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Home My WebLink AboutPermit Building 2011-1-24 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 WWW.ci.springfield.or.us PROJECT STATUS: STATUS DATE: 01/24/2011 04/30/2010 Issued ISSUED: APPLIED: 01/24/2011 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: 07/10/2011 $463,860.00 SITE ADDRESS: 2601 17TH ST, Springfield ASSESOR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES OWNER: ADDRESS: New single family dwelling and garage- FEMA SFHA zone AE No temp power needed ROSER VAUGHN EDWARD & MARCIA JEAN 3414 WINCHESTER WAY EUGENE OR 97401 ' PROJECT DESCRIPTION: Phone Number: CONTRACTOR INFORMATION Contractor Type General Contractor Mechanical Contractor Plumbing Contractor Electrical Contractor Name KACHINA PROPERTIES INC INNOVATIVE AIR INC KEVIN COHEN"PLUMBING INC CHRISTENSON ELECTRIC INC Lie Type CCB CCB CCB ELECTRICAL I Lie No Lie Exp Phone 101476 08/05/2011 541-895-4502 161742 10/11/2012 541-746-1040 176311 05/30/2011 "541-607-9208 26-34C 07/01/2011 503-419.3600 BUilDING INFORMATION I # of Units: 1 23,00 FG Construction Type Occupancy Type Occupancy Comments U # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: G G N # of Bedrooms: 3 Sprinkled Building: N Fire Alarms: Energy Path: 001A 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: 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: 16005 2792 2635 972 Site Information ~ Engineered Fill: . F'II V I ' ATTENTION: Oregon law reqUires you to FI' dOHume'd A fo.llow rules adopted by the Oregon Utility 00 azar r,e,ll;t'f' t' C Th I l d H d A I'U Ilca Ion enter. ose ru es are set forth an azar reJl:OAR R la" W II In 952-0.0.1-0.0.1 0. through OAR 952-0.0.1- S \ In~ng rtaR: 00.90..1 You may obtain copies of the rules by 01 S epo equ8"aning the center, (Note: the telephone number for the Oregon Utility Notification Center is 1-80.0.-332-2344). :- ."~"';>:..<.I"'~' NOTICE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT_ COMMENCED OR IS ABANDONED FOR _ ' ANY 180 DAY PERIOD. " Springfield Building Permit 1/24/2011 2:56:01PM Page 1 of 8 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 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 01/24/2011 ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: 07/10/2011 $463,860.00 SITE ADDRESS: 2601 17TH ST, Springfield ASSES OR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage- FEMA SFHA zone AE No temp power needed I DEVELOPMENT INFORMATION I Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: 17.30 10.00 20.80 10.00 Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: FP 4 Yes 34.20 REQUIRED PARKING Total: 2 Handicapped: Compact: 2800 PUBLIC IMPROVEMENTS I ,Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: FI CG Yes Sidewalk Type: C7 Downspout/Drains: Valuation Description I Descrietion Bid Tvee of Construction NA Unit Amount Unit Tvoe 463,860.00 Bid Unit Cost 1.00 Value 463,860.00 463,860.00 Springfield Building Permit 1/24/2011 2:56:01PM Page ~2 of 8 .... 5. P~I.N G. fIEL~D" " ~~~..- .....;ri<,~ .."-~ OREGON 225 Fifth St Springfield,OR 97477 Phone. 541-726-3753 Inspection Phone. 541-726-3769 Fax. 541-726-3676 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 www:ci.springfield.or,us permilcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: Issued 01/24/2011 07/10/2011 $463,860.00 SITE ADDRESS: 2601 17TH ST, Springfield ASSESOR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage- FEMA SFHA zone AE No temp power needed I FEES PAID ~ Description Amount Paid Date Paid Overwidth A,pplication ~e $45.00 04/30/2010 Plan Review Residential $1,254.34 04/30/2010 ". .. SDC MWMC Compliance Charge ...__..__,.,'._.... $22.63 05/18/2010 SDC MWMC Administration $10.00 05/18/2010 SDC MWMC Improvement $1,333.57 05/18/2010 SDC MWMC Reimbursement $101.97 05/18/2010 Exhaust Hoods $13.00 01/24/2011 Appliance Vent $9.00 01/24/2011 Vent Fan $45.00 01/24/2011 Heat Pump $17.00 01/24/2011 SDC Sanitary/Storm Admin $294.78 01/24/2011 Building Permit $2,190.23 01/24/2011 Gas Outlets 1-4 $7.00 01/24/2011 SDC Tran Reimburs-Residential $211.21 01/24/2011 .._-- San~",.'Y.Sewer - Reimbursement ____..._.