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HomeMy WebLinkAboutPermit Electrical 2009-10-9 (2) SPRl:GF1:LD,~ E~~ l....u....- COM Z()() 9- 0/ ZbO -.... _ Penmt no.: I Date: /0 - 9 - C> ? 225 Fifth Street+Springfield, OR 97477.PH(541)726-3753+FAX(541)726-3689 This permit is issued under OAR 918-309-0000, Permits are nontransferable. Permitsexpi~e if work is not started within 180 days of issuance or if work is suspended for 180 days. ' ~~~lliIll!:otAE1\GO'ilERNMEN;JW?APPRo'ilAIl"~\1i1q','["ri!1\'l<jl '~L~~\~~~k'flr~EEE~(SCHE[),UtE~'ll~rt~~i1'f~~~ ci~~:;appro~alve~fiecl? []~e~ '" . []N~~"'-~""'I ~~I!!~~'I~!!!!!!~li~12!11~~tll/i~~~1 ~:=~:~1~IAmEG~rg~~~~~;~:~;tR!1CIIO~~=~~:7?~~11 Residential, per unit, semee included: ~~~~i~iJ<>~l'SIl;E~'N~ORI\lIATIONiiiAN[ji~AJ:I()N~;!1t~'l~1 \1,000 sq. ft, OT less (4) /I '- I I Eacb additional 500 sq. ft. or portion Job site address: I. ' . tU lUlU-j thereof City:c . " " , State:O~ ZIP: 0, 1, 'I 7 ~ I Liinited energy (2) I Refere ce: f 0:> /J>'IV IJaxlo':O{fO J I EachmanufacturedhomeoTmodular rI~;i1i~w;~W~~~j~~~[)eSCRI~mION!OF~),W_d_R~~4~~i~~t5~~j dwelling service or feeder (2) I/l-tll . atr:LSs ..5l.cun'h A " \"1I<..f..etn. .10 I I Servi-:es or feeders: installation, alteration,.re/ocation I DCi;m COWer j I ~ I 200 amps orless (2) $ 81.00 $ ~'!I"iJ";*,:;r""%,"f-';Si)i"''''P R'O,"E' R;T,ViiO'W N' 'E"R'iir!l':);!e;11lfiJO""i"''!\';1:i'i~''" I 20i to 400 amps (2) $ 95,00 $ 1~:::"''''~''~{~77-f ''';'-''''i'';''~'''''';'''"'0'~i''''':'1 I 401 to 600 amps (2) $158,00 $ I Address: I 601 to 1,000 amps (2) $205,00 $ I City: I State: I ZIP: I Over 1,000 amps OT volts (2) $469,00 $ I Phone: I Fax: I I Reconnect only (2) $ 63,00 $ E-mail: I I Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or farm property 1'20()amps or less (2) $ 63,00 $ owned by me or a member of my irrunediate family, This I 201 to 400 amps (2) $ 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) $126,00 $ Signature: I Ov~r 600 amps or 1,000 volts', see services or feeders section above fS~::~:::~~N~Cf}~;h~:~AT.t~~:~:::~{11 :r;::~o:i::::: ;i::~~:t::::T:::~:n:,:~::e~r feeder fee Address 25'117 . svJ C(lJU/PY! f'red..12J. v ~ I I ,Eac.hbranch.ciTcuit I ' I $ 6,00 I $ City" wil~II.1lt: I State 'oK:. . I ZIP: C)lt170 I I ,~i~~~7"foT"PT'!'Ch circuits without purchase ofa service OT feeder fee: I Phone 5fJ3' {}J2- qCz.OO I Fax '5O::s '&~2 -'l5OOl l---f',i"-,,,bflln,Ch'cireuit (2)," I I $ 55,00 I $ I E.mail: rfJ><.Cu1ne..fh@rC5S ~(S I l--f~Sh,~,dfltnonalhTanchclfcUlt $ 6,PO $ I CCB license no.: t, 7 III 7 I BCD license no,: 34, /1'-1 tt-4; f-Ms~el1aneous fees: service or feeder not included I Signing supervisor's license no,: q) 2-<:fLr:; I I Eai:hp~p or irrigatiOli ciTcle (2) I I $ 63.00 Print name of signing supervisor: 'TX:a.fl f.!ee ~ I I Each SIgn OT ouUme hghtmg (2) I $ 63.00 Sgnature of signing supervisor 1\ - J i.l- - /, 6 _ I I Sign,' ;11. circuit or a li~ited-energy panel, I I I $ 63.00 I . ~ [(Jtl ~ - alteratIon, or extensIOn (2) [ Each additional inspection: (1) J I $58,00 I $ r 1_~;1~~r~~~~1t.