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Home My WebLink AboutPermit Building 2005-10-25 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01232 ISSUED: 10/25/2005 APPLIED: 09/09/2005 EXPIRES: 04/25/2006 VALUE: $ 235,200,00 Status: Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Springfield TYPE OF SITE ADDRESS: 559 Ethan Ct ASSESSOR'S PARCEL NO,: 1703221206300 Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence, Breanne Commons lot 5 Residential Phone Number: 54I-463-1000 "Owner: MIKE GANSEN 'Address: 362 HWY 99N STE 2 , EUGENE OR 97402 ,; I CONTRACTOR INFORMATION I \} ,- 'l0 ,','-I Contractor ~(\\}\Ie"'~,,~ic~~~,e MIKE GANSEN CONSTRUCTI~~GO~MW~I~~\)\. MAG ELECTRIC INC leQ,00- 'O'l ,'{Ie ,e'" 'O-1~~9834 \l'l COMFORT FLOW O~. 0 oWO o",e 1'\\01' ~~O,\}W'" e CHAPIN ENPii~~S\m.{:~. ""2',n\o\lg_c. 0' '8J?~.4\0~,()" r- ~'''"_ 1 .-.' ....,"'" -,,, ,.... ,- ''-\vV' \0\\0 ~,BI'JILDJNG INFORMA nONI -N.o'i.,~,(j" 9':Jt 'O-~L- <>.1, ~- \)\\"" -:oD,~I' 1 O~~ 'lo~f~tii"., ,:~Q,o" ,-:o-:o'l/?:- 2 R-3,1',,\)9\)' ,^"q"fiI!l\,t\,J.':f. \,<o\)\) 26,00 v ",\,'-,l"~-\<..c, , U (j'O' ';!;)if. ~\C/[lHeat: Forced Air Gas VN I'\I~ ater Type: Gas Range Type: Gas Energy Patb: Path 1 Sprinkled nla Expiration Date 06/14/2009 12/13/2005 06/27/2007 05/0612008 Contractor Type General Electrical Mechanical Plumbing Phone 541-463-1000 541-461-0387 541-726-0100 541-485-1146 # of Units: Primary Occupancy Group: Secondary Occupancy . Primary Construction Type ~' Secondary Construction , # of Bedrooms: Lot Size: 5,332 Sq Ft 1st Floor: 1,458 Sq Ft 2nd Floor: 784 Sq Ft Basement: Sq Ft Garage/Carport 440 Sq Ft Other: Occupant Load: 3 " ~ InEVELOPMENT INFORMATION I A~. REf+.lV~~RKING 13.60 Overlay Dist: ~t.~ l\\ ,S ~ 2 19.00 # Street Trees "~ \,i-\l\ ~"il ~P~d: 5,00 Paved Drive Rqd: . ~ '\~'\ act: 13.00 % of Lot coverag~,\\~\:~~\\ ~'il> ~fO~ 0,00 ~~\~ '?;~1..\~S' \)'il> \~C\l\), IPUBLIC IMPROVEMEN1i..&~~":.'\\"~~ 'it --..,tS ~~ Fullv Improved \>-~-{ dewalk Type: Curbside 5' Yes DownspoutslDrains Curb and Gutter Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Subdivision Not Accepted Street, Storm Sewer Available: Special Instruction: '. , ,Notes: No hook-up to City lnrrastructure until Public Improvements accepted by the City; storm drainage piped to curb face 9/13/2005 CAS t 1 of 4 . Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line c . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-01232 ISSUED: 10/25/2005 APPLIED: 09/09/2005 EXPIRES: 04/25/2006 VALUE: $ 235,200.00 A,C, - Residen Dwellin!!s Gara!!e Type of Construction AC - Residential V Wood Frame Garaee I Valuation Descriotion I $ Per Sq Ft Square Footage or multiplier or Bid Amount $4.00 2,242.00 $96.00 2,242.00 $25,00 440.00 Value Date Calculated Description Total Value of Project $8,968,00 $215,232,00 $11,000.00 $235,200,00 09/09/2005 09/0912005 09/09/2005 F....., PIiiJ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $654.97 9/9/05 1200500000000001332 -Mecbanical Issuance Fee- $10.00 10125/05 1200500000000001604 + 10% Administrative Fee $164.57 10/25/05 1200500000000001604 + 7% State Surcharge $11 5,20 10125/05 1200500000000001604 - 3 Baths One & Two Family $306.00 10125/05 1200500000000001604 Addressing Assignment $31.00 10125/05 1200500000000001604 Appliance Not Listed $18,00 I 0125/05 1200500000000001604 Building Permit $1,007,65 10/25/05 1200500000000001604 Copies - Ea Addtl @ SO Cnts Ea $10,00 10/25/05 1200500000000001604 Copy 6th @ 75 cents $0.75 10/25/05 1200500000000001604 Curbcut Permit $80.00 10/25/05 1200500000000001604 Dryer Vent $6.00 10/25/05 1200500000000001604 Exhaust Hoods $9.00 10/25/05 1200500000000001604 Furnace - up to 100,000 btu $12.00 10125/05 1200500000000001604 Gas Fireplace $i5.00 10125/05 1200500000000001604 Gas Outlets 1-4 $4.00 10/25/05 1200500000000001604 Heat Pump $12.00 10125/05 1200500000000001604 Plan Review Major - Planning $150,00 10/25/05 1200500000000001604 PW Disc - 2nd Permit (Street) $-30,00 10/25/05 1200500000000001604 Residence Wiring 1000 Sq Ft $106.00 10125/05 1200500000000001604 Residence Wiring Ea Addtl 500 . $76.00 10125/05 1200500000000001604 Sanitary Sewer - Improvement $457.68 10125/05 1200500000000001604 Sanitary Sewer - Reimbursement $601.68 10125/05 1200500000000001604 SDC MWMC Administration $10.00 10/25/05 1200500000000001604 SDC MWMC Improvement $.0,39 10/25/05 1200500000000001604 SDC MWMC Improvement $865.70 10/25/05 1200500000000001604 SDC MWMC Reimbursement $82.03 10/25/05 120050000000000I604 SDC Sanitary/Storm Admin $65.67 10/25/05 1200500000000001604 SDC Sanitary/Storm Admin $127.80 10/25/05 1200500000000001604 SDC Transpo Improvement $805,70 10/25/05 1200500000000001604 SDC Transpo Reimbursement $182.69 10/25/05 1200500000000001604 Sidewalk Permit $80.00 10125/05 1200500000000001604 Storm Drainage Impervious Area' $864.35 10/25/05 1200500000000001604 Temp Power 200 amps or less $50,00 10/25/05 1200500000000001604 2 of 4 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01232 ISSUED: 10/2512005 APPLIED: 09/09/2005 EXPIRES: 04/2512006 VALUE: $ 235,200.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Vent Fan Willamalane Single Family $24.00 $1,000,00 10/25/05 10/25/05 1200500000000001604 1200500000000001604 Total Amount $7,975.05 I Plan Reviews , ". Initial Review 09/12/2005 09/13/2005 APP LLH Plannine Review 09/13/2005 09/3012005 APP TAJ Public Works Review 09/13/2005 09/13/2005 APP CAS , ./.. Structural Review No hook-up to City Infrastructure until Public Improvements accepted by the City; Storm drainage piped te curb face 9/13/2005 CAS Approved as noted on plans 09/13/2005 09/22/2005 APP TCM 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. I Reouired I nsnections I 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 ror Inspection in conjunction with rooting 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: Berore 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. Sanitary Sewer Line: Prior to filling trench and including required testing. 3 of 4 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01232 ISSUED: 10/25/2005 APPLIED: 09/09/2005 EXPIRES: 04/25/2006 VALUE: $ 235,200,00 Status: Issued 225 F1fth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underl100r Mechanical. Prior to insulation or decking and including required testing, Underl100r Gas: Arter 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 ir 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: Wben 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 stale 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 or Springfield and the Laws of the State of Oregon pertaining 10 the work described herein, and thai NO OCCUPANCY win be made of any slruclure without permission of Ihe 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 Inspecllons are requested al the proper time, that each address Is readable rrom the street, that the permityBrd L<i I d at the front ofthe property, and the approved set of plans wID remain on the site at all times during construct ~~ ___-- /0- '2-~_o..r - Owner or Contractors Signature Date 4 or 4 CITY OF StiNG FIELD SYSTEMS DEVELOPMEAoRKSHEET JOURNAL OR JOB NUMBER: COM2005-01232 NAME OR COMPANY: Mike Gansen LOCATION: 559 Ethan Cl TAX LOT NUMBER: 1702221206300 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF: 2810 LOT SIZE (SF): 5332 VJ ~ Cl 110 I~ I~ VJ (3 ~ I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I CHARGE I "2676.00 I $0.323 = I $864.35 