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Home My WebLink AboutPermit Building 2011-6-10 SP~~.N G..=.L~ ~">" ,...... ",'...z..~ ".'^",. "'0', OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00774 IVR Number: 811192317797 225 Fifth SI 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 06/10/2011 ISSUED: APPLIED: 06/10/2011 05/09/2011 EXPIRES: VALUE: 12/06/2011 $153,766.73 SITE ADDRESS: 4868 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105700 PROJECT DESCRIPTION: Single family residence SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential Phone Number: OWNER: ADDRESS: HAYDEN HOMES LLC 2464 SW GLACIER PL STE 110 REDMOND OR 97756 Contractor Type Electrical Contractor General Contractor - - Plumbing Contractor Mechanical Contractor # 01 Units: Construction Type Occupancy Comments Occupancy Type Occupancy Comments Occupancy Type Construction Type # of Bedrooms: Sprinkled Building: Fire Alarms: Energy Path: Contractor Name GARNER ELECTRIC CO HAYDEN HOMES llC STUlZMAN SERVICES INC CONTRACTOR INFORMATION ~ Lie Type CCB CCB CCB CCB BUILDING INFORMA TION ~ PACIFIC AIR COMFORT INC Type VB 1387 s.t. # of Stories: Height of Structure: Type 01 Heat: Water Type: . Range Type: Hazmat: R-3 396 sJ. Garage plus 120 s.t. Shop U Type VB 2 23.58 Forced Air Gas Gas Gas Lie No 121159 172526 31747 39237 lic Exp Phone 03/14/2012 503-648-4552 10/11/2012 541-923-6607 05/12/2012 541-928-8942 03/25/2012 541-672-9510 Lot Size: Sq Ft1 st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: 1224 679 51 Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specially Code Edition: law requires you.t~ _~""':\i'''''' Oregon 0 gon Ultlity Residential Specially Code EditlOl)i pted t~8e re t f rtll . .," W' r"I"5 auo ules are se 0 Structural Special'91C~de Editi~nter. Those r R 952-001- NotifICation v i 0 through OA in OAR 952-001-00 . copies ofthe rules by 0090. you may o~ta'n Note: the t~\~?h~ne Site Inlornf~Ji~'ifr" r the 01 :~g~_33~1-~344). Cen er 3 No Path 2B All ducts and air handler within building thermal envelope Englneel'l!d: Fill: '~OJ t .\.1.... Ff..1'l~uIlI~R~nIT SHAll EXPIRE IF THE WORK Fldod-Hazar~'Area. S OT L~JbTt\~Q.Prd7A~aWNDER THIS PERMIT I N R.it'ili"iAg[Wlt'ilED OR IS ABANDONED FOR S,6,i,I~\R~i&'Jl B~!lu ji{<\~ I 0 D. Springfield Building Permit 6/10/2011 9:16:26AM Page 1 of6 SP.RING_ F IE_L~ ~,.h ,." if!ffJ 0A~~REGON www.ci.springfieid.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00774 IVR Number: 811192317797 225 Fifth St Springfield,OR 97477 Phone: 541-726,3753 Inspection Phone: 541-726-3769 Fax: 541.726.3676 pe rmitce nter@ci,springfield,or.us PROJECT STATUS: STATUS DATE: Issued 06/10/2011 ISSUED: APPLIED: 06/10/2011 05/09/2011 EXPIRES: VALUE: 12/06/2011 $153,766.73 SITE ADDRESS: 4868 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Single family residence DEVELOPMENT INFORMATION ~ Frontyard Setback: 10 Overlay Dist; Hi!!side REQUIRED PARKING Interior Setback: 5.07 # Street Trees Reqd: Total: 2 Sideyard Setback: 5 Paved Drive Reqd: Yes Handicapped: Rearyard Setback: 49.09 % of Lot Coverage: Compact: Solar Setback: 0 Highest point on structure to north property line: 24 PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ DescriDtion R-3 1 & 2 family U Utillty, misc. U Utility, misc. Tvpe of Construction VB VB VB Unit Amount Unit Tvpe 1,387.00 Sq Ft 120.00 Sq Ft 396.00 Sq Ft Unit Cost 96.83 37.72 37.72 Value 134,303.21 4,526.40 14,937.12 153,766.73 Springfield Building Permit 6/10/2011 9:16:26AM Page 2 016 SP~~~~~~~ .""'