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Home My WebLink AboutPermit Building 2010-12-17 www.cLspringfield.or.us PROJECT STATUS: STATUS DATE: CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00455 IVR Number: 811191148445 Issued 12/17/2010 ISSUED: APPLIED: 12/17/2010 1 0/06/2010 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 SITE ADDRESS: 4895 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109500 .PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Phone Number: OWNER: ADDRESS: JHD3 LLC 2464 SW GLACIER PL REDMOND OR 97756 Contractor Type General Contractor # of Units: Construction Type Occupancy Comments Occupancy Type Occupancy Comments Occupancy Type Construction Type # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wall: Soils Report Required: Springfield Building Permit CONTRACTOR INFORMATION Contractor Name STUTZMAN SERVICES INC PACIFIC AIR COMFORT INC HAYDEN ENTERPRISES INC TOP NOTCH ELECTRIC INC Lie Type CCB CCB CCB ELECTRICAL BUILDING INFORMATION I 2 Lot Size: 4879 28 Sq Fl1 st Floor: 1408 Forced Air Gas Sq Ft 2nd Floor: , S "OU to ,^", ,Agulre 1 U \11" Gas 0'" e~,r;t BasementO' rec!tso 1 '"IEN11 l". , \,,' 1\18 ~ I \orl\1 ElectriC {\, le5 a@q:F.t'Garage:(ules aA03e Oi No 10110'11 ru ceScj'Ft C~r~~~: \1 O,,\'. 952-0 - Noti\lcallon 0' _O"in tI'luu.9 itPo rules b~ , O,,\'. 952.-0 Sq Ft Oth.r~pleS 0 224 "one In ~a" 001<:>.11' v 'he lelep" . 0090. 'Iou,,, 0ccupa,\~y,lload: "otiilcalion 1\18 cent"'. Ulillty l" Electrical Specialty Code Edition: call1n~r lor 1\18.ore90n.332._2344). Springfield Fire Code Edition: numb cenler IS i .800 Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Type VB 2388 # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: R.3 403 U Type VB 5 No No Path 2A Certified performance-tested duct system 2008 .., 'f 'E \~'['\RI<. NOi\~tl1 S\-\"-'-'- E~P\RE ~~MI1 IS \,\01 ~\~\-I~R\~~D \J~~~; ~:~~~O\'\ED FOR COMME\'\CD~~ PERIOD. p,\,\'{ "\80 Yes Site Information No No Yes Yes 12/17/201 9:22:23AM Page 1 of6 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00455 IVR Number: 811191148445 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: 155 ued ISSUED: APPLIED: 12/17/2010 10/06/2010 EXPIRES: VALUE: 06/15/2011 $246,431.20 12/17/2010 SITE ADDRESS: 4895 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 15 5 10 24.12 o New SFD SAME AS 591 S 48th PI DEVELOPMENT INFORMATION ~ Overlay Dis!: # Street Trees'Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north properly line: 3 REQUIRED PARKING Total: 2 Handicapped: Compact: Yes 39 18.5 PUBLIC IMPROVEMENTS ~ Stre.et Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description , Description R-3 1 & 2 family U Utility, misc. Tvpe of Construction VB VB Unit Amount Unit Tvee 2,388.00 Sq Ft 403.00 Sq Ft Unit Cost 96.83 37.72 Value 231,230.04 15,201.18 246,431.20 Springfield Building Permit 12/17f201 9:22:23AM Page 2 of6 SPRINGFIElD ~"A . . 11>,). tV'"...., '\.~^' t ,w.'. OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00455 IVR Number: 811191148445 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us permitcenler@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: 4895 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI FEES PAID ~ Descriotion Amount Paid Date Paid Receiot # Same as Plan Review Submittal $250.00 10/06/2010 374517 SDC: Improvement Cost - Local Wastewater $1,767.81 12/17/2010 375158 Sidewalk up though 90 Feet $88.00 12/17/2010 375158 Curb CuVDriveway 1st Cut $88.00 12/17/2010 375158 Multiple Permit Discount (Max 2) $-30.00 12/17/2010 375158 SDC: Reimbursement Cost - Storm Drainage $447.94 12/17/2010 375158 SDC: ~n;proveme!'.t Cost - Storm Drainage $813.36 12/17/2010 375158 SDC: Reimbursement Cost - Local Wastewater $3,505.26 12/17/2010 375158 ~~-_.- SDC:: Total Transportation Administration Fee $11859 12/17/2010._ _~!5~__ SDC: Reimbursement. Transportation SDC __._____$42~._..__~2/17/2010_____ __ __ _3.7~1..5~__ SDC: Improvement - Transportation SDC $1,597,62 12/17/2010 375158 SDC: Reimbursement Cost - MWMC Regional Waste~ $101.97 12/17/2010 375158 SDC: Improvement Cost - MWMC Regional Wastewater.~ $1,333,57 12/17/2010 375158 SDC: Compliance Cost - MWMC Regional Wastewater SI $22.63 12/17/2010 375158 SDC: Administrative Fee. MWMC Regional Wastewater: $10.00 12/17/2010 375158 SDC: Total Sewer Administration Fee $382,76 12/17/2010 375158 Technology fee (5% of permit total) $7,30 12/17/2010 375158 Each added 500 sq. ft, or portion $100,00 12/17/2010 375158 Residence wiring 1,000 sq. ft or less $134.00 12/17/2010 375158 :;:,emp_~_rJ~~~~~O-"_rT1P" or less $63.00 12/17/2010 375158 Technology fee (~'IO ofpe~mittotal) $14.85 12/17/2010 375158 ~~a!::..~!..Ore:.g~3'.~charger.12%_ of applicable fees) $35.64 12/17/2010 .___ .~:..5~. ___ Residentia~r~ (,05 Per S'!.foot)______.....,._____!:.s.ll!.5._. 12/17/20..1.?_....__.._?2~8.._._.. Admin fee (100/".. of applicable fees) ______......!1,s.08 12/17/2010,37515!....__._ Willamalane fees - Single family detached $3,468.0.0 12/17/2010. 375158 Address Assignment, each new or change $38.00 12/17/2010 375158 Planning - Major Review $211.00 12/17/2010 375158 Technology fee (5% of permit total) $1.90 12/17/2010 375158 Structural Building Permit Fee $1,307,04 12/17/2010 375158 State of Oregon Surcharge (12% of applicable fees) $156.84 12/17/2010 375158 Technology fee (5% of permit total) .______ $65.35 12/17/2010 375158 Gas Piping up to 4 outlets $7.00 12/17/2010 375158 .Furnace - up to 100,Oo.o._~TU ____________~_~~. 12/_17/~0~_____~515~_ Range hood/other kitchen equipment _..5.:"3.00___ 12/17/2010 375158_ Flue vent for water heater or gas fireplace ~$9.00 ___12/17/~010 ___ 3752:~__ Single-duct exhaust (bathrooms, toilet compartments, utili $45.00 12/17/2010 .._.37?2!5~._ Heat pump $17,00 12/17/2010 375158 First Appliance Fee $79.00 12/17/2010 375158 State of Oregon Surcharge (12% of applicable fees) $22.44 12/17/2010 375158 Springfield Building Permit 12/17/201 9:22:23AM Page3of6 .. ~SP~:NGFIELD :,c'~ - "~;f\. OREGON CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00455 , www.cLspringfleld.or.us IVR Number: 811191148445 PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 