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Home My WebLink AboutPermit Building 2009-3-4 en Y Vf< ~rRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00273 ISSUED: 03/04/2009 APPLIED: 02/26/2009 EXPIRES: 09/04/2009 VALUE: $226,150.72 Status . II Issued " 225 Fifth Street, Springlield, OR 541-726"3753 Ph?ne 541-726-3676 Fax 541-726-3769In~pection Line " SITE ADDRESS: 1783 BRANDY WAY ASSESSOR'S PARCEL NO.: 1703331101200 SPRINGFIETYPE OF WORK: Single Family Residence PROJECT DES€RIPTION: New Single Family Dwelling . TYPE OF USE: New Residential Fully.lmproved Sidewalk Type: Curbside 7' Yes Downspouts/Drains: Curb and Gutter For this parcel in Dove Estates, it is the recommendation to the Building Division, by the City Enginneer: "That no connections shall be made to sanitary or storm H20 systems, until the Storm water to cubdOOWut)k<lwlEepted.by City Council". Owner: Address: BENSON VERN W PO BOX 71095 EUGENE OR 97401-0182 11 Contractor Type General I: Electrical Plnmbing ____. ._,.....~, ,,",_._ ___ I":'.., ...I"\.....llirn~ \/nll tn 1~';:~';I":"li;~ '~dr: ~O~~~C{'O~~I';7E~~A TION ,. N0tj~r.at;on Car,," . - - . - t - - , in OAl-I 932.001-0010 through OAR 952-UU1-. ConJ&~5~orou may obtain copies 01 the rules I:I,\lcense ADAI~~~H?,l}'I."i:i U'!€!er. (Note: the telephone 593 INTEi\t&J:t\:TE:EUEGFRI!:NNOility Notlflcatlo'117121 GARY YAEOERlter is 1-800-332-2344). 75545 . BUILDING INFORMATION I # of Units: 1 # of Stories: 2 Primary Occupancy Group:. R-3 ...Height of Structure .' 25.00 " Secondary Occupancy Group: UType of Heat: Wall Heat Primary Construction Type VB Water Type: Electric Secondary Const,'uction Type:."r':"'!:' Range Type: Electric ~, J). ~V~. . # of Bedrooms: , THIS PERI~IT SHALL ~f:'iI\~'T1:1~. WORK / ii ,,; I~,:nr:mm II~mFR ~Ptf1g~tr\,v~f' I\l:PNOT n a GOMMENGEDllDEwm0i>NffiiNf:ikj,t;\tMATION , ANY 180 DAY r"t\luu. . 18.00 .Ovcrlay Dist: 5.00 # Street Trees Rqd: 10.00 Paved Drive Rqd: 25.00 % of Lot Coverage: . 0.00 " Front yard Setba~k: Side I Setback: Side 2 Setback: ,. Rearyard Setback: Solar Setbacks: Subdivision Not Accepte(l I PUBLIC IMPROVEMENTS I Street Improvements: , Storm Sewer Available: Special Instruction: . Notes: ~Q~ Page I of 4 Expiration Date 03/19/2010 09/05/20 I 0 08/14/2010 Phone 503-645-1156 503-393-2223 541-972-5460 Lot ~ize: 5,625 Sq Ft 1st Floor: 1,040 Sq Ft 2nd Floor: 1,040 Sq Ft Basement: Sq Ft Garage/Carport 656 Sq Ft Other: Occupant Load: 2 Yes 37.00 REQUIRED PARKING Total: ' 2 Handicapped: Compact: _~i'~J,,~:g!I~~;'~"J!fjll~~J I., " t Status IssJed 225 Fifth Street, Springfield,OR 541-726-3753 Phone 54 I -726-3676 Fax 541-726-3769 Inspection Line Description Garace/Misc SFlDuplex . Tvpe of Constrnction U VB Utilitv R-3 VB 1&2 Familv Ii " Fee Description 11 + 12% State Surcharge . I; + 5% Technology Fee 1st Appliance " 3 Baths One & Two Family Addressing Assignment Building Permit: Curbcut Permit Dryer Vent Fire SF Fee - Residential Plan Review Majo!' - Planning Plan Review ReSidential PW Disc - 2nd Permit Residence WiriJg 1000 Sq Ft Residence Wiriri'g Ea Addtl 500 Sanitary Sewe.r! Improvement Sanitary Sewer! Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC R~imbursement , SDC Sanitarv/Storm Admin . , SDC Transpo Improvement SDC Transpo R~imbursement SDC Transport~tion Admin Sidewalk Permit Storm Drainagei:lmpervious Area Vent Fan " Willamalane Siri.gle Family !' " Total Amount Paid " 1! . Plannine: Review 0212612009 I Y~I~a~ion D~scrio~ion I $ Per Sq Ft or multiplier $37.72 $96.83 Square Footage or Bid Amount 656.00 2,080.00 Total Value of Project Fpp~ Amount Paid $239.36 $117.58 $79.00 $402.00 $38.00 $1,225.64 $88:00 $9.00 $136.80 $211.00 $796.67 $-30.00 $134.00 $100.00 $567;99 $746.96 $10.00 $/,009.17 $97:90 $138.55 $888.98 $201.54 $73.96 $88.00 $727.76 $45.00 $2,858.00 $11,000.86 Date Paid 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 3/4/09 .3/4/09 3/4/09 3/4/09 I Plan Reviews I 02/26/2009 APP DDK Pace 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00273 ISSUED: 03/04/2009 APPLIED: 02/26/2009 EXPIRES: 09/04/2009 VALUE: $ 226,150.72 Value Date Calculated $24,744.32 $201,406.40 $226,150.72 02126/2009 02/2612009 Receipt Number 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000~00000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000157 1200900000000000]57 1200900000000000157 1200900000000000157 1200900000000000157 See conditions of tree feeling DRC2007-00031 for "save" trees and approved plan. Ii Status Issljed " 225 Fifth Street, Springfield, OR 54]-726-3753 Phone . 541-726-3676 Fa~ 54]-726-3769 Inspection Line Public Works Review 02/26/2009 02/26/2009 APP LKW Structural Review 02/26/2009 APP CJC 02/26/2009 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00273 ISSUED: 03/04/2009 APPLIED:. 02/26/2009 EXPIRES: 09/04/2009 VALUE: $ 226,150.72 For this parcel in Dove Estates, it 'is the recommendation to the Building Division, by the City Enginneer: "That no connections shall be made to sanitary or storm H20 systems, until the subdivision is accepted by City Council". Need engineering for non-prescriptive 1st tloor joist support To Request aJ inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be mhde the same working day, inspections requested after 7:00 a.m. wi\(be made the following' work day. I! ... . I R~"',irprll~?~rtinn~J Vfer Electrical.Ground: Install ground rod at footing and call for inspeCtion in conjunction with footing and/or foundatior in.spection. Footing: i\fter trenches are excavated. Foundation: After forms are erected.but prior to concrete placement. " Post and Beam: Prior totloor insulation or decking; " Floor InsJlation: Prior to decking. , , Shear Wan Nailin.g: Before covering sheathing with finish materials: Framing Inspection: Prior to cover and after all rough in inspections have been approved. jl. , Wall Insu~ation.: Prior to cover; Ceiling In,sulation: Prior to,cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter'Foundation Drains: After gravel and tilter cloth is installed but prior to backfill. Vndertlotir Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to c~ver or placement of concrete. , Rough Plumbing: Prior to cover and including required testing. , Water Line: Prior to tilling trench and including required testing. Sanitary Sewer Line: Prior to tilling trench and including required testing. Storm Sewer Line: Prior to tilling trench.. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Paee 3 of 4 CITY OF SPRINlJf<lELD Building/Combination Permit Status Issued PERMIT NO: COM2009-00273 ISSUED: 03/04/2009 APPLIED: 02/26/2009 EXPIRES: 09/04/2009 VALUE: $226,150.72 225 Fifth Street,Springtield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough EI~ctric: Prior to Cover Electric Sfrvice: Approval reqnired prior to utility company energizing service. Final Electric: When all electrical work is complete. " Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk, Curbside: After forms are erected but prior to placement of concrete. Curbcut ~:Standard: After forms are erected but prior to placement of con.cret~. " By signatnre, I state and agree, that I have carefully examined the completcd application and do hereby certify that all . information her~'on is true and correct, and I further certify that any,andall work performed shall be done in accordance with the Ordinances ,,'f the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUP'ANCY will be made of any structure withont 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 t~ 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 con~truction. .' . ',,------- ~- >-- --., , Owner or Contr~ctors Signature II Date --3.- '-r .-.0 I Paee 4 of4 :~ . " . , 2~ Willamalane t~ Park &.Rew~ation District. ' Job. NO. c;9- 2- 73 SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2008 "NAME:. /J. []EJV5o f'-/ PHONE: (;X'lf - 'S,f77 ADDRESS: ffCjo /-It./'/ 91 CITY EaC/;Yt: STATE:~'l.ZIP: Cj')l.f62 ;f LOCATION OF PROPOSED BUILDING SITE: , '733, . Street Address: ~ '8{Z.J'tM)y vJ'I " fl Plat Name: Tax Lot Number: . , !' 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.).. . . A. Sinale-Familv Detached NO; OF UNITS . / ~ . X $2,513 per unit = $ ;2S13 B. Sinale-Familv Attached NO. OF UNITS II II I II i: X $2,726 per unit = $ C. Multi-Familv Aoartment NO. OF UNITS X $2,323 per unit = $ u;-Sinale-Room-0ccupanc'; NO. OF UNITS X $1,162 per unit = $ E. Accessorv Dwellina Unit NO. OF UNITS X $1 ;257 per unit = $ $ 1/ ~I . WILLAMALANE SDC ' ,'2.500 CRED,IT (ifappiicabie)SQt payer must furnish prOCtof . Willamalane C~dit approvaL) ':3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) . $ $ ;?-~ CJ ~ . ;2. I 70 I ocr 'Date. Development Services Department citY of Springfield . 5 '. . CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2009-00273 NAME OR COMPANY: Vern.Benson LOCATION: 1783 Brandy Way TAX LOT NUMBER: 1703331101200 DEVELOPMENT TYPE: Single Family Residence NEW DWELLING UNITS I BUILDING SIZE (SF: 2080 LOT SIZE (SF): i~U.l 10 o U 0:: 5227 1 ~ .