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Home My WebLink AboutPermit Building 2009-8-11 _S~!!I~~I,li!h~), ' ;. . ...... . ',. U ' Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-0I041 ISSUED: 08/1112009 APPLIED: 0:?/17/2009 EXPIRES: 02/11f2010 VALUE: $' 76,924.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1960 INLAND WAY ASSESSOR'S PARCEL NO.: 1803023306700 Springfield TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New, Residential PROJECT DESCRIPTION: Manufactured Home Replacement Owner: Address: DINWIDDIE WILLIAM J & L M 1960 INLAND WAY SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION ,I Contractor Type General Contractor JOHN LEE License 178860 BUlLDlNC: INFORMATION' Expiration Date 1lI2912009 Phone 541-5]0-8616 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: #,of Bedrooms: 2 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: I Lot Siie: Sq Ft rst Floor: ' Sq Ft 2nd Floor: Sq Ft Basement: " / Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 6,534 855 I R-3 VB n/a J" DEVELOPMENT INFORMATION' Frontyard Setback: Side] Setback: Side 2 Setback: Rearyard Setback: . Solar Setbacks: 53.00 13.00 14.00 24.00 10.00 Overlay Dist: # Street Trees Rqd: I Paved Drive Rqd: Yes % of Lot Coverage: 13.00 .. REQUIRED PARKING Total: 2 Handicapped: ' Compact: I PUBLIC IMPROVEMENTS' Street Improvements: Storm Sewer Availahle: Speciallnstrnction: Sidewalk Type: . Notes: NOTICE: THE WORK TUIC: DmMIT SHALL EXPIRE IF,_ on ~;"T UNDER \ II" ~--""" ." ,,- AUTHORIZED ,- .' ;-",-r. en';!, .. I COMMENCED OR IS AB! ~Maluat1oft'ueScrlDtl~n I\~IY 180 DAY PE~IOD. $ Per Sq Ft Square Footage Type of ConstructIOn It' I' B'd A t or rou Ip lef or I moun Downspouts/Drains: No new impervious surface. Fixtures to septic. Floodpla\lni!liq(rna.lionCsubJIIittMN NO:,BWJis~u'es. to follow rules adopted by the Oregon Utility Notification Center, Those rules are set forth ili OAR 952-001-0010 through OAR 952-001- UU8U. YOU mCly,uuldll1 t:UfJ'~::' VIllI!::; lUll;;:.;) LJl calling the ce'nter. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). Value Date Calculated Description Pa2e I of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line ManufHome Manufactured Home Fee Description Plan Review Residential + 12 % State Surcharge + 5% Technology Fee Demolition Manuf Home State Issuance Manufactured Home Placement Plan Review Minor - Planning Total Amount Paid Initial Review 07/20/2009 Plan nine Review 07/24/2009 Public Works Review 07/24/2009 Plannin2 Review 07/30/2009 Structural Review 07/2412009 Structural Review 08/05/2009 $1.00 Total Value of Project 76,924.00 Fp~.< !'''IiIJ J Amount Paid $387.88 $47.64' $28.70 $58.00 $30.00 $397.00 $119.00 $1,068.22 I Plan Reviews I 07/24/2009 07/29/2009 07/29/2009 07/30/2009 08/05/2009 08105/2009 Date Paid 7/17/09 8/11109 8/11109 8/11/09 .8111/09 8/11109 8/11109 APP LLH WI DDK APP LKW APP DDK WE CJC APP CJC Paee 2 of3 CITY OF SPRINGFIELD BuiJding/CQmbination Permit " PERMIT NO: COM2009-01041 ISSUED: 08/11/2009 APPLIED: 0:7/17/2009 EXPIRES: 02/11/2010 VALUE: $: 76,924.00 $76,92~.00 $76,924.00 07/24/2009 , Receipt Number , 2200900000000000815 1200900000000000901 1200900000000000901 1200900000000000901 1200900000000000901 1200900000000000901 1200900000000000901 Pendingidecision on Flood Plain , Overlay::Application. (SHR2009-00002) No