~fJ,i:~R'ii:l~~~T~~.uS-g~:;*~fJl:~~~'f~I:~\ I (A) EnteT suhtotal ofahove fees I $ 1_1- / (Minimum Permit .Fee $58,00) to 'J I (B)'EnteT 12% surcharge (.12 x [AJ) I $ I Sit? I I (C)Technology Fee (5% of[AD I $ 3 ./5 I I TOTAL fees andsurcharges (A through C): $1 ~ .1/1 '-IiI $134,00 $ 25,00 $ 32,00 $ 63,00 ~ && ~I\:\\\) . \~!ff n ~~ 440~2584-J(9/08/COM) , I I I I I I I I I I I I I I I I I I I I I I I I I I $03-1 $ $ $ $ $ $ ~ , .CITY OF SPRINGFIELD Building/Combination Permit Status In Review :'~":::::.,, "-, ';;i'~~~~3~~e~i~!i~~.~~el~:.;?~*~'~f/:'\; ':' 541-726-3676 F~x'::{Ci:' . . :; 541, 726.3769I';:sp~ciio'IiLiue '{;:,-;! ", .' .~, ". ":>:::' ~ :i'~~i:<.'~::~:,x;,..,;'~~,:,:;,t:.~' PERMIT NO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: 08/26/2009 04/12/2010 $ 1,300,000:00 ~. ,; \'( . "':';i,."''''~;;;; >".' h SITE ADDRESS: ' 123 INTERNATIONAL WAY Springfield TYPE OF WORK: Interior ASSESSOR'S PARCEL NO.: 1703154001101, ,. . '... ~;) , ,,'" ''''',' "':; ,/,,,:,;,,.-i;,, ....,', " . TYPE OF USE: Remodel . :PROJECTDES9R.i:r~i()Ne!tD*j~rs:~~ie~iSto"-age Remodel: Original Building Designed Pel' 1994 UBC . .:.y:<:,/.;:.i;/~'.- ..'~~ ;. '.;- Commercial ,: ()wner:,. PEA:CEHEALTH , "i:Address:',:' 123\INTERNATlONAL WAY . . .. ~ >-', -"-' - . ~.; - '.-: "i" " , 'SPRINGFIELD:OR"97477 ' () I CONTRACTOR INFORMA nON ~ .1' . ~i . " Contractor Type':i;,(if$.Contractor Geueral ,~nhIA-'''~DATA SPECIALTIES INC Electrical "'L '< ' -- , , OLSSON INDUSTRIAL ELECTRIC Fire Contractori[i;y'i'):;~' HARVEY,& PRICE CO Low Voltage EleCtrical ,C RFI ELECTRONICS INC OREGON '.,BUILDING INF~RMAnON I License Expiration Date Phone 714-523-8489 63473 01126/2011 541-747-8460 77 10/3112010 541-746-1621 67147 0710712010 408-298-5400 # of Units: : ~rimary occup~ney,,,qr~uP::_:cS:~"B ' ., Secondary Occupiincy'Group': '~"'r SI Primary Constr'uciion Type lIB . ." . . , Secondary Construction Type: I # of Bedrooms. 'lL.:t ,l~ '. I.. ".. i~ . - ',. j.., ft . ,>'; ~"Ii\."i ',' " # of Stories: Height of Structure, Type of Heat: Water Type: Rauge Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: Yes , D~VELOPMENT INFORMATION I Frontyard Setb~cl{:1: ~:!.} -- , Side 1 Setback:T ;"r;:-:-' , ' , Side 2 Setback: '1, \ " , Rearyard Setba~k;, .~r :'I~L,. Solar Setbacks: ' ," -- , , 1.,.0. , ...\_:t::11~ij^ . ~, . Overlay Dist: # $treet i'rees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I ,i I"~P 'f~~' ti'; ,- : ,. I PUBLIC IMPROVEMENTS I ATTENTION: Oregon law requires you tD ' , "," I II' ,,,II"" q"ooted by the Oregon Ulility Street Improvements: ';.: ';,:' . "'OD\<. 