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Home My WebLink AboutPermit Miscellaneous 2011-8-15 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01938 IVR Number: 811124630054 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: ISSUED: APPLIED: 08/15/2011 08/15/2011 Issued 08/15/2011 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 EXPIRES: VALUE: 02/10/2012 $40,000.00 SCOPE: Fire Damage WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential Repair Fire Damage to (1) Bedroom, Convert (1) Bathroom to (2) Bathrooms, Demo (1) bathroom and Add Heat Pump. SITE ADDRESS: 123 GREENVALE DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262201300 PROJECT DESCRIPTION: Phone Number: OWNER: ADDRESS: ROWE CARLA J 123 GREENVALE DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION ~ Contractor Type General Contractor Contractor Name STEVEN ROBERT CORNELIUS Lie Type CCB # of Units: BUILDING INFORMATION I # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Hazmat: o ATT~ !' -='1' r'I'cnon 18W requires you to foIlG" -":,.~ ad' r-oj b'f tho Eleetrieal:Speeialty Code Edition: .....~... ...H.Jl~_ j .... '-',......t::l...'" ......,.Illy Notification Center. Those ruISpringfield-F.ir~-j;ode Edition: in OAR 952-001-001 0 throughM),~ffa\1fc'illlSp~~ialty Code Edition: 0090. You may obtain copies "f Ibe n'l~o hv # of Bedrooms: II' th t (N I thMunlelpal1 Development Code: . . . ca mg e cen er, 0 e: e lelepnOne . . . Sprinkled BUlldl~Rimber for the Oregon Utilit~I~,'lJ~I,~,\l,,~PJw'alty Code Edition: Fire Alarms: Center is 1.800-332-;ro.si,~~ntial Specialty Code Edition: Energy Path: Structural Specialty Code Edition: Lie No 185248 Lie Exp 01/23/2013 Phone 541-461~5949 Lot Size: Sq Ft 1 st Floor: Sq Ft 2nd Floor: Sq Ft Bas~ment: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: 0 Occupancy Load: 2008 Site Information I Engineered Fill: Fill Volume: Flood Hazard Area: Land Hazard Area: Retaining Wal!~OTr!r.E' ' Soils Report 'rHIs' ~ERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, Spring~ie\o Building Permit 8/15/2011 12:04:23PM Page 1 of4 SP~I N... GFIE..L.~ IIv -~~-'\ ,~ . .',.. .. OREGON www.ci.springfield.or.U5 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01938 IVR Number: 811124630054 225 Fifth St Springfield,OR 97477 Phone: 541~726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenler@ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued 08/15/2011 ISSUED: APPLIED: 08/15/2011 08/15/2011 EXPIRES: VALUE: 02/10/2012 $40,000.00 SITE ADDRESS: 123 GREENVALE DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262201300 PROJECT DESCRIPTION: Frontyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: SCOPE: Fire Damage WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential Repair Fire Damage to (1) Bedroom, Convert (1) Bathroom to (2) Bathrooms, Demo (1) bathroom and Add Heat Pump. I DEVELOPMENT INFORMATION I Overlay Oist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Description