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Home My WebLink AboutPermit Building 2006-5-1 ./.CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00401 ISSUED: 05/0112006 APPLIED: 04/05/2006 EXPIRES: 11/0112006 VALUE: $ 129,668.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4595 Camellia St ASSESSOR'S PARCEL NO.: 1702324309800 TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence, Lot 5, Andrew Acres I PUBLIC IMPROVEMENTS I "'. ATTFs~1~~k 9f~Q:on law requires you to follow rules adopted by the Oregon Utility Notifid?l~.~tP8iq~MPr~~~s.:ie rules are set forth in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). Owner: MIKE BLANKENSHIP CORP Address: 8063 THURSTONS ROAD SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing License 78966 87145 102455 110163 Contractor MIKE BLANKENSHIP CORP G MILLER ENTERPRISES INC JUNG ENTERPRISES INC DOUGS PLUMBINC INC BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: 1 Height of Structure 17.50 Type of Heat: orced Air Electric Water Type: Electric Range Type: Electric Energy Path: Path 1 Sprinkled Building: nla 1 R-3 U VB 3 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18.00 12.50 12.00 11.00 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: 'OOltl3d A\fO 08 ~ AN\! tlOj 03NOON\f8\f SI tlO 03JN3lN\f\lOJ iON SIiII/'Jtl3d SIHi tl30Nn 03ZItJOHlnV >1tJOM 3Hl ::ll 3tJldX3 ll\fHS 11I/'JtJ3d SiHl ':!l "' fi ~ 111" . .L \Y1 B ",,--.. t, : 1 Notes: Pa2;e 1 of 4 Residential Phone Number: 541-746-0194 Expiration Date 01/0912008 11/10/2006 10/04/2006 11/24/2007 Phone 541-912-4582 541-741-2596 541-741-0002 541-688-3385 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: 5,412 1,200 418 REQUIRED PARKING 3 Yes 30.40 Total: Handicapped: Compact: 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00401 ISSUED: 05/01/2006 APPLIED: 04/05/2006 EXPIRES: 11/01/2006 VALUE: $ 129,668.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Dwellinl!s Gara2;e Tvpe of Construction V Wood Frame Gara2;e $ Per Sq Ft or multiplier $99.00 $26.00 Square Footage or Bid Amount 1,200.00 418.00 Value Date Calculated Description Total Value of Project $118,800.00 $10,868.00 $129,668.00 04/0512006 04/0512006 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $431.05 4/5/06 2200600000000000425 ~Mechanical Issuance Fee~ $10.00 5/1/06 1200600000000000572 + 10% Administrative Fee $117.02 5/1/06 1200600000000000572 + 8% State Surcharge $93.61 5/1/06 1200600000000000572 2 Baths One or Two Family $254.00 5/1/06 1200600000000000572 Addressing Assignment $31.00 5/1/06 1200600000000000572 Building Permit $663.15 5/1/06 1200600000000000572 Dryer Vent $6.00 5/1/06 1200600000000000572 Exhaust Hoods $9.00 5/1/06 1200600000000000572 Furnace - up to 100,000 btu $12.00 5/1/06 1200600000000000572 Minimum/Adjustment Mechanical $6.00 5/1/06 1200600000000000572 Plan Review Major - Planning $150.00 5/1/06 1200600000000000572 Residence Wiring 1000 Sq Ft $106.00 5/1/06 1200600000000000572 Residence Wiring Ea Addtl 500 $38.00 5/1/06 1200600000000000572 Sanitary Sewer - Improvement $457.68 5/1/06 1200600000000000572 Sanitary Sewer - Reimbursement $601.68 5/1/06 1200600000000000572 SDC MWMC Administration $10.00 5/1/06 1200600000000000572 SDC MWMC Improvement $865.31 5/1/06 1200600000000000572 SDC MWMC Reimbursement $82.03 5/1/06 1200600000000000572 SDC SanitarylStorm Admin $125.24 5/1/06 1200600000000000572 SDC Transpo Admin $65.93 5/1/06 1200600000000000572 SDC Transpo Improvement $805.70 5/1/06 1200600000000000572 SDC Transpo Reimbursement $182.69 5/1/06 1200600000000000572 Storm Drainage Impervious Area $818.32 5/1/06 1200600000000000572 Storm Sewer Each Addtll00' $14.00 5/1/06 1200600000000000572 Temp Power 200 amps or less $50.00 5/1/06 1200600000000000572 Vent Fan $12.00 5/1/06 1200600000000000572 WiIlamalane Single Family $1,000.00 5/1/06 1200600000000000572 Total Amount Paid $7,017.41 I Plan Reviews I Initial Review 04/06/2006 04/11/2006 APP LLH Pa2;e 2 of 4 CITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: COM2006-00401 ISSUED: 05/01/2006 APPLIED: 04/0512006 EXPIRES: 11/01/2006 VALUE: $ 129,668.