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Home My WebLink AboutPermit Building 2008-3-18 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00339 ISSUED: 03/18/2008 APPLIED: 03/12/2008 EXPIRES: 09/1812008 VALUE: $ 222,565.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1707 S 58TH ST ASSESSOR'S PARCEL NO.: 1802030009200 SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single Family Residence Owner: HA YDEN ENTERPRISES Address: 2622 SW GLACIER PL #110 REDMOND OR 97756 Residential Phone Number: 541-228-6935 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor License Expiration Date HA YDEN ENTERPRISES 92208 07/29/2009 TOP NOTCH ELECTRIC INC 16~ you to 09/29/2008 PACIFIC AIR COMtffl~\Q'froN: Oregon law ~J~on Utility 03/25/2010 DENNIS SCOTT E~~~~~ules adoPte~~~~ nW:!s7ffiJie set fo~th 05/05/2010 ti, U"~I~a1VIWP1h~~e~~~~~U~y 'r~In I;UP''''....1iIt 0090. You may 0 (Note: the te\epho~e . ca\l{h~~t~wm~er. Utility NotificatlonLot Size: numUit~<tflS!ar~9P .a32.234"'~'00 Sq Ft 1st Floor: TYR!lert_ta: 1-800 Gas Sq Ft 2nd Floor: Water Type: Gas Sq Ft Basement: Range Type: Gas Sq Ft Garage/Carport Energy Path: Path 1 Sq Ft Other: Sprinkled Building' n/a Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB 3 I DEVELOPMENT INFORMA nON I Phone 541-228-1081 541-317-1998 541-672-9510 541-459-0110 1,008 1,005 400 REQUIRED PARKING 2 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 19.30 14.00 10.00 46.00 18.50 Overlay Dist: Total: # Street Trees Rqd: 2 Handicapped: Paved Drive.R,gd: Yes Co~act: % of ~O(fM<<~;ge: HAll EX",~!qf THE WOR THI~ PE~~i~ ~Mn~R TH\5 PERM\T_~;-~OT I PUBLIC IM~~{~ \5 ~BANDUNtU f F II I d ANY 180 oAYPER10P.Uewalk Type: u V mprove Yes Stormwater to be directed to weep hole in curb. Street Improvements: Storm Sewer Available: Special Instruction: Downspouts/Drains: Notes: Paee 1 of 4 Curbside 5' To Storm Sewer Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Type of Construction Dwellinl!s Garal!e V Wood Frame Garal!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 Fireplace (Listed) Furnace - up to 100,000 btu Gas Outlets 1-4 Gas Outlets 4+ Plan Review Major - Planning PW Disc - 2nd Permit 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 Vent Fan I Valuation Descriotion I $ Per Sq Ft or multiplier $105.00 $28.00 Square Footage or Bid Amount 2,013.00 400.00 Total Value of Project ~ Amount Paid $691.07 $40.00 $185.48 $208.10 $103.96 $337.00 $35.00 $7.00 $1,063.18 $85.00 $7.00 $10.00 $120.65 $17.00 $14.00 $5.00 $2.00 $205.00 $-30.00 $117.00 $63.00 $612.12 $805.00 $10.00 $990.39 $95.35 $141.06 $862.25 $195.48 $71.28 $85.00 $676.12 $16.00 $55.00 $21.00 Date Paid 3/12/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 3/18/08 Pal!e 2 of 4 CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2008-00339 ISSUED: 03/18/2008 APPLIED: 03/12/2008 EXPIRES: 09/18/2008 VALUE: $ 222,565.00 Value Date Calculated $211,365.00 $11,200.00 $222,565.00 03/12/2008 03/12/2008 Receipt Number 2200800000000000313 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 1200800000000000245 Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00339 ISSUED: 03/18/2008 APPLIED: 03/12/2008 EXPIRES: 09/18/2008 VALUE: $ 222,565.