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Home My WebLink AboutPermit Building 2009-7-24 Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01056 ISSUED: 07/24/2009' APPLIED:- 07/22/2009 EXPIRES: 01/24/2010 VALUE: $ 186,969.00 SITE ADDRESS: . 1243 W Quinalt St ASSESSOR'S PARCEL NO.: . 1703273107200 Springfield TYPE OF WORK: Single Family Residence PROJECT DESCRIPTION: New Single Family Dwelling TYPE OF USE: New Residential Owner: NORTHWEST BANK Address: 4900 MEADOWS RD STE 410 LAKE OSWEGO OR 97035 Contractor Type Electrical Mechanical Plumbing I CONTRACTOR INFORMA~ION I Contractor DML ELECTRIC, INC . CROWN HEATING LLC NW MECHANICAL, LLC I BUILDING INFORMATION I 18.30 . Overlay Dist: 5.00 # Street Trees Rqd: 1 5.00 ATTE Paved Drive Rqd: Yes 36.75 NT/O}J:ofllmMi'PYWM" 37.00 o.OQ!ollow rUles adopted b" CJUlres you 10 Noll II calia!, r;on'M ~', Y Ihe Oreqon Ill/HI" ~b~;( filiDieJINUlr.i@y~~~~I_lorih I' -'J -~'''ll/ cople I 001-. F I..~f l/np Iha cenler (N I . so Ihe rule$ibY'walk Type: u mJlW8~PJllr th O' 0 e. Ihe lelephon . c'e\i'1 e. regon Utility NOlil/cali flownspouts/Drains: Storm water to curb Via Wle/fu;lt@00'332.2344). on # of Units: Primary Occupancy Group: Secondary Occupancy Gronp: Primary Construction Type Secondary Construction Type: # of Bedrooms: Fmntyard Setback: Side 1 Setback: Side 2 Setback: RearYard Setback: Solar Setbacks: Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: Notes: License 161"264 171074 I\~OTlCE: # of Stories: I Ri3!IS PERMllIW~t'l!'~la'fl!;'/!,f, THE vyd~1F AUTHORIZEltg1f~~fl:\is PERrvme~S'I{~s ~~MMENCEq:a1iJ~~NDONED FOR G A~Y 180 DAYER~~th: as Sprinkled Building:' No I DEVELOPMENT INFORMATION I ) Pa2e I of4 Expiration Date 08/27/2010 07/1112010 Phone 541-923-9897 541-420-3307 Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 1,763 431 REQUIRED PARKING 2 Total: Handicapped: Compact: Curbside 7' Curb and Gutter Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-0I056 ISSUED: 07/24/2009 APPLIED: 07/22/2009 EXPIRES: 01124/2010 VALUE: $ 186,969.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Gara!!e/Misc SFlDuplex U VB Utility R-3 VB_I&2 Familv $ Per Sq Ft or multiplier $37.72 $96.83 Square Footage or Bid Amount 431.00 1,763.00 Value Date Calculated Description Tvpe of Construction Total Value of Project $16,257.32 $170,711.29. $ I 86,968.61 07/22/2009 07/22/2009 I " ':p~~ Pqi~ I Fee Description Amount Paid Date Paid ReceiptNumber Total Amount Paid $0.00 I Plan Reviews I Plannint! Review 07/22/2009 07/22/2009 APP DDK Approved as shown on plans. Minimum setbacks - inspector to verify at time of footing inspection. Pnblic Works Review 07/22/2009 07/22/2009 APP LKW Storm water to curb via weep hole Structural Review 07/22/2009 07/22/2009 WE KLK I) Engineering, 2) Easment Issue Structural Review 07/23/2009 07/23/2009 APP KLK To Request an inspection caIJ 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. L.Re(]lIire<Ur~n';~!)f}~ Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer 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 