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Home My WebLink AboutPermit Building 2009-8-3 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01081 ISSUED: 08/03/2009 APPLIED: 07/2712009 EXPIRES: 02/03/2010 VALUE: $ 180,000.00 ;. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone / 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1979 S 58TH ST ASSESSOR'S PARCEL NO.: 1802033305600 SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPTION: Single family reftilIe!!~~cIM!YI:!}r~~fuIIMW~p.~s you to follow rules adopted bv the Orenon lltilitll '"OlITlCallOn venter. I hose rules are set forth HAYDEN HOMES LLC in OAR 952-001-0010 through OAR 952-001- 2464 SW GLACIER PL STE IIB090. You may obtain copies of the rules by REDMOND OR 97756, calling the center. (Note: the teleohone IIUlllu~r ,ur me uregon Utility Notification ICON~€~@R~M~~ON. Owner: Address: Contractor Type General Electrical Mechanical Plumbing Contractor License HAYDEN ENTERPRISES 92208 TOP, NOTCH ELECTRIC INC 172366 PACIFIC AIR COMFORT INC 39237 STUTZMAN SERVICES INC 31747 Nu flIifiILDING INFORMA nON. ' "I .. THIS PI:RMIT SHALL EXPIRE IF THE WORK I AUTHOR1~l~~J?,~~R THIS PERMIT IS ~I)-,T R-3 COMMEN~~\~~~Bflstru~~W;'mlJ:[1 :Jf\:50' ANY 180 ',I;r.~erJP:J'if# LF"H'celf Ihl~as VB W~ter'l'y~eP. ' Gas Range Type: Electric Energy Path: Sprinkled Building: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 3 n/a I DEVELOPMENT INFORMA nON . Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 18.00 19.00 5.00 23.36 0.00 2 Yes 19.26 , Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS I Fullv Improved Yes Storm water to curb via weep hole Sidewalk Type: Downspouts/Drains: Curbside '7' Curb and Gutter Notes: Pa!!e I of 4 New Residential Expiration Date 07/29/201l 09/29/2010 03/25/2010 05!l2l2010 Phone 541-228-1081 541-317-1998 541-672-9510, 541-928-8942 Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 5,353 1,031 400 REQUIRED PARKING Total: Handicapped: Compact: 2 Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Bid Amount Use Bid Amouut Fee Description' + 12% State Surcharge + 5% Technology Fee 1st Appliance 2 Baths One or Two Family Addressing Assignment Appliance Vent Building Permit Credit - Trans Improv SDC Curbcut Permit Dryer Vent Exhaust Hoods Fire SF Fee - Residential Gas Outlets 1-4 Plan Review Major - Planning Plan Review Same As PW Disc - 2nd Permit Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMCImprovement SDC MWMC Reimbnrsement 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 WiIlamalane Single Family Total Amonnt Paid I Valu~ti~n Descr!!lti~~ , $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 180,000.00 Amount Paid $208.48 $104.72 $79.00 $337.00 $38.00 $9.00 $1,034.35 $-931.65 $88.00 $9.00 $13.00 $71.55 $7.00 $211.00 $250.00 $-30.00 $134.00 $25.00 $507.07 $666.84 $10.00 $1,146.50 $101.97 $136.24 $211.21 $931.65 $80.52 $88.00 $759.99 $63.00 $27.00 $2,858.00 $9,245.44 Total Value of Project fpp~,r"W Date Paid 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3109 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3109 