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Willamalane Single Family $2,513.00 3/18/08 1200800000000000245 Total Amount Paid $10,435.49 I Plan Reviews I Plannine: Review Public Works Review Structural Review 03/12/2008 03/12/2008 03/12/2008 03/12/2008 03/12/2008 03/12/2008 APP APP APP TAJ BRC DLM SDC Worksheet Attached. BC Approved as noted on the plans 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. 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. 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. 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. Pae:e 3 of 4 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2008-00339 ISSUED: 03/18/2008 APPLIED: 03/12/2008 EXPIRES: 09/18/2008 VALUE: $ 222,565.00 225 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 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. 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. 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. - ~~/)~-~ Owne~ or Contractors Sign:kwk 3' -/t'-o ? Date Pa2e 4 of 4 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER COMl008-000339 NAME OR COMPANY Hayden Homes LOCATION 1707 South 58th Street TAX LOT NUMBER 18-02-03-0009200 DEVELOPMENT TYPE Smgle Farmly Residence NEW DWELLING UNITS 1 BUILDING SIZE (SF: 1954 LOT SIZE (SF) 1 STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S F x I COST PER S F CHARGE 1954 00 I $0.346 = $676 12 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S F 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 ! $676.12 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = ! 3 TRANSPORTATION A REIMBURSEMENT COST I ADT TRIP RATE x I 957 2 SANITARY SEWER - CITY A REIMBURSEMENT COST NUMBER OF DFU's x 30 B IMPROVEMENT COST NUMBER OF DFU's x 30 B IMPROVEMENT COST ADT TRIP RATE x 957 7056 r:/) f.I.l o o u ~ f.I.l t-< r:/) o ~ DISCOUNT $000 $676.12 1070 COST PER DFU $26 83 $805.00 1091 COST PER DFU $20 40 $612.12 11092 I I $1,417.12 I NUMBER OF UNITS x I 1 x INEW TRIP FACTOR I 100 COST PER TRIP 2043 $195.48 1093 I NUMBER OF UNITS x I 1 x INEW TRIP FACTORI I 100 I $862.25 11094 I I = $95.35 1054 COST PER TRIP $90 10 $1,057.73 ITEM 3 TOTAL - TRANSPORTATION SDC = ! 4 SANITARY SEWER - MWMC A REIMBURSEMENT COST NUMBER OF FEU's 1 x 1 I B IMPROVEMENT COST NUMBER OF FEU's x 1 ICOST PER FEU I $95 35 COST PER FEU $990 39 = $990.39 1055 $0.00 1054 $10.00 1056 =! $1,095.74 r =, $4,246.71 I CHARGE $21234 14106 11079 $7128 , 1078 TOTAL SDC CHARGES $4,459.05 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMlNISTRA TIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL (ADD ITEMS 1,2,3, & 4) 5 ADMINISTRA TIVE FEE I SUBTOTAL x ADM FEE RATE I $4,24671 5% TOTAL SANITARY ADMINISTRATION FEE TOTAL TRANSPORTATION ADMINISTRATION FEE Billy Curtiss PREPARED BY 3/12/2008 DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIV ALENT ~ DRAINAGE FIXTIJRE UNITS (NOTE FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 