0 D,Sidewalk Typ,e:Those rules are set forth ..,c' , ," V .. j(; :-,;-';;''''''1' F I\-1E" " Notllicatlon ven,c:, ,: 52.001- Storm Sewer Available:\:G\3"" '-c-:::'1\lIll EY--PIRE I \'JIll IS NOl in Of\Do-Wnspouts/Dr'ili.l's:')ugh OAR 9 I b Special Instructjon'::V:(S~ PERMIl'S OcR 1\-\IS pER FOR 0090, You may obtain copies of thle r~~~e Y ::' \~,\ \1~\ORI2ED U~n \~ 1IP.f>..\'-\DO\'-\cD . calling the center, (Note: ii~e ~!'o~~catlon 'Notes: , No ehauge in occupancy) No'new SDC charges, No worksheet attaehedlber lor the Oregon Ut21 2Y344) ;: GO\ji\\'!lp,<jV',}{PcRIOQ, Center IS 1-800,33 ' , r:>.N'I1 ~O DI~, , . - , ~.,l I ~! ".',."~.. 1"-' 'il"'(;; . ,To.; ~< {: ' " - iJ . _"..;;...,;r~". ::1;' ~ ::f~ :t: ~ ., Page 1 of4 '.:: " .. " . ,t~i;~:~~~f~:' , i' ,.~ :iStatus ' "jJn:'Review, " .. "~i ;\~:...'. .:: ":;';"~l;.~'~:'.d~{;:,3:::'>';': '.'.~-......:~';';~\.:V '225 Fifth Street;Sprh;gfield;'gRi" '",; 541-726-3753 Phone ' i/<, . j' .. " 541-726-3676 Fax ,,' ." i 541-726-3769 Inspection Line' :';;.:-~1t ;',~r< ~:~,i', . ~!:i':' .~".: .j};/..:':~ic:" ;' < t::~~~M,:{~;:~~?f~":'" ;<:.~,. , ,'fi,-?Y:~~~~~~;i'~~J;')i'V.u;a, :,i ' . Description';': :Tvpe:<:lf CO!!st~l!c!i.o,Il .:: .' '. '.. .'~~'L-":~'" "." . Estimate" Estimate ','::'", ;:c " 'to;,,: .,_'..;." :,"'...,.:..:....,;..,;.. ,~; ,~ {f"~~:~;', , I..",',j. {,.,;:.- 'i " . !":.J} -." . 'IF~e DescriPti~~f!~~i~~Ji~:~~::.~, ," ..I"J:~..'!l."'" ";. ,'~ ,Plan Review,CoinmlIiid/Public ::!, ,;. + 12% State Surcharge' .,' + 5% Technology Fee Add, Alter, Extend Circ " Refund - Electrical ,', ,,' ,4[ . .:'~'li; :'lll";~l;ld ~ <-;.:'~--L't:':...!\:" " Refnnd - Surcbarge' :'01., -:., ,"- '~ .._ .1: ';">. - , .. t + 12% State Sui-cbarge ' ", ,. + 5% Tecbnology,Fee : , ,,". , !. .. "'- - - ';; _1.. "'~":' : ';,Traffic Sig~al';'Jr~~i~I~:~~t.~~'. '~~~ ~ .i~ I, " . :12-: .~. Totai' Amou~t Paid 4 " '. , , " . . n ': _ -' .t~ .:;!~. , ,-' 1 I ,"ljJ~;:U~' tlir'~~-:l:-;hi''l1 Fire Department Review' ',-' '09/11/2009 11: ~ ~f; :;.'r '. (, ,flannine: R,evie~" h :.. 09/01/2009 i ," ; !t({;_~~,21:;:~t"~ ...L. .~~:_ , ..'h' ""'_'''",'.__",,, c, I' '1."1" . '." ~ ,', .~ /-. J '; J Structural Review' 09/01/2009 Structural Review' r.:;ij1~" ",!11" 10/05/2009 -.., ...j!~. . SUB Review. ,'J; ':~ l~;: . 09/03/2009 I,f~; :' t; . ,il. , ., 'I \! .1.:' 'it ',". ;1 -I" J. I!. . J I ... t1r .'I~' _ i1-,' ~~ ~. ' ,. . . . 11t.. ~1'~' "" t.., 'I .. . Initial Review hr' ", -' __ ",",' , ::"': 08/28/2009 I' .. Public Works Review 09/01/2009,) . l~ ,;.(1; c<'1~~\r :,' ". ':'.l , . 'I ' ii;..,t.i.t,~L~B<,.. .!~,: ~ !L,\;i'~, "n' .;j'!"""T".~ "t' . ';f"~ '\: 'i"'~ ''':~i ~ ~ . ~ ..., ,+,,11 " , ,1[,1'\','" .. ./" ;4~..!" :':_~.l ,,' .- :,' -- , \, '\i:: d~ y.