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HomeMy WebLinkAboutPermit Building 2009-3-11 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008"00976 ISSUED: 03/11/2009 APPLIED: 07/02/2008 EXPIRES: 09/11/2009 VALUE: $ 134,288.00 I """ -i!.J'!~~Im;1) ," f-". , Status Issued 225 Fifth Street, Springfield, OR 541'726-3753 Pbone 541-726.3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1360 S 2ND ST ASSESSOR'S PARCEL NO.: 1803022401600 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence - DO NOT ISSUE WITHOUT SEPTIC APPROVAL Owner: YOGI CHARLENE Address: 1360 S 2ND ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Architect Contractor License NAGAO PACIFIC ARCHITECTURAL p,c. BUILDt,~G ~~FORMA!~?~ I # of Units: Primary Occnpancy Group: Secoudary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure 20:00 Type of Heat: orced Air Electric Water Type: Electric Range Type: Electric Energy Patb: Patb 1 Sprinkled Building: nla I R-3 U VB 2 I DEVELOPMENT INFORMATION I Froutyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: 0/0 ,of Lot Coverage: Urban Fringe' ,54.00 5.00 43.00 33.00 17:50 I PUBLIC IMPROVEMENTS I Residential Pbone Number: 541-556-5558 Expiration Date Phone 541-687-9600 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Occupant Load: , 12,632 1,200 296 REQUIRED PARKING Yes 11.40 Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Storm water drainage to Rain garden witb overflow to creek on soutbside of property Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Paee I of 3 Value Date Calculated )<%~~9glE;!,~t , T Status Issued 225 Fiftb Street, Springfield, OR 54] -726-3753 Pbone 541-726-3676 Fax 541-726.3769 Inspection Line Dwellin2s Gara2e V Wood Frame Gara2e Fee Description Plan Review Residential Total Amonnt Paid Initial Review Public Works Review Public Works Review Structural Review Planninl! Review Public Works Review CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00976 ISSUED: 03/11/2009 APPLIED: '07/0212008 EXPIRES: 09/11/2009 VALUE: $ 134,288.00 $105,00 $28,00 1,200.00 296.00 Total Value of Project F'PP~. ~ Amount Paid $126,000.00 . $8,288.00 $134,288,00 07/02/2008' 07/02/2008 07/03/2008 07/07/2008 , 07/10/2008 07/07/2008 07/07/2008 03/11/2009 Date Paid $486.29 7/2/08 $486.29 I Plan Reviews I 07/03/2008 APP LLH Receipt Number 1200800000000000728 Credit given for square footage of existing residence and garage. I] II square feet per RUD. 385 additional sqnare feet cbarged for fire fee. Willamalane fee and addressing fee do not apply. Tbis owner will remain at this location, so tbey may keep tbeir same address. Applicant needs to submit new way for storm water drainage to street. No splash blocks will be allowed for tbis site. Will do review and forward on to other reviewers but I am requesting not issued until new site plan or plans sbowbow water is being diverted to storm sewer. Waiting for approval of Septic from Lane County and new plans sbowing either rain garden or drain gage of storm water to swale As noted on plans Option of raingarden was cbosen for storm water drainage. To Requestan 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, . 07/09/2008 10 LKW 07/10/2008 WE LKW 07/16/2008 APP CJC 09/02/2008 APP DDK 03/t ] /2009 APP LKW Pa2e2 of 3 \ ~P.~Gr:.Irr."