Bid Springfield Building Permit PUBLIC IMPROVEMENTS I Valuation Description Tvpe of Construction NA Unit Amount Unit Tvpe 40,000.00 Bid 8/15/2011 12:04:23PM Sidewalk Type: Downspout/Drains: I Unit Cost 1.00 Value 40,000.00 40,000.00 Page 2 014 CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01938 IVR Number: 811124630054 www.ci.springfield.or.us PROJECT STATUS: STATUS DATE: Issued ISSUED: APPLIED: 08/15/2011 08/15/2011 08/15/2011 SITE ADDRESS: 123 GREENVALE DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262201300 225 Fifth 5t 5pringfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@cLspringfield.or.us EXPIRES: VALUE: 02/10/2012 $40,000.00 SCOPE: Fire Damage WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential Repair Fire Damage to (1) Bedroom, Convert (1) Bathroom to (2) Bathrooms, Demo (1) bathroom and Add Heat Pump. I FEES PAID ~ PROJECT DESCRIPTION: Description !ec~.~ology fee (5% of permit total) _ State of Oregon Surcharge (12% of applic~wble fees) Single-duct exhaust (bathrooms, toilet come.~~Tents, utili First Appliance Fee SDC: Improvement Cost - Local Wastewater Water closet Showe~Showerpan Sink/basin/lavatory sac: Reimbursement Cost - Local Wastewater SDC: Total Sewer Administration Fee ~~no~?_gy fee L5% of p~r~it_to~ai!._ 8t8t8.':.f Or~~_o~~S~:<::.~arf;leJ13%__C?! 3lPpli~able fees) ~truc:t~al Buildin[~mit Fee Amount Paid Date Paid Redel # $19.60 08/15/2011 2011002241 ~-'---~--~'--- $47.05 08/15/2011 2011002241 ~'~.~----~-,,- $18.00 08/15/2011 2011002241 $79.00 08/15/2011 2011002241 $66.09 08/15/2011 2011002241 $57.00 08/15/2011 2011002241 $57.00 08/15/2011 2011002241 $57.00 08/15/2011 2011002241 $135.41 08/15/2011 2011002241 $10.08 08/15/2011 2011002241 $13.40 08/15/2011 2011002241 $32.16 08/15/2011 2011002241 " "-----~~- $392.05 08/15/2011 2011002241 $983.84 Total Amount Paid Plan Review ~ Deeartment Application Acceptance Received Due Date Comeleted Result 08/15/2011 08/15/2011 08/15/2011 Application Accepted Reviewer Kip Kaufman ~-'--~-~~-_ --...,-. --"rr--_~_'__--H'__"H__ 08/15/2011' ,08/.15/2011,08/15/2011 \ '. Appr<;v.,,~, ." ,-, : i<:aye Wilson. ,> -, .~~.< .. L~_~ ,-:o.:...L:~__~__ --A'_~___."':': ~1~~L_._':. - ,,-,., Planning Review 08/15/2011 08/15/2011 08/15/2011 F~~liC-,''fOfkS. ReJi~,:.7_. i, - ' <r' L..;",,-. "."--, Permit Issuance 08/15/2011 08/15/2011 08/15/2011 Issued Carpenter Chris Carpenter Springfield Building Permit 8115/2011 12:04:23PM Page 3 of 4 SP1:..~..G.~._FIEL.~ ~~1~ ~N. &> \:;::0' " ~".~ OREGOt<( www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2011-01938 IVR Number: 811124630054 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: 155 ued 08/15/2011 ISSUED: APPLIED: 08/15/2011 08/15/2011 EXPIRES: VALUE: 02/10/2012 $40,000.00 SITE ADDRESS: 123 GREENVALE DR, Springfield, OR 97477 ASSESOR'S PARCEL NO: 1703262201300 PROJECT DESCRIPTION: SCOPE: Fire Damage WORK INVOLVED: Repair TYPE OF STRUCTURE: Residential Repair Fire Damage to (1) Bedroom, Convert (1) Bathroom to (2) Bathrooms, Demo (1) bathroom and Add Heat Pump. I INSPECTIONS REQUIRED ~ Inspections 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. 