new impervious surface. Fixtures;;to septic. Floodplain information submitted. No PW issues. " Adhere to the following occupancy conditions for development within the Floo~plain (SHR2009-00002): Provide a FEMA Elevation Certificate completed by a certified engineer~ surveyor or architect, AFTER placement of the manufactured home and before occupan~y. The finished tloor elevation of the manufactured home shall be a minimum of 18 inches above the Base Flood Elevation. NEED CURRENT OREGON ENGINEERING FOR FOUDA:fION SYSTEM Engineefiog provided- approved as noted on..plans / review,letter. _~~51,~~,SI)I~C!1 ~~'" "..;" _"M~~ Status Issued CITY OF SPRINu1<l~LD Building/CQmbination Permit PERMIT NO: COM2009-01041 ISSUED: 08/11/2009 APPLIED: 017/17/2009 EXPIRES: 02/11/2010 VALUE: $' 76,924.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line , 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. win:be made the following work day. R'~"'1"ed Inspections. 11111. .._ I III Mannf 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 heen installed. ' 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. MH Pedestal: Approval required prior to utility company energizing service. 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 ofthe 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 onthis project. . . I further agree to ensure that all reqnired 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 wi'" remain on the site at all "'"..~ .. (( /;( 09 ow"d Contractors Signatu-;;-n Date ( (I V' . Paee 3 of3 Building Owner's Name W ,,' , ,ILLIAl!1 VIIJv.ltJ)f)lb Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route'andBox No. I%D IA.tLAUt) WAY City , '~j)titll(1~It::.Q)" State oR. ..Property,Description (Lot and.&lock-,~4mbers. T,ax._parcel Numqer,'l.e'gal Description, et~.) " L "j _ II ' , TAx W1A.!>' 19'>-C>~-b2.~ 3~ TIlr)C l..ci'r' h7tr:! "Building Use (e.~'., Residential, Non:'Reside~tial. Additio~-.'AC~S~~~'. ~i~.) ~Oj;_~{~~ftlAL';" 'r.. _ latitude/longitude: lal-.!:Ll/D 0/ ' 'J,6.h" IJ lOhg: 17<<'& ~I' 2..~. q" '-.} Horizontal D~tum: D NAD 1927 C9"NAD 1983 Attach-at least 2 photographs of the building if the Certificate is bein!fused to obtain flood Insurance. Building Diagram Nurnber~ , . .:,i ~ For abuilding VJith a crawlspace or enclosure{s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) $ij 55 sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings,in the crawlspace or bJ. No. of permanent fIocx1,.'openings in the attac d garage ' enclosure(s) within 1.0 foot above. adjacent grade 7 within 1.0 foot above adjacent grade c) Total net area offload openings in A8.b ~ sq in c) Total net area.offlood 9penings in A9.b sq in, d), Engineered f1ood'openings? Dyes IVfNo d) Engineered flOOd openings? 0 Yes 0 No "" " U,S, DEPARTMENT OF HOMELAND SECURI1Y Federal Emergency ,Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1,9, ,SECTION A - PROPERTY INFORMATION A1, A2, A3, A4, AS, , 'A6, A7, AS, SECTION,B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 10MB No, 1660-DOO8 j I Expires March 31, 2012 1~:;for;fns-ariin're.'com-"-arr':ws.,.,trt';","L~}<:~l c, "",'C' ".' - '''-.''.0_.__*..,......... R".-,y;.;.:+",.~~"j~i'~>j;i,.,' . ~R9IJcy~Nqrn~~m.f'~~~~1i~~i!JW,~'~: , !' "'''.. ,<.;~f";o'"'~X,"!!-!~.n,, "f,'!,'l""".~,_.;t'm:j.j;,.i""j~:1i'-i!'