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Home My WebLink AboutPermit Building 2010-12-17 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 81i1-SPR2010-00454 IVR Number: 811186543611 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 12/17/2010 SITE ADDRESS: 4881 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109700 PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI. Phone Number: OWNER: ADDRESS: JHD3 llC 2464 SW GLACIER Pl REDMOND OR 97756 12/17/2010 10/06/2010 225 Fifth St Springfield, OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield.or.us EXPIRES: VALUE: 06/15/2011 $246,431.20 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Contractor Type CONTRACTOR INFORMATION lic Type CCB CCB CCB ELECTRICAL BUilDING INFORMATION I 1 18.5 Forced Air Gas Electric Electric ~ Lie No lie Exp Phone 31747 05/12/2012 541-928-8942 39237 03/25/2012 541-672.9510 92208 07/29/2011 541.923-6607 C220 07/01/2011 541-317-1998 Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: 4574 1408 980 403 224 Electrical Specialty Code Edition: Springfield Fire Code Edition: ATTENTION: Orell"" law rOf:llirps you to Mechanical Specialty Code Editi~~~?W r~les adopted ~~ I.:::. _ ;",: Jon U~ility . . Notification Center. Tro~~ rwi' .' ~re set TOrth MUnicipal f Development Code:in OAR 952-001-0010 iJ',roc'lh 0/4.,1 S52-001- Plumbing Specialty Code Editi'tJ'~90, You may obtai" c",';'" <;>; 'he rules by Residential Specialty Code Editionalling th2008nter. (~Iote: l'le 101ephone Structural Specialty Code Editiomumber for the Oregol1 utility Notification Center is 1-800-332-2344), General Contractor Contractor Name STUTZMAN SERViCES INC PACIFIC AIR COMFORT INC HAYDEN ENTERPRISES INC TOP NOTCH ELECTRIC INC .. # of Units: # of Stories: Height of Structure: Type of Heat:. Water Type: Range Type: Hazmat: Occupancy Type Construction Type Occupancy Type R3 Residential Type VB U Utility & Miscelllaneous Structures Type VB Construction Type # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: 5 Path 2A Certified performance-tested duct system Site Information I Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: Yes No Yes Yes Springfield Building Permit 12f17f201 9:29:0SAM NOTICE: L,"" .- .. THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THI~ PERMIT IS NOT COMMENCED OR IS ABANDONE9a~P19,f6 ANY 180 DAY PERIOD. www.ci.springfield.or.us CITY OF SPRINGFIELD' 'Building I Residential Permit PERMIT NO: 811-SPR2010-00454 IVR Number: 811186543611 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541'726-3676 permilcenter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 12/17/2010 ISSUED: APPLIED: 12/17/2010 10/06/2010 EXPIRES: VALUE: 06/15/2011 $246,431.20 SITE ADDRESS: 4881 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Fronlyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 12.42 5 5.19 26.06 o New SFD SAME AS 591 S 48th PI. DEVELOPMENTlNFORMA TION I Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: Yes REQUIRED PARKING Total: 2 Handicapped: Compact: % of Lot Coverage: Highest point on structure to north property Ii~e: 39.5 18.5 PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: I Fully Improved Storm Sewer Yes Sidewalk Type: Curbside 5' Downspout/Drains: No Valuation Description ~ Descriotion R-3 1 & 2 family U Utility, misc. Tvoe of Construction VB VB Unit Amount Unit Tvoe 2,388.00 Sq Ft 403.00 Sq Ft Unit Cost 96.83 37.72 Value 231,230.04 15,201.16 246,431.20 " Springfield Building Permit 12/17/201 9:29:05AM Page 2 of6 SPR.I.N. G~,~L,D~ ~.h' '~2" ,~ "'1!/,,,,~,;_,. OREGON Ww-N ,cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00454 IVR Number: ,811186543611 225 Fifth St Springfield, OR 97477 Phone: 541 ~ 726-3753 Inspection Phone: 541-726-3769 Fax: 541-726~3676 permitcenter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 12/17/2010 ISSUED: APPLIED: 12/17/2010 10/06/2010 EXPIRES: VALUE: 06/15/2011 $246,431.20 SITE ADDRESS: 4881 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI. FEES PAID ~ Description Amount Paid Date Paid Same as Plan Review Submittal $250.00 10/06/2010 Sidewalk up though gO Feet $88.00 12/17/2010 Curb Cut/Driveway 1st Cut $88.00 12117/2010 Multiple Permit Discount (Max 2) $~30.00 12/17/2010 SDC: Reimbursement Cost - Storm Drainage $384.82 12117/2010 SDC: Improvement Cost - Storm Drainage $698.75 12/17/2010 SDC: Total Sewer Administration Fee $373.51 12/17/2010 SDC: Improvement Cost - local Wastewater $1,767.81 12/17/2010 SDC: Reimbursement - Transportation SDC $426.92 12/17/2010 SDC: Improvement - Transportation SDC $1,597.62 12/17/2010 SDC: Reimbursement Cost - MWMC Regional Wastewah $101.97 12/17/2010 .~DC: Improvement Cost - MWMC Regional Wastewater ~ $1,333.57 12/17/2010 SDC: Compliance Cost. MWMC Regional Wastewater SI $22.63 12/17/2010 SD'C: Administrative Fee - MWMC Regional Wastewater: $10.00 12/17/2010 SDC: Total Transportation Administration Fee $118.96 12/17/2010 SDC: Reimbursement Cost - local Wastewater $3,505.26 12/17/2010 Admin fee (10% of applicable fees) $15.08 12/17/2010 Planning - Major Review $211.00 12/17/2010 Temp services 200 amps or less $63.00 12/17/2010 Residential Fire (.05 Per Sq Foot) $150.75 12/1712010 Address Assignment, each new or change $38.00 12/17/2010 Willamalane fees - Single family detached $3,468.00 12/17/2010 One or Two Family Dwellin~ with Three Bath ~~9.(),<l.~~ 12/1712010 Furnace - up to 100,000 BTU $17.00 12/17/2010 Range hood/other kitchen equipment $13.00 12/17/201'0 ~~gle-duct exhaust (bathrooms, toilet compartments, utili $36.00 12/17/2010 Heat pump $17.00 12/17/2010 First Appliance Fee $79.00 12/17/2010 Gas Piping up to 4 outlets $7.00 12/17/2010 Residence wiring 1,000 sq. ft. or less $134.00 12/17/2010 Each added 500 sq. ft. or portion $125.00 12/17/2010 State of Oregon Surcharge (12% of applicable fees) $246.47 12/17/2010 Technology fee (5% of permit total) $111.89 12/17/2010 ~tate ~ Oregon Surchar~12% of appiicable fees) $-134.87 12/17/2010 :r.:echnology fee (5% of permit total) $~56.19 12/17/2010 Structu,:,,1 Building Permit Fee -11,307,04 12/17/2010 State of Oregon_Surch~rg,,(12% of ap~~ee~L- _..