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Home My WebLink AboutPermit Building 2009-7-15 Status Issued 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541.726.3676 Fax 541.726.3769 Inspection Line CITY OF ~rKll'lld:;mLJJ Building/Combination Permit PERMIT NO: COM2009.01000 ISSUED: 07/15/2009 ApPLIED: 07/08/2009 EXPIRES: 0111512010 VALUE: $ 171,542.00 SITE ADDRESS: 1233 W Quinalt St ASSESSOR'S PARCEL NO,: 1703273107300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single Family Residence, Lot 7 Quinalt Suhdivision Owner: Address: NORTHWEST BANK , 4900 MEADOWS RD STE 410 LAKE OSWEGO OR 97035 Residential - I. CONTRACTOR INFORMATION I . Contractor Type General Electrical Mechanical Plumbing Contractor EQUITY HOME BUILDERS, LLC DML ELECTRIC, INC CROWN HEATING LLC NORTHWEST MECHANICAL LLC License 176016 161264 171074 186277 Expiration Date 05/0412011 08/27/2010 07/11/2010 04/10/2011 Phone 541.382.0803 541.923.9897 541.420.3307 541.504.1988 BUILDING INFORMATION I # of Units: Primary' Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: , 1 R.3 U VB # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: , Sprinkled Building: 3 I 18,00 Electric Electric Electric Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 461 6,074 1,592 No I DEVELOPMENT INFORMATION I Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18,00 15.00 12.00 11.50 0,00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING I Yes' 33,80 Total: Handicapped: Compact: 2 :~, 1t:1\I I IUI\l. VIt:\:lUIIIUVV IGl.-1L'IIvv y........ 'v Subdivision Not Accepted I PUBL,IC IMPROVEMENTSj,lIow rules adopted by the Oregon Utility, S 1 ' NotificrS',;i1"en ('al',n~' e,hose rules are set forth treet mprovements: Fully Improved in OAR 952'."~0'r01l~0'through OAR 952,SHback 5' Storm Sewer Available: Yes 0090, cj)jl~MPpl!(~m:raiu,~:Jies of t0urblaud)~utter Special Instruction: PUBLIC WORKS RECOMENDS NO HOOK UPc1iJ?Iij>~WJi:&\:INJT.I~t<!:.0,UN@Il5ll\cjlP.R0N AL AI OF SUBDIVISION number for the Oregon Utility Notification Notes: StormQIWltd curb and gutter, Center is 1-800.332-2344), THIS PERMIT SHAL AUTHORIZED UN L EXPIRE IF THE WORK COMMENCED OR~~~ THIS PERMIT IS NOT ANY)80 DAY PERIOD,BANDONED FOR , Page I of 4 _$!1'lllcf!l~,Ij'IIl:!;e;, ~.. Status Issued 225 Fifth Slreet, Springfield, OR 541.726.3753 Phone 541.726.3676 Fax 541.726.37691nspection Line Descriotion . Type of Construction GaraeeIMisc SFilluplex U VB Utility R.3 VB 1&2 Family Fee Description + 12% State Surcharge' +'5% Technology Fee 1st Appliance 2 Baths One or Two Family Addressing Assignment Building Permit Curbcut. 2nd Curbcut Curbcut Permit Dryer Vent Exbaust Hoods Fire SF Fee. Residential Heat Pump Perm SerylFdr 200 amps or less Plan Review Major - Planning Plan Review/Residential Hourly Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer ~ Improvement Sanitary Sewer - Reimbursement' SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Tran Reimburs.Residential SDC Trans Improvement.Resident SDC Transportation Admin Sidewalk Permit Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan Willamalane