-~j.mt '~";'$:t; " :;;;-re-,;t,,;d->Ja:.' ".'.-'~""..~~..;w,M.f.'''".~itl><;~l1l' 'ic"",~. . " r:CompailYNAIG,\NiJmoe"~~;;~~,~);r~~1!-Jii;/;~ . i5:i:'leif~~te<o~~;iliig~~~;l1t~&;~~1gi:W'l,~1h~;ffi~:: ~:;".:j!!:,~~-,>_"" ..>J":>I:....:i<lf~_'n:-iI'I'~'l'T"''''='''''''~''~''');\ ZIP Code: .. ". _ . ' .' Q7'17? ' 82. County Name L.WG' 83. State , O~ C 1. Building elevations are based on: .&1 Construction Drawings" 0 BUilding Under Construction* 0 Finished Construction * A new Elevation Certificate will be required when construction of the building is complete.. . . \ C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1"V30. V (with BFE), AR, ARIA, AAJAE, ARlA1-A30. AAJAH, ARlAO, Complete Items C2,a-h below according to the building diagram specified in Item A7. Use the same datum as the 8FE. j: BenchmarkUliIized C1TV oP sP/2.IIJ(i,!=J€LD ~.r- liB? 'VerticalDatum Ai/Nfl '}..q Conversion/Comments ,f). ~ t=€.BT Al\l:IE.O rD ~III tl: lI(A,?:: AlAlffl 2q I{JI? ql? pe;e;:r Check the measurement used. 1/4 7 S 00 feet B met~n; (Puerto Rico only) 45 I ~ tJa feet mete'n; (Puerto Rico only) U /,/1 ~ feet 0 meters (Puerto Rico only) ~ A - , n feet 0 meters (Puerto Rico only) f- ~L n feet ~ 0 meters (Puerto Rico only) CClI"o'\WI~ . 1.J47 ,.fi.~feet tJl/? , S Ii(J feet lJ1I7 ,...Q:.1lZI feet 81. NFIP Community Name & Community Number b 0.1" 'I'5S'1/ I 64. Map/Panel N!Jmber I 85.-Suffix I B6. FIRM Index I 87. HRM Panel . ~ Date. Effective/Revised Date I.JI03'tC.lltJl./ F .\lJLI" 2. WR :\/I1J6 Z.ltlqq 810. Indicate the source of lheBase Flood Elevation.(BFE} data or base flood,depth entered in Item 89. ~FIS Profile 0 FIRM Community Determined 0 Other (Describe) .1311. Indicate elevation datum used for BFEin Item 89: IX1 ,NGVD 1929 0 NAVD 1988 0 Other (Describe) 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protecled Area (OPA)? ~I Designation Date , 0 CBRS DOPA B8.Flood Zone(s) A~ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) a) b) c) d) e) ~ op of bottom floor (including basement~ or enclosure floor) Top of the next higher floor Bottom of the, lowest horizontal structural member (V.Zones only) Attached garage (topofslab) Lowest elevation of machinery or equipment servicing the building (DescribeWpe of-equipment and locauon in Comments) Lowest adj~cent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at.lowest elevation. of deck or stalrs,.lncluding structural SUDDort n g) h) 1,..:/ 89. Base Flood E1evation(s) (Zone I . AD. use base flood depth) I I l/5D.4 , DYes IA:'l No o meters (Puerto Rico only) o met~rs (Puerto Rico only) o mete!s (Puerto Rico only) SECTION D,- SURVEYOR. ENGINEER, OR ARCHITEc:r CERTIFiCATION This certification is to be signed and sealed by a land surveyor I engineer, or architect authorized by law to certify elevation information. I certify that the information on this. CertffJcate represents my best efforts to interpret the data available. .j I understand that any. false statement may be punishable by fine or imprisonment under .18 U.S. Code, Section 1001. rzr Check:here if com~ents are provided on back ofform. Were latitude and longitude in Sectlo~ A provided .bY a ~' licensed land surveyor? DYes ~ No. Certifie(s Name I2e.tli~G: LlOLJG ~ Title j)p JA1c..l~AL ,"5I.M.J/E..V/')!Lompany Name P.2,AWfl Address _ TU ~. City " 1,/r) ~ -S I . 9,P/2JU(b f!tQ)) Signature~~ Date - ,.