~'OR'GO'" 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-SPR2011-00774 IVR Number: 811192317797 permilcenter@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 06/10/2011 ISSUED: APPLIED: 06/10/2011 05/09/2011 EXPIRES: VALUE: 12/06/2011 $153,766.73 SITE ADDRESS: 4868 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Single family residence FEES PAID ~ Descriotion Amount Paid Date Paid Reciol # Structural Plan Review Fee Residential $432.20 C5/C9/2C11 2C11CCC9C3 SDC: Improvement Cost - Storm Drainage $632.20 0.6/10./20.11 20.110.0.1516 ~D.c::,-R';;rn.bU!Se-"!,!n'-~l!~n_~Eorta_ti.<>.~ SDC ._ _ _. ~~.. 0.6/10./20.11 20.110.0.1516 ~)D.c:::..!m,,!~v~.rn.~.~t.~.l!~nsportalion SDC _._...__.$.1,81151 0.6/10./20.11 20.110.0.1516 SDC: Reimbursement Cost - local Wastewater $3,556.44 0.6/10./20.11 20.110.0.1516 ---_._-~.-. ---,. ._--~- ._.._--~."-, ..--. ".--- -- -... SDC..:..!..mprovemerll.~ost. local ~stewater $1,735.83 0.6/1 0./20.11 2_C~ 10.0.151 6_ SDC: Reimbursemenl Cost - MWMC Regionai Wastewatf $101.97 0.6/10/20.11 20.110.0.1518 SDC: Improvement Cost. MWMC Regional Waslewater ~ $1,333.57 0.6/10./20.11 20.110.0.1516 SD~pliance .Cost - MWMC Regional W~slewaler SI $22.63 .""_"" 0.6/10./20.11 20.110.0.1516 SDC: Administrative Fee. MWMC Regional Wastewater: $10.00' 0.6/10./20.11 20.110.0.1516 SDC: Total Sewer Administration Fee $371.81 0.6/10./20.11 20.110.0.1516 SDC: Total Transportation Administration Fee $134.98 0.6/10./20.11 20.110.0.1516 Willamalane fees - Single family detached $3,409.0.0 0.6/10./20.11 20.110.0.1516 Structural Building Permit Fee $928.53 0.6/10./20.11 20.110.0.1516 R.a!!ge ::.':od/oth.'" kitchen equipment .~~~___. 0.6/10./20.11 20.110.0.1518 A~rrlin f:'~ !1D% ofapp~c.a..b.l~fe-"s) _'_ _______.___ $9.77 0.6/10./20.11 2~11.0E151!!. ~asPyingupto~outl,,!~. n. _____.__ .__ $28~___~~D11__. .__..3D11D015~~ .F:"~t Applianc~ Fee ____...__._.___.______. _ $79.00. 0.6/10./20.11 _ _.. . _~01.129~ ~ Residence wiring 1,0.0.0. sq. ft. or less $134.00 D6/1~~2D1:...._ 20.110.0.1518 Each added 50.0. sg. ft. or portion $50..00. 0.6/10./20.11 20.110.0.1516 Fur~ace' up to 10.0.,0.0.0. BTU $17.00. .._.....I!6/1Dl39~_.___..__.... 20.110.0.1516 Single.duct exhaust (bathrooms, toilet compartments, utili $45.00. 0.6/10./20.11 20.110.0.1516 Flue venl for water heater or gas fireplace $9.0.0. 0.6/10./20.11 20.110.0.1516 One or Two Family Dwelling with Three Bath $439.00 0.6/10./20.11 20.110.0.1518 Re~identiaIFin:(.C5PerSqFoot) $97.70 0.6/10./20.11 20.110.0.1516 !:',Ian Review Adjustment. ~i;idential ____._ __ ___ $171.34 0.6/10./20.11 20.110.0.1516 Firs~c-"p.1..-....__....__..._.. $.oc~_ 0.6/10./20.11 20.110.0.1516 ~~~_a.ddi!!,,-~~~opL._.. _________._. _ _._.._. $12.00 06/10./20.11 20.110.0.1516 Planning - Major Review - City $211.0.0 - -----0611'0./20.11- ---20.11 0.0.1516 Staje~ ot ~~go-n'iu;~harge (12% ot-"RPlicab~fees)--'-_-=- .