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Home My WebLink AboutPermit Building 2010-1-19 (2) Status C" ~ "." Issued 225 Fifth Street, Springfield, OR 541- 726-3753 Phone 541- 726-3676 Fax 541- 726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01834 ISSUED: 01/19/2010 APPLIED: 12/24/2009 EXPIRES: 07/26/2010 VALUE: $ 1,500,00 SITE ADDRESS: 2481 L ST ASSESSOR'S PARCEL NO.: 1703254306131 Springfield TYPE OF WORK: Garage Conversion PROJECT DESCRIPTION: Partial garage conversion Owner: DASSEN JOSEPH D Address: 2481 L ST SPRINGFIELD OR 97477 TYPE OF USE: Alteration Residential Phone Number: 541-505-7240 J CONTRACTOR INFORMATION' Contractor Type General Electrical Plumbing Contractor OWNER OWNER OWNER , .,,' BUILDING INFORMA TlON' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Heigbt of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: R-3 VB License Expiration Date Phone n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT.INFORMA TION I Frontyard Setback: Side 1 Setback: Side 2 Setback:' . Rearyard Setback: Solar Setbacks: . Overlay Di,!: # Street Trees Rqd: , Paved Drive Rqd: ' % of Lot Coverage: ,.. ,...Ilftetll grIl9~" I...., rMd:'r~J;, follOW rules adopted 1=W6'L ''l"'',~x~A'1ENTS I Notification Center. ..,c L' J.I" :., Street Improvementsln OAR 952-OO1.oo10through.oAR 952-001- " bt I' pies of the rules by Storm Sewer A vallabOO9O You may 0 a n co .' I h" , . . nt (Note: the Ie ep one SpCClallnstruclI,oll: calling the ce er. Ut'lity Notification , number for the .oregon I Notes: Center 18 1-800-332-2344). Page I of3 REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: . .' ..',::,".-':,:_~,),:i;~r.y:~i:\:::::7.F~:ri',{.''':;~~~' NOTICE: ',' ,,' E lFTHE WOR\{ THIS PERMIT SH~~~ ~~ PERMIT IS NOT AUTHORIZED UN IS ABANDONED FOR COMMENCED OR " ANY 1 BO DAY PERIOD. . Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01834 ISSUED: 01119/2010 APPLIED: 12/24/2009 EXPIRES: 07/26/2010 VALUE: $ 1,500.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Oescriotion I Estimate Tvpe of Construction Estimate $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 1,500.00 Value Date Calculated Description Total Value of Project $1,500.00 $1,500.00 12/24/2009 l."""< pqiiJ Fee Description Amo'unt Paid Date Paid Receipt Number Plan Review Residential $37.70 12/24/09 1200900000000001360 + 12% State Surcharge $22.68 1/19/10 2201000000000000044 + 5% Technology Fee $9.45 1/19/10 2201000000000000044 Add, Alter, Extend Circ $55.00 1/19/10 2201000000000000044 Add, Alter, Extend Circ Ea Add $18.00 1/19/10 2201000000000000044 Building Permit $58.00 '\ 1/19/10 2201000000000000044 Fixture $19.00 1/19/10 2201000000000000044 Minimum/Adjustment Plumbing $39.00 1/19/10 2201000000000000044 + 12% State Surcharge $22.20 2/2/10 1201000000000000097 + 5% Technology Fee $9.25 2/2/10 1201000000000000097 1st Appliance $79.00 2/2/10 1201000000000000097 Add, Alter, Extend Circ Ea Add $6,00 2/2/10 1201000000000000097 Fixture $19,00 2/2/10 1201000000000000097 Perm Serv/Fdr 200 amps or less $81.00 2/2/1 0 1201000000000000097 Sanitary Se\\'er - Improvement $154.32 2/2/10 1201000000000000097 Sanitary Sewer - Reimbursement $202.95 2/2/10 1201000000000000097 SDC Sanitary/Storm Admin $17.86 2/2/10 1201000000000000097 Total Amount Paid $850.41 Plan Reviews I Initial Review 12/28/2009 12/30/2009 APP LLH Structural Review 12/30/2009 01/04/2010 APP CJC Approved as noted on plans- Planninl! Review 12/30/2009 01/05/2010 APP DDK Interior remodel only, No planning issues. " '.