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Home My WebLink AboutMiscellaneous Application 2009-12-15 12/15/2009 08:59 5416539590 BANYAN CONSTRUCTION _.lNv"'lna~ i." l.J~.' ,,~~6t~ ~~-~ APPLlCA TION TO DEFER l'EES AND CHARGES AND CONSENT TO ASSESS LIEN PAGE 02/05 The o......-nerll of the prope!'ty shown below hel~eby apply to the City ofSprini.rfile.ld to pay the fees and charges of$. 1693'1.24, deferred wlti,l fInal building occupancy is 'requested, Such fees and charges include System Development Charges a~se$s'ed on the property for the City and Wil1amalane hrk & Recreatian District. In ille event that the real prop<rty an wbich the fees bave been defemd pursuant to Ordi:umct:$ 6233 and 6234 is sold Ot cODveycd} ~e-fees or charges deferred shall become im.m.ediately du.e and payable to the City of Springfidd. Sale or conveyance includes either actually selliug, conveyhig Or assigning any or aU of the property or any or aU of the o~ner'a interest in the property. The o\.'vnot$ hereby apply for and consent to the voluntary imposition of a Jienf"r $ fflJ'I.2..(" upon the following d.,crib,d.J'nd in th, City of Springfi,ld, Lane County, Oregoo: MAP AND TA.X LOT II~o2. -31- " SITE ADDRESS 38'1 ( E ~c.dt CfTY,STATE,ZlP .sfr''',5~,dJ, at!... S,m We are all of the legal owners of the dcscribed hmd or all of the contract purchasers otrecord of the described land to which these "fees and charges'are applicable, We ~~ive: any and all ~'regularj.lies 0: defects,juri.sdictional, or othe:I""'iVise;in ao.y prQceedings to irnp03~, calculate ~d collect these fees and charges, und in the irnpo:sition',,-ud collection of tbe lien com~nted to in this application. We promise to pay these fees and cha'('ges wh~ final bui,lding occupancy is requested or at such time the real property is sold Or conveyed_ The charg::$ may b,: paid in full at any time w!thou! penalty. We understand that ifilic::rIV is a subsequent' fa.ilure to pay the! [c~s and .::;harges the: City s.hall have: the: ~ig.ht to enforce -pa)'~nc:nt of the amount due in any manner provided by . 'the gel1erallaw of the State of Oregon, or by the Springfield Municipa.l Code, including bUt not 1inlite-d to foreclosure of the 1atld. We acknowledge iliat the City has on interest in tbc propcl~Y to collect these fees and chnrges. including Sy'temDevelopmem .Charges, al1d .lhat the CiCy has ihe aulhorit" 0 hen th property to collect those fees and charges, In the event' of any proceeding to enforce collection or to foreclose, the entir npll; b 1anc~ and any fees shall be considered delinql1enl" ,md due. We :als.o agree to pay the cily's, cost of collection or foreclos a 'attorney,fees necessary for sllch collection or foreclosure. 1Yl\,!'D~qJ /1<''-'10 cnp,fllv Print Name of Owner . OFFICIAl SEAL JUUA TOLLSTRUP \,../ NOTARYPUBUC-OREGON . , COMMISSION NO. 429415 MY COMMISSION EXPIRES JUNE 1, 2012 IV-rhd,yof c:er~Q.Y . '2-rY'"f1 SEE ATTACHED LEGAL PROPERTY DESCRlPTlON KLr>1 C'..u>,~ - DAvi. lV~-L.)o,.l 97/2... SI<-J ~AT>>'" k '77.J~"" "t12. ZiP 970&,2- BILLING NAMB BILLING ADDRESS CITY STATE FEES AND CHARGES DEFERRED $ ~9:S '1. 21,; TOTAt.I.1EN .