--.-----IC/J o U.l 0:: 1. STORM fJRAINAC,E DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F, ' , I. COST PER S,F, I 1 CHARGE I . 2040,00 I $0.357 = 1 $727.76 1 RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS' I IMPERVIOUS S.F. 1 , 1 COST PER S,F, I, 1 DISCOUNT RATE 1 I 0,00 I 1 $0.357 I 1 50% 1 ~ I ITEM I TOTAL - STORM DRAINAGE SDC $727,76 DISCOUNT $0,00 $727:76 1070 - - 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: 1 NUMBER OF DFU's 1 ' 1 27 ~ B. IMPROVEMENT COST: I NUMBER OF DFU's I , I 27 I COST PER DFU $27,67 11091 , $746,96 COST PER DFU $21.04 $567.99 11092 I ITEM 2 TOTAL" CITY SANITARY SEWER SDC ~ I $1,314.95 3. TRANSPORTATION A. REIMBURSEMENT COST: 1 ADT TRIP RATE 1 . , ' I 9.57 I 1 NUMBER OF UNITS I ' 1 1 I I ,< INEW TRIPFACTORI I 1.00 i COST PER TRI P . 21.06 $201.54 11093 B, IMPROVEMENT COST: . I ADT TRIP RATE 1 , 1 NUMBER OF UNITS I x I 9.57 1 1 I 1 I ITEM 3 TOTAL - TRANSPORTATION SDC = , 4. SANITARY SEWER. MWMC , A, REIMBURSEMENT COST: INUMBER OF FEU', I x 1 I I ' INEW TRIP FACTORI 'I I 100 COST PER TRIP $92,89 , $1,090.52 $888,98 1094 I ICOST PER FEU I $97. 90 11054 I $97,90 = B. IMPROVEMENT COST:. INUMBER OF FEU's I, x ICOST PER FEU I 1 I $1,00917 . MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC I 105: 1 1054: i 10561 II $1,009,17 $0.00 $10,00 = ~, ~, $1,117.07 SUBTOTAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE: ISUBTOTAL x I ADM. FEE RATE I~ I. $4,25030 1 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: $4,250.30 l CHARGE $212.51 138,55 11079 $73,96 11078 2/26/2009 Kaye Wilson PREPARED BY, TOTAL SDC CHARGES $4,462.81 DATE "'EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE YEAR 'ANNEXED BEFORE 1979 1979 1980 ]98] 1982 1983 1984 \~85 . 1986 1987 198.8 1989 1990 1991 1992 ]993 I ]994 1 ]995' I 1996 I 1997 I \9911 I 1999 1 2000 1 2001 CREDIT RATE/$1.000' ASSESSED VALUE $5,29 $5,29 $5,19 " $5:12 .:, $498 $480 ' . $463 $4.40 $4.07 $3,67 $3,22 $2,73 $2,25, . $1,80 ,:,. $1.59. $1.45 $1.25 $1:09 ..$0,92 '$072 " . $0.48. $0.28 ' $0,09 $0,05 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter I for Y cs. 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0,00 x $0,00 ~ I CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE 11000 CREDIT RATE $0.00 . x $0.00 TOTAL MWMC CREDIT = 2 2 2007 $000 $0.00 o I I I I 1 I Willamalane Park & Recreation District Job. No: ~!1 ~ 0 }1-S SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: \\h'f\ ~X\SfJy\ PHONE: \.Q"~' ~~ql ADDRESS:C\4D ~O \ q qlTY W~~~TATEC1(zJP: O"14rf2-.. LOCATION OF PROPOSED BUILDING SITE: . Street Address: ' \ f1,6D OON\ 1 \ \U ~ '. ' . . Plat Name: .