HomeMy WebLinkAboutPermit Building 2005-10-25
Status: . Issued
.~ 225 Fifth Slreet, Springfield, OR
" 541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
-.
.. CITY OF SPRINGFJELD '
Building/Combination Permit
PERMIT NO: COM2005-01234
ISSUED: 10/25/2005
APPLIED: 09/09/2005
EXPIRES: 04/25/2006
VALUE: $ 204,800.00
,
. SITE ADDRESS: 570 Etban Ct
ASSESSOR'S PARCEL NO.: 1703221207400
Springfield TYPE OF
Single Family Residence
. TYPE OF USE: New
.:. PROJECT DESCRIPTION: Single family residence. Breanne Commons lot 16
Owner: MIKE GANSEN
Address: 362 HWY 99N STE 2
EUGENE OR 97402
. Contractor Type
General
Electrical
Mecbanlcal
Plumbing
:h # of Units: .
;' Primary Occupancy Group:
Secondary Occupancy
Yrimary Construction Type
Secondary Construction
# of Bedrooms:
: Front yard Setback:
Side I Sethack:
Side 2 Setback:
Rearyard Setback:
Solar Se tbacks:
Subdivision Not Accepted
'! Street
"
, Storm Sewer Available:
Special Instruction:
Residential
Phone Number: 541-463-1000
REQUIRED PARKING
Overlay nist: Total: 2
# Street Trees 2 Handicapped:
Paved Drive Rqd: Yes Compact:
% Jlib"t~&rage: 33.60
T~IC: PFRMlT SHAll EXPIRE IF TH~.~O~K
~~3...1L!'=Jlt:K IMI\) rt:n"'" ,.:./4J."
IPUBLIC Il\l1I'RONEMI!lN'l.'f'. ONED FOR
"~IJI~It:T:":L.f. U;, IS ABAND
Fullv Improved . ANY 180 DAY PERIOD.Sldewalk Type:
Yes DownspoutslDrains
I CONTRACTOR INFORMATION'
I
R-3
U
VN
3
I DEVELOPMENT INFORMATION'
14,00
18,00
7.00
15.00
22.50
Phone
541-463-1000
541-461-0387
541-726-0100
541-607-8879 .
5,153
1,296
642
440
, Curbside 5'
Curb and Gutter
Notes: No hook-up to City Infrastructure until Public Improvements accepted by the City; storm drainage piped to curb
race 9/14/2005 CAS
Contractor License Expiration Date
MIKE GANSEN CONST~Cfri!iNa:lf)~"~l!m9 06/1412009
MAG ELECTRIC INC N olow rUles adoPted'i4983~~qUires yoJMI3/2005
COMFORT FLOW . otlflcation Center Th ~60(he Oregon Ut06~712007
TOMS PLUMBING siR~~00I-on'1 n ,JS}J42s'es are set :il~I,!..212006
I nLJ,;'~';,~d W-F9RMA1ll:lQN~'; 'o7~H 952-001.
nUmb 'r f(J~ -~, ""', (JlJote: the tel: rUles by
# orS~i'l~~ Oregon Uti/it ^,,,,2phoD,ot Size:
HelglliWiter IS l-aOO.332.!.2J:;00ICat,S(jIFt 1st Floor:
Type of Heat: Forced A'fr &as Sq Ft 2nd Floor:
Water Type: Gas Sq Ft Basement:
Range Type: Gas Sq Ft Garage/Carport
Energy Path: Path I Sq Ft Other:
Sprinkled nla Occupant Load:
I or 4
.
.
CITY OF SPRINGFIELD
Status: Issued
, 225 Firth Street, Springfield, OR
54I-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit.