~_~~_____~~3.011 SDC Transportation Admin $71.47 01/24/2011 SDC Trans Improvement-R~sident $931.65 01/24/2011 + 12% State Surcl1arge $340.35 01/24/2011 Willamalane Single Family $2,858.00 01/24/2011 Plan Review Residential $169.31 01/24/2011 Addressing Assignment $38.00 01/24/2011 Fireplace (Listed) $40.00 01/24/2011 Gas Outlets 4+ $16.00 01/24/2011 PW Disc - 3rd Permit $.60.00 01/24/2011 Plan Review Major - Planning $211.00 01/24/2011 ~~ One & Two Family $402.00 01/24/2011 Sanitary Sewer.:.~mprovem~nt $74~.5.8 .. .....__....'ly2~/2011 SDC Storm - Reimbursement $2,609.17 01/24/2011 --_._~-""~'-"'--'--"'-' SDC Storm - Improvement $369.55 01/24/2011 Curbcut Perrriit--------.-------.-.$88.00-..~.-.61i24i20i1"...- Dryer Vent "--moo--'- 01/24/2011 1st Appliance $79.00 01/24/2011 Fire SF Fee - Residential $319.95 01/24/2011 + 5% Technology Fee $158.16 01/24/2011 Sidewalk Permit $88.00 01/24/2011 Total Amount Paid $16,037.69 Springfield Building Permit 1/24/2011 2:56:01 PM Recio! # 1201000000000000398 2201000000000000448 1201000000000000493 ..~~..__.._._. 1201000000000000493 1201000000000000493 1201000000000000493 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 ._-- 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 2011000150 Page 30t8 4 'J S~~I~ G..:EL~, ~".. :": ,,;;... c~"'" ~ '","~-OREGON CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 . Building I Residential Permit www.ci.springfield.or.us PERMIT NO: COM2010-00551 IVR Number: 811000053735 permilcenter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: 155 ued ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: 07/10/2011 $463,860.00, 01/24/2011 SITE ADDRESS: 260117TH ST, Springfield ASSESOR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage. FEMA SFHA zone AE No temp power needed I Plan Review ~ Department Initial Review Received Due Date Comoleted Result Reviewer 0510512010 APP DJB Application Acceptance 08/11/2010 05/05/2010 Deferred Payment David Bowlsby Structural Review 08/11/2010 08/11/2010 05/10/2010 Comments: Review complete- waiting for other departments ,~trU:ct(jr~I.~~vi~W:,:~:~;,;, <,-,:" '~~"~';-~t>~~:;~~~<I' >~'~'":_ ~g~~/'19!?9.~~~::::-~"~~<;;~::~,'::VJ:'.~-~~,,~s,:,; '~CJ,~" :- ":c~mm~nu;:'7':',R~YieY':cojnplete.'~~~t!~~{f[r\O.!h~r:~*ep~~tInen(s*.;;~?:;,~:~t:"t~:: ~(€~.~;~~ Xh?~:,';' :C" ~~': }_ ('+'-" Waiting Internal S Shamberger . ,. "".. ,.-,: ""'""!,<,/":,,,,-.,],, . -- ~ . , ..' " " , ", ., :~~ Ff::''.~ c;:T~,~"'; ..,,~;,'.~5 ;:~:; \,:~~: ;'.. Planning Review 05/11/2010 APP DDK Comments: This lot is in the 100 year floodplain, therefore the following occupancy conditions apply: 1) Provide a FEMA Elevation Certificate completed by a certified engineer, surveyor or architect, prior to construction, at completion of first floor construction and at completion of structure (prior to occupancy). 2) As per condition 5 of FloodPlain Overlay approval (SHR2005-00008) and Note 4 on the recorded plat for Legacy Estates: New construction and substantial improvement of any residential structure on lot 18 & 19 shall have the lowest floor, including basement, elevated to one foot above the base flood elevation (449'), that is 450'. Structure is being built over property fine - Deed restriction has been recorded. See attached document. ~1~~~~i1t~~~~dij;~1~~~;~~1~:1~~~~~~i~~i~~~t~~~~f~~~2~Ji&Y!~oj~Pi~tf\;~~li~~r1j~,:tj~i~~;::~~~~:;~i~,l,;,~~j ',.' .~ . ",,>-"L J0+tf CertIficate' complet~?_by,a ;cert'fiedl~ng Ineer;~ s urveyoL or,archltect," pn or:to, construction;; ati qqrnpletl()n, o!,first-',f1oor ~,-~ ......"' t,,:~j . '.' ,"0' ':' ~.,. ~ :1l<~ qj -~ ;-;, -~ :',_-~:"-~)~Rcoh-sJruc,~i.O!1 :an~' ~~~~OrT)p(~ri06 .ol~J~~ture~tPfiO!.'!o'c:c~u,p~ancYf_~) :A,?,.p~75~n~itjO"Tn_,~;,Of):].oq_SF:iajb;tSy:erl~Y'C!PRrOV~~ ..;::' "':;~<?::;4:\~ ,)'i~:<:~'~~,;~(: 1 IF ',' . ,~~~~;3~;~~i~f~~;u~.;u~eNl.~.I.~~~~, ~i~~~~~~~,~~~.~~ri~~~:.~~~E.o;~a.",~\.~.~~;~. :;:~~~~:O~I:~a~;d,;.f,~.t~k~j~~'f~~::;.t~:.tO..f:r;:,.;: .... : >j: ,I r \ t.o". "~hJfbas'e'fiood,e!~<.-v.~ti~n~f!4?')fi~a!:i~ 45~';',si1QS!G,~~1is"b"eing,bl!fit"Qiir;,'p[<>p'er:ty lin~:~~qee~_ re~!adTon'-"h~s:bee~i~corde~~:7~:':i~~,~~r: :,' ;;, ;,'. I of, , ," 'I,See attached:document. ..' ,'~ -,,;:~~2?,.i' ',' . ,,- ;-... ',""'" ,j[~; , " F 4 " -<,.' :;::...l;.":7:",zV$':;';~~ ,"", ;-L,,;*,~;,:~,~;::{:':J..~:_';.,_~:' . Public Works Review 05/12/2010 APP LKW ' Comments: Storm water to curb via weep hole, Overwidth driveway approved by Jesse Jones on 5~10-2010 P,~Nlic:wP_rl<.~~gj?~~~~. /' ........ ". '0~t1Ji-72~~"t: ,P?/~ V~Q1 0'~':"~~2;2/~01 0: . !~p.P[~V;~8' ~i~"..~ "i: ~ ~: Kaye Wlls,C?n~ ~'" ~r'; l ~~ ,;9,?mme~~'<Stc:r[1;1 Y1<il:r,t.??