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Home My WebLink AboutPermit Building 2010-6-16 CITY OF SPRINGFIELD . _ NOTICE: "",~' HE WORK Building/Combination Permit ), '~' "" rlllB f[m~l1 [~." ~DIRF ~ Status Issued AUTHORiZED UNDER THIS PERMiTlS NU I PERMIT NO: COM2010-00773 225 Fifth Street, Springfield, 060MMENCED OR IS ABANDONED FOR ISSUED: 06/16/2010 541-726-3753 Phone ANY 180 DAY PERIOD. APPLIED: 06/16/2010 541-726-3676 Fax EXPIRES: 12/16/2010 541-726-3769 Inspection Line VALUE: $ 230,377.00 SITE ADDRESS: 2597 17TH ST ASSESSOR'S PARCEL NO.: 1703243104500 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: Single family residen~e Owner: BRUCE WIECHERT CUSTOM HOMES INC Address: 3073 SKYVIEW LN EUGENE OR 97405 I CONTRACTOR INFORMATION I Contractor Type Electrical Mechanical Plumhing Contractor License L & E ELECTRIC INC 105475 COMFORT FLOW HEATING CO. 460 STEVEN R JOHNSON 65065 BUILDING INFORMATION I Expiration Date 03/3012012 06/271201 f 0311212012 Phone 541-933-2653 541-726-0100 541-342-3765 3 # of Stories: Height of Structure 17.00 Type of Heat: Forced Air Gas Water Type:, , Gas Range Type:' Electric Energy Path: Sprinkled Building: nla ~' " Lot Size: Sq Ft 1 st Floor: ,Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: 8,020 2,200 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # 'of Bedrooms: 1 R-3 U VB 460 I DEVELOPMENT INFORMATION I , . Frontyard Sethack: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Sethacks: 22.00 15.00 10.00 23,00 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: :":0"::; ,.,l~. ....' . ,." l. ,." 5 Yes 32.40 REQUIRED PARKING Total: 2 Handicapped: Compact: I PUBLIC IMPROVEMENTS I '1'0.:' F II I d" Sidewalk Type: u V mprove Storm Sewer Available: Ves Downspouts/Drains: Special Instruction~TTE~~>>'8_rftlt1ftl1l.ack sidewalk 'on\17thl Storm water to curb " follow rul.. adopted by the Oregon UtIlity Notes: Notification Center. Those rulel8rt IllIfortb In OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies 01 the ruin br calling the center. (Note: the telephone ' number for the Oregon UtIlity Notlllcatlon , Center 111-800-332-2344)., "I, Street Improvements: Curb and Gutter ;:;; , ',' . PAVTO THE ORDER OF SPRINGFIELD BRANCH USBANK FOR DEPOSIT ONLY 153601452508 CITY OF SPRINGFIELD Paee 1 of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description TVDe of Constrnction Estimate Garaee/Misc SF/DnDlex Estimate U VB Utilitv R-3 VB 1&2 Familv Fee Description + 12% State Surcharge + 5% Technology Fee 1st Appliance 2 Baths One or Two Family Addressing Assignment Appliance Vent Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Fire SF Fee - Residential Fireplace (Listed) Gas Outlets 1-4 Heat Pump Plan Review Major - Planning Plan Review Residential PW Disc - 2nd Permit Rcsidence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer - Improvement. Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Compliance Charge SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Storm - Improvement SDC Storm - Reimhursement SDC Tran Reimburs-Residential SDC Trans Improvement-Resident SDC Transportation Admin . Sidewalk Permit Temp Power 200 amps or less Vent Fan /:,......', ,LF: ~ . ;,C I Valuation Description ~ $ Per Sq Ft or multiplier $1.00 $37.72 $96.83 Square Footage .or Bid Amount 225,000.00 460.00 2,200.00 .' Total Value of Project ~ Amount Paid $246.83 $120.70 ',:' $79.00"" .'. $337.00....~ $38.00.V'; $9.00;!c) $1,241.92 $88.00 $9.00 $13.00 $133.00 $20.00 $7.00 $17.00 $211.00 $807.25 ',;. $-30.00 $134.00. $100.00 $740.60 $1,238.32 $10.00 $22.63 $1,333.57 $101.97 $223.63 $1,138.4t;;:~:.: $316.57:;::.'