$ }?9J'f 2(" Print Natne of Owner Signature of Owner Print NlUTIe ofCNmer SignRhlf" ofOwn.cr Print Name ofOwne.r STATE OF OREGON <S. CQU(lty Qf Lane li/(w/~ Dale Date DAt~ ate SOsXc;x.t Phone # 02- (,0.1- Phoneil Ph~fle # PhOrte';'-- v;\clJmmonl.a.cc:\tinBUSSt5Slrtc\l)efl;l'TccJ fl:cs t"onlTi~I.dO(.. 5tA~~E~ CITY OF SPRINGFIELD Building/Combination Permit Status Deferred Payment Agreement 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2009-01779 ISSUED: APPLIED: EXPIRES: VALUE: 12/14/2009 06/15/2010 $ 179,000.00 SITE ADDRESS: 3847 E ST ASSESSOR'S PARCEL NO.: FOUMAL SUB E STRE Springlield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: ' Single family residence - DPA- SAME AS COM2009-01778 3841 ESt Owner: KLM CAPITAL INC Address: 9712 SW ALABAMA ST TUALATIN OR 97062 I CONTRACTOR INFORMATION ~ Contractor Type General Electrical Mechanical Plumbing Contractor License BANYAN CONSTRUCTION LLC 165147 HARDING ELECTRIC INC 132089 LOWES WEATHERIZATION 176741 'I' & S PLUMBI w: 186903 _~~ote)()e~\ INFORMATION '\'VY.....M\\~ 110 ~ 'le\UeO Ul tlol- 11\ # of Units: ~~ e~ .,e\O~ ,"0.0 f.1l 1/;,vi'O'liles: 2 Primary Occu~~ilse\dO'JI()It\~IIO~ Structure 29.50 Secondary Ocqw~tl! ~tltlOI 'le\U~ 1>8\~~~ eat: orced Air Electric Primary Const~ . se\tIl8Sf,: e\OOP :~O~ ype: Electric Secondary COll,.l/Jlt 0 ell\,..e\ UO08lO Range Type: Electric # of Bedrooms: M\\~_, eel\tI~ 3 Energy Path: 0\ tl"" Sprinkled Building: n/a Expiration Date 06/15/2011 02/0112010 06/19/20 II 06/01/2011 Phone 541-434- I 333 541-688-5006 541-485-2282 541-915-1000 Lot Size: Sq Ft I st Floor: 668 Sq Ft 2nd Floor: 633 Sq Ft Basement: Sq Ft Garage/Carport 237 Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION ~ Frolltyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18.00 5.00 29.00 12.25 30.70 Overlay Dist: # Street Trees Rqd: .' . "..:;:,:..:' 0".:, ~:.:~dL~;~:v~~:~e:~;~~;'~~~~1 ~l, "'OI\C~. S\\1\\.\. rJ..? ?'f.?W\\I \S, ..<: G REQUIRED PARKING Total: 2 Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: ,,(\'~N\'f. peolGO. Sidewalk Type: Fully ImptoYl!iI Q 01\'/ <-" Curbside 7' 1\\I'iis '\ 8 Downspouts/Drains: To Storm Sewer Roof runoff from Lots 2 will be directed to the existing city stormwater system through all 8" stormwater pipe in the joint utility trench. Notes: Paee I of 3 -, CITY OF SPRINGFIELD Building/Combination Permit Status Deferred Payment Agreement 225 Fifth Street, Springfield, OR 541- 726-3753 I'hone 541-726-3676 Fax 541-726-3769 I nspection Line PERMIT NO: COM2009-0]779 ISSUED: APPLIED: EXP]RES: VALUE: ] 2/] 4/2009 06/]5/20]0 $ ] 79,000.00 I Valuation Description ~ Estimate Tvpe of Constrnction Estimate $ Per Sq Ft or mnltiplier $1.00 Sqnare Footage or Bid Amount 179,000.00 Value Date Calculated Descrintion Total Value of Project $179,000.00 $179,000.00 12114/2009 ~ Fee Description SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement Amount Paid Date Paid Receipt Number $10.00 $1,044.54 $101.97 12/16/09 12/16/09 12/16/09 1200900000000001339 1200900000000001339 1200900000000001339 Total Amount Paid $1,156.51 Plan Reviews ~ Plan nine Review Public Works Review 12/14/2009 12/14/2009 12/14/2009 12/1412009 APP APP DDK LKW Roof runoff from Lot 2will be