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Home My WebLink AboutPermit Building 2009-8-7 Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5783 MINERAL WAY ASSESSOR'S PARCEL NO,: 1802033302600 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01142 ISSUED: 08/07/2009 APPLIED: 08/06/2009 EXPIRES: 02/07/2010 VALUE: $ 164,925.00 l SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: NEW SINGLE FAMILY DWELLING SAME AS 5759 MINERAL Residential I CONTRACTOR INFORMATION I , ' uirAS yoU to Contractor' c: \ ION: Oregon laW re6refj~e.iiS'e:Y HA YDEN EN1fER'pM1h,;~ adopted by the les 4l;2208l jorth TOP NOTCH if'~Et~%r~<JN(ler, Th~S~~~h OPIl1.i36600~y P ACIFIC AIR'\:';o8\l~FQRTJfI'Ml01 0 t cropies oj 3923'l'les ~\l, :;,\(. .-- obtain ",-~hOne STUTZMAN 'YIf~.w<5lE.lS IN(j' _,_, INote: the 31'117_0""n \,'-"''''1'''''''''''''''' 1'"''J''' \........., ca 1': BUlLDIN(';JINfORMAT,101j'i' nU' 1\ ,,' ..,.., "" I - center 10 '-U.- # of Stories: Height of Structure 15,50 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Electric Energy Path: Sprinkled Building: Overlay Dist: , Total: # Street Trees Rqd: 2 H\l2dicapped: Paved Drive Rqd: Yes,\\t 'tl~fpact: % of Lot Coverage: ?\~,\fu \, \'0 ~O ' ..ni\C~" "; c,~f>,\..\.._t!~\'O ?t~~\I to?' I PUBLIC ll'i,RQV:W~1'i\~\J~~' f>,,,f>,~\Jv"- ,\\\"U Ct.\; vii'- ~.n, F II I d """r:~ nr:?\V>IOewalk Type: u y mprove CO ,,,,,,<. f>,'l r <. , No ~'l '\ 'Oil () DownspoutslDrai,ns: Stormwater to curb via weep hole po; , Owner: HAYDEN HOMES LLC Address: 2464 SW GLACIER PI, STE 110 REDMOND OR 97756 Contractor Type General Electrical Mechanical Plumbing # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I R-3 U VB Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18,00 5,00 10,00 24,00 0,00 Street Improvements: Storm Sewer Available: Special Instruction: Notes: Expiration Date 07/29/2011 09/29/2010 03/25/2010 05/12/2010 Phone 541-228-1081 541-317-1998 541-672-9510 541-928-8942 3 Lot Size: 4,590 SqFt 1st Floor: 1,031 Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport 400 Sq Ft Other: Occupant Load: No I DEVELOPMENT INFORMATION I REQUIRED PARKING 2 Curbside 7' Curb and Gutter Pa2e I of 4 Status Iss u ed CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2009-01142 ISSUED: 08/07/2009 APPLIED: 08/06/2009 EXPIRES: 02/07/2010 VALUE: $164,925.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line I Valuation Descriotion I, Description, Tvpe of Construction Bid Amouut Use Bid Amount $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 164,925.00 Value Date Calculated Total Value of Project $164,925,00 $164,925.00 08/06/2009 ~ Fppo, t.iWU Fee Description Amount Paid Date Paid Receipt Nnmber + 12% State Surcharge $201.16 8/7/09 1200900000000000891 , + 5% Technology Fee $101.67 8/7/09 120~900000000000891 1st Appliance $79,00 8/7/09 1200900000000000891 2 Baths One or Two Family $337,00 8/7/09 1200900000000000891 Addressing Assignment $38.00 8/7/09 