1430 Insulation Wall 1440 Insulation Ceiling 1999 Final Building Ceiling Insulation: Prior to cover. 2300 Rough Mechanical Final Building: After all required inspections have been requested and approved and the building is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. 2999 Final Mechanical 3500 Rough Plumbing 3999 Finai Plumbing 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 construction. ~ /--:/7 /' """",: r:1: 7;7-'--";;::? /7~ ...- ~_...-...... ,')j 00~1 /;7 IY{ / _/~.. --' ~/ ~~ Owner or Contractor Signature Date Springfield Building Permit 811512011 12:04:23PM Page 4 of 4 Plumbing Permit Application fl ..':;.''''_'h''_'''-''''';;''~__,.'''''' i":.' '"_.:', ..,.<.~. ,.;....,.,::..'""...".'.: " ", OEPARTMENTUSE oNi..y,)::,~'f Permit no.: oS; I , rtJd Date: 2?J I ) 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. '"\,~i#/i~i:', :'ilOCAl; 'GOVE RN M ENT,''AP PROV'Al!t,!i~0'tr~ls;:,l:i,"j Zoning approval verified? DYes D No Sanitation approval verified? DYes D No CATEGORY OF, CONSTRUCTION ' '. o Residential 0 Government 0 Commercial ,,(,A,i0.JOB,SI;rE ,INFORMATI()N,iANOi,L'QCATION:;,:;,i'.';/,;.; \1:> ,:t!::~'tl~M,,~:i}:tf\~~ _. . PROPERTY. :OWNER/'r'; Phone: 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 OAR 918-695-0020. Signature: CONTRACTOR INSTAllATION. "'to Business name: Address: City: Phone: E-mail: CCB license no,: Plumbing license no.: Print name: Signature: ZIP: 'BCD license no.: 440-2500-J (11/08/COM) I;~:',;;'~/r i:;t;~i,:::(2":I}~~J:r~;~i1;t1~~:FEEf{s.GH EOO ~E!';~h"(' "~:~(.~F~:.~b:;i~:.'5!!~;~~;,ii3} ;.\R~~:~f:tR:t~~,'~;~~~t~~;:~}';ft.'(J~}';~~R~~j~~:i;~\ 2~~'. i~:~~~;!i~;~' .,~;,~_;~.~~~.tg~ New residential 1 bathroom! I kitchen (includes: first lOOfeel o/water/sewer lines, hose $238.00 $ bibs, ice maker, under floor low-point drains and rain-drain packages) 2 bathrooms/l kitchen $374.00 $ 3 bathrooms/l kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Each additional kitchen (over I) $95.00 $ Residential fire sprinklers (includes plan review) o to 2,000 square feet $58.00 $ 2,001 to 3,600 square reet $115.00 $ 3,601 to 7,200 square feet $174.00 $ 7,201 square feet and greater $232.00 $ Manufactured dwelling or pre-fab (circle one) Connections to building sewer and $58.00 $ water supply Commercial, industrial,.and dwellings other than one~ or two-family Minimum fee . $58.00 $ Each fixture /,,p $19.00 $ 11'-1 Miscellaneous fees 1 00' storm, sewer, water line $76.00 $ Each fixt.ure, appurtenance, and piping $19.00 $ Storm water retention/detention facility $19,00 $ Irrigation systems $19.00 $ Piping or private storm drainage $19.00 $ systems exceeding the first 100 feet Specialty fixtures $19.00 $ Reinspection (no. ofhrs. x ree per hr.) $58.00 $ Special requested inspections (no. or $58.00 $ hrs. x ree per hr.) Each additional inspection: (I) $58,00 $ XM~~fic~~'i~g~~:s'~'prpr~"g~:~l~~~l\;:~~Tf;\~?;~'}?