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HomeMy WebLinkAboutPermit Electrical 2009-10-9 225 Fifth Streett Springfield, OR 97477tPH(541)726-3753tFAX(541)726-3689 '~DEr;AttTMENmrsE\oNiW'~~1 8"':0':'" ~ ~,,,,,_~,,,~.,,,,,=,..<.~,,,,",,,,,,..,",....,,,,,,,,<;;; L........ calM Z()O 9- 0 I ZbO I -...._.. Penmtno.: I Date. /0 - 9 - 0 ? I tfectrical Permit Application :'~ " ,', , . -, . " ~, .;' , , " ',' ',. , . eICl~VO.F' SPRINGFIELD, OREGON This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days ofissuance or if work is suspended for 180 days. . 1~~~tO~CAL"{G9YERNMENT;{"AI;!I;!RbVAIt~~~1 1(~y~~F;EEYSCHEDUl!E'1i'''~~M~~1J!1 I Zoning approval verificd? DYes D No 1 1~~~?&'~f~=r.~~~IQ?Y11~~S'Q"t'~IIT"t.~1 i!1 ;"''''.~I;<I$_~-';;--:'&#_';<'~~';:l:L~~''''-'kf~[~ ~ti,..;; ~1-:t;l~;!~;'i1.~ -<..'f:ic_ost~.t-;: 1~~~CATEG~ORY,iOFACONS.IRUClIPN~~~ I Residential, per unit, service included: I ~ 0 Residential I 0 Governmcnt tI Commercial I I 1,000 sq. ft. or lcss (4) $134.00 $ I ~J.oB~SIJ:E~INEORMMIONWAND~ ' ,'CATfoN~~;'~ I I A I. I I Each additional 500 sq. ft. or portion $ 25.00 $ I' . Job sitc address. - , liJ lUtUIf thereof City:,. . ,State:Oe.. ZIP: q 117 ~ 1 Limited cnergy (2) $ 32.00 S I Refere ,€ O;J I ~'fV I Taxlot.:O /t 0 { , 1 Each manufacturcd home or modular ;~~DEStRIP';T10N!i;OFliWORK~Ji't1&'[~ dwelling service or feeder (2) $ 53.00' $ 1:~l~~:?NE~:::~1iJ I ~:~:::;:::?:e;:f installation, alteration, relo:t::n:: : I Name. ~(-fr:::A-t.-77.f I I 401 to 600 amps (2) $158.00 $ I Addrcss: I I 601 to 1,000 amps (2) $205.00 $ I City: State: 1 ZIP: 1 lOve; 1,900 amps or volts (2) $459.00 $ I Phone: I Fax: I 1 Reco~oeet o~ly-(2) -: m 1'- - $ 63.00 . S I E-mail: I 11_ t,ern!~,-ra?-;~~~!CeS o-r'~;'~~~~:,~~t~:~;'i~~ alt~~dtion: ;el;'~ation This installation is being made on residential or fann property ~QO.~~ps 9f 19S5 (2) , .'..,. $ 63.00 . $ owned by me or a member afmy immediate family. This I 201 to 400 aif1ps (2) . . $ 87.00 $ property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). 1 401 to 600 all1ps (2)$126.00 $:. Signature: lOver 600 am~s or- 1,000 volts, see services or fceders section above ~,[C~ONTFtll;CTOR'~INSTAi!I!ATION~~;2~1 1 Branch circuits: nf'v, alteration. extension per panel Business name: I1Pt ICllefrvnic..s .I/ll _ a-('tiJv1 I I a. ~ec fo~ bra~c~ ci~cuits with purchase ofa service or fceder fee: Address: 2.5'117 svJ CtlmIVYI t'ree1. /21. v Ji~ I I" .E~eb, branch circuit 1 $ 6.00 1$ City: wil.~~.a/;:> I State: 0,( I ZIP: 0, 1tJ 70 I ~it~f,:.o:.~~~e~ circuits without purchase of a service or fecderfee: Pbone: '3D3, tJJ2- qCjOD 1 Fax: '50~ ,(,'62 -7500 f--t'if$Tb.