1200900000000000891 Appliauce Vent $9.00 8/7/09 1200900000000000891 Building Permit $973.30 8/7/09 1200900000000000891 Credit - Trans Improv SDC $-931.65 8/7/09 1200900000000000891 Curbcut Permit $88,00 8/7/09 1200900000000000891 Dryer Vent $9.00 8/7/09 1200900000000000891 Exhaust Hoods $13,00 8/7/09 1200900000000000891 Fire SF Fee - Residential $71.55 8/7/09 1200900000000000891 Gas Outlets 1-4 $7,00 8/7/09 1209900000000000891 Piau Review Major - Planning $211,00 8/7/09 1200900000000000891 Piau Review Same As $250,00 8/7/09 1200900000000000891 PW Disc - 2nd Permit $-30,00 8/7/09 1200900000000000891 Residence Wiring 1000 Sq Ft $134,00 8/7/09 1200900000000000891 Resideuce Wiriug Ea Addtl 500 $25,00 8/7/09 1200900000000000891 Sauitary Sewer - Improvemeut $507,07 8/7/09 ' 1200900000000000891 Sanitary Sewer - Reimbursement $666,84 8/7/09 1200900000000000891 SDC MWMC Administratiou $10,00 8/7/09 1200900000000000891 SDC MWMC Improvemeut $1,146,50 8/7/09 1200900000000000891 SDC MWMC Reimbursement $101.97 8/7/09 1200900000000000891 SDC Sanitary/Storm Admin $151.07 8/7/09 1200900000000000891 SDC Tran Reimburs-Residential $211,21 8/7/09 1200900000000000891 SDC Trans Improvement-Resident $931.65 8/7/09 1200900000000000891 SDC Transportation Admin $16,89 8/7/09 1200900000000000891 Sidewalk Permit $88,00 8/7/09 1200900000000000891 Storm Drainage Impervious Area $715,59 8/7/09 1200900000000000891 Temp Power 200 amps or less $63,00 8/7/09 1200900000000000891 . Vent Fan $27,00 8/7/09 1200900000000000891 WilIamalane Single Family $2,858,00 8/7/09 1200900000000000891 Total Amount Paid $9,080,82 Paee 2 of4 CITY VI' ~rKlJ~GFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-01l42 ISSUED: 08/07/2009 APPLIED: 08/06/2009 EXPIRES': 02/07/2010 VALUE: $: 164,925.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line , Plan Reviews I Plannine Review 08/06/2009 08/06/2009 APP DDK Access restricted to one drivewa~/Iot. Follow street tree plan, Puhlic Works Review 08/06/2009 08/06/2009 APP LKW Storm water to curh via weephole Structural Review 08/06/2009 08/0612009 APP CJC AS'NOTED ON PLANS To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. wilhbe made the following work day. Rpnllirptllnli',np.pt~ Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed, i 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 1100r 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, Ce~ling Insulation: Prior to cqver. Drywall: Prior to taping, Final Building: After all required inspections have been requested and approved and the building is complete, Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.' Underl100r Phimbing: Prior to insulation or decking. Underfloor 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, Underl100r Mechanical. 'Prior to insulation or decking and including required testing, Paee 3 of 4 .....:"i~Il!,!'