Single Family Total Amount Paid CITY OF SPRINGFIELD ,Building/Combination Permit PERMIT NO: COM2009.01000 ISSUED: 07/15/2009 APPLIED: 07/0812009 EXPIRES: 01/15/2010 VALUE: $ 171,542.00 I Val~ation Descrintion I $ Per Sq Ft or multiplier $37,72 $96:83 Square Footage or Bid Amount .461.00 1,592,00 Value Date Calculated $17,388,92 $154,153,36 $171,542,28 07/08/2009 07/08/2009 Total Value of Project F"r' ~ Amount Paid $220.41 $108,94 $79,00 $337,00 $38,00 $1,001.79 $.45,00 $88,00 $9,00 $13,00 $102,65 $17,00 $81.00 $211.00 $104,00 $134,00 $75,00 $483,84 $636,30 $10.00 $1,009,17 $97.90 $140,79 $201.54 $888,98 $73,72 $88,00 $962,50 $63,00 ' $27,00 $2,858,00 $10,115,53 Date Paid Receipt Number 3200900000000000534' 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 3200900000000000534 7/15/09 , 7/15/09' 7115/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15109 7/15/09 7/15109 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 7/15/09 71l5/09 7/15/09 7/15/09 7/15109 7/15/09 Pa!!e 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-0]000 ISSUED: 07/]5/2009 APPLIED: 07/08/2009 , EXPIRES: 01/]5/20]0 VALUE: $ ]7],542.00 Issued 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541-726.3676 Fax 541.726.3769 Inspection Line Plan Reviews I Structnral Review 07/08/2009 Initial Review 07/0812009 07/08/2009, WI NJM Initial Review 07/08/2009 07/08/2009 APP LLH Plannine: Review 07/0812009 07/09/2009 DON DDK Approved as shown on plans, Puhlic Works Review 07/08/2009 07/0912009 APP BJG STORM WATER TO CURB AND GUTTER. Structural Review 07/10/2009 07/1012009 APP KLK 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. Rp'\lloirpr!lm,neftions I Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed, Sidewalk. Setback: After forms are erected but prior to placement of concrete, Curbcut. Standard:' After forms are erected but prior to placement of concrete, Vfer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection, Footing: After, trenches are excavated, Foundation: After forms are erected but prior to concrete place"ment. Post and Beam: Prior to tloor insulation or decking, Floor Insulation: Prior to decking, Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved, Wall Insulation: Prior to cover, Ceiling Insulation: Prior to cover. Roof Sheathing Drywall: Prior to taping. Hold Downs Installed: Special Inspection performed prior to placement of concrete, Provide report to City Building Inspector, Final Building: After all required inspections have heen requested and approved and the building is complete, Vndertloor Plumbing: Prior to insulation or decking, Rough Plumbing: Prior to cover and including required testing, Page 3 of 4 CITY OF SPRINuf<lI!.LD Building/Combination Permit Status Iss u ed PERMIT NO: COM2009-01000 ISSUED: 07/15/2009 APPLIED: 07/0812009 EXPIRES: 01115/2010 VALUE: $ 171,542.00 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541.726.3676 Fax 541.726.3769 Inspection Line Water Line: Prior to filling trench and inclnding reqnired testing, Sanitary Sewer Line: Prior to filling trench and inclnding required testing, Storm