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Home My WebLink AboutPermit Miscellaneous 2006-7-7 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00634 ISSUED: 07/07/2006 APPLIED: OS/25/2006 EXPIRES: 01107/2007 VALUE: $ 53,646.00 '. Status Issued 225 Fifth Street, SpriDgfield, OR 541-726-3753 PhoDe 541-726-3676 Fax 541-726-3769IDspection Line SITE ADDRESS: 6531 MaiD St ASSESSOR'S PARCEL NO.: 1702344300201 SpriDgfield TYPE OF WORK: MaDufactured Home OD Private Lot TYPE OF USE: New ResideDtial Sidewalk Type: PROJECT DESCRIPTION: Manufactured home OD MDR Owner: Address: JOHN FERGURSON 6535 MAIN ST P "1 ~"TION' a I . SPRINGFIELD OR 97478,,' _ '. regon aw reqlJlres you to . 'u.~, aoopted h\l thQ r"............._ I h.:'"A . .I~ ~ ~ellter, Thnoo ,,,1M --.- - ~:-,!...,.:l /', ~,' 1 [:,,2 O~11 (!:ONTRACT.OK1NFORM'II:TION I OCO Y " _.J u.- - :, uu may obtain copies of the rule I. ContractoI;g the center (Note' th t I t,~/{ense . ,e e ephonp. MAGElJEGmRl€t!~<OreQon Utility Notificali~9834 HARRISON JAG~J~~.9~,:!t'S-332'2344) .,,0447 HARRISON JACOBSON INC . 66447 Contractor Type Electrical MaDufHome IDst Plumbing BUILDING INFORMATION I # of Units: Primary Occupancy Group: SecoDdary OccupaDcy Group: Primary ConstructioD Type Secondary Construction Type: # of Bedrooms: # of Stories: 1 Height of Structure Type of Heat: orced Air Electric Water Type: Electric Range Type: Electric EDergy Path: Sprinkled BuildiDg: D/a 1 R-3 VN 3 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION I Overlay Dist: nt' W 11-\1'. \!'l()\'I~ 5.00 ~\C,,:. # ~tr~~t\!te.!SI~(!;d:\'I~11 IS ~() \'to ?t.\'I~\PaV!~.pctv~'t~q~t ~t.\) f()\'I 11-\1'0 ()\'Illt.~lJf\b~tC~~~~!lgp' O.O~\\.\},~'!I'I'\Ct.\) ~~a\(\D, \Jf>..~;;1 P,l!IBUIC'IlVIPROVEMENTS I Fully Improved No Street Improvements: Storm Sewer Available: Special Instruction: PhoDe Number: 541-746-6508 Expiration Date 12/13/2009 05/07/2007 05/07/2007 Phone 541-461-0387 541-689-7762 541-689-7762 Lot Size: Sq Ft Ist Floor: Sq Ft 2nd Floor: Sq Ft BasemeDt: Sq Ft Garage/Carport Sq Ft Other: ,OccupaDt Load: 1,080 o Yes REQUIRED PARKING Total: 2 Handicapped: Compact: DownspoutslDraiDs: Curbside 7' Drywell - Provide Drywell Engineering Notes: Drywell approved 6/23/06 Sanitary extended at Cleanout Paee 1 00 . .CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00634 ISSUED: 07/07/2006 APPLIED: OS/25/2006 EXPIRES: 0110712007 VALUE: $ 53,646.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Description Type of Construction $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 2,646.00 51,000.00 Value Date Calculated Total Value of Project $2,646.00 $51,000.00 $53,646.00 OS/25/2006 OS/25/2006 Foundation Only Use Bid Amount ManufHome Manufactured Home ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $34.32 5/25/06 1200600000000000711 + 10% Administrative Fee $55.78 7/7/06 2200600000000000938 + 8% State Surcharge $40.30 7/7/06 2200600000000000938 Addressing Assignment $31.00 7/7/06 2200600000000000938 Fire SF Fee - Residential $54.00 7/7/06 2200600000000000938 Fixture $14.00 7/7/06 2200600000000000938 Foundation Permit $52.80 7/7/06 2200600000000000938 Manuf Home State Issuance $30.00 7/7/06 2200600000000000938 Manufactured Home Feeder $50.00 7/7/06 2200600000000000938 Manufactured Home Placement $160.00 7/7/06 2200600000000000938 Manufactured Home Service $50.00 7/7/06 2200600000000000938 Sanitary Sewer - Ist 50 Feet $45.00 7/7/06 2200600000000000938 Sanitary Sewer - Improvement $457.68 7/7/06 