___~.~~~~_.____,. 12/17/?010 Tec~."la9Y fee (5% of permit to~_.___ $65.35 12/17/2010 Receipt # 374518 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 375159 --- 375159 ._~.._-~_.-- 375159 ~ ....,.-.. ._._< -",- - 375159 Springfield Building Permit 12/17/201 9:29:05AM Page 3 016 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00454 IVR Number: 811186543611 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 12/17/2010 ISSUED: APPLIED: 12/17/2010 10/06/2010 225 Fifth 5t Springfield.OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci,springfield.or.us EXPIRES: VALUE: 06/15/2011 $246,431.20 SITE ADDRESS: 4881 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI. Total Amount Paid $17,247.18 Plan Review Department Application Acceptance Received Due Date Completed 10/06/2010 10/06/2010 10/12/2010 Result Application Accepted fStruCt0ra1 ReVT~w?7'-!f1;;;ji;'0 '1 0/12/201 0\, ,10/12/2010""1672672010" ~d'i"ii;ib:R;;'quiied-' V J;o~tn~nt~:' ;N;~'d"corifir~~lion'fr~~,'e~~i'riee:riQr:j6oops{I6fi:b~arin~:~'~~acrty~'.;-" r'" ',/' ,.-.'>' i,;1:~~~~." . ",", '\"'~,,--,,"...~...,"t_..~,.. "c"" Initial Review 10/12/2010 10/12/2010 10/12/2010 Approved ~ Reviewer David Bowlsby ~- ~~Ch'rffis~aW~p~nt~"r>i":' ~~--:,~~~~'-7:,~~-.~. .~,l,' ..,,-' ~ .. '.. , ~ -..:.J David Bowlsby rl~nning Rey'ie'";1;f;;.t',,~1~'c;i19/12120.!0:.10/12!2010'}1Q!J~Z3QW,J~-$p,p"lved,r,' '_~>\' EleyetteKel!y' '7.,' . " ..c<::m~nie!l~~;~4!v1,~~~t~, mj~jmu" :1]1, :~~tbackS~ ,In ~H,' ;~t,?E_ t9.~Vi~ri!X,BJ~~7n:'en.tJa,tt,~n11.e,,?f;~?pjJ~g-jg~P,~E~lqn"0' FJ:E'_~t elev.~ti2.f1S :~r~:~i.te;-,sp ,e, Cift,IC .' ..~'., ,': ~,~~nd:~ont,!If).r~qul[ed de?ign,'eler:pe,nt~.:~If1sp~ctgr~",wll!, fi~~~,~eckt~ClJ',?.ct~,q!::~lE:!y\~tlons~m,~tcb'su~rpJ~,eg:,d~srg~$ ''':$', ':' ~'" _ . '::~hown cin:t.b.~.]p"Rroved seF61;Rlans:" . _ ~'-f',,,-'~"%.:< -'~l:;_b- L, <"::Y\'_:-:::~-:/'-;'--,i- . .i _ -. v'..', "" -;<','.: Structural Review 10/12/2010 10/12/2010 10/27/2010 Add'llnfo Required Chris Carpenter Comments: Need engineer to confirm-30QQPSF soil bearing capacity ~ruC~U-{al.~e,-:iew-: '::s.~::"w~~}O/-1t~~q1~;~,J9~?,~!~~~~, ~ .:;~_ _:12/j~12b1~q.:\: ~~~:~~~roved-;~~ :;+":~-:~'5': _ Ch:iS. 9~rp~ent~T, ~,' ~--r,- 1 L~,c~mments: E,ngme~n~g(9~;~QqQpSf.SOI~r~C~tyed.., 0,. '. ;'~>,::t ~<) - ,-.,'" \ " :-" .~::.-- ". A .,1 , ' d~ ""'~--"--._ "", "-_~._____~_...-....-.~__.~~ ,~_ ____~___ _ Public Works Review 10/15/2010 10/19/2010 10/22/2010 Approved Ben Gibson Comments: Storm water to storm sewer. 