HomeMy WebLinkAboutPermit Building 2005-9-7 (3)
l
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
. 1..11 i' OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: cOM2005-01116
ISSUED: 09/07/2005
APPLIED: 08/17/2005
EXPIRES: 03/07/2006
VALUE: $ 258,284.00
SITE ADDRESS: 520 Ethan Ct AT~~i-ffI5I~: O;.e~mil->>'~~~'Ylll'lf<!lmily Residence
, ASSESSOR'S PARCEL NO.: 1703221206900 t ~ h th Oreg,gn Utility
follow rule~ adJYPl OF urof: l.1~e~t f rth Residential
PROJECT DESCRIPTION: Single family residence - B~eali~rgtli1llhbriS'1fi'iid ~ftr r heOsAaRtl952 g01
in OAR 952-001-0010 throug -.
. _ _,__ _6..1....... ""ln~ "'"
uu~u. IUU 1II00y v.........,.. ............-. - )
calling the center. (Note: theP..hOD,eINulilber: 541-954-3067
number for the Oregon Utilityl!-II9!!:~i\lPl1er: 541-747-8495
Center is 1-800-332-2344).
Owner:
Address:
DENNIS R MINIUM
8745 THURSTON RD
SPRINGFIELD OR 97478
Contractor Type
General
Electricai
Mechanical
.' Plumbing
I CONTRACTOR INFORMATION I
Contractor
DENNIS R MINIUM
STEVE HAUCK
MICHAEL GRIFFIN
CHAPIN ENTERPRISES INC
Phone
541-747-8495
541-221-2665
541-942-8339
541-485-1146
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
, Rearyard Setback:
Solar Setbacks:
. Subdivision Not Accepted
Street Improvements:
Storm Sewer Available:
Special Instruction:
1
R-3
U
VN
4
10.00
54.00
20.00 .
22.00
32,50
Fully Improved
Yes
License
62682
147618
150189
81994
. Expiration Date
12/1112005
04/3012007
0112312007
05/0612008
BUILDING INFORMATION I
# of Stories: 2 Lot Size:
Height of Structure 27.00 Sq Ft 1st Floor:
Type of Heat: Forced Air Gas Sq Ft 2nd Floor:
Water Type: Gas Sq Ft.Basement:
. - 1" 'e 'l\Iunl'
Range Type:. __:, 'l\ LGasp.E. ISqlFt.Garage/Carport
Energy Path; '- -r, :11 SH" P~ihi, pCSqiF:t Otb~'r! \
. t ' "' ..... . Dr.:.u . nl'" L,:.. nn
Sprinkled Building:D \IN '-' D1a . "DGOecupant.Load:
lit \ .~ nUl \10.. . _ nn \Co o..HA.l'\l 1"'-'"
7,971
969
1,501
520
I DEVELOPMENT.INFORMA:rIONJ'..
h\\l1 ,....-
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
6
Yes
18,60
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
DownspoutsIDrains:
Curbside 5'
Curb and Gutter
Notes: No hook-up to City Infrastructure intll Public Improvements accepted by the City; Storm drainage piped to curb
face 8/19/2005 CAS
Paee 1 of 4
Status Issued
. 225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
. 541-726-3769 Inspection Line
Description
A.C, - Residen
Dweliines
Dweliines
Garaee
Tvpe of Construction
AC - Residentiai
V Wood Frame
V Wood Frame
Garaee
Fee Description
Plan Review Residential
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
3 Baths One & Two Family
Addressing Assignment
Appliance Vent
Curbcut Permit
Dryer Vent
Exhaust Hoods
Furnace - up to 100,000 btu
Gas Fireplace
Gas Outlets 1-4
Plan Review Major - Planning
Plan Review Residential
Plan ReviewlResidential Hourly
PW Disc - 2nd Permit (Street)
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sanitary Sewer - Improvement
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC SanltarylStorm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Storm Sewer Each Addtll00'
Vent Fan
.