2200600000000000938 Sanitary Sewer - Reimbursement $601.68 7/7/06 2200600000000000938 Sauitary Sewer Each Addtll00' $14.00 7/7/06 2200600000000000938 SDC MWMC Administration $10.00 7/7/06 2200600000000000938 SDC MWMC Improvement $865.31 7/7/06 2200600000000000938 SDC MWMC Reimbursement $82.03 7/7/06 2200600000000000938 SDC Sanitary/Storm Admin $89.19 7/7/06 2200600000000000938 SDC Transpo Admin $70.56 7/7/06 2200600000000000938 SDC Transpo Improvement $805.70 7/7/06 2200600000000000938 SDC Transpo Reimbursement $182.69 7/7/06 2200600000000000938 Storm Drainage Impervious Area $189.92 7/7/06 2200600000000000938 Storm Sewer - 1st 50 Feet $45.00 7/7/06 2200600000000000938 Water Line - 1st 50 Feet $45.00 7/7/06 2200600000000000938 Water Line - Each Addtll00' $28.00 7/7/06 2200600000000000938 Willamalane ManufHome Private $1,000.00 7/7/06 2200600000000000938 Total Amount Paid $5,103.96 I Plan Reyiews I Initial Review Plannine Review OS/25/2006 OS/25/2006 OS/25/2006 06/22/2006 APP LLH APP 'I' AJ Approved as per the Site Plan Review approval DRC2006-00034. Paee 2 of3 -(if . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006.00634 ISSUED: 07/07/2006 APPLIED: OS/25/2006 EXPIRES: 0110712007 VALUE: $ 53,646.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Public Works Review OS/25/2006 06/23/2006 APP CAS Approved 6/23/06Called for Drywell Calcs 5/26/2006 CAS Structural Review OS/25/2006 06/23/2006 APP DLM To Request an inspection call the 24 hour recording at 726.3769. All inspection 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 Reollirerl Jnsne~tionsJ Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Foundation: After forms are erected but prior to concrete placement. Manuf Home Set Up: When installation of all piers or stands is complete. Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Drywell: Engineered Drywell is Required. Provide the City with a copy of the DEQ application to keep on file. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. MH Service: Approval required prior to utility company energizing service. Final Building: After all required inspections have been requested and approved and the building is complete. 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 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, 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 "m.::2~ 7- 7-06 Owner or Contracto.<'Signature Date Paee 3 00 SPR'~:iJEt :~:~'.~w;;;;"H'"')''''''' .,~::;; _~~ ~,; '-:.'-'-''::'''r'' --~;:,;.~:O::::':'~~ -....-...."~,,._",.,..,...""..~:.''''.,~.....~......... . ...!,w.... ^r',J 1. g(;QeATION-011lINST., 'A1JI::A110Nf...Ljf''H:i\ _a1;~~t~~~oi LEGAL\~~~ WLQ\ JOB DESCRIPTION \~/ Permits are non. sferable and expire if work is Dot started within 180 days of issDance or if work is Suspended for 180 days. ~Di,,,;:;,,,,;:,,"'+''''~~''''''ii'_;'';-'W.'''.:-_...,~o'i''''''':l-o''''''''-'W'"'~=_~ 2. ~ff;l!~WJ!i!!J.S,[e..!11'f!QNP1'fl/Y.7 . Electrical Contractor Address a...cp:J . City ~41IR_ Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date City \4\~ The installation isbeing made on r.-y-.:;I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Vf.(J(JMPilifj'E/ifERseiiEiJuLiNfEWWAa~$~~l'J.'Jt~lr. 3. tL.:~~...w.I'''",m'-~'~'''''''''-'-'--_!:\':l<...;;-.:."~..~.J>'!t.'!Z~v~~~A A. E1N~-1i~ia~tblf~;Siir~~~~~r.:i~hilF.r':i~1';~t~~rllii~nilW~ ~,;.1:i.~~d....,..""S".,..,.--.."..,. -'~",...