~fg*~ Minimum ree $ Enter value of installation and equipment $ Enter fee based on installation and equipment value. $ f!ii,\:~'>t!fi";;ij,f~'''B~RRE'le'P:N]~iiIfs'E"~_~is'''' ,*,,!1;:,,~T~;g?-.~L{~. ':,~ti,,'( ,._..<1tlIL.'__,.___.~.._,--"m__:~...;__,m",'i*. "" \,'"' ,.',~ ~~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ I 1'1 (B) Investigative ree (equal to [AD $ (C) Enter 12% surcharge (.12 x [MB]) $ I,?"r (D) Technology Fee (5% of [A]) $ S""7;.!- TOTAL fees and surcharges (A through 0): $ I.?'(:.:!:- ;Btruct~ral Permit Application i , DEPARTMEt.h USE ONLY, ""J'. "._,--.~-",.~ ..'0..-" .~_... "l.~~ "J"'Jf:". _.,,,,,~ "'~if . ~~. ~ "3;, ~;~ "_ -"'-_ . ':'\I". ,"~ ..~ .~ ''I-..,. <l~' ~ ~ r ~,%"'.:l _....,1:", ."..~.~ _ .~: "r . C ~-~, 't 'i!C ~~;t..:i";i&:l'!fl'; Ql} .~~~IN.<1i.IiWpp...~RJ;:qQ!'i~.i;;;h~~ {JI' ,.::.; 'j- ,;-~, Date: This permit is issued under OAR 918-460-0030, Permits expire if work is not started within 180 days of issua suspended for 180 days, 'tqCAL.. . ~QYE~t'ltv1~Ni:'M8@YA!l!;;';;\';":,l~:~:lJ!.'~~1 This project has final land-use approvaL Signature: Date: This project has DEQ approval. Signature: Date: Zoning approval verified: 0 Yes 0 No Property is within fiood plain: DYes D No *1.;~~~.~.;-i;!&:t~~!):;A'[EgQ8Yi\1QFJ!,G:9Ns;rf{u,t.;fI,9r'j;i":..;:;;,;[.;'jj;:g~iib' ,Residential 0 Government 0 Commercial '>;~i,:" ,;J()B:iSIJE i~f,PRMATI()N)'iNDfEo.CAtT()Nh!~t~i!;,!f,~(, .j<-L City: State: 01':" 225 Fifth Street. Springfield, OR 97477. PH(54])726.3753 . FAX(54 ])726.3689 Reference: 1 OJ ~. 0 :, PROPERTY OWNER 6 ee/'l C~ ~ f2.<=.r;;rJV 4-1..-<!' Name: Address: City: Phone: State: 6lL-- Fax: ZIP: '1 fl;7 E-mail: This installation is being made on residential or farm property owned by me or a member afmy immediate family, and is exempt from licensing requirements under ORS 701.010. Sign here: ~ \~!n.'~;;~;,~~~~??~~!;T:~)~~$1:)~';G:0NmMG;t"9R}IJ~f,QRM~mi'qN'~~1~~t{;~~U~:~:f;1'i Name CCB License Number Phone Number Electrical Plumbing Mechanical SPRINGFII!LD ...._i:Q;r, . ~ =~~."""", .....,-~'.,'.-- ... ~"~' 11)i(J''''~' Permit no.:>t 1-/75 d ,., ,'V '.'^:'/"'FEESCHEpUL..E"h': ~..::":'..'" ;;i:,:.y~i~itrbR\~~o!r.~'a~~q'~;ir~1~h\;~;:~J~i~\':.~)~: .<;'f.:l~),_\,~':,i.;:/'J, i) :. .y\,~~,~,~~~ ,<:~' (a) Job description: Occupancy 12-- 01':>, e" Construction type: Square feet: Cost per square foot: Other information: Type or Heat: Energy Path: o new [6"alteration (b) Foundation-only permit?- D addition DYes Total valuation: ;,~2~;~; ~,~.!Id~# '~{.f ~'~s.i};~;~1(~~:;' kJ\~:;i(~~~;~':.1~/;f[6_:,;~J+;~j. <'-:,';'::'" (a) Permit fee (use valuation table): (b) Investigative fee (equal to [2a]): (c) Reinspection ($ per hour): (number of hours x fee per hour) (d) Enter ]2% surcharge (.12 x [2a+2b+2c]): (e) Subtotal of fees above (2a through 2d): (a) Plan review (65% x permit fee [2a]): (b) Fire and life safety (40% x permit fee [2a]): (c) Subtotal offees above (3a and 3b): ~'~'~W:M~~f,~J!.