Sewer Line: Prior to tilling trench, Final Plumbing: When all plumbing work is complete, Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete, Temporary Electric: Approval required prior to Utility Company energizing pole, Ufor Electrical Ground: Install ground rod at footing and call for irispection in conjuction with footing and/or foundation inspection. Underground Electric: Prior to cover Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service, Final Electric: When all electrical work 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 times during construction. ;L~~ l-/S-~07 Owner or Contract~gnature Date " Paee 4 of4 Structural Permit Application - . .. - ". .' _..,,,"--. 225 Fifth Street tSpringfield, OR 97477. PH(54 1)726-3753 . FAX(541)726-3689 I~DEeARTMENtIUsEroNtIY;iJl i;htiiim,y;","Am%'__"__'Cec,.__,"'C'-'''' -1'''',__'.: _"'ii",'--?"":'''''' c,'..~,.. Vii.} {OWZ-OO't- ~'~ Permit no,: cx::x> 1 Date: s:=c 7- U '-71 This permit is is~ued under OAR 91~-460-0030. Permits expire if work is not started within 180 days of issu?,ce or if work is , suspended for 180 days, YJ .cr cY\ '~{ji!ft1i;){trd,~ff:f;~:~O,'GAL:~~G:QY~'R~'MEJ{f~~'.4.RPR"QY~~~1~Z~*~~j;~7;~;l~~! I T~is project has final land-use approval. . I Signature: Date: I T~is project has DEQ approval. I Signature: Date: I Zoning approval verified: 0 Yes 0 No I I Property is within flQod plain: 0 Yes 0 No I I (a) Job description:. 1 Occupancy ll: '3 1 Construction type: ~ r3 r . 1 Square feet: / 5 ., 2 ,(.,.. '- o addition ii,~:~~J~;~;~~~~g~~~~~E~~;;~\~~~: : i~t:~~:~::~:~~nIY penUlt? 0 Yes 1 Address: \\~{) "ihY\en-e \.~'P I 0...:\.1 City FIAf'v'\e. I St';;-6\[IZIP:9=vYOII ,'IPhone~l-l'9-""'fOS'-2m1Yax - - I '~I E-mail: 1 , This installation is being made on residential or farm property. owned by me or a member afmy imm~diate family, and is exempt from licensing requirements under ORS 701.010. Sign here: Wo I (a) Permit fee (use valuation table): 1 (Ii) Investigative fee (equal to [2a]): I (c) Reinspection ($ per hour): (number of hours x fee per hour) I.<d) Enter 12% surcharge (.12 x (2a+2b+2c]): 1 (e) Subtotal of fees above (2a through 2d): I (a) Plan review (65% x permit fee [2a]): I (b)'Fire and life safety (40% x pennit fee [2a]): I (e) Subtotal of fees above (3a and 3b): I I '161 ~Ar""rJ I I I 1 1 ~ _-" 1 .5J " [I 1 I I I I I: I $ $ $ I : 1 $ 1 Business namc:t::qll'l-hl \-\tlVIleb\)\"KP,f,\ U,C, 1 Add,;ss \ I ?'~..MIJ 1'.1. ~ill bTrf".{'';:/ ~ I 1 f City: ~M . l State:C1Z.. r ZIP.'A-~II ", 0 '. Phone.eJ..U -3:i:;] --("!M"S Fax:~~- ?-~- ~,l 4 I,(a) SelSmlcfec, 1 YoCOI x pennlt fee [2a]). 1$ I E,mail:QJ\o\.\J €LA. LJI~I (!) bendbyr.:.rlb:; 1 TOTAL fees and surcharges (2c+3c+4a), S I ' " r . CCBlicenseno,: I~~\ ~ ' , I p,ri,ntnan,':;,R-m,' ~", nt"G,U" I I Signature "~ I i":I::~;;~;sgar~~~$:~~~~T~O~~:=:~ I Plumhing I t'2:llD'Z..-:r":f I~l-~~~~~ Il\-'fechanicar I ~~ 'N)' ~ ~k ,~ 'D~' "- " Plumbing Perin it Application I"~ 'D~PARTMENTUSE' ONLY I Permit no,rtJ;-Ir.J:::LJ I Date 1).801 225 Fifth Street. Springfield, OR 97477 .