The URL can be used to link to this page

Home My WebLink AboutPermit Building 2007-5-11 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00623 ISSUED: 05/11/2007 APPLIED: 05/01/2007 EXPIRES: 11/11/2007 VALUE: $ 162,112.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2449 MAlA LOOP ASSESSOR'S PARCEL NO.: 1703251408400 Springfield TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New Residential PROJECT DESCRIPTION: Manufactured Home Placement on Private Lot Owner: Address: GRAHAM MORRIS LEE PO BOX 8379 COBURG OR 97408 Phone Number: 541-302-9553 Contractor Type General Electrical Mechanical Manuf Home Inst Plumbing ,'OU \0 _ ~l \\taS J . t"'!1ll\' \a"" ,...-{ Onu." \ I CON~_.:;I(\WNmRQ~. se\~,\ p:\ \ \:.,' ~eS ~ 1'nOse 'U:- n~f\ 9S'2: t Contractor \o\\O\f'J t~ cen\e~1Q..~~tclUi~mf\\'\e 19~ration Date HARDACKER & o~t\iB&~~::~~-:t~~% 0 \e\e?\'\o~WiR9/2009 OWNER O~Pt 9 {{\0.~ 0'0\0.\ ~~o\e', \~e \'lot\f\Ca\\O OWNER In OgO. "(oU 0 cen\0t. 0(\ \Jt\\\\'/ 44). HARDACKER & 0&~\Di~f~~~('1f)_~-2~ 02119/2009 HARDACKER & OLE~mb~~LOPMENT 79496 02/19/2009 I BUILDING INFORMATION I Phone 541-895-4307 541-895-4307 541-895-4307 4 # of Stories: 1 Lot Size: Height of Structure: S~ Ft..lflt Floor: ;I;~P.1 pfrJleat: orced AirJj:I~t\i-c1\-\ES1Jl0~d Floor: ~Wn\~~rnrl S\-\~LL E~\F)tt1~lrlhN\\1~s~sement: mmtP1:Y"Pll'} UNDER 1 HtledtRC' ~t GaragelCarport ~~~'~;XW-Atf:D ~B~NDONEO rS\1'Ft Other: S'j)xm~~idib\f. \S nla Occupant Load: C\ 11'J\ . , rO,IlII'1. I DEVELQNME~"~ 'l~~FORMATION I 8,280 2,082 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB 528 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.00 9.40 5.00 42.00 5.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: 2 Handicapped: Compact: o 31.50 I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: AC Mat Yes Sidewalk Type: Downspouts/Drains: Curbside 5' Curb and Gutter Notes: Storm to curb & gutter. JLP APP 5/9/07 Pa!!e 1 of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00623 ISSUED: 05/11/2007 APPLIED: 05/01/2007 EXPIRES: 11/11/2007 VALUE: $ 162,112.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description Tvpe of Construction $ Per Sq Ft or multiplier $1.00 $27.00 $1.00 Square Footage or Bid Amount 3,250.00 528.00 144,606.00 Value Date Calculated Total Value of Project $3,250.00 $14,256.00 $144,606.00 $162,112.00 05/01/2007 05/01/2007 05/02/2007 Foundation Onlv Use Bid Amount Gara!!e Gara!!e ManufHome Manufactured Home ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $110.37 5/1/07 3200700000000000243 + 10% Administrative Fee $76.03 5/11/07 2200700000000000738 + 5% Technology Fee $31.49 5/11/07 2200700000000000738 + 8% State Surcharge $50.38 5/11/07 2200700000000000738 Add, Alter, Extend Cire Ea Add $6.00 5/11/07 2200700000000000738 Addressing Assignment $31.00 5/11/07 2200700000000000738 Fire SF Fee - Residential $130.50 5/11/07 2200700000000000738 GaragelCarport $169.80 5/11/07 2200700000000000738 Manuf Home State Issuance $30.00 5/11/07 2200700000000000738 Manufactured Home Conn - Plmb $45.00 5/11/07 2200700000000000738 Manufactured Home Feeder $50.00 5/11/07 2200700000000000738 Manufactured Home Placement $160.00 5/11/07 2200700000000000738 Manufactured Home Service $50.00 5/11/07 2200700000000000738 Plan Review Major - Planning $198.00 5/11/07 2200700000000000738 Sanitary Sewer - 1st 50 Feet $45.00 5/11/07 2200700000000000738 Sanitary Sewer - Improvement $534.34 5/11/07 2200700000000000738 Sanitary Sewer - Reimbursement $702.72 5/11/07 2200700000000000738 SDC MWMC Administration $10.00 5/11/07 2200700000000000738 SDC MWMC Improvement $961.52 5/11/07 2200700000000000738 SDC MWMC Reimbursement $91.61 5/11/07 2200700000000000738 SDC SanitarylStorm Admin $165.08 5/11/07 2200700000000000738 SDC Transpo Admin $66.57 5/11/07 2200700000000000738 SDC Transpo Improvement $836.32 5/11/07 2200700000000000738 SDC Transpo Reimbursement $189.58 5/11/07 2200700000000000738 Storm Drainage Impervious Area $1,306.89 5/11/07 2200700000000000738 Storm Sewer - 1st 50 Feet $45.00 5/11/07 2200700000000000738 Storm Sewer Each AddtI 100' $14.00 5/11/07 2200700000000000738 Water Line - 1st 50 Feet $45.00 5/11/07 2200700000000000738 Willamalane Single Family $2,303.00 5/11/07 2200700000000000738 Total Amount Paid $8,455.20 Pa!!e 2 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00623 ISSUED: 05/11/2007 APPLIED: 05/01/2007 EXPIRES: 11/11/2007 VALUE: $ 162,112.