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Home My WebLink AboutPermit Building 2010-11-23 CITY OF SPRINGFIELD Building I Resid~ntial Permit PERMIT NO: 811-SPR2010-00661 IVR Number: 811137076737 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 11/23/2010 ISSUED: APPLIED: 11/23/2010 11/04/2010 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541.726-3769 Fax: 541-726-3676 permitcenter@ci,springfield.or.us EXPIRES: VALUE: OS/22/2011 $164,000.00 SITE ADDRESS: 4854 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Single family residence - SAME AS COM2010-01058 546 S. 48th pi PROJECT DESCRIPTION: Phone Number: OWNER: ADDRESS: HAYDEN HOMES llC 2464 SW GLACIER Pl STE 110 REDMOND OR 97756 CONTRACTOR INFORMATION ~ Contractor Type Contractor Name Lic Type Lie No Lie Exp Phone Plumbing COntractor STUTZMAN SERVICES INC CCB 31747 05/12/2012 541-928-8942 Mechanical Contractor PACIFIC AIR COMFORT INC CCB 39237 03/25/2012 541-672-9510 General Contractor HAYDEN ENTERPRISES INC CCB 92208 07/29/2011 541-923-6607 Electrical TOP NOTCH ELECTRIC INC ELECTRICAL C220 07/01/2011 541-317-1998 # of Units: BUILDING INFORMA liON ~ # of Stories: 1 Height of Structure: 18 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Electric Hazmat: # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: 3 Path 2A Certified performance-tested duct system Lot Size: 5142 1290 Sq Ft 1 st Floor: Sq Ft2nd Floor: Sq Ft Bas~ment: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 40 Occupancy load: . es you to N. 0 gon law reqUlr .,. ATTENTIO ' re b the Oregon u\i'lty follow rules adopted h ~e rules are set forth Notilication cente~i 6 t~roUgll OAR 952 .,jOi- in OAR 952-00i -0 . con'os of the rules by 0090. You may obtam Noi~: the telephone calling the center. ( Utility Notiiica\lon 200amber for the orie~g~_332_2344). Center IS - 401 Site Information ~ Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: No No No Springfield Building Permit 11/23/201 9:20:18AM NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABAND01~E'b1 ~t,6il ANY 180 DAY PERIOD. ., ..,...... ,.::":,:~.?:: CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00661 IVR Number: 811137076737 SP:IN..G.FI.EL~. .~ ,'.~ . . .;"~OREGON www.ci.springfield.or.us 225 Fifth'S! Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@cLspringfield.or.us PROJECT STATUS: STATUS DATE: Issued 11/23/2010 ISSUED: APPLIED: 11/23/2010 11/04/2010 EXPIRES: VALUE: OS/22/2011 $164,000.00 . SITE ADDRESS: 4854 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Single family residence - SAME AS COM201 0-01 058 546 S. 48th pi PROJECT DESCRIPTION: DEVELOPMENT INFORMATION ~.. Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 14 5 5.37 28.85 o Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: Hillside REQUIRED PARKING Total: 2 Handicapped: Compact: Yes 328 / 18.3 PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Yes Sidewalk Type: DownspdutlDrains: Valuation Description ~ Description R-3 1 & 2 family U Utility, misc. Tvpe of Construction VB VB Springfield Building Permit 11/23/201 9:20:18AM Unit Amount Unit Tvoe 1,330.00 Sq Ft 401.00 Sq Ft Unit Cost 96.83 37.72 Value 128,783.90 15,125.72 143,909.62 Page 2 'of 6 SPR.IN....G.f.l. E~ ~ll._. .. ~ .~lt--o;:g \>~ '" ','~-'<<" OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00661 IVR Number: 811137076737 www.ci.sprin~field.