PERMIT NO: COM2005-01234
ISSUED: 10/25/2005
APPLIED: 09/09/2005
EXPIRES: 04/25/2006
VALUE: $ 204,800,00
Description
A.C. - Residen
Dwellines
Garaee
Type of Construction
AC - Residential
V Wood Frame
Garaee
I Valuation Descriotion I
$ Per Sq FI Square Footage
or multiplier or Bid Amounl
$4,00 1,938.00
$96,00 1,938,00
$25.00 440.00
Value
Date Calculated
Tolal Value of Project
$7,752.00
$186,048,00
$11,000.00
$204,800.00
09/09/2005
09/09/2005
09/09/2005
Fpp< P'lW
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $589.49 9/9/05 1200500000000001331
-Mechanical Issuance Fe.... $10.00 10/25/05 1200500000000001603
+ 10% Administrative Fee 5151.39 10/25/05 1200500000000001603
+ 7% State Surcharge $105,97 10/25/05 1200500000000001603
3 Baths One & Two Family 5306.00 10/25/05 1200500000000001603
Addressing Assignment $31.00 10/25/05 1200500000000001603
Appliance Not Listed $18.00 10/25/05 1200500000000001603
Appliance Vent $6.00 10/25/05 1200500000000001603
Building Permit $906,90 10/25/05 1200500000000001603
Copies - Ea Addtl @ 50 Cnts Ea $12,00 10/25/05 1200500000000001603
Copy 6th @ 75 cents $0,75 10/25/05 1200500000000001603
Curbcut Permit 580,00 10/25/05 1200500000000001603
Dryer Vent $6.00 10/25/05 1200500000000001603
Exhaust Hoods 59.00 10125/05 1200500000000001603
Furnace - up to 100,000 btu $12,00 10/25/05 1200500000000001603
Gas Fireplace $15.00 10/25/05 1200500000000001603
Gas Outlets 1-4 $4.00 10/25/05 1200500000000001603
Plan Review Major. Planning $150,00 10/25/05 1200500000000001603
PW Disc - 2nd Permit (Street) $-30,00 10/25/05 1200500000000001603
Residence Wiring 1000 Sq Ft $106.00 10/25/05 1200500000000001603
Residence Wiring Ea Addtl 500 $57.00 10/25/05 1200500000000001603
Sanitary Sewer - Improvement $495,82 10/25/05 1200500000000001603
Sanitary Sewer - Reimbursement $651.82 10/25/05 1200500000000001603
SDC MWMC Administration $10,00 10/25/05 1200500000000001603
SDC MWMC Improvement $865.31 10/25/05 1200500000000001603
SDC MWMC Reimbunement $82.03 10/25/05 1200500000000001603
SDC SanltarylStorm Admin 5145.71 10/25/05 1200500000000001603
SDC Transpo Admin 564,03 10/25/05 1200500000000001603
SDC Transpo Improvement $805.70 10/25/05 1200500000000001603
SDC Transpo Relmbunement $182,69 10/25/05 1200500000000001603
Sidewalk Permit $80,00 10/25/05 1200500000000001603
Storm Drainage Impervious Area $1,101.43 10/25/05 1200500000000001603
Temp Power 200 amps or less $50,00 10/25/05 1200500000000001603
Vent Fan $18.00 10/25/05 1200500000000001603
2 of 4
.
.
CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01234
ISSUED: 10/25/2005
APPLIED: 09/09/2005
EXPIRES: 04/25/2006
VALUE: $ 204,800,00
Willamalane Single Family
$1,000,00
10/25/05
1200500000000001603
Total Amount
$8,099.04
I Plan Reviews I
Initial Review
Plan nine Review
Public Works Review
09/12/2005
09/13/2005
09/1312005
09/13/2005
10/03/2005
09/14/2005
APP
APP
APP
LLH
TAJ
CAS
No hook-up to City Inrrastructure
until Public Improvements accepted
by the City; Storm drainage piped te
curb face 9/14/2005 CAS
Approved as noted on plans
Structural Review
09/1312005
09/22/2005
APP
TCM
To Request an inspection can 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. win be made the following
work day,
i '~'~i,~,[,rr.,t T' ~rJections I
lIilli!ifil 'f1r'" ...11 r
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed,
Sidewalk - Curbside: Arter forms are erected but prior to placement of concrete.
Curbcut - Standard: Arter forms are erected but prior to placement of concrete,
Vfer Electrical Ground: Install ground rod at rooting and call for inspedlon in conjunction with roollng and/or
foundallon Inspection.
Fooling: After trenches are excavated,
c
Foundation: After forms are erected but prior to concrete placement,
Post and Beam: Prior to Door Insulation or decking,
Floor Insulation: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials,
Framing Inspecllon: Prior to cover and after all rough In inspecllons have been approved.
Wall Insulallon: 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.
VnderOoor Plumbing: Prior to Insulation or decking.'
Rough Plumbing: Prior to cover and including required tesllng,
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.
3 of 4
.
.