directed to the existing city stormwater system through an 8" stormwater pipe in the joint utility trench. Structural Review 12114/2009 12/15/2009 APP CJC As noted on plans 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. ~e(]lIirerUnsnections ~ Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected bnt prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to deckiog. Shear Wall Nailing: Before covering sheathing with finish materials. Pa2e 2 of 3 CITY OF SPRINGFIELD Building/Combination Permit Status Deferred Payment Agreement 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2009-01779 ISSUED: APPLIED: EXPIRES: VALUE: 12/14/2009 06/15/2010 $ 179,000.00 Framing Inspection: Prior to cover and after all rnugh in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the huilding is complete. Perimeter Foundation Drains: After gravel and liIter cloth is installed but prior to backfill. Underlloor Plumbing: Prior to insulation or decking. Underlloor Drain: Prior to cover or placement of cnncrete. Rough Plumbing: Prior to cover and including reqnired testing. Water Line: Prior to filling trench and fncluding required testing. Sanitary Sewer Line: Prior to 1iIling trench and inclnding required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underlloor Mechanical. Prior to insnlation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is cnmplete. Temporary Electric: Approval required prior to Utility Company energizing pole. Roogh Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefnlly examined tbe completed application and do hereby certify that all information hereon is tfue and correct, and [ 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 fnrther 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 tim during construction. / p{- /6 - (7 '7 Date Page 3 of 3 I ~e-""S" ~E>CU e-sr C1~ Ol"17~ Structural Permit Application - 225 Fifth Street. Springfield, OR 97477. PH(541)726-J75J. FAX(541)726-J689 I. D~PARTMENTUSE ONLY. (!OIAA. Z,.oO ?~o I T7 11 Permit no.: . Date: II:-I'{-O 't This permit is issued under OAR 918-460-0030, Permits expire if work is not started within.t80 days of issuance or if work is suspended for 180 days, :,'. 0 ,'.,; ~~,;;, ~~~,i{~bcC'A~~.:'9:QY~'R~-M.~~.t;~,'~~~R~V ~,~t~:m~:~;1;r~J1?{(i~li;~ This project has final [and~use approval. Signature: Date: This project has DEQ approvaL Signature: Date: Zoning approval verified: 0 Yes 0 No Property is within flood plain: 0 Yes 0 No ':'!i[ii4'1J;<~i~t~r~'iiiCAtEGbRYf;0"~\C6'N!l:fRjjc;rjoN'',;f~:I'~':'''''~~~j:Nj ~;.ij":I~>i'~";l:,<n_..."_.1'.,..,,._....,,: ._.,,_....~ ..,_,.>t:~_CP.<,.,.. ..__ _~'"...' ..' ,~.. _._"..,,,,:i'ii1i,~iL..~~.,,,bI.'n , . Residential 0 Government 0 Commercial l;t;j~!-r~.}~~~:9B~'~.It.:~J :fN~pI;iMA Tr&?N.~A~-Q~"~9PAf-'!.9N;;;j;,1~~~;~11~:~ Job site address: .38 '1 s.~---..k City: .s;.~ r, Subdivision: Ro'beIMo^ t Reference:\1-0L-..3I- 13 :'; P.ROPERTY 9W~ER ".' ,- ':' .~.~ Name: KLm c.A(.".-AL - O~;;: tJ€L~O,v Address: 97/2. ~ I-/H3/tf>1A &T' City:Tv.....