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$4.00
$96.00
$96.00
$25.00
Square Footage
or Bid Amount
2,041.00
429.00
2,041.00
520.00
Total Value of Project
Fpp<. PliILI
Amount Paid
$616.95
$10.00
$57.20
$40.04
$306.00
$31.00
$6.00
$80,00
$6.00
$9.00
$12.00
$15.00
$4.00
$150.00
$86.61
$90.00
$-30.00
$106.00
$76.00
$200.00
$238.61
$576.61
$10.00
$865.31
$82.03
$124.81
$65.97
$805.70
$182.69
$80.00
$854.58
$14.00
$18.00
Date Paid
8/17/05
9/7/05
9/7105
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
9/7/05
Paee 2 of 4
. CITY 0.. ~rK.ll"'lj1'1Jj,LD .
Building/Combination Permit
PERMIT NO: cOM2005-01116
ISSUED: 09/07/2005
APPLIED: 08/1712005
EXPIRES: 03/0712006
VALUE: $ 258,284.00
Value
$8,164.00
$41,184.00
$195,936.00
$13,000.00
$258,284.00
Date Calculated
08/1712005
09/0612005
08/17/2005
08/1712005
Receipt Number
1200500000000001207
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
2200500000000001226
r-
.
CITY OF SPRIl'iut<lELD
B_ding/combination Permit
PERMIT NO: cOM2005-01116
ISSUED: 09/07/2005
APPLIED: 08/17/2005
EXPIRES: 03/07/2006
VALUE: $ 258,284.00
Status Issued
U5 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
WlIIamalane Single Family
$1,000.00
9/7/05
2200500000000001226
Total Amount Paid
$6,790.11
I Plan Reviews ,
Initial Review 08/18/2005 08/18/2005 APP SKG
Plannine Review 08/18/2005 09/01/2005 APP TAJ
Public Works Review 08/1812005 08/19/2005 APP CAS
Structural Review
08/18/2005
08/26/2005
WE DLM
No hook-up to City Infrastructure
until Public Improvements accepted
by the City; Storm drainage pipied
to curb face 8/19/2005 CAS
Drawings Incomplete. Called
contractor requesting floor plan for
bonus room and truss dwgs. Bonus
rm. not shown on drawings 8/26/05
dim
Received bonus room pian and truss
drawings 8/31105 dim
See documents for plan review
comments.
Structural Review
08131/2005
09/06/2005
APP DLM
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.
~n,,~,~ti,'"IW
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are Installed.
Sidewalk - Curbside: After forms are erected but prior to piacement 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 andlor
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.
Paee 3 of 4
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-01116
ISSUED: 09/0712005
APPLIED: 08/17/2005
EXPIRES: 03/0712006
VALUE: $ 258,284.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Buiiding 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.
Shower Pan. Prior to covering and including required testing.
Water Line: Prior to filling trench and including required testing.
Sanitary Sewer Line: Prior to fiiling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is compiete.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
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: Approvai required prior to utility company energizing service.
Final Eiectric: 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 ~g-~n.
~ //~ Y;---2;~6(
....-
Owner or Contractors Signature
Date
Paee40f4
lU.,ifi~' a~. S SUbrnitte
approval a ~ d has the '01
n -7- O..J spaN!jji;."ifd:
Zom"g
a'a~Ql-~
IJlIlOf/Zed ..
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 _Slgna'ure~
ELECTRICAL PERMIT APPLICATION 9- 7...- 05'.' ~jJl
City Job Number &y. 0 II 110 Date
. CITY Of"SPRlNGFIELD, OREGON V '
I. LOCA110NOFINSTALL4TlON
>2LJ E~t
or
LEGAL DESCRWTlON
l~o1 2Zi2-0b1oo
JOB DESCRIPTION
J..~ f!u,.,11v IkIJt4,f~.
Permits are non-tr(nsferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 da)'s,
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor StEvE. #/Iud:-
Address p, O. &)C =1-1 J(, I
Phone :JJ./-7166f'
City k
v
Supervisor License Number
55"7-7:1-5
Expiration Date
10-1--07
Constr. Contr. Number /'If-bIg
Expiration Date 4 - .3u - 0 "+
Signature of Supervising Electrician
f) .Jt? a-v
Owners Name ~"n I \\ ~
Addre 8~lJ\
- Phone 104:1
City
. OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale. lease or rent.
