HomeMy WebLinkAboutPermit Building 2008-2-13
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5773 OBSIDIAN AVE
ASSESSOR'S PARCEL NO.: 1802030008500
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2008-00211
ISSUED: 02/13/2008
APPLIED: 02/12/2008
EXPIRES: 08/13/2008
VALUE: $ 179,235.00
SPRINGFIETYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - SAME AS 5780 Cinder COM2007-01685
Owner: HA YDEN ENTERPRISES
Address: 2622 SW GLACIER PL #110
REDMOND OR 97756
Contractor Type
General
Residential
Phone Number: 541-228-6935
I CONTRACTOR INFORMA nON I
Contractor
HA YDEN ENTERPRISES
Phone
541-228-1081
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
1
R-3
U
VB
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
21.00
10.00
5.00
46.20
0.00
Street Improvements:
License
92208
Expiration Date
07/2912009
BUILDING INFORMATION I
3
# of Stories: 1 Lot Size:
Height of Structure 19.00 Sq Ft 1st Floor:
PTTr~-rflef1'l~~t: Forced ~ir Gas Sq Ft 2nd Floor:
f I' >>,ate~ T~8~fegon law reqUlr~~u tOSq Ft Basement:
N~t',~~~ ~~R~,o~teth by the Oregon Utilitysq Ft Garage/Carport
in OAJ!i'!M~Yotr;! Q' t~rse rules fi'lfHillt fo~ Ft Other:
0090 SV6tp~~: B~JP.W2 o~gh OA~/i52-00~ccupant Load:
\~. _ cty \'Nil 'CoeJes of the rules t,1v
D~"':i!lll .. IU~' hone .
. 'cation
Center IS 1-800-3a2-2344)_
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
480
1,579
2
Yes
30.80
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
NOTICe- Downspouts/Drains:
No final occupancy approval S~SWAQt~d. g,rior to Public Works approval for pump station.
IVIIT ~HAll EXPIRE IF THE WORK
Stormwater routed to public storm pipe. AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ARAl\lnmu:n rnn
."tIH 1 ~U ~A'{ fllRIOO - - I:'
I Valuation Descri tion .
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square""Footage" '"
or Bid Amount
Date Calculated
VahIe -
Pa2e 1 of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-00211
ISSUED: 02/13/2008
APPLIED: 02/12/2008
EXPIRES: 08/13/2008
VALUE: $ 179,235.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Dwellin2s
Gara2e
V Wood Frame
Gara2e
$105.00
$28.00
1,579.00
480.00
$165,795.00
$13,440.00
$179,235.00
02/12/2008
02/12/2008
Total Value of Project
~
Fee Description Amount Paid Date Paid Receipt Number
~Mech Iss 2+ Appliances~ $40.00 2/13/08 1200800000000000127
+ 10% Administrative Fee $161.72 2/13/08 1200800000000000127
+ 12% State Surcharge $181.71 2/13/08 1200800000000000127
+ 5% Technology Fee $92.46 2/13/08 1200800000000000127
2 Baths One or Two Family $280.00 2/13/08 1200800000000000127
Addressing Assignment $35.00 2/13/08 1200800000000000127
Appliance Vent $7.00 2/13/08 1200800000000000127
Building Permit $909.24 2/13/08 1200800000000000127
Curbcut Permit $85.00 2/13/08 1200800000000000127
Exhaust Hoods $10.00 2/13/08 1200800000000000127
Fire SF Fee - Residential $102.95 2/13/08 1200800000000000127
Fireplace (Listed) $17.00 2/13/08 1200800000000000127
Furnace - up to 100,000 btu $14.00 2/13/08 1200800000000000127
Gas Outlets 1-4 $5.00 2/13/08 1200800000000000127
Plan Review Major - Planning $205.00 2/13/08 1200800000000000127
Plan Review Same As $220.00 2/13/08 1200800000000000127
PW Disc - 2nd Permit $-40.00 2/13/08 1200800000000000127
Residence Wiring 1000 Sq Ft $117.00 2/13/08 1200800000000000127
Residence Wiring Ea Addtl 500 $63.00 2/13/08 1200800000000000127
Sanitary Sewer - Improvement $489.70 2/13/0S 1200800000000000127
Sanitary Sewer - Reimbursement $644.00 2/13/08 1200800000000000127
SDC MWMC Administration $10.00 2/13/08 1200800000000000127
SDC MWMC Improvement $990.39 2/13/08 1200800000000000127
SDC MWMC Reimbursement $95.35 2/13/08 1200800000000000127
SDC Sanitary/Storm Admin $134.93 2/13/08 1200800000000000127
SDC Transpo Improvement $862.25 2/13/08 1200800000000000127
SDC Transpo Reimbursement $195.48 2/13/08 1200800000000000127
Sidewalk Permit $S5.00 2/13/08 1200800000000000127
Storm Drainage Impervious Area $850.17 2/13/08 1200800000000000127
Storm Sewer Each Addtll00' $16.00 2/13/08 1200800000000000127
Temp Power 200 amps or less $55.00 2/13/08 1200800000000000127
Vent Fan $21.00 2/13/08 1200800000000000127
Willamalane Single Family $2,513.00 2/13/08 1200800000000000127
Total Amount Paid $9,468.35
I Plan Reviews I
Plannin2 Review
02/12/2008
02/12/2008
APP TAJ
Approximate location of street trees
shown on plot plan.