---- _.s~9~66'-' .-- D6/~~O:~~~.:::...~..:=._.==.=20_~i6oi5.iE ::echn~~9X.!~e.(5% of per",it total) $10~:89 D6/1D/2D1..:!..........._._._.~~1!!. SDC: Reimbursement Cost - Storm Drainage $434.51 06/10./20.11 20.110.0.1516 Mu:~p~e Permit Discount (1V1~-"-3) $-30..00. 0.6/10./20.11 20.110.0.1518 Curb Cut/Driveway 1st Cut $88.0.0 0.6/10./20.11 20.110.0.1518 Sidewalk up though go. Feet $88.00 0.6/10./20.11 20.110.0.1516 Address Assignment. each new Of change $38.00 0.6/10./20.11 20.110.0.1516 Total Amount Paid $17,247.36 Springfield Building Permit 6/10/2011 9:16:26AM Page 3 ot6 s..p ~N.~fIE~ ~,.~~, '. ..,~f>\1t:;U ,. ' m OREGOl'4 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00774 IVR Number: 811192317797 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilce nter@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Issued 06/10/2011 ISSUED: APPLIED: 06/10/2011 05/09/2011 EXPIRES: VALUE: 12/06/2011 $153,766.73 SITE ADDRESS: 4666 GLACIER DR, SPRINGfiELD, OR 97477 ASSESOR'S PARCEL NO: 1602051105700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Single family residence Plan Review ~ Department Initial Review Received Due Date 05/10/2011 05/10/2011 Completed 05/10/2011 Result Approved Reviewer David Bowlsby Public Works Review 05/10/2011 05/10/2011 05/11/2011 Approved Kaye Wilson Comments: Storm water to tap rPfan,ning;,Reyjew:--~f,'\ .:;' ',~ 05/19/20'1:t_07B5/10!2011,,:,~051;1~~o,tj:~y,,, ,,-,YVajtirigjht~f"nal";~~'~\:,,;' :_'Tla.r:~ 'J~nes~;>;')t';. ~'i~- ,'_v,' ~" 'co~~m~~rits:;'~ ~1~iaJl~~S:~Ub~itt~,~-_CJr~~~9!pr~a'p~r~~ed! ,~~je~"y{jli ta~eE~~gffr\~:i~;~s~~ri1u~t ;~~ie,~ ~~~r~~!~stW'5Ub~i_Y~~~_d~sigh ! :.' -~,;- ,~ 9_nten<!~!!9-,t:t~!J.g~lson'IQJormed,on;511g!J.:t7 't7+;;" . );: _ ~ ~~-.<'~ ...., ,r ,,/ Structural Review 0,5/10,/20,11 0,5/10,/20,11 0,5/19/20,11 Add'llnfo Required Kip Kaufman 'J ., .-. 0, , ~_ '~_', , ~""--- :PlannirigRe~ew~.-'M""_~ _ ," i 'o-571-0j?61_-1~o5f10;2~;11"-"~ 06l02/201~-_ _-,-~APprOV~d_ ,"~' 0 T~_ra-JqM~-,~"':.~~ ~ Comments: .suK-eyrequired 10 verffy property Jines because of minjri,urii"side'setb.backs~t _ __ l .Priorloc~mme_~cing constrU6!i6~:,~ttivit!eS;-'1_. Siak.~ buil.ding.envelop ? ,_}~@c~,.orange'conSFructiOn:!~!"c[;'g afong the-' I rear:ljn~.of,Jhe building'envelop 'to:protect-trees., No construction'actiVities.are.'~Uowed'outSjdethebuHdjn~-:envelop~" r ':~'~~nif~~~~,~~~q~~~e:tt~ ~speclfic a~'d~;~~lal~'r;qu';r~~'des:~n ~e~~~~t~ ~1~'~i~tt~:~:Wlll field~h~~(tha;'a~;ual elevatIons - ~ L_.. . ~ -/'match~~!!P16!!t~(!.~J9!Jia,s~~!l9wn~on,th~ar:?J::!roved;s~t'of Rlan~_."~ '. ,,' ,~- 0h:,,~ ~ . - : Structural Review 0,5/10/2011 0,5/10/20,11 0,6/0,8/2011 Approved Kip Kaufman i { 1 Springfield Building Permit 6/10/2011 9:16:26AM Page4of6 SP~I..N....G...FIEL.~ ~;- :-l"> 4<.' '"'"U ...:;:U ."