-PH(541 }726-3753 . FAX(541)726-3689 This permit is issued under OAR 9t"S-780-0060.Permits are is~ued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. I LOCAL'GOVERNMENT;'AP,PROVAI! , I Zoning approval verified? DYes D No 1 1 Sariitation approval verified? DYes D No I I CATEGORy;'OF:'CONSTRUCTION,~ ' '" . ,I I tIDResidential I 0 Government 1 0 Commercial J I JOB,'SITE INF;ORMATION:,ANDiLOCATION ?'(;""-9) I Job site address~lJi:;..? .-.: ~ l2...~o I.VU, I City~""yr.'~~~lrt I State:{) r ZIP: I Subdlvlslon:t~\'{l0 +- ' I Lot no,: q I I" ";,,, ,;,,);,DESCRI~ 1()N;:Ot=J:WORK:J':~;,${~',?,'iR:l\t:;c:i1 l1.' Pl A \ ( Irnctn ~;Wr1)- <?-.if'q \~ I ~J)V\lllA ~ki.fvre 1 I ' ''', "".J .;,; PROPERTYKOWNER"J,i,:r;...;:';:' Name: Rrth! Jo(" -:\a,l1n i ~dl i Address: \ \H) 'L'br-lmt'.. l..n, An.J- 2.(0~ City. 17 -;a('Yle. I State: 01Z r Z1P:Cj::;<fOI Phone: f1 te)- Tr::6. '2CIfa.Fax: ~ I E.mail: This installation is being made on residential or farm property owned by me or a member afmy immediate family, and is exempt from licensing requirements under OAR 918,695.0020, Signature: ICONTRACTOR5;INSTAL:.loA TIONJ'f,' ~;c:';:,;;~"t't ,;,I I Business name: A ltJ rvl I (1 ,C I I Address: q ,[ rr: '1 f'J/ I I City State: D12. P:q'1-7-S1 n I I PhoneS'!/ - EDt/-f1f';P, I Fax: 51/-FfJif -d?b 7-1 I E.mail: 'Uh}pt'Y{2ll/fl1bll1~hDtrnai1, ('{frI. I CCB Ii~se no,:/'f2,/dL=t-=l- B license no: .1 Plumbing license no.: I Print nam't-;;;/O~ M( (IY' / , I SignaturetF~/l4,{ '" 440,2500,J (11/08/COM) I'.,,: : ,,';t=EE, SCHEDULE" :'D~~t,;ipti~h~:;,::,"e' ", : : ,I9tYl ~~~t I New residential 1 bathroomll kitchen (inciudes: first 100 fier of water/sewer lines, hose bibs, ice maker, undedloor low-point drains and rain-drain packages) s kitchen $374,00 3 bathroomsll kitchen $439.00 ! Each additiol1,al bathroom (over 3) $95.00 I I Each additional kitchen (over I) $95.00 1 Residential fire sDrinklers (includes plan J'eview) ). 0 to 2;000 square feet $58.00 12,001 to 3,600 squardeet $116,00 I 3,601 to 7,200 square feet $174,00 I 7,201 square reet and greater $232,00 I Manufactured dwelling or prcMfab (circle one) I Comlectionsto building sewer and I I $58 00 I water supply . I CommerC,ial, industrial, and dwellings other than one- or two-family , . I Minimum ree I I $58,00 I I Each fixture $19,00 1 Miscellaneous fees I 100' stann, sewer, water line I Each,fixture, appurtenance, and piping I Storm ,water retention/detention facility Irrigation systems Piping or private storm drainage svstems exceedin2 the first 100 feet ! Specialty fi:>.:,tures ) Reinspectian (no. ofhrs. xJee per hr;) I Special requested inspections (no. of hrs. x fee per hr.)" : I Each additi~nal inspectiqn: (I) $58.00 1;;\ftdi~'aTta~tp'i'piW.lN~j;;~~'. ',1 Minimum fee I Enter value of installation and equipment $ _< I Enter fee based on installation and equipment value. $238,00 $76,00 $19,00 $19,00 $19,00 $19,00 $19,00 $58,00 $58,00 I JA) Enter subtotal of above fees $ (Minimum Permit Fee $58,00) I (E) Investigative fee (equal to [A]) $ I (e) Enter 12%sureharge(.l2x [A+B]) $ 1,(D)Technology Fee (5% of[A]) $ I TOTAL rees and surcharges (A through D): $ Total' cost $ $ I $ I $ I $ I I $ I $ I $ I $ I I $ I I $ I $ I I $ I $ I $ I $ I $ I $ I $ I $ I $ I $ I I $ :1 I I I I I Permitno.': ~ / 225 Fmh St"'t\0;;;i~.m;;SAX(541)726_3689 , , I DateCli- \~ ~CF/ This permit is Issued uuder OAR 918.309.0000, Permits are uontrausferable_ Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days, IK~;,~m[0,CAIB-^~GOVERNMENT?lARRROVAl!hm~~~l!iI!l I Zoning approval verified? 