- Public Works Review 12/30/2009 01/08/2010 APP TSS No Public Works issues. To Reqoest 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. Paee 2 of 3 Ll1 i' OF ~rKmvt<IELD Building/Combination Permit Status Issued PERMIT NO: COM2009-0I834 ISSUED: 01119/2010 APPLIED: 12/24/2009 EXPIRES: 07/26/2010 VALUE: $ 1,500.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line R~ouired Insnections I Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover: Drywall: Prior to taping. Rough Plumbing: Prior to cover Hnd including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Final Building: After all required inspections have been requested and approved and the building is complete. 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 1 further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springlield and the Laws uf 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, 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 further agree to ensure that all required inspections are r,equested 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 will remain on the site at all times during construction. '," c-r~' ;2 ~ .2 - ;2 0/(:) Owner or Contractors Signature Date " , :":'. :l-i' Paee 3 of 3 225 Firth Street + Springfield, OR 97477 + PlI(541 )726.3753 + FAX(541 )726-3689 I ~ , " ",' .~ DEI?ARTMENT USEONL V ~~I~~l?:~/?i'l.. I Date: 21?~O / I This permit is issued under OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. Electrical Permit Application . I ,,':'LOcAI.:;GOVERNMENT AeRROvAI.:<, Zoning approval verified? D Ves D No CATEGORY:,OF;tCONSTRUCTION'. LErResidential I 0 Government I 0 Commercial 1 JOb'S;t~~:dr:~~E~N~O';;TlON~D2~~TION 1 City: S1>FiJ 1 State: 6L 1 ZIP'77'177 1 Reference: 17D;lZ~l(:1 I Taxlot.:C>bI3( ,.~ fL)-';~le~~~~V\I0R~W~""L Services or feeders: installation, alteration, relocation /r'te L O~ 200 amps or less (2) / I $ 81.00 $ l( / Ilt;1.g,'.':fd\.'!"l!':,~~~.wRROeERP(:iiioV\lNER~';,ifu<~:f4::;i:,::r'~1:.gt4.&.:t'" 201 to 400 amps (2) I $ 95,00 $ 1 Name: 'C",oS=/'-", t:J/,)J.'.I-r::--> 401 to 600 amps (2) I $158,00 $ 1 Address: -:j t.j ~ I L. S I 601 to 1,000 amps (2) $205.00 $ 1 City: 5;7""''''/'7:"1/ 1 State:CI/I.- I ZIP: 77/17- rl'Overl,000ampsorvolts(2) $469,00 $ 1 PhoneSvl -:lX' i':J. y (J I Fax: 1 Reconnect only (2) $ 63,.00 $ I E-mail' "7 7"'..u (""J - I Temporary services or feeders: l'nstallatJOn, alteration, relocation . .':>n-c..- n".r ..../Z.. ~ 'i~"/""'.e- a/ P7fh~ c..O..4-; to This installation is being made on residential or fann property ~OP~~V~~J)OJ..'tJ $ 63.00 $ owned by me or a member of my immediate famil~~Otl: 0 e l\:i~<t\looQMlQ~ .r" Ih property is not intended for sale, exchange, lease, rb'ii~ty{i\tB-adC Ipt "'0 ;:.!r~"1 101 $ 87.00 $ 479.540(1) and 479,560(1), ~I. afoncener 'VbP~'arlI\'ff:tl52'OO~- $126.00 $ Signature: ~ .., _________ ~o~~~ ~2-001' ~~~~R~ tiiI.Il,IItl!:~itl, see services or feeders section above , CONTRACTOR INSTAlLATlONOO90. lO~\:~~ ~~~;jirjblfA~'ltiiiffi~ti0ftiOIl, extension per panel Business name: , ca~~~. Inl \11 a q>1<ll~i%\\l\fs:ults WIth purchase of a service or feeder fee: ....(TRr- Ie' il h~ Address: /1'\. Can Each branch circuit I I $ 6.00 I $ City: (HState: I ZIP: r b. Fee for b.ranch circuits without purchase ofa service or fceder fee: Phone, J r I Fax: I I First b<;!'1ch circuit (2) I I $ 55 00 I $ E-mail: f)v I I E~ach additional branch circuit $ 6.