~:n..)e fOO tes Tax Lot Number: 17(X=32:>3 \\O\~ 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type ,definitions are on the back,) A. Sinale-Familv Detached . NO. OF UNITS' \'. . X $2,858 per unit =' $ .1JCE:fj~ cV B. Sinale-Familv Attached NO. OF. UNITS X $3,100,per unit =' $ C. Multi-Familv.Aoartment NO. OF UNITS X $2,641 per unit = $ D. SillJlle Room.c>c:cuoancv I~O~OF-ONIT~ X-$-1~3L'1 per unit = ;p E. Accessorv Dwellina Unit NO. .OF UNITS X $1,550 per unit = $ 3. TOTAL WILLAMALANE NET SDc ASSESSED (if SDC. reduced for Credit) .D~~~;~,~~~0 if City of Spnngfield . ~ . " $ ''0/41 $ fl8r:::/6 ~ ff 2fJffi9U 21JOq $ WILLAMALANE SDe 2. SDC CREDIT.(lf applicable) SDC payer must furnish proof of Willamalane Credit apl'roval.) Date, 5 pStructu~al Permit.Application 225 FiJ)hStreel. Springfield, OR 97477. PH(54 1)726-3753 . FAX(54\)726-3!589 I ,.PEf~RT~!,i,rf'YSE,O~F(."[ SPR1No.,.IEI..D :,~" J . A"-<"",_ ,/'i:'<' " . ~, ~.. ." Permit no, 61 - -:Y7J I Date J...!4/0 7 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days odssuince or if work is suspended for 180 days. ;""~/'~, ~~V@i1Y:.0~jSPRI1\JJF:1ElfID; 0ltEGO'J\r.;;,;,:: '/,,;L~' ~';> - ~ '" ." ..".l"'~". " ~n.~ -" ~_, ,,'Ow..... "f..""~'''' "..."" , iP.~." '''' Sign here: '. _~._... ',r.tq.. '!'......'O>O._....._.'. ',.._"".' "-.. ""'. ...- ,_ .,..... -., .:-,. _0" " ,....., 1>,o;':.~Y,~1i~C'ON;rf.lAqOR; INSTALLATION';-,.,' ., I Busincss name: A 0 A \ ~ }-fa lI':1 E c::; Address: ' 1,OC"\ M~ \I ST_ I City C R~ W'U...,- I Statc: I PhoneS-fI- SC/I!>- 32.6<::> Fax: I E-mail: I CCB license no,: 5"1 ~ 1 Print name: c;: /'rf< yen,..., ,om rJ I Signature ~ ~~ I i'f! ;:qi;'i/StJB'CON"~C;1:OR'INFt!RMe.T!ON':~;t\" ,; ;:1 I Name CCB License Number Phone 1\1umber I I Electrical 24 - '2,54 L 5()3- 3'13 -21ZZ 3 I Plumbing 14- 7 077 1503 - 9 ~'l-27i'fj I Mechaniclll I" I, i_ ,;,LQCAL'GO"ERNMENj,APPR.OVAL I I :h is project has final land-use approva. I. I I, . c .' FEE',SCHEDULE ' 1 Signature: _ '_.". Date: I This project has DEQ approval. ' I 1,I.~V~luation info~mation " ' ,,' ,'. ,'I Signature: Date: I (a) Job description: I I Zoning approval verified: 0 Yes 0 No I I Occupancy I Property is within !load plain: 0 Yes 0 No I] Constfllction'type: - _ .J\ \ "', :"";1l;r",C:4TEG,ORV0F'.CONSTfWcT1QN I I Squarefeet I 1 """Residential I 0 Government 1 0 Commercial I I I l,AJ Cost per square foot: i';ob;s~~'l~~~~:'~I~~O~~~~O~S~;ATION, .'i II' Ot,hcrinformation: II Type of Heat: I City SPR;yJ~ Fifi...!) 1 State OR 1 ZIP 1 I I I ~ ~ II Enerb,)' Path: Subdivision: OOVe.. ~S +-Q..J\~ Lot no,: '* 2.. 1 D D I' D 1 new a teratlOl1 addition 1 Reference: 1 Taxlot /7-03--33-11-01200 1 . i ,..z" . ".'., '''''..'' ."" ., ' "1 1 (b) Foundation-only permit? DYes D No I "..,.v'" ::"'''PROPERTY,,'OWNER" ...;. I,., ' , I Name Vf:R (J Rcrvsa (Ii 1 1 Total ~al.uat:C~~:' }~.60,;7 2-.. J $ L4flj"~~1 I Address, '1'/0 HwY "rCJ AJ. I I Z"BUlldmgfees. , ,q~, \':,"""..:,..,\'."..'..,.,1 In I 0 '^ 1 q,; -j I (a) Permit tee (use valuation tab Ie): $ I City: E-u {;.