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Plan Reviews I Initial Review 05/02/2007 05/02/2007 APP LLH Planninl! Review 05/0212007 05/10/2007 APP TAJ Public Works Review 05/0212007 05/03/2007 WI JLP Rcvd 5/3/2007---Waiting in order PW rcvd for rvw.JLP WI 5/9/07 Public Works Review 05109/2007 05/09/2007 APP JLP Storm to curb & gutter. JLP APP 5/9/07 Structural Review 05102/2007 05/09/2007 APP RJB 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. UeouireCUnsnections I Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing andlor foundation inspection. Footing: After trenches are excavated. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Firewall: Located and constructed according to plans. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Manuf Home Set Up: When installation of all piers or stands is complete. Final ManufHome Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Final Building: After all Conditions have been completed as required on Development Agreement. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Sanitary Sewer Line: Prior to filling trench and including required testing. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Storm Sewer Line: Prior to filling trench. Water Line: Prior to filling trench and including required testing. Final Plumbing: When all plumbing work is complete. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. Pal!e 3 of 4 CITY OF SPRINGFIELD' Status Iss u ed Building/Combination Permit PERMIT NO: COM2007-00623 ISSUED: 05/11/2007 APPLIED: 05/01/2007 EXPIRES: 11/11/2007 VALUE: $ 162,112.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line MH Service: Approval required prior to utility company energizing service. MH Pedestal: Approval required prior to utility company energizing service. 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 of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. 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. ~'1~~_~'o-/ Owner or Contractors Signature s/; I /tJ l' , , Date Pa!!e 4 of 4 CITY OF S. JGFIELD SYSTEMS DEVELOPMEN1 C0M2007-00623 Morris Graham 2366 Maia Lp 1703251408400 SINGLE FAMILY RESIDENCE 1 BUllDING SIZE (SF' 2634 JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM. IMPERVIOUS S,F. x COST PER S,F. . "CHARGE 3894,00 $0.336 = $1,306.89 , " RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S,F. I x COST PER S.L x DISCOUNT RATE 'I 0.00 ' I $0.336 50% = I ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A REIMBURSEMENT COST: I NUMBER OF DFU's I x \ 27 I COST PER DFU $26.03 B. IMPROVEMENT COST: NUMBER OF DFU's 1 x 27 I $19.79 ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A REIMBURSEMENT COST: ADT TRIP RATE I x 9.57 I I NUMBER OF UNITS x I 1 1 1 ICOST PER FEU 1 $91.61 B. IMPROVEMENT COST: INUMBER OF FEU's x ICOST PER FEU "I 1 $961.52 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATNE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) = , 5. ADMINISTRATNE FEE: SUBTOTAL x I ADM. FEE RATE 1= $4,632.98 I 5% I TOTAL SANITARY ADMINISTRATION FEE: TOD\LTRANSPORTATION ADMINISTRATION FEE: "Jeff Prociw 5/9/2007 PREPARED BY DATE $1,306.89 =, $1,237.06 COST PER TRIP $19,81 $1,063.13 $4,632.98 CHARGE I $231.65 I )RKSHEET LOT SIZE (SF): DISCOUNT $0.00 x NEW TRIP F ACTORI 1.00 I x I NEW TRIP FACTOR' I 1.00 TOTAL SDC CHARGES 8280 " , $1,306.89 , $702.72 $534.34 $189.58 $836.32 = $91.61 = $961.52 $0.00 $10.00 , . 165.08 I $66,57 = I . $4,864.63 r/) P-l Cl o u ~ P-l E-< r/) ...... o ~ 1070 l~1 1092 ]093 ]094 1054 I ]055 1054 ]056, 11079 ]078 I I " DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOlE: FOR REMODELS, CALCULAlE ONLY THE NET AuU1110NAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBA THruB 2 0 3 = 6 IDRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE I Oll-I SOLIDS I ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 iLAUNDRY ruB 0 0 2 = 0 I CLOTHES WASHER I MOP SINK 1 0 3 = 3 CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBll-E HOME PARK TRAP (I PER TR..All-ER) 0 0 12 = 0 RECEPTOR FOR REFRlG I WATER STATION I ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK I DISHWASHER I ETC. 1 0 3 = 