~O $ CCB license no.: I BCD license no.: I I Miscellaneous fees: service or feeder not included Signing supervisor's license no,: 1 I Each pump or irrigation circle (2) $ 63.00 Print name of signing supervisor: 1 1 Each sign or outline lighting (2) $ 63.00 Signature of signing supervisor: I I Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) I Each additional inspection: (1) I ['. :.::;t;, .."'o,:,,,.':':ApPLlCANFUSE': i\CE' (A) Enter SU~ffJ~~aRK NO S PE.RNlIi !;WihW,ux.~~~'r,!~btft,,~%~l i\-l\\-IOR\2E.D _~r\ti'!'f~rli6\1.[A]) ~~NlNlE.NCE.~ ~~~bgy Fee (5% of [A]) f\N'< 180 Df\1 i'61'J[-Cees and surcharges (A through C): h"".," ..:".... -'. ,. .!~.um~ber. ~f i~Sp,~c~ions>Ptf,:.~tem (2~ ~.FEE.SCHEDUL.E'..,( . I Qty; I ~ Total cost Residential, per unit, service included: 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) $ $ $58.00 I $ ~o ~CV~~ ~~ $ g'1 $ 971.. $ 1.(0 ) $ <Jl(771 440,2584,) (9/08/COM) -. , . . . , . '. ." " .' Construction Contractors Board 700 Summer St NE Suite ~OO PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www~eeb.state:or.us Permit #: GOvVI ZOO 9 - 0 / 8'.s L{ s.f- 248"1 L.- Dt'S: Date: Y:~o Address: Issued by: Statement: Information Notice'to Property Owners About Construction Responsibilities Note: OregonLaw, ORS 701. 055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under . ORS 701.010(7), need not submit/his statement. This statement will be filed with the permit. , ' Fill in the appropriate blanks and initial boxes I and 2, and either box3A or,3B: ~ I own, reside in, or will reside in the completed structur~. , ~2. '.' I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My-general contractor is (Name) (CCB #) .. I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. ' OR ?B. I will be my own general contractor. , If! hire subcontractors,'! will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I bereby certify tbat tbe above information is correct and tbat I bave read and do understand tbe Information Notice to, Property 9wners about Construction Responsibilities on tbe reverse side of tbis form. ~~ 2-~-.2()/O (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) Property- owner. doc 06-01-04 " I' .~ ,::,>,.\", - ,,\ Acting 'as 'You't'Owu' Gell1leralContractor?' ..:.. .':1 \ <I.' ':J- .' . ~INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES -'-- -' -.... - . ."' NOTE: This Informaiion Notice to Property Owners about Construction Responsibilities was de~eloped by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. _ ~;'. ':. _ " ':;. .> .~ ..J' ...' ' " ' ,.' : .. ~-: If you are acting as your own contract9r to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems.by. being aware of tI1e,following responsibilities and concerns. Employer Responsibilities . '. l.. " , '. ~ ~ '. . . ",' , '.' '. '" , You .\Vi!l; in.rnost instapces,be, ruled to be an '.'e.!TIp!oyer:' ~d the, contractors youcontract.with will be "ernployees" i ' you use contractors not licensed with the 90nstruction C;9ntractors Board to do lab~r in c\mstruc!ing or to assisJ in th, construction or.improv,,~ent of a resi~,entiaI str:icture. As the:employer, rop.mustcomplt wit~,~he;coIlowing: ,--.. .:. ........ '-""'\' ~ ':':'.r ~. -; - .' . .... r .,~, ,,' ,. ,!. '. ", ."n ~',,' I,., Oregon's Withholding Tax Law: AB an employer, you must withliold mcome taxes from employee wages at the timt employees are paid. You will beJiable for the tax,payments even if you dOl1't actUlilly withhold the tax from yow employees. For more informati01tcaj(tIi~cDepa'rtnltint of Revenue atS03-3784988!' " ,,~,; '. I... ..... Unemployment Insurance Tax: As an employer, you are required to pay a tIDifor urtemployment insurance purpose~:""--........ on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. ., ". , L!-~.' ).. 1"' . . . . ~ f -,...... ... .,' . , '" t I'. '~". .J '.., ,I t.,'.. \.- ."\ _ ~ The Oregon Business Identification Number. (BIN) is a cOIl).b~ne9 nwnber. for ,both Oregon, Withholding andl Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. c .,"C) , .' - .f~ Workers' Compensation Insurance: As an employer; you are.subject to the Oregon Workers' Compensation Law, and must.obtain workers' compensation insurance for yoUr employees. If you fail to obtain workers' compensation insurance, yo"ti'coGiCi b~ st,bject to p~alties ;md be iiable fo~ all clai~ 'co~ts if one ~f your e~pl.oyees.'i~ injured on the job. For more information; call the Workers' Compensation Div'ision'a:t'fue Departrrfenh:>fCOIisumer amI Business Services at 503-947-7815. 'l., U.S. Internal Revenue Service: As an employer, you must withhold federiil'iilcometa,efrom employees' w~~ "- You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the "- IRS'at 1-800-829-4933 or visittheir.web site atwww.irs.l!Ov. .- . -': .', , ., '". ' , l.r.1 ~J,;.:~);tf')' .J.~'- ~, '_tj.~;'t.;~,""::- .' .'~'. +~;l>:. :.t." .:1 ,. , , .... .; ~ ;Other,J~esponsibiUties aJm~ Areas .9fConcer~s , Code Compliance: As the permit holder for this project, you are responsible for resolving any'failure to meet code requirements that may, be brought to your attention tlrrough inspections. .', '. :;." .~.:". ,.~..' . '.:_ '. '..~;' .' ~.'". _,1 ....:.. ~ .:, . ","';:,',",.." ' ..... ""~~' .~" ,-) .~.; . -'''','' ..-,'. Liability and PropertY Damage Insurance: Contact your insurance agent to'see tf you have'adequate msurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe pW1ctureS, ftre or work that mu~t, be redone. , . , , -...~ , , , ~ Time: Make sure yoti have sufftcient time to supervise your employees~' '". . ' . (.. Expertise: Make sure you have the' ~kiiI~,-to act as your o~- general contr~ctor:to coordinate the work of rough-in and finish trades, and to notify building officials as the al'l',vl,,;ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. .; Property_ owner,doc 06-01-04 .. . . CITY OF SPRINGFIELD SVSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2009-01834 NAME OR COMPANY: JOSEPH DASSEN LOCATION: 2481 L ST TAX LOT NUMBER: 1703254306131 DEVELOPMENT TYPE: Sin~1e Familv Residence NEW DWELLING UNITS .-I-" BUILDING SIZE (SF; 0 LOT SIZE (SF): L STORM DRAINAGE DIRECT RUNOFF TO CtTY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F, I I CHARGE I 0.00 $0,374 I = $0,00 I RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F, I x ! COST PER S.F. I x I DISCOUNT RATE I I I 0.00 I I $0.374 I 50% I ~ I ITEM I TOTAL _ STORM DRAINAGE SDC $0.00 2, SANITARY SEWER - CITY o ~ lel 18 1<>:: I~ o u.J <>:: DISCOUNT $0.00 $0.00 11070 I !11091 I 11092 I A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 7 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x 1 7 I COST PER DFU $28,99 $202.95 COST PER DFU . $22.05 $154.32 