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Home My WebLink AboutPermit Building 2008-1-25 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01249 ISSUED: 01/25/2008 APPLIED: 08/22/2007 EXPIRES: 07/25/2008 VALUE: $ 259,358.00 _~~~I\'!!~'!~"'!)!J !II. ~I Status Issued 225 Fifth Street, Springfield. OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6190 Graystone Lp ASSESSOR'S PARCEL NO.: 1802032206100 SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence- MtGate West lot 90 Residential Sidewalk Type: Downspouts/Drain~: requireS you to ATTENTION: Oregon a~he Oregon Utility follow rules adopted by rules are set forth Notification Center. Those hOAR 952-001- In OAR 952-001-0~~~h;~~i~S of tlie rules by 0090. you may 0 (Note' the telephone calling the cen~r. on uiility Notification number for the, 1re8g00-332-2344). Center IS . Owner: GENE .LOEWEN Address: 2334 LOCH DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMA nON I Contractor Type General Electrical Mechanical Contractor GEMSTONE BUILDERS INC BURRELL BROS ENTERPRISES INC COMFORT FLOW License 82340 136446 460 BUILDING INFORMA nON I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construclion Type: # of Bedrooms: 1 R-3 U VB # of Stories: 2 . Height of Slructure 28.00 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Gas Energy Path: Path 1 Sprinkled Building: n/a 2 I ,DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18.00 16.60 8.00 28.00 40.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Notes: StorMg,TtC~lped to ~~lf ~E If iHE WORK iHIS PERMI1 S ER iHIS PERMli IS NOi AUiHORIZED UNO IS ABANDONED fOR COMMENCED OR ANY 180 DAY PERIOD. ,. Paee 1 of 5 Phone Number: 541-744-1744 Expiration Date 06/17/2009 08/2012009 06/27/2009 Phone 541-343-5788 541-747-2724 541-726-0100 Lot Size: Sq I'll st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 10,430 3,026 Hillside 3 Yes 35.90 .REQUIRED PARKING Total: 2 Handicapped: Compact: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction A.C. - Residen Dwellin2s Gara2e AC - Residential V Wood Frame Gara2e Fee Description Plan Review Residential -Mech Iss 2+ Appliances- + 100/0 Administrative Fee + 12% State Surcharge + 5% Technology Fee . 2 Baths One or Two Family Addressing Assignment Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Fire SF Fee - Residential Fireplace (Listed) Furnace - up to 100,000 btu Gas OuIlels 1-4 Mountaingate Impervious Area Plan Review Major - Planning Plan Review/Residential Hourly PW Disc - 2nd Permit Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursemenl SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Sidewalk Permit Storm Sewer Each AddIlI 00' Temp Power 200 amps or less Vent Fan WilIamalane Single Family I Valuation Descrintiim , $ Per Sq Ft or multiplier $4.00 $103.00 $27.00 Square Footage or Biid Amount 2,234.00 2,220.00 806.00 Tolal Value of Project ~ Amount Paid $758.55 $40.00 $178.09 $195.56 $98.23 $280.00 $35.00 $1,195.64 $85.00 $7.00 $10.00 $151.30 $17.00 $14.00 $5.00 $1,495.33 $205.00 $96.42 $-40.00 $510.10 $670.83 $10.00 $961.52 $91.61 $171.91 $67.95 $862.25 $195.48 $85.00 $32.00 $55.00 $14.00 $2,303.00 Date Paid 8/22/07 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25108 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25108 1/25108 1/25/08 1/25108 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 1/25/08 Pa2e 2 of5 CITY OF ~rKm\JFIELD . Building/Combination Permit PERMIT NO: COM2007-01249 ISSUED: 01125/2008 APPLIED: 08/22/2007 EXPIRES: 07/25/2008 VALUE: $ 259,358.00 Value Date Calculated $8,936.00 $228,660.00 $21,762.00 $259,358.00 08/23/2007 01/10/2008 08/22/2007 Receipt Number 1200700000000001075 . 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 2200800000000000106 _~~~l,ttGF;t.~I:S: #1L1}~~1..