!!1<I!I~II!I'..,wIti.,' " ij. " ",' *{' , CITY OF SPRINGFIELD Status Issued Building/C()mbination Permit PERMIT NO: COM2009-01l42 ISSUED: 08/07/2009 APPLIED: 08/06/2009 EXPIRES: 02/07/2010 VALUE: lI64,925.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax. 541-726-3769 Inspection Line Underlloor Gas: After line is installed and ~equired testing and capped if uot 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, 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, 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 siguature, 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 Servi~es 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 frout of the property, and the approved set of plaus will remaiu on the site at all times during construction. < ~/2A~ Owner or Co:rt;:;;;tors SigU;~ g~7-ay Date , if Page 4 of 4 ,'.' 5'A'N1 fE AS 675&:1 I'\IlI'ntPv1 Structural Permit Applicatiou -.."'.-..,', " . ..' ," '. ,- . - .~,' .....,...- " ," , ,.!:i' "_., ,'_. 1.,_ ., D o.e _.~.', '-:.".,'-"" ,- .... - .,,,,.. .., ..'''. 225 Fifth Street' Springfield, OR 97477' PH(54 1)726,3753 ,FAX(541)726,3689 SPRINGFIELD J;.'.......:'e;i,~_ ":,it:J:~~& ;lM. ....". '- '.!JV"~~ I, DEPARTMI:NT uSE ~NLyl pehnit n~ {!/I- / / "j Z I Date ~ It. This permit is issued under OAR 918-460-0030, Permits expire if work is not started within 180 days of issuance or if work is , susperided for 180 days, 10' ..'../,. ,.~i,.:t'i/L(Q,cAWii3Qy~B}iM.~~~j;'~~BR~y:a.g)t!i!\r'iI,;j'i:H,i;'"~i!\1 I T~is project has finalland~use approva.l. I SIgnature:. Date: I This project has DEQ approvaL I . Signature: Date: I Zoning approval verified: 0 Yes 0 No I I Property is within flood plain: 0 Yes 0 No 1 l~t~~~~~,,~\(~t~~t~'~t~~:GiJ'i~iG,'EJ;KG:QN_~fR~,Gtf;I.@~~jt~f~~~JlWt;~~~~t~riWl:1 I IlI'I Residential, I 0 Government I 0 Commercial .1 I l~j>;t~~'h':i~p~i$IJi:~rfN~1J'R~'AT1QJ':l!jiANpX~9CAif;(6Ni;0~i;:~i,,;c;:; I I Job site address: ~'57l!2. MMe,,,,1 I I I City: 5.".....C;..1a. .I State: 011 ,I zIP:17<ar I I J I ' I SUbdivi;ion::T".r _,.f,~,...., ,I Lot no,: ..:1.73 1 I Reference: I Taxlot: I I'. ". ,', · ,', ~~ClF'E~TY:,9WN~~"";Tt~\'1 1 Name: 1-I.......1~" ~"'......<:. I I Address: ;).ti,q ~""', t./4L.'b- flu/' ' 1 1 City: 1i'1'IlI~ I State:oR. I ZIP:1nS~ I I'Ph~ne: <'/I,m -'4'5r Fax: 5'11 '7t/t- .2~,n, ' I I E-mail: I This instiillation is being made on residential or farm property owned by me or a member afmy immediate family, and is exempt from licensing requirements under ORS 701.010. Sign,here: 1",'"GONTRAG]Q~:;It'lSTALLA11QN;,,):,;, " I B~sines~ name: O")&/~ I Address; I City I Phone: I E-mail: I CCB license no.: I Print name: I Signature: I State: Fax:' I ZIP: 1~,('.,:rfA~'\''';~;lSLJE!:C,0/'1t(lAc:tGRJtiFOR,M.Af:iQN~f;'if.i';J;/7,*'1~;1 I Name 1 Electrical I Plumbing , I Mechanical eeB License Number Phone Number !l;;l5 (d, :<17Q, 3'b.37 5L#1- '6n- M'j ,911 -"):J-c;~ '~J A1:t~_ 3'142- " "~(;,;W'?'::~;,Yl;,~'EE'{sfiH~JjiJg~':";r!