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $357.28 3, TRANSPORT A nON A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIPFACTORI 11093 I 9.57 10, I 22.07 I 1.00 I $0.00 B. IMPROVEMENT COST: 11094 I ADTTRlP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRtP FACTORI 9.57 I I 0 I I $97.35 I 1.00 I ~ $0.00 ITEM 3 TOTAL - TRANSPORT A nON SDC = , $0.00 4, SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU I 0 I I $101.97 = $0.00 1054 B. IMPROVEMENT COST: I NUMBER OF FEU's I x ICOST PER FEU I 0 I I $1,333.57 = $0.00 11055 C. COMPLIANCE COST: I INUMBER OF FEU:s I x ICOST PER FEU I 0 I $22.63 = $0.00 MWMC CREDIT tF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMINISTRATIVE FEE $0.00 1056 ITEM 4 TOTAL- MWMC SANITARY SEWER SDC ~, $0.00 SUBTOTAL (ADD ITEMS t, 2, 3, & 4) = , $357.28 5 AI1MINISTRATIVE FEE: I SUBTOTAL x I ADM, FEE RATE I~ CHARGE , I $357.28 I 5% I $17.86 TOTAL SANITARY ADMINISTRATION FEE: 17.86 11079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $0.00 J 1078 Ben Gibson 2/2/2010 TOTAL SDC CHARGES =1 $375.14 PREPARED BY DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TIm NET ADDITIONAL FlXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTU RE . FIXTURE TYPE NEW OLD EQUIVALENT UNITS r BATHTUB 1 0 3 = 3 IDRlNKlNG FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0 ItNTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = 0 I ILAUNDRY TUB 0 0 2 = 0 I ICLOTHESWASHER / MOP SINK 0 0 3 = 0 I ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12, = 0 :1 RECEPTOR FOR REFRlG / WATER STATION / ETe. 0 0 1 = 0 RECEPTOR FOR COM, SINK / DISHWASHER / ETC. 0 0 3 = 0 ISHOWER SINGLE STALL 0 0 2 = 0 ISHOWER GANG (NUMBER OF HEADSl. 0 0 2 = 0 ISINK: COMMERCIAL/RESIDENTIAL KlTCHEN 0 0 3 = 0 ISINK: COMMERCIAL BAR 0 0 2 = 0 I SINK: WASH BASIN/DOUBLE LA V A TORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1 I URINAL, STALL'lWALL 0 0 5 = 0 ITOILET, PUBLIC INST ALLATtON 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 1 0 3 = 3 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 7 .EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE ~ CREDIT RATE/$I,ooOlr--- ASSESSED VALUE ~ IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter t for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT'? (Enter t for Yes, 2 for No) BASE YEAR YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 o o 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 ~ , $0,00 CREDIT FOR IMPROVEMENT (IF AYfER ANNEXATION) VALUE / 1000 CREDIT RATE $0,00 x $5,29 o TOTAL MWMC CREDIT $0.00 = 225.Fifth Street Springfield, Oregon 97477 541-726-3759 Phone fi{i'i City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-0 1834 COM2009-0 1834 COM2009-01834' COM2009-0 1834 COM2009-0 1834 COM2009-0 1834 COM2009-0 1834 COM2009-01834 COM2009-0 1834 Payments: Type of Payment CreditCard cReceil1tl RECEIPT #: 1201000000000000097 Date: 02/02/2010 Description Fixture I st Appliance Penn Serv/Fdr 200 amps or less Add, Alter, Extend Cire Ea Add + 12% State Surcharge + 5% Technology Fee Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Stonn Admin Paid By JOE DASSEN Item Total: Lheck Number Authorization Received By Batch Number Number How Received djb 575202 In Person Paym~nt Total: .',",.<l',. ,",!,. '. ~. ,.;~, "i'. .' '::~ . 'r ~~, .\. ;.' 'j, Page I of I 12:00:15PM Amount Due 19,00 79,00 81.00 6,00 22,20 9,25 202,95 154,32 17,86 $591,58 Amount Paid $591.58 $591,58 2/212010