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Plannin2; Review 04/11/2006 04/26/2006 APP TAJ Andrews Acres Plat recorded 3/29106. Plant street trees outside the vision clearance triangles: 2 on S 46th and 1 on Camellia, west of the driveway. PW cannot review until final plat is recorded 4/11/2006 CAS Plat recorded. LDAP ISSUED. See Documents for plan review comments by dim 4128/06 Public Works Review 04111/2006 WE Public Works Review Structural Review 04128/2006 04/11/2006 04/28/2006 04/25/2006 APP APP SB RWC To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. ~eouire<UnSDections I Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough 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 building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Pa2;e 3 of 4 .'V'"".---~ Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00401 ISSUED: 05/01/2006 APPLIED: 04/05/2006 EXPIRES: 11/01/2006 VALUE: $ 129,668.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough 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 carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all t;mesdu~i~ si/t- Owner or Contractors Signature Date Pa2e 4 of 4 CITY OF S~"ti~GFIELD SYSTEMS DEVELOPMEN..;~,,~;)RKSHEET JOURNAL OR JOB NUMBER: C0M2006-00401 NAME OR COMPANY: Mike Blankenship LOCATION: 4595 Camellia TAX LOT NUMBER: I7 02 32 43 Lot 5 DEVELoPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUll.DING SIZE (SF: 1647.5 LOT SIZE :SF): I, STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S,F, x I COST PER S.F. CHARGE 2533.50. I $0323 = I $818.32 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F, I x COST PER S.F. x I DISCOUNT RATE , 0.00 I $0.323 I 50% I ITEM 1 TOTAL - STORM DRAINAGE SDC I $818.32 I ;l, SANITARY SEWER - CITY A REIMBURSEMENT COST: I NUMBER OF DFU's' x I 24 B. IMPROVEMENT COST: I NUMBER OF DFU's x ,I I . 24 I COST PER DFU $25,07 $19.07 DISCOUNT $0.00 o $818.32 $~OI.68 $457.68 --. (/) ~- o o u ~ ~ r-< (/) ,..... CI ~ 1070 1 1091 1092 DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUN ALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TIIE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BA THTIJB ---. 2 0 3 = 6 IDRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE I OIL / SOLIDS I ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = 0 r /LAUNDRY TIJB 0 0 2 = 0 " ICLOTIIESW ASHER / MOP SINK 1 0 3 = 3 I ICLOTIIESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK I DISHWASHER / ETe. 1 0 3 = 3 SHOWER, SINGLE STALL 0 0 2 = 0 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTlAL KITCHEN 1 0 3 = 3 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LA V ATORY/RESIDENTlAL BAR 1 0 1 = 1 IURINAL, STALL / WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRlV ATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 *EDU (EQuivalent Dwelling Unit) is a discharge equivalent to a single family dwel1in7~t (20 DFD's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1 CREDIT RATE/$I,OOO _~~c~ESSED VALUE $5.29 $5,29 $5.19 $5.12 $4.98 $4,80 $4.63 $4 .40 $4.07 $3.67 $3,22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 2 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 = , $0,00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $5.29 o = $0.00 TOTAL MWMC CREDIT 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH,(541)726-3753 . FAX, (541)726-3689 ~~~,_ ~~ \ ~~~~~~~DfPLICATI~= 5/~/O~ ~~~ 1. LOCA110N OF INSTALLAI10N 3. CO.M,PLETE .FEE SCHEDlJLE BELOll\! ~~l\S t\)S{\e1LL~ f~qAL DESCRIPTION t'QO \102.3"2. Ar 3> D4 \oO(.{. New Residential- Single or Multi-Family per dwelling unit. -.ill\, :\. k\~{f'lc.") A(IJ'('5:::> S""icelodudcd \ \OI.o,oD ~0~~;;;:~~~~~~~? ti~o:~:~}~~~o:, :,0' ~ :',:: ~.Cf) not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder $50.00 B. Services or Feeders - Installation, Alterations or Relocation: CONTRACTOR INSTALLATION ONLY 2. Electrical Contractor C; t' v ('", v' d c 1-(: l..\ $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only Address :3 '15',/ Jf~t...t d.l/V R., i<.c! City)/) ,{- l d Phone '1"'; {"~2.5-(;{~ Supervisor License Number .' ] (~ ,5 -'i. S C. Temporary Services or Feeders G) f.I\ je -j -dill ~7 Installation, Alteration or Relocation \ 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits 5D ,00 Expiration Date $ 50.00 $ 69.00 $100.00 Constr. Contr. Number ,? ? /.../ ') Expiration Date J / -. / () ,{;; ~ C:~ .~ Signature of Supervising Electrician New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit ~....}1 ('I.~ -'/ "._~C_\ ~J . ownerSN]' ~\k ~\r\f\'tro&hl? Address O\o~ \n\~\~~ City ~M.c:-r...!~one "l~lo. O\Y.i- \ -\\'tAX OWNER INSTALLATION $ 43.00 $ 3.00 E. JVliscellaneous (Service/feeder not included) -Each Installation $ 50.00 $ 50.00 $ 25.00 $ 45.00 Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited EnergylCommercial The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges \C\'\:9D \~. 