~rb,'vjif~~,e~',pole"~9v:~id.t!1,:ariv~yJ~Y;~p~p~o~~~~~eSi~;JoD~~,<?!:i~~~19~~g~~", ',;:" - :$ ,-: __~..+ .'" , _ Public Works Review 08/11/2010 08/11/2010 05/14/2010 Approved Chris Carpenter Comments: As noted of! plans !~X~:~t~ial~e_Yie~~:~;:_~~~.~: '-'~.~' ,'~~Y~~19"}:?~o/1l{!~J~~.., J~~~(~2~ R .. ~~:.:om~en~~: _'f.-snot~~ Orj~:r:.:;..: ~:~~'-;-';.."'~"4:L,,;~' > :'. '~:'-':;;",d~~" ,-'~ ~ Structural Review 05/14/2010 Comments: As noted on plans 't'_"-' Appi6Ved"j.,~~':',i:'"' .~ v Chris:Carpenter,;,. 'f ~. < ~ 0 f:; . ,..~. ......l<-'..~-.;,.....-.:-",.~._;.'f,\;,., "- ,:<J.~,:.:r_i}+;~'f~:';c" ':',. ..., - ,....'. _,~" ;,{i:,:.,~_-:;",_:}",-. r~,Jji~_~ ~".." .,,'~ ~'---~:!?Q " -t", _ " - _,1 , .', . '.< , ",~ ^~: . ~ APP CJC Springfield Building Permit 1/24/2011 2:56:01 PM Page 4 of 8 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 225 Fifth Sf 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 01/24/2011 ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: 07/10/2011 $463,860,00 SITE ADDRESS: 2601 17TH ST, Springfield ASSESOR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK.INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage- FEMA SFHA zone AE No temp power needed rFfermit~T~u~1I1ce'<''i:;:';:;;~:J:.~r~'0811:1d510t:t:t~08~t1'fl20,10, : c05i:18j~OI(f ~/: 'lssUIci ',~:"~:'Y~~",~};,'!~Y}:?D%iVicf Bbwjsby,;,~"'\~.:"" -, v,f,,:rt("r:vr,,';:=1 Print Permit 05/18/2010 OK DJ8 Comments: DPA Inspection 08/11/2010 08/11/2010 08/26/2010 Comments: Inspection in process Robert Castile In Process . Springfield Building Permit 1/2412011 2:56:01PM Page 50f8 S;!:lH::~ .(~,~ /L~'ORfGON www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 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 01/24/2011 ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: 07/10/2011 $463,860.00 SITE ADDRESS: 2601 17TH ST, Springfield ASSESOR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage. FEMA SFHA zone AE No temp power needed I INSPECTIONS REQUIRED ~ Inspections 2200 Underlloor Mechanical Underfloor Mechanical. Prior to insulation or decking and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Underfloor Gas: After line is installed and required testing and capped if nat attached to an appliance. Underfloor Plumbing: Prior to insulation or decking. 3200 Sanitary Sewer 3400 Storm Sewer 2210 Underlloor Gas 3170 Underfloor Plumbing 1120 Foundation 1120 Foundation 1170 Post & Beam 1110 Footing 4120 UFER Ground Foundation: After forms are erected but prior to concrete placement Foundation: After forms are erected but prior to concrete placement Post and Beam: Prior to floor insulation or decking. Footing: After trenches are excavated. 2200 Underfloor Mechanical 1120 Foundation Underfloor Mechanical. Prior to insulation or decking and including required testing. Foundation: After forms are ereCted but prior to concrete placement 1170 Post & Beam Post and Beam: Prior to floor insulation or decking. 1110 Footing 1410 Underfloor insulation Footing: After trenches are excavated. 3170 Underlloor Plumbing 3200 Sanitary Sewer 2210 Underlloor Gas Underfloor Plumbing: Prior to insulation or decking. Sanitary Sewer Line: Prior to filling trench and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. 4120 UFER Ground 1110 Footing Footing: After trenches are excavated. 1120 Foundation Foundation: After forms are erected but prior to concrete placement. 1160 UFER Ground Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 1530 Exterior Shearwall 1520 Interior Shearwall Shear Wall Nailing: Before covering sheathing with finish materials. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. Springfield Building Permit 1/24/2011 2:56:01 PM Page 6 or 8 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 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 01/24/2011 ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: 07/10/2011 $463,860.00 SITE ADDRESS: 260117TH ST, Springfield ASSES OR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage- FEMA SFHA zone AE No temp power needed 1420 Insulation Vapor Barrier 2250 Gas Piping 2260 Gas Service 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 Gas: After line is installed and required testing and capped if not attached to an appliance. 2310 Rough Gas 3315 Water Line 3400 Storm Sewer Storm Sewer Line: Prior to filling trench. 