~Jl:""':~i~....!b:,Ij,;J...;i~ Service Included 1000 sq. ft. or less Each additional 500 sq, ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $19.00 ~ $50.00 \oop) B. ~~~i~itfiFJar~~tiiilitti~~~ti.61rmri~~~~lr,~?U,'~ ~"""';-;"~"""'FI,W.",~..~,,,~~~ .,.~t::J:..~~&;;;lk:,<<-~~1 ~ - 0/ the a You to 200 Amps or less. ~". I nO~e r ' regOn ~~ 00 201 Amps to 400 Aiop; 0 thr;u~'''-'' are s~ tia~: 4Oi"Am to 600' lJ/.U,,,in Co . 9 . ':'IiH 95'~li1tlf10 nu Ps, ~ v"nte.... Pies t" ""<IV!- 601')\"" ;io.IOOOA r. INot . lne rUI-'6,l.o0 mps ""C umps e. thn t' '""""'Y' Oyer lO00f~~~~gOn Utility:,{",ephoim75.00 Reconnect Only 00-332_2'>._ vIIIICatilS,po.oO_ '- ......,.}. " C tf.?ff.'"'"""~''''''!'">'''-'''S''~''-'i.~:.'~4-,..,.....;:I-''-F'--'~d':"~:M~.c.,'t!tJ.{"1't'"ii14~'V"ii", . "''':\'':,3f'W.:t!i! . ~~~ary'~~~~~9!L,.~~~~?:;~:J:te~,'. ~--~~11 Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. ~~~~~~~:~~i5~~!1tj,~th~ri~:rJ1it!~ N'W/Alafal!p.i,tjoSf,~rri~n Per Panel cliJflitcu. 'i,'~ZED~ND~Q T~/RE IF THE.\~djjOO atv!l.4~,qffi!';< cUlt6t wlmS PERMIT IS 1\ S~c~8[)~~p ~~BANDCI\CU l'ut:f.tlO "" E. ~~~ri'lJ~~l~fJdJfiiJriJ\fifci~d'~Etc".. ' ''ilU'a'tiol,1 . . '," -""<-'0,>;) .~"J~~~~';:;:~4.,;,l.ti~~~~.~t:'~~~-"'--"{..-,--:l Pump or irrigation $,50.00 k~~ Sign/Outline Lighting $ 50.00 "': . Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges liE~~~'~'Mlif&;-~~;4'ic-i, :i..-~.-J\t'~{~;{~:(;?il;~~i::y':::f~ 00 4. t~l;.u...tv...AL OE1lBO;VE-;;:;t~:~~~ ~\,.~t",..'!-^~'j:'~@,~J~ ~.;e';:'''jt'~"\.<:- ,~_1",...;j,d,;,~""~~.1;~',"i1"~: ,",,-':~'.:,..- ;~" ,'t, .;*'fi.>\:~,!~ \00.. .... ..._.... " .' ~~.:"'~-'-"..........~,......4..'""~._k".'>d.,. B.W \nOD -UP> ,cr) $ 50.00 , $ 69.00 $100.00 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive<T:)lBuilding Fonns'Elec:trical Pennit Applic"ation l-03.doc CITY OF StlNGFIELD SYSTEMS DEVELOPMEtAORKSHEET JOURNAL OR JOB NUMBER: COM2006-00634 NAME OR COMPANY: John Ferguson LOCATION: 6531 Main St TAX LOT NUMBER: 1702344300201 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF' 1080 LOT SIZE (SF): 1. STORM DRAINAGE 65758 en ~ Cl o u ~ ~ en G gj DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S,F. x I COST PER S,F, I CHARGE I 0.00 I 50.323 = I $0,00 I 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 1176,00 I I 50.323 I 50% I = I DISCOUNT $189,92 ITEM 1 TOTAL - STORM DRAINAGE SDC $189.92 $189.92 1070 2, SANITARY SEWER - CITY A, REIMBURSEMENT COST: I NUMBER OF DFU's I x 24 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x 24 I 519.07 ITEM 2 TOTAL - CITY SANITARY SEWER SDC COST PER DFU $25.o? $601.68 11091 I 11092 I $457.68 = , $1,059.36 1 TRANSPORTATION A REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x !NEWTRIPFACTORI I 9.57 I I I 519,09 i 1.00 I $182.69 11093 B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIPFACTORI I 9.57 I I 584,19 I 1.00 I $805.70 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = , $988.39 4, SANITARY SEWER - MWMC -- A REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I I I $82.03 = $82.03 11054 B. IMPROVEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I I I 5865.31 = $865.31 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMINISTRATIVE FEE $10.