~ t' $279.54 $1,140.17 $92.46 $88.00 $63.00 $27.00 Date Paid .",..' 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/16/10 6/i6/10 6/16/10 6/16/10 Paee 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00773 ISSUED: 06/16/2010 APPLIED: 06/16/2010 EXPIRES: 12/16/2010 VALUE: $ 230,377.00 Value Date Calculated $225,000.00 $17,351.20 $213,026.00 $455,377.20 06/16/20 I 0 06/16/2010 06/16/2010 Receipt Numher 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 1201000000000000711 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00773 ISSUED: 06/16/2010 APPLIED: 06/1612010 EXPIRES: 12/16/2010 VALUE: $ 230,377.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Willamalane Single Family $2,858.00 6/16/10 12010000000000007]] Total Amount Paid $13,255.57 . I. .'PJ~n R~~iews I PJannjlJf! Review 06/16/2010 06/] 6120] 0 APP DDK 2 street trees along 17th Street (trees along 17th St. to be placed in plantel strip) and 3 street trees along Vera Street. Public Works Review Structural Review 06116/20] 0 06/] 6120] 0 06116/20 I 0 06116/20] 0 API' APP LKW CJC As noted on plans 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. l.P-eolJirerUnsnections ~ Ufer Electrical Ground: ]nstall ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but pr~~",~,? ~,~_~.~.~:~~ pla,~ement. Slab: To be made after all inslab building s,~rWJe eq~ip!"erit, conduit piping and other equipment items are in place but prior to concrete. ;,,,v,' Post and Beam: Prior to noor insulation or decking. Floor Insulation: ~rior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. 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. Masonry: Final Building: After all required inspections have been requested and approved and the building is complete. ~ i " ;' 'i:~ ' . Perimeter Foundation Drains: After gravel and IiIter cloth is installed but prior to backfill. Undernoor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. ;",,:1' r- . 'j;,.'l';" '. . Water Line: Prior to filling trench and inchidi~g required testing. ~,'ii: :.':;'v: if'.' . ,',"'" Pa2e 3 of 4 ~_ ~ l' I"" '. {; i . \,. i.,. ' ! ~~ilEf ';:";;:\,r,',:."" , ~ ,:,.'. CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2010-00773 ISSUED: 06/16/2010 APPLIED: 06/16/2010 EXPIRES: 12/16/2010 VALUE: $ 230,377.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Sanitary Sewer Line: Prior to filling trench and including reqnired testing. Storm Sewer Line: Prior to filling trench. Final Plnmbing: When all plnmbing work is complete. Underlloor Mechanical. Prior to insnlation or decking and inclnding reqnired testing. Underlloor Gas: After line is installed and reqnired testing and capped if not attached to an appliance. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. ~', ~. " ,,,.-, Gas Service: After line is installed and line h'as beeri'coilnected to a minimum of one appliance including required ',' '",.,..;1 ., ~." '~'.' .~ testing. Presure test done at this point. ..' ,:"". ' ",', ' 1;.;(""~:" " '~"""" Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete.. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to ntility company energizing service. Final Electric: When all electrical work is complete. Erosion/Grading Inspection: Prior to ground disturbance_rid after erosion measures are installed. .J':,;':,\. :1 Sidewalk.. Curbside: After forms are erected but prior to placement of concrete. Sidewalk - Setback: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. By signature, 1 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 L~ws ofthe~tateofOregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structiiiJe>...'vithbiit'permission of the Community Services Division, Building Safety. I further certify that only conll'actors and employe~s,~\ho a~e:in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requeste~,at the proper time, that each address is readable from the street, that the permit card is located at the front of the pro .tf,Ond the approved set of plans will remain on the site at all "m" '"'"C:Zt""" lAc . (; /;/; () / / Owner or Contractors Signature Date '.:',' ':<' ":1. Pace 4 of 4 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2010-00773 NAME OR COMPANY: BWCH CIl LOCAT!ON: 2597 17th ~ 0 TAX LOT NUMBER: 1703243104500 0 DEVELOPMENT TYPE: Single Family Residence U NEW DWELLING UNITS I BUILDING SIZE (SF: 2600 LOT SIZE (SF): 7841 ~ ~ f-< I. STORM DRAINAGE CIl ~ DIRECT RUNOFF TO CITY STORM SYSTEM 0 6J A. REIMBURSEMENT COST AREA DRAINING TO .1 IMPERVIOUS S.F. x I COST PER S.F. I DRYWELL I CHARGE I 1 3475.00 '1 $0.091 1 ; 0 I $316.57 $316.57 B. IMPROVEMENT COST .- I IMPERVIOUS S.F. x 1 COST PER S.F. 1 I CHARGE I I 3475.00 1 $0.328 1 ; I 0 I I $1,138.41 1070 $1,138.41 I I I ITEM 1 TOTAL - STORM DRAINAGE SDC $1;454.98 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBE~30F DFU's I x I COST PER DFU I I $53.84 I ~ I $1,238.32 1091 B. IMPROVEMENT COST: I NUMBE~30F DFU's I x I COST PER DFU 1 I $32.20 1 ~ I $740.60 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC ~ I $1,978.92 I 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER IOF UNITS I x I COST PER TRIP I x 1 NEW TRIP FACTOR I 9.57 29.21 I 1.00 1 ~ I $279.54 1093 B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBERjOF UNITS I x I COST PER TRIP I x I NEW TRlP FACTOR 1 9.57 $119.14 1 I 1.00 1 ~ I $1,140.17 1094 ITEM 3 TOTAL - TRANSPORT A nON SDC ; I $1,419.71 I 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER ~FFEU'S I x ICOST PER FEU ' I I $101.97 I ; I $101.97 1054 B. IMPROVEMENT COST: INUMBER 7F FEU's I x ICOST PER FEU I 1 $1,333.57 1 ; I $1,333.57 1055 C. COMPLIANCE COST: INUMBER 7F FEU's I. x I COST PER FEU I I $22.63 I ; $22.63 MWMC CREDIT IF APPLICABLE (SEE REVERSE) ~ $0.00 1054 MWMC ADMINISTRATIVE FEE ~ $10.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~ I $1,468.17 I SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) I $6;321. 78 I 5. ADMINISTRATIVE FEE: I SUBTOTAL I x I ADM. FEE RATE I~ I CHARGE I $6.321.78 5% $316.09 TOTAL SANITARY ADMINISTRATION FEE: I 223.63 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE:' I $92.46 1078 Kaye Wilson 6/16/20] 0 TOTAL SDC CHARGES -I $6,637.87 PREPARED BY . DATE DRAINAGE FIXTURE UNIT (DFU) CALCULA TION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TIIE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIV ALENT UNITS BATHTUB 1 0 3 - 3 DRINKING FOUNTAIN 0 0 1 - 0 FLOOR DRAIN 0 0 3 - 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 - 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 - 0 LALINDRY TUB 0 0 2 - 0 CLOTHESW ASHER / MOP SINK 1 0 3 - 3 CLOTI-IESW ASHER - 3 OR MORE lEA) 0 0 6 - 0 MOBILE HOME PARK TRAP II PER TRAILER) 0 0 12 - 0 RECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 - 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. I 1 0 3 - 3 SHOWER, SINGLE STALL 1 0 2 - 2 SHOWER, GANG ER OF I-IEADS) 0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 - 3 SINK: COMMERCIAL BAR 0 0 2 - 0 SINK: WASH BASIN/DOUBLE LA V A TORY 1 0 2 - 2 SINK: SINGLELAVATORY/RESIDENTIAL BAR 1 0 1 - 1 URINAL, STALL / WALL 0 0 5 - 0 TOILET, PUBLIC INSTALLATION 0 0 6 - 0 TOILET, PRIVATE INSTALLATION 2 0 3 - 6 MISCELLANEOUS DFU TYPE NUMBER OF EOD'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS I 23 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 OFlJs) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 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 .> IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 2 2005 CREDIT FOR LAND (IF APPLICABLE) VALUE/1000 CREDIT RATE $0.00 x $0.00 $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $0.00 o TOTAL MWMC CREDIT $0.00 = Electrical Permit Application CITY OF SPRINGFIELD, OREGON 225 Fifth SIred. Springfield, OR 97477. PH(54I)726-J753t FAX(541)726-3689 _9P, RINOIWtELD ~,~, _ ~-~ L~~~~i f,tl\;IK.'O,,:. AI. .,.,,~ ~5b~~; ...,. --~l ,DEP~~TMENT USE ONLY Cou,"'.'ZOtO-OO 773 Pennit no.: Date: b - / '- -/ D This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL' GOVERNMENT APPROVAL' ,,' Zoning approval verified? 0 Yes 0 No ,', ,CATEGORY 'OF, 'CONSTRUCTION';';' D Residential D Government D Commercial f~'~\kS\VjOaYSrrE; I NF(jRIIIIAtIONrAN[)tL(j:CA-rION~<!i'~:'';>;'' Job site address: t-Z. ~ i 7 '>97 I 7-1' L, City: S \b State:D (L. ZIP: C; 7'i 7'8 Reference: <AJ ~ v' iU!!. Taxlot.: ,wORK'i: fewt I PROPERTY OWNER, Name: e:,.(\/u W, t>J-.W\ CvS,+o", Addfess:5D7 ~ S It I FJ City: (u e)-<..- ZIP: 17'10) Phone:S~/ -bab Of ~ ~ Fax: G~/-'3Yf 331:. 'Z.- E-mail:W;t:c.-\"..~1-k<J~5 e Mc....st,NC-T This installation is being made on residential or fann property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: CCB license no.: O~ 47S- BCD license no.: 83.:::... Signing supervisor's license no.: '-i I 7 '( - S- Print name of signing supervisor: t; a 0", "ov.l~" Signature of signing supervisor:~() v-e- ~~'V ~~ ~0 \,o,'0-}:. :\Y ~~ '~ 440-2584-) (9/08/COM) ,..- ,,<"J';'>':,'.' F,EE,SCI'IE,OULE;!:!>i;';';~i;:":'!.i1{i';:,"';" .Nu~ber,o.finspectio'~~ pe~ it~.~-_(.), Qt}>. Cost Total ea:, ' cost Residential, per unit, service included: 1,000 sq. ft. or less (4) \ $134.00 $\?J4\ Q) Each additional 500 sq. ft. or portion "\. $ 25.00 $ Un ~ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation. alteration, relocation 200 amps or iess (2) $ 81.00 $ 20 I to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation. alteration, relocation 200 amps or less (2) \ $ 63.00 $~S, xJ 20 I to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over '600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a, Fee for branch circuits with purchase of a service Or feeder fee: Each branch circuit $ 6.00 $ b, Fee for bnmch circuits without purchase of a service or feeder fee; First branch circuit (2) $ 55,00 $ Each additional branch circuit $ 6.00 $ Miscellaneous fees: service or feeder ~o/ included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) . Each additional inspection: (I) $58.00 $ ;'::3);!:i:V;;;~';;:?!L;:".AppLitANtUSE\':;;" .. .<;.:,... . .'.'.0< . . () (A) Enter subtotal of above fees $ ~ Ql.C (Minimum Permit Fee $58.00) cA (8) Enter 12% surcharge (.12 x [AD $ ~5. \ (e) Technology Fee (5% of [AD $ \ -\.~5 TOTAL rees and surcbarges (A tbrough C): €>4\'~ '" Structural Permit Application._ '. '. ~~~ . . . ,:'~!ll1:7' CI;f!Y~'OF SPRIN6FIELD,9R/;,GON ,;' .' 'J" . ;.!~,::-. '. i~P:A..~......., ~~:.., l\ffi.. ,..... ~ ...,. bEPARfMENf;u5"E"ONii~i ,""" c_.~:.;;,.,._, '.,0. .,;;":",,~,,~.,,;>,,_'~,,,", ,"""~ :~, ""....'t.,. CO...... .:b 10 . 