3411 Perimeter Rain Drains 3500 Rough Plumbing 3999 Final Plumbing 9506 Sidewalk- Setback Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Sidewalk - Setback: After forms are erected but prior to placement of concrete. Rough Plumbing: Prior to cover and including required testing. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Rough Mechanical: Prior to Cover 3500 Rough Plumbing 1260 Framing 2300 Rough Mechanical 2260 Gas Service 2310 Rough Gas 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 Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Plumbing: Prior to cover and including required testing. Sidewalk - Setback: After forms are erected but prior to placement of concrete. 3500 Rough Plumbing 9506 Sidewalk - Setback 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved. 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 9506 Sidewalk - Setback 9501 Curbcut - Ovenwidth Sidewalk - Setback: After forms are erected but prior to placement of concrete. Curbcut - Overwidth: After forms are erected but prior to placement of concrete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. 9505 Sidewalk - Curbside 3650 Shower Pan Shower Pan. Prior to covering and including required testing. Springfield Building Permit 1/24/2011 2:56:01PM Page 7 of 8 SPi~N~.IE.~~ L~~ ~.OREGOH www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: COM2010-00551 IVR Number: 811000053735 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 01/24/2011 ISSUED: APPLIED: 01/24/2011 04/30/2010 EXPIRES: VALUE: 07/10/2011 $463,860.00 SITE ADDRESS: 260117TH ST, Springfield ASSES OR'S PARCEL NO: 1703243104300 SCOPE: SFD WORK INVOLVED: NEW TYPE OF STRUCTURE: RES PROJECT DESCRIPTION: New single family dwelling and garage- FEMA SFHA zone AE No temp power needed 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 here:in, 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. Owner or Contractor Signature Date Springfield Building Permit 1/24/2011 2:56:01PM Page 8 of 8 Structural Permit Application 1;_~~1m/';".," 225 Fifth Srreet. Sp<ingfieJd, OR 97477. Pfl(54 1)726-3753 . FAX(541)726-3689 DEPARTMENT USE ONLY I~ pennitno.:(F/t7. 5;:1 Date: '-1 ., / U This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days ofissuance or if work is snspended for 180 days. lOCAL GOVERNMENT APPROVAL This project has final land-use approval. Signature: Date: FEE SCHEDULE This project has DEQ approval. 1. Valuation information Signature: Date: (a) Joh description, -1/ c:u Jr-u Zoning approval verified: DYes DNo Occupaacy ;2.. -' tA. Property is within flood plain: DYes DNo Construction type, VB CATEGORY OF CONSTRUCTION Square feet: ).. '1"1'2- It / .]..(,;~<: t:,' [g Residential I 0 Government I D Commerc.nl Cost per square foot: . JOB SITE INFORMATION AND lOCATION0.i,OI i vn j Other information: Job site address: ) A.,., J Sl a 19 L eR<to:.Y F' A ~.s Type of Heat: t11f5 -;::iJf!-c:.~ ']J ./J-t ,z. /. /'t1111 City, c;-- .r\ r-; 1.' 1'..1:1 Statc, bo ZIP: 'L.Pr Subdivisfon, J e;;'ac V .f:" (t...t-e.!> I Lot n~., / If? 4. J 9 Energy Path: []'hew D alteration D addition Reference' n. $. / ". ""I Taxlot led 1'9' . ~ (b) Foundation-only permit? DYes DNo PROPERTY OWNERI70'~ J..'GI '13CO Name, Un.. _1-." F g IY>a.r'{';" T /7_ Total valuation: '-If">' ftt.J $!.f~:1~11 Address, ,~..;.T I.J I~.J.~. L .L.["'L"~" 2. Building fees City, r=u~~ ~ State'~R ZIP:97~ I (a) Permit fee (use valuation table), $ (b) Investigative fee (equal to [2a]), PhoncS'/f74': h 71q Fax, $ - - (c) Reinspection ($ E-mail: per hour): $ (number of hours x fee per hour) This installation is being made on residential or farm property owned by (d) Enter 12% surcharge (.12 x [2a+2b+2c]), $ me or a mem~y immediatc: p~ is exempt from licensing requirements und 701.010. (e) Subtotal offees above (2a through 2d): $ Sign here: ~ c: , J 3. Plan review fees (a) Plaa review (65% x permit fee [2a]): $ /25'1 . 3 I ddNTRACTOR INSTALLATION Businessnam.. K.., c-h :^b 0_ ('l, .r' J..r (b) Fire and life safety (40% x permit fee [2a]): $ Address, x.J. '7 ) q <;no R, - ,p'f=......."R (e) Subtotal offees above (3a and 3b): $ City, r ~_., .'.... '.1 State, "..., LJ ZIP,~ I ~J 4. M iseellaneous fees Phone~1 tZq_<; -LJ 50::1 Fax:~JJ.I.~_"--:<,, . (a) Seismic fee, 1% (.01 x permit fee [2a]): $ E-mail, /t'" ~ L ' . ~ of7'>} /'. ./.... __,. ~ ~/ '-'b f:.: TOTAL fees and surcharges (2e+3e+4a): $ CCB license no.' /0 J [rrL, / Print name' I /.I M"" V r;.. '\ L71'1e<; - {blfi~' Signature: ~ :.