("neb'c;rcu;t (2) I I $ 55.00 I $ I E.mail: r{JJ)(..arJt1l'~fh @rC.5S. fA s I I ~"~Sh',~.d~!tional brancb circuit S 6.00 S I eCB license no.: t 7 JLl7 I BCD license no.: 34-/14l"L--f" ~.S~~l~~~~~us ~~t;s: service or feeder not included I Signing supervisor's license no.: q i 2.J"L[:;" I I Eafh:purnp'or irrigation circle (2) $ 63,00 I Print name of signing supervisor: J)Ea./) I<ee ~ I I Each sign ()r o.u!line lighting (2) $ 63.00 I Signature of signing supervisor ~ J ~ C-t-- I I Signal, circuit or a Ii~ited-encrgy panel, $ 63.00 . ___ alteration. or extensIOn (2) ! Each additio~al ins~ection: (1) I I. $58.00 I $ I 1~~~""mijl![JCANT:iQSE'\...~?(:~~ I(A} ~nt,:sub:6,t~?!abov:f:~._" .1, ,~.$I.'J../. (Min~mu~ Permit Fee $58.00) .. ~. . to"J liB)Emer I2%-sUrcha~ge (.IZ-x[A]);'I- $/.Sb 1 nC)TcCilnologyF~~'(5o/; of[Aj)- '. -:-.- I $. 3./5 I 1 TOTAi~ fees ~ndsu;ch"rg~;'(A'thro~gh C): $"1~.1/1 I I 1 I I 1:-1 1 $03-1 \':'~~~' ~"~~" , . ~-rC1 n_ \S:y\~'V~'\ ,- ~ ~~' ~& 440,2584-J (9/08/COM) "i!~~.ll~s 1~: ': f \l. ~ .~: :~;. - .. ,- ~,.. ~ CITY OF SPRINGFIELD Building/Combination Permit Status In Review '" .- .'.{>-'/~.,:.. ," . 225 Fifth Street; Springfield; OR,},,";,;:;,!:, ": . '.;.~ -_'~~"~:~';~V~':' ..,!f.r.;.,' :~.'i<'~'!''.',':'-:''/. . 541-726-3753 Phonep':."'.-,' """:"",,., "(,,'i"" ....-;:)'ll<...,.,.....' -...-.:,.,' : 541 726 367' 6 F:' ","'~n;.:(:j' -:ci ,. -; ';\. , - - ,_ax-':"';, ,~.... . :, 541-726-37~9 In'sp~Ctiol1 Line ' :,....;. , "1~', ',;"i~\,:';;':'...~; .....:0.:.. 0 PERMIT NO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: 08/26/2009 04/12/2010 $ 1,300,000,00 . ." ';;:!;-il~:.',l~:"~'{!{:,~."- .. ";?-:i~~~: -~:. SITE ADDRESS: .' 123 INTERNATIONAL WAY. ,.. .,... ASSESSOR'S PARCELNO.: 1703154001101 Springfield TYPE OF WORK: Interior .' ,'. . ~.;i,.. ,,) : TYPE OF USE: Remodel PROJECT DESCRIPTION,)Da'ta'.'Center/Storage Remodel; Original Building Designed Per 1994 UBC i': :, " '~" :{~~'~:~f~~A~~~;~+~;\~l:Sf~-~i~]~tr/:::: ; Commercial ",l'~~'~ :~~ 'r;;' .: Owner: PEACEHEALTH. if+ddress:',:\Pn~NIJ<;~A TIONA~ WAY .... " : SPRINGFIEL.D:"OI{'97477' . ICONTRA,CTOR ,INFORMATION ~ . \ l~ Contractor l)'J>,~,::~;;~Co~tr~,c~~r . General. " ~~~4,1H~~'.DATASP~CIALTlES INC ,. Electrical .' ..ii,!' l' h OLSSON INDUSTRIAL ELECTRIC " Fire Contr~cto;I": it :i, HARVEY & PRICE CO ,I Low Voltage EIJCihcal,~,..RFI ELECTRONICS INC OREGON ;:) License Expi~ation Date Phone 714-523-8489 63473 01126/2011 541-747-8460 77 10/31120 I 0 541-746-1621 67147 07107/2010 408-298,5400 " , BUILDING INFORMATION I # of Units: . 11' U ,Primary OccuP~'?'~y",~~o~P:;;",,;~:~;:B : :. Secondary Occupancy Group: '--'c. ;'1;: SI ~ .~,., 'i '~" ~. :""', 'r Primary Construction, Type .' llB , ".. " Secondary Coristruction Type: 'I 0 :!t ~ . 'I '.. , # ofBedrooms:,f.'!:c "'c-!", ,," o " . h .~\ .:1',: "'I'''r:\::.~ ..."" I ..... ,'.0 . ., ~ ' ~"--, 'or : ;. t;,tl:-.. .) .~ # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ftlst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: Yes '. J.~~ S : .' d:, t ".~:~;.jtV! r, Frontyard etb~.c1~, ~:' W"~ ,,'.' ~l~l ;.'