\"-"~'" State: 0 t!.. ZIP:'l70bL PhoneSo3 8Q'i- f)7-~2- Fax503-ZI -sins E-mail: B"d 0""' 757 e 00. "'" This installation is being made on residential or farm property owned by me or a member of my immediate family, a is exempt from licensing requirements n r 0 701.01 Sign here: Address: 3'11 City: \Z:u Phoneb"fI-'f:J'I- /333 E-mail: .;.... _3 if 1S..It CCB license no.: 11.$1 'l, Print name: Atl1'\~ OA. V<..- State: 012.. ZIP: C, 1'10'5" Fax5H1 - ~~$-9r'1 0 ~1) _ (Jo~_ G..."-,,,~ Signature: ~'(J:~:~);1;i)i!ff~!~$l!B-C0NjT;Mc:t;QR}INfQ~MA,.'QN~~~j~~~~J Name CCB License Number Phone Number Electrical , 3- 20 89 bfffl - 5'OQ.(;" Plumbing I lI\" '1 a 3 '1 I :)'- J 0 0 0 Mechanical I 7(P 7"1/ "'/ISS- z.z.o 2.. , '. ~."', <,:": .:,~.:.l:":'\~'?j~~!;'~j.F.EE';'S~H-~pTJr::~r':\'i~.~ .. . ;.; 'j ~~':~:Y~1~~:t)6:~r;Int6rh1~i~9JII~~~g1f:~'lf~tn1i':~?~-~~(~jil~}~U:i ~.!t\if,~':~~:.l!~. (a) Job description: Occupancy Ide;v SIW, ~> Construction type: Square feet: Cost per square foot: Other information: Type of Heat: Energy Path: new D alteration (b) Foundation-only permit? Total valuation: o addition DYes ,EtNo i~7~!~B<~,O#}itg:"f~~~~~~~~~?':ittu~i?l~<:*i~~~~i]i,;~'f\1:' .' (a) Permit fee (use valuation table): (b) Investigative fee (equal to [2a]): (c) Reinspection ($ per hour): (number of hours x fee per hour) (d) Enter 12% surcharge (.12 x [2a+2b+2c]): (e) Subtotal of fees above (2a through 2d): ~'~~~J~.lTIryy.i~wf~~~~;~~~~:t~~i~1!i\~*~~'\'WI"f $ $ $ $ (a) Plan review (65% x permit fce [2a]): (b) Fire and life safety (40% x permit fee [2a]): (c) Subtotal of fees above (3a and 3b): $ ~t4}~"MI~.~:~Ii:~'~~~~ifS}f~~sJ~~~i~~f:~Cj;}~~J~r~tZ~,~;f-~'l:~'~.~';{"):;}{'~~: T':~~.~:,:..:'l-,.:~'~" (a) Seismic fee. 1% (.01 x permit fee:[2a)): $ TOTAL fees and surcharges (2e+3c+4a): $ Plumbing Permit Application ':.''0''':~,.\i't'.x''''.~?0,,,.;.;>,.,..,';j'''_:''''li~.,, ~"".,:,,;; ....:. ,'.....{,~"'" ;;-;"""';~:>tt~~' :~:;, :DEPARTMEN:t'l:iSEfONLYN'_j\~i: '.~ '.)".' '" ". . .;. ."... ". ':,".. Pennit no. Date: 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~!(,:~jli';'{.;'?}[f0CALtI\GO'f.JERNMEN1W'Ag"R0'f.JAh~1~:jW'Ji~1;ij(1 Zoning approval verified? 0 Yes 0 No Sanitation approval verified" 0 Yes 0 No CATEGOR'COF. CONSTRUCTlON-' jig Residential D Government D Commercial ~{!;'::ff:ii;j()B;SIiJ1E ',INF.oRMMjoN~l'.a:Ntl~lfO(i;A"loN'!~jiil~;<'il Job site address: 3'€ 'i ~e....k City: cSfll 10\1 (, i=',,;:":'o ZIP: '17'178 Reference: ;t~!;~~:t~\~~~;~;;}~?i0111~~~;bE_SCRI-~TiON;r0I7}L'W,()RK?~t~it~;Q~::!f~i%j;j[~~ 225 Fifth Street + Sp,ingfield, OR 97477 + PH(541)726-3753 + FAX(541)726-J689 ~~I Ne<-.! H <> """"'-- . \, ;P:RQR-ERTy~110WN-E,~~J,~;5~~;1(~r:ri;;,~r~~~~~~'~~W: . Name: )(Lm CI>rf> ,. Address: 17/ 2. .s;..J City:Tvc;,.\~\.._ Phone: 6'03 g GLJ . 02-" 2- E-mail: &n.J~o,.. 757 ti.),,,,o. <A>..... 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. Business name: T 1f Address: 'PO J!", City: ~; Phone: /-96/000 E-mail:Ts I"""!,, ".,.J~o,., e 1"\'" I _ c..t>...... CCB license no.: I g (", 'i 0,3 BCD license no.: Plumbing license no.: Print name: Signature: o 440-2500-J (I I/OS/COM) New residential I bathroom! 