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 $0.323 I 50% = / ITEM I TOTAL- STORM DRAINAGE SDC $864.35 2. SANITARY SEWER - CITY DISCOUNT $0.00 $864.35 1070 A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 24 B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 24 $19.07 ITEM 2 TOTAL - CITY SANITARY SEWER SDC COST PER DFU $25.07 $601.68 11091 $457.68 1092 =, $1,059.36 3 TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x I NEW TRIP F ACTORI I 9.57 I I I $19.09 I 1.00 $ 182.69 1093 B. IMPROVEMENT COST: I ADTTRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTOR I I 9.57 I I I I $84.19 I 1.00 I $805.70 1094 ITEM 3 TOTAL - TRANSPORT A nON SDC = , $988.39 .. 4 SANITARY SEWER - MWMC A. REIMBURSEMENT COST: /INUMBER OF FEU's I x ICOST PER FEU . I I I $82.03 = $82.03 /1054 B. IMPROVEMENT COST: I INUMBER ~F FEU's I x ICOST PER FEU I $865.31 = $865.31 11055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 11054 MWMC ADMINISTRATIVE FEE $10.00 /1056 ITEM 4 TOTAL- MWMC SANITARY SEWER SDC = , $957.34 I SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ , $3,869.44 I 5. ADMINISTRATIVE FEE: I SUBTOTAL x / ADM, FEE RATE I~ CHARGE I $3.869.44 I 5% I $193.47 TOTAL SANiTARY ADMINISTRATION FEE: 127.80 11079 TOTAL TRANSPORTATiON ADMINISTRATION FEE: $65.67 [1078 , Cheryl Slaymaker 9/13/2005 TOTAL SDC CHARGES =l $4,062.91 PREPARED BY DATE '~.' . . . c' .;.:,~ , ,. DRAINAGE'FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTUREs x UNIT EQUlV ALENT - DRAINAGE FlXllJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TI-lE NET ADDITIONAL FlXllJRES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYpE .~. . NEW OLD EQUIVALENT UNITS I BATHTUB 1 0 3 = 3 I DRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE lOlL I SOLIDS / ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION I ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK I DISHWASHER / He. 0 0 3 = 0 I SHOWER- SINGLE STALL 1 0 2 = 2 I SHOWER- GANG (NUMBER OF HEADS) 0 0 2 = 0 ISINK: COMMERCiAURESIDENTIAL KITCHEN 1 0 3 = 3 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 4 0 1 = 4 IURINAL. STALL I WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S I 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 :1 .EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 m1J's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDIT RATE/$I,OOSlj ANNEXED ASSESSED VALUE ' IS LAND ELGlBLE FOR ANNEXATION CREDIT? 2 BEFORE 1979 $5.29 (Enter I for Yes, 2 ror No) 1979 $5.29 IS IMPROVEMENT ELGII3LE FOR ANNEX. CREDIT? 2 1980 $5.19 (Enter I for Yes, 2 for No) 1981 $5.12 BASE YEAR 1979 1982 $4.98 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 I 1986 $4.07 I 1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) I 1988 $3.22 VALUE /1000 CREDIT RATE 1989 $2.73 $0.00 x $5.29 0 I 1990 $2.25 I 1991 $1.80 I 1992 $1.59 TOTAL MWMC CREDIT = $0.00 I 1993 $1.45 I 1994 $1.25 I t995 $1.09 I 1996 $0.92 I 1997 $0.72 I 1998 $0.48 I 1999 $0.28 I 2000 $0.09 I 2001 $0.05 ,. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . ~~<Ir~~f)726-3 "\~ ELECTRICAL P.~g~~CATION ~"e~~.. ~~ " a{\:-J-a: r+-\to.... City Job Number. Date "..oQ'o . '!-o 1J\<0 . 3. IC(!jMl'hEiFEf#I;:i!f,;,'"A,;.JjjUEEIBEl~. . ,,__ ,..",.., ,..~-"'~.~~=:-.. ,j"".,,,rjr. , ,r.u\\ . O' ' I. I!e€!!TldM'dFlnvST:A"!"!li.:f.i@N:"i!t1~.. 6'G-\--~ ..~ LEGAL DESCRleT,ION (\ f\J _'1 rY'I \ " 03'L.'l. \ L.. l JW;"'l.LI JOBDEjC~~~ ~I\~~ pe~n-transrerable and e~re If work Is not started within 180 days oflssuance or (fwork is Suspended ror 180 days. . A. ~~w~R~~1!!.I~!!g~L~r~M~lti~falmilrJpS)~~e'~h~~lu~it~ Service Included 1000 sq, ft. or less Each additional 500 sq. ft. or portion thereor Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 \Dbft> .5to~ \ 4 $ 19.00 $50.00 Expiration Date 2 rfC'~i~,'J',;Jt'Ci(j)R~~;';;'~':A.' ~-'/'.;~.