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Home My WebLink AboutPermit Electrical 2004-9-28 ~PRINaFUiLD ~l h 1~". 225 F,IFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (54I)7~J6~9 ~.' ' .... .6!.. ~;;'t'~. ELECTRICAL PERMIT APPLICATION ~,o~~~.::. ~ ~.Jf ...~ City Job Number CbIMZP04 - 01/ b z. Date 1 -oJ. ~ -'fJr :',0,.% '. ' "'9 '-~ ~ ",so'-, ~* ~ ,.~ ~:'~~ ~~.$f.~",~,:.,,-<,,9,'l'fP~}~~.s~:;.1""~ -....,"''!1 ,t~:o;"rr:r; 3, 'eOMPIiETE FEE' UllpBEEy"f...!'vo;~"":';\";"~'\':"'; . ., ~~~ '~'."'''':''-''-' '-6'-'L~ .~. ~N~,,;,~?(.{,,~;;',IL. .." -"""~.('."::" . 0'& """& i/;"19 A. ~~~Ji~"idf~::I ~':'Si;:g~f?"~;h~'"">rifL'! ,;~i~f~:~;r":' Ii &..t:'A~lJ~~' '" ~ ...~...:s.~ ~~ '~~"'-~~~~41~ Service Included ""-~~ O'v..:~.,.(> 1000 sq, ft, or less ~ <- Each additional 500 sq, ft, or ~,?S "'- portion thereof , ~ , Permits are non-transferable and expire if work is Each Manufact'd Home or ,- not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder 2 ~oNTRAaiXR3nVsTALI1AT1OJV70Nljy] B. ~~gVk:~~$'~j.c~W~defs~J'ih~t~Yiiit~?A~tt~~'t.iiffis 'ti~"Rel~~~at'iO:n.;~ltl E'le:~::':::=::~:'7Jt' ~/;:f-i;;;~ C 200 A:;S"::'::::""'" V\~~",. ,.,,,,~", ,~g<"$63',O:'''''''~'-M~ n ' .J:Jf) 201 Amps to 400 Amps $ 75,00 Address Jf' 0])0')(4l.O/(" &.:..':;~n~ 40IAmpst06ooAmps $125,00 , <:Q'= 'i,.~Jr601 Amps to 1000 Amps $163,00 City f.J.r~1 0.. q'f.:ffJ:1 Phone 1iP.12S7~ ~(~"I)..OOO AmpsNolts $375,00 ,\\t 'R'eco~ect Only $ 50,00 4~'~ ~~."s>\'i''t. ~'i'(l~\\ \~""'-"*-'""',....,"'... "'7, ,.."",., ,""'''''''~' ,t:\",' ""'~ Supervisor License Number c;. <:,",~ O"S' (.I=.c,'0IlOmporary,Ser,vlces orlFee~ers, ',',',.' l' "",' ",Vj"~'\'Y"'t I',~"~:...,,. \\ ~. ~\ ":J[t :t.'i' \'\\i-~~\J~'-\,) \~"" ..0"""'" '., h ,.' ., ",. Expiration Date 1'-" \)~'i) \c, \>.'01" Installation, Alteration or Relocation "\i,.- ~ ~Cj .'V't.'i) \l 't.'i'\\J'i). 200 Amps or less Constr, Contr, Number "i,\}~ '? 201 Amps to 400 Amps ~~ :,-'\'0\1'. 401 Amps to 600 Amps Expiration Date 'I {, , '7 ' . Over 600 A~ps or 1000 V olts s~~"B ' above, s~'g~atur of Superv,'s,'ng Electn'c,'an D. {r:Bff.kt{cif~itS '~~jiKf?~:;~t:.!:f~\~~;,,-;"q'i:':~r~~~>', ';;:~:~r~J.:'~~::"~';';_,":'I>:/~~I;~ . ~ ...,..,w.~,,'...,....-<<....,..--~,-;^..,h''''''''''~''&''\a "......,. .....,Il!'...,~.....~..:;.~..,.r..,.., .......1'0" ..~,. '.0 ~ 1 /1 New Alteration or ~~~ Panel , - '> 'JI-Sn/;lOJJJ~,t:.r17i1 .. _ o~e~i~;~~~~~e~~li&\'O<<<' I $43,00 4~ EaCh~'1,8"~)~~~;:Q~~~ ?'iii;r OwnersName ~ <", , C10 I ~\~ile9~<Ii~O;0~6",~9 tU\e $ 3,OO;rlZ' - '''''' ,,\;<;;.~ ~a~'<!l."", ~~~ t)\l.~,"""n\~~"":<\~'" . .., ." " ,. .,~" 'd Address I u '7 c;- I 11 V//II II d r.c:~ r "'Oi'll ~E'X"'fis~' 'ScC:Mlb'Vu;e/f~r:iUiO'\\C1uded) ;;Each,Iii'staliiition" -I::: AT -; ',0", \c-o.'i.\O"~.\; "i\~f);j'(;"7.,<<,:e~o'i.~$jf!"..:cc'" ,,-' '" .."~ s.?.- ~ Phone ~o\\\ "'~ ~~3lt ~li~O $'i.