placement. Post and Beam: Prior to floor 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. Pa!!e 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-01056 ISSUED: 07/24/2009 APPLIED: 07/22/2009 EXPIRES: 01124/2010 VALUE: $ 186,969.00 225 Fifth Street, Springfield, OR 541'726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Ceiling Insulation: Prior to cover. Roof Sheathing Drywall: Prior to taping. Hold Downs Installed: Special Inspection performed prior to placement of concrete. ProvideTeport to City Building Inspector. Final Building: After aU required inspections have been requested and approved and the building is complete. Underground Plumbing: Prior to tilling the trench and including required testing. Undertloor Plumbing: Prior to insulation or decking. Undert100r Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. 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. Final Plumbing: When all plumbing work is complete. U ndertloor Mechanical. Prior to insulation or decking and including required testing. Undertloor.Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. 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 inspection in conjuctionwith footing and/or foundation inspection. Rough Electric: Prior to Cover Electric Service: Approval required 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. Cnrbcnt - Standard: After forms are erected but prior to placement of concrete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. - Paee 3 of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01056 ISSUED: 07/24/2009 APPLIED: 07/22/2009 EXPIRES: 01/24/2010 VALUE: $ 186,969.00 By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 further certify that any and all work performed shall be doue 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. 1 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. -Lv~ owrr Contractors Signature Page 4 of4 7 h-4/0 q Date I . ~ , . Structural Permit Application - 225'Fifth Street. Springfield, OR 97477 .-PH(541)726:3753. FAX(54 1)726-3689 I', ~~~,,~_n__ '-~~~-'-~" ',. -," 'I li;'i'2~~~~:r:rl!w~:r~l,I~~;q~t:l~y;',; P~rmit no-C? - / t)Jl, 1 Date: ?b$../~7 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of i(suanc~ or if work is suspended for 180 days. I ~~:ld~~~~;i~~:~'GQ'~e;4~:G~QY~RNr~~f~~JE4p~PRQVA'l3}I~t~~d~c;~ry~~ I This project has final hrnd.use approval. . Signature: Date: IThiS proj~ct has DEQ_approval. ,Signature: Date: 'J Zoning approval verified: 0 Yes 0 No I Property is within flood plain: 0 Yes D No I (aJ Job description: NIVV I r F t> I Occupancy pj /A I Construction typl: vB I Square feet: /'1(,3 /4"31 c.~ ~Residcnt!al r 0 Government I 0 CommercIal I I Cost per square foot: ' I ~1~~rr"'i1i!;JOB'" ~JTE;IN!ORMATfoN~"AND' Ud~AiION kii::::\,~1 I _ Other 41fonnation: I ~~ys~;e~sS:G~";~ ~; II II Type of Heat: 'F:.A . ~ptS ~ .., - - I .... Energy Path: S- Subdivision: I'\Q t I Lot no_: \,p . . I I 0 new 0 alteration 0 addition I I Reference L'70'i ~'ltlaxlot:"?~,,e;j 117~1'-Y';;';-Li' ,;~;~':lf~R6ifER.