- l ii. " CITY OF SPRINGFIELD Building/Combination Permit '," PERMIT NO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: 08/26/2009 04/12/2010 $ 1,300,000,00 I Valuation Descrintion I' , , $ ~er Sq Ft or multiplier , $1.00 Square Footage or Bid Amount 1,300,000.00 $1,300,000.00 $1,300,000.00 08/26/2009 :' Value Date Calculated Total Value of Project ti L..~pp~, P'lirl J Amount Paid Date Paid , Receipt Number $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 1200900000000000990 1200900000000001034 1200900000000001034 1200900000000001034 154008 154008 2200900000000001169 2200900000000001169 2200900000000001169 $3,724.89 '.l Plan Reviews I WE Harvey and Price - Modify Sprinkler System Amy Chinitz with SUB Water Quality Protection requested additional information on the chiller from Scot~ Koons (contractor) on 8/26/09, Called with 2nd request on 9/6/09. LM ' ',' Plans and energy forms set to SUB/IIh 09/01/2009 APP Piau, not submitted in sets, Charged for extra staff time to compile No change in occupancy. No new SDC charges. No SDC worksheet is attached. LLH 09/01/2009 APP EW Pae:e 2 of 4 ~;y~ ~;~~t._. , ,. Status ' In il.e~ie~f : /L: ,. i':; , .'" '{ji "-:":.,,., 225 Fifth Street, Springfield, OR'-;",,;: ":': 541-726-3753 Pboue " ~:'.- 541-726-3676 F~x .-, ,,' __\:""':''-''-'' 541- 726-3769 IuspectiilliLin'eL::3f~W:,;).-,; " .frti~,:., .,';t.d;'~::;-i.:,:' :;:;.:-:~ ';,:"::::',:;. ~f~{f'.~:' c Plannin:::;);t~I~;:~;;i;~,: . , ,. ' \." 09/10/2009 '. ;'\ v', "~t<"';:~~i~. _' l.) Iuitial Review',' :<iiz"\;\{09/~9/io09\" . ;'.::;1 :. ;':;:~~i;.;W~{t~.~;!;~~f~~r~~~1f~:~~f~';&" . ':: ( '1' ,.. , " Structural Review " , 09/15/2009 , , '. ,; ~ II -"4- ~! -;-,J;~~j ,''''-:ti'!l:,',:''-!,,\,')~l'i~h<!,..,'''''l...,:( ~ '-,' , '.' .' ", .~.'. ' ':~\""'",=",., ~1'1~-'~ ~ 'A' ,~ Fire Departmeut Review, , .,;; " 09/01/2009 'I :, - .,I::-r' , ~;~'IT;:' ,:,~i '- 09/~:1/2009 . Structural Revi~w if:_s~~. ,,[,.,,',.:;'...V+ . . ".;.~;};{,rt(T'! '" .'" \ Fire Departme~.~ Review 09/30/2009 :i;,~tructur~I,l!e[v,~tr.;)I"';1~:' ~9/~0/2009 . ,ll~'f,' h A ~',';' .t- I"~'" ,,+.' . ".'.' ;1,1.".. _, . "r~( 1. !'" Initial Review .- -: '. 10/05/2009 ." r'" Structural Review ;,1 1 0/07/2009 ,) ~i/'! Ht~; '::." ~ ~ i~~,~ ' , "",;!.,:; , '~l . \ ; I. t; ~ 'I ' . .. ! : . : j1~':: ~ \~ . "'.. 'I' Fire Departmeut,Review, "" 10/08/2009 .,: -..F.." 1" ,,,I .!I.!! , , .~J;':ijji'it~,~j~. '41." 'I'!::~- ';:' :'~ ~ ~.~. ~" . .(:~" ,.- . ;~;'!~.,' :, ): i~r~!i.ll"): . .'} ""'.'~!',::I/'. . ,~;~u '~[~";,;~iE:- : ~'t'~ \14r~ ,'l-i '~ " , ..:.:;~: ,L ; ;;~"pj '~f!~ t'. ,:~,t '-~f'~ ~r;." . ~ . 't~ .~': .