HomeMy WebLinkAboutPermit Building 2008-2-21
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-00078
ISSUED: 02/21/2008
APPLIED: 01/18/2008
EXPIRES: 08/21/2008
VALUE: $ 285,442.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2595 16TH ST
ASSESSOR'S PARCEL NO.: 1703243103700
SPRINGFIETYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Legacy Estates lot 12
Owner: DOUGLAS LARSON
Address: 1830 FRIENDLY ST
EUGENE OR 97402
! CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Mechanical
Plumbing
Contractor
NORTHFORK CONSTRUCTION INC
BEAR MOUNTAIN ELECTRIC LLC
HOME COMFORT HEATING & AIR
WILLAMETTE V ALLEY PLUMBING
License
174207
136298
84164
170401
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: 2
Height of Structure 28.50
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Gas
Energy Path: Path 1
Sprinkled Building nfa
1
R-3
U
VB
3
! DEVELOPMENT INFORMATION I
Residential
Phone Number: 541-515-2857
Expiration Date
02106/2011
08/06/2009
06/25/2011
06/05/2008
Phone
541-515-2857
541-741-8844
541-345-2838
541.344-0411
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
7,848
1,513
554
699
350
REQUIRED PARKING
Frontyard Setback: 18.00 Overlay Dist: Total: 2
Side 1 Setback: 8.00 # Street Trees Rqd: 2 Handicapped:
Side 2 Setback: 11.60 Paved Drive Rqd: ATTENTlollP. Oregon<JQfilJIDqUlres you to
Reary1t~~t&zGk: 42.00 % of Lot Coverage: follow rul~~lAdopted by the Oregon Utility
Solar ~~. Pd. a~R' 'MIT ~ . 30.75 , . Notlflc.atlon.. Center. Th. ose rules are set f. orth
. i21-1AI r EX~/!1~ I::-Tl IF :i!-J",.. :..C!::: c:: ~~~ r':'~ ':' ~f;Hglt9b Oll C a:::,?_IJQ1_
C/\U I HORIZED UNDER THIS PERM/T!_ IMPROVEMENTS fl090. You may obtain copies of the rules by
OMMENCtQ OR IS ABANDn cal~na th~ c~nter. (Note: the telephone
StreeAf.NPf~'tf'tJA)JsPERIOD F'<<Wl~gltved num~'eY"df~t-fl~egon Utility Notifi~ck 7'
Storm Sewer Available:' Yes DOWHlipt.%lhlID1-~~~-332-2~~}u and Gutter
Special Instruction:
Notes: weep holes to curb and gutter
Pae:e 1 of 4
..,
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
Dwellin!!:s
Gara!!:e
AC - Residential
V Wood Frame
Gara!!:e
Fee Description
Plan Review Residential
-Mech Iss 2+ Appliances-
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
3 Baths One & Two Family
Addressing Assignment
Appliance Vent
BUilding Permit
Curbcut Permit
Dryer Vent
Exhaust Hoods
Fire SF Fee - Residential
Furnace - up to 100,000 btu
Gas Outlets 1-4
Gas Outlets 4+
Heat Pump
Plan Review Major - Planning
Plan Review Residential
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
SDC Transportation Admin
Sidewalk Permit
Storm Drainage Impervious Area
Storm Sewer Each Addtll00'
Temp Power 200 amps or less
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$5.00
$105.00
$28.00
Square Footage
or Bid Amount
2,417.00
2,417.00
699.00
Total Value of Project
~
Amount Paid
$809.74
$40.00
$216.15
$240.69
$119.04
$337.00
$35.00
$7.00
$1,288.72
$85.00
$7.00
$10.00
$155.80
$14.00
$5.00
$2.00
$14.00
$205.00
$27.93
$117.00
$105.00
$673.33
$885.50
$10.00
$990.39
$95.35
$174.49
$862.25
$195.48
$68.30
$85.00
$1,143.51
$16.00
$55.00
Date Paid
1/18/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
2/21/08
Pa!!:e 2 of 4
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2008-00078
ISSUED: 02/21/2008
APPLIED: 01/18/2008
EXPIRES: 08/21/2008
VALUE: $ 285,442.00
Value
Date Calculated
$12,085.00
$253,785.00
$19,572.00
$285,442.00
02/20/2008
01/18/2008
01/18/2008
Receipt Number
2200800000000000069
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
1200800000000000159
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2008-00078
ISSUED: 02/21/2008
APPLIED: 01/18/2008
EXPIRES: 08/21/2008
VALUE: $ 285,442.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Vent Fan
Vent Fan
Willamalane Single Family
$7.00
$21.00
$2,513.00
2/21/08
2/21/08
2/21/08
1200800000000000159
1200800000000000159
1200800000000000159
Total Amount Paid
$11,636.67
I Plan Reviews I
Initial Review 01/21/2008 01/23/2008 APP LLH
Public Works Review 01/23/2008 01/24/2008 APP LKW Storm water to weep holes to street
Plannin2 Review 01/23/2008 02/05/2008 APP TAJ
Structural Review 01/23/2008 02/19/2008 APP RWC
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(]uire~nSDections I
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Curbcut. Standard: After forms are erected but prior to placement of concrete.