~;r<ilW~.i~R;i:,~~K~5,~~~~i~;Ii;;iJ1!1 I (b) Foundation-only pennit? 0 Yes 0 No I I NamcA\\~o. \1'(vv\eY'I-~V\ I Iv~:ta.I~~~u~~~~~_:0y_(~~,.t~~9["t~Y-1~.. ...... II ! ~~:~~~~~::r~~:~ ~ _ I ZIP~' :K~;:::;:::~i~~s~:~:::~::~~~~'::~~~~~'::tll~~-;:":"~~",,,;,}: I (c) Reinspection ($ per hour): I I I E-mail: . I (number of hours x fee per hour) $ This installation is being made on residential or fann property owned by I (d) Enter 12%surcharge'(.12 x [2a+2~+2c]): I $ I me or a member o(my immediate family, and is exempt from licensing requirements under ORS 701.010. I (e) Subtotal of fees above (2a through 2d): I $ I Sign here: (a) Plan review (65% x pennit fee [2a]): I (b) Fire and life safety (40% x pennit fee [2a]): I (c) Subtotal of fees above (3a and 3b): I: ., I BUSinessnamc:~AU~l( ~~b~F:LLC: I I Address: ~ \ ~ k ~ 1 ~:4- 5-.tC", \ I City: ~ r State: I~ I Z[P~ '=R'o\ I -, 0" - I Phone:~ 1_ 2.8Z.-C@b~ Fax: EHf _ 3~z,-1'5i.6 (aJ SelSmlC fee, 1 Yo (.01 x pennlt fee [2a]): I E-mail: o..lY\.I ~ i+-y ~ hetrlhroc.d band.a ~ TOTAL fees and surcharg.. (20+3c+4a): $ I CCB license 110_: \ -=rta D\ ~ ,I Print name: ~ - I . ^ Signature: $ $ fA .,- fds:r M (?ff) ~2e - 7883 ~ . _ <' __ _ n r~~li~!:=;\~!~.g~~B ~~;~~:~;r~IMA!~~n:~~~:~~~: I Electrical I Plumbing I Mechanical jlo\l..1ll4 I ~lo Vt-:r ~ 1rJ.l1-<.t!aO-. 15<..11--z,if';- I5'-1J- - c.v ,.rrJrc:.--r Mechanical Permit A.~plication I Permit no.: 0"" /a>~ I Date ~.2./"" 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. E-mail: I - I l_zIP:4=1V~ I This installation is being made on property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010_ Signature: . 1~.ILY:c:QiliilM:'c::f~]t1!fIN~j]e:~mlg8lJllllI~1 I Business name: C'rtJL.){J fjeullM, Ltc I I Address 189=1- A}f; ~~ ~tJ I City: ~ 1 State: tJ 72 j-zIP: Cf:r1QJJ PhonKLlf-Zlzo__'3,t'Ff j Fax~/~~~6 -7ifzJ l I E-mail-L!.r{L)J1h~/1f~/)p~dh~~1 I CCB license no_:/'9- /0 I I Print name:~ Sl:-.e,p~ 0. ~.e.v'\ I I Signature~-f?h--;J: I 440-2545.1 (11I08/COM) I First Appliance I !Furnace/burner including ducts and vents 1 Up to lOOk BTU/hr. I I $17_00 I S lover lOOk BTUlhr. $20.00 $ I Heaters/stoves/vents Unit heater $17_00 $ Wood/pellet/gas. stove/flue $38_00 $ Repair/alter/add to heatingappliancel refrigerationuilit or cooling system! $58_00 $ absorption syste!ll I Evaporated cooler. 1 $13.00 1 S I I Vent fan with one duct/appliance vent I $9_001 $ I I Hood with exhaust and duct I $13.00 1 $ 1 I Floor furnace including vent $58_00 I $ 1 I Gas piping 1 lOne to four outlets " I I $7_001 $ I Additional outlets (each) $4.001 $ 1 I Air-handling units, including ducts I 1 Up to 10,000 CFM 1 I $11_00 I $ I lOver-! 0,000 CFM 1 $20_00 $ 1 I Compressor/absorption system/heat pump I 1 Up to 3 hp/l OOk BTU I $17.00 S I Up to 15 hp/500k BTU 1 $29_00 $ 1 1 Up to' 30 hp/l ,000 BTU 1- $43.00 $ 1 1 Up to 50 hp/I, 750 BTU 1 $57_00 S 1 lOver 50 hpll, 750 BTU I $95_00 $ I Incinerators J Domestic inCinera,tor $ J Enter total v~luation of mechanical system and installation costs $_ Enter fee "based on valuation of mechanical system,. etc. I Reinspection I Specially requested inspections (per hr.) I Regulated equipment (unclassed) I Each additional inspection: (1) I (A) Enter su~total of above fees (or enter set miriimum fee of $ 79.00\ $ I (B) Investigative fee (equal to [A]) $ 1 (C) Enter 12% surcharge (.12 x [A+B]) $ 1 (D) Seismic fee, 1% (.01 x [A]) $ 1 (E) Technology Fee (5% of[A]) $ I TOTAL fees and surcharges (A through E): $ , - -.