~ "<~ OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-0077 4 IVR Number: 811192317797 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 perm itcenter@ci.springfield,or.us PROJECT STATUS: STATUS DATE: Issued 06/10/2011 ISSUED: APPLIED: 06/10/2011 05/09/2011 EXPIRES: VALUE: 12/06/2011 $153,766.73 SITE ADDRESS: 4868 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Single family residence INSPECTIONS REQUIRED ~ Inspections 1020 Zoning/setbacks 1065 Sidewalk 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 fod at footing and call for inspection in conjunction with footing and/or foundation inspection. Post and Beam: Prior to floor insulation or decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. 1170 Post & Beam 1260 Framing 1370 Masonry Veneer 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall Wall Insulation: Prior to cover. 1440 Insulation Ceiling 1450 Insulation Duct Ceiling Insulation: Prior to cover. 1520 Interior Shearwall Shear Wall Nailing: Before covering sheathing with finish materials. 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. Roof Sheathing Final Building: After all required inspections have been requested and approved and the building is complete. 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 Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Final Gas: When all gas work is complete. 1630 Roof Sheathing 1999 Final Building 2260 Gas Service 2300 Rough Mechanical 2310 Rough Gas 2995 Final Gas Springfield Building Permit 6110/2011 9:16:26AM Page 5 of6 SP.~.I~..~.FI:~ ~~ ~OREGON www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-00774 IVR Number: 811192317797 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci,springfield.or.us PROJECT STATUS: STATUS DATE: Iss ued ISSUED: APPLIED: 06/10/2011 05/09/2011 EXPIRES: VALUE: 12/06/2011 $153,766,73 06/10/2011 SITE ADDRESS: 4868 GLACIER DR, SPRINGFIELD, OR 97477 ASSESOR'S PARCEL NO: 1802051105700 SCOPE: Single Family Residence WORK INVOLVED: New TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Single family residence 2999 Final Mechanical Final Mechanical: When all mechanical work is complete. 3130 Footing/Foundation Drains 3315 Water Line 3400 Storm Sewer 3500 Rough Plumbing 3999 Final Plumbing 3200 Sanitary Sewer 4120 UFER Ground Storm Sewer Line: Prior to filling trench. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Sanitary Sewer Line: Prior to filling trench and including required testing. 4225 Service or Feeder 4500 Rough Electrical 4999 Final Electrical Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 4140 Underground Electric Underground Electric: Prior to cover 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 remai~ on the site at all times during con..~c.r/:.uct.i_O. n.. ~. . /" ?- /"/ //" Ct-IO- II Owner or Contractor Signature Date Springfield Building Permit 6/10/2011 9:16:26AM Page 6 of6 225 Fifth StrcettSpringfie1d. OR 97477 t PH{S41}7:!6-3753t FA..X(541)7 SPRIf\lGFlELD __DEPARTMENT USE ONLY. Pernlit no.: 5:11--rM- --- Date: 5'-~- Jl.. tiff This permit is issued under OAR 918-309-0000. Permits are nontrDnsfcrnble. Permits expire if work is not started within 180 - ___~ ~ays of !ssuil~~e or if work is suspend.ed for 18? days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION .'. I5Resid~nti~i-'::--: - 0 Government _ 0 Commercial . .'.JOS:SITE INF0RMATIOI'f I\N[j;l:OC'AtION". . Job sile address:1.f8le/o G(..~",-<L City: ':>1'l1-I"'hr\,,:1.D I':)rL Reference: -I/O ZlP: CIT~-lo ffPl{()c'N-H0Mc5 .