'I Springfield Building Permit 12/17/201 9:29:0SAM Page 4 of 6 Www.ci.springfield.or.us . CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00454 IVR Number: 811186543611 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspeclion Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 12/17/2010 10/06/2010 EXPIRES: VALUE: 06/15/2011 $246,431.20 12/17/2010 SITE ADDRESS: 4881 GLACIER DR, SPRINGFIELD, OR 97477 ASSES OR'S PARCEL NO: 1802051109700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI. INSPECTIONS REQUIRED I 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 Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 1220 Underfloor framing 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved, 1370 Masonry Veneer 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. Shear Wall Nailing: Before covering sheathing with finish materials. 1520 Interior Shearwall 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 line 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 point. 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 31,30 Footing/Foundation Drains Springfield Building Permit 12/17/201 9:29:05AM Page 5 of6 SPRIN.G F.IE.L~. .~ A'" i1JJJ ~,~~ OREGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00454 IVR Number:.811186543611 225 Fifth St Springfield, OR 97477 Phone: 541,726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permi1center@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 12/17/2010. 10/06/2010 EXPIRES: VALUE: 06/15/2011 $246,431.20 12/17/2010 SITE ADDRESS: 4881 GLACIER DR. SPRINGFIELD. OR 97477 ASSES OR'S PARCEL NO: 1802051109700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: I New SFD SAME AS 591 S 48th PI. 3170 Underfloor Plumbing 3200 Sanitary Sewer 3315 Water Line Underfloor Plumbing: Prior to insulation or decking. 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 Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. 4000 Temporary Power Service 4225 Service or Feeder 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agre~, 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 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 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. f!z- /2..- If-' /0 Owner or Contractor Signature Date Springfield Building Permit 12/17/201 9:29:05AM Page 6 of 6 225 Fifth Stmt+Spdngfield, OR 97477 +PH(541)726-3753+ FAX(54 1)726-3689 .~PRINGFIELD ~,'r}!.':l:!'91 tr~d~J;}~~r~~!~f~ ;.~~.,,>.$;<;.;"d, ~. '~<i;~' \8'i\@~ilitJ'~':l:. ~Jf -';"ij DEPARTMENT1USE(ONbY,t)~i .,' , ,-,' ._.;:,.-.~ :j'..::;~:i,;~.~t;'~,~,~~.:..::;:.i:'~;~1't'~. Pelmit no.: Stu -00 4 ~-l.{ Date: 10 This permit is issued under OAR 918-309-0000. Permits arc nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. ~~~~lil1~m1~;~Q:-Q!f{~1~:GQ5I.Et{~.M~~N"ff~t~:ee_r{OSIA~;1iti~~~~~~~~~10i~ Zoning approval verified? 0 Yes 0 No ~~1!~7J~~it~8mE.~G~Q~Y~IG&~9:QN$mRQ~0J]J,Q:N.W1~~~~~ti~tf~; o Residential 0 Government 0 Commercial ",",""r"''-O'B'-:~S'-''''''Ei!!I'N--F.' . '''''R'HM''Ac''''-'-O-N''''A'N----r.-;'.'i''O' '''A'''I''ON'w'''',''''''< ~~.H:f!:i:!j~~'i.<.~, .:. _ ..~__ _.J':__ ';.;;. ,__ ,;',9..