-r> I CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2008-00976 ISSUED: 03/11/2009 APPLIED: 07/02/2008 EXPIRES: 09/11/2009 VALUE: $ 134,288.00 225 Fiftb Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line I Reauirerll nsnections I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction witb footing andlor foundation inspection. Footing: After trenches are excavated. Fonndation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have'been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover; Dry~all: Prior to taping. Final Building: After all reqnired inspections bavebeen requested and approved and the building is complete. Underfloor Plnmbing: 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: Wben all plumbing work is complete. Rough Mechanical: ,Prior to Cover Final Mecbanical: Wben all mecbanical work is complete. Rough Elcctric: Prior to Cover Elcctric Service: Approval required prior to utility company energizing service. Final Electric: Wben all electrical work is complete., By signature, I state and agree, tbat I have carefully examined tbe 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 berein, and that NO OCCUP ANCY will be made of any structure witbout permission of the Community Services Division, Building Safety, I further certify that only contractors and employees who are in compliance with ORS701.005 will be,used on this project. I furtber agree to ensure tbat all required inspections are requested at tbeproper time, tbat eacb address is readable from tbe street, thaUbe permit card is located at the front oftbe property, and the approved set of plans will remain on tbe site at all times during construction. o(2~;,""jJU' 3/,/0 1 Date Page 3 01'3 CITY, OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2008.00976 NAME OR COMPANY: Aimee Yog} LOCATION: 1360 S, 2nd Street TAX LOT NUMBER: ] 80302240 1600 DEVELOPMENT TYPE: Single Familv Residence NEW DWELLING UNITS 0 BUILDING SIZE (SF: 1496 LOT SIZE (SF): I. STORM I1RAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S,F, x 1 COST PER S,F, CHARGE 1 ' 0,00 I $0.357 I = I $0,00 I RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS , 1 IMPERVIOUS S,F, I x 1 COST PER S,F, 1 x 1 DISCOUNT RATE 1 1 I 1697,00 1 I $0.357 I I 50% 1 ~ I ITEM I TOTAL - STORM DRAINAGE SDC '$302.70 2 SANITARY SEWER - CITY A. REIMBURSEMENT COST: 1 NUMBER OF DFU's I x 1 221 B. IMPROVEMENT COST: , 1 NUMBER OF DFU's 1 x 1 22 1 COST PER DFU $27.67 I COST PER DFU $21.04 ITEM 2 TOTAL - CITY SANITARY SEWER SDC DISCOUNT $302,70 = I S1,071.44 3, TRANSPORTATION A. REIMBURSEMENT COST: I ADTTRIP RATE I x 9,57 I B. IMPROVEMENT COST: 1 ADTTRIP RATE I 1 9,57 I 1 NUMBER OF UNITS I x 1 1 0 1 1 COST PER TRIP 21.06 x I NEW TRIP F ACTORI I LOO x I NUMBER OF UNITS I x 1 1 '0 1 =1 COST PER TRIP $92,89 $0.00 x INEW TRJP FACTORI I 1.00 1 ITEM 3 TOTAL - TRANSPORTATION SDC (, 4 SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x o 1 ICOST PER FEU I $97,90 B. IMPROVEMENT COST: INUMBER OF FEU's I I 0 1 x ICOST PER FEU I $],009,17 MWMC CRED]T IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = , SO.OO = , SI,374.14 I~ CHARGE 1 $68,71 SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) 5 AI1MINISTRA TlVE FEE: /SUBTOTAL x I ADM, FEE RATE 'I $].374,14 I 5% TOTAL SANITARY ADMINISTRAT]ON FEE: TOTAL TRANSPORTATION ADMINISTRAT]ON FEE: 7/1112008 Kaye Wilson PREPARED BY DATE I TOTAL SDc CHARGES I 12632 S302.70 $608.63 $462.80 SO.OO SO.OO = SO.OO 'I I~ 10 10 I~ 1t.Ll " E- (/) 6 ~ 11070 11091 I 1 1092 I 1093 1094 I "'-1 1054 = SO.OO 1055 SO.OO :11054 SO.OO ! 1056 , 'I I' 68,7] 1079 SO.OO 111078 =, $1,442.85 I I ---- DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULA TE ONLY TIlE NET ADDITIONAL FlXTIJRES) NO, OF FIXTURES UNIT FIXTURE TYPE NEW OLD EQUIVALENT !BATHTUB . ------,,-~"- 1 0 31 = IDRINKING FOUNTAIN 0 0 1 = I FLOOR DRAIN 0 0 3 = IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = INTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = I LAUNDRY TUB 0 0 2 = ICLOTHESW ASHER / MOP SINK 1 0 3 = ICLOTHESWASHER - 3 OR MORE rEA) 0 0 6 = IMOBILE HOME PARK TRAP (l PER TRAILER) 0 0 12 = IRECEPTOR FOR REFRlG / WATER STATION i ETC, 0 0 1 = IRECEPTOR FOR COM, SINK / DISHWASHER / ETC, 1 0 3 = ISHOWER, SINGLE STALL 1 0 2 = ISHOWER, GANG (NUMBER OF HEADS) 0 0 2 = SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = SINK: COMMERCIAL BAR 0 0 2 = SINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 = IURlNAL. STALL / WALL 0 0 5 = ITOILET. PUBLIC INSTALLATION 0 0 6 = jTOILET. PRIVATE INSTALLATION 2 '0 3 = MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = TOTAL DRAINAGE FIXTURE UNITS :EDU (Eoui~ent Dwelling. Unit) is a discharg..: equivalent to a single family dwelling ~i~~~~O ?FtYs) seut~~t 167 ~~~ns per day DRAINAGE FIXTURE UNITS 3 o o o o o 3 o o o 3 2 o 3 0' o 2 o o 6 o 22 MWMc CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATElSl,OOO III ASSESSED V AL~ > $5,29' $5,29""", ~;:'II;;~;:;~ 0'11" ~'i,: 't~:E:i~~~.;""; ~., <~;~~c~'" ,,- =-$3,67 -=~: i~~J}f"':,~,,~3.,~r'.~~, ~ - '-'$2,73"00 c" ,;.:$2,25,ci~ f:~:-~ii'it ;.,~ '$' . "BO^"'t'i'1 :f~'Ii"'r' ""." 1. "-,- ,,~$1,59 ,- ~::: \~~~~ :~; f, ! , $1,09 __. r;:" i~~:j~ ~;"' ;~, ,,' ,,;~$0.48 'J,::':f::ig'~~,,~Lc ,I 2 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enler 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) VALUE /1000 CREDIT RATE $0,00 x $5,29 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE /1000 CREDIT RATE $0,00 x $5.29 TOTAL MWMC CREDIT = 2 1979 ~ , $0,00 \, o SO,OO I APPLICANT'S COPjY , , , Parcels R SEPTIC INSTALLATION PERMIT SP097026 18-03-02-24-01600 Site: S ON PIONEER PKW A Y/TURNS INTO S 2ND/ON 1360 S 2ND ST SPR ' Applicant: YOGI CHARLENE Owner: YOGI CHARLENE 1360 S 2ND ST SPRINGFIELD OR 97477 1360 S 2ND ST SPRINGFIELD OR ' 97477 I I Site Inspection'Number: Work Description: NEW SEPTIC SYSTEM System Type: ALT_MJR , ALTT Issued Date: ;? ~ il- f Expiration Date: p -1/..../0 INST ALLA TION REOUIREMENTS: Projected Daily Flow: 300 gallons Drainfield Size: 150 feet ' Special Conditions: Drainfield construction cannot occur until (July-Oct). Soil must be dry. Septic/dosing tank may be used as a holding tank. 8" trench w/ 20" soil cap. Submit As-built and Materials list for Inspection. Fax # 682-3947 Call 682-3751 to discuss permit. Septic Tank Size: 1502 gallons Trench Depth: 8 in. OTHER REouiREMENTS: 1. Installation of an effluent pump requires and Electrical Permit. 2. Install disposal trenches on contour, The trench bottom shall be level within a tolerance of plus, or minus one (I) inch over the entire trench length. 3. Minimum of eight (8) inch fall from top of septic tank outlet to top of rust head~r pipe leaving D-box. 4. New systems must meet setback requirements in Table 1. (/j/: < -. Jay ~son, Environmental Health Specialist 03/11/2009 Date' LANE COUNTY ON-SITE-SEW AGE OFFICE 125 E 8TH Avenue, Eugene OR 97401. PH: (541) 682-3754. Fax: (541) 682-3947 SEPTIC TANK DECOMMISSION (ABANDONMENT) Township Iff Range t/3 Section/1/4 Section &2..2'i- Tax Lot /Jt::l7 If you are connecting to an area-wide sewage collection system or you are ~eplacing your septic tank, please don't forget to properly decommission your septic system. An unattihded and forgotten s~ptic tank can become a serious danger for everyone's safety. Present Oregon regulations require you to properly decommission the septic tank as described below. Please have I this form signed by the appropriate people and return the completed form to: LANE COUNTY SUBSURFACE SANITATION PROGR'AM Public Service Building 125 East 8TH Ave Eugene, Oregon 97401 Name of Property Owner ' Septic tank located at Pumped of sludge on by (Date) (Signature of Licensed Operator) License # " The septic tank located at backfilled with sand or clean bank run gravel after being pumped of sludge on was (Date) Signature of Operator (may be owner) , Oregon Administrative Rules (OAR) 340-71-185 Decommissioning of Systems, 1. The owner shall decommission a system when: a. A sewerage system becomes available and the building sewer has been connected thereto, or ' b. The source of sewage has been permanently eliminated, 2. Procedures for Decommissioning: , a. The tank(s); cesspool. or seepage pit shall be pumped by a licensed, sewage disposal service