! 1 S b k .'.."......~, .-"- ,.,,"r., '.. Side et ac :~:" 1 .W>'. ..' >" ..., lo, Side 2 Setback:'S' '1 r '.' . Rearyard Setba~k: ." ", Solar Setba.cks:-~p;.fhJr ~~l'! ;;''1; ;.. 'G~ :: . . 0 . .... .0 I DEVELOPMENT INFORMATION I u REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: . I PU~LIC IMPROVEMENTS I Street Improvements: '. ':: u Sidewalk Type: \ w requires you to . Storm Sewer A~~i1able:i~~. ,,~:.~.;;r;!J;;L:~' . i' ATT'ImJ2Np~~~7a~;;n:: the Oregon UttfiolitrYth . ;, ,,,,,,ii'-:'::" ""'".. ' follow ,\I'''' ~"'" . rulesarese SpeCial Instrucl1on: " .': " " N t'f' t'Jon Center. Those ^R 952-001- r'Ir'lTHlI=" . O/Ica 10 through 0.... ,'('..!, -',.._ ~." I ~ DIRf( Ie Jf:lF WORI( in OAR 952,001-00 . of the rules by Notes: No f~a.,!ge\iIi)9ccupancy.LNo\(new SDC charges'ONi> worksheet attaclied, You may obtain cOPlesh t lephone ,., : 'ArJfH'd~i!1:D,U\~O,~~ THIS PERMI\~~N I uU~~II\ng the center. (~~t~ii:it; Neotilication CNflM~NCED OR'IS H'lBANDONED number tor the. OI~~00'332-2344), ANY 180 DAY PERIOD, ,> ,. Center IS 1 " . ",..' {;:.\lY~t~ "'"'!~. ....ll,.. f.... . , '. ,!t1; .~~~..~~~..; \... ~1 ~;t Paee 1 of 4 , '., .. , . .~. ~. . ,; ~n:~~!~~~~}t~:;~t;:";:~-:'~E~\;~!:i~'{ " 225 Fifth StreeiL1ipringfield, OR \ 5,41-726-3753 Ph'ol)e\;.:;~.;... ..'~.., : '5'41 726 3676 Fa"'x'Y'!!""";;:s '...,.:':.... N~ ,', - - ';..,<.:';'.-:. . ,"..;.:i;;,.:;'f', ,~...~ 541-726-3769 Inspec'jion' Lin'e '\. ":'(;i''g' .: .,~. . >~W~t;:~;i&~;T'.t)):;~\~~h' Description '.1; :Tvpe of Construction ~.;""i; _"'" '. .~,;.~A~':~~>!l-. ~,<. :,'.. ., ~1(.:::i: Estimate:.~. 'i~;~~~~~'~~l~s#mate ':).~h..ft". . " :' .\.r~, . .-'t~;'~~(2i::;;~.'-,., ;' " I,h ",: Fire Department Review '.....\. 'l Planninf! Review'.j" ~:.'..Ia ~:. :: 1~!~!1~1 - ~-&l ,'!.l- )-.: . r. ' , . , ~.:p ~ Ii" ""10. " .~rj~,:1 \=,r.+; , \1' , , .r'l: Structural Review Structural Review SUB Review , ,1J~.-':.j: 1:":!J~!. .;;!:' 'Jl:I'i,h , ,_._1: jr~H, ." 'Initial Revie;" ;li.!, i ). ,; - '1: ~ ~,., " j.. :1. , '~J-:-"I . ,. " . ~.., '1' " " . .. .ttr~ Fr. t' .:':~~." . . ".f'. Public' Works Review .l , 09111/2009 " :,-f:" t- 'l' ..C : 09/0112009 . , '~;q:l:'<~::l!-:;~tj. :~r :-:~#; 'f" \::." li.~~~"'-' f. 1~ i ~t" l~: ' r ' , I'.., ',"1: '. , , .". "Iii,: '" ,,~. : ,. ,". .r"l" I""" t "t I ~ . '''~;' ~; ii, CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: : I Valulltion Descriution I , II , $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 1,300,000,00 . ,) Fpp<, p.'w _'~.{' .:~;-- r. --:, .:;~'f~ . ;I . .~. ,:Ipil" ~~~. '''~'''''_ ~,,, - . , . .,':, '1,1,""'.". ...., Amount Paid Fee DescriptIOn, i: '~"l.,r'::i ' " 'V''''.. ,''' Plan Review CommllndlPublic " II ' '" -, I .~ . ;1 'nt'l;%~ Sta~e s~t5~.~rg~E~ ":" io" ,; + 5 X:. Technology Fee :':,",:--.. . .J:~'9'l'!I~"~ Add, Alter, Extend Circ ,." " Refund - Electrical Refund - Surcharge + 12% State Surcharge :.' ~,. , ~"'. ..... 