->9~ SUB-CdNtRACt6R INFORMATION Name CCB License Number Phone Number Electrical /.J~ ~ .'1'91 . k!1'if --M:J./ MIZ-,$T1/1NSOv./ Plumbing J 71,3 . I 51.{/~L/;7. "1:J..cC Wr\~ _ .t.~ Mechanical I t.",J ./. 'fi,i.. 5''1/ -7J1L. /P~O I tJ,Vdv "t'l,'/C hfV\ ft 2-AJ=:- J4-~ :-, ~......,. ~~ APPliCATION TO DEFER FEES AND CHARGES AND CONSENT TO ASSESS LIEN The ownm of the property shown belo'w hercby apply to thc City of Springfield to paythc fccs and chargcs of$~ IJ'fgt!., def=cd until fina1 building occupancy is requested. Such fccs and charges include System DevclOJltIl=Ilt Charges asscsscd on the prOperty for the City and Willama1ane Park & Recrcation District to thc event that thc real property on which thi: fces havc been . def=cd pursuant to Ordinanccs 6233 and 6234 is sold or conveycd,' the fces or chargcs deferred shall become immediately duc and payablc to the City of Springficld. Salc or conveyancc includes either actually selling, convcying or assigning any or all ofthc property or any or all of ~e owner's interest in thc property. Thc ownm hercby apply for and consent to the voluntary imposition of a lien for $ ~ 7J#f L . upon thc following descnbcd land in thc City of Springfield, Lanc County, Oregon: MAP AND TAX LOT /70 324'3 I 04 ")cO SITE ADDRESS ::( ?t> I J 71J:l. S-.f:l'ed::: CITY, STATE, Zil' "'1r'~,;t r "",l;'<?/.:>/? &:;7'/77 SEE ATTACHED LEGAL PROPERTY DESCRIPTION BILLING NAME BILLING ADDRESS CTIY STATE rJq~"__ ~'H""-r- -4'7' "I 1..1 j rnr I-. e.c-re,.. kJ~ J' ~..~ .ZIP ~7~1 . FEES AND CHARGES DEFERRED $ /3." 74'$.2!.. TOTAL LIEN $/S/}Jf.g:!L . , We arc all of the lcgal ownm ofthc descnbed land or all ofthc contract purchasm of record ofthc descnbcd land to which thcsc fces and charges are applicable. W c waive any and all irrcgularitics or defects, jurisdictiona1, or otherwisc, in any proccedings to impose, calculate and collect these fees and charges, and in thc imposition and .collection of the lien consented to in this application. We promise to pay thesc fces and charges when:fina1 building occuparicy is requested or at such lime the real properly is sold or conveycd. The charges may be paid in full at any lime without penalty. Wc understand that iftherc is a subsequent failure to pay the fees and charges the City shall have the right to enforce payment of the amount due in any nianner provided by the general law of the Slate of Oregon, or by the Springfield Municipal Code, including but not limited to foreclosure of the land. We acknowledge that the City has an interest in the property to collect thesc fees and charges, including System Development Charges, and that the City has the authority to lien the propertylo collect those f7es and charges. In the event of any proceeding to enforce collection or to foreclose, the entirc unp . d balance and aiJy fces shall be :considered delinquent and due. W c also agree to pay the city's cost of collection or foreclosure any atto~es necessary for such c~ection or foreclosurc. \/ Aa" ltiJG ,<1=?oSfA2- 11\ ~. . ~ -/ g -) 1) Print Name of Owner Si tureofOwner - . Date Phone # M AJo?e.11,1: Ro.s-e~ t:L ~ ..5-/(,-10 Print Name of Owner Signature of Owner Date Phone # Print Name of Owner Signature of Owner Date Phone # Signature of Owner Date Phone # Print Name of Owner . OFFICIAL SEAL . JENNIFER GONZALES , NOTARVPUB~AEGON .' COMMISSION NO. 431903 MY COMMISSION EXPIRES AUGUST 25, 2012 STATE OF OREGON ) ) 55. ) County of Lane Notary as executed before me this ~ ,X~ daYOf~ v:lcommon~cnting\assC3Sltlllllclcn. fcc3 ccntnll:t.doc 05/J}/2010 MaN 15:28 FAX 541 687 07J9 GOEBEL ENGI~~ERING , -' ' ~ 0021004 u.s. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Inouranee Program Important: Read the instructions on pages 1-9. OMB No. 1660-0008 Expires March 31. 