HomeMy WebLinkAboutPermit Building 2006-6-6
.
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
*
't
. CITY OF SPRINGFIELD
- ,
Building/Combination Permit
PERMIT NO: COM2006-00515
ISSUED: 06/0612006
APPLIED: 05/02/2006
EXPIRES: 12/06/2006
VALUE: $ 2,950.00
j', '-:-~:''T')hl: Orn,:on I~w reCiI 'Ires YOLl to
Status
Issued
l,.\~'./r,". i '\.:_"" ._~'ll::';<)I:"'~;UIIUtlIllY
SITE ADDRESS: 3527 KATHRYN AVE
ASSESSOR'S PARCEL NO.: 1702304300900'
'.f. - ,,'......".r. t I ...,.~en.r...'t.::areC""'{TOnn
Springfield TYPE'OF WORK!'Mannfactured'Home on
I'r' ll"" ,\ 'J.nfl", ,.., Oil' \ ' ('" If "1 I ]J\!i \.':.)~-UU1-
. ,.1 ........_ ,-..J...\I PrIvate L.;ot v
C03CTY'PErOFiUSE,.in rN'eW"S 01 the rules k1'sidential
PROJECT DESCRIPTION: Manufactured bome on private lot, See (lOiVI2006'00514'for i"Dd'Cr~dii;elepl1one
numoul fOI the 01 "Son Utility Notification
Owner: LYDIA E SENTER REVOC TRUST
Address: 3529 KATHRYN AVE
SPRINGFIELD OR 97478
Vt:lllt:l I:;' l-OVU-vv.::..-.c.........,...,.,.
Pbone Number: 541-726-5749
, CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Manuf Home Inst
Plnmbing
, Contractor
HARRISON JACOBSON INC
MAG ELECTRIC INC
HARRISON JACOBSON INC
HARRISON JACOBSON INC
License
66447
149834
66447
66447
Expiration Date
05/07/2007
12113/2009
05/07/2007
05/07/2007
Phone
541-689-7762
541,461-0387
541,689-7762
54 I ,689-7762
VN
BUILDING INFORMATION I 'I 01 ",LL E" _
"u ., ',cU UNO ,~F/HE IF T
# of Stories: ",,':'/'ICIVL'tu O~ ER.i[JtISi~eU<M/~E WORK
HeigbtofStructure "J U"y PrQ/S fSq;f..tJ&\\r,I~or:IS NOT
Type of Heat: orced Air Electric/OO,Sq Ft 2nd'Floo6R
Water Type: Electric Sq Ft Basement:
Range Type: Electric Sq Ft Garage/Carport
Energy Patb: Sq Ft Otber:
Sprinkled Building: n/a Occupant Load:
1,188
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Constrnction Type
Secondary Construction Type:
# of Bedrooms:
I
R-3
3
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
60,00
11.00
5,00
15,00
0,00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
2
Total:
Handicapped:
Compact:
2
19.80
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Partially Improved
Yes
Sidewalk Type:
DownspoutslDrains: To Cnlvert - Provide
Drainage Plan
Notes: Storm drainage piped into existing ditcb 5/5/06 CAS
Pa2e I 00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541,726-3676 Fax
541-726-37691nspection Line
Description
Tvpe of Construction
Foundation Onlv Use Bid Amount
Manuf Home Manufactured Home
Fee Description
Plan Review Resideutial
+ 10% Administrative Fee
+ 8% State Surcharge
Manur Home State Issuance
Manufactured Home Placement
Manufactured Home Service
Piau Review Minor, Planning
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addtl100'
Total Amount Paid
Initial Review
Plan nine Review
05/04/2006
05/04/2006
Public Works Review
05/04/2006
Structural Review
05/04/2006
.
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
$1.00
Square Footage
or Bid Amount
2,950.00
50,000,00
. CITY OF ~rK11~ld<u'LD
Building/Combination Permit
PERMIT NO: COM2006-005I5
ISSUED: 06/06/2006
APPLIED: 05/02/2006
EXPIRES: 12/06/2006
VALUE: $ 2,950.00
Value
Date Calculated
Total Value of Project
)(pp~, ~
Amount Paid
Date Paid
$2,950.00
$50,000.00
$52,950.00
05/02/2006
05/02/2006
$34.32
$26.90
$21.52
$30,00
$160,00
$50,00
$112.00
$190.70
$250.70
$31.18
$182.17
$45.00
$14.00
5/2/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
6/6/06
Receipt Number
1200600000000000589
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
1200600000000000798
Provide 32 sf of enclosed storage.