12/17/2010 10/06/2010 Issued 12/17/2010 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci.springfield,or.us EXPIRES: VALUE: 06/15/2011 $246,431.20 SITE ADDRESS: 4895 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI Technology fee (5% of permit total) One or Two Family Dwelling with Three Bath State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) Total Amount Paid $9.35 $1,317.00 $158.04 $65.85 $18,452.86 ~ Plan Review 12/17/2010 12/17/2010 12/17/2010 12/17/2010 375158 375158 375158 375158 ... ... ..... ."'... .,_... ',. ..., ~ ~,~..'" ....... ... , J ,;;."'_........'~... .........,.. ,,'^ _." _ , Structural Review~.R,:.""'_~' ,;..1011f!2010:-- :10/12/20,10~-.J2/13/2010.'" ;;Approved ... ~.: , ., "Chrls Carpenter. . ~ ;6~~~ht~r,~::~'i~~Q~~d.'6n'-~I~~S!~O;qi!i-4'n~~~i~.-~',::-;~~~:3:;\~~:'. ~~- -~~f~~:.:~.;,~ ::~, ~~~ .':,E{ .,~ . ~ ;;,,_:~:~ ,~_:::-4~__/" ~\. ~ ~ - : ~ ,. ~o ~ \ y' Planning Review 10/12/2010 10/12/2010 10/13/2010 Approved Deyette Kelly Comments: Meets minimum setbacks. Inspector to verify placement 'at time of footing inspection. Front and street side 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. fnlt~al.ReV!e~. :r~~ .~_:0>- ~?1~/1~:~A~q~~1~.0~/~.?}~ :;~12/~~L~~~~,.., .~^~::pr~~~d :-~\.; _,.4%~ '~:~;,~i~I~?W[;b~ ~~ .~>,~ ~. ~-- _. - "., I t "":':!"">:'ffi.;";,~~' :~'~A ~ ...':'1'- '" y, p ~'1l.;.~Q.'7 h t:. '2~., ':iv""._-~~.. ''''.d':!t".~_?,tAj ~ '"'\. - . '1 ,,,,,'~....,.i.______%'~ ,~ w;k._____U~'W_.......~_:ll-_ , . ~ "",,-,,_"W~~_~g;~,,-__,^..____J Structural Review 10/12/2010 10/12/2010 10/27/2010 Add'llnfo Required Chris Carpenter Comments: Need engineer to confirm 3000PSF soil bearing capacity Department Application Acceptance Received Due Date 10/06/2010 10/06/2010 Completed 10/12/2010 Result Application Accepted Permit Issuance 12/13/2010 12/13/2010 12/17/2010 Issued Springfield Building Permit 12/17/201 9:22:23AM Reviewer David Bowlsby .'.~~ ';''', ....1 -.0. n>" Chris Carpenter Page 4 af6 SP~I..~~ FIE~~ ~...~ ,:'~ ~)' ,\~~ -\ OREGON CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us Building I Residential Permit PERMIT NO: 811-SPR2010-00455 IVR Number: 811191148445 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: 4895 GLACIER DR, SPRINGFIELD, OR 97477 ASSES OR'S PARCEL NO: 1802051109500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New SFD SAME AS 591 S 48th PI I 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 Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 1220 Underlloor 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 Insuiation 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 Shearwall 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 Mechanic,?l: 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 Springfield Building Permit 12/17/201 9:22:23AM Page 5 of6 www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00455 IVR Number: 811191148445 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield,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: 4895 GLACIER DR; SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051109500 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: 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. 