2 0 3 = 6 IDRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0 \INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 = 0 LAUNDRYTUB 1 0 2 = 2 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC 0 0 1 = 0 \ RECEPTOR FOR COM SINK / DISHWASHER / ETC 1 0 3 = 3 ISHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 I SINK COMMERCIAL BAR 0 0 2 = 0 SINK WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 SINK SINGLE LA V ATORY/RESIDENTIAL BAR 2 0 1 = 2 URINAL, STALL / WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 ,TOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 30 'EDU (Eqwvalent Dwelling Umt) IS a discharge eqwvalent to a smgle famIly dwelling umt (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE $529 $529 $519 $512 $498 $4 80 $463 $440 $407 $367 $322 $273 $225 $180 $1 59 $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 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0 00 x $5 29 = I $000 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0 00 x $5 29 o TOTAL MWMC CREDIT $000 = ZON uL(' INlTIALS f\ (>';) j DATE c;ho \0 ~ SOURCE 2251<lJI HI STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number CD i11~ . on --; 7., ~ ~N"<"~-~~JW:lr,",;;~~--": 1. tiJ,T,Q'(tAt'F,v 1 "'m:-~ ,~~~<-k'tfJ <r'~":}l~r,,, ~~!.{ .:;-} P;;:~:..T 1 ~:'l"'~'Y~I~1{ Jl;'-U:' , ,~~,~" :TL,,~ ,Q'Pf;1!:;1~':, .. ~.t, ,:::~'.~.<~lfu......,~~~_..d "_k,,-olJt:::' ~ i':. '", Date _ ~! 12-/ cJ6 I, ~1 :1"~ <<:-~"'-~ -:ow-, ~t^'!J=<'i"'-'~~T<t~"",~"'~r;'r'i,~~~"4l ~-~d""'i"'F"r~:~"T,..-,~t;fJ7'i~~"= ,~~:"P 1;<'i'i;;';- 3. ", COMPLETE.1:'~'S'CHEJ)l.lLEB1mOW"'::~;2;: ; i~" ~i-~ _::_:t ,'.-.<'" k.<j.;:q:~iL\(x,~""....Ll\,~;~_",\.~~;..~\",_~f~~=c. ~';,L~ <t...Y ,_"';,,'^, ~<l- '101 S' 5<6t'h LEGAL DESCRIPTION: Hol3rJ!J0l) \ q2-t JOB DESCRIPTION: .(~!f ,n~"?M~~?;~0:: ':~i-. A. ~:"NiiwX:R'esidP' ~lt~d'-k l<LuJ...~<v~~~~~l<j~JJ" ~,~ 7~i\;: w~<t; 3tmib\~ ' ,I> ,!l","<f.m"><~~ h~ ~ Service Included 1000 sq. ft. or less Each addItional 500 sq. ft or pomon thereof Each Manufact'd Home or Modular Dwellmg Service or F e_e(lf~r I 3 $11700 /l7,{ff) ~3()-r) $ 21.00 Permits are non-transferable and expire if work IS not started within 180 days of issuance or If work is --Suspended.Jol'--180-days_-~--- $55 00 2. B. Electncal Contractor ?;tf1)Jb!cJ., .r-/ec 200 Amps or less , 201 Amps to 400 Amps Address ;;20879 ~ C f 401 Amps to 600 Amps n ATTENT'O~ o.~ggnJ~}~..re' 601 Amps to 1000 Amps CIty --iD~!O-::.Cvv IlJ1n~agplU(n~YUi'e~~ Y~er 1000 AmPSI vOllS \lUIIT/Catlon Center Those I n Utll~connect Only in OAR 952-001-00'10 throuruhes are set forth 0090. You m~' . 9 OAR 952-00:t..":;p Supervisor License ~ng t/:le atn~io/~Ples of the rul6S &fi ' numbe for t~ 0 I. (Note:. ~ne te'~~hone ExprratIon Date ~e1 i~ ~~i~on aUtlllty Notlflcatiol\nstallation, Alteration or Relocation - 32-2344). 