3 SHOWER., SINGLE STALL 1 0 2 = 2 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCIALIRESIDENTW.. KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASINIDOUBLE LAVATORY 1 0 2 = 2 SINK: SINGLE LA V ATORYIRESIDENTIAL BAR 2 0 1 = 2 URINAL, STALL I WALL 0 0 5 = 0 TOll-ET, PUBLIC INSTALLATION 0 0 6 = 0 TOll-ET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 27 "'EDU (Equivalent Dwelling Uuit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE J 979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$l,OOO ASSESSED VALUE $5,29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4 .40 $4,07 $3,67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1,25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 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 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE $0.00 x $5.29 = I $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT = $0.00 Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: COIM\-z::~~~7 - 0062-3 2YLt 9 MAlA- LP , ~L5 Date: S/II/07 I Address: Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities.' .. . . . Note: 'Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not li~ensed with the Construction Contractors Board to sign the following statement before a building p~rmit can be issued. This statement is required for r.esidential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with thepermit. . Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ 1. I own, reside in, or will reside in the completed structure. ~.. 2. . offered for sale before or on completion. _ I '-. 2t 3A. My general contractor is ~~~ oL~ .' (Ncupe) I understand that I'must become licensed as a construction contractor if the structure.is sold or 79l(90 (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR o 3B. I will be my own general contractor. If I hire subcontractors,. I will hire. only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building .permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Noticll to Property Owners about Construction Responsibilities on the r.everse side of this form. 0'7,...~ cEo ~......,. I %/c;7 ; (Signature of permit applicant) / r (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 Acting as \)[ our' Own' General Contractor? L :i1 t fN~ORMAtION i\iOTICETO PROPERTY OWNERS . .: . A6.0Uf CONSTRUCTION RESPONSIBILITIES -\- - '. NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you. are acting as your own contractor to construct a ~ew home or make a substantial improvement to'an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Respo~sibilities . . T. . You will, iI'!- most inst~nces, ~e ruled to be an "employer" and the contra~tors you contrac;t wit~ will be"e~ployees" if you use contractors not lipensed with ~he. Construction Contractors Board to d~ iabor in constructing or to assist in the construction ~r- !p1provement of a resident~al structure. As the employer, yon m:u~t comply with the foUowin~: Oregon's Withho"iding Tax Law: As ~m employer, you must withhold inc~me taxes from employ~'e wages at the time employees are paid.. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information; call the Department of Revenue at 503-378-4988. ~.f Unemployment Insur~nce Tax: As an employer,yo'tiare'required to pay a tax for unemployment insurance purposes'" , on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. i>~ .'. t. ~ -: \ ',- '.", " ... The Oregon Business Identification Number. (BIN) is a cQlJlbilJ.ed number, for. both. Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, caH 503-945-8091 or vv'Ww.dor.state.or.us/formsoav.htmll for the , "..:.;... ':fi- .......- , f .. '.,' . \. .\..- . ".~ !... ' . appropr-late 0rms. .. '" '. . J: ,~ "~~I 7"1 I'. ~. .-" - ,'. , ' -'. . '. _. . '. ..: . .', -. ' "1 .. . ".- - .:\' )::' " .' .' '-..... . ',.. , " '.... . "~' ~. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mU,st ob~~in wor~ers,' cvwpensa.~ion insurallce fOfyour emPl.~Yyes, If you fail to obta~n workers' compensation insurance, you could be 'subject to penalties and be' ~iab~e for all claim, costs if ~ne of your eniployees is'injured on the job. For more information, call the Workers' Compensation DiVision at the Department'of Consumer~and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax 'from' employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at\'ir".......woirs,gQY. . ,; OtheJr' Re~p(f)lUl~ibilihl:ie.