<0-'- Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor , , ~~~ ~f 4.1O-25B4-) (9/OB/COM) FEE SCHEDULE ....- ..--,.-'.:-:,-.-' --. Number orinspectiDns per item () 'IQty. Cost Tot.' -~ ea. .cost --~ - Residential, per uni~ service included: 1.000 sq.-ft. or less (4) ! $134.00, $/3' ~,.o, Each additionill 500 sq. f1. or portion !X $ 25.00 $!:O Cd thereof Limited energy {2} $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling sen'ice or feeder (2) Sen'ices or feeders: installation, alteratiolT, relocation 200 amps or less (2) $ 81.00 $ 20110400 amps (2) $ 95.00 $ 40110600 amps (2) $158.00 $ 601 10 1,000 amps (2) - $205.00 $ Over 1,000 amps or VOllS (2) $469.00 $ Reconnect only (2) $ 63.00 $ Tempornry services or reeders: instaJ/atioll. alteration, re/aeolion :WO amps or less (2) $ 63.00 $ 20110400 amps (2) $ 57.00 $ - -, 40110600 amps (2) $126.00 $ -Over 600 amps or 1,000 volts. see services or feeders section obove . p' Branch circuits: new, alteration. extension pel" panel a Fee far branch circuits with purchase. of 11 service or feeder fee; Each branch circuit $ 6.00 $ b. Fee for branch circuits without purchase ora service or feeder fee: First brilnch circuit (2) $ 55.00 $ Each additional branch circuit $ 6.00 $ Miscellaneous fees: senl;ce or feeder /tot included EDeh pump or irrigation circle (2) $ 63.00 $ Each sign or oUlline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration. or e>>lensian (l) E.ach ndditional inspection: (I) $58.00 $ '.':.' :,:-:,:'-'.: ,.";".: .' ApPLICANT USE' .:'. .,' .. (A) En\er subtOLaI of above fees $12t; u.J (Minimum Permit Fee $58.00) , ..... (B) Enler 12% surcharge (.12 x [AD $- f) I r -) (C) Technology Fee (5% of [A]) $ '(, .~ ~~ TOTAL fees nnd surcharges (A through C): $ -F ~\t;).~ Structural Permit Application .- ,:>- -..." ,-~"'m ''''VI" b -=...... - .... -....,.~ .,t-, "C:" '" -' :" ,t- 1 C--~---~ .t$'-'S'-' -- .... ~'-"'''''j;""-~,=~"""",,,,,,,.,"~'),,,,,,,,:;'~'hff;'::J 1J,~.tit':e: _S_ ,i5' t" )TY: 9F"..l~!NgFlpL[);'@~EG()~,;:i ~\,}: ;;.:":1';(':"0' 5P,~'N~A~, """', -- ~ '. ....e'.":. ........~ '- ~- .- '. .. ", '. DEPARTMENT USEONL Y 5f71l'Z(J1I-60 77'1 Permit no.: Date; S - '7 -( / 225 Fifth Street' Springfield, OR 97477' PH(541)726-3753 'FAX(541)726-3689 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. ,U, ' ." _" ,.",-,-,.., - .. ,-. .. '-"-"d~ .. .'" .", ',-, ",' ",\, ,.. ,.. " -r',-'5-.;,' , ., n ,:;,'I;Oc.A!:-'qQYE!:l~MF.t-fll;-APxR~OV Al1jtii.~J;;/<f~ht'Mw, This project has ~nalland~use approval. Signature: This project has DEQ approval. Signature: Zoning approval verified: 'orYes 0 No Property is within flood plain: 0 Yes 0 ~,~::,j~;~i~ik~t9ATE9JjRY!9"l~c.6NsiRucfl,0N~t":{(t',t:(;~~iW{' ~esidential 0 Government D Commercial ,.ii,;;:,..;'DPB,sl.TEI iNJp~MATI0N~;ANRft6i:Ati9t:lel'~~l'i;;~'.'; Job site address: 1'8&<8 . C'T<-A." i ",---c.- City: <;f'"...,..lC"~Il?L<D. State: Occ- ZIP:'lT'i Subdivision: W~. '"^.., D'> Lot no.: 31- Reference: Boz.D~ { Taxlot: 6S7ot::> ;,\P.ROPERTY '9W~E~' .~,,;, OvN 'l'-"1..~ 1<;&'1 Sw C,.... Date: Date: {lL- lOlL 110 ZIP:<1+~'ll> City: .~ Phone: i,"l<{. - sl)t..