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I $957.34 SUBTOTAL (ADD ITEMS 1,2,3, & 4) = I $3.195.01 .J 5, ADMINISTRATIVE FEE. I I SUBTOTAL x I ADM, FEE RATE 1= CHARGE I 53.195.01 I 5% I 5159,75 TOTAL SANITARY ADMINISTRATION FEE: I 89.19 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: I 570.56 I 1078 Cheryl Slaymaker 6/23/2006 TOTAL SDC CHARGES =1 $3,354.76 PREPARED BY DATE _n_ 0___ . . DRAINAGE nAl lIRE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY ruE NET ADDmONAL FIXTURES) NO, OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS , I BATHTUB 2 0 3 = 6 l IDRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE 1 OIL 1 SOLIDS 1 ETe. 0 0 3 = 0 I INTERCEPTORS FOR SAND 1 AUTO WASH 1 ETe. 0 0 6 = 0 ILAUNDRY TUB 0 0 2 = 0 ICLOTIlESW ASHER 1 MOP SINK 1 0 3 = 3 ICLOTIlESWASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRIG 1 WATER STATION IETe. 0 0 1 = 0 IRECEPTOR FOR COM. SINK 1 DISHWASHER 1 ETe. 1 0 3 = 3 I SHOWER. SINGLE STALL 0 0 2 = 0 ISHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0 ISINK: COMMERCiAuRESIDENTIAL KITCHEN 1 0 3 = 3 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1 IURINAL. STALL 1 WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 !TOILET. PRIVATE INST ALLA TION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwellinp: unit (20 DFU's) set at 167 R8l1ons oer day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE -. -- ,.-------- YEAR CREDIT RATE/$I,OOO ANNEXED ASSESSED VALUE IS LAND ELGlBLE FOR ANNEXATION CREDIT? 2 BEFORE 1979 $5,29 (Enter I for Yes, 2 for No) I 1979 $5,29 IS IMPROVEMENT ELGlBLE FOR ANNEX, CREDIT? 2 I 1980 $5,19 (Enter I for Yes, 2 for No) I I 1981 $5,12 BASE YEAR 1979 I 1982 $4,98 I I 1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) 'I I 1984 $4.63 VALUE 1 1000 CREDIT RATE r 1985 $4.40 SO.OO x S5,29 ~, $0,00 1986 $4,07 I 1987 $3,67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) 1988 $3,22 VALUE 1 1000 CREDIT RATE 1989 $2,73 $0.00 x $5.29 0 1990 $2.25 t991 $1.80 t992 $1.59 TOTAL MWMC CREDIT = SO.OO 1993 $1.45 1994 $1.25 1995 $1.09 1996 $0,92 1997 $0,72 1998 $0.48 1999 $0,28 2000 $0,09 2001 $0,05 . SPJlt,F,IELD DEVELOPMENT SERVICES DEPARTMENT 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726.3753 FAX (541) 726-3689 www.ci.springfield.ar.us 1t.....';f1:f~t(jy~' ~."',;M:, ", '.Ir~ MANUFACTURED HOME SET-UP AGREEMENT As required by the City of Springfield Development Code, I understand and agree that with the approval of the attached pennits, one of the following manufactured homes will be placed at ( ...., <=t'3 I m ~ )0\ . Springfield, Oregon, City Job Number C Co - CSO(-......'-f l:pe'nYlai1iifacture~~!~~,>) . ).,~sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thennal envelope meeting perfonnance standards which reduce heat loss to levels equivalent to th<:J<erf~ance standards required for single family dwellings at the time of construction. ~./' initials;(. P/ A unit 0 not less than 12 feet in width enclosing a minimum floor area of 500 square feet, that has a nominal ro pitch of 2 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has b .certified by the manufacturer to have an exterior thermal envelope meeting performance standards which re ~ heat loss to levels equivalent to the perfonnance standards required for single family dwellings at the~ne of construction. initials [ further state, by my signature below, !