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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01744
ISSUED: 12/09'2009
APPLIED: 12/08/2009
EXPIRES: 06/09/2010
VALUE: $ 160,000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE AnDRESS: 5777 MICA ST
ASSESSOR'S PARCEL NO.: 1802033303900
SPRINGFIETVPE OF WORK: Single Family Residence
TVPE OF USE: New
PROJECT DESCRIPTION: New single family Dwelling SAME AS 1852 S 58th
Residential
Owner: HA VDEN HOMES LLC
Address: 2464 SW GLACIER PL STE 110
REDMOND OR 97756
I CONTRACTOR INFORMATION'
Contractor Type
Contractor
License
Expiration Date Phone
, BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
2
# of Stories:
Height of Structure 15.00
Type of Heat: orced Air Electric
Water Type: Electric
Range Type: Electric
Energy Path:
Sprinkled Building: No
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
6,750
832
I
R-3
U
VB
280
I DEVELOPMENT INFORMATION I
Notes:
2
Ves
16.47
I requireS you to
ATTENTION: ?r:?o,;' h~~11e Oregon Utility
fOllOW run;;;", u............ las are 5tH 'VIUI
I PUBLIC IMPROVEMENTS ~Notification Center. ThO~~~uh OAR 952.()()1-
In OAia~~~rPq1;00,1~ th ,9 s ofthe rules by
Fully Improved 0090, You may Bfitam COPI~th telef)homide 7'
Ves cda\lYg'- iQSrD\llti n~l\lotet'li~o'!i!llltllllntte r
Storm water to cnrb via weep hole number tor the ore90~ 2344)
NOTICE: EXPIRE IF THE WORK. Center \81-80 - .
THIS PERMIT SHA~~ HilS PERMIT IS NOT
^lITHORIZED UNO ',.,~~"cn mR
NCED l''' '.~ ,,~_..,,-,,-
COMME I' ~~,:]~ . D' .. I
ANY "ISO DAY F~v:a uatlOn escnotlOn
18.00
15.00
10.00
40.00
0.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
2
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Description
TYlle of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of 4
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 I'hone
541-726-3676 Fax
541-726-3769 Inspection Line
Fee Descl:iution
+ 12% State Snreharge
+ 50;', Technology Fcc
I Bath One & Two Family
1st Appliance
Addressing Assignment
Bnilding Permit
Credit - Trans Improv SDC
Curbeut Permit
Dryer Vent
Exhaust Hoods
Fire SF Fee - Residential
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 MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC TnHl l{,eimhul's-Residl'lltial
SOC Trans Improvement-Resident
SDC Transportation Admin
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
Total Amount Paid
Amount Paid
$181.67
$93.55
$220.00
$79.00
$38.00
$952.95.
$-931.65
$88,00
$9,00'
$13.00
$55,60
$211.00
$250.00
$-30.00
$134.00
$25,00
$352.74
$463.89
$10.00
$1,044,54
$101.97
$122.50
$211.21
$931.65
$17.95
$88,00
$624.74
$63.00
. $18.00
$2,858.00
$8,297,31
Total Value of Project
Fpp~
Date Pnid
12/9/09
12/9/09
12/9/09
12/9/09
1219/09
12/9/09
12/9/09
1219/09
12/9109
12/9/09
12/9/09
12/9/09
1219/U9
12/9/09
12/9/09
12/9/09
12/9/09
12/9/09
12/9/09
1219/09
12/9/09
12/9/09
12/9109
12/9/09
12/9/U9
12/9/09
12/9/09
1219/09
12/9/09
12/9/09
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-0I744
ISSUED: 12/09/2009
APPLIED: 12/08/2009
EXPIRES: 06/0912010
VALUE: $ 160,000,00
Receipt Number
120U9UOOOOUOOOOl317
12U09UOOU0000001317
1200900000000001317
1200900000000001317
1200900000000001317
1200900000000001317
1200900000000001317
1200900000000001317
12009000000UOOOl317
120U900000UOOOOl317
1200900000000001317
1200900000000001317
1200900000UOOUOl317
1200900000UOOOOl317
120090000000U001317
1200900000000001317
1200900000000001317
1200900000UOUOOl317
12009000UOUOOOOl317
12009000UUUOUOU1317
120090000000UOUI317
120U900000UOOOOl317
12UU9000UOOUOOOl317
120090000UUOOOOl317
120U9UOOUUUUUOOl317
120U900000000001317
12U0900000000001317
12U0900000000001317
12009000000UUUU13]7
1200900000000001317
Plan Reviews I
Plannin2 Review 12108/2009 12/08/2009 APP DDK Access restricted to I drivewayllo!.
Follow street tree plan.
Public \Vorks Review . 12/08/2009 I2IU8/2009 APP LKW Storm water to curb via weep hole
Structural Review 12/08/2009 12/08/2009 APP CJC As noted on plans
Paee 2 of 4
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-01744
ISSUED: 12/09/2009
APPLIED: 12/08/2009
EXPIRES: 06/09/2010
VALUE: $ 160,000.00
225 Fifth Street, Springfield, OR
54] -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. will be made the following
work day.