34111 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 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 conin# /2- I ':f-~ to Owner or Contractor Signature Date Springfield Building Permit 12/17/201 9:22:23AM Page 6 of6 .5~016 1l--.5. 5trlH 22~ Fit\h Slf.:.:1 t Spring(lcid fet s 4~:r", f'L. Sc",'''CFLO:\.[) DEPARTMENT USE ONLY P,rml, ",:' 90- 4 s-S" i D3Ie~fol/D.. , ] so dclYS of ISSU:]llce or Il work 15 "~y, This permit is issued under OAR 918-:..160-0030. Permits expire if wor~ is not started wiihin suspended for 1 SO days. LOCAL GOVERNMENT APPROVAL. I I IDale: I I I This projeCi h3S r,n3113IlG-liSe approval Signature This projecl h3S DEQ c;ppro\'31 Signature: Dale: lo,.ing 3pprc.vJI verified: 0 Yes 0 No D ~" ProptrTY is 'ii:~.:;-; n::.cd plain: "{es U i"O 'CA TEGciRXO(C.ONSjR'UCTlON' o Government o COiT,me,ci3.1 (gj Residtl11i81 JOB SITE IN~ORMATI6N: ANb. lQCATlol:l;- City' ""'v0irlcf Subdivi'sion':' W-e()- , Reference/BdZOS'1 PROPERTY OWNER Name: )/6..\l":h.'r'1. JlOVl'1L'Z. I Address: c,'1(;,4 <,LJ City: K~c rAoncA FfI'JLle: :':;-i..!! - ~ (...c..o...,S- hie! ,\/(' St2!.te: I i Fax: oQ ZIP177'C, E.-mail: This lllslallation is being made on rtsidential or farm property ~wne~ by me or 3 member of my immediate family, and is exempt from l1censmg requirements under ORS 701.010, Sign here :? fA . ", ' CONTRAC;J:OR:II:JST<LATI9N Business name: l-&yd. jJo; Address: q 3' Vv '7/(1((" r . C,ry: Rc" ",on?1 ' Slate: OK. c,. Phone: 'J-! I Fax::J11 - ?-U E-mail: CCB license no.. , o Print name" Signature: 50 BCONTP:.i>.t;ToR'.1 NFpR'r;1>':T(gW" ,. , , -.; ~ . Numbel- I Number Name CCB License Phone Eleclric;J\ OJ" G0 I Plumbing 3/ 71.{7 I Mech:lnic:ll 3'1;). 37 I FEE SCHEDULE 1. Valiib't1-oji"'informJtio'!l'" (a) Job description: 5'"",- Occupancy (2. '3 Constrllclioi"' r;.'pe: Squorefeet' O?S / / Cost per square foot: Other infOfmation' Type ofH<':3t: "'" Energy Psth: rJ/~ [X} new 0 nlteration (b) Foundation-only permit? Tot:!1 vnluntion: ~!,Btiiliij;'gTeeS; '. . . (a) Pemlit fee (use valuation table): (b) lnvestigative fee (equal to [23]): (c) Reinspection ($ per hour): (number of hours x fee per hour) o 3ddiliofl DYes (d) Enter 120/1> surcharge (.12 x [2;>.+2b+2c])" (e) Subtotnl of fees nbove (2(1 lhrough 2d): hI_ : ( ~""fJ'''' ..EtNo I 0= (a) Plan review (65% x permit fee [2a]): (b) Fire and life safety (40%\ x permit fee [2a]): (c) Subtotal of fees above (3a <lfld 3b): ::)(~$i,~~Iit~'h:f-B~!~.::'.N~~{t:":,,- .':": ',. (3) Seismic fee, 1% (,01 x permit fee [2a1)' TOTAL fees and surcharges (2e+3c+'-la): I I I ./ 225 Fifth Slrcc,.Springficld, OR 97477. PI-I(541)726-3753. FAX(S41)726-3689 ~;~iE:€ii~ . 'd:JEPARTMENT, USE.oNLX;,;'" "".\. .... ';,.;.-;. '..-.:-.--. .;. :''';-,. '.',:;,-~;: Permit no: 510 -co I{sr Date:. 