-- -::..:!. -0 , Electrical Permit AplYlication I Permit no_tJ 7- lOS' I Date: rj /:t '2.-1 () 5 I , 225 Fifth Streett Springfield, OR 97477. PH(541)726-3753+ FAX(541)726-3689 This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 17:~;:~~~~:fv~;:~~iERNM~~~e~~b~g;:r..1 f=:;~~tE~'~~~~~::~:;tRQY~0~0::~::~~1 : ~~~:::ti~I,:,~:s:~~; service included: fli~030ajJ$lmE~.INIi0RI'/IAmlC:'>NJ[j,\~Djl.f0Cj,\jTlC:'>.N.-lii1lll! 1..L JII Each additional 500 sq. ft. or portion $ 25_00 $ Job site address: I 7T lie thereof i~~tL~1t~~~S~~~"~:;;1i2J~K~~~~!W.1Ill~ I ~~~~:;::~;%~~~; Pe~dl:r(~)odular : ::::: : , u \ I'J ~ a . ,)/t:A,(p I Services or feeders: installation, alteration, relocation 1 .'fIJfe y- 1 200 amps or less (2) $ 81.00 $ ..il'''"''~ROI'!E~'I'M'!0''ii:IE~.Hl1'''iB"Jjfuj!fu'il''ml!lli1Wllffiffi'' 1 201 to 400 amps (2) $ 95_00 $ "" 41ilii2k.:A_, , """M '" _,_,,,\W,.;J',J'J'I!,,,.._._10fagmlliW);.iJiiM,,,.,8i!!2!ih.,9lIfkYJilifi I Name: aLt<~_ta t. \c.M.c.l'2::...EaVf611 I 401 to 600 amps (2) $158_00 $ 1 Address: ilL/52 _ \.p'Ii('C, I 601 to 1,000 amps (2) $205_00 $ I l '~ /9 Af"D 1 c.~U7.l:) 1 Over 1,000 amps or volts (2) $469.00 $ City: (i , f/(1. State: U IL ZIP: ,. 7"1 l.Q I Phone: Lf I 2. -5idl./ I Fax: 1 Reconnect only (2) $ 63.00 $ I E~mail: I I Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or farm property 1 200 amps or less (2) I $ 63.00 $ owned by me or a member of my immediate family_ This .1.201 to 400 amps (2) 1 $ 87_00 $ property is not 'intended for sale, exchange, lease, or rent. OAR. 479.540(1) and 479.560(1). I 401 to 600 amps (2) 1 $126.00 $ ~;~qC:'>NjTR;6;qi(O~iJfINSMI2~mI0NJ!~~f!llllfEl~1 : ~:::::~i:::i:S~rn~:~~I~::::;::e e:~::i:sn :::;:::1 section above I I B.llSineSSi1am~e. ~lnc.. 1 I a_Feeforhranchcircuitswithpurchaseofaserviceorfeederfee: I I Address:Lflt ~ ~_---C-- _'f1~ I I Eachhranch circuit I $ 6_00 I $ I City:" ~( State: tIi2-: I ZIP:q Rfjl; I b. Fee for branch circuits without purchas,e of a service or feeder fee: I ~ fh- ~1'.?,g I Fax:~ - qZ'!, -~::i( y'i I First branch circuit (2) . I I $ 5500 I $ 1 IE-mail:dIlALp!eelrlt-int>,tlII.HoL.CoJv\--- - I I Each additional branch circuit I 5; 6.001$ 1 CCB lic~BCD license no.:. ) Mis_cellaneous fees: service or feeder not included [ Signing supervisor's license no.: &:;/0 C<;. I E?-ch pump or irrigation circle (2) I I $ 63.00 I Print name of signing supervi. sor: I>A R\At.J ~ ",;...S I Each sign or outline lighting (2) $ 63_00 I - f. . '. ~ .... A . I Signal circuit or a limited-energy panel, I SIgnatureo slgnmgsuperVlsor. .\)a.