Sidewalk - Setback: After forms are erected but prior to placement of concrete.
Site Inspection: To be made after excavation but prior to setting forms.
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Dfer 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.
Final Building: After all required inspections have been requested and approved and the building is complete.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Dnderfloor Plumbing: Prior to insulation or decking.
Pa2e 3 of 4
CITY OF SPRINGFIELD.
Building/Combination Permit
Status
Issued
PERMIT NO: COM2008-00078
ISSUED: 02/21/2008
APPLIED: 01118/2008
EXPIRES: 08/21/2008
VALUE: $ 285,442.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Underfloor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Shower Pan. Prior to covering 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 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.
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
-~~ ____ Z/21 I,,~
Owne/or ~Signature '-----"" Date I . (
Pa2e 4 of4
_ ccnn (Q)W ~~~nNCGJ1FnJEIL.[2\ (Q)~IE~(Q)lM
~
Date ;) Id II 0 r:
, I
C()MPL/:-'1b PEE SCHEDULE BELOW':' .
ZON i Alv
INITIAL~ i \ H\ . <-
DATE F7_1' 0 y
SOURCE -'f'l "'" 0
22:' HVI U ~ I RI;E I . ~PRINGFIELD, OR 97477 . PH (:'41)726-37:'3 . FA:\. (:'41)726-3689
ELECTRICAL prrff!lr:::~fiit TION
Cn) Job Number \A) U Ai n
-
1. 4~E\~OF1N\\QW\~rt- 3.
LE\~~3 \ 06\00
J~DE'SCRIPTI~1 .. ?c1a -- 1000 sq ft 01 less
~ \1 J- (O"^rach addItIOnal 500 sq ft or
. \ \lJ I lI--6ortlon thereof
Permits are n-transferable and plre If work IS Each Manufact'd Home or
not started wlthm 180 da}s of Issuance or If work IS Modular Dwelling ServIce 01
Suspended for 180 days. Feeder
. -
-\. New Residentillf": Single' (}I' MultI.Family p~I' dw~nfl'ilrunft.
Service Included
\
,C) ,
SI1700
\\l~
10'5.(1)
S 2100
S55 00
CONTRACTORINSTALIATIQN ONLY
2.
Electrical Contractor!!JJIR. !JJ{(J/IJli1/AJ ELE""c
Addressg5Agg /)/W/R/J flaES5 /?f)
Cit),EUGE/lJf. Phone 1!Lbft t/ tj
B. Servires or Feeders - rnstallathm, Alterations or Relocatjon:,
n Date r
...--
"~;"D'~'"I' E:"~"'~
. - '---'"
1/otj(), S
If) /10
IJ6~q 8'
,r/o~
· . V.I~ to
200 Amps \2f.t~f.1TION Oregon law requl!6fu {) f't.'
20 I Amp~RJ ~orf1w.Pj ~dopted by the urf$~g~ t ;~~1h
40 I Am'iM~lfl ~~tW\1P~enter. Those rLl\I~j~~g~.Q01_
601 Am~ht01~~!5mjjS)1-0010tnro~~~tM1ru\es bv
Over I O~aoops~u@ay ob:atn t~~~~ th'3'elep'~one
Reconnect <e~tjlng the center. (_._ UtlHty Nh1If\~atlon
~umber for the. or~~O(;.332-2344).
c. 'Temporary sCI"\G.ep~rF~\ldcrs
Sup<::rvlsor License Number
E\.plratlOn Date
Installation, AlteratIOn or RelocatIOn
~~aJ
\.