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. . '[~~_~~~i~~:~~];~~;~~i;~1~~1M~ Residential, per unit, service included: 1,000 sq. ft. or less (4) I $134.00 $fJ't Each additional 500 sq. ft. or portion r $ 25.00 $ ,cfC thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ dwelling service or feeder (2) 63.00 $ Services or feeders: installation, al/era/ioll. reloea/ioll 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 fceders: installation, alteration, relocation 200 amps or less (2) , $ 63.00 $&3 201 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, alteraiio.n, ex/ensioll per pane] a. Fee for branch circuits with purchase of a service or feeder fee.: Each branch circuit I $ 6.00 $ b. Fee for branch 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 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 $ ~[i~~l~~~i~~~~!~~~W1Ngg~I~rlN.~H,~~f$~I;@~~{t ~,\~~'.:;.:.~-r.i?"l'~'if'S;:.,;;;, I')!'" ~'-~""'-:"V,~".!........ Ad,~,,;{ . ~'g :;,..~:'?K~~(..\iI: (A) Enter subtotal of above fees. 2,1 (Minimum Permit Fee $58.00) $ (B) Enter 12% surcharge (,12 x [AD $ '" S:.~ (e) Technology Fee (5% of lAD $ It.'~ TOTAL fees and surcharges (A through C): $~; , ~~~~~~~illih{W.QJ~~'e;1iti:G'~Y\E}{N'.M.'J;,NI{!~J?.B,.t{9V:/g.~~)1~~~~~tJ;fN.~1';~t;i Zoning approval verified? 0 Yes 0 No ~~Mf1A'i\~1fi;~;.~f~~I~~({Q'Rlf4~Q.fi;~j~~{QN$mgQftJrtJ.o:r:d~}M1&tWJf;R~~~,;\f;Z'~ o Residential 0 Government 0 Commercial (;f'lj&<<,fifiIQEl\1f$:rrr~~i.li\i.5QBMAJjIQfiF?AN D>iIT<:J\'J'Att:!\)NJi,F;~;P;\ Job site address: 't c 'e City: ZIP: '77'17 . Subdivision: Lot no.: ~M~I[~\~&~iii~%~'fE~~~QI=,$~G R1Bt)~0~f~t~YF.~;,~W:5D_R_K1~5-r.;n~f~~)r~f.1'11rJ~:,~~t~fi c W'{C ...,.... ~'t1~t~~i~:'}n~~?~M\~~t~~1~~~.:J;~:B Q~~~~.R:~~!QWN '~J{~f~t]0D?:;tf&C;~:~f;~~,E~;;fii~~~~;:~:;~ Name: Address: e Phone: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family. This . property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: ~~7~~~!1~~;t'~J?J..Nm8.~,G{f;:$Bi;i\-I:t{~illAU'(fAm"(Q.N~~P?~~W~:~~I~,~*(~Y~i:} Business name: Phone: E-mail:, CCB license no.: Fax: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: ~jP ;;~ . . _ _ ~n' , "''''0 ,...............f\ '$'( \ '\ \ .\ . 2~ willamalane t-w Park and Recreation District Job. NoS/O - q rJ SYSTEM DEVELOPMENT CHARGE WORKSHEET July 1-December 31, 2010 NAME: !fA Yi'E p PHONE: 22.~ (01 J S- ADDRESs./'IlW SW y~~..e.cCITY RPp,/Vp STATE:d/-2ZIP: "J17~ . LOCATION OF PROPOSED BUILDING SITE: Street Address: tflJ'7S C;~ I~'"Z- PlatName:WJTWNDS . TaxLotNumbe~~~t)'-1/ 0"9:'0 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) ~.~-T()TAb-WlbLAMALANE NET SDC ASSESSED (if SDC reduced for Credh( $ 7L(t,~ /2-, /7, /CJ Date . ... 'J<1c Development Services epartment City of Springfield \ \ .1 \ 5 , S~!~:~E.~ .~~ .. >,S':s,'OREG'ON www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2010-00455 4895 GLACIER DR CITY OF SPRINGFIELD 225 Fifth $t Springfield, OR 97477 541.726-3753 permilcenter@cLspringfield.or.us RECEIPT NO: 2010001072 RECORD NO: 811-SPR2010-00455 DATE: 12/17/2010 fDESCRipTION';+:;i:~ /'-'\:"'~"\t::+...,-: ',.j'>,,/\.~, :!i~L:6Aq:CJ3.LJ~T':'C:OQE" ;i.!.:..t'::'V:"."