Pa2e 2 of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-00211
ISSUED: 02/13/2008
APPLIED: 02/12/2008
EXPIRES: 08/13/2008
VALUE: $ 179,235.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Public Works Review
02/12/2008
02/12/2008
APP TSS
Stormwater routed to public storm
pipe.
See documents for Plan review
comments
Structural Review
02/12/2008
02/12/2008
APP DLM
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.
~eouiredJnsnections ,
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
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 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.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
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.
Pa2e 3 of 4
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2008-00211
ISSUED: 02/13/2008
APPLIED: 02/12/2008
EXPIRES: 08/1312008
VALUE: $ 179,235.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Underfloor 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 including 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.
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
times during construction.
- /._:)2 /r
? {../' /6
Owner or Contractors Signature
-z;;~ y
I /
Date
Pa2e 4 of 4
-- ~. ~u~u ~I.~~ rrom:M & W ELECTRIC
rCD-U4-'UU~lMUN) U~:4~
5417541872
m tU' 1M S'J'Rn'r · SPlUNuIJu.J.D, OR !l'1~77 . PH:(S41)~ . VAX: (54!)T.l~
ELEcrR.ICAL PBRlJ..uJ 'APPUCA770N
City Job'Nwnbclr C~ ~ - 6) 0 2J t--
L 3.
..$773 &J/I)/Atf 7 _
LEGAL 0BScrun10N:
Iiic7L&-J tJo [;) ~/'J!Tn
JOB DESCRIPTION:
4
S/I~a JZMt ,ea-s i k~
A.
To: 15417412572 P.1/1
(FAX)154J7412572 POOl/DOl
4~.~ ~lJ
~ ~~:C".'
I~
~
"'10'_-
$JJ7.01 1/7,~
$ 2J.00 , ~ '? "-eJ
,
L~
%..
Elcctrlcal Contrnctor
ServJce Included
1000 sq. it. or leas
Each BdlfitlClaIll SOD IIQ. ft. or
portion thCl'QQt
Jlqch MlUlU1hct'd Honll~ QJ"
Modular OweJUns Scrv~ or
Focdor
, $55.00
Pormlb ant nOI-h'ibltcrablQllnd npJre If"'<<trk II
not .CarCDd within 180 days of Isluunal or Ifwork fa .
9u.pendcd for 180 day..
~~~"l
B.
~ fw fl~(" '2o~r8A,es ~OIj\.\\I\'/
,'ON' oro2(fi ~~m ~'~~\ '~g~_
ott~v ':t:J .~'T'tt~!'\e'" ill 40J,~mpa~Jiqg!Ai1~u~-esb\)
"' L\\U~'~' ' " o\.l_~n t ,\
1'1 ~\'ica\\n:~ ,,". 601 ~i~06 one
PhDne ePll"~~"'C1111 ',";'\' OYCr\ ~ ~\\on
M('(' " RIlCb _tV .14\ '
vyl} .'. (,,' ~', \' r)re9 2-2$.. 'J. . ';~\~:>!;.",., \
G-' .' . 0 " ~. ,
LJ .....~/J 5 ","'.\W ,..