If there are existing street trees, they
maybe used for the street tree
requirement.
Storm to roadside ditch 5/5/2006
CAS
RWC
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,
$1,148.49
I Plan Reviews I
05/0412006
OS/22/2006
APP LLH
APP TAJ
Manuf Home Set Up: When installation of all piers or stands is complete.
05/05/2006
APP CAS
OS/25/2006
OK
~lrrJlir~rI .nsnections I
Paee 2 of3
.
. LIlt OF ~rK11~'..d<1J'.,LD
Building/Combination Permit
PERMIT NO: COM2006-00515
ISSUED: 06/06/2006
APPLIED: 05/02/2006
EXPIRES: 12/06/2006
VALUE: $ 2,950.00
Issued
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54]-726-3676 Fax
54],726-3769 Inspection Line
Final Mannf Home Set Up: After all reqnired inspections are requested and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc. have been installed.
Manuf Home Plumbing: After home has been connected to water and sewer.
MH Service: Approval required prior to utility company energizing service.
Storm Sewer Line: Prior to filling trench,
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information bereon is true and correct, and I further certify tbat 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 berein, 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, tbat 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,
~ ~~ 6-6-o~
Owner or Contra~or; s~re - Date
Paee 3 of3
rT:~~r,. ,
t' -<e,,' ..,~"~" .;>'h? c..nOI
225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~i~ltf~:ii;~,""'i~,~--J
ELECTRICALPERMITAPPUCATION " 'Date ~'" '"I'iU.:a"L:'i!';i'~" ,I",
City Job Number Q.l o. ~\5 v
L \'
I. 3. fCOMP.iill:i:tl;;~ETseHE.6'VLE;iiEooWl';""J,'It~w.~~~
l~'_--'"",""___-'_.J"'''_~i"~,,,,,..n&.;n,"~.~~~~~~~'
~},~(:{>:'\,": 'diT:\f'(DF.l:'!RLNGFIELD OREGON: "~J" -~.;:
':z.,'(..).;1r-:--"'",:-" . ~ .. T' .~'_~ .:-..8...'..... ~', .'. ., -. '. '. ' '-!
;'
tJ:Otl)
lOB DESCRIPT[ON
per~r~nr~:d'exp~b
not started wlt~~~V::O days of issuance or If work b
Suspeuded for 180 days.
~eoN7fRAero~fir7i!;riiOMONE~'
2. ~~:,!i!.--=-~W9~~J:L-!;' ,'-.. ' ".~
.
Electrical Contractor
Address
City ~...(;fIL
Phone
Supervisor License Number A./1,/(1 5
Expiration Date / () -I -D 7
. .
Consll'. Conb'. Number I 19 ~,7;, ~'
Expiration Date, /<1 /1.3 I d1
j '"
Signature ofSupeivising Electrician
~4C-'/1--~
OwnersName Lw\\a. ttrkf-
Address ~ ~QJ~ \c:' MH R.\-\.lU
City ~('\C\[\~~,1(t Phone i1..~'~1'\4
OVVNERINSTALLATION
The installation is being made on y.vy.../ [own which
is not intended, for sale, lease or rent.
Owners Signature:
[uspectIou Request: 726-3769
A. ~f:Niw~iamttii[~siri~i~~1\iNffiSF.1i~ii;.1!.1'~~dw~iiili~~cr.ii,~~j
~~~..........."".~_~.,~.."..".,~...:..,-_ ,.._.l...R.,.1i:!......u..,g-,-L~~
Service Included
t 000 sq. ft. or less SI06,OO
Each additional 500 sq. ft. or
portion thereof S 19.00
^T-"'r--.TTrr-". r.- ,_,
IEa~hMaoufact'([Home'ora"" requires YO'l to 0
, Modular DWelling SerViceo.rlS Oreoon U' \il,'1 S'50 00 ",.r\0
r'CF' d" (' ',~ y. 0V.
in e~ n~~~ ::--~ntsr, Tllose rules are set lorth
C'ull~~!'!r"~"""'-f!iI.l~'~""''*~''''''''''''''~1.''''''''''~r,1
t!I.i,~~~~rS,-'IoSpillali!l'!.~lte.ralj9!1~~t'RC,log~M:l
, . -1-.-.... VI "IG I UIC'~
~~'~~q~ster, (Note: the telephontS 63.00
nw IOU'" Jor InA Orf'Clf) Ut'/'t N " ,
201 Af11P.s to 400 A~ n I r y' otlllcatlos 75.00
401 A~I~1fo\Y A~~O'332-2344), S125.OO
601 Amps to [000 Amps S163.00
Over 1000 AmpsIVolts S375.00
Reconnect Ooly S 50,00 - ..