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726.3769 Fax: 541-726.3676 permitcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 11/23/2010 ISSUED: APPLIED: 11/23/2010 11/04/2010 EXPIRES: VALUE: OS/22/2011 $164,000.00 SITE ADDRESS: 4854 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105500 SCOPE: Single,Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Single family residence. SAME AS COM2010.01058 546 S. 48th pi PROJECT DESCRIPTION: FEES PAID I DescriDtion Planning - Major Review - City Gas Piping up to 4 outlets Flue vent for water heater or gas fireplace Furnace - up to 100,000 BTU !:mp services 200 amps or less Each added 500 sq. ft. or porti?n ~esiden.::e wiring 1,000 sq. ft. or less ~~rst Appliance Fee Single-duct exhaust (bathrooms, !oilet compartments, utili Range hood/other kitchen equipment One or Two Family Dwelling with Two Bath Willamalane fees - Single family detached Address Assignment, each new or change Residential Fire (.05 Per Sq Foot) SDC: Total Transportation Administration Fee SDC: Administrative Fee - MWMC Regional Wastewater: Sidewalk up though 90 Feet Curb Cut/Driveway 1 st Cut Multiple Permit Discount (Max 2) .SDC: Reimbursement Co~t =,,~~rm Drajnag.~,,_ SDC: Improvement Cost - Storm Drainage SDC: Reimbursement Cost-- LocaIVV~ISt~~ate~ - .,~--, SOC: Improvement Cost - Local Wastewater SOC: Reimbursement - Transportation SDC SDC: Improvement - Transportation SOC SOC: Reimbursement Cost - MWMC Regional WastewatE SOC: Improvement Cost - MWMC Regional Wastewater ~ SDC: Total Sewer Administration Fee SDC: Compliance Cost - MWMC Re9ional Wastewater SI Admin fee (10% ~f applicable fees) .~ :,tate of Ore~n Surch~.!le (12% of applicable ~ees) Technol09Y fee (5% of permit total) Structural Building Permit Fee ~ch~ologyf~;(5%~Tp~~itt;t;j)---"---" S~;;ro;g;n Surcharge i1'2%-~f;ePTi~~~;}.~. Same as Plan Review Submittal Amount Paid $211.00 $7.00 $9.00 $17.00 $63.00 $50.00 $134.00 $79.00 '. '---'~--- $36.00 $13.00 $374.00 $3.468.00 $38.00 $86.55 $122.46 $10.00 $88.00 $68.00 $-30.00 $405.00 $735.39 $2.549.28 $1,285.68 $426.92 $1.597.62 $101.97 $1,333.57 $300.94 $22.63 $8.66 $93.84 $48.30 $969.23 $48.46 $116.31 $250.00 $15,157.81 Date Paid Receipt # 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 , ------,- 11/23/2010 374962 --'.._-- 11/23/2010 374962 --- 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 11/23/2010 374962 _W'_~,__ 11/23/2010 374962 11/23/2010 374962 11/23/2010 :ii4962-.~ 11/23/201'0--- ~-- 374962~" 1 i723i2010....-----. -374962--- 11/04/2010 ---3748'07--- Total Amount Paid Springfield Building Permit 11/23/201 9:20:18AM Page 3 016 SPRIN..G. F.IEL~ .-;- . .".-.\~ ,'. Ie OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00661 IVR Number: 811137076737 www.ci.springfield.or.U5 225 Fifth Sl Springfield,OR 97477 Phone: 541-726-3753 Inspeclion Phone: 541-726-3769 Fax: 541-726-3676 Issued permilcenler@cLspringfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 11/23/2010 11/04/2010 11/23/2010 SITE ADDRESS: 4854 GLACIER DR, SPRINGFIELD, OR 97477 . ASSESOR'S PARCEL NO: 1802051105500 EXPIRES: VALUE: OS/22/2011 $164,000.00 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Single family residence - SAME AS COM2010-01058 546 S. 48th pi PROJECT DESCRIPTION: Plan Review ~ OeDartment Application Acceptance Received Due Date Cornoleted 11/04/2010 11/04/2010 11/05/2010 Result Application Accepted Reviewer David Bowlsby ~Yi~~:;Z~~i~;~tig~~~f~i:~~~~l~~~:,~~~l~~lI~~:1 i~~:\~~:!%ilfpf~viq~!Xr:~\~~e~~i~~i;'-C-~~.~.