~!"L.'" .,,,, V..,~I
'~P_J
Addrw
$ 70.00
S 83.00
- $)31.00 1,
. $180.00 ~ I
$4 r 3.00
$''''.00
City ~\ ~lI\i
SUpcMsor l.icolUlC Number
Expil'iltion Dare
10 .. iO
lupoctlon Requart: 7%603769
lDaWlstlon, AJtcll'lltfou or .R&'Ucatlmt ,
200 Ampll or leu ~ S 55.00 S-S 0-0
201 Amps 1D 400 Ampo S 76.00 I
-
401 ADIpI to tiOO Amps Sl10.00 [I
Ovcr 600 AJ:n or J 000 V olrs llCe ".B" ebo\l~ J -
I~
Nno AlteraUoD Qr i'.xtelllloo }Jcr .PoGaI
One Circuit $ 48.00
Each AddltJoDDL CltclUil Qr ~"''''" 0 ,
ScrvlcD or Feeder Po,",Ii(:~t'.'< ,/>'('. rr1 ) _ $ 4.00
\Ny"'. . lr\of
E. " '''~I
~",'t1Ci.: ~\\ \<0 \:' r . '
City - PhollC ~~'M~rS?t.~~~~~\)a~t.'\) $55.00
1\'\~ \,\Q~\~~~8 $ 55,00 ~l
OWNllBIN!lT..LtAnON . jI.\l1 W\t~~i_ - $28.00 I
Th. _,otion" bolllgmDdc OIl prop"", I.... "'hi.~()\'II1 \)~ '&;;;sy,eomIDcn:lllI . 5 50.00 r
"lIDt ~ fer PIll.. J.... '" "'L ~"''''''l!lcdri. p....lrrn.~. Fan " ....00 + Surcbl...
o...nm SI_, 4. .s: 6<J
.,. . ~z.o
::#' - 0
~C-o
5% tochnoloD Fee , I !, ~S"
ro~ 2~~t4j
ShIInd Dri.r(l':)lBlllldlnll FOlWIIIleCJrianJ Permit Applllllltlp ; J oOl.doo
CoWlD'. Contr. Number
Co 7~~
Ip-ii-:Jo11
EqJinstian DI1tp ,
Slenafuro DfSupcrvfs!ng Electrician
~
OwnorsNmnc ~~J
Addrca8
&7;~/
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
JOURNAL OR JOB NUMBER COM2008-00211
NAME OR COMPANY Hayden Homes
LOCATION 5773 ObsIdIan
TAX LOT NUMBER 1802030008500
DEVELOPMENT TYPE Smgle FamIly ResIdence
NEW DWELLING UNITS I BUILDING SIZE (SF: 1989 LOT SIZE (SF)
I STORM DRAlNAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S F x I COST PER S F CHARGE
, 2457 00 I $0 346 = $850 17
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS SF x I COST PER S F x I DISCOUNT RATE I
o 00 I $0 346 I 50% = I
ITEM 1 TOTAL - STORM DRAINAGE SDC 1 $850.17
2 SANITARY SEWER - CITY
A REIMBURSEMENT COST
I NUMBER OF DFU's x
I 24
B IMPROVEMENT COST
. I NUMBER OF DFU's I x
I 24 I
DISCOUNT
$000
COST PER DFU
$26 83
COST PER DFU
$20 40
=1
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
3 TRANSPORTATION
A REIMBURSEMENT COST
I ADT TRIP RATE . x
I 957
B IMPROVEMENT COST
ADT TRIP RATE x
957
$1,133.70
I NUMBER OF UNITS - x I
I I I
COST PER TRIP
2043
x NEW TRIP FACTOR
100
J NUMBER OF UNITS I x
I 1 I
ITEM 3 TOTAL - TRANSPORT A nON SDC
=1
COST PER TRIP
$9010
$1,057.73
x NEW TRIP FACTOR
100
5317
r/)
r.r.1
o
o
U
0:::
r.r.1
r-<
r/)
.......
o
~
$850.17
1070
$644.00
1091
$489.70
11092
I
$195.48
1093
$862.25
1094
4 SANITARY SEWER - MWMC
A REIMBURSEMENT COST
INUMBER OF FEU's x
I I
B IMPROVEMENT COST
INUMBER OF FEU's x
I I
ICOST PER FEU
I $95 35
I COST PER FEU
I $99039
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, $1,095.74
--- .
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = I $4,137.34
=
$95.35
1054
= $990.39 1055
$0.00 1054
$10.00 1056
I
i
134 93 ! 1079
$7194 1078
I
=, $4,344.21
5 ADMINISTRATIVE FEE
SUBTOTAL x ' ADM FEE RATE 1=
$4,13734 5% I
TOTAL SANITARY ADMINISTRATION FEE
TOTAL TRANSPORTATION ADMINISTRATION FEE
CHARGE
$206 87
Todd Singleton
TOTAL SDC CHARGES
PREPARED BY
2/12/2008
DATE
-- -~---~~~~.-_.
'-' "....,..