\\\~ #,. $ 50,00 $\ ~9$'~t:1~el!}i~IIt~~Z $ 50,00 OWNER INSTALLATION 0 ...~\'fj 'l\llIIe'\ri:-?R~sidential $ 25,00 v:o :o"e....-. , (\~~lmit&lfnergy/Commercial $ 45,00 "." ',Y". : '.' . " " ;I'li..TRFIEF:n';OREGON''\'''''' " ",." 1.t.l;.i-;ofA.:P,," , ~~. " . ~ . t t ",~!L __';':.l]:"lU' 1;;V t ~l.~l,,'1..~'~, < 4;, <,€ ...!'111~'lt. 1.'< ~""',\;.J ,,1~'\.."'\"'1 ~;:....fl1i4t'''r ,f-!~:"'~,,. ':,"f' ' ' 40:'~ :l\~ :.).1 ~. ,;'~-:'{lt.:; '''\'s:: j;"~~:h'; "~,,.--..!<. ~.~... : r:.fI""";"~tN"!-"'l'''''. """",,:.cy,;";"~~':-:~.~-'I$;:II,_ .,<<._~.".:r"mr:::?\] 1. ';LOCATION'OF1NSTALI:ATIOM.,'ii',,~'inl"&: ~.:.:...'J::T;;:;"~~"".'l;,.'<"'" J. ,'_ "__~"-k;,""""'-' f!:t"""%"'''~~''''''.')'1'<J Jtf35 LAWN RIO~t. '5PFUJ (}((, LEGAL DESCRIPTION )7032-5'22 06700 JOB DESCRIPTION /3 Mlt R~MoOtL $50,00 $ 50,00 $ 69,00 $100,00 city The installation is being made on property I own which is not intended for sale, lease or rent. . Minimnm Electric Permit Inspection Fee is $45.00 + Surcharges Inspection Request; 726.3769 ~.%",...._"'-'lJ".. ..,. ~,,~" "'. ~,,: .- .,~"""':"'~ '..' ,-,.. -,' '..- " - ._ ,. "'f"""'" "',' :'I'~.-. ..."'....4, ;,,,,,,.' .'-",., -"'~~'''''.- ~ ,C !':,...,., ;'-'....; ....:JJ:'J,,~. ;~.'\'<" l. "r 4. rfSUBTOTAEOF'ABOYEt'"lf,:;J:'~"!lil.,\',;',;~'""'- '~- k"\'.'<"."~.~~<~t:2;:~;~w.'~ ';.~.'!,;;"j'U':;""<I'\<;ii.t-,'4i,... ,,"H;;.-->'.L'i' * ~(!J --- \ \_ ' - -37z7 -:;,.2.:1.. _ .\ - -..:4-:tPO 4",{;O ...i..... --... i~5'P. 7% State Surcharge 10% Administrative Fee Owners Sigmiture: TOTAL , ~ I ' " Shared Drive(T:)/Building FonnSlElectricl!l.pmni. ,.pp......lion 1 ~03.doc . . CITY OF SPRINGFll!.LU Building/Combination Permit PERMIT NO: COM2004-01l62 ISSUED: 09/30/2004 APPLIED: 09/21/2004 EXPIRES: 04/18/2005 VALUE: $ 29,700.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1435 LA WNRIDGE AVE ASSESSOR'S PARCEL NO.: 1703252206900 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Remodel PROJECT DESCRIPTION: Remodel two bathrooms - add one fixture (within area of existing bathrooms) Adding to permit 10/14/04 - enclosed sunroomlIaundry at covered patio area. Residential Owner: TINDOL DORIS B TE Address: 1435 LA WNRIDGE AVE SPRINGFIELD OR 97477 Contractor Type General Electrical Plumbing I CONTRACTOR INFORMATION I Contractor r \\\t. \NCl~~ License GEORG~!JRADDO<;I~"j..?\rr.t. irr.WI\\ \'0 ~ 77180 W~#A~~~~I!I\'i~ ~~? ~t.\) tClrr. 138121 ~~~.f~~r~@."c;;~~ ..~~~\)\) 38123 r>-\\\\\~~~~C.t.\) ~'~pUmDING INFORMATION' C'}JWI'" \)t>,i \ ~ r>-~i \ ~I.) # of Stories: R-3 Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Expiration Date 12/16/2005 10/19/2007 01/24/2006 Phone 541.342-3478 541-461-2590 541-484-7246 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport /' /' Sq~Other: .' 