RPll.,irprl.ln~nprtiow
Erosion/Grading Inspection: Prior to gronnd distnrbance and after erosion measures are installed.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection. I
Footing: After trenches are exc~,vated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to floor insulation or dCl~king.
Floor Insulation: Prior to decking,
Shear Wall Nailing: Before covering sheathing with finish materials.
Framing Inspection: Prior to cover ..lId after all rough in inspections have been approved.
\Vall Insulation: Prior to cover,
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Final Bnilding: After all rcquired 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 Plumbing: Prior to insulation.or decking.
Undernoor Drain: Prior to cover or placement ~f 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 Se~"er Line: Prior to filling trench.
Final Plumhing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
UndertloorMechanical. Prior to insulation or decking and including required testing.
Final Mechanical: Whcn all mechanical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Rough Electric: Prior to Covcr
Electric Service: Approval required prior to utility company energizing service,
Pa2e 3 of 4
CITY OF SPRINGFIELD
Status
Issued
'Building/Combination Permit
PERMIT NO: COM2009-01744
ISSUED: 12/0912009
APPLIED: 12/08/2009
EXPIRES: 06/09/2010
VALUE: $ 160,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541,726-3676 Fax
541-726-3769 Inspection Line
Final Electric: When all electrica' work is complete.
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
jnformatiOl~ hereon is true and correct, and I further certify that any and llll work performed shall be done in Hccordance \'t'ith
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUI'ANCY 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 on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is rcadable 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.
'-~~/A~
O'~ncr or Contractors Sign~
/,/- '7'- O'<}
Date
Page 4 of 4
, ,
I!~ Willamalane
't-w Park & Recreation Oistrict
Job. No. .
1!9-/'7 iL(
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009
.,,' . , . . '. ",'
NAME: HN-/ DEN' HOIo\E::S ' PHONE: ?-~O(#~JS-
ADDRESS:,J.Lftl. 4Sw t::,-Ii-~/t:.YFf i!-J>1Vl1J1> STATE@IP: q '74'J'i
. ,
. LocATION OF PROPOSED BUILDING SITE:
Street Address: S'J?iJ I'll tl1
Plat Name:
Tax Lot Number:
, . ,
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are ori the
.~~. ,. ,
A. Sinale-Familv Detached
NO. OF UNITS
( X $2,858 per unit =
'$ '2-Frd
B. Sjnale~Familv Attached
NO. OF UNITS
X $3,100' per unit =
$
c. Multi~Familv Abartment
NO, OF UNITS
X $2,641 per unit =
$
D. Sinale Room Occuoancv
NO.OFUNITS
X $1,321 per unit =
$
E. Accessorv Dwellino Unit
NO. OF UNITS
WILLAMALANE SDC
X $1 ;550 perunit = ." $
$
. 2. .SDC CREDIT {If applicable) SDC pay~r must furnish proof of ,
WillamElIane Credit approvaL)
$
3., TOTAL WILLAMALANE NET SDCASSES$ED
. (if SDC reduced for Credit)
$ 23S!)
,l~
/2,
. 'Date'
4,
Ocr
(j7
, -DevelbprilentServices' DepEi'rlril-enl
City of Springfield
5
22S Fifth Street. Springfield, OR 97477tPH(S41)726-3753t FAX(S41)726-3689
. 1'?:;,r':';';';':'-";"''';i~:~''>ih:;.,-,;;.t;~'.''~\''''''.i'iie;'~~~~V-~''',~t;i:,.;~"';':'j
, . ' ~~mOEpARTMENm;USE"QNlh'i:~\'~
SPRINGFIELD ~ .,~,:,.-c-1; ~.>".:"'--' ."~"""'~i;,:,<;;~~:;.1rp~~~6h ~"''''-<~P:'~'''.''
I Permit no. 01-)74=;".>-"1
I Dat~: 1:LlllO 7 I
(
Electrical Perinit Application
D
This permit is issued uuder OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started within 180
days of issuance or if work is snspended for 180 days.
I
I $I.f 'Y
$? )1-
I
I
I
I
I
I
I
I
I
I
1~"""""'~'1l'i!'0'@AJl1ffG0!Z(ERN'M'Ei;i[;'JIj(RER0V!,ig&"""''''~.<;t;~,,~
r~=-;;;~~~I~~:fi~~;~' "'[i~~:~C'L' 'D~~7'-A,;c'''''1
~~~~]~l?JjJ~;YI"t\f~lilJ[iii$Jfji::{t!.ii!EijIQN~~!A'i\t'liB.*1
~~;~~~W~j~~~;~;;~;n;~p}~:~Q~;7;~;;~~%J : ~:~~::ti:l,:,el::.n(:; service inclnded: I $134,00
1 I Each additional 500.sq, ft. or portion
Job site adru-ess: 577; M Ii' '" ' ' '" ",.... . - thereof I $ 25,00
City:~"","C:r 10\ I State: 01<", I ZIP: '17'178' I I Limited energy (2) $ 32,00 $
i~:~;;~~~~~~i'Jil~WJ~~~~~~~~)mi I J~~~I~~S~~~~~~~ ;e~~~r (~rodular $ 63,00 $
I u / -r I \ Services or feeders: installation, ~lteration, relocation
,:';o'J:X.. VJ('C /T'N"" '
D -:1.'"2. JYbC\c:::t/ 11200 amps or less (2) $ 81.00 $
~",,\!,'l;-~: ;::~RB~[l;.fu!iR.-ii:(!l'Wf{I;B~;1fj.'i;;'ii~fuf~i:~\1i;\\fuill&1 I 201 to 400 amps (2) $ 95,00 $
I NIl I \r 1 I 401 to 600 amps (2) $158,00 $
ame: \-k....."'~ v'\. nC;vy-.e <.. . .