't.~ + 50/0 TechnologyFee,~b~ '--i-:-;~ :"-1::1 l!i" Traffic SignaJ'-:P~n'~i'?~;"" '. I: ~ .0....: ~ I ~~ ',', . , ,.. .::'1', .~ TotalAmoUlit Paid .~r ': -!~ .. ,. , , ,~ .1 ~, , 09/0112009 10/0512009.) 09/03/2009 .-. 'rt;1:!J . -r'":!;.' \ 08/28/2009 09/01/2009 APP LLH , , , 09/0112009 09/0112009 APP EW .< Total Value of Project Date Paid $3,635.29 $6.96 $2.90 $58.00 $-46.40 ,) $-5.57 $7.56 $3.15 $63.00 8/26/09 9/8/09 9/8/09 9/8/09 9/11/09 9/11/09 10/12/09 10/12/09 10/12/09 $3,724.89 I Plan Reviews I WE ,) Paee 2 of 4 .' 08/26/2009 04112/2010 $ 1,300,000.00 Value Date Calculated $1,300,000,00 $1,300,000,00 08/26/2009 Receipt Number 1200900000000000990 1200900000000001034 1200900000000001034 1200900000000001034 154008 ]54008 2200900000000001169 2200900000000001169 2200900000000001169 Harvey and Price. Modify Sprinkler System Amy Chinitz with SUB Water Quality Protection requested additional information on the chiller from Scoll Koons (contractor) on 8/26/09. Called with 2nd request on 9/6/09, LM Plans and energy forms set to SUB/IIh Plans not submitted in sets, Charged for extra staff time to compile No change in occupancy. No new SDC charges. No SDC worksheet is attached. ~1!9UlIli."IEI.&:I:?" ,1 - ~;I:-":'"~'r'h-~'''''''''''f~~''''';"t''''' ',/.,. j. " "., , .'*; '. " '. ,,: , ;.n. ,:J"~' .3"F; ~~.'i~. , Status In :~~~i~w. . r 'l' . '_"_ ...... -.~ Ii. ~ .... !.':i25'Fifth Str~t'iSpfjngiield,cQR~),...i' 541-726-3753 P~one" '.i'" '>\''''[;)-4 541-726-3676 Fax. ,. .; 541-726-3769 Inspection Line ". .. .' .',,\,- . Planninl! Revie:>,:, ". ,f.." :;i"".; '..;ti)o:,.Q?/W/2009 '.. .'" 'jfm.f;J;~~0~~~"';"~'\~;~' " :i:r!i: :",j:"i:'~'~~;~:;~~':':t;~j;/~hii Initial Review 09/0912009 ,:;',:;N:~ . . '" .' 09/1512009 Structural Review ~: ..." . ~~. ~ lti_~,~,::" ~.' ". ~ '~~;;'i '~r''';:-,; .' , Fire Departme'o,i Review 09/01/2009 i di, " ',;"~l"JU~~i~i~l;~~~ .', ~ . . :. ,::./.:" -':1 :r:~f\-~' ,'t; .' ~ .:~ Structural Review , i~!-.!J ~I: ~j~;!, .",.. ~: .', ~t." :,...- " Fire Departme~t Review' , .,. I . - ~ !. \~ . .... . \'.'fl"'lt-.., , , . <~~.".."., .~_l I. i.," .~_ .r' . ;!l i..,: t!:'.;"!l ~,_~ t.: ,fl/.;....;- ." I I ",. , ;!; ,". I i "l'i-~\ \; '~... ,..... "i"" ~~, ; !1r41!'-lf ':~'L" . ' ""',,,;: '. . i~ .<. ,~ 09/2112009 " " , 09/30/2009 09/30/2009 10/05/2009 ';.~: J >. "'.? i 1 (lIt7l2009 :!fi?~. . 'i 10108/2009 " h ~.~ .' r "]",: . N ..~,: ..