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
IBA THTUB 2 0 3 = 6
IDRINKING FOUNTAIN 0 0 1 0
I FLOOR DRAIN 0 0 3 = 0
!INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0
!INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 = 0
I LAUNDRY TUB 0 0 2 = 0
ICLOTHESWASHER/MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 0
RECEPTOR FOR REFRIG / WATER STATION / ETC 0 0 1 = 0
RECEPTOR FOR COM SINK / DISHWASHER / ETC 1 0 3 = 3
SHOWER, SINGLE STALL 0 0 2 = 0
I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
I SINK COMMERCIAL BAR 0 0 2 = 0
! SINK WASH BASIN/DOUBLE LA V A TORY 1 0 2 = 2
ISINK SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 1
IURINAL, STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
TOILET, PRIVATE INSTALLATION 2 0 3 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 24
*EDU (EqUIvalent DweIhng Urnt) IS a discharge eqUIvalent to a smgle faImly dweIhng umt (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$l,OOO
ASSESSED VALUE
$529
$529
$519
$512
$498
$480
$463
$440
$407
$367
$322
$273
$225
$1 80
$1 59
$145
$125
$109
$092
$072
$048
$028
$009
$005
IS LAND ELGlBLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
2
2
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE /1000 CREDIT RATE
$0 00 x $5 29
= ,
$000
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0 00 x $5 29
o
TOTAL MWMC CREDIT
$000
=
Willamalane
Park & Recreation District
Job. NO.~~ ,/ OD2l
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2007
NAME: JIJ1.u]J~7 ~ PHONE: 77 42, -C:::, C} J.r
AD~~ESS:.g,i~4'~lA-~:rr~Lf"41Hl4.r1J . STATE~ZIP: 177~t.
LOCATION OF PROPOSED BUILDING SITE:
Street Address: ~7 7,~ V~ W /~~ /'
Plat Name:~'Bre _/I!~~ Tax Lot Number: /~()2- OJ t;>/) "., ~5"6"t7
1. DEVELOPMENT TYPE (Check appropriate dwelling(s) Dwelling type definitions are on the
back )
A. Sinole-Famllv Detached
NO, OF UNITS I
~(1
X $2:;303 f'er unit ==
$ 2<)"/.1-
B. Slnale-Famllv Attached
NO. OF UNITS
, X $2,426 per unit ==
$
C. Multl-Famllv Aoartment
NO OF UNITS
X $2,032 per unit ==
$
D. Sinale Room Occuoancv
NO OF UNITS
X $1,016 per unit ==
$
E. Accessorv Dwellino Unit
NO, OF UNITS
X$1,151,50perunit== $
WILLAMALANE SDC $
2. SDC CREDIT (If applicable) SDC payer must furnish proof of
Willamalane CredIt approval) $
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
$ 2S/3
'2 IIJI 67
Date
)~CS
Development Services Department
City of SpringfIeld
5
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Developm,ent Services Department
Public Works Department
Job/Journal Number
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-0021I
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-0021I
COM2008-00211
COM2008-00211
COM2008-0021I
COM2008-00211
COM2008-00211
COM2008-0021I
COM2008-00211
COM2008-0021I
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
COM2008-00211
Payments:
Type of Payment
CredltCard
cRecemtl
RECEIPT #:
1200800000000000127
Date: 02/13/2008
DescriptIOn
Plan Review Same As
Sidewalk Permit
Curbcut Permit
PW DIsc - 2nd Permit
Storm Dramage ImpervIOus Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC AdmmlstratlOn
SDC SanltarylStorm Admm
Plan RevIew Major - Plannmg
BUlldmg Permit
Addressmg Assignment
Willamalane Smgle Family
2 Baths One or Two Family
Storm Sewer Each Addtl 100'
Furnace - up to 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Gas Outlets 1-4
Fireplace (Listed)
-Mech Iss 2+ ApplIances-
Residence WIrIng 1000 Sq Ft
Residence WIrIng Ea Addtl 500
Temp Power 200 amps or less
Fire SF Fee - Residential
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Admmlstratlve Fee
Paid By
HAYDEN ENTERPRISES
Item Total:
Check Number AuthOrizatIOn
ReceIVed By Batch Number Number How Received
dJb 077104 In Person
Payment Total:
Page I of I
9:04:26AM
Amount Due
220 00
8500
8500
(40 00)
850 17
644 00
489 70
195 48
862 25
9535
990 39
10 00
134 93
205 00
909 24
3500
2,513 00
280 00
1600
1400
2100
700
10 00
500
1700
4000
11 7 00
6300
5500
102 95
9246
181 71
161 72
$9,468.35
Amount Paid
$9,46835
$9,468.35
2/13/2008