-S',..,u State: Fax: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under -.?~O1.01O. Sign here: - 7"( '- '. CONTRACTOR .1t:lSTALLA'n~:lN'c Business name: S LAl\e- Address: City: Pbone: E-mail: CCB license no.: Print name: State: Fax: ZIP: Signature: :'i?~\u,:,?)~,:~".SlJB-C;0N;r;MC:IOR.'IN,".o.RMA'1:IQN~~,;'1';;ji}\~*~~ Name CCB License Number Phone Number Electrical (:-' AJ2-...n"l-_ Plumbing S1VL'1'~........,..) Mechanical Po"", A.L :.\..,.'. \', ~ ':'::~'1.1.:'~ l'.""':,j:~l?~FEE \'SCH~DijCE-r';'-"r', ":' .;.,.'=',\.-' !i':.'<- "~~"". .i;" -::l':~v1i~ii~tIbW'i.~forffi~'t~()'n~t~l~!'j~;~~tt;~'\~J:.,~'~}t~~i~:f::}':~j~I~f:""f~,~~i~':~~~~t:I~~ (a) Job description: Occupancy 'S D lL-~ -LA Construction type: Nc~ Square feet: 1:3 Cost per square foot: Other information: Type of Heat, ('--, rt<:, Energy Path, 2 ~ ew 0 alteration (b) Foundation-only permit? zg- fA D addition DYes Total valuation: J~}~B:uti~J~gJe~si~~[ift~:/_~~}:~~;::~~i~t';~f:h~/,!r'i;'~, ':4;~ -. ..' ')c'" (a) Pennit fee (use valuation table): (b) Investigative fee (equal to [2a]): (c) Reinspection ($ per hour): (number of hours x fee per hour) (d) Enter 12% surcharge (.12 x [2a+2b+2c]): (e) Subtotal of fees above (2a through 2d): $ $ $ $ $ :S",', .".,.~ ""~t'H-''-''.'-'_'~'''''' il(-~"'~"~ :r-'!.'" ---!!jt.. - - ......;;1'~.~---...,..-w.- ~,f~:"I'"I.aQ}teYJ_t:-W.:[~,eflt~~~;,..$~:i.@<,r.';~~f;:lt~:~%~e{~,~:,~~~.fr:A{JS:~~o;::i' (a) 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): $ !fi'MI~.~elj_~~n~~m~siie~J-.;~~:~~:~n;;J.:~.:~ii:~~i~>:~\.. L',:.~..,;~:;;:~ ': ~Il~)":' (a Seismic fee, 1 % (.01 x permit fee [laD: $ TOTAL fees and surcharges (2e+3c+4a): S beY?;, ~~32-, l17/./ 'IA1)J 115':I ri of': 'fL-A~ R-el(~ " 2~willamalane tlJ Park and Recreation District Job. No. <:;.u- - 7H PARK AND RECREATION SYSTEM DEVELOPMENT CHARGE WORKSHEET January 1-December 31, 2011 NAME:-Y-kY DE).} j+v1"1r3"S ADDRESS: :;?--1-1,1' 5W ~CITY: ().J3:;j)M())/P LOCATION OF PROPOSED BUILDING SITE: Street Address: 41J6'6, ~~ >-r: Plat Name: \ \Jfsk\D'~ . Tax Lot Number: PHON$~i> 5S6 -51-56 STATE~ ZIP: q?-?5'--6 J-.R E:52-- 05 l'- . /)-. s 780 1. DEVELOPM ENT TYPE.(Refer to development type definitions on the reverse.) A. Single-Family Detached NO. OF UNITS ! B. Single-Familv Attached NO. OF UNITS C. Multi-Family Apartment NO. OF UNITS D. Single Room Occupancy NO. OF UNITS E. Accessory Dwelling Unit NO. OF UNITS X $3,409 per unit = X $3,404 per unit = X $2,800 per unit = X $1,400per unit = X $1,705 per unit = 2. SDC CREDIT (If applicable. SDC payer must furnish proof of credit approval.) 3. TOTAL PARK AND RECREATION SDC ASSESSED $ "3111'/ $ $ $ $ ($ e---- $ '3 t01 6 /L tJ Date of building permit submittal C;; / /0 / // Date of building permit issuance TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 8t Springfield,OR 97477 541-726-3753 www.ci.springfield.OLUS 811-SPR2011-00774 4868 GLACIER DR permitcenter@cLspringfield.or.us L~~yjvJlfJ,jiJ:X~g , 7'i.,ip~ioR' :'CASHIERttiMACHADO:"'-:~ 1~;:d<.c5MMgNJ~'i+.:;,' Check HAYDEN HOMES LLC 37783 RECEIPT NO: 2011001518 RECORD NO: 811-SPR2011-00774 DATE: 06/10/2011 !DESCRII1.TIONc->jf''''''';' J'; 1 --,,,~-;-?qit.,;. -,::~{-;1:i: ")\'CCQUNTic00E" ./l;"':,";:-~h.6.I\IfQI:JNT~bUE~ 'J~ Address Assignment, each new or change 224-00000-425602 36.00 Admin fee (10% of applicable fees) 224-00000-426605 9.77 Curb CuUDriveway 1st Cut 201-00000-428060 88.00 ~, Each adde~OO sqJ!:._or portion 224-00000-426102 50.00 Each additional cOPL. 224-00000-425602 12.00 __....First Applia~.