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Home My WebLink AboutPermit Building 2008-3-26 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00398 ISSUED: 03/26/2008 APPLIED: 03/25/2008 EXPIRES: 09/26/2008 VALUE: $ 176,995.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1791 S 58TH ST ASSESSOR'S PARCEL NO.: 1802030009500 SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: Single family residence- SAME AS COM2007-01576 5781 Cinder Owner: HA YDEN ENTERPRISES Address: 2622 SW GLACIER PL #110 REDMOND OR 97756 Phone Number: 541-228-6935 I CONTRACTOR INFORMATION I Contractor Tvpe General Contractor HA YDEN ENTERPRISES License 92208 Expiration Date 07/29/2009 Phone 541-228-1081 I BUILDING INFORMATION' 3 # of Stories: 1 Lot Size: I T r=lHeig~~:o{j~MtW%e re . 16.00 Sq Ft 1st Floor: fc,l(',~" my;p..~(}JcJI~~~d by ~~r~!r~Mt9h'~~O Sq Ft 2nd Floor: l~utll;':"2W.ateJ8fue~: Those rules :gortY~"ty Sq Ft Basement: In OAR Rang~TW10 through OA~e9set_forth Sq Ft Garage/Carport 00_90 YEitergw/Whtm caples of th 52001- Sq Ft Other: ~callrnQlp1in4wntEDJ.litwmh: the te':~hJes by Occupant Load: fjumhcf fM th" '"'".- - U'[ fJ one I DEVE~EN~i~~atlon 1,579 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB 400 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.00 12.10 12.50 32.50 10.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 2 Yes 29.60 REQUIRED PARKING Total: 2 Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Yes NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT GDMMCNDCD on Ie .\D.\N~~NE~ F~R I vit~~tl&Q~~c~fili19rQ'l Sidewalk Type: Curbside 7' Curb and Gutter Downspouts/Drains: Notes: DescriptIOn Type of ConstructIOn $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pal!:e 1 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00398 ISSUED: 03/26/2008 APPLIED: 03/25/2008 EXPIRES: 09/26/2008 VALUE: $ 176,995.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Dwellinl!:s Garal!:e v Wood Frame Garal!:e $105.00 $28.00 1,579.00 400.00 $165,795.00 $11,200.00 $176,995.00 03/25/2008 03/25/2008 Total Value of Project ~ Fee Description Amount Paid Date Paid Receipt Number ~Mech Iss 2+ Appliances~ $40.00 3/26/08 2200800000000000356 + 10% Administrative Fee $147.25 3/26/08 2200800000000000356 + 12% State Surcharge $176.70 3/26/08 2200800000000000356 + 5% Technology Fee $92.38 3/26/08 2200800000000000356 2 Baths One or Two Family $280.00 3/26/08 2200800000000000356 Addressing Assignment $35.00 3/26/08 2200800000000000356 Appliance Vent $7.00 3/26/08 2200800000000000356 Building Permit $898.50 3/26/08 2200800000000000356 Curbcut Permit $85.00 3/26/08 2200800000000000356 Dryer Vent $7.00 3/26/08 2200800000000000356 Exhaust Hoods $10.00 3/26/08 2200800000000000356 Furnace - up to 100,000 btu $14.00 3/26/08 2200800000000000356 Gas Outlets 1-4 $5.00 3/26/08 2200800000000000356 Plan Review Major - Planning $205.00 3/26/08 2200800000000000356 Plan Review Same As $220.00 3/26/08 2200800000000000356 Residence Wiring 1000 Sq Ft $117.00 3/26/08 2200800000000000356 Residence Wiring Ea Addtl 500 $42.00 3/26/08 2200800000000000356 Sanitary Sewer - Improvement $489.70 3/26/08 2200800000000000356 Sanitary Sewer - Reimbursement $644.00 3/26/08 2200800000000000356 SDC MWMC Administration $10.00 3/26/08 2200800000000000356 SDC MWMC Improvement $990.39 3/26/08 2200800000000000356 SDC MWMC Reimbursement, $95.35 3/26/08 2200800000000000356 SDC Sanitary/Storm Admin $136.37 3/26/08 2200800000000000356 SDC Transpo Improvement $862.25 3/26/08 2200800000000000356 SDC Transpo Reimbursement $195.48 3/26/08 2200800000000000356 SDC Transportation Admin $71. 