0 Yes 0 No I !~~~J;~~~~::~j~~~:;~~TNR:l~~o~=~;~:! [::~:::ti:I':~:s:::; se~ice iucluded: / $134,00 I $I~.f I Job SIte address: \~\ \" vh ';~tW Yl..OO\,.V tsz~~ritionaI500Sq ft or portIon .3 $ 25,00 I $ ~s.f I City: ~~~-eJc,\ I Slate: ~ I ZIP: I I Limited energy (2) $ 32,00 $ I 1~~~;f~~~~~~~\~T'0N\l:c)FJlwJ~~~~~~'!'#)~!i I J~~71~:"S~~~:~~ ~e~d:r (2)odular $ 63,00 $ I Ml.,\ ('~-h",I('MDVl- ~\~ loe_ I ~e~ices or feeders: installation, alteration, relocation I E",,",," or ....J <>1/1,", Q, I 200 amps or.less (2)' $ 81,00 $ I ~..:~,1}4 ,\ ,~\O~~f>. I ~;;;~"::~Jifd!i!1.o)!I::.;:rr:RRO' 'RER""'!!'O'WN'ERiiii""lGE,0Qtld!,ij',!:l>:ftt'tC1::ffiI, 201 ,to 400 amps (2) $ 95,00 $ I 'S;:L=''''.:M..' "",~~...'__.,..'__4'",,~'&.,__r. "..'--.. .-" .. :lii.lbL _.... '. W%iZ4",';Q"'{0..,,dtL,:.,",,'3Ni;'4W;:X~~ I Name: 8t:fbur =.lant1 tcel Ii I I 401 t.o 600 amps (2) $158,00 $ I IAddres~:II00~rlm~IY1, fHlJ.?.lig I 601 to 1,000 amps (2) $205,00 $ I I City: 1:2.29et'lt", I State: oft. TZIP:974QL Over 1,000 amps or volts (2) $469,00 $ I I Phone:f> J.fj ~ 7'05- ZIY-IlJ. Fax: .' '. Reconnect only (2) $ 63,00 $ I I E-mail: I Temporary services or feeders: installation, alteration, relocation ! This installation is being made on residential or farm property , 200 amps odess (2) I $ 63,00 I $ I owned by me or a member of my immediate family, This 20110400 amps (2) $ I $ I property is not intended for sale, excharige, lease, or rent. OAR 87,00 479,540(1) and 479560(1), 401 to 600 amps (2) I $126,00 $ I Signature: Over 600 amps or 1,000 volts, see services or feeders section above I ,~~~l~jKCONTRJXCiT:OR.iliINS;rAl.!;cAT:ION~,l2~~ Branch circtlits: new, alteration, extension per panel I I Business name: Dm L F- It'..cfri C. J lfla. I a, Fee for branch circuits with purchase of a service or feeder fee: I I Address: q r, / IV IN ~ <)120 J(!.e 'Place I Each branch circuit I $ 6,00 I $ I I city:11J&.kmd . J State: i:2R I ZIP:ctr~ I b. Feefor'branch circuits without purchase ofaservice or feeder fee: I. I Phoneffli-f./lbc'?5IP'tJ I Fax:ff.l1-q2'2,- ?-/!;'12, I First branch circuit (2) I $ 5500 I $ I I E.mail:.1mldeotrlc)nc eJ o"O/,(lj;fY'I I Each additional branch circuit' I $ 6,00 I $ I I CCB license no.: ,~/1J.gLf I BCD license no.: 9'..3 tie. I I Miscellaneo!ls fees: service or feeder not included 1 I Signing supervisor's license DO.: S/OS;>' I I Each pump or irrigation circle (2) I $ 63,00 $ I Print name of signing supervisor: ~l~ ~.,L~ I I Each sign or outline lighting (2) I $ 63,00 $ I Signature of signing supervisor:'" ." . 