~~;:-~':~'~~'c'J Planning Review 11/05/2010 11/05/2010 11/12/2010 Approved Deyette Kelly Comments: Front elevations are site specific and contain REQUIRED design elements. Inspectors will field check that actual elevations match submitted designs as shown on the approved set of plans. Meets minimum setbacks. Inspector to Structural Review 11/05/2010 11/05/2010 11/1712010 Approved Chris Carpenter, [PUblicvvorks:ReView - ".' ',..1!i05i~?N). .,~1^1105/201d' ~'\1,1r15/?010, .:=A.'PPf,bvecfJft;'f co.m.n,!ent.s~' . S!~rm ~ater to tap , 0,;;~., ~;;\'0 .~. c.', ". ~ ~~.. , .^~",,' 'lo'l ",-"..----'IIM Permit Issuance 11/17/2010 11/17/2010 11/23/2010 Issued ';-"., , Springfield Building Permit 11/23/201 9:20:18AM .15~Y,~WllsQn"-1~~-"0 ..': . ,I '. ~.',,-. . " ." 'f. /,~",""'1i.~' . ". ..~^ ~\-.:'._ Chris Carpenter Page 4 of6 SP~.I~.~.:....IE~D. ..... ~..~.:1M. :~""':" ~W :<, ,}\:, OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00661 IVR Number: 811137076737 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pe rmilce nter@ci.springfield.or,us PROJECT STATUS: STATUS DATE: Issued 11/23/2010 ISSUED: APPLIED: 11/23/2010 11/04/2010 EXPIRES: VALUE: OS/22/2011 $164,000.00 PROJECT DESCRIPTION: SCOPE: single'Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Single family residence - SAME AS COM2010-01058 546 5. 48th pi SITE ADDRESS: 4854 GLACIER DR, SPRINGFIELD, OR 97477 AssEsOR's PARCEL NO: 1802051105500 INSPECTIONS REQUIRED ~ Inspections 1020 Zoning/setbacks 1090 Street Trees 1110 Footing 1118 Footing Drain 1120 Foundation Footing: After trenches are excavated. 1160 UFER Ground Foundation: After forms are erected but prior to concrete placement. Ufer Electrical Grou~d: Install ground rod at footing and call for'inspection in conjunction with footing and/or foundation inspection. 1220 Undefiloor framing 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved. 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling 1520 Interior Shearwall Ceiling Insulation: Prior to cover. Shear Wall Nailing: Before covering sheathing with finish mate~ials. 1530 Exterior ShearwalJ 1540 Gypsum Board/Lath/Drywall Drywall: Prior to taping. Lath/Plaster: To be made after. all lathing and gypsum board, interior and exterior are in place, but prior to plastering. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After tine is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this p'oint. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. 1999 Final Building 2200 Underfloor Mechanical 2210 Underlloor Gas 2260 Gas Service 2300 Rough Mechanical 2995 Final Gas 2999 Final Mechanical 3130 Footing/Foundation Drains 3170 Underlloor Plumbing Underfloor Plumbing: Prior to insulation or decking. Springfield Building Permit 11/23/201 9:20:18AM Page 5 of6 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00661 IVR Number: 811137076737 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perm itcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 11/23/2010 11/04/2010 EXPIRES: VALUE: OS/22/2011 $164,000.00 11/23/2010 PROJECT DESCRIPTION: SCOPE: Single family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Single family residence - SAME AS COM201 0-01 058 546 S. 48th pi SITE ADDRESS: 4854 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105500 3200 Sanitary Sewer 3315 Water Line Sanitary Sewer line: Prior to filling trench and including required testing. 3400 Storm Sewer Storm Sewer line: Prior to filling trench. 