200 Amps or less \ S 55 00
20 I Amps to 400 Amps S 76 00
401 Amps to 600 Amps SilO 00
Over 6~0 .\mP\.~D1~tE~lts see"'8 above RE If 1HE WORK
D. Branch Circb)b S PERMII SHP--LL EXPI PERMII IS N01
-\\-1\ MI1i:R 1\-11S
New AlteratIOn p.tJ~ft~rmEf'eUYiJlrje1 BANnONED FOR
One CIrCUIt t\'~11ENCED OR IS A 'S'~g-OO
Each Additional ~Pf~ll~~OV&AY PERIOU.
ServIce or FeederJ.WL-\{llIt S 400
Constr Contr Number
The II1stallatlon IS be1l1g made on property I own which
IS not Intended for sale lease or rent
S 55 00
S 55 00
S 28 00
5 50 00
Owners Signature
, -
4. SUBTOTAL OF ABOVE
(~ State ~urcharge
10% Admllllstratlve Fee
5% Technolol,')' Fee
InspectIOn Request: 726-3769
TOT-\L
"h",~d 1)"",,( I )/l:luildmg 11Irms/LkLlrl(nl Permn ApplKdllon 7-07 dOL
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
JOURNAL OR JOB NUMBER: COM2008-00078
NAME OR COMPANY: Douglas Larson
LOCATION 2595 16th Street
TAX LOT NUMBER 1703243103700
DEVELOPMENT TYPE Smgle Family ResIdence
NEW DWELLING UNITS 1 BUILDING SIZE (SF: 3116 LOT SIZE (SF)
1 STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS SF. --" x COST PER S F CHARGE
330475 $0346 I = I $1,14351
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F x I COST PER S F x DISCOUNT RATE I
o 00 I $0 346 50% = I
7841
if)
~
Cl
o
U
~
~
r--
" rf)
>-<
c.J
~
DISCOUNT
$000
ITEM 1 TOTAL - STORM DRAINAGE SDC
2 SANITARY SEWER - CITY
A REIMBURSEMENT COST
NUMBER OF DFU's x
33
$1,143.51
$1,143.51
1070
COST PER DFU
$26 83
$885.50
1091
B IMPROVEMENT COST
NUMBER OF DFU's I x
33 I
COST PER DFU
$20 40
$673.33
1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
=,
$1,558.83
3 TRANSPORTATION
A REIMBURSEMENT COST
I ADTTRlP RATE x I NUMBER OF UNITS x I COST PER TRIP x INEWTRIPFACTOR
I 957 I 1 I 2043 I 100 $195.48 1093
B IMPROVEMENT COST
ADTTRIP RATE x I NUMBER OF UNITS x I COST PER TRlP I x NEW TRIP FACTOR
957 I 1 I $9010 I 100 $862.25 1094
ITEM 3 TOTAL - TRANSPORTATION SDC = , $1,057.73 I I
I
I,
4 SANITARY SEWER - MWMC
A REIMBURSEMENT COST
NUMBER OF FEU's x ICOST PER FEU
1 I $95 35 = $95.35 1054
B IMPROVEMENT COST
NUMBER OF FEU's x COST PER FEU
1 $99039 = $990.39 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054
MWMC ADMINISTRATIVE FEE $10.00 1056
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, $1,095.74 'j
- 'j
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $4,855.81
5 ADMINISTRATIVE FEE '" -
I SUBTOTAL x ADM FEE RATE 1= CHARGE
I $4,85581 5% , $242 79
TOTAL SANITARY ADMINISTRATION FEE 17449 1079
i
TOTAL TRANSPORTATION ADMINISTRATION FEE $68 30 ! 1078
- --
- ,
Kaye Wilson 1/24/2008 TOTAL SDC CHARGES =1 $5,098.60
PREPARED BY DATE
- - --~~.--~.