'n1a ",fJll , nt Load: -Al..",lItoN MIl. I DEVELOPMENT INFORMATION ~~~,~,. r:P"(l>"~ ..dl>~e ~~'l;l.e~1ill\!U1RED PARKING Overlay Dist: O\e($ eO vs\ ~ ~'~ O~e ~ ~'Dl~J;. # Street TreeJ,.lY!'it: oo~'1 '\'('0 ~~e'1> d- ...~e~Jlin'dYcapped: Paved D~*iJ.i!!> ~~\e\r:.'!;) ~ co~'1 . ~ ~o~'e'ompact: % Ofl\o\~'!.ve'1:~. !:),JJ 'tJ~~ ~O\~~~ '!;~'1' ....~,'c~ b'l:CS ,,0 rJ..~-t:-.~~'f,: ;',~~ .; C1j f'?>"',,~(N J~J:- !!iT I PUBLIC IMPRt>.Vj,;MID<l'S1' .:s-e ,0. ,:c; 11. . '\ .. '\"" V" ~,~. ~ ,'" ~~ c'l> ~'Q0 v0~'Sidewalk Type: (\>$ 288 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: DownspoutslDrains: Notes: Paeelof3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Use Bid Amouut Use Bid Amount Bid Amount Bid Amount Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 70/0 State Surcharge Building Permit Fixture Minimum/Adjustmcnt Mechanical Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid . . CITY OF SPKll~\.J1'1I!.LlJ Building/Combination Permit PERMIT NO: COM2004-01162 ISSUED: 09/30/2004 APPLIED: 09/21/2004 EXPIRES: 04/18/2005 VALUE: $ 29,700.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 14,700.00 15,000.00 Value Date Calculated Total Value of Project $14,700.00 $15,000.00 $29,700.00 09/28/2004 10/14/2004 Fpp< PiWLI Amount Paid Date Paid Receipt Number $95.16 $10.00 $27.54 $19.28 $146.40 $84.00 $39.00 $36.56 $48.08 $4.23 $6.00 $95.16 $4.60 $3.22 $43.00 $3.00 9/21104 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 10/14/04 10/21104 10/21104 10/21104 10/21104 1200400000000001369 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000290 1200400000000001493 1200400000000001493 1200400000000001493 1200400000000001493 $665.23 I Plan Reviews I Initial Review 09/22/2004 09/22/2004 APP SKG Initial Review 10/14/2004 10/14/2004 WE DLM Converting covered paito to sunroom and laundry - adding to eisting permit. Plan nine Review 09/22/2004 09/28/2004 APP TAJ No comments - an interior remodel. Public Works Review 09/22/2004 09/27/2004 APP CS Structural Review 09/22/2004 09/28/2004 APP DLM See documents for plan review comments Structural Review 10/14/2004 10/2112004 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. Paee 2 00 . . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01162 ISSUED: 09/30/2004 APPLIED: 09/21/2004 EXPIRES: 04/18/2005 VALUE: $ 29,700.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Reouired Insne~tions I Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. UnderOoor Plumbing: Prior to insulation or decking. Shower Pan. Prior to covering and including required testing. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover 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 of any structure without permission ofthe 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. Owner or Contractors Signature Date Pal!e 3 of3 . 