>:,,'t:"i;:.."'"",""; I I (a) Job description: Occupancy Construction type: Square feet: !tJ '5/ Cost per square foot: Other information: Type of Heat: Energy Path. :J^ [Jg new 0 alteration I (b) Foundation-only permit? I Total valuation: Oaddition DYes ONo 1- (a) Permit fee (use valuation table): I (b) Investigative fee (equal to [2a]): I (c) Reinspection ($ per hour): (number ofhoUfS,X fee per hour) I (d) Enter 12% surcharge (,12 x [2a+2b+2c]):' 1 (e) Subtotal of fees above (2a thr~ugb 2d): I $ $ $ $ $ , 1 ':., ,",..",,:' I I 1 I I I 1 I I (a) Plan review (65% x permit fee [2a]): $ I (b) Fire and life safety (40% x per~it fee [2a]): $ I (c) Subtotal nf fees .bove (3. and.3b): $ I' (a) Seismic fee, 1 % (.01 x permit fee [2a]): I $ I TOTAL fees and surcharges (2e+3c+4a): $ I I ,I ZON \~, INlTIALS ~ DATE " .\0.0'\ SOURCE fk ~.......... 225 FIFTH STREET. SPRlN'GFIELD, OR 97477 . PHl(541)726-3753 . FAX: (541)726-3689 i .1 < ELECTRICAL PERMIT APPLICATION 1!9~//l/2 I I I \~'~'!:!W;iW,'!l~.lI~', ~"~~"''i'tli:t;rr~~;;ITi 1I:;J~t't;.~'W;','lf~~'~tiiffii!~''')~f.':'~''"';'''''j\~ 1 ;~~'0~1?J&,,;':, ''<' l 'S:Uf - .'\, l'-, \';L~:J!@N::~~,~'\,,;~m: -l~~~;1;i, . lill'l'il.:~n"r[jj'~'~.wi ~ll'"'''' ~'~"~~r..;:t':~'~~"''''''\2''''~1.f"",'jl!A:!l".li!;';;r.i'1:i'"~'~':~ ~; ~M:r-1Jl .- '.-'""'']''.'" LEGAL DESCRIP. TION: j ~ A igOZD 33,~ OZ'?()U JOB DESCRIPTION: I #0 '^-2> e W ((1_~' I ?1='n.1 / , f I bl d ' I 'f Ik, PermIts are non~trans era e an expIre I wor IS , 'not started witbin 180 d~ys of issnance or ifw6rk is ______ '_ _Suspended-foD80_daysl ___ ,___ __ ______ _J_ I I l;lrriWtiM!f.'~~~~~~"l.".t':.~,. 'i\li;\i""lmlj'!'''lif,o'~I'f'~,:t1t~JG;1",",," ~iWml" "I<!I ,- ,- - ~,i1r.!'!.",1,~.~~~." "~:I~l'~. !l)~Th~~:1~~'J:t:iI~~Ji1f~11A,"~';~11Gm~r~~%IZ,"~~~.J:< ",'it'll~','~\~(""!~:t%i::~~ ~i";;tr;rr-r:r~",,..I~;~' 'f~'E, --'l"~.'@, i\lwm,"" 1,~~J!~Ifj" I'! ~''J)~'r~;'fti'~'ki:b7fj ;)~;mlti" B. ~~.sellV-j:!'t1!iiIO'~~)<;l\"lrWit". .\ll:i[illnllIlofl'~t€r~fio'lisYot'iRalOt:li'nlln,:'!\l\l 2. ,1, ,')l;,:ttt~~~1i.~~~~~: "~ ~H,,,ni':~' ,'r'1f~;l$~i[f.~ rt'~1.#~~ di1:1fi'~":i.1Jj;li\T~:::iM,",~F~I~'I~!lii~li~l, ~!j~iR),~jl&~$t.~"':ml:t'^li1,",i'%'1Jl!~\j:Mih~&]m"iri2 Electrical Contractor t,t';V~k..4.-~.r-/e"J ^__ 200 Amps or less $ 70,00 ,7', . f ~''-':don law rr:-r<'I,."-:oC" """.-t. I - 'U', r::!~s dopled b th 201 Aiilps to ,,00 Amps $ 83.00 ~ ...-~-?a' /l J,I 1 f/-:c.k... y e (I'enon llti/'J., Address .r-uU t (, ~;,,' "'T,m Center, Those ruf9I Amps to 600 Amps $138,00 rll(:'nH tftJ') 001 001 0 ~~ are "et torth .0090 Yn,t~o!" hH}12~0_U~160:~AntP"S2t~d990 Amps $180,00 rnon"a~hh~79'J,8-e.,"ooCJv"rl u)OO(1Y!lRsi'Vons $4'13:0v nUmber fo; tlj~'o" (,wte:, tJR'ecobne'ctI3nIy $ 55,00 Ce t I, regon Utility Notlftcation 1J /0<:- <'/5e(IIS 1-800'33'C~~~~l1li'lf~I'~~~t'i10'''J~'JIi'~~~I,I.,~iI)!il\1i'l!~11$$:.ltJl!!liJli~~~~W!!ilJi1lt'~~ ' t Vv' '7 ~Iflli~" ~ ~':smb\1.i\.m~~~' '"" ",~",9,!]i.au:itliilb~U!l1.lli~?t~1h;l,~'W~'I)~'I,!jf~dWmi!!:!illi~\':fl~~ir~!