200 Amps or less j Constr Contr. Number /7 2- "3 fR C:, 201 Amps to 400 Amps 401 Amps to 600 Amps ~7 $ 70.00 $ 83.00 $13800 $180.00 t413-00 $ 55 00 55,O?) $ 55 00 $ 76 00 $11 0 00 ExprratlOn Date SIgnal 're of S,:pervJsing plectncian ~R_ Over 600 Amps or 1000 Volts see "B" above. ?!' l ~=-J"',,"V D. "ilK: '<.1<::-"",,~,'>"IMN New Alteration or Extension Per Panel One Circuit Each Additional Circmt or with Owncr, N";"e / ~'L k...-.lJ Scryice 0' Feodcr Penrut Address ;laJlffl/S ~-+.- I_E. .? ^ ;1 AUTHOQ ~ll EXf3/I1E IF THE WORK City I;>~I OOMM 'P Yft0ER7Rifs ~'T IS~or irrIgation ENCED OR IS ABANDONED FOftIgn/Outline Lighting OWNER-INSTAL&-NbJPf>_DAY PERIOD. - $ 48.00 $ 400 -The installation is being made OD})fOperfY I-own which-- IS not intended for sale, lease or rent. $ 55.00 $ 55 00 Limited Energy/ResidentIaI- - - - - $ 28-00 - - ---LimIted Energy/Commerclli1~ -- ------$-50 00 Mini.mum Electric Permit Inspection Fee is $50.00 + Surcharges Owners Signature' 4. Inspection Request: 726-3769 TOTAL :;;.35 ~r2D :J-~ .!:::>-O- -1/,~5 ;)Qg.45 -12% State Surcharge 10% Administrative Fee 5% Technology Fee Shared Dnve(T )/Bmldmg FormslElectncaJ PermIt ApplIcatIOn 1-08 doc ecf -- db 3 3 9 Job. No. SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2008 NAME:!Y{l(./d//Yl/ t/l j PHONE: 5LjI- d ~ ~ - (/f35 . l. '/), ADDRESS~7t1dJ Stu Olactff'V /C1tJ/i1t5'rlc4TATE: 041P: 971?y LOCATION OF PROPOSED BUILDING SITE: -#v S/- Street Address: /707 5. lL))[ Plat Name: Tax Lot Number: 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) I A. Sinale-Familv Detached NO. OF UNITS I X $2,513 per unit = $ ;)5/3. 0l.J B. Sinale-Familv Attached NO. OF UNITS X $2,726 per unit = $ C. Multi-Familv ADartment NO. OF UNITS X $2,323 per unit = $ D. Sinale Room OccuDancv NO. OF UNITS X $1,162 per unit = $ E. Accessorv Dwellina Unit NO. OF UNITS X $1,257 per unit = $ $ d5/3. OV WILLAMALANE SDC 2. SDC CREDIT (If applicable) SDC payer must furnish proof of Willamalane Credit approval.) $ >, Date $J5/3, UV /~ Cf? 3. TOT WILLAMALANE NET SDC ASSESSED (if SO reduced for Credit) ~rA~ ..---, 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 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 COM2008-00339 Payments: Type of Payment Check cRecemtl RECEIPT #: 1200800000000000245 Date: 03/18/2008 DescrIptIOn ResIdence W mng 1000 Sq Ft ResIdence WIring Ea Addtl500 Temp Power 200 amps or less FIre SF Fee - ResidentIal Addressing AssIgnment Wlllamalane Single FamIly Curbcut Permit SIdewalk Permit PW DIsc - 2nd Permit 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 TransportatIon Admm Plan RevIew Major - Plannmg BUIlding Permit 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 Outlets 4+ FIreplace (Listed) -Mech Iss 2+ ApplIances- + 5% Techno]ogy Fee + 12% State Surcharge + 10% AdministratIve Fee PaId By HA YDEN HOMES LLC Item Total: Check Number AuthOrIzatIOn Received By Batch Number Number How Received dJb 5172 In Person Payment Total: Page 1 of 1 8:41 :30AM Amount Due 11 7 00 6300 5500 12065 3500 2,513 00 8500 8500 (30 00) 676 12 805 00 612 12 195 48 862 25 9535 99039 10 00 141 06 71 28 205 00 1,063 ]8 33700 ]600 1400 21 00 700 10 00 700 500 200 1700 4000 103 96 208 10 185 48 $9,744.42 Amount Paid $9,74442 $9,744.42 3/] 8/2008