C r;:.:.W'<~"'=,' "S='''''~'''''''--F.,]:''','d."^,..,,l;qr,Jr.~,'~,'' '~
. ~,'emp~~~:MS!?!!~'~~.Hg~~r..s~~:i.it~~.~', ',;;e-;t!
Instal[ation, Alteration or Relocation
200 ~~I'1."Jess S50.00 f
20l'AlI)P.S to 400 Amps'S 69.00
401~~'tot6001W~ALL EXPIRF IF nj~loo,ooK
U I nUHILtD I i~IOr:Q TI-IJn n_ VVUH
<>ver,6OjlrAmpsorr[OOO Volts see~B"iailO~'eT
D: ~Bifafi'Cii@~~~~ilJ- :' "..,"'"..'."'€'N~l
_._._~~U ..-_ L" .'u. ~~~,~'"""'- 'i...~t~
New A[teration or ExtensioD Per Panel
Ooe Circuit
Each Additional Circuit or with
Service or Feeder Pennit
.. S 43.00
S 3,00 ~
c::::
E; ~~b~~t~~iI~f;1Jilfi.rl~did"')ilJ"r"~,'."",;u..",an,,~
1~.~.-"t!T"::>'.r..-~.'.c~'.;;I.-~....~~.. .Ir.... ~~u-:Ji
. ,..
. ,~"-,,
Pump or irrigation S50.00 i'
Sign/Oudine Lighting S 50.00: ;{
Limited EoergylResideotial 's 25,00 "r:'"
Limited Energy/Commercial S 45,00
Minimum Electric Permit Inspectiou Fee b $45.00 + Surcharges
~...,_.~;., ~!:i>~~%~_'~',;~,;,~;(~:r.'?~;~~!!i.,':1i~ 'C{) ,{)
4. 'SVBT01ID;'OEABOVEt~~~~~1J;"\\!,,,~(:'! UV
, ~ ';'~'U'Jl:'o'.~....l;,,':'~~','Wi'lTi.P~f\oi~.'t'\o!:~i~W:~~;;~", 'Mt\i-~a~~ .
7% State SU~harge ,'-'~ ' A.. ex:>
10% Administrative Fee c:::.. ()(.)
"-" oJ
TOTAL ~.
Shared Drive(T:)lBuilding Forms'Elcctrical Pennil Application I-OJ.doc
CITY OF tllNGFIELD SYSTEMS DEVELOPME&ORKSHEET
",
JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
C0M2006-00515
Lydia Senter
3527 Kathrun
1702034300900
SINGLE FAMILY RESIDENCE
o BUILDING SIZE (SF' 1188
LOT SIZE (~~):
I. STORM DRAINAG\l
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S,F, x I COST PER S,F, CHARGE
I 564,00 I $0.323 I = I $182,17 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S,F, I x ! COST PER S,F, I x I DISCOUNT RATE I I
I 0,00 I $0.323 I I 50% = I
ITEM I TOTAL.. STORM DRAINAGE SDC $182,17 I
2, SANITARY SEWER, DTY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x
I 10 I
COST PER DFU
$25,07
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 10 $19,07
ITEM 2 TOTAL, CITY SANITARY SEWER SDC
=,
$441.40
,1 TRANSPORTATION
A, REIMBURSEMENT COST:
I ADT TRIP RATE I x
I 9.57 I
B. IMPROVEMENT COST:
I ADT TRIP RATE I
I 9,57 I
I NUMBER OF UNITS I x I
I 0 I I
COST PER TRIP
$19.09
x
I NUMBER OF UNITS I x I
I 0 I I
= ,
COST PER TRIP
$84,19
$0,00
4 SANITARY SEWER, MWMC
ITEM 3 TOTAL .. TRANSPORTATION SDC
A, REIMBURSEMENT COST:
INUMBER OF FEU's I x
I 0 I
B, IMPROVEMENT COST:
INUMBER OF FEU's I x
I 0 I
ICOST PER FEU
I $82,03
ICOST PER FEU
I $865.31