-'C'1J,- State lX., ZIP: 1,,0<:1 I I 1 (') Q", q 7 I (b) Investigative fee (equal to [2a]): $ Phone:54/-bSll 00 I Fax - I I .. (c) Reinspeclion ($ pcr hour): I E-mail: b0ssevvcoe..c)..cl . ce """" 1 (number of hours x fee per hour) $ This installation is bein? made. on resi~ential o~ farm propertY.9wnc? by I (d) Enter 12% surcharge (.12 x [2a+2b+ 2<.:]); I $ I me or a member of my ImmedIate family, and IS exempt from Itccnsmg requirements under ORS 701.010. I (e) Subtotal of fees above (2a through 2d): I s I I j~;PI~Yn'''i~y-!~'Y fee~~":' r: .., . '" ,~., . ~,.,;'.~;/~.~{;~XJ0.~-:<:.F.f,~l,f;1 I (al Plan review (65% x permit fee [2a]): I $ 1 I (b) Fire and life safety (40% x permitfce [2a]): $ I 1 (c) Subtotal offees above (3a and 3b): I $ I 1.;,'4;:Mi.~ell~ri~()U_s"fee~:~ !f, '", '." ".'~~~:;~~;:'~." '0',1,. ,'<' :1 1 (a) Seismie fee, 1% (.01 x permit fee [2a]): 1 $' I I TOTAL fees and surch~rges (2e+3c+4a): I $ I ;;1 I oR. 1 ZIP 9742C,1 'O'IS" -"321 Co 1 I Tbis pertJ.1it is Issued under'OAR 918-309~01l00. Permits are nontransferable. Permits npire if work i~ ~qt s's.rted witl'<jn uti days of i5~uance or if werk is suspended for 180 da"-lJ. i"!&i:,,'(if"r'i-J!,~lOo.C:,,U:!;(i;OVI;RNI!IlENT~X.j(P,eRIllYAl!\!!'~&!\'i~m:k!ii' rz~ri.inE--;~pt\)Val verified? - 0 Yes 0 }..iO f:r/Yfft~~\~h/B)::Jt'1~.CJ\\fE~"~~t5~Of\i.\~G_ONS1;~tH;:TiONi.(4?~:~~?;~t/~~~\~1.(ii i ?'fResid<ntial -~I 0 Government -TOcom~erCi'I---1 i:::';:;~:.i:',Jl!)a:iSI1'e';;INFORMATlONlANP;;lO.OATIONSji:i!,h;!.',1 U:~b site .ddre,,: [7 fJ (!wp...~ IA/i. "'1.. . _I. i City: StJ f f ~ I Sta..: i3L.-! nP4 7 '{ 711 1;~~~~~~~;~~1,,9p~~R~Ni&~:wJ~~\~;;'~!i;1~\iffi\~C\iJ i 'UJ 'to U1 'S1=D' I i - -- I '..-...'''..''.'...''.''..'.r...'...''.''''.'-....jt'.''. . .K.E.K~~V.' "0'. .'E.'..."'.'C'."""...."....' '''.'.''..''.'.''..'.'1' txaf}\t,tl~-;N;;t~:\:'J!',~':1';:l*.,:::<il.~. -r:; _ ",OI;'.J.~'" <0. r.t. ~'W:.'-'~\:;:U''!~';,'ff~';;::;-\i::'.J)P/;l!"1&:;, i Name: Ib...,V..{,V , u.-t ~ .' _ I i Address: '1 r..{ 0 t;wq "0, N i . Citd~~I"/ I State, (fIL.! ZIP q 7ftl1-:j : Ph':.~rr" rfi1_.1 Fa:<i: ! ! E-mail; US Fil'tb Stntt+SpringfitJd, ~R 97477. PH(!4_1)i26.375hFi~X(S4])726-3'fl9 This installation is being made on reside.1tial or farm property owned by me or iI memhel' of my immediate family. This property is not intt::nded for sale. ex~h,mge., lease, or rent. OAR 4795400) and 479.560(1). Signature: ..i'1i,;j;;@;"*")~CClN;rRACIORT.lNSTALGt.TIONf\;:!,'i;01~i,i;~i,{j;,,~'I Business n";.: h/'ler"r.k..,k t'~ feo/r..",-_ Address:/~ d. 1.3<, r '7;) <; 2. City; :5111.B-<h ' I Statec.'/Z IZIP:9,7.3d3 I Phone: 50"$.-37:3-2.2.2:11 Fa." 57l:>-:; :c,C(')-'77;2.2.1 E-mail: I ccn license no,: / /7 f:J-.( 1 BCD lkea" no,: .;l9''-3 f7,U.j Signing supervisor's iicense no.: C/'rl:, I .J I 2rint name of signing imperviscr: /2(c~ _ Af!.1.::i'./-t- J' ! Signature of slgoing supervisor: ~ .-........ ~- . 4.<1.0-15&4-1 (91O€/COM) EOO/ZOO'd EIH# eg:EL SoaZ/BO/EO !(I2,,1;1D'~~~tI11'ME~T:~sE::oN'~~1~$lf !":'6/i,?~..;.!,:,:,~~:'~V,;l';;i;.,'1'_;"',.;,;~',..r': .,;.- .~i<,,,;.'7_".'-':::', :'~';c'.r<~'i") j". 'j>ennit 'ne.:' --- Date: ------- 1~:~~t~~~~i~~I~~~];~iKi~m;j~]~~;:;~~;~ji~j:~t~i;i L~.ide.dal, pe, uni~ ,,"Ice iaeluded: --~ I II,OOO,q,ft,orlm(-l) -.