Owners Signature:
Inspection Request: 726-3769
-
3. ' COMPLETE FEE SCHEDULE BELOW
A. ; New Residential- Single or 1\1ulti-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
J
If-
$106.00 JO{p,OO
$ 19.00 '7{,JP
Each Manufact'd Home or
Modular Dwelling Service or I
Feeder ATTENTION: Oregon Id" 'C'1u:::S ~a~~8
. c" I. ~rl, !pr! nll the Oregon Utility
B, Services~or F~detS"--crn~hllationt&li~rID~'t;'l:lY~&th>cal iOIl:
Notification Center, Those e A 52-001-
200 Amps of]es~2-001-001 0 through 0 ~ ~~ 00 t
' . J tlie'tUleS '{
201 Amps1b 400JAllijl'S obtain CUfJlt'~ v. ~el'h~e
40] Amp;;:tSi6Qo\A.1n\p.enter, (Nu,,,~.'.':~ le$lit&ffi T'
, ,. lar the Orego.. U"I", tJOl 0
601 Amfi\l.\\llIOOO :<\mp~ is 1-800 332 2~4&i1.63.00
Over 1000 Amps~\\\e ~375.00
Reconnect Only $ 50.00
-
C. Temporary Ser\'ices or Feeders
Installation, Alteration or Relocation
200 Amps or less $ 50.00
M012~OJ 'Amps to 400 Ampsp\oE- IF 1HE- WUt\Y$ 69.00
\". ''';]; C:l'^\ \ L" n IS NUl:.
1H\~QI[Amps to 600 :A:mpsrl\S pE-Rt--A\i $100.00
_ ,,,o<1~[I lINDE-K I . ,'r..~.Cf:lQ
I\\J ,0v~r_t?~tnmrM)'t5 og?,Xp!\.l@eec'B\aDb've:
CD.M\Branch.Ci~cu itsOD
- v .:r DI\Y I't\'l\ ,-- .
I\NNe1v8~lteratioD Dr Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. : SUBTOTAL OF ABOVE
162..,DD
17" l'-I
1620
f2-\Z-/~f
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FOnl'l"/Electrical Pennit Application I-03.doc
erN..QF StlNGFIELD SYSTEMS DEVELOPME~ORKSHEET
JOURNAL OR JOB NUMBER: COM2005-01116
NAME OR COMPANY: Dennis Minium
LOCATION: 520 Ethan Ct
TAX LOT NUMBER: 1703221206900
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF: 2746 LOT SIZE (SF):
7971
,..J;
sa ' Cl
o
U
~
IW
_ ,f-l
en
G
- ~
I STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
, IMPERVIOUS S.F. x I COST PER S.F. CHARGE 1
I 2645.75 $0.323 1 = I $654.56
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 1 I
0.00 I $0.323 I I 50% = I
ITEM I TOTAL - STORM DRAINAGE SDC $854.58 ~
DISCOUNT
$0.00
$854,58
I
I 1070
2 SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x COST PER DFU
I 23 I $25.07 $576.61 1091
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 23 I $19.07 $438,61 11092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $1,015.22
I
3. TRANSPORTATION l
A. REIMBURSEMENT COST:
I ADT TRJP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI
I 9.57 I I I I I $19.09 I 100 I $182,69 1093
B. IMPROVEMENT COST:
I ADTTRJPRATE I x I NUMBER OF UNITS I x I COST PER TRJP x INEW TRIP FACTORI
I 9.57 I I I I I $84.19 I 1.00 $805.70 1094
ITEM 3 TOTAL - TRANSPORTATION SDC "" $988.39
4. SANITARY SEWER. - MW'ill:;
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $82.03 = $82.03 1054
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $865.31 = $865.31 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054
MWMC ADMINISTRATIVE FEE $10,00 11056
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =1 $957.34 J
SUBTOTAL (ADD ITEMS I, 2, 3, & 4) = 1 $3.815.53 .I
5 ADMINISTRATIVE FEE:
I SUBTOTAL x I ADM. FEE RATE 1= CHARGE
$3,815.53 5% $190.78
TOTAL SANITARY ADMINISTRATION FEE: 124.81 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: $65.97 J 1078
Cheryl Slaymaker 8/19/2005 TOTAL SDC CHARGES = I $4,006.31 II
PREPARED BY DATE
. . . "
DRAINAGE FI!TURE UNI'!JDFU) CALCULATION TABLE