~:~~-q~~j!~~~~~-:)~':[i'~~:;~]j;h!f/;i:~~)\~Ji,'<r:T;~;-:::~;:' ;~,.!. (a) Seismic fee, 1% (.01 x permit fee [2aD: TOTAL fees and surcharges (2e+3c+4a): $ $ $ i;.c;1' '--'/:-.'., $ $ t.t 5.6 '7 Mechanical Permit Application '~'\i"L:':',:,b 'ox",. ';.~,.i",;< r~''''''_:'~;o'f'''':~<Al1';:f;,;,-, ."\":, """=#'"/!:'~7"'\ ,:';;t;: :',;,'i:OEI?ARJ;MEN;r:USE ONLY;~'.,~~ ;',. \ '. :,}";.' ":'/.' ~~.'.,\. .,~;"",t.;:''''..;c.-';'~.''' .::;-" . This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. "i();i';F;:";;'jl\cCAff,~G(jRY.'7.QI},lGbNS1iROq:tION:'!0;i:F}':,,. " '< SlResidential 0 Government 0 Commercial ~ltiJ(?'z':i,6B,:!SiTE1rINr;QRMATIQ~MN[jJtilQPAIIQN;~f~."t}iJ, 1.2 3 6.;I1~11 V City: State; ZIP; Taxlot.; -OESCRIP.tioN:OF w.oRK,;': " 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 ~~&t~~1flt01:\'iT~'ffR~1tEB.I:~~LQwN,~B~t~liJl:f~~~'~ Name: <;: Address: ZIP; City: Phone: E-mail; This installation is being made on property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. City: Phone: ZIP: '11"/0 ,: E-mail: Print name: Signature: 440-2545-) (II/OS/COM) Permit no. SI/ - I 9"3 cf Date: <i(, ...... . ", --,?'.' ,', ';'FEESCHEbuLE "-" . - \ ~~~~)~(f~:hl!~!~~~ri~s*~'5.~j;{~J~~~~:t~~ti1~, 9n:.:, ~~4~~~~~~,;{f! ",,;,l'otal.. f&41CC)st ::ft;: First Annliance I $79.00 $'1 c:; Furnace/burner including ducts and vents( Up to lOOk BTU/hr. $17.00 $ Over lOOk BTU/hr. $20.00 $ Heaters/stoves/vents Unit heater $17,00 $ Wood/pellet/gas stove/flue $38.00 $ Repair/alter/add to heating appliance/ refrigeration unit or cooling system! $58.00 $ absorption system Evaporated cooler $13.00 $ Vent fan with one duct/appliance vent ~ $9.00 $/Ir Hood with exhaust and duct $13.00 $ F]oor furnace including vent $58.00 $ Gas piping One to four outlets $7.00 $ Additional outlets (each) $4.00 $ Air-handling units, including ducts Up to 10,000 CFM I I $11.00 I $ Over 10,000 CFM $20.00 $ Comoressor/absorotion svstem/heat oumo Up to 3 hpll OOk BTU $17.00 $ Up to 15 hp/500k BTU $29.00 $ Up to 30 hp/l,OOO BTU $43.00 $ Up to 50 hpll,750 BTU $57.00 $ Over 50 hp/l, 750 BTU $95.00 $ Incinerators Domestic incinerator I I $20.00 I $ .',"';' Enter total valuation of mechanical system and installation costs $ Enter fee based on valuation of mechanical system, etc. $ ~r~J~E~:I'i~U~~~y~t~~~~~i~~tl~~{l~!~€"~ r.~~~~~Wi~1 ~:<Jotah~ :~';~, co-st ~:li;~' Reinspection $58.00 $ Specially requested inspections (per hr.) $58.00 $ Regulated equipment (unclassed) $13.00 $ Each additional inspection: (I) $58.00 $ - (A) Enter subtotal of above fees (or enter set $q7 minimum fee of $ 79.00) (B) Investigative (ee (equal to fA]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ II~ (D) Seismic fee, 1%(.01 x [A]) S (E) Technology Fee (5% of [A]) S Lt!:;... TOT AL fees and surcharges (A through E): SJ('?'t o ':l , '.f' \y) C :.J ,. jj J Ol ,j III III J: ID - a: III '"' a: <: 0 '"Z-OClO }., 03 t- Ul . 