~ FEMA Fonn 81-31, Mar D9 Ucense Number f.D:IlI~7 'OLe:, ~1.uI=..s/2./(/{,>. 'IOC.I State ~ ZlP Cade f J"- q7t1?7 Telephone I III ' ';;4. 7.,/:1. 0" ~? See reverse side for continuation. r ~? t , REGISTERED PROFESSIONAL LANREl.Ll~VEYOR OREGON NOVEMBER 30, 2007 RENEE CLOUGH 6~162LS 1 . " ~ , epr~ ~lIiodi IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., UnH, Suife, and/or 8ldg. No.) or P.O. Route and Box No. . L9bh 1A.Jl.AJ.L/\ I.JIJ.V . City State ZIP Code c.:,Pe.JAJo,r:,EL1) CJR... Q7t17?' SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICA TION.(CONTINUED) &f7:Q[~'Ln.ilii'fi~BGe.1G9J!I~~DY1PJ~:t,~p,~~ ~PblicYiN!Jrjibet~~'St~~~~~1I'';;~~~;~f~~jli~. ~!~:t~~;"!~~~i:\~~;;WfJ1~~1[~~i~~~g;ll},t\tiRf#) It~~rgft~~~i~~fll~tiYtJ~ Copy both sides of this Elevation Certificate fC!r (1) community official, (2) insurance agenUcompany. and (3) "building o.w~er" Comments MAl'l:IIAlt<:~Y 6-12. ""1k2b!!1' F- U:.VJ+1'IDA I Cj\AJfJi'fr RG"" .f'Jt=:.'-E.I2.NHAJI"'JJ SjgnaJUTe~ e::=--- - - . ...." :' " Qate 8' J .. ff/?" '. : '"', :. ',' '.. t7kf'l .' ..,.,'. ,Dcheckhereifattacnmenfs . SEC'ffON E' BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ,ZONE A (WITHOUT BFE) kll.,,- (?A1 EG:ll)Il>t4FH'T" >.P,~Aj(~ rll-t::: r n'u '" -rRJ)Q'".JD1J TI.,.t,6 PutAl<\ . 4T J?niLhtlJtf, W4s. Ti+E:"~ LOWp.<<.ri- Tf:J,1~ -r) 0e. For Zones AO and.A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F"request, complete Sections A, B, and C. For.ltem~ E1-E4, use natural grade, if available. Check the measurement used" In Puerto Rico only, enter meters. E1, Provide elevation information for the_ following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG),and the lowest adjacent grade.(LAG)~ " , ' . \ a) Top cif bottom floor (includlngbasement, crawlspaCe, or enclosure) is ----,-. ~. Ofeet Dmeters Datiove or . Obelow the HAG. b) Top of bottom floor (including basement, crawlspace; or endosure) is _' _ DfeetDmeters Dab:ove or Dbelow the LAG. For Building Diagrams 6-9 with permanent flood openings provided, in Sectiqn,A [terns 8 andlor 9 (see ~es 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building.is . _ 0 feet U meters 0 above or U below tOe HAG. Attached garage (top of slab) is . _ 0 feet 0 meters 0 aboye or 0 below the HAG. " . Top of platform of ~achrnery and/or equipment servicing the building is . ---.:....- 0 feet 0 meters 0 ai?,Ovs"of"- 0 beJow the HAG.', Zone AO only:- If no flood depth number is available, is the top of the bottom floor elevated in accordance with the-community's f1o"odplain management o~dinance? 0 Yes 0 No "0 Unknown. The local "official must certify this infonllation-in Section G. E2, E3. E4, E5. , SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTA TIVE)' CERTIFICATION '. The property owner or owner's authoriZed representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A. B, and E are correct to the best of my knowledge. I' , ' Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Dale - Teleph_one Comments :", SECTION G - COMMUNITY INFORMATION (OPTIONAL), ' !i . The local official who is authorlzed by: law or ordinance to adl!linister the community's floodplain management ordinance can complete Sections A, S, C (or E), . and G,ofthis Elev~lion Certificate. Complete the applicable item(s) and sign below. Check the measurement used in ItemS G8 and G9. " G1. 