3411 Perimeter Rain Drains 3500 Rough Plumbing 3999 Final Plumbing 4000 Temporary Power Service 4225 Service or Feeder Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover Final Electric: When all electrical work 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 I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or 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 Sa'fety. I further certify that only contractors and ~mployees who are in compliance with ORS 701.005 will be used on this project. 1 further agree to ensure that all required inspections are requested at the proper time, that ~ach 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. Owner or Contractor Signature //~-< -d:? Date Springfield Building Permit 11/23/201 9:20:18AM Page 6 of 6 n~ willamalane t-w Park and Recreation District Job. No. 5/CJ -6c;r SYSTEM DEVELOPMENT CHARGE WORKSHEET July 1-December 31,2010 NAME: I!AYi:>E/V PHONE: 2Zb Co7J) ADDRESs.;:::>.,..~ SiAl 7~",-,t.cCITY Rt>PfNp STATE:d/.2ZIP: q1J7~ LOCATION OF PROPOSED BUILDING SITE: Street Address: '/Yrl,/ r?C:~/t!.?-- Plat Name:?l~~A//,....,J).J Tax Lot Number: /~tJ2 tJ$7/ t7J:JdC) . 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) : A. Sinole-Family Detached NO. OF UNITS t X $3,468 per unit = f $ J y 1.P3 B. SinQle-Family Attached NO. OF UNITS X $3,538 per unit =. $ C. Multi-Family Apartmerit NO. OF UNITS X $2,906 per unit = $ D. Sino Ie Room OccupancY NO. OF UNITS . X $1,453 per unit = $ E. Accessory Dwellino Unit NO. OF UNITS X $1,734 per unit = $ $ WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer must furnish proof of Willamalane Credit approval.) $ J' 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) $ '7'ic,~ \ \ ,1:2, Q.()\() Date 5 Electrical Permit Application 225 Fifth Street. Springfield, Oll97477+PH(541)726-3753+FAX(541)726-3689 _~- ..,.....c.".,'..:.>.'~.d.'..'....-...,~_"'....,,'..""=I"""""'"'......-...-'u .' ," ... ,..,--',., "". ""'--""-~'~"'"lI''''' . \i,f'DE~ARTiMEN:r;~l!JSE(0Nt:,Y,'. ,.~ ~:,',:;;ffi"" ,:,,_,w~ '''',,"~.~~''~i~~~~1;iIV~;'.~~... t SfSv2.za,6 _00 Permit no,: Date: J/ - (-/0 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. ~t.a~~1E0.CJMLGQV.ERNMEN[f;N~~P.RO~A'~'jq,\'l\~~!.~ Zoning approval verified? 0 Yes 0 No 1IJi:';'l!3'~'if.;1:jw,J:.liC)\;r:E({0RYdloF,jgc::~0NSiI1RtiJ.QmIQN\!i\\t'l~~~litff~.; o Residential 0 Government 0 Commercial m~'?30B~SlitE',~INr:...0RMA,"IQN~AND]Jl!0G~'I;10N:r),I!:;~;;;;;i Job site address: &i.l"c( Dr City: 5 /I State: 15~ Subdivision: w"{>~ w tw!s Lot no.: '30 (~.ill~h'Y!~}\W~1t.WJIDES:CRI~mI0N'K0~W.0RI(>~t.~~i}~fi~1ii:l, ..1ooS(. vJ\\[-( \ i:~~~~!:!.~~~~~-~(D~-ERJ1~!tQwN-E~4~:t&f_%~~:~t~~~f~;,'~ff~RS:~ Name: 14.. Address: . ZIP: "i7/5fi-: City: Phone: E-mail: This installation is being made on residential or farm 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: !j]f&PI'"J,\;1ml.l';:QNmR:((;jJt0R:~INSil'~IlI.€AmIQNH~.,11,*~;f} I- ~ City: Phone: E-mail:, CCB license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~~ \\.{); ,(J& 440-2584-) (9/08/COM) m!~f!N~I~!jr~F"I;I:[S:(;IilEQilJIEE~Iflw.>'lY<;;~~~'&)9,~~ *N~'N1?~Q~i.~~*'titit~~~1~Wf~;:~J!;~.\i~ rl~~ :,~~;t:ost1~1~~toml~ , urn erto 'I"spee IOns;pe"ltem'(')~^', Q y" l:i\ij.r--l":ill~~""" , i.;:,'tI'~:.I1r'f."~';! '~\i\~~~,'~~.ilt!:::ti:;'~(:I--:>C~W~ },1~{~;!';1 ;:..'...;';;~ tj"' ~ ~ah:.~i ~). ~'l.