CITY OF SPRINGFIELD I
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-01234
ISSUED: 10/25/2005
APPLIED: 09/09/2005
EXPIRES: 04/25/2006
VALUE: $ 204,800.00
Final Plumbing: When aU plumbing work Is complete.
Undernoor Mecbanical. Prior to Insulation or decking and including required testing,
Undernoor Gas: After line Is installed and required testing and capped ir not attached to an appliance,
Rough Gas: Arter 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,
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 stale and agree, thai 1 have carefully examined Ihe completed application and do hereby certify that all
information hereon Is true and correct, and I further certifY thai any and all work performed shall be done In accordance
with the Ordinances of the City of Springfield Wld the Laws of the State or Oregon pertaining to the work described herein,
and that NO OCCUPANCY wID 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 . 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. ated at the front ofthe property, and the approved set ofplWls wID remain on the site
at all ti~~, d~~7st OIL
.P';4;:?'~~_ /()~z....>-o5
Owner or Contractors Signature
Date
4 of 4
",\(\\1
10110
,~0 . '0,0
. ~e' e(\"
'l.I0" .\\e I
:0((\' aC\ .-"""
s.'5s'J; $09 ,~
0' \1 lEU> .'. /'
225FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX!:'(5~~3689 {.. ' 'i,~ ...........-
70(\\ :\Ia" ~"""""''''',~'
'(\99\0 1.0(\\<:' .
2. ~'i::ii~Cf9RLYSTA.LiA'1tqN:6,yi;Y;1 B, f~~~i~es oh~e~ ,Installatio"n, Aiteraii~ns or~~io~:ilio~: '1
Electrical Contractor .t:in/./) 1.ItZ/iJ'I &" 200 Amps or less $ 63.00
I 201 Amps to 400 Amps $ 75.00
Address cZ1..,){} /),tI/hV k (wC 401 Amps to 600 Amps . $125,00
AT601~riGNoq6061%h~1W reqUires you to $163,00
Phone y'{, I-C 3%7 foll'ffi!e\-lj'llo02A1fIp>sYv6IUY the Ore[,jvlI vu:")' $375.00
- NotifRect\1i1'eft'OrlW' 1 hose rules a,,, """. .v,ts 50,00
in OAR 952-001-0010 through OAn "::,,,,-uvl-
0C'e9tTeilIit~r9lS'tr\G&&llltfJii,m~i1~rUtes. uY. <'
catting lhe cehler, (Mlle. LtrEl'lSttiI-'IIUrll:l
nu ~iI'stallli"t1on'1fARefallo'il b~iR'ejo"~81i~iYation
200 A!rtljJ1Wli!!.sl-BOO-332-2344). \ $ 50,00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
D. I JirliitCti.drctiits .\" . ' '. ' .. ..'
:;:tur: ~erv;.'sin ~.g E~leCtrician New A1teratioo or Extensioo Per Paoel
#,1./{ ,. ~ One Circuit
Each Additional Circuit or with
M I' ^ ~r.r.. Service or Feeder Permit $ 3.00
~::: Na; \ ~~' fifJ5 \ E. LMisc"Jlah~ous: (Se~ice/feederoot included) -'Each:li.si.Il~lion 1
City fiYlP"~ _ Pho~ ~ Pump or irrigation ''IIOfl,\\$50,00:
~ . ~~utline LI' hli'!'1.P\P-f, If 'lHt... l~~ 50.00
OWNER INST ALLATION ~O, ,~~~~ '\..~'WliSl PEP-t;\"-'i) I $ 25.00
'l~\.l11S.l'r.,~.,,<>nJ. ~,_ , 1I\!In:"'OO~E\J rt{., $ 45.00
The installation is being made on e'-em/ I own which _ ~U~~'''- , I"'"''
:::::~;7::: sale, le~e or rent, ~~d.~~;.~tlon Fee Is 545.00 +iur~\5~
\4. .'\ \
i..\-W
~4C\.t\
ELECTRICAL P~RM{r.{1ffLlCATION
City Job Number ~~~ Date
1. W:.().ii4'ijON.OFnv.STALLA'fI()N.\'.'~,"-, ';.1
5~O t1hlV\ ('!""