1 kitchen (includes: first J 00 feet of water/sewer lines, hose bibs, ice maker, under floor low-point dralns and rain-drain packages) 2 bathroomsll kitchen $374.00 3 bathroomsll kitchen $439.00 Each additional bathroom (over 3) $95.00 Each additional kitchen (over I)' $95.00 Residential fire 5 rinklers (includes plan review) o to 2,000 square feet $58.00 2,001 to 3.600 square feet $116.00 3,601 to 7,200 square feet $174.00 7,201 square feel and greater $232.00 Manufactured dwelling or pre-fab (circle one) Connections to building sewer and water supply Commercial, industrial, and dwellings other than one- or two-family Minimum fee $238.00 $ $ $ $ $ $ $ $ $ $ Each fixture Miscellaneous fees 100' storm, sewer, water line Each fixt.ure, appurtenance, and piping Storm water retention/detention facility Irrigation systems Piping or private storm drainage s stems exceedin the first 100 feet Specialty fixtures Reinspection (no. of hrs. x fee per hr'.) Special requested inspections (no. of hrs. x fee per hr.) Each additional inspection: (l) $ $ $76.00 $ $19.00 $ $19.00 $ $19.00 $ $19.00 $ $19.00 $ $58.00 $ $58.00 $ $58.00 $ Mjnimum fee $ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (B) Investigative fee (equal 10 [A]) (C) Enter 12% surcharge (.12 x [A+B]) (D) Technology Fee (5% of [A]) TOTAL fees and surcharges (A through D): $ $ $ $ $ Mechanical Permit Application . fS\)~~:iE~:':':~~~'~~~''i'~~~f~':~;/'Z'~h:1"'{;"W "~:1.~_:~,<~\,.~ "'''''0I?Ep.p.]n~~",NT':!!l'iE;ONl:Y,:%~, , ,,_ * x 0'.', '","~;""" ~:., _..!>__...'.,' .,.'i'_ ,_ .",.S.,.... . ',;~/f..;..;";.::';i1;-.,'.'l' 1 ~,;c:,q; Permit no.: Date: 225 Fifth Street. Sp,ingfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 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. ~:!t'0~f~~I"i~1l'\c!\ifEQ'6R~YQ~tbqNSTROq;tlqr;j:t%:i:':,F''f-'/ '; Residential D Government D Commercial r~jT;'~'j9E3'iSJ:m~'''INF,.Q.R~~!TQ~t:~Np~:[QG~],lq.NVffI'f~;i~Ii Job site address: 3:5 y ,Ii- C:, ~e.e:k City:S -r,~...lJ State: orL. Reference: I -02..-5) -13 Taxlo!.: !;DESCRIp,iioN:9F WORK: , .s, Ho V"LL ,w- Lh\Jc..W c Address: 971 z.. S w fh.~, p, ~,.., City:T.>o-\.... .~ State:o.ll. ZIP:'j ,01., 2.. Phone:,-tJ-30'f -02--(, Z-- Fax:5b3- 213 -51!?S E-mail: nd<>0^ 757 e t<),""'_ <:..0....... 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 701.0 I O. Signature: ~~1!;~Jl~~~;~qNmr{A(;;i:0}~~[I'~$j"ljAi!Ii'~jtiQf\t~ri~1t.,9~l:~.'i1i Business name: lovue!:> tJ~ 40~ 2.\337 Address: Y''D '" City: ~' Phone: ':J-J) -I.{S5' - 2:l.$z. ZIP: '1)401.. E-mail: CCBlicense no,: \7 '" 7 '1 \ Print name: Signature: 440-2545-J (1 IIOSICOM) ,,-,. -'''" 'c",'.' '''':-.' FEE 'SCHEDULE' '., ,-,.. .' , " 3,~~!,&!~,~:!~:t~:~~t~~~~~~{~~t~J! :Qij, 4,;~CO:Sttiil: ~f~~~~t~~i: ,,, .~~<~ 'rl~ea~;;iit,t::t. First ADoliance $79.00 $ 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 wlth one duct/appliance ven~ $9.00 $ Hood with exhaust and duct $13.00 $ Floor furnace including vent $58.00 $ Gas piping One to fOUT outlets $7.00 $ Additional outlets (each) $4.00 $ Air-handling units, including ducts Up to 10.000 CFM $11.00 $ Over 10,000 CFM I $20.00 $ Comoressor/absomtion svstem/heat oumo Up to 3 hp/1 OOk BTU $17.00 $ Upto 15 hp/500k BTU $29.00 $ Up to 30 hp/1,OOO BTU $43.00 $ Up to 50 hp/I.750 BTU $57.00 $ Over 50 hp/1, 750 BTU $95.00 $ Incinerators Domestic incinerator $20.00 I $ ,;t'O'nrm:er~i:aJ~~;:lT:~?:i;jE)f~~S~~/~;_~r~~1~~:f~~~~:1fHK~~~~;~~t!:?