78 3/26/08 2200800000000000356 Sidewalk Permit $85.00 3/26/08 2200800000000000356 Storm Drainage Impervious Area $875.78 3/26/08 2200800000000000356 Storm Sewer Each Addtll00' $16.00 3/26/08 2200800000000000356 Temp Power 200 amps or less $55.00 3/26/08 2200800000000000356 Vent Fan $21.00 3/26/08 2200800000000000356 WiIlamalane Single Family $2,513.00 3/26/08 2200800000000000356 Total Amount Paid $9,442.93 I Plan Reviews I Planninl!: Review Public Works Review 03/25/2008 03/25/2008 03/25/2008 03/25/2008 APP T AJ APP LKW Storm to curb & gutters Pal!:e 2 of 4 CITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: COM2008-00398 ISSUED: 03/26/2008 APPLIED: 03/25/2008 EXPIRES: 09/26/2008 VALUE: $ 176,995.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 03/26/2008 03/26/2008 APP DLM See documents fo Plan review comment. 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. UeolliredJnsnections 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 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. 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. Pal!e 3 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00398 ISSUED: 03/26/2008 APPLIED: 03/25/2008 EXPIRES: 09/26/2008 VALUE: $ 176,995.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. 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 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 ofany 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. ~L2A - . ~ """ ~ Owner or Contractors Signature :? ~G, -o<({ Date Pal!e 4 of 4 ZON IN1TlALS ~ YV\ DA~L7&J(~ SOUR~i'-y"J i Date 6lZ/(J! c) Y : : ~7: ,~~it If( 4"'i\(t,~':J~ ,f: It,,'t-['(5';f 1~~1 :""";~< ~i!i1":;I'{:.r:: !-~J.!i~l :~;.:f,1'7~'('~~-'l~~"t.J.' en" ~ ~l"(~N:-lil?~~i~lrl ~ 0" _ -...." \ trJ.T'll~]i""...G 1- \.. 3. if GPl}1i;?-0 Y,.el]fEE;'S,,(iIPlEn tEriE-$d0. *,,\~I;i,::f:~;i'~' i.~;> ,1;:~;,~ :;i'<~'; ~'. i;: ~ : I '",\ . ". . rot c,l , ,,2 "c ,""', "'~,1i'".J,,',,,~' J :l'~b, ,'~-'!l~.i:'i,oj,' "",41.0.,'",;" i' d~' ,i~~".';";: ,.'J_,.'._:~,~1 ,It,,,,:.5. \:": q.'7~~'J~i~e~:t "J1,~I:\'i',-::'fti~ T.":"1.~-..\fL"''''1:'''-~''''i1'' -~ ....... A ~ I ~i!(~~ ~,' 'f r .r~h 1; [,.'1' "r;~~ ?....&J'~N~';()I '-;M>,({i'p'.1-{'j~ILf'll.l"~=,;rr 1ft.,,, v., . ~;i'!','~, t. , ." ." " , ,~', ' ,11;i~FJi:miI;v::'i\:e)if(hv'HliJ1:'g'1!ub'i~~\~;'r~; 111l""'L!I!lJ':~iloJliJ"'II,lol;1*" 1"l'lL.l~~..~1.~I""'~<:-l!i,<"!';;l~1,q;~b.rl,..,J""",,,~~i,1.~.;!'~', 1;, IJ\,_J"r ,r ....l'-~I\ ",~";.I I - .-". '-" '" '_"'M '-"-".' ,.." ..-' ServIce Included I 1000 sq ft or less Each ~ddltional 500 sq ft or I portion thereof I Permits are non-transferable and expIre if work IS Each f!auufact'd Home or not started within 180 days of issuance or If work is Modular Dwelling ServIce or I u _ ______Suspended-fo}:-180_days___~_,_______"___ _ _______, ,Fe_eder I 225 FIFTIl STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (5.11)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number . COW1 2-CJO~ ~3 C; ~ 1. ~~i]?@~~~FI(f), )N ,~.~~~,'l~~ti,;-,''\\s.~;~tJ~ .l~,i~\~ I /75/ ~), 51!b!!J .)''0 LEGAL DESCRIPTION /002 t!J_~~ d7St70 (5/1I/4te ~ m ; 4~t- ( 2- $ 21 00 JOB DESCRIPTION: $11700 //7 42- $55.00 2. ElectrIcal Contractor -r;f)JtJk~ r-/ec 200 Pmps or less 201 kps to 400 Amps Address ;2087'1 c:\~. -. .'t/.;!~ 401 Amps to 600 Amps .': fO':;l/;~;:Zvl;'~~;~ ~~~~~~~h~eg~~~~~~~? 