225.Fifth Street Springfi~ld, Oregon 97477 541-726-3759 Phone ,- Job/Journal Number COM2004-01162 COM2004-01162 COM2004-01162 COM2004-01162 Payments: Type of Payment Check f' ,- 10/21/2004 . RECEIPT #: ,Aity of Springfield Official Receipt .velopment Services Department Public Works Department 1200400000000001493 Date: 10/21/2004 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Paid By CHINOOK ELECTRIC CO Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2082 In Person Payment Total: Page I of I 1I:36:03AM Amount Due 3,22 4,60 43,00 3,00 $53.82 Amount Paid $53,82 $53.82 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01162 ISSUED: 10/21/2004 APPLIED: 09/21/2004 EXPIRES: 04/21/2005 VALUE: $ 29,700.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1435 LA WNRlDGE AVE ASSESSOR'S PARCEL NO.: 1703252206900 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Remodel PROJECT DESCRIPTION: Remodel two bathrooms - add one fixture (within area of existing bathrooms) Adding to permit 10/14/04 - enclosed sunroomflaundry at covered patio area. Residential Owner: TINDOL DORIS B TE Address: 1435 LA WNRIDGE AVE SPRINGFIELD OR 97477 5o\k~M.1 \~~ ~ T\~~~ Contractor Type General Electrical Plumbing , CONTRACTOR.lNI\lDRM'ATlON I la'i' '" -, n JI,ll.. . "r"~tl' ule90 I Contracll!~~\.r' ' ,.- ~.,'/ S! \1'\9. sale sll\ . nse GEO~ BRADDOCK':' r .se IUle O/>.I'\ 952 THO~~:Ci,~ BALCOM JR\IO\l91'\ \ \De lulEl13 I ARPS~\$1.QING CO INC ~O?\es.~~ \"Ie?1'\9~~3 a;ao.-iO\l,\\', BUlLDlNG'rN~ORl\'li\fiON'" ," t\- 'i- lf~f.I' I _\\\0"1" 'Jl"'''~ ".,_~;;r<"" -- "',0.3"- III.ll'l'".; .. ~,;of.Sto'ties: . R-3 ".., Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Expiration Date 12116/2005 10/19/2007 01/24/2006 Phone 541.342-3478 541-461-2590 541-484-7246 .. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: 288 Occupant Load: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: ,\\t. ~Cl?-~ \. d?\?-t. ~\,~\'1 \~ ~Cl\ I PUBLIC IMPRO~~~r,$I\\ ~~~t.i\\\\~;Q~~\) ~U~ \\'\\~\\\)?-\lt.\) ~~\Glm~pe: t>-~\)~~t.~~t>-#\&\~~utslDrains: t>-W( '\ 'O\) Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: ,.;' . Street Improvements: Storm Sewer Available: Special Instruction: Notes: Pal!e I of3 - Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Bid Amount Bid Amount Use Bid Amount Use Bid Amount Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 70/0 State Surcharge Building Permit Fixture Minimum/Adjustment Mechanical Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 10% Administrative Fee + 7% State Surcharge + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Dryer Vent Fixture Minimum/Adjustment Plumbing Not Covered Mechanical Total Amount Paid . . CITY OF ~rK11'\jLi1<u.LD' Building/Combination Permit PERMIT NO: COM2004-01l62 ISSUED: 10/21/2004 APPLIED: 09/21/2004 EXPIRES: 04/21/2005 VALUE: $ 29,700.