}~1"';5:J,~r.~{?~; Enter total valuation of mechanical system and installation costs $ Enter fee based on valuation of mechanical system, etc, $ ~Mij:e;rlj~&6ti~f~'~~!~k1Mi.~~~ It~ri1~ i~;~,~!,~;:,- :,l'.Total,,~t: i,f';"'". ;';t:,:,,,,~,,. _.:n,,"-~''''','i'c._'.:-0'':'''!'"';~'t;'f_ '&'"€.~<!'~!;:":I~,'-1}" .' r; <Yi.'l"'~': ,,'0'-_~ ea.W+"m :~;c'ostW;7;, Relnspection $58.00 $ Specially requested inspections (per hr.) $58.00 $ Regulated equipment (unclassed) $13.00 $ Each additional inspection: (I) $58,00 $ irji$~~~i\l'~~~'ifAPP[EfcANT~l:JSE7~~1\\:{!i!~~it'#';_~1 ""-,,,'.<<<:... ":..s"....,,o;_..~ '."'-0-'\.<;<'-' "_"'" '.",..", ,'_ '. .. "'. .. .. .f. .._~ "k~" 0",7/ ,M;S"-'~"-. :,,'_, _ ,w, (A) Enter subtotal of above fees (or enter set minimum fee of $ 79.00) $ (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (,12 x (A+B]) '$ (D) Seismic fee, 1%(,01 x [A]) $ (E) Technology Fee (5% of[A]) $ TOTAL fees and surcharges (A through E): $ 225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+ FAX(541)726-3689 DEPARTMENT USE ONLY ",,"" """" -c CO'^"zoo9.0 1/,'1 Penn it no.: Date: I z.-f(:r 0 '? This permit is issued uuder OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. "l!0CAV~OVERNME/IITA~PR0VAr:,,}.' , Zoning approval verified? D Ves D No ."CAtEGORYOF.CQN~tRU(;tI0Ni-" ' ':!i:":';< ;.;:~ " Name: Phone: E-mail: This installation is being made on residential or fann property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: CONTRAC1:0R INSTAllATION I (I E urn"L- :::r:Nc-, Address: ;) 1::7-3 State: 0, ZIP: 97.1f62. -5'1/" <,,53 -? /30 E-mail: CCB license no.: 13:< u ? 9 Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: . 440-2584-J (9/08/COM) ~\~.'1 \\) >\.. ^ \ p~ 9't}Y- ~ G ;~;~ (":','n'M'~~;~~f\;'\:,i"o/*~~f~-:~E1;FI:E~j;sGHEJjJIJUE;~;~U\?~tJ!f1~~?~;f1tf~~{~r ,N~~~er9P?spectio~; p~rA~();,Qty.,~~~t,,;I.~~~~1 . '- -.- -. -,', ,-----. .'" .. Residential, per unit, service included: 1,000 sq. ft. or less (4) r $134.00 $ 1'3f/ Each additional 500 sq. ft. or portion '- $ 25.00 $ 50 thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 20] to 400 amps (2) $ 95.00 $ 40] to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) , $ 63.00 $ b:S 20 I to 400 amps (2) $ 87.00 $ 40] to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 55.00 $ Each additional branch circuit $ 6.00 $ Miscellaneous fees: service or feeder I!ot included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (1) $58.00 $ :.~~~~,;::?;~q;"i*~~~~i;~~ci~k~~~,iiAR~JliGANI:~;Os.El:::i\;:U;HJi:t~~':f:',;;~~';;f:!!::'t;g{:.:" . (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ 247 (B) Enter 12% surcharge (.12 x [A]) $ Z9~ (C) Techno]ogy Fee (5% of [A]) $ IZ~ TOTAL fees and surcharges (A through C): $ 2- 88 . "l"l '" . 2!tWillamalane . . t'W .. Park & Recreat;onD;str;ct . Job. No.tJ1~ /7 '1'1/ SYSTEM DEVELOPMENT CHARGE IiVORK~HEET FOR 2009 . '.NAME: )cl.-M..~I rl:tt- . PHONE: ~3 .l'f~~ &' f "'~:z.~~ ADDRESS:9?/:l.. SW~~If-~r. .'It:~1VA-fE:~IP:'7I>kt72- LOCATION. OF PROPOSED BUILDING SITE: Stre~t Address3EI-E. ,~r .. Plat Name: Tax Lot.Number:/70:2- ;r/~ 7~ 1.