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 8/3/09 Pa!!e 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01081 ISSUED: 08/0312009 APPLIED: 07/2712009 EXPIRES: 02/03/2010 VALUE: $ 180,000.00 Value Date Calculated $180,000.00 , $180,000.00 07/27/2009 Receipt Number 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 2200900000000000868 CITY OF SPRIr~ul'mLD , Building/Combination Permit Status Iss u ed PERMIT NO: COM2009-01081 ISSUED: 08/0312009 'APPLIED: 07/2712009 EXPIRES: 02/03/2010 VALUE: $ 180,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Planoi"!! Review 07/27/2009 I Plan Reviews I 07/27/2009 APP DDK Access restricted to I driveway/lot. Follow street tree plan. As noted on plans / review letter Structural Review 07/27/2009 07/27/2009 APP CJC Public Works Review 07/27/2009 07/28/2009 APP LKW Storm water to curb via weep hole. 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. Rr~1 f",nections I Site Inspection: To be made after excavation bnt prior to setting forms. 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 conjnnction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placeOle~t. 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 bave been approved.. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underground Plumbing: Prior to filling the trench and including required testing, Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Undertloor Plnmbing: Prior to insulation or decking. Undertloor 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 tilling trench and including required testing. Storm Sewer Line: Prior to filling trench. Pa!!e 3 of 4 CITY OF SPRINGFIELD Building/Combination Permit Sta~us Issued PERMIT NO: COM2009-01081 ISSUED: 08/0312009 APPLIED: 07/27/2009 EXPIRES: 02/03/2010 VALUE: $ 180,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Cas: After line is in~talled 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 ~n 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. Rougb Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Masonry: Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Curbcut - Standard: After forms are erected but prior to placement of concrete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. 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 Springtield 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 aud 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. n~ ---- // ,~ "" 4" -4/1'/ Ow;;;': o~ Co~S(gna~ure - U g--~ -O,,/- Date Pa!!e 4 of 4 .sAM 6 As S7C> C( frI ,'....er.J Structural Permit Application - 22S Fifth Street.. Springfield, OR 97477 .. PH(54 1)726-3753 .. F!-\X(541)n6-3~89 SPRINGFIELD :';y,='i:~: " "~""z.f~~iM~~J .-~ . '>"AJI ~ ;:!i:R~~~~~M~~fu;lli~g~8fi~'Y'f1 COf,/fU>O?- c), 0 &1 Pennit no.: I Date 7-Z7-0 cy This permit is issued .under OAR 9] 8-460-0030. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. ' l~i!4:~~~[fc[~_i%~:QM~B:~'&t~N.J~f~,f?gB1ir~:~~t$~i~~~~~y;W[@! 112~:~~e~:::: ::~I:~:::::pprovaL Date li~=:=:i~~il~i~~~~~~~i=iti~ii:;] Signature: Date:! (a) Joh description: I Zoning approval verified: ~ Yes 0 No I Occupancy l~, :~~~:;.