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL-MWMC SANITARY SEWERSDC =,
SUBTOTAL (ADD ITEMS I, 2, 3, & 4) ~ ,
~ AOMTNISTR.<\TlVE FEE:
$0,00
5623.57
I SUBTOTAL x I ADM, FEE RATE
I $623,57 I 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMJN]STRATION FEE:
I~ I
CHARGE
$31.18
Cheryl Slaymaker
5/5/2006
1079
! 1078
PREPARED BY
DISCOUNT
$0,00
6000
~
1m
lEi
10
u
I~
m
G
~
$182,17
$250,70
$190.70
11070
11091
I
11092
I
x INEWTRlPFACTORI
I 1.00 I
x INEW TRIP FACTORI
I 1.00 I
$0,00
$0.00
11093
I
11094
I
DATE
TOTAL SDC CHARGES
=
$0,00
11054
I
I
I 1055
I 1054
$0,00 I 1056
~
J
=
$0,00
$0,00
31.18
$0,00
$654,75
. .
"
DRAINAGE "lA> uRE UNIT (DFU) CALCULATION_TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDmONAL FIXTURES)
NO, OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUlV ALENT UNITS
BATHTUB 2 1 3 3
DRINKING FOUNTAIN 0 0 1 = 0
FLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE lOlL I SOLIDS I ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0
ILAUNDRYTUB 0 0 2 = 0
ICLOTHESW ASHER I MOP SINK 1 0 3 = 3
ICLOTHESWASHER, 3 OR MORE tEA) 0 0 6 = 0 ,
"
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRIG I WATER STATION I ETC. 0 0 1 = 0
IRECEPTOR FOR COM, SINK I DISHWASHER I ETC, 0 0 3 = 0
ISHOWER. SINGLE STALL 0 0 2 = 0
ISHOWER. GANG (NUMBER OF HEADSl. 0 0 2 = 0
ISINK: COMMERClAURESIDENTIAL KITCHEN 1 1 3 = 0
ISINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
ISINK: SINGLE LA V ATORYIRESIDENTIAL BAR 2 1 1 = 1
IURINAL, STALL I WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET. PRIVATE INSTALLATION 2 1 3 = 3
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 10
.EDU (Equivalent Dwe1lin~ Unit) is a disc~ eQuivalent to a sins::le family dwellinJ!: unit (20 DFU's) set at 167 ~Ions per day
MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE
I YEAR CREDIT RATFJ$I,OOO II ;r
ANNEXED ASSESSED VALUE IS LAND ELGlBLE FOR ANNEXATION CREDIT?
I BEFORE 1979 $5,29 (Enler I for Yes, 2 for No)
I 1979 $5,29 IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT? 2
I 1980 $5,19 (Enter I for Yes, 2 for No)
I 1981 $5,12 BASE YEAR 1979
I 1982 $4,98
I 1983 $4,80 CREDIT FOR LAND (IF APPLICABLE)
I 1984 $4,63 VALUE I 1000 CREDIT RATE
I 1985 $4,40 $0,00 x $5,29 ~, $0,00
I 1986 $4,07
~ 1987 $3,67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 $3,22 VALUE I 1000 CREDIT RATE
I 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 1995 $1.09
I 1996 $0,92
I 1997 $0,72
I 1998 $0,48
I 1999 $0,28
I 2000 $0,09
2001 $0,05
,
.