~M.QI,JI'tTDLJg,,- --',.,: "-. J SOc. Improvement Cost - Local Wastewater 443-00000-448025 $1.767.81 Sidewalk up though gO Feet __201-00000--:~.2.60 $88.00 ~urb CuUOriveway 1st Cut 201:00000-428060 $88.00, Multiple Permit Discount (Max 2) 201-00000-428060 $-30.00 _.. .. ----. -----~--, 441-00000-448029 $447.94 440-00000-448028 $813.36 442-00000-448024 $3,505.26 719-00000-426604 $118.59 446-00000-448026 $426.92 447-00000-448027 $1,597.62 444-00000-448024 $101.97 445-00000-448025 $1,333.57 444-00000-426607 $22.63 611-00000-426604' $10.00 719-00000-426604 $382.76 100-00000-425605 $7.30 -----~ 224-00000-426102 $'100.00 224-00000-426102 $134.00 ------ 224-00000-426102 $63.00 100-00000-425605 $14,85 821-00000-215004 $35.64 100-00000-424005 $150,75 224-00000-426605 $15.08 821-00000-215023 $3,468.00 224-00000-425602 $38.00 100-00000-425002 $211.00 100-00000-425605 $1.90 224-00000-425602 $1,307.04 _'~_.__._'__'__.'.N'_'._____ 821-00000-215004 $156.84 100-00000-425605 $65,35 224-00000-425604 $7.00 224-00000-425604 $17.00 ---- 224-00000-425604 $13.00 224-00000-425604 $9.00 224-00000-425604 $45.00 224-00000-425604 $17.00 224-00000-425604 $79.00 821-00000:~15004 $2244, 100-00000-425605 $9.35 - ---- - --- 224-00000-425603 $1,317.00 _ UN .+__,_..'___ __ 821-00000-215004 $158.04 _,____1..00-~~000-425605 -------:-_-:-~__:__=~~5-:B5 TOTAL DUE: $18,202.86 ,~"6';';.( '~JY!.oUNTftilP ','-.' ~DC: Reir:nburseme~t Cost - Storm Draina~e SDC: Improven:.ent Cost - Storm Drainage SDC: R~~~0l!!seme:~~~ost - ,~,~~~ Wastewa~!: SDC: Total Transportation Admj~istration Fee SDC: Reimbursement - Transportation SDC SDC: Imp~avemen!.~ Transportation SDC SDC: Reimbursement Cost - MWMC Re~ional Wastewater SDC SOC. Improvement Cost - MWMC Regional Wastewater SOC SOC. Compliance Cost -MWMC Regional Wastewater SOC SDC: Administrative Fee ~ MWMC Regional Wastewater SDC SDC: Total Sewer Administration Fee Technology feej5% of permit total) Eactc addecJ. 509...~9' ft. or portion .!37sidence wirinQ 1 ~OOO sq, ft. or less Temp services 200 a~ps or less Technology fee (5% of permit total) State of Oregon Surcharge (12% of applicable fees) Residential Fire (.05 Per Sq Foot) Admin fee (10% of applicable fees) Willamalane fees ~ Single far:,nily detached Address Assi~nment, each new or change ~~nnjng - Major Review Technolo~y fee (~!~".~L'permit to~al) Structural Building Permit Fee n___.'__ St!,~...!!f Oreg.o.n Surchacg~12% ".f..'lEplicable fees) TechnoloQL!~~J5% o~E~~jt tota!) Gas Piping up to 4 outlets Furnace - up to 100,000 BTU Range hood/other kitchen equipment Flue vent for water heater or gas fireplace Sin!;)le-duct exhaust (bathrooms, toilet compartments, utility rooms) Heat pump ~~st Ap.p1~~~ Fee .____ St~ of O!~9-"n Surcharg!'j12% o!2ee.tica!'.~~e~L Technolqgy. fee.(~~% of permit totalt 9ne or Two Family Dwellin~",~i~~ Bath State of .9regon Surcharge (120~ of applicable fees) Technology fee (5% of permit total) , L.e8YJYlENT TYPI;" C;)>:J?AY0R':' <'CAS~lERrCCARPE'mR '~,G_Q.MME:N'!'.Sc}%: '.2;'~" "~l - -<. RECEIPT NO: 20]000]072 RECORD NO: 81 ]-SPR2010-00455 DATE: 12/17/2010 rDESCRIPTION',<fc7Ji*,~J!;'i: --~:.;~t,tlr;;~~,,~~tfc~'~,:.s-,,~'te'_.." :A~J;.QiJ:r{TB::'.QJ1g- .. -- - ~-';".','~.MQ.l.Jl!TD-UE 'I SDC: Improvement Cost - Local Wastewater 443-00000-448025 $1,767.81 Sidewalk up though._9.9..i.