~s;~~~~,~~,O::,~.I'~:~'''~'''{~~''_'~'~~'_'''''~'ifF"'i"") I Construction type. ~~~~4~~$f1~~~~~~<R~llE.<@~J:tY~lQJf~~i;fg~~ili.R!LC?Jl.IJP.J:.Jj}:~.r~N~f~~t~~Jl1{~U~~Jl{~~ I Square' feet: ~ Residential j 0 Government ,I D Commercial _ I C ost per ~quare foot: ![.~~(GJt{~lmg~~FJf~M~fiQEfRA:MQi]:!ff<&~]WQrlIf&,1't~,{~t~~t1 I Other iqformation: Joh'site address: 1'179..s !!1>1 sf ,I I Type oCHeat; 6.....- ~r..A 1.1:... I City: ,(....,...r~..!J. I State: oR. I ZIP:'l"l<r71 I I Energy Path; i! A 1 SubdivisIon: ];.'\;>0<' 1'ftrqd0000C I Lot no,: '~o'J I I ~new 0 alteration 0 addition l~illBt~~~~~~~iE.iii~~:~g~isi*~~[i ;:;';;E1 I (b) Foundation-only penn it? 0 Yes 0 No ::;r:ss fhJ;~~~:-'6~"("'~ It :;;%;'i~il~~~it~~fl~?l!l'~~{~r~f:~r~{)rtiY;:iT~~\]R~lJ1\~~~i~~ I (a) Permit fee (use valuation table): $ I City: {...I"""",l State: ap' I ZIP: 'in,-G, I I (b) Investigativefee (equal to [2a]): $'" Phone:,..lt -"2&-~3.5 Fax:5'f1 -7</t- .257.1. I I (c) Reinspection ($ per hour): E-mail: (number ofh.ours x fee per hour) $ " This installation is being made on residential or farm property owned by I (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ I me or a member of my immediate family, and is exempt from licensing , requirements under ORS 701,010. 1~~~;~;;;;~;;~~;~~~;Ji~ntr~~~~~~~~~~i Sign here: , ~'(~);7;;::;;;'('~"~~"p;:~:~~~"['~:]-)'-;~~' '~Wf';1EZS--61- 121i1f_~~WNim~K~tLQ7iwI~~ft~~.~~iIGm'~~~~tI~ll~~~~f~; I (b) Fire and life safety (40% x permit fee [2a]): $ I Subtotal of fees above (3a and 3b): 1 Business name: I Address: I City: I Phone: 1 E-mail: I CCB license no.: I Print name: 1 Signature: QlA.I.....~r I State' Fax: I ZIP: I (a) Seismic fee, 1% (.01 x pennit.fee [2a]): I $ I TOTAL fees and surc"harges (2e+3c+4a): I $ 1ri>~~'ff.:~\\\1!!t~:[![F;ll.@\j'tiImM9J1Q811@QBM&]E[~jJ:~fllt~)~,~\i!i:ll I Name CCB License Number Phone Number I [Electrical n.;l'l~ 'I'/\-q<n-.;IO")") I I Plumhing 1.Q'l2 NI - '7LI- 7~O I I Mechanicat 3".;1'31 $</,- J'a .53'" I SPRINGFIELD _.-,.,.".....' li'" AA_""i"""" ~1:t~~ i':W,.if1\l.,., ~, .,'h,,,.f!,~;:\;,~',.~.". ~'I ZON INlTIALS DATE SOURCE , , 225 FIFTH STIlEET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 I ,'I ELECTRICAL PERMIT APPLICATION City Job Number co~ LoC> f - 6 (0 l5 f , '" , , "" """"'"'''' I"".,..., '~'iJlW'l'.1!"-"','" 'v~I~~m"'!ll1c~:r:~~g-~,~,el'H'i:m,t,ilJ"J!r.J'i~'11],,""H,;S"1E1j,Ir,':~:iJo',''t';i'''r'?';:;;,i':L,~~d:~r,,'', ;;;:f';,t_.,~ 1'~' t@~:HJ[@l'WWi?WJ:&;;sm~i]::T01'Vi::t~~\i:.~~f~~_I~j!/ . i ,}I1.\i.I~~;!!"Jl~'!dtlfi!li~jiii,,'!.1:t"~' r:a;.":~~~%'E:'li~;;lo14'~:;'I.:ilM~~:!li!cli:~~f;~\i!,!';1J~ili1'i~i.'Ei4:l!:i' /q7~.5 SS f+'"\: I LEGAL DESCRIPTION:! I / go 2 ():s:. >:5: 0 s-t1oo JOB DES, CRIPTIO N: ~', ~ 1000 sq. It or less " /: , _ ( Each addltlOnal 500 sq, ft, or $( 'Vf / r- "'^, ~ portion thereof Permits are non-transfe~able and e4ire ifwo~k is Ead, Manufact'd Home or, not started within 180 d~ys of issuance orif w6rk is Modular Dwelling Service or m_.'___ _ -Suspended,fo<,180_da)'s..'