~ 'ri.' '}4'-!; ~" r ',' ii, i' ., ;,,,' ,:~:. ,-:~;~~: J ,'; 09/1 0/2009 09/11/2009 09/15/2009 09/18/2009 '-' 09/21/2009 09/30/2009 09/30/2009 10/05/2009, 10/07/2009 10/08/2009 '-' ,) ,.,' APP APP lQ WE WE 10 10 APP . CITY OF SPRINGFIELD Building/Combination Permit PERMIT.NO: COM2009-01260 ISSUED: , APPLIED: EXPIRES: VALUE: EMM LLH KLK GRG KLK KLK KLK LLH WE KLK APP 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 011 plan. Harvey and Price. Modify Sprinkler System Starting' 1st Review. Waiting on missing pages. See attached document for Fire Department Plans Review comments. Completed I st 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: I1-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 an ,insp~~tion call the 24 hour recording at 726-3769. All inspections requested before 7:00 "~;m. will ben!.ad~: the same ~orking day, inspections requested after 7:00a.m. will be made the following workday: ":~ ".' ' Paee 3 of4 ). l:......;; !_fti,~~; .~.. . ,) Status < . :'~n~;".~l' i , 1, CITY OF SPRINGFIELD ,., lq'; ,i Building/Combination Permit In Review '.' 'J' PERMlTNO: COM2009-01260 ISSUED: APPLIED: EXPIRES: VALUE: . ,. ':. 225 Fifth Street, Springfield, OR,,:-;::,; , 541-726-3753 Pbou~",:~,:, ",t},:[i::j/ ..' 5.41-726-3676 F.~;xj~i;~~;;~;~~~::,:;:",;{:~:i"~X~~:.'(~tft: , 541-726-3769 Irispeciiiiii"Line'"",,;;, , ~ .~t~. -: -:< ',~ : ~ ~~il . .t' '1"'1(': "... \-,!' .",,, , .'j. .:) 08/26/2009 04/12/20 IO $ 1,300,000.00 ',. 'j"J:~~~:Ji:;~~i}~:~tll'~'~f;~~~:" '~~;:.i~,j ~/c't:~}:.'. \. '. ~'~ .J?\C,:: -:;?::~?3;~~~~}::.: ,Re,\uired Insnections I ~ ~.: Rough Electric: Prior to Cover >" N Fiual Electric: When aU el~ctrical work is complete. /.,\ _..e ~', :.; "":.':.-:v;::';:i;:~'~':;':;; 'l,. \. -, : Fire Depa,r~njeiifqeall'i\geqiSystem: Coord ill ate inspection ,,:ith City Fire Marshal's Oftice . . :,~:~;";~ ';:~l-~~'-~~i~{\ ':(.:.c: . .'.':i' ':';; " . , , ': Fire Dep}irtnjeut-8prinkler System: Prior to cover. Hydro pressure test, fire line tlow test, .,r,_", ".... FireDep~ft;neut.Alarm System: Fire Department Alarm System Acceptance Inspection. This inspection must be req~~sted and approved prior to requesting any occupancy approval. ' . .j " ~ .~- Post and Beall]: Prior to tloo-r insulation or decking. Framing Inspection: Prior to cover and, after aU rough in inspeCtions have been approved. ',' ,'.J FirewaU:l,Located and coust~ucted according to plans. ' :. ..;._':1L:Li~6l~~",.;.j~i:UL~itrr~.i MasonrY~'r ~ JI:l1.....\;..~..:,:; .;i ",~V " ' !tt~;l'l~ :';..':~' .' , ',r:' ..' Fiual Fire Department. After aU requirements of the Fire Department have been met. . ~,;:, ':)i,'l: _;~.;~:~' Final Building:':After, aU required inspections have been requested and approved and the building is complete. " .' ," 'j'.. Backtlow ~evi~e: Prior to'covering and provide a copy of/he test report on site at the time of inspection. Undertloor Mecbanical. Prior to insulation or decking and including required testing. ,) Rougb Mecbauical: Prior to"Cover .}1\11J.:i,1!l1>.-.f:: ..~., J~ :i::- . Final Mecbauical: Wben all mechanical work is complete, , . ~',;J; ,f-i, 1! 