2012 SECTION A - PROPERTY INFORMATION for Ins.urance Comp~ny Use: Al. Building Owner's Name ROSER. VAUGHN & MARCIA Policy Number A2. Building street Address (including Apt., Unit, Suite, andlor Bldg. No.) or p,O. Route and BoX' No. Company NAle Number 2601 17'" STREET City SPRINGAELD Stale OR ZIP Code 97477 A3. Property Description (Lot and Block Numbe"., T8)( Parcel Number, logl!!lr DescriptIon, etc.) TAX LOT <300 MAP 17-0~24-31 A4. Building Use (e.g., Resldantlsl, Non-Residential, Addition, Acce&8ot), etc.) RESIDENTIAL A5. LoiltudelLon9rtude: un 44~0.7 Long. 122-5~56 5Hor~ontal Dalum: 0 NAD 1927 1&1 NAD 1963 '-A.B. Attlu:h allent 2 photographs of the buIldIng" the Certlficale is being usMt to obtain flood in9urance. A7. Building Diagram Number _ AS. For 8 bulfding wTth II crllwlspace or encJ06ure(a): A9. For a buIlding with an attached garaga: 8) SquaT. footage of crawlspace or enclolSuJl)(s) sq ft. ill) SqLlare footage of attacited garage sq 1\ b) No. of pe.rm8!'lent flood openings In the crawlslpaC8 or b) No. of pelT1'1anent flood opening~ in the ilttached garage enclosure(s) withIn 1.0 foot above adjacent gf3de within 1.0 foot above adJacent grade c) Total net iilrea of nood openIngs In A8.b sq in c) Tolal nM area of "000 openings In ARb 6q in d) Engineered flood opening5? 0 Yes 0 No d) Engineelltd flood openings? 0 YRS 0 No SeCTION B - fLOOD INSURANCE RArE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number SPRINGFIELD 41559< B2. County Name LANE BJ. State OR 64. MaplPanel Number B5. SuffIX B6. FIRM Inde. B7. FIRM Panel Be. Flood 89, Base Flood Elelvation(s) (Zone 410:l9C1153 F Date EffedivelRevi8&d Date Zone(s) A.O, Ll!e bese flood depth) JUNE 2, 1999 JUNE 2. 1999 AE 448.6 ....... B10. Indicate the source of the 8as8 Flood Elevation (BFE) dllfa Of base ftood depth entered in Item 89. o AS Profile 0 FIRM 0 Community Detcnnine<l 1&1 Othar (Describe) CASE No. 0If-l0~043A IndiC21le elevatIon dmum used for BFE in Item 89: 181 NGVO 1929 0 NAVO 1986 D other (Desaibe)_ Is the, building located In a Coastal Barrier Resourt:81S System lCBRS) area or otherwise Protedsd Area (OPA)? 0 Deoignation Dolo> _ 0 CBRS 0 OPA Y.. 1&1 No Bll. Bl<. SECTION C - BUilDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are b8~ed on; 18I Construction Drawings. 0 Building UMef COnstrudion. D Finished Construction -A n&IN E~v8tion CertifiCilt.e will be required wtlen con~trUdion of the building 1& complete. C2. Elevations -Zonee Al-A30. AE- Afl, A (wIth BFE). VE. Vl-V30, V (wltJ1 BFE), AR. ARiA. ARJAE. ARlAl-A30. ARlAH, ARlAO. Completall<lms CZ.a-h below accon:Ung to the buildIng dlagrom &pedfiBd in Item A 7. U9C ths same daturn 85 the BFE. Benchmark Utilized SPRINGFIELD BENCHMARKVertiea] Datum NGVO 1929 Conversion/Comments .) b) 0) d) e) Top of the next higher floor Bottom of the I~t horizontal structural member (V Zones only) Aneched glilnilge (top of slob) LO'oWst sle....ation of machinery or 8Ctulpment 68Nicing the building (Describe type of equipment and location in Comments) lOWMt adjacent (finished) grade neKt to building (LAG) Highest adJa09M (finished) grude na)ct to building (HAG) lowerot adjacent grade at IOYM5t elevation of deck Dr Gtai~. indudir'l9 PitructuraJ support :&U W8_ W8'_ Il!!\-_ ChelO<: thel me8~Uremelnt u39d. 181 feel 0 mate", (Puertu "Ico only) ~ feet 0 mliltenl (Puerto RIco only) o feet 0 meters (Puerto Rica only) o feet 0 msters (Puerto Rico onty) o fNt 0 mete~ (Puerto RiCo only) Top or bottom floor Ondudlng basement. crawlspace, or enclO1iure floor) ~.! n g) h) !WI. W8'_ !WI._ o leat 0 mete", (PuMo RIco only) o fair 0 meteR!. (Pueno RJco only) o feel 0 me[ers (PuBno Rico only) SECTION D - SURVEYOR, ENGINEER, OR A.RCHITECT CERTIFICATION Thl5 certification Is to be GIgned IInd sealed by a land ~urveyor, enijllneer, or architect 3uthorrzed by law 10 certify elevation infolTl1ation. , cerrify that the informotJon on this C6rtJfJcstrJ represents my b93t efforts to inturpmr the data avJtilablQ.I understand rhat anyf8/s9 statomenr may b8 punishsble by fins orimprl3onment under 18 U,S. Code, Sectlon 1001.1&1 Check here if commenb are provided on back of form. WemlatitudB and longitude in Section A proyjded by 9 Hcen88d Ja.nd 6LlNe)lor? .l8I Yes 0 No PROFESSIONAL LAND 5URVEYO Addrs&!. 