0 0 n:J Penn it no.: Date: {; -(6-10 225 Fifth Street. Springfield. OR 97477. PH(541)726-3753. FAX(54 1)726-3689 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days or issuance or if work is suspended for 180 days. rU~iIoCA~OVERNMEN"FZAi?PRi5VAit~f.,i~(~.\~;F'"" ~. , '., -- .~_ ,__:___,~,~,~,"'~_'._.",~~" ~.......-,__:,.>f>l",_..~~.__........'_ ..it~ ,.,_~",,"\l,>,... ,-":E;@>t~ This project has final land-use approval. Signature: Date: This project has DEQ approvaL Signature: Date: Zoning approval verified: 0 Yes DNo Property is within flood plain: 0 Yes DNo ~~~l>~~ 1i':';;;i{t':''7f~''-r,.....,'~L>_",...""",..n~''-'~}.~'' ,-, ,,>.,, ~-""~',' .....,,-...,..-', .... 'r:i ~,". 1....;., r -. , .'~ '.' ,Ji': ~~~.:"1~tr,<,~;JiQ~ II;G9RYi<.9lf"C;9NllJR.UC:np',.;,;>;;',..f.;:;. :. Ci1 Residential 10 Government o Commercial i~~7f:&:JQ!'f~~!f~ll~i;QRM.:(fiQ&[A:NP[i~QGAf!QN:~~i;i.;i;i~; Job site address: -z.S17 nfL 5-f- City:C;o.-; ".. c: <-1..1 I State: 0 IL I ZIP:tf7Y17 Subdivision: r-,~ ,I .-> '1' I Lot no,: <"Sr-oI-l<J Z Q > Reference: J 7C>:l 2 '-( ~ (I Taxlot: 01.{ s-o-o I tftiififS~~~~'~~!;ill~Rf~~~~~(~fiQ~~Rty1fQWNe~i;:(;, . ~::;,< .:' L Name: G ,.JC~ Iv;, c~. ,t CY',t.:ll'- \lQ",..s :1:1'Ii:- Address:30,~ S (,,,. i~w I-N City: tV<lc,,-<. State i) '" I ZIP:<) 71 0') Phone: -bib - ~'1,>g Fax: -,n- ;:;3b? E-mail:W \C"c.-he..;r ,",0""'-5 (J..,cvr"u..')l Net' This installation is being made on residential or fann property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. Sign here: .J!&~~:cONfRAci'oR\!iNsfALIilli.TioNf;.\j;~l1lii5€1,1'.';;'.:,;!",: ,"'^ ...,;,.'/ '..r~iIL .".~._".", ....."._.. ...'. ._.~>._.. .~...., ........'..e-'_.'... _~.. ".' ,,,..,_;0....,..,.,.. i.l;".~.,.,...tt~.-~..." d'''' . Business name: Ib,;vl.< ~ ;ed,,~, Lu~bl'-- iIo,Wi. .. J"V'-- Address: '3 07 3 <; I<~ "c>Ai /...'" City: f.'v.;e~ State:O ,L I ZJP:0 7~D\- Phone: . -6.1'& cl '7 S ? Fax: -3'1'1- 33 b Z- E-mail: w.; e"k,;>.\ .....o,-"'<~ @ COi\r\ U,.,4 ~ It..Jc...t CCB license no.: 101 J r 7 Printn~e:~ ~......',.;../~ W~-J\-o';-"v Signature: W IN' .________-- ,.. ';liWm~v.~~9N[iVig:tQ~"N!tt:lBM~:trQNI~~i,iii;:', .' Name CCD License Number Phone Number Electricall-+-e 51-1'114 I> Plumbing 51<--< i > ~ l- 3' &S- Mechanical (I" H 7Zb.. 0 I 0 () 1-lfr'J ",\",,,wnmr,~f'~--" .,: ...._".'>'>2..,_1~r""'. ;,'!;;"''':Jl,l;1ikll(. ~J;;,~ !<',f,r;!3!lc::!ie;DUI:.E:~M~'t.,1&1f, _ .:';'" . jj;l!"",j~!"; ,-' !'{:''-,;r ;:-:>rv.',;:''''':;/;;'i:-;'-~~W~~';';;::i:i~~'~1 _".", ':"<~;';I;;,'Rlt.'-*1~ri~':";"r~.''' ~.,l.'Y ~11J~J!..()9)lgf9.:~:H!~~9.i1;~_i'I;~;~,}'i!if!,,:~,;;:tl:4f..~i~~\!~.\.~,'~", '.~ ~m:~\~,:-,;.,:i (a) Job description: J,'...../e h4-_. l.. I~ . J~ Occupancy 2.7 /'-'\ Construction type: d[S" Square feet: 2 L 00 Cost per square foot: Other infonnation: Type of Heat: Energy Patb: I A ~new 0 alteration 0 addition (b) Foundation-only pennit? DYes cEf1'Io ., Total valuation: I s2ZS 1 ilii iIdi~g':f~~~~;:~~~0~/;~ts~~t-:t~;.,. ...:' '~""'r"l\f- 2, '.. . -:,o.;~i!t~1}1:!~t~r}.;.; ..'<' ,_ (a) Pennit fee (use valuation table): S (b) Investigative fee (equal to [2a]): S (c) Reinspection ($ per hour):' S (number of hours x fee per hour) (d) Enter 12% surcharge (,12 x [2a+2b+2c]): S (e) Subtotal of fees above (2a throngh 2d): S ~:3?p.iati1ffeVii.~rret'~'i ., '"r~~!{':"I.V;'~t.'>{On~if~~~*~S~~.~~i};isl4:)~ . ._~...,..ll'..,. '_~)Jl';ii~~'~"';i:"':::':;'" ~!"i',' }':'fe;H;,i'.~~'i-i~!.'1':,J .::.'