< _ __> ~I.L_".,.. fiL-.._;_ U,jj'};'.~ )~-_' )L.'_ ,~::~'1:h~~'~ Job site address: City: S Subdivision: vv~.J.. W,\ Lot no.: ~~~J]i%~t~~~J~Di;~~F{IRmT~~.~~~~WGJ~}s'~~~~~~~]'{{fir~t~~;~ (:;I e,...vl"e. l5f1~~iJUE~~~m.!t14Jt4}X~~J;?;~O:[I:1B::1R(M~.W:~.');R:tf~;Wi'@Jf~:l)~~~~X~t~~:~~.;~~:; Name: Address: City: Phone: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent OAR 479.540(1) and 479.560(1), Signature: \%",W,"ij\'.14i~~.3~r~r'o', "N--;r,""''''i;'J'm;e'R ,':~IN' SM""l!'I!Afr. ;1r,;Nm~i)~,~4_w::&',:t,;).':'"',, ,.~~,:r.::""_~I~~3;!;},,"'&.,___, . i.1!J~~_~. .,_ w. n'" 11'_1;\-... __'- \..::~__._..~"':'.<:1,,,''1~.,.,,,~,,,;,,.j-1'.,,.. City: Phone: E-mail:, CCB license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~ f\ ,1\ \.\0 \d~ ~~. 440-2584-) (9/08/COM) trrr":~M_EE";S'd8EDl!JI!!E'ii!'W..i.\l"'~\! :~,:;;';~,:~.;~;i:~, ;~~.;,~~'--__:~":;~;;;,;:::;::-',~;;";;:,:;, L,.:." .<t~J.~:'" r~.~' ..ff":",',:e~~". .' , :.~~,iWc~"r,<.,,~.()::<..,!..,:,-..;z :.,"~'r,~; ,.~;WGost~~l o't1HF;, ~N~~,lb,~~~'9.,pn}ee. J\w~.e!;:~t~:ri~[M~l~~;' QtY~j ~'~fut~~;;}~~1i >.."~t~1 ,-,,,,,,,,,'f,;:r.-;'_"""H,':!?;..,~.,~'!\C..J-', ;...~t~I"~"I!l.~,'-',h.l"'iii:.'i ,1,,., l>'i:\., "'~,- ea.,~,~\.l$ .~p,~t:i.t.:~! . '.' .... .'__' ,,-.,':. .. _.....e..'...l. Residential, per unit, service included: 1,000 sq. fl. 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 $ $ dwelling service or feeder (2) 63,00 Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 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 $ 201 to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or fee~Iers 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 I $ 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 not 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 $ ''ijj1if;~i''''''''W'!i;*~'!''f'-;"rifl?RiEWA''-ffi!!iB''-'''''''''1Ji,''11\i_'''r''i'",'" W ..",:...t;~~,,~.w, ijll:-:,.1lt:&JlIH; " . ". N: ';:' I SE,~'. ~'. l.f[" !B~; "1'~figitJ ...,w._..",.,C<.. "'" .....; ,_ ..'"..lIl_b,,,. ,,,,.,'___' ,....,.".~.,,_..."".~J .L,J, ,..' !...~i11 (A) Enter subtotal of above fees (Minimum Permit Fee $58,00) $ (B) Enter 12% surcharge (.12 x [AD $ (C) T,chnology Fee (5% of [AD $ TOTAL fees and surcharges (A through C), $ "''' \1( Permit Application _. -: ..........."'~r~~ ~..-=~ ~~~',.I) ~ ~> '_I~ :il"-l~ ". 0 ,~~~~~~ 22~ FifJl Sur.:! ~ Spr.ln~lll:ld, OR 9/-\77 t PH(541 )776-3753 + FA....X(541)?J:6-36S9 5 Afl'16 f.!-s ~ S"/I .:5 4&'1+'1 fl- ~ - --------~-- DEP/\f~TfvH:::NT USE ONL'>' ! 5P""'''''''O:' &..<... "'::4'!1 Perm!, ncD) () - q .s-y DJte I D/r, /ID , , ] SO d~1Y5 of issu;lnce or if,york is This permit is issued under OAR 91S~:.l60-0030. Permits e;..:pire ifwor\.\ is nOl SLlrled ,,"ithin suspended for 1 SO days. LOCAL GOVERN~'EiH I I I This project has flllall3.I1G-lJse approval. Sign3!UrC'" This project has DEQ r:pproval. .APPROVAL' I I I Date: Sign8.!me: lOl,ing. 3ppru...'31 verified: 0 Yes Proptrry lS \,,;:~.i;i nGc.d plain" 0 Yes Dale: DNa ~.. U!"Jo !CATEGORY:OFCONSJRUCTIQN .' . I lZ1 Residential 0 Government 0 COiTLmerc\31 JOB. SITE INFORMAT!ON' AND LOCATI 0 I'r .' Job site address' ZIP: '77,(7$'. PROPERTY OWNER Name: /-Ie...