1 ~ ~ I I Signal circui~ or a limitedMenergy panel, 'I $ 63.00 $ I ~ M; -Jr"" alteration, or extension (2) \J Each additional inspection: (1) r $58.00 $ Electrical Permit Application J ~~ e,lll ~ , ~~6" , <\~~ 440-2584,) (9/08/COM) ~, (A) E~ter subtotal of,above fees I (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (.12 x [A]) , I I (e) Technology Fee (5% of [A]) I I TOT Ai fees and surcharges (A through C): I" :~ $ ~~.:J $ 2.44. SO Mechanical Permit Application ,I' DEPARTMENT USE ONLY I Permitno,: M-{[(f) I Date: f) .f;{Y\ 2?5 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689 \'103'2.'13\ DlW This permit is issued under OAR 918-440-Q050. Permits expire if work is not started within 180 days ofissuan'ce or if work .is suspended for 180 days, , CATEGORY: OFCONSTRUC,TION' ' : .. ,I I:~!;;;' 1 mesidential I D Government 1 D Commercial 1 I;Be~j~~PJi~r',", .. ,'I Qty,l ~~:t i ~~~i~!~slsT~~ti:~~::~~L~~~~N~ (1~?~~~:;~~:IUding ducts and venlts I $7:~O:00 I : I ' ,t'" ' - I I 1 Over lOOk BTUIhr, $20,00 $ SubdiVISion: '" W\C \;.r" ",.. " " Lotno,::" q .' .. I Heaters/stoves/vents I DE:SCRIPTION,OF.:,wORK,;' ,;','", I 1 Unit heater .. I tJ"0 OD"\f\,<:l...,tr\/(I;\k:V)- ~\f'A\e. 1 Wood/pellet/gasstovelflue I ~"\ \~,'(_~~ ,.., ",_. __ '~r--n ,~~ :~,'_,', ,'_. "!''--''t~~)1 ~%~i~~;~~~~aud~tt~:~g~l~~gar~~~~~el r-':, ' ,,', ':.";PROf1ERRi''oWNER',t!;,:,S'" ~t';:,}'{,,;,,,,,,;!, absorptIon system I Name:ArY-~-;\"nY'l()lrp\\ i. I 1 Evaporated cooler I 1 1 Address: \ \'Q) TlC,r\ ~, ~ Th9.. I I Vent fa~ with one duct/appliance vent I 1 c - rc cR ('i 'I I Hood WIth exhaust and duct 1 City: r J~~n." State: , ' ZIP: ~() I ,I Floor furnace including vent 1 1 I Phone::,le-~-2D-f7IFax: I I Gas piping 1 E-mai/; 1 lOne to four outlets I This installation is being made on property owned by me or a 1 Additional outlets (each) 1 1 member of my immediate family, and is exempt from licensing ! Air-handling units, including ducts " requirements under ORS 701.010, 1 Up to 10,000CFM I I $11,00 I $ Signature: lOver] 0,000 CFM $20,00 $ - ... CON'[RAC):OR):II\iS;fA~I!:p.flbN;;,;f,;'\/ I Compressor/absorption system/heat pump I B ' ('t.~ "'" 11LJ. \ '~ 1 Up to 3 hpllOOkBTU 1 $17,00 I $ usmess name:~, \ f'I.-12,*1l1 f1 ~ I I - (I' -' , Up to 15 hp/500k BTU I $29,00 $ Addre~s: I ~ 1-- ~ I;;\fDDl'1" - I Up to 30 hpll,OOO BtU $43,00 I $ 1 City: ~\(\ A I State: r;R.:. ZI. '"=f<j/ 1 Up to 50 hp/l,750 BTU I $57,00 I $ I phonetHl-'-{'2.r.. -~~ Fax:Fi-l1 ?,~-T021 lOver 50 hpll,750 BTU $95,00 $ I ~~mBail~~~~~~r.b~~t~!~~~l~~~le;;~:f';: .. $20,001 $ 1 Print name; =..,.J..4'~~ j........~_ I 'I Entertota.1valuatio,nofmechaniCalSy!'tem I .. ~ /..) ( I and installation costs $- Signature: ~ ~ -.{, - IE" b 'dl . -- - " nter ee ase on va uatlOn ofmechanicaJ-system, ete, $ 1~,M~s~'~),1a.'n,~o.u.s.;~~~s':?~'- .'.~ ,:,IIte~sl ~~:t ~~~~l J Reinspection . 