~:;i'L _",:, (a) Plan review (65% x pennit ree [2a]): S (h) Fire and life safety (40% x permit ree [2a]): S (c) Subtotal of fees above (3a and 3b): S 4. Misc~n~r~l!s~f~~~}.~, ~:,~>:.,:-:. " "-::':,~i:{~;~:;:.;:~~;~,I~!~1t}~qfl:~g~'iS.' (a) Seismic fee. 1%(,01 x permit fee [2a]): S TOTAL fees and surcharges (2e+3c+4a): S . .2~ willamalane . 't\i Park and Recreation District '. '1.. Job. No. (!/ () -'(1:J SYSTEM DEVELOPMENT CHARGE WORKSHEET JanuarY 1-June 30, 2010 NAME:. J3t<LfC-t VUIEcttOLiCWT'6t<.. ~1:-s PHONE:)lf I bEt.> t:t'fr% ADDRESS:'!dlJ S/t!J/vl€"W Uv CITY b(4E"N.e - LOCATION OF PROPOSED BUILDING SITE: Street Address:.. 2)"'1? /7"- JT. STATE~ ZIP: c/?'foS Plat Name: Tax Lot Number: . . . 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definition~ are on the back.) . . A. Sinqle-Family Detached NO: OF UNITS I X $2,858 per unit = . $ ~ s;-~ B. Sinqle~Family Attached NO. OF UNITS X $3,100 per unit =. $ C. Multi-Familv Apartment NO.. OF UNITS X $2,641 per unit::: $ D. Sinqle Room OCCUpanCY. ._._.____."_~___,_~-----.J'l.Q.-QEJl~ 11__$ . . )C$J_,3?JJ~_e.Luriit = ____$ E. Accessory Dwellinq Unit NO. OF UNITS WILLAMALANE.SDC X $1,550 per unit = $ $ 2~~ 2. SDC CRE.[)IT (If applicable) SDc payer must furnish proof of .. Willamalane .C~edit.approval.) $ 0 - --- - --: -- _.:....._-~::....:=.=......:.:.::;::---.::=..::-.:.:...;::.:::.-:..::._::.:-..:-;.:;:::::---~ ----:-:::::-..:..:::.:::---- - -- ---...:::..~_._.....--- -- - .. ---.. .. ---.- ..-. - - . .~~-- -. "-'--'-"'---~- -,_...~_.- ,.-- _.~-_.~.,":".. 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) &e-.. $ ~st t; I (& I /0 Date Development Services Department City of Springfield 5 RECEIPT #: 1201000000000000711 Date: 06/16/2010 1:53:49PM Job/Journal Number COM20 1 0-00773 COM20 1 0-00773 COM20 1 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 10-00773 COM20 I 0-00773 COM20 1 0-00773 COM20 1 0-00773 COM20 I 0-00773 COM20 10-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 1 0-00773 COM20 1 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 1 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM20 I 0-00773 COM201O-00773 COM20 1 0-00773 COM20 1 0-00773 COM20 I 0-00773 COM20 1 0-00773 COM20 1 0-00773 .COM2010-00773 COM20 I 0-00773 COM20 1 0-00773 Payments: Type of Payment Check CreditCard cRcceintl Description Plan Review Major - Planning Plan Review Residential Building Pem1it Addressing Assignment Willamalane Single Family 2 Baths One or Two Family 1st Appliance Vent Fan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 Fireplace (Listed) Heat Pump Residence Wiring 1000 Sq Ft', . Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Fire SF Fee - Residential + 12% State Surcharge Sidewalk Pennit Curbcut Pennit . PW Disc - 2nd Penn it SDC Stonn - Improvement SDC Storm - Reimbursement Sanitary Sewer - Reimbursement: Sanitary Sewer - Improvement SDC Tran Reimburs-Residential SDC Trans Improvement-Resident SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC MWMC Compliance Charge SDC Sanitary/Stonn Admin SDC Transportation Admin + 5% Technology Fee . " Paid By Received By WIECHERT CUSTOM HOMES njm WIECHERT CUSTOME nJm HOMES Page 2 of2 Item Total: Check Number Authorization Batch Number Number How Received 19650 In Person 055320 In Person Payment Total: Amount Due 211.00 80725 1,241.92 38.00 2,858.00 337.00 79.00 27.00 9.00 13.00 9.00 7.00 20.00 17.00 134.00 100.00 63.00 133.00 246.83 88.00 88.00 (30.00) 1,138.41 316.57 1,238.32 740.60 279.54 1,140.17 101.97 1,333.57 10.00 22.63 223.63 92.46 120.70 $13,255.57 Amount Paid $3,755.57 $9,500.00 $]3,255.57 6116/20 I 0