HomeMy WebLinkAboutPermit Building 2006-9-22 (2)
.
-=ITY OF SPRI)'\jl.d'J.I!.LD
Building/Combination Permit
PERMIT NO: COM2006-01103
ISSUED: 09/22/2006
APPLIED: 08/28/2006
EXPIRES: 03/22/2007
VALUE: $ 4,000.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection. Line
SITE ADDRESS: 2037 HARBOR DR
ASSESSOR'S PARCEL NO.: 1803112202300
Springfield TYPE OF WORK: Manufactured Home on
Private Lot
TYPE OF USE: New Residential
PROJECT DESCRIPTION: Replacement Manufactured Home
Owner: ALTERNATIVE FINANCIAL SERVICES INC
Address: 240 OAKW A Y CENTER
EUGENE OR 97401
Phone Number: 541-556-9524
I CONTRACTOR INFORMATION I
VB
ATIENOI j\,AGMsegO;"; Expil:l\tionsijliteIO Phone
follow rulEl.8 adopted by the Oregon Utility
Notlficationf~4.fil!er. Those r08tl.'4J200Mtfort!;41-686:5444
in OAR 952-001-0010 through OAR 952-001
BUILDING INVORMlI:'ntlNl.obtaln caples 01 me rUles 0)
Lt.llll.y \, I~w~nter. (Note: the telephone
# of Stories:number for the Ore!ilon leJ~'Sill!ptification
Height of Structure Center is 1-BOO-:?s\i~ttt:j~Floor:
Type of Heat: orced Air Electric Sq Ft 2nd Floor:
Water Type: Electric Sq Ft Basement:
Range Type: Electric Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
1,404
Contractor Type
General
Electrical
Plumbing
Contractor
OWNER
ROBS ELECTRIC INC
OWNER
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I
R-3
3
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Sola r Setbacks:
26.00
24.50
7.00
45.00
0.00
Overfay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Urban Fringe
2
Total:
Handicapped:
Compact:
2
17.20
I PUBLIC IMPROVEMENTS I
Street Improvements:
Sidewalk Type:
Fullv Improved
Storm Sewer Available: NOTICE: DownspoutslDrains: Curb and Gutter
Speciaflnstruction: THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHOruJl EQ UND~ THIS PERMIT IS NOT
Notes: Lan~ County infrastr~cture.. Lane County approved sept,il:(~nl~~ Ir-lV 1i~)1 ill;.,ViUI,I!!l.l"sUP,PON.1l drywell sytem
(ltr ID file), storm dralDage lied to curb and gutter,same aslfll'hI"Ov ihhlllli'g.J !j>IlI\NUUNtlJ ~Ut1
ANY 180 DAY PEHIOD.
Paee I of 3
-ii:~
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Descriotion
Tvpe of Construction
Foundation Onlv Use Bid Amount
Manuf Home Manufactured Home
Fee Description
Plan Review Residential
+ 10% Administrative Fee
+ 5% Technology Fee
+ 80/0 State Surcharge
Foundation Permit
Manuf Home State Issuance
Manufactured Home Conn - Plmb
Manufactured Home Feeder
Manufactured Home Placement
Plan Review Minor - Planning
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Storm Sewer - 1st 50 Feet
Total Amount Paid
Initial Review
Plannine Review
08/30/2006
08/30/2006
Public Works Review
08/30/2006
.
.ITY OF SPRINGFIELD
Building/Combination Permit
'PERMIT NO: COM2006-01103
ISSUED: 09122/2006
APPLIED: 08/28/2006
EXPIRES: 03/22/2007
VALUE: $ 4,000.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
$1.00
Square Footage
or Bid Amount
4,000.00
52,514.00
Value
Date Calculated
$4,000.00
$52,514.00
$56,514.00
08/28/2006
08/30/2006
Total Value of Project
Fpp<, P~W
Amount Paid
$39.39
$36.06
$23.63
$28.85
$60.60
$30.00
$45.00
$50.00
$160.00
$112.00
$118.74
$156.16
$17.34
$71.82
$45.00
$994.59
Date Paid
Receipt Number
8/28/06
9/22/06
9/22/06
9/22/06
9/22106
9/22106
9/22/06
9/22/06
9/22/06
9/22/06
9/22106
9/22106
9/22/06
9/22106
9/22106
1200600000000001338
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
2200600000000001332
I Plan Reviews I
08/30/2006
09/20/2006
09/11/2006,
APP LLH
APP TAJ
32 sf of enclosed storage required.