--;. r'~ ~ alteration, or extension (2) $ 63.00 $ V Each additional inspection: (1) $58.00 $ $134.00 I (A) Enter subtotal of above fees $ (Minimum Permit Fee $58.00) 1 (B) Enter 12% surcharge (.12 x [A]) $ I (C) Technology Fee (5% of[AJ) $ 1 TOTAL rees and surcharges (A through C): S 440-2584-} (9108/COM) $ I I I I I I I 1 I 1 1 1 1 $ $ ( Plumbing Permit Application U'-;P~~AR!MENT_lJSE ONLY. I Permit Q.Y\" \O~\.9 I Date: 225 Fifth Stre;t . Springfield, OR97477 . PH(541 )726~3753 . FAX(54] )726-3689 This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire jf work is not started within 180 days of issuance or if work is suspf.llded for.] 80 days. 1 LOCAL! _GbVERNMENT--MPROVAL-,:\~' - ,<-_,;;:1 1": ,to; ;-;;_.::',,:;;J-_:;\"FEE'SCHEDULE:: I Zoning approval verified? DYes D No Ibesc~i.pjiOri~;:;~;IQti.1 <;,~~'- I I Sanitation approval verified? DYes 0 No I New residential I CATEGORY>,OF/CONSIRUCTION _c>(: I bathroom/l kitchen (includes:flrst I ....A.-. I I JOO/eel a/water/sewer lines, hose L>>'Kesidenti~1 . 0 Government 0 Commercial bibs, ice maker, under floor low-point 1 ',-JOB"SITE:-'INFORMATION,AND"'LoCATION '..'1 drains and rain-drain packages) Job site address: _,I1...'-t3.J.Je.st- ~() lYltL I f-jff'(j 12 bathrooms/l kitchen $374.00 CitylS",)r"i'~~{~1 State: ~ I ZIP: I 13 bathroomsll kitchen $439.00 I Each additional bathroom (over 3) $95.00 I i SUb~:~io~':~~~~1~2~N::Q~CW~~~~~~;;:~~".,~;:",~I' : ~::~d:~~:~;;':~ ;~~~:~I~o~e;i~~ludes plan reV1ieW)$95_00 1 Jili'l4lt,+6ttlt!VJ/L<;f(ffPl(Jf)- A!{tJ I IOto2,OOOsquarefeet $58_00 ~~U~ I 12.00Ito3.60Qsqwu-efeet $116_00 i :ame:-;lli(!i~ PRl/orERT;~~~~%~~'-~"" I J ~:~~: :::~~~~e:~:::ter ~~:::~~ tl_____ - J<<Y1 I Manufactured dwelline; or pre-Cab (circle one) I Addre;s:W'5 2 _ ~c.<:;/('t:1 I I Connections to building sewer and I I $58_00 I I City:"i?iJlf1~-fliid I State: 6f?- I ZIP:'1~_ water supply -'f:;----1-!L - I Commercial, industrial, and dwellings other than one- or I Phone::5 I 9/z-Fllll1l Fax: - - two"family - I E-mail: I I Minimum fee I I $58_00 I 1 Each fixture 1 $19_00 This installation is being made an residential or farm property owned by me or a member afmy immediate family, and is ,I Miscellaneous fees exempt from licensing requirements under OAR 918-695-0020. ) 100' stonn, sewer, water line I Signature: I Ea~h fixture, appurtenance; and piping I i Bus;ness na~~NTRAClOR"INSTA/~JN~~~~""':"""'1 : ~~~;:i::~;s:::tion/detention facility : '.. 1 Piping or private- stonil drainage 1 I.A9dress: 4? W'-~t systems exceedin{l. the'first 100 feet I City: - State: tJl ZIP: r~1 1 Specialty fixtures . 1 I r-:1JI-OI - l ,_&:.111 ~- ~ RemspectiOn(no_ofhrs,xfeeperhr.) I Phone:1'7J-, C'.)I5- ~&5:<' Faxuy[ }<"]. -~~ Special requeSted inspections (no_ of - I E-maiinaJm~eMn;(0li1t..1i? J1_'tl. . . ,hrs, x fee per hr) J CCB license no.:/{S&'l~D license n9.: Each a-dditio!1al inspectio~: 0) S58.00 IPlumbinglicens~ no.:. . . I ~-MJdiC-aJ:'~as,phJin-2'tf.-.:~,~:'-' ;:; ~ .:1 Minimum fee I P - t .-.