-.\ Address: ~'IG'i <,W City: KC' ,iOflC,,{ Phone: -:-'-!I - ~ - (;"0 _""JS- tc;la,,'d I State' 0 Q !' Fax: E-mail: This installation is being made on residential OT farm property owned by me or 3 member of my immediate family, cmd is exempt from licensing requirements under ORS 701-010. S;gn here: ~ /2,{(L CONTRAqOR .lNSj;~LATI9N. 110, Address' C,ry R" Phone: 5'-/1 . '(<::lee r State: GK_ E-mail: CCB license no." 0 Print name: Signalure 'S.UBCONTR!'IttTOR!NFO}{MAf,i'(jW .... N~me Eleclricnl Phone Number P~umbing MechLlnic~d FEE SCHEDULE 1. V8hi.3'~ion- ioform31ion",' I I I (3) Job description" Occupancy -' rAw-. C,)~slruc\ic,jl ::.'pe Square feel: .... COSl per square foOl Gihei ir,foimation: Type of HI;'3(: -,c, Energy P:Hh: ~!~ 1XI new 0 alteration (b) Foundation-only permil') Tot::!l Vfllu::ltion: o addition DYes ~o Co (a) Permil fee (use valuation table): .$ (b) lllvestigative fee (equa! to [:28)): S (c) ReinspettioTl ($ per hour): 1 (number cfhours x fe~ per hO\.!f) .) (d) Enter 12% sUfcharge (.12 x [2a-+-2b+2c1): $ (e) Subtotal of fees :lbove (2a through ld): (8) Plan review (65% x permit fee [2a)): (b) Fire and life safety (40% x permit fee [2a]): $ (c) Subtotal of fees above (3a and 3b): $ c. (a) Seismic fee, 1% (.01 x permit fee [2a1): '}; TOTAL fees 3nd surcharges (2e+3c+4a): $ 2~willamalane t~ Park and Recreation District Job. No>/6 - q rr , SYSTEM DEVELOPMENT CHARGE WORKSHEET July i-December 31,2010 NAME: ffA Yt?E.,;t.-- PHONE: 2zF (0'7 '.J S- ADDRESs.?'I~ SiAl f~~,e-~,TY RIJtJfwp STATE:d/.2ZIP: &:J1J7~ LOCATION OF PROPOSED BUILDING SITE: . Street Address: '1$3! Ct~lZ- Plat Name: t-J~ N 1> S Tax Lot Number: /;5"0 ~ 4511" r~ 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) . A. Sinole-Familv Detached NO. OF UNITS t' X $3,468 per unit = f $ J '( {p~ B. Sinale-Familv Attached' NO. OF UNITS X $3,538 per unit =. $ C. Multi-Familv Aoartment NO. OF UNITS X $2,906 per unit = $ D. Sinale Room Occuoancv NO. OF UNITS X $1,453 per unit = $ E. Accessory Dwellina Unit NO. OF UNITS X $1',734 per unit = $ $ WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer'must furnish-proof of.-- Willamalane Credit approva1.) $ J'- 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) ~.- $ 7L(C,g- Development Services Department City of Springfield /2-//1//0 Date 5 . www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2010-00454 4881 GLACIER DR CITY OF SPRINGFIELD 225 Fifth SI Springfield,OR 97477 541-726-3753 permitcenler@cLspringfield.or.us IlECEIPT NO: 2010001073 IlECOIlD NO: 811-SPR2010-00454 DATE: 12/17/2010 IOe:SCRII?TfON' '_/_f.'r--'~}};,;".,; ",.," ,," ":' - 7'1"-'" -'A-CC'OU'NT';CO'~O'E' 7: ..-.:,~, '. A"M'OU N T'O' 'UE;': , ,n j ._,_. .....__......_t....'