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726'3753
FAX (541) 726,3689
www.ci.springfield.or.us
MANUFACTURED HOME SET,UP AGREEMENT
As required by the City of Springfield Development Code; I understand and agree that with the appIJlval of
the attached pennits, one of the following manufactured homes will be placed at -:0., ~ L T- K.~ "'t-'
, Springfield, Oregon, City Job Number ee......,~"'.... - L,- 1'::,-
-----= ....... '
Type-lNlanufactured Home:
7- ----- '
\. A multi sectional (double Wide or Wider) umt With an enclosed floor area of not less than 1,000 square feet,
that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or
roofing, and dlat has been certified by the manufacturer to have an exterior thennal envelope meeting
perfonnance standards which reduce heat loss to levels equivalent to the perfonnance standards required
for single family dwellings at the time of construction, ~
A unit of t less than 12 feet in width enclosing a minimum floor area of 500 square feet; that has a
'nominal roo 'tch of 2 feet in height for each 12 feet in width, that has no bare metal siding or roofing,
and that has bee . ertified by the manufacturer to have an exterior thermal envelope meeting performance
standards which re e heat loss to levels equivalent to the perfonnance standards required for single
family dw~llings at the ' e of constlUction. initials
I further state, by my signature below, tj1at I have been provided with the following infonnation:
Manufactured Home Blocking, Water Line Connection, Street Tree Standards, Sanitary Sewer Connection,
Electrical Connection, and Minimum requirements for pennanent steps.
I also understand that the manufactured home shall be placed on an excavated and backfilled foundation
not to exceed 6 percent slope within 10 feet afthe perimeter enclosure, enclosed at the perimeter with
stone, brick or other concrete or masonry materials approved by the Building Official and with no more
than 24 inches of the enclosing material exposed above grade, '
, ~ j "
.~/~
(~ ~ ,/' /----
b-~-t/~
Date
I
I
I
I
<,
<
I
01
.
.
MANUFACTURED HOME LAND USE AGREEMENT
As required by llie City of Springfield Development Code, I agree that wi~ the ~roval of ~.it:ched
permits, one of the following manufactured homes will be pla~d ~.3 :::. "Z' / 1:: rl'_
Springfield, Oregon, City Job NumberCOwc ~-OO ~ I:::. , '
'~ 'T~anufactur~ome. A multi-seCtional (double wide or wider) unit with an enclosed
floor area or;o; i;~s than_I,O?o';quare feel, that has a nominal roof pitch 00 feet in height for each 12
--
feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to
have an exterior thermal envelope meeting performance standards which reduce heat loss to levels
equivalent to the performance standards required of single family dwellings construcied under the State
Specialty Codes.
_ Type II Manufactured Home, A unit of not less than 12 feet in width with an enclosed floor area
of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width
and that has no bare metal siding or roofmg.
The manufactured home shall be placed on an excavated and back,filled foundation not to exceed 6
percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the
home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of
the enclosing material exposed above grade.
I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60
days of the date of issuance of the manufactured home set up permit. These requirements may include, but
are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on
your approved set up plans andlor permit and your partition approval if applicable:
. Street Trees
. Paving Driveway
. Minimum 32 square foot storage structure
. Completion of partition approval
. Removal of any existing structures as noted on your partition approval
. Signing and recording of any required partition, easement, improvement agreements, etc.
. Final lot grading
. City Sidewalk and curbcut installation
. Any outside agency approval as required i,e., Division of State Land approval.
By my signature below, I agree to complete the above mentioned land use requirements.
Owner Signature ;I
~~~;P'\
Contractor4I'g6arirry j ,
Date
h~ 6-0?
~
Date
225 Fift~ Street' .
Springfield, Oregon 97477
541~726-3759 Phone
Job/Journal Number
COM2006,00515
COM2006..00515
COM2006..00515
COM2006-00515
COM2006,00515
COM2006-00515
COM2006,00515
COM2006-00515
COM2006,00515
COM2006-00515
COM2006,00515
COM2006,00515
Payments:
Type of Payment
Check
cReceintl
.
~,".,
~
~.-._.., ~
~ of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
1200600000000000798
Date: 06/06/2006
8:21:2IAM
Description
Manufactured Home Service
Storm Drainage Impervious Area
, Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Sanitary/Storm Admin
Plan Review Minor - Planning
Manufactured Home Placement
Manuf Home State Issuance
Storm Sewer, 1st 50 Feet
Storm Sewer Each AddU 100'
+ 8% State Surcharge
+ 10% Administrative Fee
Amount Due
50,00
182,17
250,70
190,70
31.18
112,00
160,00
30,00
45,00
14,00
21.52
26,90
$1,114.17
Paid By
GOODEN,HARRISON
Item Total:
<':heck Number. Authorization
Received By Batch Number Number How Received
Amount Paid
njm
In Person
Payment Total:
$1,114,17
$1,114.17
9704
Page I of I
6/6/2006