'r' " , Bolts Iustalled iu Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to . ,.\', City'Buildiug'luspector. " " , :;;r ~ 1!'O,'1; ," '~." ' Epoxy A,;chors:' 'To be d6ne'py Certified Spdallnspector. Provide Inspection res~hs to City Building Inspector, Ceiling Grid: After drywall approval but prior to cover. . ,'t' , By signature, I st~te,ilUd.agree; th~tI have carefnUy examined the completed application and do h,ereby certify tbat aU informatiou ber,~~~,!~,h~e ani! corr'e.ct, and I further certify that any and aU work performed shall be done in accordance,with the Ordinances of tbe City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and -- that NO O<,:CUt:ANCY,,will be made of any structure without permission of the Community Services Division, Building Safety. 'I'further certify!tbiltiouly contractors and employees who are in compliauce with ORS 701.005 will be used on this project. I furtber agree to ensure thai' all req,uired iuspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of/he property, and the approved set of plans will remain on the site at aU times during coustructiou. t.:::! {[_'~~J:~ I ,j "';,_i_~~~.",::" ;.~, ..~... -' ", - ~r. " .J .j: . ''':.' - "', ~~ '. ,-, , , :' " Owner or Contracto'i-s Signature " -- " I ':"!:rL' V:< ", 1 ,1'1":11,, 'j , -";1f:I"pll J~';;1.~! , . . ~ '-:'" . '1 Date :h;t2:';~' :l -: 'r " Page 4 01'4 'J! ~f~ ~.~: ::~ ;i,: ~;-' , .,~ .'.: -I -~ 225 Fifth Street 1;; ,;r'~~ Springfield, Or~gon' 97477 541-726-3759 Phone, " ii, ll';\' ,i;-;~. , <, " RECEIPT #: Job/Journal Number... Qescription ~.~.._,.. _. COM2009-01260" ,.Traffic Signal ~:'Panel COM2009,O 12qO h,~m:.};j;'iAf:'o1f~h~~1~~'Fee COM2009-0 1260: ili}{;!!~:I;~% Si~te Surcharge ;,' . t ,,::'J.j,.>(,.: Payments:. , Type of Payment CreditCard ';:";(;:Jf~i~~if~~!:; ;:;:':1~i~:l~~L~~-;~; -~ : ROXANNE E, MARTIN " 1-;/ '- '\;;'.,:. :1: .'( ''''11 .. .:"i;rl~;:'~~" '. ~ ~.;< ,\~L;~, L .. .,'I.....l,,,,. '!yii- " ,,' I,:, I. --.1. ..-,....,. . . ~~~:.l~.ili;,j~~f.. ::~~; ~t:~~~l-; . "'1r i:~qf'.~~~~.'.i.~ ,~. \ . -. '<; I. . <!S...!.. >. ,'.. ,- - ~~r'"'' '1~~' h.j ;~. '. ~-;'11 .~!A:'" ~: . " ..\ ' ,t:' - ~,. , .\;. 1;~,j '? I' ",;'1.\ ~!:,lr.~~ :i~'. : ,ij;:: :p~' 'j/ '{ f .... ' 'r .' .~! .' - \~ ..... !.W.,:l-~'Af ,i-~~\ ,J. , .. "... ~.~~'~~L'; ~.. ., ~'. ,~ 'lI,' '-.:, ",'-.. ,'II ~. , ,.,'u, , .of.i:1:. :-; - -:\'1"'- :t:: .' "tj '1_,1 ;,!. ~ ~ , ,'.. },~~; ~ ;t~q2 0" :H " i~- r:. . ,to_ : ~ . I!:;, \ ., 'II ~j: . ~. .'~ ~, i..1 !!,.Ji 11,;;;~ ..;.0 , r 0 :~, 'J', ~~ .. .,:; cReceintl r'!;r,~'~ . .;.;!?::. ;~ ..~~'!Bi' ':, ""':'f, " 2200900000000001169 Received By NJM <-'heck Number Batch Number ,.; " 1,_) " -' " Page 1 of I City of Springfield Official Receipt Development Services Department Public Works Department Date: 10/12/2009 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 10/12/2009