~ I Installation, Alteration or Relocatioo I 200 Amps or Iess 20] Amps 10 400 Amps I 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see HB" above, Sc:c..i'~g.al, ~r~Je of sqperv-iSin,pl,,,,,t,lec~tn",,Cian Cl (' ~I:,." _ D. ~13'r~~~~~W~lti*~*'i~~11W!~;~11,'fl"~~r,~ll~Z~j*~i~~tk~i:~~,~11~:~"'11J(~'1w~l~~~11~1~~~ , ~ n n J-' " 'I," ."!:fl~~lili.\.:1'1\J1~J.ltil!wld{Ji1 : " ";~"'il..:]!"\~],)lj'"',~iilb.ili~e."-i<',;,.I')I~:I(~",',,,[.,f-l,,M.~j,':'""~~,,,,,,fiN.1IDti , I New Alteration or Extension~PeT Panel " , " (, One Circuit $ 48:00 - I .' - -N 0 neE'J EachAdditionaI Circuit or with OwnersNaIoe !lA-'/6f::;.--NrFi/'t/:E-~ ServlceorFeederPenmt $ 4,00 '2' ,;b"~, '. - r=~); I ;~' USNHAL,JtL.' lI@, ,.lil!<i~ ,~~ "'iI"~'~:J"~~1~~'l:!j\\!rl~~!~j",^I"~'a"~I~'''j~~'';:''1l'~.'~,,~~",j)I,'~L'" 7 ~ (LT; DE, ',;lili: n 1ilS" . ".' e"ee .or.rml'mc u eu" '. "aC!I}lIlSlliUhtlQil _. ~- . _ ~~ , - ' . """"Ff~~ "', '~l.i' "I!]',~,;.~"~",.,,.:,!<;';),.I;ii...j:;:;;i;ll"'''',M'''N~~,\\' ,ldJ.,;,;-~;r<i";I""""I<!!~tillt!.! City ~-1J~N'1 Phoue_~-~-""VI;; E ~1~sffi~tiQl}l T $ 5500 : I' 'SigniOutline Lighting , $ 55,00 OWNER-INSTALLAT,ION j LumtedEnergylResldentml" - - , $ 28:00 -The instalIation is being made onpropertY roWri-:;;;iDch' '-Limlted Energy/Commerciar------ $ 50,00 is not intended for sale, I:ease or ~ent Mi~imum Electric Permit Inspection Fee is $50.00 + Surcharges Owners Signature: 4,ltllil.w.~B~IJ.I;., ZZ-Z- ~ ~..'<'\,) _C\.' ~ ~..,,~# () -12% State SUrcharge zt, &'1 ~~\.0,~~f::'\V. ,'".' ~ I ~~ 10% Administrative Fee II ,~ ,~ ~"l..l 5% TecbnoIogy Fee b~ C\: 71-( Inspection Req~ 7~6-3769 TOTAL City Job Number 51lt C' 1,~~;r;!w:[-~14."9~':,;;,,~~I_ri1~'I!&:'t3IWEf;1t;:p!:1l~"l.~'l!\m."'i',':'i'~~'d%~:c1P!"'!';::f:1ijJf;i:nn],~~~g1'fRQ:,1i:~y.:i~ill':;::' 3. t~~Q1Yl11(,J1F)!tWJ~1t:.It.1ft~S'63jf.HiI11WaE~B:k.EID;Bf1~~~jJii>f;,j~~:~*]~~1~~~\-r~{~"I'J~ Vii:.;t':;-;;;~.\:;;:;;;""'".Jj-;;\i~:r:l:l:r~J~J~j1)i~,Th;i,i.:fj!a~lill:~[(~'t&1i~<l)\.'I~~","'~,'a~"..,."",:"i!":rjf"~J;iI,\.:L::;:!'s1~,>MJ!;11:"i,,,;g Date / ~~''f':l:'i9:liiTj..~..,~~f,j1r_jj,l' ;m~B:'I"''''''''''''''oIi''~'~'1tt'''''~"l,t''''''~~~1.,,"_c,~'5~~1'''C''l!',<''''''~"r"'<iol'~:l,r:-;l"H'''''~~)::'; Ail.' "'~':R'eS11r":ijt''''II'''''S'"'''';J''\''6\l\'ii'''''';I'j:i''o''''Ii''''Y'YW''.'ilJ'";Tli;"~ ;~'t""\'"' . 'i,'I:';'c~"",.l""1"~e..",,,~R,,",,~~,%J:.\~,,;..:MlK;K,~'":;>IH:~'JL"";.ir:,';""JP,JMt~H~~L.~~.,,,.Hg:;}I~~')"J:'~~-+;":;-~ u ,;;Ul<,"" ;="""',..,.....=...",."'.m: ~ "J,,~=,.",.1.'c=""~"'...'It:..:.~"" ,~"'........._~""""'-".',,,..l.._,,=....,~. .l!l~,....."u , Service Included 1 000 sq, ft, or less Each additional 500 sq, ft, or portion thereof ( ) /7'( y-ftOO z:)~ $/,00 jJrj Z)' Each Manufact'd Home or Modular Dwelling Service or ___Fp:p.np:r $55,00 CIty n / .rj tm...,I I I Supervisor License Number I Constr, Contr, Number i ; /2n '7 i 172 )~c;, 1m'? ($ roo $ 76,00 $110,00 61 Expiration Date Expiration Date Address , zS9 SharedDrive(T:)/Building FormslElectrical Permit Application I.O&,doc ~ ~ Willamalane t . Park & Recreation District Job, No, C:., -117-' .J- SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME:5"""~ PHONE: ;2~J' c,;,'1J J , . ADDRESS~7Y~ 9- &..; t;l.LP-CITY /Zi>iYttiJJ ST~TE:dj(:ZIP:~~- LOCATION OF PROPOSED BUILDING SITE: Street Address: ". 