.. __'- n__ __ __ _ _ _J_ ___ __Ee.e,deJ:_ I I 'Ii~'wr~_~,~ i.;~1fIj '~I,lal.::l~", );\t..'I:!l'WNr'If,JilOl.j;;;,"~~t~ t~~~~j,llt~, 'tr,'~': l1t,~~(~t:lj;"'.l~f1~~'! !'i&@"'7iIj11?1l\\~' . I 001 "'mIl\wr6)NM"~~\ 2. It;~~~t.~~a~"~',1 .".t,'"" ;""~~~'J:t{t.aitii!,;~"~.~ Electrical Contractor t;,'*'))~ !ci') .r-!C(' I Address ;;2087''11} ~A (,+ ! ( I ' "none Jo/l--:Jti?79'J3 CIty n I ,(j~1 Supervisor License Number '-I O)~ '7 S Expiration Date i ~ '7 Constr, Contr. Number' n 2 -:,."G:. "~7, Expiratiou Date I I Signal Te of Superv,isingl;Electrician ~i Owners Name /f" ~ __.L -1__;; I r-'.... --, -j Address ;-' ~ TJ Phone -.--..1.--- City / ""I OWNER'INSTALloA-TION '-The installation is being )Dade onpropei01oWD~whlch--" is not intended for sale] l~ase or rent. Owners Signature: Inspection R,equest: 726-3769 ! Date 7;2~, 1 J"~)',,"',r<,::.t,N':1!:;:;;w,"''''m,\1~~wr'i/,=~'9i:gv.;s>!''c~~m;}<.Ar~.w;;.p.:a:e~p.t:''1t=f.ljP;~';'ijil;!~~~'''''''';"fl!llffl.;i!l~,"'{J~J 3. ~~~~~~B~~!~J[.M4~!R'1~!111[~~~;~lfj1~1t~~~~i~r~ I ~\~1~'~"1. ~:?r~~i~~m!r' TIJf,i~~'~I,\;,:!i!]e~~I,,;..~~;]1t;it,}ln~w:~;;~'~~m~:Ul;:;~{ii1i')it"t.~';~'~~ A. ,~,,,e, ';!}eSluemla1!4"S,ng elUr"",u ti"J';aPl)I").n'e"'u,we",!!'g':Un)",~k 1~~;t~1'[;df4iBtil';i~(i;!l'~1iil\;,'l:likojft,\lj;;;;'1'.:.I)I...di:~"t~~,'ii,#;,'..",c,~..,:Ji~'Mi:,:;1:l..,i)"!:ti1i~d",,,,"'-~"'L~~) I Service Included $117.00 $ 2 1.00 $55,00 - , , I'"!'''~.'''~''''I'~''"~''. -~!'~."-"""'~""Il' '-"~""'-'''''''"'''''--'-''''-l''''''''''" B l~.IS'<<,';~iA~:t7,~'I:'~Jik:(~~~Ji~I,. ,ljiMiW~It),lll'"" ~';;!tj".fUI'"~fi~rli\j~il~; , ~'11}i\;,t14l ''im'''J~',li.l1.t~~\Ji~.ij'f!.jl;''%l]';:\<ff~'tr-;:'\';';~,tWt~'!' . !;.Ii: ..'elt"'m!es'~OFljJ:l~ee e.r.,s,1~:ns.a. 'On'.'l ,,' tera:, O.llS~Or,' :e ocn JOmi'r! ~.iW;0}J.l't1l<<ii.~.U:!"','>,;::~il'~'JfM~'t:i~'W!i~);l.:f.r~~'1i~;;'."~ n,.C\;>,Nl~..J;iI:j) ":'t(,,-,..p\:t~~ .,~~~ti;w:!J.WS~\,' 200 Amps or less 201 Amps to 400 Amps AOI Amps to 600 Amps 60 I Amps to 1000 Amps vvor 100o-AIDpSN01LS Reconnect Only " $ 70.00 $ 83,00 $138.00 $180,00 $413:0v $ 55,00 c' mwt~~~~~j!~~~~Jt;Jot~~~~~d~~e~~~I~m~~Li~~~r~~t~f*~1I!~i~~~~ir~ . ~~U~l!!:i,~!6~J~~~;m~~......-0~~~...(.,~i~:~1~[ljII,jl~!'lJl;lJ,,\ii\~~ki~il;"io1~{M,~t,~,,;'''\:~jlli!';<'''ft ~@ .~! Installa'tion, Alteration or Relocation 200 Amps or less 20] Amps to 400 Amps 40] Amps to 600 Amps $ 55,00 ' "'$ 76.00 $110,00 Over 600 Amps or ] 000 Volls 'see "B" above..., D rm~~~~1}1W~llljl,~1~g~1~1~1nl~.,~wmr:i;N~~~~'l~TI0f1~~~~~~',~~?,;1:';?';;~I:~W(?''fI,\~,~\..~;~;; . b~R!t"..h~!~~'U}"'~tJ~!~mw.1It::~M~IM.~;~~~il\,;~~~:f~m~J~t~1J}i}t~~,)i1&~~~~7~!~f,': ~,\1;,'l~J:~i\\~rm~r:f;~t New Alteration or Extension,Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 48.00 $ 4,00 E '~El'~,li[15ilifl'~i~I:~}.~!'"~:i!i""!G'~;t!!1?~)'!!,)""!l'l'N~~'~""'It,&~ij!j."'d'. .:~;iWJ'~~li1'i1l~I;' 'fl'lil.lJ;'lfW,', ",!lJl,"':!!1~~ '. "i, 'JS<<~I", ~,o ,,,,,,~,,,,!ce,Jee~~r:~o 'm'c:JU"eu;,!'!! "ac" Ilstliuatio.' ',.. 9~":'>! ~'W!!l!;.;;l!JiI, '$:,,",,;.,{I,.1(tl.,o\1EI"";:~ ;:1;;,,,, !~i:::~!tr~Ii:j~jl.,f:Wlti~l;ttiSat~. "''''~\''''''''''!''