NUMBER OF NEW FIXTUJiEs x UNIT EQUIV ALENT ~ DRAINAGE FIX11JRE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EOUIV ALENT UNITS
BATHTUB 1 0 3 = 3 I
DRINKING FOUNTAIN 0 0 1 = 0 I
FLOOR DRAIN 0 0 3 = 0 I
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0 I
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 I
LAUNDRY TUB 0 0 2 = 0 I
ICLOTHESW ASHER I MOP SINK 1 0 3 = 3 I
ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRlG / WATER STATION / ETe. 0 0 1 = 0
IRECEPTOR FOR COM. SINK / DISHWASHER I ETe. 0 0 3 = 0
ISHOWER- SINGLE STALL 1 0 2 = 2
I SHOWER- GANG (NUMBER OF HEADS). 0 0 2 = 0
ISINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
I SINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
I SINK: SINGLE LA V A TORY/RESIDENTIAL BAR 3 0 1 = 3
I URINAL. STALL / WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 23
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a sinRie family dwellinlt unit (20 DFU's) set a11671!ll11ons per day
-
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
~YEAR CREDIT RATEJ$I.OOO 21
ANNEXED ASSESSED VALUE IS LAND ELGlBLE FOR ANNEXA nON CREDIT?
BEFORE 1979 $5.29 (Enter I for Yes. 2 for No) I
1979 $5.29 IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? 2
1980 $5.19 (Enter I for Yes. 2 for No) I
1981 $5.12 BASE YEAR 1979
1982 $4.98 I
1983 $4.80 CREDIT FOR LAND (IF APPLICABLE)
1984 $4.63 VALUE I 1000 CREDIT RATE
1985 $4.40 $0.00 x $5.29 ~, $0.00
1986 $4.07
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
1990 $2.25
1991 $1.80
1992 $1.59 TOTAL MWMC CREDIT = $0.00
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 $0.09
I 2001 $0.05
t.
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
.fity of Springfield Official Receipt
.,evelopment Services Department
Public Works Department
Job/Journal Number
COM2005-0 1116
COM2005-01116
C0M2005-01116
COM2005-01116
COM2005-01116
COM2005-01116
COM2005-01116
COM2005-01116
COM2005-01116
COM2005-01116
COM2005-0 1116
c;OM2005-0 1116
COM2005-01116
COM2005-01116
COM2005-01116
C.OM2005-0 1116
C0M2005-0 1116
C0M2005-01116
COM2005-01116
COM2005-01116
COM2005-011l6
. COM2005-0 1116
COM2005cOlll6
COM2005-0 1116
COM2005-01116
C0M2005-01116
COM2005-01116
COM2005-0 1116
CbM2005-01116
dOM2005-01116
CoM2005-01116
CeM2005-01116
CbM2005-01116
Payments:
Type of Payment
CreditCard
.'
)
:>
,
+
;.
9nJ2005
RECEIPT #:
2200500000000001226
Date: 09/07/2005
Description
Addressing Assignment
Willamalane Single Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sidewalk Permit
Curbcut Permit
PW Disc - 2nd Permit (Street) .
Storm 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 Sanitary/Storm Admin
SDC Transpo Admin
Sanitary Sewer - Improvement
Plan Review Major - Planning
Plan Review Residential
3 Baths One & Two Family
Storm Sewer Each Addtl 100'
Furnace - up to 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
Gas Fireplace
-Mechanical issuance Fee--
+ 7% State Surcharge
+ 10% Administrative Fee
Plan ReviewlResidential Hourly
Paid By
DENNIS R MINIUM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 0077387 In Person
Payment Total:
Page I of 1
9:36:16AM
Amount Due
31.00
1,000.00
106.00
76.00
80.00
80.00
(30.00)
854.58
576.61
238.6i
182.69
805.70
82.03
865.31
10.00
124.81
65.97
200.00
150.00
86.61
306.00
14.00
12.00
18.00
6.00
9.00
6.00
4.00
15.00
10.00
40.04
57.20
90,00
$6,173.16
Amount Paid
$6,173.16
$6,173.16