'f '. .J <( 'j \I. J:Ul LC >-01 ,"'Wo ~.)~@ ~:t_~ O~a. ..la::ll. --0< ~~~. za~~ ~~t~ ~8;~ J: '"i z5011J Ool-tj: . IIlWb/(j;;! a:!:i~w~ 1Il!.!:!J: :to I- IDZIDo: 1--~WCl ~~!:i$~ ~Qa:I-..l 8~~~~ Il!<(OI;l ~!JO:Il:::t F<(OIl.I- ~~, s-q[0-/ ~ ~ <,~~ ~~~ (S) ~~/ (--- r ''J -:0. . Q - 1(' j' i>.- I. '-;t:.. ! I- <!: t:O tf) ~ r- \ 17.1 ", '~ L -' - ~. _-:r (-- ,s-~, ('A\ ,~I~- ~ 0, r '..., ., v <:> --> '-) q) " <S P-:r <l.l ~ J ~,~"i q) \-0 0 cl i 4. -0 r-:) ~ '> N ('oj ~ 1 0 I).l "'"(j ~ --- tt \I) 0 '* f-- , cr> ,- (-- .' m ~ II '- '" ~ ";:p a.. " ~ cf) /" ~ , ~ ~ ~ i , 0' '07' -~ '.z k ,i> 0- j '" 1 35 91~' ! '" L. ~ .. s ;. --i' ~__ _.._..._ i"SG1'. lI) \0 '" ~1 -'$, :;J " <~~ \~~ ~ (', [' 1-'; -6 !u .. '" J "" i -' '" ,0 (7,' (/ i----'-' ( ,OJ \ T' - ,J '.0 :r 8 J. '" Z '7 .:J a '" (- .., 5 ;~ J --,. GJ . (-- J , /1" "'.! :; ~ _.. - >. ' -'. -' '-' 'i -~ ':) - .~ d T 1.(1 \J r,>\ '. ~ "F 'E ::../. .lJ -..: r- \ll ~\ C''-z- I ~. c C' Zf I -- <-- , ,7:1-'> OT? ,1 ,::" ;;,J.';j\ -( (-- 7- "'- oS> 0-:;" :; ~ 8 --.:, l.J~ -"I;/., ~ J: ~ !~ ~~ \S1 i- 'If'\ c:r ,.f) "" 1/ v -:r r- (fl ~ 1~\J' GI <;: ,- J;- )(. [..LI -. .. -,>'-' ~ ..___"i<:. , ,',I ~ --,...~,:-'-- ~~ '\ . . , H,\ '-'" , ....~ ! I j ~l -i" - _:~-- ----.. ...--- '''.'. t Vl Q - <0 . TUl}/1 ,~< _ J.~- _ i ---...:~:.:.- i i ! , ... ~ _,1 - \]- '--'-f... ~ .' t i , ~ f, ; fi ~ { _n no- j, I [U - - ~. -.- -~~- _.- , -, ____~J ." i , I I ______ l' --'--'- -- -:- t 4' /' V/ . . , "- rl 11 - -- ~-\ -"'",,> '5 (l) z , ..... --~ ::s.: "" a - ..' t f ~ " , , L_." .___..... ;# Q:J ,:: CZJ r:::J . \-'----. U'nO"w ~. . 'I .'" ....... }--) (i "'- ...... c{ ~ I i i I I I ! <eO "CJ '1 -.~I ,~'-'l' f=, ; L_ J~+~~~ A_~ ~ , 6 ~ 1 J , J '_.,.__ - -. --.-....i.. , .. _ ,. " __, - .". ".____ SP~~~~E~ III;, -,f et; ". - '\. OREGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2011-01938 123 GREENVALE DR CITY OF SPRINGFIELD 225 Fifth 81 Springfield,OR 97477 541-726-3753 permltcenler@ci.springfield.or.U5 RECEIPT NO: 2011002241 lDES.CRIP-lION First Appliance Fee SDC: Improvement Cost - Local Wastewater SDC: Reimbursement Cost - Local Wastewater SDC: Total Sewer Administration Fee Shower/Shower pan _ _~i~~~.duct~xha~~tJbat~rooms, tc:!let co~partments, utility roor Sink/ba~~n~lavatory _ _______________ _s:.o:t= of Oregon Surcharg_eJ12% of appl~cable fee.sl Structural Building Permit Fee Technology fee (5% of permit total) Water closet RECORD NO: 811-SPR2011-01938 ACCQUN'LCODE 224-00000-425604 443-00000-448025 442-00000-448024 719-00000-426604 224-00000-425603 224-00000-425604 224-00000-425603 821-00000-215004 _._--_.._~-- 224-00000-425602 ---~..- 100-00000-425605 224-00000-425603 TOTAL DUE: DATE: 08/15/2011 AMOUNT. DUE 79.00 66.09 135.41 10.08 57.00 18.00 57.00 79.21 392.05 .~._'._._-,---.."...- 33.00 57.00 983.84 AMOUNTPAID' 983.84 UAYM.ENLT:YPE "-', Credit Card 154533 " 'pAYQR .'-"CASHIER,i.KAUFMAN ;. STEVEN ROBERT CORNELlU~ FCOMMENTS '. ~.;. , I. .,~ . '-j TOTAL PAID, 983.84