~ "-I :"Pump or irrigation $ 55.00 SignlOutiine Lighting $ 55.00 Limited'EnergylResidential'''' , $,28:00 ....., "'Tirmteo tmergy/CommerC13I-"---'- ~ 5U.UU Minimum Electric Permit Inspection Fee is $50.00 + Surcharges " ~'~~m'~l!1I~:!:I!~i!!"k.Il" il\'lJl,'i~lim"', "."I~""III""""I" ";j'''''','"~~, ""I1ill1l.' ~B: 4. ~:e,(!J.~' ~tl); '~J(:z' .'~@" ,'~~~~~~rJlq;~~\;1!'I!il,~~';;i~'Mi:'1:; ~~'W'J!'" ,.1,1, '~U~clJm~'il" rl~~~1i~,~\\:~,r~!J,~~.; l'~lJfr...~~,ffi:;$}j - 12% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive(T:)/Building 'formslEleclrical Permit Application I-08.doc Job. No._t!1-/0o( SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: I1'~A/ ~hT . PHONE: ;J.:J.T 6.'?:Jr ADDRESS: 2W,~ c;(.Aqt:-/l lIIOfTY .;2.1:>"""" b ST A TEO~ZIP: ma. LOCATION OF'PROPOSED BUILDING SITE: Street Address: 1',.,9 cS. ~tt... Plat Name: Tax Lot Number:(.fa.2. (U3,J ~"OO 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) .. A. Sinale-Familv Detached ,NO. OF UNITS I X $2,858 per unit = $ ZfSi B: Sinale-Familv Attachii'd 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 $1,550 per unit =. '$ WILLAMALANE SDC $ ?Y>5t6.~ 0' 2. SDC CREDIT (If applicable) SDC payer must fumish proof of Willamalane Credit approval.) $ 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) $ ).I$"o- 7 /.:z.T /~., Date ~ Development Services Department City of Springfield 5 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-0 I OSI COM2009-010SI COM2009-0 I OSI COM2009-0 1 OSI COM2009-0 I OSI COM2009-0 I OSI COM2009-0 I OSI COM2009-010S1 COM2009"0 1 OSI COM2009-0 I OSI COM2009-0 I OS I COM2009-0 I OSI COM2009-010S1 COM2009-010S1 COM2009-0 10SI COM2009-010S1 COM2009-0 I OSI COM2009-0 I OSI COM2009-010S1 COM2009-010S1 COM2009-010S1 COM2009-0 I OSI COM2009-010S1 COM2009-010S1 COM2009-0 I OSI COM2009-0 I OSI COM2009-0 I OSI COM2009-010S1 COM2009-0 I OSI COM2009-0 10Sl COM2009-0 I OSI COM2009-0 IOSI Payments: Type of Payment CreditCard cReceintl RECEIPT #: Date: 08/0312009 2200900000000000868 Description Plan Review Major - Planning Addressing Assignment Willamalane Single Family 2 Baths One or Two Family 1st Appliance Vent Fan Appliance Vent Exhaust Hoods Dryer Ven! Gas Outlets 1-4 Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Fire SF Fee - Residential Sidewalk Pennit Curbcut Penn it PW Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Tran Reimburs-Residential SDC Trans Improvement-Resident Credit - Trans lmprov SDC SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Stonn Admin SDC Transportation Admin + 5% Technology Fee + 12% State Surcharge Plan Review Same As Building Penn it Paid By TIM DRlELlNG Item Total: Check Number Authorization Received By Batch Number Number How Received cjc 0449S6 In Person Payment Total: Page I of I 2:19:00PM Amount Due 211.00 3S,OO 2,S5S,OO 337,00 79,00 27.00 9,00 13,00 9.00 7,00 134.00 25,00. 63,00 71.55 SS,OO SS,OO (30,00) 759,99 666,S4 507,07 211.21 931,65 (931.65) 101.97 1,146.50 10,00 136.24 SO,52 104,72 20S.4S 250,00 1,034.35 $9,245.44 Amount Paid $9,245.44 $9,245.44 S/3/2009