LEGAL DESCRIPTION
I 'lLJ.3'Z.211.. 01'\CO
JOB DESCRIPTION . c9.3')B
~n~~~~I;W~
not started within 180 days of issuaoce or Ir work is
Suspeoded ror 180 day.. '
City .dy!'/h P
Supervisor License Number J-.l7C;~ <;'
/tJ~/-OI
JC/CJ %3</
J<2-/3~a:;-
Expiration Date
Constr. Contr. Number
Expiration Date
Inspection Request: 726-3769
~",.,\e C.\o.ft'u
3. r '9QMPUT~ FIfE.SCHf,Aflt;i, B:ELOW: ..
.',,-, "
,I
A. r);te!i'i!!~ide~t!~!::' l!ingi~ or ~uiii-Fa';'i1y p~r dwel)iI!g'';n!t.'. :1
I\'){O Lt>
ffi .0{)
Service locluded
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereor
t $106,00
~$19,00
Each Manuract'd Home or
Modular Dwelling Service or
Feeder
$50.00
,., .
.1
"
cDpo
,
C',',
> ,t~,.'
$ 43,00
"
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding Fol'l1'1SlElecmcal Pennit Application I-G3.doc
CITY OF aNGFIELD SYSTEMS DEVELOPME.ORKSHEET
JOURNAL OR JOB NUMBER: COM2005-01234
NAME OR COMPANY: Mike Gansen
LOCATION: 570 Ethan Ct
TAX LOT NUMBER: 1702122207400
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF: 1958 LOT SIZE (SF):
I'~
en
u.:l
Cl
o
u
e<:
5153 ~
en
G
~
L STORM ORAINA(;E
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I
I 3410.00 I $0.323 I = I $1,101.43
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I
I 0.00 I I $0.323 I I 50% = I
ITEM I TOTAL - STORM DRAINAGE SDC '$1,101.43
2. SANITARY SEWER - CITY
A. REiMBURSEMENT COST:
I NUMBER OF DFU's I x
I 26 I
DISCOUNT
$0.00
$1,101.43 11070
COST PER DFU
$25.07
$651.82 1091
I
$495.82 11092
I
B, IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 26 I $19.07
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $1,147.64
,1 TRANSPORTATION
A. REIMBURSEMENT COST:
I ADTTRlPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI
I 9.57 I I I $19,09 I 1.00 I
8. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIPFACTORI
I I , I 1.00
9.57 I I I $84.19
ITEM 3 TOTAL - TRANSPORTATION SDC = I $988.39
$182.69 1093
$805.70 1094
4 SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER ~F FEU'S: x
ICOST PER FEU
I $82.03
=
$82.03
1054
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I $865.31
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANlT ARY SEWER SDC =,
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = ,
~. AOMlNISTRATIVE FEE'
I SUBTOTAL x I ADM. FEE RATE I~
I $4.194,80 5% I
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
= $865.31 11055
$0.00 11054
$ 10.00 11056
$957.34 I
$4,194.80 I
CHARGE
$209.74
145.71 :11079
$64.03 11078
TOTAL SDC CHARGES =, $4,404.54
Cheryl Slaymaker
9/14/2005
PREPARED BY
DATE
. .