..e...,'...._.___~..,..:.,'_~'""-.~__..:.....:-...:;:,.-';,:.__._~":--'.~~._._~.. ......... . :.;. .. _ .. --0.--:..:;:;0,;....0.... ..., ,"::. ,'.. ,..- 'J Sidewalk up though gO Feet 201-00000-428060 _~~0.9_ Curb Cut/Driveway 1st Cut 201-00000-428060 $88.00 Multiple Permit Discount (Max 2) 201-0~00?-428060 $-30.00 SDC: Reimbursement Cost - Storm Drainage 441-00000-448029 $384.82 SDC: Improvement Cost - Storm Drainage 440-00000-448028 $698.75 SDC: Total Sewer Administration Fee 719-00000-426604 $373.51 SDC: Improvement Cost - LocaLliVastewater,. 443-00000-448025 $1,767.81 SDC: Reimbursement - Transportation SDC 446-00000-448026 $426.92 SDC: I"-,provement - Tr~~sportation SDC 447-00000-448027 $1,597.62 SDC: Reimburseme!'t Cost - MWMC Re9ion~'--Wa~fJwater SDC 444-00000-448024 __~___~_.__ $10197 .s;DC ImP.':.o~"'!!'L Co~t :~YY~_~~g~~W~~tewater SDC 445-00000-448025 _.__.__ $1 ,333~~_ ~DC ~,:!,p!~a~,,_C?st - MWMC Reg~.;;le>_,:"ater SDC 444-00000-42!'.~, _~2~63_ SDC: Administrative Fee - MYY~S:_Regional Wastewater SDC 611-00000-426604 $10.0.9_ SDC: Total Transportation Administration Fee 719-00000-426604 $118.96 SDC: Reimbursement Cost - Local Wastewater 442-00000-448024 $3,505.26 Admin fee (10% of applicable tees) 224-00000-426605 $15.08 Planning - Major Review 100-00000-425002 $211.00 Temp services 200 amps or less 224-00000-426102 $63.00 Residential Fire (.05 Per Sql:o.ot) 100-00000-424005 $150.75 Addr.'!.~ Assig_~rr:ent, each new or change 224-00000-425602 $38.00 Willamalane fees - Single family detached 821-00000-215023 $3,468.00 _.._.__.__.~...,"...-----_.~.....-..._------'"'--- ------- .Q.ne~~ Family Dwelling with Three Bath 224-00000-425603. $439.00 Furnace - up t01Oo:bOOBTU--'--==~==::----224~OOOOO:42s604----------.- --. $1700 ~~g"~~.!.other kiIE'en e__q~pment 224-00000-425604 ----=~=-$13.?~. Sin~le-duct exhaust (bathrooms, toilet compartments, utility rooms) 224_00000-425,~04 $36.00 Heat,pump 224-00000-425604 $17.00 F}rst Appliance Fee 224-00000-425604 $79.00. Gas Piping up to 4 outlets 224-00000-425604 $7.00 Residence wirin~..!."OOO sq. ft. or.!'!.~_,.. 224-00000-426102 $134.00 Ea_ch .a.<Jd"d 500 s'L ft_o-,.~rtion . _.____. 224-00000-426102___________. $125.00 State of ~"gon Surchar9"j~2% of a~plica~s)__ 8~1-00000-215004 $246.47 Technology fee (5% of permit total) 100-00000-425605 $111.89 ;;t;;;;;;-fO;;~~Sur.ch~r;.(--12o:;;;t;;;ii;bi;feeS) ----821-00000-215004-------~ 3487 lechnology fee (~permit total) 100-00000-425605 - -.-.- -$~56.i9 Structural Building Permit Fee 224-00000-425602 -- __co. --$1,30704 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 .._-----$156.84- Technology fee (5% of permit total) 100-00000-425605 $65.35- TOTAL DUE: $16,997.18 l~l!A'Y_Mi;NT:r;Yii.E.if ,"'P.AY.QB:..: "e C}\S~LSR::CcAR.PENTEfu::lCOMMEt(I'S~ 4i-';-vr~~l:7~*:---- . ~'c Aj\iI6jJNT ~Afb- . j:c ,- -, I Check 32058 HAYDEN ENTERPRISES INC Check also used for s10-0455 and -456 $16,997,18 $16,997.18