<, $!. . Status Issued CITY OF ~rKINGFIELD Building/Combination Permit PERMIT NO: COM2007-01249 ISSUED: 01/25/2008 APPLIED: 08/22/2007 EXPIRES: 07125/2008 VALUE: $ 259,358.00 225 Fifth Street, Springtield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Amount Paid $10,857.77 I Plan Reviews I Structural Review 09/1012007 Initial Review 08/23/2007 08/23/2007 APP LLH io -- 1110/2008 Don Moore received revised ~rawings and will be adjusting the square footage for the residence for the struclural page on Tidemark and for the fire/life safety fee. Puhlic Works Review 08/23/2007 08/28/2007 NOK TSS Total impervious surfaces exceed 35%. Review not approved. ( Plan nine: Review 08123/2007 08129/2007 WE TAJ This on hold because of coverage issues. I spoke to the owner today and left a voice mail with the contractor also. Structural Review 08/2312007 09/10/2007 10 LLH Forwarded to Shawn Eaton with the Building Department for review under contract wilh Ihe City of Springfield. Plan nine: Review 09/14/2007 09/14/2007 APP TAJ I received revised site plans on 9/12. The 35% coverage for this lot is met. No additional impervious surface may be allowed. Choose street trees from the list of native trees for Hillside Development in the street tree handout. Public ,"Yorks Review. 09/17/2007 09/17/2007 APP TSS Storm water piped to storm sewer. 'Structural Review 01110/2008 01110/2008 APP DLM Received revised plans & engineering for minor revision to master balh, reducing Ihe floor area by 14 s.f. 1I10/08dlm. 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. Pa2e3 of 5 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2007-01249 ISSUED: 01125/2008 APPLIED: 08/22/2007 EXPIRES: 07/25/2008 VALUE: $ 259,358.00 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I I?Pflllirr'\Jnsnections I Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk - Curhside: After forms are erected hut prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. Ufer Eleclrical 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 but prior to concrete placement. Post and Beam: Prior to Iloor 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. Underground Plumbing: Prior to filling the trench and including required testing. Underlloor Plumbing: Prior to insulation or decking. 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 fiiling trencb. Underlloor Mechanical. Prior to insulation or decking and including required tesling. Underlloor Gas: After line is installed and required testing and capped if not attached to an appliance. ( Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance inc,luding required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Final Plumbing: When all plumbing work is complele. Final Building: After all required inspections have been requested and approved and the building is complete. Paee 4 of5 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY 01' ~rKHII\.jI'IELD . Building/Combination Permit PERMIT NO: COM2007-0I249 ISSUED: 01125/2008 APPLIED: 08/22/2007 EXPIRES: 07/25/2008 VALUE: $ 259,358.00 By signature, I state and agree, that I have carefully examined the compleled application and do hereby certify that all informalion 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 Ihat 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 Contractors Signature Paee 50f5 Dale ~ Willamalane Park & RecreationDistrict Job. No. ..~n "VL~ SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2007 NAME:[yffi.el j~ . . .. . PHONE: 144. \141 . ADDRESS:!lQ34. 1 (YhITY~ ii=STATE:D!kw: Q1411 . LOCATION OF PROPOSED BUILDING SITE: . Street Address: \9~C\D (\((lu~~ Lf . . .... .. _.. . PlatName~lv ~. Tax. Lot Number: \ ~l)l.o51')r~\cV .' 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are .on the back.) A. Sinale-Family Detached \ NO. OF UNITS X $2,303 per unit = .. $ 1LYJ3/xJ B. Sinale-Family.Attached NO. OF UNITS X $2,426 per unit = $ C. Multi-Family Apartment NO. OF UNJTS . X $2,032 per unit = $ D. Sihale Room Occupancy . , NO. OF UNITS X $1 :016 per unit = $ E. Accessorv Dwellina Unit NO. OF UNITS X $1,151.50 per unit = $ . $ 2:D3.