 02/10/2009 02/01/2009 APP LKW Storm water to tie into existing system Plannin1! Review 02/10/2009 02/10/2009 APP DDK Structural Review 02/10/2009 02/1 0/2009 APP CJC 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, ~lIirprllnl;'.nections I Footing: After trenches are excavated, Foundation: After forms are erected but prior to concrete placement. , Paee 2 of 3 CITY OF SPRINGFIELD Building/Combination Permit Status Issu'ed PERMIT NO: COM2009-00189 ISSUED: 02/10/2009 APPLIED: 02/10/2009 EXPIRES: 10/27/2009 VALUE: $ 15,851.00 225 Fifth Street, Springfield, OR 541-726,3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Framing Inspection: Prior to cover and after all rough in inspections have been approved, Final Building: After all required inspections have been requested and approved and the building is complete, Rough Electric: Prior to Cover Final Electric: When all electrical work is complete, Perimeter Foundation Drains: After gravel and Iilter cloth is installed but prior to backlill, Electric Service: Approval required prior to utility company energizing service, Underground Electric: Prior to cover By signature, I state aud 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 Springlield and the Laws of the State of Oregon pertaining to the workdescribed 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 properly, and the approved set of plans will remain on the site at all times during construction. . Ua-/4L<' /Y!r;# Owner or Contractors Signature i/-2,f~o9 Date J Paee 3 013 225 Fifth, Street' Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009,OO 189 COM2009-00 189 COM2009-00 189 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description Storm Sew,er . I st 100' + 5% Technology Fcc + 12% State Surcharge Paid By , WAYNE MADDY City of Springfield Official Receipt Development Services Department Publie Works Department 2200900000000000447 Date: 04/28/2009 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 09726c In Person Payment Total: Page 1 of 1 9:33:46AM Amount Due 76,00 3,80': 9,12 $88,92 Amount Paid $88,92 . $88,92 4/28/2009