to removal septage ' b, The tank(s), cesspool or seepage pit shall be filled with reject sand, bar run gravel, or , other material approved by the Agent, or the container shall be removed and properly disposed. H:\LMD\SANITATION\FORMS\septic Tonk Decommission form,doc Lane Caunty SubSurface Sanitation Program 125 East 8th Ave, Eugene OR 97401 (541)682-3754 Fax (541) 682.3947 - . . . TO: SEW AGE DISPOSAL ~Y~TEMS PERMIT APPliCANTS FROM: LANE COUNTY ON-SITE SEWAGE SECTION You are required by law (OAR 340-71-160) to be in possession of a permit authorizing installation of a sewage disposal system before construction of your septic system can begin.' .In addition, the law' ,,) specifies that all work oil said system must be performed by a person licensed with.the State of , Oregon Department of Environmental Quality (DEQ). The work can also be completed by the owner, contract purchaser or their'regular employees. Before starting any digging, carefully read all the specifications on the installation permit, plot plan & plans. If-you have any questions regarding i installation procedures or specifications of the approved area, call your sanitarian at (541) 682-37~ . & they will be glad to assist you. If you intend to hire 'someone to do the work for you, you should make sure that the person is licensed with the DEQ'to perform such work. This protects you as the consumer, as each licensed installer has to post a bond & is liable for the work performed. To check the licensing of an individual, you can call the Lane County On-Site Sewage Section at (541) 682-3754 & we will check for you to see if the, individual or contractor, you have chosen is licensed. ORS 454.705(3) requires that every licensed installer must provide to each permittee (owner) a written notice of the name & address of the bonding agent & of the permittee's rights. This must be provided before the work is completed. We urqe you to request this from the installer or contractor you have chosen prior to hiring them. , When the construction of your septic system is complete & before yo'u backfill, it is necessary to have the system inspected. To obtain an inspection, make a drawi'ng of the system as installed on the detailed system plot plan (As-Built) form provided.' Submit the completed As-Built & Materials List forms to this office & the inspection will be scheduled. Final insDection for sewaae systems can not be reauested bv teleDhone. Do not hesitate to conta'ct Lane County On-Site'Sewage Section if. you have any questions. Lane County Land Management Division On:..Site Sewage Program 125 East 8th Avenue Eugene OR 97401 H:\LMD\SANITATION\FORMS\Permit Cover letter,doc (TItle as shown on DEQ Iice.nse) MUST BE IN INK Permit #Sfo'l- l{lZ L Twnshp I (f Range {73 Se~t!9!'" CZ-, z.'/. _ Tax Lot Standard System Alternative System ~ TYJle? AX7t/"d/.v1 t',fI7-ld/b A:'/LL Site Location (Street Address) I '3kt7 'S 7x'1 5FI7/ar/E2b b7X , DETAIL SYSTEM SITE PLAN (AS-BUILT*) /fiP'C D.F Instoller Telephone Li cense # scale = N Bonding Com pony (Signature of Licensee)' (Date) If Installed by Owner- (Signature of Owner) (Date) Name & Address of person(s) to receive form: VICINITY MAP "'ATTACH MATERIALS LIST N FOR OFFICE USE ONLY , Approved, "Not Approved Needs Corrected COMMENTS RF /5C?v?/.4B/ ;= KE J::%/~ ...!.../Tv w./,77='( Sq:/O ~/$. /It/fUr (;f:tI71UfT 1/ rJrrEt1f;;7-t/Jt,/pf.\.. System orrected Date System Capacity..