0 The infonnation in Section Cwas taken from other documentation that has been signed and sealed by a licensed, surveyor; engineer, or architect who is authorized by law to certify elevation information. (Indicate the Source and date of the elevation data in the Comments area below.) . G2. 0 A community official completed Section E for a b~ilding lo~tediIT Zone A (~thout a F~MA-issued or COll1mUnity~\ssued BFE) or Zone AD; G3. 0 The following infOrinatio~ (lte~s G4-G9) is provided for community tloqdplain management purpos~s. ' I ; G4. Permit Number I G5. Date PenTlillS~Ued I G6. Date Certifi9ate or ~omPIi~nceIOccupancy Issued G7. This permit has been issued for: 0 New Constructi~n " D. $ubstantiallmprovement " GB. Elevation of as-built lowest floor (includlng'basement).of the bullding 0 feet' D meters (PH) G9. BFE or (in Zone AD) depth of flooding at the building site 0 feet 0 meters (PR) G10. Communityis design flood elevatlon o feet o meters (PR) o Check here if attachments (" -~~~~~~~~'r;s;.~~~~~":-~'".'._) C9W!p:uryty:~~(I;1Et}liji\."\ Datum Datum Dalum~~_ TItle Telephone Signature " Date "-....~C&mm&Rls-,,- P~._"'--'~..~,..~ 'l:.' -;,;;'i".":::~;::';,;;;~. ! ". ","..-.".~~.:}~'.; ,~._,. .~~~.~~"~--' o ChRCk her!'! if att::lr:hment'1. .1Ji;I\olA:Forrn81r~j ,'M?[,~9 ; J Replaces all previous editions The following is a project summary for the replacement of William and Leilani Dinwiddie's 15' x 70' single wide manufactured home at 1960 Inland way, Springfield OR The existing structure and all other structures on the I'OVI'''';Y will he demolished and removed to make way for the new 15' x 57' manufactured home. The new 'home will be placed on the same footprint of the old home but with a revised foundation pad that will , consist of ballast rock and crushed gravel. This new foundation pad will be.set at an elevation of approximately 447.5' (about one foot above existing grade) a Standard double block set will be used to support the mfg home, this standard set will also be backed buy our engineered foundation system provided by Advanced Fouridations Inc (Engineering provided in packet), After the mfg home is set and the foundation is in place the home will be skirted with concrete skirting which includes ventilation per FEMA standards(diagram included in packet), After skirting is completed a final backfill around the mfg home will allow for proper slope out away from the home for runo,ff of rain water, Final stages of this project include the installation of decks, ramps, and hookup of the existing utilities to the mfg home. 1~.Rl:.~WfMENt'Q~,g{g~i1;Y-!:1 I Penn it no {}7- /OC( I I I Date 7/t'7kfJ I 225 Fifth Street . Sorine:field. OR 97477 . PH(541)726-3753 . FAX(S41 )726-3689 Manufactured Dwelling/Recreational-Park Trailer Placement Permit Application ' This pcrmit is issucd under OARs 918-500-0105 and 918-525-0370. Permits expire if work is 'not started within 180 days of issuance or if work is suspended for 180 days. ' . l~f;~'~\;'L6c.Jl;L~g(;),YE~NlVlftff,;;A~FfRgI~.6:.[.$;~,~;" ~~I I Zoning approval verified: 0 Yes 0 No I I Property is within flood plain: 0 Yes 0 No I I Sanitation approval verified: 0 Yes 0 No I I ~:-'T_"~_ ~rt'~- " _" '''''~- "--;-r~'-', ",-~ , _ "-lr~i<<' ,""c=~;~~P~_, -, :.~ _ ~---:"Y:~:~::\.\~- .