~9sti-@ Residential, per unit, service included: 1,000 sq. ft. or less (4) I $134.00 $1 ,?C( Each additional 500 sq. ft. or portion ;)- $ 25.00 $ SV thereof limited energy (2) .. $ 32.00 $ , Each manufactured home or modular $ $ dwelling service or feeder (2) 63.00 Services or feeders: insta{lation, alteration, relocation 200 amps or less (2) $ 81.00 $ 20 I to 400 amps (2) " $ 95.00 $ 401 to 600 amps (2) $158.00 $ 60 I 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) I $ 63.00 $?3 201 to 400 amps (2) . $ 87.00 $ 40 I 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 branch circuits without purchase ofa service or feeder fee: First branch circuit (2) $ 55.00 $ Each additional branch circuit $ 6.00 $ Miscellaneous fees: service or feeder no! 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 $ l!il~l2'~{~~~~1!j(:;ANIf.Jlli!JsE~it!9'~j~j)J1!~~;fl~ (A) Enter subtotal of above fees , 2r() (Minimum Permit Fee $58.00) $ (8) Enter 12% surcharge (.12 x [AJ) $ 2..? "'f (C) Technology Fee (5% of [AJ) $ IJ} ~- TOTAL fees and surcharges (A through C): $1XK'1J... SItME ~S - 5Z-f~ .s 4€t" ft- CIO-OIOr~ StnH 225 Fi1i.ll Sueel. Springfield, OR 97477. PH(S~ 1)726<3753. FA.X(541)/26-J6S9 SPCl'NCF'ELD DEP,6,RTMENT USE ONLY i Srfl.lGIO. 60 ~i Permit no.: I , , ... .. . ...",. "__..'~JI Date 1(- c.( -( D This permit is issued under OAR 918-460-0030. Permits expire if work is not st:nted within 180 days or iS5u3nce or if work is suspended for 180 days, LOCAL GOVERNMENT APPROVAL . ,,",' ',- '-, . This project has final land-use approval. Signature: This project has DEQ approval.. Signature: Zo"ing apprvval verified: 0 Yes Property is v;~:h;i1 fleod plain: 0 Yes I \ Date: Dale' DJ'o ~" U ['10 "CATcr.;CJ!iX: OFCONSTRUc;TI.ON : ..... [3J Residenlial o Govemmenl o COi\,liItrc\3.\ .JCJBSITE INfbR:MATI(jNANDL6cATI6N City: Subdivision: Reference: ZIP 97<t7'iJ. 3d>. c>-~c::::. PROPERTYOw.NER Name' Address: Co City: " \"-C Stete: a Q r Fax: Phone: )LIt -, ~-/C: "'S- E~mail: This installation is being made on residential or farm property owned by me or a member afmy immeqiate family, and is exempt from lioensing requirements under ORS 701.010. FEE SCHEDULE i :.y~du~'t1.orl"iD form a Ho:n", .:" (a) lob description: Occupancy ConSlnlClio~ type: Square feet: o -f-'-/PO - Cost per square foot: Other information: Type of Heat: Energy P2th: (J~r [X] new 0 alteration 0 addition (b) Foundation-only permit? 0 Yes "EJNo Total valuation: .~ (a) Permit fee (use valuation table): (b) Investigative fee (equal to f2aJ): (c) Reinspection ($ per ~our): I (number cfhours x fe~ per hour) (d) Enter 12% surcharge (.\2 x., [2a+2b+2c]): (e) Subtotal of fees above (2a through 2d); s , $ I ) J Sign here: LATIONc Business name: Address: ']1 1-10, City: phone: ':J..l ( - E-mail: CCB license no.: 0 '/4rc r State: OK_ Print name: Signature: . o' '._ 0 'v' .,,-....'_-;..,.,..._.;_.'...... ".--'"'. '.....,.'. "",o"";'-""""'''' ",- ',,'<: .- :SU.~.CQNTRAq()R INFO,RMATlQW>\:' N3me CCB License Number Phone Number Electrical J 77'\&;;' Plumbing 3/ 7'17 Mechanic::!l 3CJ.;) 37 zS'o (a) Seismic fee, 1% (.01 x permit fee [2a1): $ $ . './ fig 'I~. $ TOTAL fees and surcharges (2e+3c+43): $/ J '3 i-- &l>(Q .~~ ~\t (, www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00661 4854 GLACIER DR CITY OF SPRINGFIELD 225 Fifth SI Springfield,OR 97477 541-726~3753 permitcenler@ci.springfield,or,us RECEII'T NO, 2010000899 RECORD NO, 811-SPR2010-00661 DATE, 11/23/20.10. !DESCRIPTION ,,;\:~;+;;",-;'-; "r;;- < ' : s,-,,::,,:C', y, 'ACCOUNT CODE ; 'F, AMOUNT DUE, '" J ,_ "_ " . ~.,,,.,,.,.._, ,__ ~. _ o"_____,_~_..._."".~.;'.......".....,, ".0 _. _'.