~l~;Y '. .' .. ) ,:l~ f.J , " 1" r " ,) 09/10/2009 09111/2009 '.; 09/15/2009 09/1812009 09/21/2009 09/3012009 09/30/2009 10/0512009 10/07/2009 cJ 10/0812009 u CITY OF :'In{Jl~l'''' u.LD Building/Combination Permit PERMIT NO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: APP EMM APP 10 WE WE 10 10 APP WE APP LLH KLK GRG KLK KLK KLK LLH KLK GRG 08/26/2009 04/12/2010 $ 1,300,000.00 Amy Ok'd approval no DWP changes required after conference call discussing material and design of chiller. See reference to noise standard for CI performance standard on plan. Harvey and Price - Modify Sprinkler System Starting 1st Review, Waiting on missing pages. See attached document for Fire Department Plans Review comments. Completed 1st Plan Review Received Correction Submittal Received Correction Submittal Revised drawings, Forwarded to kip kaufman Provide: I) Product Cut-Sheets for Fire/ Smoke Dampers, 2) Mechanical Value ($) for calculating mechanical permit fee, Revised Plans Review: Conversion of two hazardous materials rooms to IT rooms, Job #COM2009-01260. Occupancy Classification: to be determined, Construction Type: II-B sprinklered. Area of work: 3,000 sq. ft, out of a total building size of331,546 sq, ft. Plans reviewed under the 2007 Springfield Fire Code and 2007 Oregon Structural Specialty Code. See revisions added to' the original plans review dated 9/17/09 in FMOBIS, To Request a!l in~p~ction ca!I the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m, will be n}ad~ the same wo'rking day, inspections requested after 7:00 a.m. will be made the following work day. . ':i:. \. 00 j I ; :I~, ,j ,r :~" :tt":!'!! 'l-. ~~~. ,.' , r. 1\' PU2e 3 of 4 ! ';: I; il~ ..' " ,.. f} " CITY OF SPRINGFIELD . "~ ..r Building/Combination Permit Status . };:.",~;;-, '1!-' . >), PERMIT NO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: 08/26/2009 04/] 2/20] 0 $ ] ,300,000.00 ., 225 Fifth Street, Springfield, OR' 541-726-3753 P~one ". . ?,\!~:> " .. 541-726-3676 Fa~" .:~'';:;~~~'., .;j_~:~ni\;~;l\~;'i{ ". " . 541-726-3769 1I{~\ie'~tjon:Liii~;"""':'@'\' ,': ,., :'::~,:r:;..;~r':.::;' . . - ...,. ~~. ;'idi:. ';.".,. ," '}~:L~i:'~~:f~t~~ . ~%:Cj~:;;~\,: Rough Electric: Prior to Cover:,., " R~(]uired Insnections I ......: Final Electric: When all electrical w.ork is complete. " .' .' .:~';}:,;:r;': :.. :: ~ . Fire Department,Clean AgeiiiSysiem: Coordinate inspection with City Fire Marshal's Office ~ 'f~;::\:'!I;'~~;f~~-;?~' .;;;v~~:::'j~~; ,<, Fire n.ep~i1,m.~~tSprinkle,"'System: Prior to cover, Hydro pressure test, fire line flow test. .) ,1 .~. Fire Department Alarm System: Fire Departmcnt Alarm System Acceptance Inspection. This inspection must be requested' and approved prior to requesting any occupancy approval. .' r, ," if .' . Post and Beam: 'Prior to floor insulation or decking', Framing Inspection: Prior to cover,and after all rough in inspections have been approved. ., Firewall:, Located and const~!Icted according to plans. -.. ~ . . ..~.l:/.:; .;~I:':l'i:.'-b" '~.:: ~~~I fi~ .. , Masonry'q~1"~I~ ;;~;:: .~~, .....!:~ i'':'" : ';"0; 0:, : . '. ~ ~ I, Final Fire Dep;rtment. After all requirements of the Fire Department have been met. .. ~;. \, ~, Finai BuUding:After all required inspections have been requestcd and approved and the building is complete, . p." . .,i, .': :.:. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection, , Underfloor Mecbanical. Priorlo insulation or decking and including required testing. ,) Rougb Mecbanical: Prior to. Cover . . ""'i1:o Final Me,cha'!,ipal: When ~U mechanical work is complete, . .'lhli'r'.'~ .l ' ,1\ Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to CityIBuilding:lnspector. ' .' ~r)l~~~', t, ~, .~'.; Epoxy Arichors:. To be done by Certified Spcial Inspector. Provide Inspection rcsults to City Building Inspector. .' . Ceiling Grid: After drywall approval but prior to cover. ,) By signature, I state and agree, t~at,I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certifv that any and all work performed shall be done in accordance with ,\,. 1;1. - . " . the Ordinances !If th~ 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, . I further certifYlf~.M:o~l~ contra~to~s 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 thc street, that the permit card is located at the front of the propeny, and the approved set of plans will remain on the site at all times during construction. ., 'f' ,;".(: - . ~~:~.~~ I ~. ,} \ '''.'' ~, g," ~ ':'"'. 1.' p.t '''t~ Owner or Contracto'rs Signature ' iJl. \ , . . ,: i \ ." "~ "+!l i~rl~)i~r'i~,!i ,Ll ",,:~'. ) I . ':,.-.1.: ;,I, '. '. Date Paee 4 of4 '~~'.'::.~; ;:.J, 'c'" :J,,: ..:;:: ,ff.; . ' ~.{?:::J~:~ft~f~'~ 225 Fifth Street'( :~ 0{ , . '~'" Springfield, ,Oregon;9'Z477. 54i:726-3759 PIit;iib'}?t'f~~;'t;i RECEIPT. #: Job/Journal Number .;; ;De'scr.iptio'n, ':'::}~~:/&';.":'</'; ':0;":"""'0'.'",' -., '. .,:..J-,(o.""" COM2009.0 12~0:: i\1i:F';(n~f!ic ~igi1abiPanel COM2009-0 1260. :Y" ,:J:':l+;;,50/o'Technology Fe,e C0M2009-01260..i';':j::{.+.12% State ;>urcharge .;r:;~ ',~ , '-. '}.~':~:~~>:,:{-<~i~ . ,~~:~. .,., Payments: Type of Payment CreditCard Paid By ROXANNE E. MARTIN. ,lh;t::,~ "." . ."\l~~~::'.:':::S' ,', r ..;...1"....__ j :'~ r , . 'oj ." h." , , :7:. .~! i:.:I~O~;~::~.. ':::\ t :, r ... ,'" .;~"-,::,.iH,:~:~:~<~~:~: 0 , ,..'rJ'.;jJ....~," "" -,- , .', " ','t, 1:- .J 1 i~ .i .~: ~~ ::' ~J;r:~ . 'i "~:, ~I,,.\ . . ~ '.' Y.' . !~' , ~ i '.~ ': "'JI. .', 'l~"~'-~ ~,~L' . , ;;\ ,_,~ _ .____......vn : _'1 ';. , '. ~ '" . , /. ." . .: , ... :'.:. ~~. ~;t ~: j ~\ .~.. . t. ',"": f'.' . - , ' :h' \, ,,__ ~~ ,,- f. \ .n, ~ J. :..~.' .i 7 t.' ;. :,~~ ,1:; '11 ~,~~i~' I ~ \ ' i':, 't " I'" , .- ,I,-j ,i '''f,' '. I I~ ,.... -:~ :~~' , " cReceintl ~ ; l' , " ~i"1-~~ f 'f' ~:!, .- ,-, - 1'-;' '. 2200900000000001]69 Received By Check Number Batch Number ~;. . NJM " " " " Page 1 of 1 City of Springfield Official Receipt Development Services Department Public Works Department Date: ] 0/12/2009 Item Total: Authorization Number How Received 21270 Phone Payment Total: 10:08:06AM Amount Due 63.00 3,15 7.56 $73,71 Amount Paid $73.71 $73,71 10112/2009