310 GARFIELD STREET City EUGENE Stele OR ZIP Code 97402 ~ ; \ ["",'''' ~', If. Certifier's Name SCOTT J. GOEBEL License Number 2280 Tille PRESIDENT Compeny Name GOEBEL ENGINEERING & SURVEYiNG, INC. Signature Dare 05126/10 Telephone 541/667.0542 06-01-10A09:36 RCYD 05/3~/2010 MON 15:28 FAX 541 687 0739 GOEBEL ENGINEERING ~003/004 IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company U5e: Building Street Addr9&s (including Apt, Unit, Sulle, andlor Slag. No.) or P.O. Route and BoX' No. Policy Number 2601 17'" STREET -" Company NAIC Number City SPRINGFIELD State OR ZIP Code 974n SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Cen:lficate for (1) community official, (2) inf.i,uramce 8genVcompany, and (3) building Owner. Comments LOT IS EXCAVATED AND READY TO SET FORMS; 8" FOOTING, 24" STEM WALL, 1-112' MUD SILL. '-1/8" SUB FLOOR, PAD ~ CRAWL SPACE, FINISH FLOOR _ PAD + 34-5/8"= (448.4') Signature Date 05-28-10 , o Check hont if anachrnents ON INFORMATION (SURVEY NOT REQUIRED) FOR lONE AO AND ZONE A (WITHOUT BFE) For Zones AQ and A (without BFE), complete Items E1~E5_ If the Cenificate is intended to support 8 LOMA or LOMR~F request, complete Sections A, B, and C. For Items E1-E4, U15e natural grade, if available. Check the meaSUf9ment used, In Puerto Rico only, enter mele~. E1. Provide elevation information for the follOWing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent gl1lde (HAG) and the low..t adJ.""n! grade (LAG). a) Top of bon om floor (inCluding basement, crawlspace, or endo~ure) is _'_ 0 feet D mete~ 0 above or 0 below the HAG. b) Top 0' bottom floor (including bafiemOl'\t, crawlspace, or enclosure) is _'_ 0 feet 0 meLel'!i 0 Bbolle or 0 below the LAG. E2, For Building Diagrams 6-9 with permanent flood openings provided 111 Section A Items 6 Qnd/or 9 (.see pages 8-9 of Instn.Jctions), the next higher floor (elevation C2,b in the diagram5) of the building is _'_ 0 feel 0 meters 0 above or 0 beloW the HAG. E3. Attached garage (top of slab) is _'_ 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _'_ 0 feet 0 meters 0 above or 0 below the HAG. E5. Zone AQ only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the communlty'5o floodplain management ordinance? 0 Yes 0 No 0 Unknown. Th8 local officiel must certify this information in SectIon G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's aUThorized representative who completes Section! A, e, and E fur Zone A (without 8 FEMA-issued or COl'11munity~issued BFE) or Zone AQ mUM sign here. The stBt8mer,13 in Sections A, e, and E are correCf to ("9 Oe~t of my kII0wl9dge, Property Owner's or Owner's AuthOrized. Representative's Name Addre5S City State ZIP Code Signature D.bo Telephone Comments ,. SECTION G - COMMUNITY INFORMATION (OPTIONAl) The local o!,icfal who is authorized by law Or ordinance fa administer the comlTlunity's floodplain management ordinance can complete Sed:ions A, S, C (or E), and G of thIS Elevation Certificate. Complete the applicable item(s) and sign below. Check the me!lQ8umment us8d In Items G8 and G9. G1, 0 The information in Section C was taken from other documentation that has been signed and sealed by Illicen8ed 6Urveyor, enginesr, or architect who Is BlrthorizBd by law to certify ele\t'atlon Information. (Indicate the source and date Ofth9 elevation data In the Comments area below.) G2. 0 A communiry ol"ficral completed Section E for a bUilding located In Zone A (withou~ a FEMA~issued or communiry-Is.sued BFE) or Zone AO. G3. 0 The following information (rterns G4-G9) is provided for community floodplain management purposos. G4. Permit Number G5. Date Permit "ssued Ga, Date Ce!tJflcate Of Compliance/Occupancy Issued o C heck hem if attachments G7. This permit nas been issued for: 0 New Construction 0 Substantial Improvement Ga, Elevation of as-built lowest floor (including basement) of t"e bUilding: _'_ 0 feet 0 meters: (PR) Datum G9, BFE or (in Zone AO) depth of flooding at the building site: _ _ 0 feet 0 metel"l5 (PR) Datum _ G10. CommunIty's design flood ele\lation _ _ 0 feet 0 mete~ (PR) Datum _ Local Official's Name Titre Community Nsme T erephone Signature Date Comment3 n Check here if attachments 05/J~/2010 MaN 15:29 FAX 541 687 07J9 GOEBEL ENGI~~ERING , ~ 004/004 Building Photographs See Instructions for Item A6 For Insurance Company Us~: BUildin\\, Street Address (including Apt., Unit. Suite, and/or Bldg, No.) or P.O. Route and Box No. Policy-Number 2601 17 STREET - Company NAlC Number City SPRINGFIELD State OR ZIP Code 97477 - If using the Elevation Certificate to obtain NFIP fiood Insurance, affix at least two building photographs below eccording to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear Viaw": and, if required, "Right ,Side View" and "Left Side View: If submitting more photographs than will fit on this page, use the Continuation Page, following, EXCA V A TED PAD - READY TO SET FOUNDATION FORMS 0' ". . ,;.," .: ;~"r':' ~,. ":"""'--' ..,. ~.:.',~~'~".~;;':-'- ., ..-.......