~ ;:: ", ~".,.l0.9A=r:E:99~I3.Yi'~f\"lg29lt~j!'J~!iI$.J!9!l.,;;., ~t,'~ I ~Residential 10 Government I 0 Commercial . If?{g~E(;:S)tCl!'t~jNf9RMl~ffiIQ:~IA.:NQ;;b9~~"TlQH~z~1 I Job site address 1%0 Till",..) w''V I I City: SOC'vVlj..e.ie-IJ County: L'lflL I I State O/J.' ZIP q7t/77 I I Subdivision: Space/lot no.: I I Reference: Taxlo!: I I # Bedrooms: I Sq, Ftg: I Value.. I'. ,~"";~':.i"<~,b_,,j:""'.t- %u:i-.t -- - -'''' "",',,,.- ,', "-""O~'W- .-----\J1f:S?"'~"','- - ''t ~ "-~;;-~ --~ ,:"'''')1., ""ie,,,,..,,'. PcROI'!ERTY",,' NER'"'*'.lh""",. '....1' ",' .. _ 11\_S':~~,- '/<"', -'.' _._""u,^" ...". "'~"'C~_""_"',,< _.^' .,", ",_""""'_""~_,,,,"",)'::?2' -~""....._.t ~.,. '-"c. -,.".... I Name Wi II; ttm OiV\ Wiolol,i'.- I Address I q ~O T!\ larl.l Wa t I City SDr\!t1all,'e,{d. I State OR I PhoneSvI E54- 5771 I Fax I E~mail: I ZIP'17t1n This installation is being made on residential or farm property owned by me or a member afmy immediate J~lmily, and is exempt from licensing requirements under OAR918-515~OOIO. Signature: l'lliil'~j,,~':'fjt3li€ONtRAC]0R~INS:rl>:L!lfAmrOI\l'~;"''\,''~~': :ii;":6I,~;"5 {;iri'?J1?bi,<,.."...... ,:..L\,_.__w"_"~' .,_,Jt',~c,,,,,,,i,,*J~,,~'=~~ U",,"~_i6!';1:;-~~...:,'-;:"1.~>";\ I Business name: Sil--e. ~e(VIC-~'7 I I Address /500 f. ('nlle1€- 1".hy,:J -5u;J.e A-1-81 I I City lilt V-e.mOIll I~tate nP. I ZIP %773-SjI37 I Phone5l/I-S/0- 3"/6 I Fax)91-~7- 3'8'11 I E-mail: I CCB license no,: 17 ZlJc, 0 I MOl license no,: I Print name: Z~ 1= ~'l I Signature: ~~ o 440-2547-J (9/08iCOM) I Qty.1 Cost each I I Description I (1) Manufactured dwelling (a) Placement (incllldts plac~mcnt, electrical feeder, water/sewer connection): I (b) Reinspection (no, ofhrs, x fee per hr.): $58,00 ,$ I Placement permit can only be obtained by homeowner or Oregon- licensed manufactured dwelling installer. I (2) Recreational-park trailer' (a) Installalion (includes stand and lot preparation: support blocking; anchoring; temporary steps:.plllmbing, mechal)icaL and electrical): I (b) Reinspection (no. afhls. x fee per hr.): $58,00 $ I (c) Each additional inspection: (I) $58,00 $ Electrical service permit to be obtained qnly by homeowner performing work or signing supervisor of Oregon-licensed electrical contractor pefforming work. !I Total t $397,00 $ $397,00 $ I (3) Surchargc. 12% (.12 x total, equal to 'I 012): (4) State administrative fee for manufactured d\velling (item 1) ,only, OAR 918-500-0105(5): I (5) Tech~ology Fee, 5% I TOTAL fees and surc'harges (3 + 4+5): $ $3000 $30.00 $ $' -S11\l<.. -zest:,"1' -'~ c' - ~\.~I(\, '~~l::. o.:hcl\..- f'UbJ f:-6-v 1"'-"" g a '7 ~. llo \ C{'l. 4. ?c./ , . 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ~Q~;:. Wii:., City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-0 1 041 COM2009.0 I 041 COM2009-0 I 041 COM2009.01041 COM2009-0 1 041 COM2009.0 1 041 Payments: Type of Payment Check cReceintl RECEIPT #: 1200900000000000901 Date: 08/11/2009 Description Demolition Plan Review Minor - Planning Manufactured Home Placement' Manuf Home State Issuance +"5% Technology Fee + 12% State Surcharge Paid By SITE SERVICES, INC, Item Total: Check Number Authorization Received By Batch Number Number How Received nim 5621 In Person Payment Total: Page I of I 12:10:52PM Amount Due 58,00 119,00 397,00 30,00 28,70 47,64 $68U.34 " Amount Paid $680.34 $680.34 8/11/2009