(j) fJ $ 2?:J)3~ci) oate\ l!Qlt " WILLAMALANE SDC 2. SDC CREDIT (II appiicable) SDC payer must lurnish prool 01 . Willarnalane Credit approval.) $ 3. TOTAL WILLAMALANE NET SDC ASSESSED ~~c~e~ed 10rcr~OJ Deveioprnent servi~arth1ent City of Springfield. 5 " ZON~ lNlTlALS DATE .0 1 . SOURC 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH,(541)726-3753 . FAX, (541)726-3689 ELECTRICAL 1f.RMI;C Aj'j:.LICATION City Job Number r\.l'~ 1. It!OcATfON!OF1INST'Jffil!ATfo7\/f;[!jf?!tj.~ 3. GIg00'_r:,:fi\U~~~ LEGAL DESCRlPTION: \ \ q,()'Z..O~~ ~- ot" \C(:L JOB DESCRJPTlON: pe:t~~an~~~ble and expire if work is not started within 180 days ofissuance or if work is Su ended for 180 days., New 4\~ration or Extension Per Panel One dl{-cuIICE: . $ 48.00 , "',... Each A.'ddRi<i/t]FlMfpiSflA'rhXPIR . Owners Nf}ame ~fne-l ":..xrk\U~ E.S;~~~;~t;i~~~~~~~~~~~~;~\Tt~li~~ Address ~~ VJ .1 '\. V' ~a'VF'1''''1'I:.'tI''I:J:I\'i''-plERTOD~'$>~--''$$.!i,,<'J;1''''''',""aa_''''''~ City ~~af"'l...., Phone ~4'4 '\"141- Pump or irrigation $ 55.00 ~\ ~ , - . SignlOutlineLighting . $ 55.00 OWNER INSTALLATION Limited Energy/Residential $ 28.00 The installation is being made on property I own which Limited Energy/Commercial $ 50.00 is not intended for sale. Jease or rent. Minimum Electric Permit Inspection Fee is $50.00 + sur~~ cf) Owners Signature: 4. )0_ 8% State Surcharge ."tl> 10% Administrative Fee ~.r:;O 5% Technology Fee lL.1 ':") - \d\.<t'S ~'Sf~~!.rW<!ii?'.~j,l?'~~'tt!t1~!,18M~~.;r~~~',:t"";"~--;';;!J':t'" 3~ 2. liS, Q~~f,~"?!!~~s..r~~!:{Q!y,~W',,~,, h--.- '_"""~''''__''''''', '.j """,'~"", -".",=."" Address City Expiration Date Inspection Request: 726-3769 Date 1ffiJ*I,"'~.$~n-':{,~N~;)f'}~./-C'-'2WJ\0';j;~Y_,l'-"",,;--- i"'-,7;;;~~'1f'C,~-""r,,,,," '. ;a;.",." '. A. f;0N~W:R~-~I(Th1i'tia1~Sin--le;~r~'Mt'fti.:FaffiilY~~~f7CiW~llfu~?b~it:-";W, , H~\if~;'i~iG'7.h~W;-.>"EU.g,,,,j'~"~"""''''-;nJ1k;;<i;b;C:''_~d,"" >",P""".:6.ti'"''-'''-''' _;_",go,_"',;",,,~,x\;,S;;.: Service Included 1000 sq. 1'1. or less $117.00 Each additional 500 sq. ft. or portioA'JIWlNfION: Oregon law --J $ 21.00 fQ)I' '~'1~"C~ yvU to . Eacb',t;)laW!r'fI!:l'a~8ii\..reled by the Oregon Utility Molltli'}lttli~Ylililm.t,<r. ifJ'iose rules are set,!Brtm FeelftiAR 952- 01-0010 through OAR @52-001- B. ~1~J'Jt~n~~~i~~~lf!!~~!~~~ 200 Amps or~!ilter IS 1-800-332-2344\. $ 70.00 . 201 Amps to 400 Amps $ 8J.00 401 Amps to 600 Amps $138.00 . 601 Amps to 1000 Amps $180.00 Over 1000 AmpsNolts $413.00 Reconnect Only $ 55:00 c. Installation, Alteration or Relocation 200 Amps or less l 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 D. ~S~ $ 55.00 $ 76.00 $110.00 TOTAL Shared Drive(T:)/Building FonnsJElectrical Permit Application 7-07.doc CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2007-01249 NAME OR COMPANY: Gene Loewen LOCATION: 6190 Gra~stone Loop TAX LOT NUMBER: 18-02-03-22-06100 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF: 3961.5 LOT SIZE (SF): I. STORM DRAINAGE 10430 I- I'" p:1 1(:) 10 I~ I~ '" ~ o gz DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I 4321.50 $0.346 I = I $1,495.33 I RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS SF I x I COST PER S.F. I x I DISCOUNT RATE I 1 I 0.00 I $0.346 I I 50% I ~ I DISCOUNT $0.00 ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY $1,495.33 $1,495.33 I 1070 A REIMBURSEMENT COST: I NUMBER OF DFU's I x I 25 I B. IMPROVEMENT COST: 1 NUMBER OF DFU's I x 1 25 1 COST PER DFU $26.83 $670.83 11091 COST PER DFU $20.40 , $510.10 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC ~ .1 $1,180.94 3. TRANSPORTATION " A. REIMBURSEMENT COST: f ADT TRIP RATE I x I NUMBER OF UNITS I x r COST PER TRIP x INEW TRIP FACTORI 9.57 I I I I I 20.43 I 1.00 I $195.48 1093 B. IMPROVEMENT COST: I 1 ADT TRIP RATE I .x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIPFACTORI 1 9.57 1 I 1 I $90.10 I 1.00 I $862.25 I 1094 ITEM 3 TOTAL - TRANSPORT A nON SDC =1 $1,057.73 - 4. SANITARY SEWER - MWMC A REIMBURSEMENT COST: INUMBER OF FEU's 1 x ICOST PER FEU I I I 1 I $91.61 = $91.61 I 1054 B. IMPROVEMENT COST: I INUMBER OF FEU's I x ICOST PER FEU I / I 1 1 $961.52 = $961.52 11055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 11054 MWMC ADMINISTRATIVE FEE $10.