5'2... L\ .~o '2}Lf) .u/~ 4. SUBTOTAL OF ABOVE Owners Signature: 7% State Surcharge 10% Administrative Fee TOTAL Inspection Request: 726-3769 Shared Drive(T: )/Building Fonns/Electrical Pennit Application 1-03,doc JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLIN'G UNITS I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S.F. x, COST PER S.F. CHARGE 2533.50 $0.323 = I $818.32 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. x I COST PER S.F. I x 1 DISCOUNT RATE I 1 0.00 I $0.323 I 50% I I ITEM 1 TOTAL - STORM DRAINAGE SDC '$818.32 I . . CITY OF SINGFIELD SYSTEMS DEVELOPME~~RKSHEET C0M2006-0040 I Mike Blankenship 4595 Camellia 17 02 32 43 Lot 5 SINGLE FAMILY RESIDENCE I BUILDING SIZE (SF: 1647.5 o rfJ ~ Cl o u ~ ~ ,E-< rfJ >-< o ~' LOT SIZE (SF): DISCOUNT $0.00 $818.32 1070 2. SANITARY SEWER - CITY A REIMBURSEMENT COST: I NUMBER OF DFU's x I 24 B. IMPROVEMENT COST: 1 NUMBER OF DFU's x 1 24 . :.. COST PER DFU $25.07 $601.68 1091 $19.07 r 11092 $457.68 = , ITEM 2 TOTAL - CITY SANITARY SEWER SDC $1,059.36 3. TRANSPORTATION A REIMBURSEMENT COST: ADT TRIP RATE x NUMBER OF UNITS x I COST PER TRIP x I NEW TRIP FACTOR 9.57 I 1 $19.09 1 1.00 $182.69 1093 B. IMPROVEMENT COST: I ADT TRJP RATE x I NUMBER OF UNITS x COST PER TRIP x NEW TRIP FACTOR I 9.57 I I $84.19 1.00 $805.70 1094 ITEM 3 TOTAL - TRANSPORTA TION SDC = , $988.39 4. SANITARY SEWER - MWMC A REIMBURSEMENT COST: INUMBER OF FEU's x COST PER FEU 1 1. $82.03 = $82.03 1054 B. IMPROVEMENT COST: INUMBER OF FEU's x ICOST PER FEU , I I $865.31 = $865.31 lOSS MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMINISTRATIVE FEE $10.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I $957.34 SUBTOTAL (ADD ITEMS 1,2,3; & 4) = , $3,823.41 5, ADMINISTRATIVE FEE: . SUBTOTAL x ADM. FEE RATE CHARGE $3,823.41 5% $19L17 TOTAL SANITARY ADMINISTRATION FEE: 125.24 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $65.93 1078 Steve Beaudry Barnes 4/28/2006 TOTAL SDC CHARGES =, $4,014.58 PREPARED BY DATE .- . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 2 0 3 = 6 IDRlNKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND I AUTO WASH / ETC. 0 0 6 = 0 ILAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER/MOP SINK 1 0 3 = 3 ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER ST AT]ON / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER I ETC. 1 0 3 = 3 ISHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 I SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1 IURINAL, STALL / WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLAT]ON 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day ----" MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE J 979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$l,OOO ASSESSED VALUE $5.29 $5.29 $5.19 $5.12 $4,98 $4.80 $4.63 $4 .40 $4,07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 ]S LAND ELGlBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $5.29 o = $0.00 TOTAL MWMC CREDIT .. . ' f> (':"v of Springfield Official Receipt elopment Services Department Public Works Department 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-00401 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 CO M2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 CO M2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 COM2006-0040 1 Payments: Type of Payment Check cReceintl RECEIPT #: 1200600000000000572 Date: 05/0112006 10:19:59AM Description SDC MWMC Improvement SDC MWMC Administration SDC SanitarylStorm Admin SDC Transpo Admin Building Permit 2 Baths One or Two Family Storm Sewer Each Addtl 100' Furnace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent Minimuml Adjustment Mechanical ~Mechanicallssuance Fee~ + 8% State Surcharge + 10% Administrative Fee Addressing Assignment Willamalane Single Family Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Plan Review Major - Planning Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement Amount Due 865.31 10.00 125.24 65.93 663.15 254.00 14.00 12.00 12.00 9.00 6.00 6.00 10.00 93.61 117.02 31.00 1,000.00 106.00 38.00 50.00 150.00 818.32 601,68 457.68 182,69 805.70 82.03 $6,586.36 Paid By MIKE BLANKENSHIP CORP Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Paid dIm 10137 In Person Payment Total: $6,586.36 $6,586.36 Page 1 of 1 5/1 12006