= 9jJ~h I I Enter value of installation and equipment$ . nn name: 16{ // - I. ;- 11. //}/ V~(, 1- I Enter fee based on irystallation and equipment value. Slgnature:\J'-' ~A ~ '/If...... / I . '.il' I' I (A) Enter subtotal of above fee: $ . (Minimum Permit Fee'$58.00) 1 (B) Investigative fee (equal to [A]) I (C) Enter 12% surcharge (.12 x [A+B]) 1 (D)Technology Fee (5%of[A]) 1 TOTAL fees and surcharges (A through D): $238.00 $76_00 $19.00 $19.00 $19.00 $19_00 $19.00 $58_00 $58.00 440-2500-J (llIOB/COM) $ $ $ $ Total' cost $ $ 1 $ 1 $ 1 $ .1 I $ 1 $ I $ I $ 1 I $ I I $ 1 $ 1 I $ 1 $ 1 $ 1 $ I $ 1 $ I $ I $ I $ I $ I I I I I 1 I 1 Willamalane Park & Recreation District Job. No. ~-\l)~llJ f SYS!EM D1VELOPMENT CHARGE WORKSHEET FOR 2009 . NAME: 4\)\\v. \~~ llin.s PHONEEA\ .?9fJ....D?f:P ADDRESS: U~~ N\0 ~~ STATECtZIP: ctlJO\ LOCATION OF PROPOSED BUILDIN~TE: . Street Address: \ Q... L\~ \ l \ l Vl)\ (Y" ~ Plat Name:--.0~\(\l) ~+ - ~ax Lot Number: \.., {)?,~ 'to \ ()\')JY) 1. DEVELOPMENT TYPI; (Check appropriate dwelling(s)_ Dwelling type definitions are on the back_) A. Sinale-Familv Detached. NO. OF UNITS t X $2,858 per unit = $~ 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_ -Sinale Room Occuoancv NO. OF UNITS X$1,321 per unit = $ E Accessorv Dwellino Unit NO_ OF UNITS . - X $1 ,550 per unit = .$ 2. SDC CREDIT (If applicable) SDC payer must furnish proof of Wiliamalane Credit approvaL) $ $ 2.rof'')~ fJ 22)2Io"rP ~. CKl't--'1 WILLAMALANE SDC .3. TOTAL WILLAMALANE NET SDC ASSESSED ~d~forcredit) Development services~ City of Springfield $ .~U Date 5 (}) 2~5 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-0 I 056 COM2009-0 1 056 COM2009-0 I 056 COM2009-0 1 056 COM2009-0 1 056 COM2009-0 I 056 COM2009-0 1 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 1 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 1 056 COM2009-01056 COM2009-0 1056 COM2009-0 1 056 COM2009-0 1 056 COM2009-0/056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-0 I 056 COM2009-01056 COM2009-0 I 056 Payments: Type of Payment Check cReceint 1 Item Total: Check Number Authorization, Received By Batch Number Number How Received RECEIPT #: 2200900000000000841 Description Plan Review Major - Planning Plan Review Residential Building Pennit Addressing Assignment Willamalane Single Family 2 Baths One or Two Family Fixture I st Appliance Venl Fan Exhaust Hoods Dryer Vent Gas OUllets 1-4 Fireplace (Listed) Residence Wiring 1000 Sq Ft Residence W}ring Ea Addtl 500 Temp Power 200 amps or less A Penn Serv/Fdr 200 amps or less (~)~ Fire SF Fee - Residential . \' Sidewalk Pennit Curbcut Penn it PW Disc - 2nd Penn it 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 + 5% Technology Fee + 12% State Surcharge Paid By EQUITY HOME BUILDERS Page I of I 3700 City of Springfield Official Receipt Development Services Department Public Works Department Date: 07/24/2009 9:26:23AM Amount Due 2/1.00 690.85 1,062.84 38.00 2,858.00 337_00 19_00 79_00 36_00 13.00 9.00 7.00 20.00 134.00 75.00 63_00 81.00 109_70 88_00 88.00 (30.00) 1,293.78 753.82 573_20 211.21 931.65 101.97 1,146_50 10.00 174.86 76.25 114.64 232.30 $11,6U9.57 , Amount Paid. In Person Payment Total: $11,609.57 $11,6U9.57 7/24/2009