-- I m~:;;;TS-.1 I Each edditiOl1a1 500 sq. ft. cr ponion I $ 25.00 I S , thereof .$ 32,00 1 ! ~n.ocl$ Limited energy (2) :2ach manufacturid home or modular dwe!lingsenice or f-eerler (2) I ] Service!! or f"den:: inswllatiOT1, aUerarion. relO'cation 112.0~~lnps or Jess (~) $ 81.00 2U I to 400 amps (2) S 96,00 r 40 J 10 6()(1 amps (2) i $1Sa.OO ~501 tn ~,OOO arn?~f2) " ! ~ H.O&JJO . 1 -O~~r 1.000 ampSQr vclu (2) --.!~69,.OO -II I Reconnect on!~. (1) I $ 63.t10 S S i .--1 . i I i $ i. s ! i ! Temp{Jnlry-~ervlcei'l or fe~den: insta:lation. aite.r-ation,.relocQ{fon 1 L200 am~_~.:. I,,, (22. I l.s 63.00 S ,-zel to 400 amps (2) .' r S 87,00 S 1101 to 600 ""p' (2) I: $129,00 $ : LO:,:r600 amps or .1,000 volts, see serv.. ice:ior feecters~ijo; ah'Ll've 1 r-Sfench <<:ircuilS: nt"l.!. aiteration, c.rtensicff p6T pafl~j i ! a Fce for braoch circuits Ufi~ l'un;hssl" ofa service or feeder fee: I E~.eh branch circ,uit " ' .: i ~ 9.00 ) 1: I b. Fe~ for brar,ch ~ircuits without pur~ha::j;c. ofa. 3Cf'vicc "r feeder f~e: : I FirstbIa."lch ~,uiil~ /" $ 5'5.00 I S --! I, Each additional branch circuit $ e..UtI I $ I' l\.1IJ1cellatlt':oWl f~t':'i: u1'vice or fteder not fndudd I Eathpumporlrdtitll.tioncircie(2)~--r.T~-63~0c I i ~ I Each. ~jgn or outline Iig-:lting (.2) .) ! $ 63.1;10 I-t- 1 Signal, cireuit,or a li:nttedMenergy pil.l"el.. ! . I. 1 83 ai).1 $ Bi:elll.lion. or exter.mm (2) ': . . -E~cb .ddl,-jonol i..p..t!..~ (1)----1-1 s..ao I ,$ I !~h;7f~~0k~%[~*~~~~B~~eltle;rA9ti{OS"~l~~W~iitfig1~1\r;~~~;11J (A) Entcr!lubl:o!a.Jof.aoo'-'c fee:;o I (Minimum hnnil f e(l $58."'0' i - - (B) En':er 12%su~charg(! (,12 x [Al) (C) Technology Fee (filiAl of fA]) I TOTAL fees and ~.rch1Ar'jie~'lA tbrnu~h C): ! S s s .\ SLZE!iSBL?!:l llJMS3ti8 S3HOH ~l~O~:WO~~ 225 Fifth Street Springfield, Oregon 97477 541-726-3759Phone Job/Journal Number COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 COM2009-00273 Payments: Type of Payment Check cReceintl' RECEIPT #: 1200900000000000157 Description Plan Review Major - Planning Plan Review Residential Building Permit Addressing Assignment Willamalane Single Family 3 Baths One & Two Family I st Appliance Vent Fan Dryer Vent Residence Wiring] 000 Sq Ft Residence Wiring Ea Addtl 500 Fire SF Fee - Residential Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC AdminiS\fation SDC Sanitary/Storm Admin SDC Transportation Admin + 5% Technology Fee + 12% Stale Surcharge , ' City of Springfield Official Receipt Development Services Department Public Works Department Date: 03/0412009 Item Total: Check Number Authorization Received By Batch Number Number How Received Paid By BENSON DEVELOPMENT cjc Pa~e I of I 630 In Person Payment Total: 8: 13:09AM Amount Due 211.00 796,67 1,225.64 38,00 2,858.00 402,00 79,00 45,00 9,00 134,00 100,00 136,80 88,00 88,00 (30,00) 727,76 746.96 567,99 20 i.S4 888,98 97.90 1,009,17 10,00 138,55 73,96 117,58 239,36 $11,000.86 Amount Paid $11,000,86 $11,000.86 3/4/2009