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~ , $1,063.13 SUBTOTAL (ADD ITEMS I, 2; 3, & 4) ~, $4,797.13 I 5 AI1MlNlSTRATIVE FEE: I I SUBTOTAL x I ADM. FEE RATE I~ CHARGE $4.797.13 I 5% , $239.86 TOTAL SANITARY ADMINlSTRATION FEE: 17191 ill079 TOTAL TRANSPORTATION ADMINISTRATION FEE: u $67.~5__' 1078 Todd Singleton If kilO:f TOTAL SDC CHARGES =1 $5,036.99 I PREPARED BY DATE r .-..JI DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY TIlE NET ADOmONAL FIXTIJRES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FlXTIJRE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 1 0 3 3 IDRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 0 LAUNDRY TUB 1 0 2 = 2 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRlG / WATER STATION / ETC 0 0 1 = 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC 1 0 3 = 3 I SHOWER. SINGLE STALL 1 0 2 = 2 I SHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMER(i~LlRESIDENTIAL KITCHEN 1 0 3 = ,3 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 2 SINK: SINGLE LA V ATORY/RESIDENI1AL BAR 1 0 1 = 1 I URINAL. STALL! WALL O. 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 TOILET. PRlVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 25 *EDU (Equivalent Dwellin~ Unit) is a discharge equivalent to a single family dweIlin,g Unit (20 DFU's) set at 167 ,gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE I r-- I I I I I I I I I I I I I I ,: I I I i I I I YEAR ANNEXED ,CREDIT RATE/$I,OOO ASSESSED VALUE _~29 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 IS LAND ELGlBLE FOR ANNEXATION CREDIT" 2 (Enter I forYes:2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT" 2 (Enter I for Yes, 2 for No) BASE YEAR 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 ~ I $0.00\ CREDIT EOR IMPROVEMENT (IF AFTER ANNEXA.TION) VALUE/JOOO CREDITRATE".. . . $0:00 x $5.29 0 TOTAL MWMC C.REDlT. $0.00 ; ,.,~. )'. .I II 225 Fifth Street . Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01249 COM2007-0 1249 COM2007-0 1249 COM2007-01249 COM2007-01249 COM2007-0 1249 COM2007-0 1249 COM2007-01249 COM2007-01249 COM2007-0 1249 COM2007-01249 COM2007-01249 COM2007-01249 COM2007-01249 COM2007-0l249 COM2007-01249 COM2007-0l249 COM2007-0l249 COM2007-0 1249 COM2007-0 1249 COM2007-01249 COM2007-01249 COM2007-01249 COM2007-01249 COM2007-01249 COM2007-01249 COM2007-0 1249 COM2007-0 1249 COM2007-0 1249 COM2007-01249 COM2007-0 1249 COM2007-01249 Payments: Type of Payment CreditCard Cheek cReceintl RECEIPT #: 2200800000000000106 Description Addressing Assignment Willamalane Single Family Temp Power 200 amps or less Plan Review Major - Planning Sidewalk Permit Curbeut Permit PW Disc - 2nd Permit Mountaingate Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Transpo Admin SDC Sanitary/Storm Admin 2 Baths One or Two Family Furnace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent Gas Outlets 1-4 Fireplace (Listed) -Mech Iss 2+ Appliances- Building Permit Fire SF Fee - Residential Plan Review/Residential Hourly Storm Sewer Each Addtl 100' + 5% Technology Fee + 12% State Surcharge + 10% Ad!TIinlstrative Fee Paid By GEMSTONE GEMSTONE Received By (;heck Number Batch Number IIh IIh Page 1 of2 City of Springfield Official Receipt Development Services Department Public Works Department Date: 01125/2008 Item Total: Authorization Number '- How Rec~ived 6895 015500 In Person In Person Payment Total: 1:17:38PM Amount Due 35.00 2,303.00 55.00 205.00 85.00 85.00 (40.00) 1,495.33 670.83 510.10 195.48 862.25 91.61 96 1.52 10.00 67.95 171.91 280.00 14.00 14.00 10.00 7.00 5.00 17.00 40.00 1,195.64 151.30 96.42 32.00 98.23 195.56 178.09 $10,099.22 Amount Paid $9,500.00 $599.22 $10,099.22 1/25/2008