~~_,_. 201-00000-428060 $88.00 Curb Cut/Driveway 1'!t...C.~t_..____._ 201-00000-42.8060 $88.00 !'1u~iple_~ermit Di~ou~LIV1~_2L-_ 201-00000-428060 $-30.00 SDC: Reimbursement Cost - Storm Drainage 441-00000-4480~~_..____ $447.94 SDC: Improvement Cost - Storm Drainage 440-00000-448028 __.._$8133~ SDC: Reimbursement Cost - Local Wastewater 442.00000.448024 $3,505.26 ~!:J.c:::...Total Tra~'!l'.ortation Admi~istration Fee 719.00000.426604 __._______~~ SDC: Reimbursement - Transportation SDC 446-00000-448026 $426.92 SDC: Improvement - Transportation SDC 447-00000-448027 $1,597.62 SDC: Reimbursement Cost - MWMC Regional Wastewater SDC 444-00000-448024 $101.97 SDC: Improvement Cost - MWMC Regional Wastewater SDC 445-00000-448025 $1,333.57 SDC: Compliance Cost - MWMC Regional Wastewater SDC 444-00000-426607 $22.63 SDC: Administrative Fee - MWMC Regional Wastewater SDC 611:0000~-426604 $10.00 SDC: Total Sewer Administration Fee 719-00000-426604 $382.76 __~ 0__~_"__~",~~,___,___+ ~~__.'_. :!:echnologx.!~e (5% of permit total) 100-00000-425605 $7.30 Each add~d 500 sq. ft. or portion 224-00000-426102 $100.00 Residence wiring 1,000 sq. ft. or less 224-00000-426102 $134.00 Temp services 200 amps or less 224-00000-426102 $63.00 Technology fee (5% of permit total) 100-00000-425605 $14.85 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $35.64 Residential Fire (.05 Per Sq Foot) 100-00000-424005 $150.75 Admin fee (10% of applicable fees) 224-00000-426605 $15.08 Willamalane fees - Single family detached 821-00000-215023 $3,468.00 Address Assignment, each new or change 224-00000-425602 $38.00 Plannin9 - Major Review 100-00000-425002 $211.00 Technology fee (5% of permit total) 100-00000-425605 $1.90 Structural Building Permit Fee 224-00000-425602 $1,307.04 State of Oregon Surchar,ge (12% of applicable fees) 821-00000-215004 $156.84 Technology fe! (5% of per,:"it total) 100-00000-425605 $65.35 Ga~ping up to_4.9utlets .._"'_.__ 224-00000-4256~~.._ ___.____.___~~.~ Furnace - up to 100,000 BTU 224-00000-425604 $17.00 Range hood/other kitchen equipment 224-00000-425604 $13.00 Flue vent for water heater or gas fireplace 224-00000-425604 $9.00 -~--' Single-duct exhaust (bathrooms, toilet compartments, utility rooms) 224-00000-425604 $45.00 Heat pu~ 224-00000-425604 $17.00 First Appliance Fee 224-00000-425604 $79.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $22.44 Technology fee (5% of permit totalL 100-00000-425605 $9.35 One or Two F~rnJ.lY Dw-"lI!~g with :r.!'~~~ Bath 224-00000-425603 $1,317.00 State of Oregon Surcharge.(1.2.'/' of apphcable fe~2._ 821-00000-215004. ___._____$158.~ Technology fee (5% of permit total) 100-00000-425665 $65.85 TOTAL DUE: $18,202.86 t -P.6.YME~Lt'y!'.E'::"~':'!'.~YPR.< CASHIER'CCARPENTER/ :C.QMMENTS; --.,~'~;, ,- ",',,' ,.',' AMOUNT pAID _....,--.,....~.._.. . ....... ."""-.,,",,..-.,", ._._..~ ~..- --- '-- " i -. --' Check 32058 HAYDEN ENTERPRISES INC Check also used for s10-0454 and -456 $18,202.86 . $18,202.86