5?E:J "'" ,N'do.;L ~L Plat Name: ' .. Tax Lot Number: . ;::, ',',j,,; ,~;,.':.,:'.I',:'7~'!'ti::r:" :~~:: ;'.'ji r'/t:;::~;:;/~':::'re&; y~u ~ :,' , 1, DEVELOPMENT.;ryPE!(ChecJ('appropriateJdweUing1s), Dwelling type definitions are on the back.) f~'C!!hnu ;,~::'!:iY ocr:::,:: ,nrc'C(.it-; ;.:~,~;to~;Gt't'lY . ffUnil--;.',J :'1'-'";' 00'1/'" ':",f Ccp:,:", .....,~r,"i' 9;:". lOll/] '- br 10" f' I ,1::1( (/\(, 1,-;::, Of f~ ,)2-001' .. S. I F --:!' D'J"t'-' h 'd' (,IN'" "T{] r'( - , A. !nO e- amu'Y,~, e ac:.8 _: ! /'.,~!JB tG!r-<r-,f~ les by NO, OF UNITS 'J,pjt/';~;~1.'$2~t#:~ per unit = $, .::JF.rr - B, Sinale-Familv Attached NO, OF UNITS X $3,100 per unit = $ C, Multi-Familv Aoartment " NO, OF UNITS X $2,641 per unit = , , NOTt.. . D, Sinale R,oorgl{gccuoancv , , .u'rCNMIT . ' ,NO, ()f"LON~T1fb:[, S:ALL 8a2iRf ~V21 per unit ~ COMME/IIC n UIVDE:R THIS p HE Worw E, AcceS6!oN E)y.i.effinr96llllil ABAND ERM. IT IS NOT , ..' - Urjf PERI' ONED F ' NO, OF UNITS OD, X $f,5B61 per unit = WILLAMALANE SDC $ $ '$ $" 2, SDC CREDIT (Ii applicable) SDC payer must fumish proof of , Willamalane Credit approvaL) $' 3, TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) ", 'rt., ~- $. ;2.Fff -'f; t; ,: d? Date Development Services Department City of Springfieid 5 225 Fifth.Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works DePl!rtment Job/Journal Number COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-01142 COM2009-0 1142 COM2009-01142 COM2009-01142 COM2009-01142 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Date: 08/07/2009 1200900000000000891 Description 'Plan Review Same As Building Permit Addressing Assignment Willamalane Single Family 2 Baths One or Two Family I st Appliance Vent Fan I Exhaust Hoods Dryer Vent Gas Outlets 1-4 Appliance Vent Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Fire SF Fee - Residential Plan Review Major - Planning Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Tran Reimburs-Residential SDC Trans Improvement-Resident Credit - Trans Improv SDC SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC.Transportation Admin + 5% Technology Fee + 12% State Surcharge Paid By HAYDEN HOMES' Item Total: Check Number Authorization Received By Batch Number Number How Received djb 074543 In Person Payment Total: Page I of I 1:39:47PM Amount Due 250,00 973,30 38,00 2,858,00 337,00 7900 21.00 ]3,00 9,00 7,00 9,00 134,00 25,00 63.00 71.55 211.00 88,00 88,00 (30,00) 715,59 666,84 507,07 21 L21 931.65 (931.65) 101.97 1,146,50 10.00 151.07 16,89 10 1.67 201.16 $9,080,82 Amount Paid $9,080,82 $9,080,82 8/7/2009