/1at I have been provided with the following infonnation: Manufactured Home Blocking, Water Line Connection, Street Tree Standards, Sanitary Sewer Connection, Electrical Connection, and Minimum requirements for pennanent steps. I also understand that the manufactured home shall be placed on an excavated and backfilled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure, enclosed at the perimeter with stone, brick or other concrete or masonry materials approved by the Building Official and with no more than 24 inches of the enclosing material exposed above grade. x.. -?'5 -~L~ Signature- ", / 7- 7-Cl 0> Date . . MANUFACTURED HOME LAND USE AGREEMENT As required by the City of Springfield Deyelopment Code, I agree that with the approval of the attached penn its, one of the following manufactured homes will be placed at ~$"3 / ~A.IAlc;'r: Springfield, Oregon, City Job Number ('~~~~ - (')t:.:rDS 1-- ~ Type 1 Manufactured Home. A multi-seCtional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch 00 feet in height for each 12 feet in width, that has no bare metal siding or roofmg, and that has been certified by the manufacturer to have an exterior thennal envelope meeting perfonnance standards which reduce heat loss to leyels equivalent to the perfonnance standards required of single family dwellings constructed under the State Specialty Codes. _ Type II Manufactured Home. A unit of not less than 12 feet in width with an enclosed floor area of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width and that has no bare metal siding or roofmg, The manufactured home shall be placed on an excayated and back-filled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of the enclosing material exposed above grade, 1 further agree to meet all land use and City Code requirements of the above mentioned parcel within 60 days of the date of issuance of the manufactured home set up pennit. These requirements may include, but are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on your approved set up plans andlor pennit and your partition approval if applicable: ' . Street Trees . Paving Driveway . Minimum 32 square foot storage structure . Completion of partition approval . Removal of any existing structures as noted on your partition approval . Signing and recording of any required partition, easement, improvement agreements, etc, . Final lot grading . City Sidewalk and curbcut installation . Any outside agency approval as required Le., Division of State Land approval. By my signature below, I agree to complete the above mentioned land use requirements. 0:::::/ ~hvL contractor ~f'ture / . Date 7-7 -~ 0 Date 225 ,Fifth Street Springfield, 0n:gon 97477 541.726-3759 Phone . .....~0~.!!~,<,. u.... . . ~~. ' <;Ii of Springfield Official Receipt .Iopment Services Department Public Works Department Job/Journal Number LDP2006.00083 COM2006-00634 COM2006.00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 COM2006-00634 Payments: Type of Payment Check cReceintl RECEIPT #: 2200600000000000938 Date: 07/07/2006 Description LDAP Short Form Impacted New Addressing Assignment Willamalane Manuf Home Private Manufactured Home Feeder Manufactured Home Service Fire SF Fee - Residential Foundation Permit Manufactured Home Placement Manuf Home State Issuance Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addtl 100' Water Line - 1st 50 Feet Water Line - Each Addtl 100' Storm Sewer - 1 st 50 Feet Fixture Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin + 8% State Surcharge + 10% Administrative Fee Paid By GOODEN-HARRISON Item Total: (;heck Number Authorization Received By Batch Number Number How Received vrj 9723 9723 In Person Payment Total: Page I of I 9:18:10AM Amount Due 600,00 31.00 1,000,00 50,00 50,00 54,00 52,80 160,00 30.00 45,00 14,00 45.00 28,00 45.00 14,00 189,92 601.68 457,68 182,69 805.70 82,03 86531 10,00 89,19 70,56 4030 55,78 $5,669.64 Amount Paid $5,669,64 $5,669.64 7/7/2006