1000 Amps !'Pllil!l~1:l@JItetP'.8~3ru,~psNo1ts In OAR 952-001-0010 through olfhltfl}!e{~y 0090. You may obtain Copies of t -001- SuperYlsor LIcense Number n~~~tJter. (N9te:. ~hcQ~ C . 0, t::Iyun Utility Notification !2e-tJ '7 enter IS 1-BOO-332-2344PstaUation, Alteration or Relocation 1 200 Amps or less Constr. Contr Number /7 '2 3 C? ~ 201 Amps to 400 Amps 401 j mps to 600 Amps ~ '1 Over 600 Am s or 1000 V oIts see "B" above CIty ----,f5 f/n..t7/ $ 70 00 $ 83 00 $138 00 $180.00 ;j,~13~Ou $ 55 00 ExpIration Date I {;;"<; $ 55 00 $ 76 00 $11000 ExpIratIon Date New !Alteration or ExtenSIOn Per Panel I One (CIrClllt Each AddItional CIrcwt or WIth Owners N~e j ~~ L fNgfJe& Servl ~e or Feeder Permit Address ':l('JJ'7 '7 (?~HtS-/pERM'T' CUAll EXEp' IAUTtj(J - -11M I E IF T City I!>~ PhO~OMritJ~f9UfJ1G&~ THIS'!I' r. J1Rj?\MQBK $ 55.00 ANY 180 D LJ OR IS ABArJOOY {~Lit@tTng $ 55 00 OWNER JNSTALLATION AY PERIOD. Lirmfe nQ)h/ResldentJal $ 28.00 -The mstallation 15 bemg made onpropertY I-awn-whIch - Limited Energy/Commerclar- - -- - -----. $ 50 00 ------ --- I IS not mtended for sale, lease or rent Milllmum IElectric Permit InspectIOn Fce is $50.00 + Surcharges 1::~mil'l:i~'W~in::iJ1 1:~\i~1"J.t' t~f ~ t1-t) Owners Signature 4. JRiJ' ZIIf' zc:;: ~., 10% Administrative Fee 2/. ~D- 5% ,'eChnOlOgy Fee l-O .1-tJ TO~AL 271- t, , Shared Dnve(T )IBUlldmg Forms/EleclncaJ Permit ApphcatJOn ] -08 doc $ 48 00 $ 400 'V~T\ ;~~~It:~{~~~~1~~~~f4,-~~j~ ]~'III:~,~lf~}r;::;f'=~~IT~~\1 -lu-aea~;f,!]}acn~ T).)staJ1a-tlOl~ rjjl:i1l'iI4M!lfjk1fi't:~ ~ \.tH~lllUit{:tj '~~'\u:m:,~'1 .J~~~~l~ - 12% State Surcharge InspectIOn Request: 726-3769 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER COM2008,00398 NAME OR COMPANY Hayden Homes LOCATION 1791 S 58th Street TAX LOT NUMBER 1802030009500 DEVELOPMENT TYPE Smgle FamIly Residence NEW DWELLING UNITS 1 BUILDING SIZE (SF' 1979 LOT SIZE (SF) 1 STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S F x COST PER S F CHARGE 2531 00 $0 346 I = $875 78 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S F x COST PER S F. x DISCOUNT RATE o 00 $0 346 50% ITEM 1 TOTAL - STORM DRAINAGE SDC 2 SANITARY SEWER - CITY A REIMBURSEMENT COST NUMBER OF DFU's x 24 B IMPROVEMENT COST NUMBER OF DFU's I x 24 I COST PER DFU $26 83 COST PER DFU $20 40 ITEM 2 TOTAL, CITY SANITARY SEWER SDC 3 TRANSPORTATION A REIMBURSEMENT COST I ADT TRIP RATE . x I 957 B IMPROVEMENT COST I ADT TRIP RATE . x I 957 I NUMBER OF UNITS' x I 1 I NUMBER OF UNITS I 1 ITEM 3 TOTAL - TRANSPORTATION SDC 4 SANITARY SEWER - MWMC A REIMBURSEMENT COST NUMBER OF FEU's I x 1 I B IMPROVEMENT COST INUMBER OF FEU's x I 1 ICOST PER FEU I $95 35 ICOST PER FEU I $99039 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL, MWMC SANITARY SEWER SDC 6534 r:/J fil Cl o U ~ fil t--< r:/J ,..... o gz DISCOUNT $000 $875.78 11070 $875.78 $644.00 1091 $489.70 ,.1092 I: I =, $1,133.70 COST PER TRIP 2043 x INEW TRIP FACTORI I 100 J 1093 $195.48 x L I =, x INEWTRIPFACTOR I 100 COST PER TRIP $9010 $1,057.73 $862.25 1094 = $95.35 1054 = $990.39 1055 " $0.00 1054 $10.00 1056 = , $1,095.74 =, $4,162.95 CHARGE $208 15 13637 1079 $71 78 1078 .---- i TOTAL SDC CHARGES =, $4,371.10 --~-~ - ...