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 14,700.00 15,000.00 Value Date Calculated Total Value of Project $14,700.00 $15,000.00 $29,700.00 09/28/2004 10/14/2004 J{ppo. PiilIJ Amount Paid Date Paid Receipt Number $95.16 $10.00 $27.54 $19.28 $146.40 $84.00 $39.00 $36.56 $48.08 $4.23 $6.00 $95.16 $10.00 $4.60 $23.64 $3.22 $16.55 $43.00 $3.00 $146.40 $6.00 $14.00 $31.00 $39.00 9/21/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 9/30/04 10/14/04 10/21104 10/21104 10/21104 10/21/04 10/21/04 10/21/04 10/21104 10/21/04 10/21/04 10/21/04 10/21104 10/21104 1200400000000001369 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000268 3200400000000000290 2200400000000001321 1200400000000001493 2200400000000001321 1200400000000001493 2200400000000001321 1200400000000001493 1200400000000001493 2200400000000001321 2200400000000001321 2200400000000001321 2200400000000001321 2200400000000001321 $951.82 I Plan Reviews I Initial Review 09/22/2004 09/22/2004 APP SKG Initial Review 10/14/2004 10/14/2004 WE DLM Converting covered paito to sun room and laundry - adding 10 eistlng permit. Plannin!! Review 09/22/2004 09/28/2004 APP TAJ No comments - an interior remodel. Public Works Review 09/22/2004 09/27/2004 APP CS Pa!!e 2 of3 . . CITY OF ~rK.ll~ut<l~LJJ Building/Combination Permit PERMIT NO: COM2004-01l62 ISSUED: 10/21/2004 APPLIED: 09/21/2004 EXPIRES: 04/21/2005 VALUE: $ 29,700.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 09/22/2004 09/28/2004 APP DLM See documents for plan review comments Structural Review 10/14/2004 10/2112004 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. \ Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. UnderOoor Plumbing: Prior to insulation or decking. Shower Pan. Prior to covering and including required testing. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: Wben all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: Wben all electrical work is complete. By signature, 1 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. 1 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. gl'AVrl ~'M IO-~/-oC; 17. r Owner or Con ractors Signature Date Paee 3 of3 225.Fifth Street 'r - . Springfield,Oregon 97477 If541-726-3759 Phone . .~I WiL ." Job/Journal Nnmber COM2004-01162 COM2004-01l62 COM2004-01162 COM2004-01162 COM2004-01162 COM2004-01162 COM2004-01162 COM2004-01162 Payments: Type of Payment ~Check f- 'if, 10/2112004 RECEIPT #: 2200400000000001321 Description Building Pennit Minimum! Adjustment Plumbing Fixture Dryer Vent -Mechanical Issuance Fee- . Not Covered Mechanical + 7% State Surcharge + 10% Administrative Fee Paid By H WAYNE TINDOL Received By djb Check Number Batch Number Page I of I .Jii.ty of Springfield Official Receipt .velopment Services Department Public Works Department Date: 10/21/2004 Item Total: AuthoriZation Number How Received 1870 In Person Payment Total: 1 :54:55PM Amount Due 146.40 31.00 14,00 6,00 10,00 39,00 16,55 23.64 $286.59 Amount Paid $286,59 $286.59