I Address: :JL;C6( SC--J ('.,(""ier I 160Itol,000amps(2) $205.00 $
I City: 12",,0{ vYlC'-1 .0 I State: () 1'< I ZIP:')775"G. lOver 1,000 amps or volts (2) $469,00 $
I Photie: )LI/- 2>~- <p')~5: I Frrx:5?//-7'//- ,;!57:? I Reconnect only (2) _ $ 63.00 $
I E-mail: .1 1 :Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 1200 amps or less (2) $ 63,00 $
owned by me or a member of my immediate family, This I 201 to 400 amps (2) $ 87,00 $
property is not intended for sale, excbange, lease, or rent, OAR
479.540(1) and 479.560(1), I 401 to 600 amps (2) $126,00 I $
Signature: I Over 600 amps or ],000 volts, see,services or feeders section above
~G,GN1n~~jJIG)R11ISIsmiN~lr~l}I.C!N~m:[':..i\~~'fJl I Branch circuits: new, alteration,.extension per panel
I Business name: ~r \\J"r(~ F I pC I I a. Fee for branch circuits with purchase ofa service or feeder fee:
I Address: ,.)0 ~ A (ov r?<f CI- 1 I Each branch circuit I I $ 6,00 I $
I City: &,,0\ I State: oR.. I ZIP: I I b. Feefor branch.circuits withoufpurchase of a service orfeederfee:
I Phone:?" -317 - rqqi'. I Frrx: ) I First branch circuit (2) I $ 55,00 $
I E-mail: I I Each additional branch circuit I $ 6.00 $
I CCB li~ense no.: -rfl3Gc' I BCD license no,: ( ..22(J, I I Miscellaneous fees: service Dr feeder not included 6V
I Signing superviso~'~ license no.: I I Each pump or irrigation circle (2) / $ 63.00 $ ~ :.2
I Print name of signing supervisor: Veri <)/"Cikr "T...... I I Each sign or outline lighting (2) $ 63,00 $ I
.1 Signature of signing supervisor: '};, /I.sJ I- '. ~'.JA. L I I Signal mCUlt or a limited-energy panel, $ 63.00 $ I
. PAl! {(JJu..rJ.//D~L-- ,alteratIOn, or extenSIon (2)
/~ I Each additional inspection: (I) $58,00 $
..'V"\ ~ - ~~~~:~:;;:~~N[~~~~~. ~"~~ OV
l\. ~ \"'\ (Minimum Permit Fee $58.00)' $ '),;J......)
'-' o-..~\J I (B) Enter 12% surcharge (.12 x [A]) $ ,,> II~ ;()
(),:~ I (C) Technology Fee (5% of [A]) $ 2?- &.,
I TOTAL fees and surcharges (A through C): ~, c::' l~ ''7l-i
0<---'(,' I
\ ~V 8'-
v~~~
~~.
440-2584-J (9108/COM)
225 Fifth Strcct
Springficld, Orcgon 97477
541-726-3759 Phone
~.~.
City of Springficld Official Rcccipt
Devclopmcnt Serviccs Dcpartmcnt
Public Works Department
Job/Journal Number
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-01744'
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
COM2009-0 1744
Payments:
Type of Payment
CreditCard
cRcceintl
RECEIPT #:
1200900000000001317
Datc: 12/09/2009
Description
Plan Review Major - Planning
Plan Review Same As
Building Permit
Addressing Assignment
Willamalane Single Family
I Bath One & Two Family
I st Appliance
Vent Fan
Exhaust Hoods
Dryer Vem
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Fire SF Fee - Residential
PW Disc - 2nd Penn it
Curbcut Permit
Sidewalk Permit
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
sot Trans Improvement-Resident
SDC Tran Reimburs-Residemial
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Transportation Admin
SDC Sanitary/Storm Admin
Credit - Trans Improv SDC
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
HA YDEN HOMES, LLC
Item Total:
Check Number Authorization
Received By Blitch Number Number How Received
IlJm
0150503 In Person
Payment Total:
Page I of I
10:OJ:18AM
Amount Due
211.00
250.00
952.95
38,00
2,858,00
220,00
79.00
18,00
13,00
9,00
134,00
25,00
63,00
55.60
(30.00)
88.00
88.00.
624,74
463.89
352,74
931.65
211.21
101.97
1,044,54
10.00
17,95
122.50
(931,65)
93,55
181.67
$~,297.31
Amount Paid
$8,297.31
$~.297 .31
12/9/2009