-FioNl(.jiiEY~ B. rSkgi~~~~~~FJ~d~~~~i' ;l'~ii':tf~~;~Xlie~ii~'s101r.'fR~la~atlol~~W . . ~":'~'~>>-""""-~-'-"...... .....Iti...-. _'-"~ ,...,... lidll.,'I......I..'. I~ /I ".#.' e~Il\le \)\\\\\'1 ElectricalContractor _fAA)t() /&//.ty cf}ec; 20o.0f\lps\(\f1e5IegOl\ \OI\tI $63.00 ,O\'t OJ8re\!rll>~ ~~O~.bmpS se~.()O~' $ 75,00 Address ~-;( a~.,fA/} _es ad4'~\A~1g.6HR\.-tn\~ 9'5 \eS '0\1 $125,00 \0" ~\Ol\ ce~%~&\I\699~rilp~ I~Ol\e $163.00 City _..c~f) _ Phone --'i".0~~5'2.'()~9't%\100'OC~~i.~Olis'l\e\\C3\\0l\ $375.00 C/ l\ () 'loll \'lI3Re~W!!1ec\t0riI\l\i\l\'l NO\\ $ 50.00 C09 " 9 \tle ce f"\~l\ .~ Supervisor License Number 47'1cZS ca~~el QlIil.T~~r".....~$lces o. l1~de~ \,J ce(\'{e /(y (-IJ/ Installation, Alteration or Relocation . ~ / 200 Amps or less J '-I9J'..:5Y 201 Amps to 400 Amps , 40 I Amps to 600 Amps /...)- / ~-o.) Over 600 Amps or 1000 Volts see "B" above. D. i~;a~~~(~lftul!~~~:>~v~~ $ 50.00 $ 69.00 $100.00 Constr. Contr. Number Expiration Date ::;:;;~Ii:g;trician Address New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43,00 $ 3.00 ll. ~ Iln .. \ ~ ~ ll\tl'11 ..,"' N.-I-",I~ ~ W ~.'~' f1~;/L'1~.:u1i"t1 ~~ !f.,Illl"'jt.,." ~ ,.' 4!"il-"......"" I l\, ~ V\~ J'-J E. r~is.ce~.laneol\s (Ser.viceJfeeile. noUucl,ud -Eac,!!lnst~lIa!ion Phone ~o...~ \a:o \\it91 i~~a~'Th\.\. ty.P\l'It "~~1 ~ ~10.00 ~~t&\L'i"l~ "{~\S,,~ ~ f~ $ 50,00 OWNER INSTALLATION ~, . '0\P.a ~i$_~OOr.ioi - $25,00 " '",;,NI' I ~~l'al $ 45,00 The installation is being made on property I own which W..... .Son...... is not intended ror sale, lease or rent. Mini'A~ fd~~~ ermillnspeclion Fee Is $45.00 + Surcbarges 4. rs'VB1:0TM;'+9~ok1 . \loO ';~~':~l: ~urcharge \ M ~:~:~inistratiVe Fee fL'L4 .:~ City Owners Signature: Inspection Request: 726-3769 Shared Drive(T:)lBuilding Fonns/Electrical Permit Application 1-03.doc 225 Fifth Street SpriJi~held, Oregon fJ747"1 541-726-3759 Phone . -:l:~':D ~.. UA.. .. : ~ Ci!y of Springfield Official Receipt .elopment Services Department Public Works Department Job/Journai Number COM2005-0 1232 COM2005-0 1232 COM2005-01232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-01232 COM2005-0 1232 COM2005-01232 COM2005-01232 COM2005-01232 COM2005-0 1232 COM2005-0 1232 COM2005.0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 , COM2005-01232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 CbM2005-0 1232 COM2005-0 1232 COM2005-0 1232 d:lM2005-0 1232 COM2005-0 1232 COM2005-01232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 COM2005-0 1232 , , Payments: TWe of Payment Check ;1 " 'I :l: :i " 10/25/2005 RECEIPT #: 1200500000000001604 Date: 10/25/2005 Description Addressing Assignment WiIlamalane Single Family Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Copy 6th @ 75 cents Copies - Ea Addtl @ 50 Cnts Ea Sidewalk Pennit Curbcut Pennit PW Disc - 2nd Pennit (Street) Stonn Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbun;ement SDC Transpo Improvement SDC MWMC Reimbun;ement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Stonn Admin SDC Sanitary/Stonn Admin SDC MWMC Improvement Building Pennit 3 Baths One & Two Family Furnace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent. Gas Outlets 1-4 Gas Fireplace Heat Pump 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 I Item Total: Lbeck Number Aulllortzalion Balch Nwnber Number How Received 13564 In Person Payment Total: 1 :24:S9PM Amount Due 31.00 1,000.00 106.00 76.00 50,00 0,75 10,00 80,00 80,00 (30,00) 864.35 601.68 457,68 182,69 805.70 82,03 865,70 10,00 127.80 65.67 (0.39) 1,007.65 306.00 12.00 24.00 9.00 6.00 4.00 15.00 12,00 18.00 10.00 115.20 164,57 150.00 $7,320.08 Amount Paid $7,320.08 $7,320.08