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUlV ALENT ~ DRAINAGE FIXTURE UNITS II
(NOTE. FOR REMODELS, CALCUI.A TE ONLY TIlE NET ADDITIONAL FlXTIJRES)
NO. OF FIXTURES DRAlNAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
IBATHTUB 1 0 3 ~ 3 -I
IDRINKING FOUNTAIN 0 0 1 ~ 0
IFLOOR DRAIN 0 0 3 ~ 0
IINTERCEPTORS FOR GREASE lOlL / SOLIDS / ETC. 0 0 3 ~ 0
1 INTERCEPTORS FOR SAND / AUTO WASH I ETC. 0 0 6 ~ 0
ILAUNDRY TUB 1 0 2 ~ 2
ICLOTHESW ASHER I MOP SINK 1 0 3 ~ 3
ICLOTHESWASHER - 3 OR MORE rEA) 0 0 6 ~ 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 ~ 0
I RECEPTOR FOR REFRIG I WATER STATION / ETC. 0 0 1 ~ 0
1 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 ~ 0
ISHOWER- SINGLE STALL 1 0 2 ~ 2
ISHOWER- GANG (NUMBER OF HEADS) 0 0 2 ~ 0
I SINK: COMMERCiAURESIDENTIAL KITCHEN 1 0 3 ~ 3
SINK: COMMERCIAL BAR 0 0 2 ~ 0
S(NK: WASH BASINIDOUBLE LAVATORY 1 0 2 ~ 2
S(NK: SINGLE LA V A TORY /RESIDENTIAL BAR 2 0 1 ~ 2
URINAL. STALL / WALL 0 0 5 ~ 0
TOILET. PUBLIC INSTALLATION 0 0 6 ~ 0
ITOILET. PRIVATE INSTALLATION 3 0 3 ~ 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 ~ 0
TOTAL DRAINAGE FIXTURE UNITS 26
.EDU (Equivalent DwellinR, Unit) is a discharge equivalent to a sin~le family dwellim~ unit (20 DFlfs) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR CREDIT RATE/$I,OOO
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 2
BEFORE 1979 $5.29 (Enler I rnr Yes, 2 for No)
1979 $5.29 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2
1980 $5.19 (Enler I for Yes, 2 ror No)
1981 $5.12 BASE YEAR 1979
1982 $4.98 I
1983 $4.80 CREDIT FOR LAND (IF APPLICABLE)
1984 $4.63 VALUE /1000 CREDIT RATE
1985 $4.40 $0,00 x $5.29 ~ , $0,00
1986 $4.07 I
1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 $3.22 VALUE I 1000 CREDIT RATE
1989 $2.73 $0.00 x $5.29 0 I
1990 $2.25 I
1991 $1.80
1992 $1.59 TOTAL MWMC CREDIT ~ $0.00 I
1993 $1.45
1994 $1.25
1995 $1.09
1996 $0.92
1997 $0,72
I 1998 $0.48
I 1999 $0.28
I 2000 I.H" $0.09
I 2001 $0.05
225 Fifth Street
SpriiIgfield, Oregon 97477
5#1-726-3759 Phone
.'
.
a~~eI\lNc'!."'lIlLD..e ....... I..,
~e. .
, .
_.r' '.
~ity of Springfield Official Receipt
.velopment Services Department
Public Works Department
Job/Journal Number
COM2005-01234
COM2005-0 1234
COM2005.0 1234
COM2005-0 1234
COM2005-0 1234
COM2005.0 1234
COM2005.0 1234
QlM2005-0 1234
COM2005-0 1234
COM2005-0 1234
COM2005-0 1234
d'lM2005-0 1234
COM2005-0 1234
COM2005-0 1234
COM2005-0 1234
COM2005-0 1234
COM2005-0 1234
COM2005-0 1234
COM2005.0 1234
COM2005-0 1234
CbM2005-0 1234
COM2005-01234
COM2005-01234
COM2005-0 1234
COM2005-01234
C()M2005-0 1234
COM2005-0 1234
COM2005-01234
""
CpM2005.0 1234
COM2005-01234
COM2005-01234
COM2005.01234
COM2005-01234
COM2005-01234
P.ayments:
T)l>e of Payment
Check
;,
l:t
~.
"
10/25/2005
RECEIPT #:
1200500000000001603
Date: 10/25/2005
Description
Addressing Assignment
Copy 6th @ 75 cents
Copies. Ea Addtl @ 50 Cnts Ea
Willamalane Single Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Sidewalk Pennit
Curbcut Pennit
PW Disc - 2nd Pennit (Street)
Stonn Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC SanitarylStonn Admin
SDC Transpo Admin
Building Pennit
3 Baths One & Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Appliance Vent
Dryer Vent'
Gas Outlets 1-4
Gas Fireplace
Appliance Not Listed
-Mechanical Issuance Fee- '
+ 7% State Surcharge
+ 10% Administrative Fee
Plan Review Major - Planning
Paid By
GANSEN CONSTRUCTION
Received By
djb
I or 1
Item Total:
l;heck Number Aulhorlzatlon
Batch Number Number How Received
13565 In Person
Payment Tntal:
1:24:0IPM
Am... nt Due
31.00
0.75
12,00
1,000.00
106,00
57.00
50.00
80.00
80,00
(30,00)
1,101.43
651.82
495.82
182.69
805.70
82.03
865.31
10.00
145.71
64.03
906.90
306.00
12.00
18.00
9.00
6.00
6.00
4.00
15.00
18,00
10.00
105.97
151.39
150.00
$7,509,55
Amount Paid
$7,509.55
$7,509.55