~ DEVELOPMENT TYPE(Che~k appropriaiEi dw~lIing(s), Dwelling type definitions are on th~ . back.) . . . . . A. Sinq/e-Familv Detached' NO. OF UNITS fx $2,858 per unit = '$ . -:i;:-s-i) Be Sinqle:-Familv 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. Accessorv Dwellinq Unit NO. OF UNITS X $1,550 per unit = $ WILLAMALANE SDC $ . . 2. SDC CREDIT (If applicable) SDC payer must fumishproof of WiUamaJane. Gredit approval.) . $ . ..u_ ".'-'-3;: 'TorAl-WlllAMALAN E'N ET-SDCASSESSED -.. --........ .- (if SDC reduced for Credit) iJh~ Development Services Department City of Springfield . . -'$' "?-Ff-.%-' .j-~: ,...,~-,------~ - ;r; I' - '. __ :::.. Dat~\\) .\Tl.. \0 ~I~ 5 SP.i:t. ~E~~ ..~(~ :~ : '.:' OREGON CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 TRANSACTION RECEIPT COM2009-0 1779 3847 EST permilcenter@ci,springfield.or.us www.ci. springfield.oLus DATE; 10/12/2010 RECEIPT NO; 2010000548 lOESCR)fTIONJ;';;\ . Building Permit SDC Tran Reimburs-Residential Residence Wiring 1000 Sq Ft Res~~ Wirin~ Ea ~.E_dtl 500 3 Baths One.& Two F.."mi!y Vent Fan Exhaust Hoods -.-.-.- --_.. Dryer Vent ~~dr~ssing Assignm~nt Plan Review Same As -_. RECORD NO; COM2009-01779 .~,:~:t~~ ",." - ;'.(~~tE~~?cs::0:;,f.{:>,~ ~,~,,,AQ~p~u0~tr[GJ~b~>~ i~00:~,,*~i;+AiViltil~J':QJJ+~~ 224-00000-425602 $1,030.28 446-00000-448026 $211.21 224-00000-426102 $134.00 224-00000-426102 $50.00 224-00000-425603 $402.00 224-00000-425604 $27.00 224-00000-425604 $13.00 ..- .. ..,_.,_..-..._- .. _._--- -----.- - ---- 224-00000-425604 $9.00 ~'____0'_0"'_""_ __.. _._,-...,..__ 224-00000-425602 $38.00 ._----,-" 224-00000-425602 $250.00 -~--- +_._--~.,~----, 821-00000-215023 $2,858.00 821-00000-215004 $216.87 ,--_.~_..__..- 719-00000-426604 $78.08 442-00000-448024 $782.81 440-00000-448028 $635.58 447-00000-448027 $931.65 ._----~ 443-00000-448025 $595.25 .------ 719-00000-426604 $137.57 100-00000-425002 $211.00 100-00000-425605 $1 00.91 100-00000-424005 $80.05 224-00000-425604 $79.00 224-00000-426102 $63.00 TOTAL DUE: $8,934.26 t:.:..E.AYi..t~NT TIel;_L,;'--y '.pA Y9R;'>:DCASHIE~9wtsBy~t:""'COMnilEtiT~";;,,~t7;;~ k~;::,-'#;;'.:;I'+C;::~AIIiIQQt!TPAIDj1C::;;"7f Willal!'~"I~ne ~~gle Family .~,.,12% State J?urcharge ,~DC Transpo'"!~tion Admin Sanitary-2~wer _=-~eimbursement Storm Draina!;:Je Impervious Are,~_,_ SDC Trans Improvement-Resident Sanitary Sewer ~ Improvement SDC Sanitary/Storm Admin Plan Review Mc.'!or - Pla~,~_ + 5% Technol~~x_~._~___ Fire SF Fee - Residential 1st Appliance Temp Power 200 amps or less Check 2879 klm capital inc $8,934.26 pay outstanding dpa amount due. $8,934.26 ,. -1 ,1 225 Fifth Street , . Springfield, Oregon 97477 541- 726-3759 Phone GO:Q~;~ u..... .,.... --.. City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 1200900000000001339 Date: 12/16/2009 2:28:35PM Job/Journal Number COM2009-0 1779 COM2009-0 1779 COM2009-0 1779 Description SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration Paid By KLMCAPITAL INC Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2564 In Person Payment Total: Amount Due 101.97 1,044.54 10.00 $1,156.51 Payments: Type of Payment Check Amount Paid $1,156.5 J $1,]56.5] cReceintl Page 1 of 1 12/16/2009