'I I $58.00 $ I Specially requested inspections (per ~r,) $58.00 I $ 1 Regulated equipment (unclassed) $13,00 $ Each additional inspection: (I) $58,001 $ CFEE SCHEDUlE, , $17,00 I $ $38,00 $ $58,00 $13,00 $ $9,00 1 $ $13,00 I $ $58,00 $ $7,00 I $ '$4,00 $ 440,2545,J (I 1 109/COM) I (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) ,[ (B) Investigative fee (equal to [A]) I (C) Enter 12% surcharge (.12x [A+BD I (D) Seismic fee, 1%(.01 x [A]) 1 (E) Technology Fee (5% of[AD 1 TOTAL fees and surcharges (A through E); $ $ $ $ $ $ 1 Total I cost I I 1 I I 1 I I 1 I 1 I I I I I 1 I I 1 I I I 1 I 1 1 I I I I I $ Willamalane Park & Recreation District Job. No, t~"l\YY) SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: \ f fl.u-JL ~1m9- ~)\ Vi Q.JP&>>NE: sq. \. ~/l: ~ ADDRESS:11?'1J,(\\t0~TY ~ STATE:[)t.zIP: ClTIOI LOCATION OF PROPOSED BUILDING SITE: Street Address: \~.....~~' t 0 CQl)\ f\rr~ Plat Name: ~\')\ffi~ Tax Lot Number:, \\03'L1~\()\CcC> 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 = $ f}JJcf:>pJ B, Sinale~Familv Attached NO, OF UNITS X $3,100 per unit = $ C, Multi-Familv Aoariment NO, OF UNITS X $2,641 per unit = $ D, Sinale Room Occuoancv NO, OF UNITS X $1,321 per unit = $ E, Accessorv Dwellina Unit NO, OF UNITS X $1,550 per unit = $ WILLAMALANE SDC $ rJ-006..W , (;Y $, 9J/06 ,W ,~ \51!J1X11 Date $' 2. SDC CREDIT (If applicable) SDC,payer must furnish proof of Willamalane Credit approval.) 3, TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) \ n ~n...-~ C)\f)(')Jl/ ~~ent Services D\Artment , City of Springfield ' 5 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009"01000, COM2009.01000 COM2009.01000 COM2009.01000 COM2009.0 I 000 COM2009.01000 COM2009.0 I 000 COM2009.01000 COM2009.0 I 000 COM2009.01000 C0M2009.0 I 000 COM2009"0 1000 COM2009.01000 COM2009.0 I 000 COM2009.01000 COM2009.01000 COM2009.0 1 000 COM2009.01000 COM2009.01000 COM2009.01000 COM2009.01000 COM2009.0 I 000 COM2009.01000 COM2009.0 I 000 COM2009.0 I 000 COM2009"0 I 000 COM2009.0 I 000 COM2009.0 1 000 COM2009.0 I 000 COM2009.0 I 006 COM2009.0JOOO Payments: Type of Payment Check cReceint 1 RECEIPT #: 3200900000000000534 Description Plan Review/Residential Hourly Addressing Assignment Willamalane Single Family Fire SF Fee ",Residential Sidewalk Pennit ' Curbcut Penn it Curbcut . 2nd Curbcut Stonn Drainage Impervious Area Sanitary Sewer. Reimbursement Sanitary Sewer. Improvement SDC Tran Reimburs.Residential SDC Trans Improvement.Resident SDC.MWMC Reimbursement SDC MWMC Improvement , SDC MWMC Administration SDC Sanitary/Stonn Admin SDC Transportation Admin Plan Review Major. Planning Building Pennit , 2 Baths One or Two Family I st Appliance Vent Fan Exhaust Hoods Dryer Vent Heat Pump Residence Wiring,lOOO Sq Ft Residence Wiring Ea Addtl 500 . Temp Power 200 amps or less Penn Serv/Fdr 200 amps or less +5% Technology Fee + 12%St~te Surcharge City of Springfield Official Receipt DevelopmentServices Department, Public Works Department Date: 07/15/2009 Item Total:, Paid By EQUITY HOME BUILDERS Check Number Authorization Received By Batch Number Number How Received njm Page 1 of 1 3648 In-Person Payment Total: 10:17:42AM Amount Due 104,00 38,00 2,858,00 102,65 88,00 88,00 (45,00) 962,50 636,30 483,84 ,201.54 888,98 97,90 1,009,17 10,00 140,79 73,72 211.00 1,001.79 337,00 79,00 17.00 13,00 9,00 17,00 134,00 75,00 63.00 81.00 108,94 220AI . $10,115,53 Amount Paid $10,115,53 $10,115,53 7/15/2009