-., .'~ >" . ..-. :"\:~,~;~~;:;',:,":",,,,:,:,"'.'''~' , '" ",: .' ~..:.;': "'\ .'__~",m ....;;=.:::.~..:;':'"_-.'.::: ...---- 2~ willamalane t~ Park and Recreation District . Job. No. 0/0 -S-.>/ SYSTEM DEVELOPMENT CHARGE WORKSHEET . January 1-June 30, 2010 NAME: ~~fa.. ADDRESS: slflt;! tJ/J?IE$TtlLCITY e~$Uf'" LOCATJONOF PROPOSED BUILDING SITE: PHONE: STATE:l3'71- ZIP: 91 Y~I Street Address: 2(,0' IIJ~ Plat Name: Tax Lot Number: \f1c:D1.i\~ \ ~ 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) A. Sinqle-Family Detached / NO. OF UNITS X $2,858 per unit = $ / B. Sinqle-Fa~iIY Attached NO. OF UNITS X $3,100 per unit = $ C. Multi-Family Apartment NO. OF UNITS X $2,641 per unit = $ D. Sinqle Room Occupancy NO. OF UNITS X $1,321 per unit = $ E. Accessory Dwellinq Unit NO. OF UNITS X $1,550 per unit = $ $ WILLAMALANE SDC 2.' SDC CREDIT (If applicable) SDC payer must furnish proof of VV1l1amalane Credit ,approval.) # $Esr $ 3. TOTAL WILLAMALANE NET SDC ASSESSED (if ~DC reduced for Credit) CY<L--- S-, /9, /0 Date ~NJ~ \.~A'\\ 5 Development Services Department City of Springfield . . SPRING. f..'E.~.D .1-' ..;C~ . "'~'OREGON WWW.ci.springfield.or.us TRANSACTION RECEIPT COM2010-00551 2601 17TH ST CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 permitcenter@cLspringfield.or.us RECEIPT NO: 2011000150 RECORD NO: COM2010-00551 DATE: 01/24/2011 I O'E'S C RI"pr'IO' N' . .;oJ .;" "" ",',"; .,;':"~':;rr,oJ0f:,;.!.;'::1 "'''i.';'i;;'?'''i:,,!k''':~'-A' 'c'c"o' u'N"-r-','c' 'O'O"E' '~:Y'-' "@:';,;.,:;;'."A"M'.'O'u...N.r""o'u-.E..F..."'f,....',.' ~ ,~. ;:;;f:;,.;Jik0i\~~ ".,. '~~l,$/"'ka. ""~:~:!:t.~",,~.:-o,,;c~,, ',' ,_ _, ",-=," ~ ,_~ ~..:ii. , " ,~, ~..........,,"tt"^'~.:....J + 12% State Surcharge 821-.00000-215004 __.,__.340.35 ...._ + 5% Technology Fee 100.00000.425605 __-.2..58.16 ____ 1 st Applia~.~e 224.00000.425604" ____79~___. 3 Baths One & Two Family 224.00000.425603 402,g.!!....___. Addressing Assignment ,. . .--E.i~00000.425602 38.00 Appliance Vent 224.00000.425604 g.OO ~Iding Permit 224.00000.425602 2.190.23 Curbcut Permit 201-00000.428060 88.00 Vent 224.00000.425604 18.00 Exhaust Hoods 224.00000.425604 13.00 ._.,,---~.,-~---_. .---,----'. Fire SF Fee. Residential 100.00000.424005 319.95 -~.,-~,-, .. ",.__.._..._-~--~-'~-~- ",.~~_._-~-_.- .....--!:~epl':':':..lListed)_ ._____ _.___.E~C!.~qg,Q:~~60~___,.___.._____,:IIJ.:~_,.._ Gas Outlets 1.4 224-00000-425604 7.00 ___"'."___...____."" ________ ____~__ ".,"~ ._ __~__.___wu .._____. _u. _ ~_ ... __""__'_U'_ Gas Outlets 4+ 224-00000-425604 16.00 ~------~~_.'.'_."--_...~- -.-- - .--. Heat Pump 224-00000-425~~" ..___ _ .._17.:00________ PW Disc - 3rd Permit 201-00000-428060 .60.00 Plan Review Major- Planning 100-00000-425002 211.00 Plan Review Residential 224-00000-425602 169.31 719-00000-426604 294.78 440-00000-448029 369.55 441-00000-448029 2,609.17 446-00000-448026 211.21 _..._._.___...~_w___._.._.___ __...."'_......._..__________.._.._ 447-00000-448027 931.65 "_._-"._~~,..._,~~--,,_..~--,,--_...._---_._----.,-_...__._----- 719-00000-426604 71.47 __ .___ _.._ _~_._~ _..,__ __..____._____ _ _ _ ______._ .~. __,.._'__4_ ._ 443-00000-448025 749.58 W_~'.'.''''.____~'.''__'_~ ,,____ __.. __ _ .___ _ __. 442-00000-448024 985.77 ~~-----_._.__...._-_.__.., 201-00000-428060 88.00 224-00000-425604 45.00 .,,--~---- ._--_.._~ 821.-00~150~_____ 2,135800________ TOTAL DUE: 13,270.18 t~p.yMgijI:t1iB,~.t~~~RpAyqR;;:E~.gHIER:~ ccARPfNt~:;z~~~~QMM~'il$l~ltr~~l71~~,~i}(}f;~MPUNJ{~f!.IO~;g;:12.~}-~~)';:.-_! ~"1 Check KACHINA PROPERTIES 13,270.18 6486 SDC S.anitary/Storm Admin SDC Storm. Improvement SDC Storm - Reimbursement SDC Tran Reimburs-Residential --..---_.~-"._._....,,+-_........._.__.._--_.._._. ~ SDC ~_~_!E!:.lP!~T~t-Resident _ SDC_Iransp~l"!ation~~min ______.______ Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement Sidewalk Permit Vent Fan __"_,,,!:!illam~ane Single Family TOTAL PAID: 13,270.18 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000448 Date: 04/30/2010 1:19:19PM Job/Journal Number COM20 I 0-00551 Description Plan Review Residential Payments: Type of Payment CredilCard Paid By LANNY JONES Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 1,254.34 $1,254.34 Amount Paid CJC 36494z In Person Payment Total: $1,254.34 $1,254.34 ',i~ ,..:\;~~pt,,: :d-J 1 ,1 ..-,.,- ~ .;~ ,,;;t;. 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