~- SUBTOTAL (ADD ITEMS 1,2,3, & 4) 5 ADMINISTRATIVE FEE I SUBTOTAL x I ADM FEE RATE I $4,16295 I 5% TOTAL SANITARY ADMINISTRATION FEE TOTAL TRANSPORTATION ADMINISTRATION FEE Kaye Wilson PREPARED BY 3/25/2008 DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS (NOTE FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 2 0 3 = 6 I DRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 I CLOTHES WASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC 0 0 1 = 0 RECEPTOR FOR COM SINK / DISHWASHER / ETC 1 0 3 = 3 SHOWER, SINGLE STALL 0 0 2 = 0 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 SINK COMMERCIAL BAR 0 0 2 = 0 SINK WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 SINK SINGLE LA V A TORY /RESIDENTIAL BAR 1 0 1 = 1 IURINAL, STALL/WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INST ALLA TION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 *EDU (EqUivalent DwellIng Urnt) IS a dIscharge eqUivalent to a smgle fmmly dwellIng urut (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$l,OOO ASSESSED VALUE $529 $529 $519 $512 $498 $4 80 $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 $0 00 x $0 00 =, $000 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $000 x $000 o TOTAL MWMC CREDIT $000 = Job. No. ~~g - t1b3?!:> SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2008 NAME: .~/ ,?){~t3!S PHONE: 22!iJ> -h9~J ADDRESS:2~~d'IA:CI~ CITY~Am...u~STATE:-MzIP: '777~G; ~~~ - LOCATION OF PROPOSED BUILDING SITE: Street Address: /7<1 / .}, 5' ~;a ~r' - ..... . PJatName:-..Jg.SIb'l ~(TaxLotNumber: /~O':3~o t)?5~ , , 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the back) A. Sinale-FamilY Detached NO. OF UNITS X $2,513 per unit = $ 25"'/:? B. Sinale-Family Attached NO. OF UNITS X $2,726 per unit = $ C. Multi-Family Aoartment NO. OF UNITS ~\ X $2,323 per unit = $ D. Sinale Room Occuoancv NO.OF'UNITS X $1,162 per unit = $ E. Accessorv Dwellina Unit NO. OF UNITS X $1,257 per unit = $ WILLAMALANE SDC $ 2. SDC CREDIT (If applicable) SDC payer must furnish proof of Willamalane Credit approvaL) $ 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) $ 25/5 ,2 6, if --~f>G 5: Development Services Department Date City of Springfield 5 225 FVth Street Springfield, Oregon 97477 541-.726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008,00398 COM2008,00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008,00398 COM2008-00398 COM2008-00398 COM2008-00398 COM200S-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 COM2008-00398 Payments: Type of Payment CredltCard cRecemtl RECEIPT #: 2200800000000000356 Date: 03/26/2008 DescrIptIOn Plan RevIew Same As Plan RevIew Major - Planning Curbcut PermIt Sidewalk PermIt Storm Drainage ImpervIous Area Samtary Sewer - ReImbursement Samtary Sewer - Improvement SDC Transpo ReImbursement SDC Transpo Improvement SDC MWMC ReImbursement SDC MWMC Improvement SDC MWMC AdmlmstratlOn SDC Samtary/Storm Admin SDC TransportatIOn Admin BUIlding PermIt Addressing Assignment Willamalane Single FamIly 2 Baths One or Two Family Storm Sewer Each Addtl 100' Furnace - up to 100,000 btu Vent Fan Apphance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 -Mech Iss 2+ Apphances- ReSIdence Wifing 1000 Sq Ft ReSidence Wifing Ea Addtl 500 Temp Power 200 amps or less + 5% Technology Fee + 12% State Surcharge + 10% AdminIstratIve Fee Paid By HAYDEN ENT Item Total: Check Number AuthOrIzatIOn Received By Batch Number Number How Received dJb 057061 In Person Payment Total: Page 1 of 1 lO:25:30AM Amount Due 220 00 205 00 8500 8500 875 78 644 00 489 70 19548 862 25 9535 99039 10 00 13637 71 78 898 50 3500 2,51300 280 00 1600 1400 21 00 700 10 00 700 500 4000 11700 4200 5500 9238 17670 14725 $9,442.93 Amount Paid $9,44293 $9,442.93 3/26/2008