<:e Fee___...._.. 224-00000-425604 79.00 __ _i!rst coPi'.______~__ 224-00000-425602 0.75 ____.i!~e vent fOf_Y"ater heater or gas fireplace 224-00000-425604 g.OO Furnace - up to 100,000 BTU 224-00000-425604 17.00 Gas Piping up to 4 outlets 224-00000-425604 26.00 Multiple Permit Discount (Max 2) 201-00000-428060 -30.00 One or Two Family Dwelling with Three Bath 224-00000-425603 439.00 Plan Review Adjustment - Residential 224-00000-425602 171.34 Planning - Major Review - City 100-00000-425002 211.00 Range hood/other kitchen equipment 224-00000-425604 13.00 Residence wiring 1,000 sq. ft. or less 224-00000-426102 134.00 Residential Fire (.05 Per Sq Foot) 100-00000-424005 97.70 SDC: Administrative Fee - MWMC Regional Waste. water SDC 611-00000-426604 10.00 __ ---.?DC: Complia~ce Cost - MWMC Regional Wastewater SQ~ _444-00000-42~607 ___~:~_______ ._._ SDC:J:r'prov-".,-,,~~: Transportati<:,:,~~__ ____ 447-00000-446027 1,611.51 _~:Improve:rnent Cost - Loc~.'!"~s!ewater 443-00000-446025 1,735.63 SDC: Improvem~nt Cost - MWMC Reg20nal Wastew~r SDC 445-?0000-~25 _____.____~33.57 .___.n_ SDC: Improvement Cost - Storm Drainage 440-00000-446026 632.20 SDC: Reimbursement - Transportation SDC 446-00000-446026 497.07 SDC: Reimbursement Cost - Local Wastewater 442-00000-446024 3,556.44 SDC: Reimbursement Cost - MWMC Regional Wastewater SDC 444-00000-446024 101.97 SDC: Reimbursement Cost - Storm Drainage 441-00000-448029 434.51 SDC: Total Sewer Administration Fee 719-00000-426604 371.61 ___SD_C: Tot~~Transportatio'2.~dministration Fee 719-00000-426604 134.96.._._ . ._~i?~walk up though 90 Feet 201-00000-426060 66.00 __~~~~!~-du~!..e:~~aust (b!lth,~~,~~_~.'_t,~!let co~P~.~~~~!~, u1jlity.!.?~_3,?~::.9~900~425604 45.00 ___ __ State of Oreg;>n Surcharge (12% of applicable ~ees) 621-00000-215004 229.66 Structural Building Permit Fee 224-00000-425602 926.53 Technoiogy fee (5% of p."rmit total) _.______..12O"~000.?0-425605 104.69 Willamalane fees - Single family detached 621-00000-215023 . ..~,~Q!J.:Q.O TOTAL DUE: 16,815.16 '," ",3:'Q', A.I'II<?4~TPAID .'" ,. '--..::1 16,815.16 TOTAL PAID: 16,815.16 ~SP:::.FI: ",' ,'""" ' ' " '''''''OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 5t Springfield, OR 97477 . 541~726.3753 www.ci.springfield.or.us 811-SPR2011-00774 4868 GLACIER DR permitcenter@ci.springfield.or.us RECEIPT NO: 2011000903 RECORD NO: 811-SPR2011-00774 DATE: 05/09/2011 rDESCRI~TION" ,". ~.;, / ",.:::0';c"""'~~dl;0'~;;;;;(~~( '~,:' "";;l\+;h7'Ac:CotJNL:C:()15E~d~;,*"'c"":'(';AI\II()UNi[DliE:!;1:;~,;,, Iv.,j Structural Plan Review Fee Residential 224.00000.425602 43220 TOTAL DUE: 432,20 L::BAYME'NT):YP.E~;,,:";:~t\Y9~'; ;:CASHiE~::~~!YhSBy;a:;' ';~4ti~QIVIME-NI~ -:;:,,~~, ';,;;;/;> ,';,' , .. ..AMOUI'.!T pAID.' ':' ,~~~J Credit Card HAYDEN HOMES LLC 432.20 031641 TOTAL PAID: 432.20