-Z/P gal/day Signature Date INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION when signed by the County's Environmental Health Specialist This certificate is evidence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. To request inspection, return this form and the Materials List to: Lane County Land Management Division, located in the basement of the Public Service Building, 125 East 8th Avenue; Eugene OR 97401 I\FO~MS\AS Built Form.com MATERIALS LIST (Required) OAR 340-71 170(3)(b) LANE COUNTY ON-SITE SEWAGE DISPOSAL PROGRAM Office: (541) 682-3754 Fax: (541),682-3947 SP#J?C; "7&Z~ T 115 R Cl~ S tl2; v. S .2: If TL / ~d:J Owner Installer A PRE,COVER INSPECTION WILL NOT BE SCHEDULED UNTIL THIS MATERIALS LIST & AS-BUlL T DRAWING ARE SUBMITTED TO THE LANE COUNTY ON-SITE SEW AGE DISPOSAL PROGRAM SEPTIC TANK Mfg. Type/Material Gallons D Water tightness tested after placement. Results w/in allowed limits (Required) D Riser (water tight) inches to ground surface (Required) D Effluent filter - Mfg. D Anti-buoyancy provided as per mfg. specs. DISPOSAL SYSTEM {D Std./Sapiolite 0 Cap fill' 0 Pressurized Dist.' 0 Sand Filter' 0 Other 'Alternative systems require additional information/inspections , D Curtin Drain - Depth of trench D Effluent sewer pipe - Length D Distribution material - Perforated pipe Dia. D Drop/Distribution box installed - Mfg, D Disposal Trench - Total Length D Drain media - Total depth Depth of gravel/media Diameter ASTM Outlet location ASTM 'lnfiltrator/EeeZzz drain/other , Materia.l Depth Depth below pipe 'Supplier PUMP INSTALLATION RECORD (IF APPpCABLE~ Mfg. & Model HP Pump Installer , D Pump & float switches installed -Gallons/dose D Audible-visual alarm installed & tested - Location D Pressure pipe - Diameter ASTM D Hydrosplitter Mfg./Supplier PSI Comments I understand that I am responsible for the satisfactory completion of all required testing, corrections & final cover of the system within 30 days of completion. I certifY that construction described above complies with the requirements of Oregon Administrative Rules Chapter 340 & the permit issued by the LANE COUNTY ON-SITE SEWAGE DISPOSAL PROGRAM. INSTALLER'S SIGNATIJRE ' DATE ATTACH TO AS-BUILT H:\LMDISANlT A T10N\FORMSIMaterials List.doc , SITE PLAN SUBMITTAL FORM OWNER NAME: ~ 1tHIu", '/tX,l' PHONE # ADDRESS: 1%03 u...( ~DN/I<,~'eJ" I>R Map and Taxlot #: I~~ -JSbo , III...., 1 Scale:, -:: e>C D '~^U:~D(' ('~CL;(' }:r:~rhvll CiA tJejA) ~Cfi\,~ &vJe~;~~~ ! v~ J ~I cA1,N I Sue, l-\oc~ , :S'l5'~ I') 8 ien to be.. ;,vS,tz..I\ee\. .s~, '-to e0'S' ()~~ tJGO '-(0 rLLWl d ~~ <;:'-.v-\v<:'e.. tc,.~ . ,- 10 'i I/.\AA.. C\~ M ,p',J . 1 ~ D,' (. +0 ~ '" V, fI;G~'?iZY(tfllJ..>0l\ u-.';- t\->e. L1D' k. . \ ~ \ 1\ \)-t ~ . Ul\v\.~ uJ'\ \. t~ \\)..'cS ~r;:,P'f.~d~l\ N\ .5~ec~ (I""~ "lr,\\~. \\ S~:(0;r- y~\ ',: .,,,,,,,J l:xt l"e~ ~. ...,l...,o\'.~~A 0'i5. ~ vJ. \)JeM rfl(;;,..:) ~.~., ~ Ap-A ~ I}l\\' \ \ y\WW' \, \y., Attv'\<-wv\' \ l)J: \\ ,b~ ~~I~ -kv~\~ WI\-\-... Q\4 0'1'\ t!2>t 5"1 2J~ ~4J. lCwvk::.. vY- v^' 'o,e. ' , ~ r'{\ 5 - {\ n \: \"5 ~ . \'~,~~~)~\' , , 0\.1-'<\ 'te+ 1-0, El yrt-o>>'\ ~ . ...... t. ~ ,,'i. 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"" 0 n <;:l.:r :r 22::Al'ifth_,Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S-00976 COM200S.00976 COM200S-00976 COM200S-00976 COM200S.00976 COM200S-00976 COM200S~00976 , Payments: Type of Payment Check cReceintl City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2200900000000000251 Date: 03/11/2009 12:03:13PM Description Fire SF Fee - Residential Stonn Drainage Impervious Area SDCSanitarylStorm Admin Plan Review Minor - Planning Building Permit 2 Baths One or Two Family -Mech Iss 2+ Appliances- Furnace - up to 100,000 btu Vent Fan -Exhaust Hoods Dryer Vent Heat Pump Residence Wiring 1000 Sq'Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less + 5%Technology Fee + 12% State Surcharge . ***+ 10% Administrative Fee*** Amount Due 19,25 302,70, 6S,71 119,00 74S,I4 2S0,OO 40,00 14,00 14,00 1000 7,00 '14,00 117,00 21.00 55,00 69,96 153,62 129,94 $2,183.32 Paid By CHARLENE YOGI, Item Total: Check Number Authorization Rece,ived By Batch Number Number How Received Amount Paid ]03 In Person Payment Total: $2, I S3,32 $2,183,32 KLK Page I of I 3/1112009