-__ -4",.,.0"::'... Planning - Major Review - City 10.0.-0.0.0.0.0.-4250.0.2 $211.0.0. Gas Piping up to 4 outlets 224-0.0.0.0.0.-42560.4 $7.0.0. Flue vent for water heater or gas fireplace 224-0.0.0.0.0.-42560.4 $9.0.0. Furnace - up to 10.0.,0.0.0. BTU 224-0.0.0.0.0.-42560.4 $17.0.0. Temp services 20.0. amps or less 224-0.0.0.0.0.-42610.2 $63.0.0. Each added 50.0. sq. ft. or portion 224-0.0.0.0.0.-42610.2 $50..0.0. !,-,,~~dence w"ic;g~~-29_s9,--~ or le~ _ __________. ___,___.224-0.0.0.0.0.-42610.2 ___________$1340.0. First Appliance Fe~__ 224-0.0.0.0.0.-42560.4 $79.0.0. Sing~duc!.ex~aust (bathrooms, toilet compartments, utility rooms) ~24-DDDDD-4256D4_ ______-. __ _,_____~3~~D~ ~'O"JI.~/ol!:',,:;,Io"-c:~ equipment_____ 234-~~25~_~____'-__ __~,______~!~.~~ gn", or Two Famj!Y Dwelli~gwith Two Bath 224-0.0.0.0.0.-42560.3 ______Ji374.o.o. Willamalane fees - Single family detached 821-0.0.0.0.0.-2150.23 $3,468.0.0. Address Assignment, each new or change 224-0.0.0.0.0.-42560.2 $38.0.0. Residential Fire (.0.5 Per Sq Foot) 10.0.-0.0.0.0.0.-4240.0.5 $86.55 SDC: Total Transpo,rtation Administration Fee. 719-0.0.0.0.0.-42660.4 $122,46 SDC: Administrative Fee - MWMC Re~ional Wastewater SDC 611-0.0.0.0.0.-42660.4 $10..0.0. Sidewalk up thou.g,~ 90. Feet 20.1-0.0.0.0.0.-4280.60. .$88.0.0. .c..~ CuVDri~~way 1st Cut 20.1-0.0.0.0.0.-4280.60. $88.0.0. .~ultiple Permit Discount (Max 2) 20.1-0.0.0.0.0.-4280.60. $-30..0.0. SDC: Reimb~rsement Cost - Stor'Tl D'-ainag"--__ _, . 441-0.0.0.0.0.-4480.29 $40.5.0.0. SDC: Improvement Cost - Storm Drainage 44D-DDDDo.-44~~a._________~=-~~'':---:j;7~5~l!.. ~eimbucsem<:.r1t Cost - Local Wastewater 442-.~DDO()~a..D3..4___ . _0-- .. $2,5~~~8_ SDC: Improvement Cost - Local Wastewater 443-0.0.0.0.0.-4480.25 $1,285.68 2DC: Reimbursement - Transportation SDC 446-0.0.0.0.0.-4480.26 $426.92 SDC: Improvement - Transportation SDC 447-0.0.0.0.0.-4480.27 $1,597.62 SDC: Reimbursement Cost - MWMC Regional Wastewater SDC 444-0.0.0.0.0.-4480.24 $10.1.97 SDC: Improvement Cost - MWMC Regional Wastewater SDC 445-0.0.0.0.0.-4480.25 $1,333.57 SDC: Total Sewer Administration Fee 719-0.0.0.0.0.-42660.4 $30.0..94 .sDC: Compliance Cost - MWMC Regional Wastewater SDC 444-0.0.0.0.0.-42660.7 $22.63 ~cjmin fe~j!D% of ~~I!.~ble feesL_ ___.____.,____ ,23~:()DDDD.:.4266D5_w _____..___~~ State of Oregon Surcharge (12% of applicable fees) ..-.-._..8.3..1;()~()O-2~~D()-:,,______,,___....Ji.~84. !~chnolog~ (5% of per,,"it totalL...... 10.0.-0.0.0.0.0.-42560.5 $48.30. Structural Building Permit Fee 224-0.0.0.0.0.-42560.2 $969.23 Iechnology fee (5% of permit total) 1DD.DDDDD-~256D5_ $48,46 State of Oregon Surcharge (12% of applicable fees) 821-0.0.0.0.0.-2150.0.4 $116.31 TOTAL DUE: $14,907.81 r, pAYMENT type~PAYOR,--:CASHIER;ccARPENTE~ .-c_QMME~ISV;,,~~.-,,~'t '2",'yf'AMOUNWAIDc " " ,(,.1 Check 31147 HAYDEN ENTERPRISES INC $14,907.81 $14,907.81 www.d.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00661 4854 GLACIER DR CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541~726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2010000762 RECORD NO: 811.SPR2010.00661 DATE: 11/04/2010 lJ;l~S'!;RIPT1Clf:.l~~,,:c.~,;.,',',:,;F,;~J>f-' t':-' .FF ,., "~',l\cC:6Di{tc-'>:PE::t,"~_'~';'~M9JJNLD.UE~;,: Same as Plan Review Submittal 224-00000-425602 $250.00 TOTAL DUE: $250.00 I ~.P;A.VIVIENT'"TVPE, "'PAVOR'Fi'<\CASHIERD80.\f4S8y;T 'CQ[VIIVI!;!'!I$'" '"',, ' "AIVIO(jll!"T~AID " " .:.::;:..:J , Credit Card 029754 HAYDEN HOMES LLC $250.00 $250.00