.- --
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE FOR REMODELS, CALCULATE ONLY TIlE NET ADDITIONAL FIXTURES)
NO OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
I BATHTUB 2 0 3 = 6
I DRINKING FOUNTAIN 0 0 1 = 0
IFLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
ILAUNDRY TUB 1 0 2 = 2
I CLOTHESW ASHER / MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRIG / WATER STATION / ETC 0 0 1 = 0
I RECEPTOR FOR COM SINK / DISHWASHER / ETC 1 0 3 = 3
SHOWER, SINGLE STALL 1 0 2 = 2
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
SINK COMMERCIAL BAR 0 0 2 = 0
SINK WASH BASINIDOUBLE LAVATORY 2 0 2 = 4
SINK SINGLE LA V A TORY /RESIDENTIAL BAR 1 0 1 = 1
URINAL, STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
TOILET, PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 33
*EDU (EqUIvalent DwellIng Umt) IS a dIscharge eqUIvalent to a smgle famIly dwellIng umt (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$l,OOO
ASSESSED VALUE
$529
$529
$519
$512
$4 98
$480
$463
$440
$407
$367
$322
$273
$225
$180
$159
$145
$125
$109
$092
$072
$048
$028
$009
$005
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
2
2005
CREDIT FOR LAND (IF APPLICABLE)
VALUE /1000 CREDIT RATE
$000 x $000
= ,
$000
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE /1000 CREDIT RATE
$0 00 x $0 00
o
TOTAL MWMC CREDIT
$000
=
Willamalane
Park & Recreation District
Job. No.
~)iU212
SYSTEM DEVELCPMENT CHARGE WORKSHEET FOR 2008
NAME: \' 1JqQS- &W\ PHONE: b\ C:y 2.€5l
ADDRESS:\~-:7i'1 tr\Pf\A~ITY f1Tle~TAT~~P: Gh402--
LOCATION OF PROPOSED BUILDING SITE: \ Jr V
StreetAddre~s: b1..ffiCO \\O~ ~\ee;~
Plat Name: ~(afJ-, Tax Lot Number: 'I1Ll:1l13 \ 03lro
-- \ - \ . .
1. DEVELOPMENT TYPE (Check appropriate dwelling(s) Dwelling type definitions are on the
back)
A. Sinale-Familv Detached
NO. OF UNITS l
X $2,513 per unit =
B. Sinale-Familv Attached
NO. OF UNITS
X $2,726 per unit =
C. Multi-Familv Acartment
NO. OF UNITS
X $2,323 per unit =
D. Sinale Room Occucancv
NO. OF UNITS
X $1.162 per unit =
E. Accessorv Dwellina Unit
NO. OF UNITS
X $1,257 per unit =
WILLAMALANE SDe
2. SDC CREDIT (If applicable) SDC payer must furnish proof of
Willamalane Credit approval)
"
3. TOTAL WILLAMALANE NET SDe ASSESSED
llin 87' ced for tJ,"
Development Service Date
CitY of Springfield
$ A,~L3.(jJ
$'
$
$
$ ,
$!l.~
~ ''l
$ ,/J
$j~1fh~
I
I
5
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
COM2008-00078
Payments:
Type of Payment
Check
CredltCard
cRecemtl
RECEIPT #:
1200800000000000159
Date: 02/21/2008
Descnption
Addressmg AssIgnment
Willamalane Smgle Family
Fire SF Fee - ReSidentIal
Storm Dramage ImpervIous Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo ReImbursement
SDC Transpo Improvement
SDC MWMC Improvement
SDC MWMC Admmlstratlon
SDC Sanitary/Storm Admm
SDC TransportatIon Admm
SDC MWMC ReImbursement
Sidewalk Permit
Curbcut Permit
Plan RevIew Major - Plannmg
3 Baths One & Two FamIly
Furnace - up to 100,000 btu
Vent Fan
Dryer Vent
Gas Outlets 1-4
Gas Outlets 4+
Heat Pump
ReSidence WIrIng 1000 Sq Ft
ReSidence WIrIng Ea Addtl 500
Temp Power 200 amps or less
BuIldmg Permit
Storm Sewer Each Addtl 100'
Appliance Vent
Exhaust Hoods
-Mech Iss 2+ ApplIances-
Plan Review ReSidential
Vent Fan
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Admmlstratlve Fee
Paid By
DOUGLAS LARSON
DOUGLAS LARSON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
NJM
NJM
1005
In Person
021012 In Person
Payment Total:
Page 1 of2
2:28:49PM
Amount Due
3500
2,51300
15580
1,14351
885 50
673 33
19548
862 25
99039
10 00
17449
6830
9535
8500
8500
205 00
33700
1400
2100
700
500
200
1400
11700
10500
5500
1,288 72
1600
700
10 00
4000
27 93
700
11904
240 69
21615
$10,826.93
Amount Paid
$1,82693
$9,00000
$10,826.93
2/21/2008