~.-211Ill~ AJrea~ of COJIll.cerim~ Code Compliance: As the permit holder for this project, you are responsible for reso1virig any failure to meet code requirements that may be brought to your a~ention ~hr~ugh insJ?ections. . . . Liability and Property Damage Insurance: Contact your insurance'agent to see '"if you"havecid'equate irtsurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone, . Time: Make sure you have sufficient time to supervise your employees: Exp'ertise: Make sure you have the skills to act as your oWn general contractor, to cobrdinate the work ofrough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owneLdoc 06-01 c04 ZON ' L1Y2- INITIALS lJ "^ DATE 5 -\ '-f -C;)-7 SOURCE r6VS. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PEW"!!T~TLICATION City Job Number { 'i, J. 0 'JA.~ Date ...... - 1. f)\{f~~~ 3. M4C LEGAL DESC~PTION: A. dO 3(i 5 (4 Service Included JOB DESCRIPTION: 1000 sq. ft. or less \'\\() ~ ~t\rm (L * Huarn -a ::~o~d:~~~~1 500 sq. ft. or Permits are non-t a sferable and expire i; ~;k:- - \ Each Manufact'd Home or not started within 0 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder $106.00 $ 19.00 ~ $50.00 1(fJ ED Own", N"i'i' ~tw\S .Au ~ Address tD ~ fj . City rDnnrC\ Phone OWNER INST ALLA }ION The installation is being made on property I own which is not intended r sale, lease or rent. Address 2. B. Ifho fOI/f.rfCJ2ittfW!(lless $ 63.00 VOtifl~ ~& t~OOr~8.s $ 75.00 111 0-1'jl!fitqp~ ~c&Jf);~'J laW ta $125.00 0090. '~s~W{t000P')pIl the oqultes '" . $163.00 CalliJf~r~ AfiQilff1htsse tLJ1e;S!}On.lJ;.tt375.00 fJU'hb 'FI~ct ~ftli" rOUgh 0 etecoA4-.!!.t,50.00 etft efJtar COp; ~~ --c ro C. . - "" Ilily AI 9PhO Installation, AIter~66b~~ R'Q~1t!ioJJne '1/ 4.4) c:((IO,., JwO~' 200 Amps or less ." $ 50,00 IL" lICE. 201 Amps to 400 Amps $ 69,00 4//'.)'PfR. . 401 Amps to 600 Amps $100.00 Ou:/ffJ,7/26/ S;Pf~ 600 Amps or 1000 Volts see "B" above. 4Ny 'fttfIVCE; ~ 780 04yD Of? /~e ~at Nor~xtension Per Panel PElT. M/hil~~l)ff?M' '[ JrO lO€ach11ct~~feif~ ~kh () flj{\i1,erv1ce or Fee'dc!rAtJyrfo/ ' // $ 3.00 E. City Supervisor License Expiration Date $ 43.00 U?pu "' ~e: ~' ~~. ~ Pump or irrigation $ 50,00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25,00 Limited EnergylCommercial $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ltJ ~ ~~t 8% State Surcharge ~ 10% Administrative Fee \ l }. ..fOlJ. 5% Technology Fee ~ bU TOTAL \~.~~ Shared Drive(T:)/Building FonnsIElectrical Permit Application- 8-06.doc Inspection Request: 726-3769 225 F.ifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number LDP2007-00084 LDP2007-00084 COM2007-00623 COM2007 -00623 CO M2007 -00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 CO M2007 -00623 COM2007-00623 COM2007 -00623 COM2007-00623 COM2007 -00623 COM2007-00623 COM2007 -00623 COM2007-00623 COM2007-00623 COM2007-00623 CO M2007 -00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007-00623 COM2007 -00623 Payments: Type of Payment CreditCard cReceintl RECEIPT #: Description LDAP Short Form + 5% Technology Fee Addressing Assignment Willamalane Single Family Manufactured Home Feeder Manufactured Home Service Add, Alter, Extend Circ Ea Add Fire SF Fee - Residential Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC SanitarylStorm Admin SDC Transpo Admin Garage/Carport Manufactured Home Placement ManufHome State Issuance Manufactured Home Conn - Plmb Sanitary Sewer - 1st 50 Feet Water Line - 1st 50 Feet Storm Sewer - 1st 50 Feet Storm Sewer Each Addtl 100' + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Plan Review Major - Planning Paid By LYNETTE E GRAHAM C;~l of Springfield Official Receipt ~ :lopment Services Department Public Works Department 2200700000000000738 Date: 05/11/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received tss 085208 In Person Payment Total: Page I of I 2:57:04PM Amount Due 300.00 15.00 31.00 2,303.00 50.00 50.00 6.00 130.50 1,306.89 702.72 534.34 189.58 836.32 91.61 961.52 10.00 165.08 66.57 169.80 160.00 30,00 45.00 45.00 45,00 45.00 14.00 31.49 50.38 76.03 198.00 $8,659.83 Amount Paid $8,659.83 $8,659.83 5/1 1/2007