2 street trees required unless they
are already in.
Lft msg for owner. Storm drainage
requires drywell & cales. Lane
County Sanitarians approval hilS
been rcvd for septic IIpproval.
Forwarded to Tara for her review,
she will return to me.JLP
WE JLP
Paee 2 of 3
.ITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-0I103
ISSUED: 09/22/2006
APPLIED: 08/28/2006
EXPIRES: 03/22/2007
VALUE: $ 4,000.00
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Public Works Review
09/18/2006
09/18/2006
APP JLP
Public Works Review
09/19/2006
09/19/2006
APP JLP
Structural Review
08/30/2006
09/07/2006
APP DLM
Storm drainage to curb & gutter as
previous home. Owner brought in
letter affirming lot does not have
enough area for placement of a
drywell. Drywell no longer
required.JLP
Lane County infrastructure. Lane
County approved septic system (ltr
in file). Site will not support a
drywell sytem (ltr in file), storm
drainage tied to curb and gutter,
same as removed dwelling.J LP
Standard M.H only plan review
comment, plus verify tha water line
material under the building is a type
approved for such use. 9/7/2006 dim
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.
I Re<ll',j~-~~, Insnection11
Foundation: After forms are erected but prior to concrete placement.
Manuf Home Set Up: When installation of all piers or stands is complete.
Final Manuf Home Set Up: After all required 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 Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to
the panel.
Storm Sewer Line: Prior to filling trench.
Final Building: After all required inspections have been requested and approved and the building is complete.
B)' signature, 1 state and agree, that 1 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.
~ {L 1~)aIOY
..
Owner or Contractors Signature
Date
Pa2e 3 of 3
9/dd-J06
CITY OF SaG FIELD SYSTEMS DEVELOPMEN&RKSHEET
JOURNAL OR JOB NUMBER: COM2006-Q1103
NAME OR COMPANY: Alternalive Financial
LOCATION: 2037 Harbor Drive
TAX LOT NUMBER: 1803112202300
DEVELOPMENT TYPE: SINGLE F AMIL Y RESIDENCE
NEW DWELLING UNITS 0 BUILDING SIZE (SF: 214 LOT SIZE (SF):
o
II-
I'"
tJ.l
10
10
I~
1tJ.l
f-<
- '"
o
~
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. ,I COST PER S.F. CHARGE I
I 214.00 I $0.336 I = I $71,82
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. I , I COST PER S.F. I, I DISCOUNT RATE I I
I 0.00 I I $0.336 I 50% I =
ITEM I TOTAL. STORM DRAINAGE SDC , $71.82
2, SANITARY SEWER. CITY
DISCOUNT
$0.00
571.82
'11070
,I
A REIMBURSEMENT COST:
I NUMBER OF DFU's I '
. I 6
B. IMPROVEMENT COST:
I NUMBER OF DFU's I ,
6 I $19.79
ITEM 2 TOTAL. CITY SANITARY SEWER SDC
COST PER DFU
$26.03
5156.16
1091
5118.74
1092
= I
$274.90
], TRANSPORTATION
A. REIMBURSEMENT COST:
I ADTTRlPRATE I ,
9.57 I
B. IMPROVEMENT COST:
I ADT TRIP RATE I
9.57 I
I NUMBER OF UNITS I , I
i 0 I I
COST PER TRIP
$19.81
, INEW TRIP FACTORI
I 1.00 I = ,
50.00
I
11093
I
-'
1094
x
I NUMBER OF UNITS I , I
I 0 I I
= ,
COST PER TRIP
$87.39
$0.00
x I NEW TRIP FACTORI
I 1.00 I
$0.00
ITEM 3 TOTAL. TRANSPORTATION SDC
4, SANITARY SEWER. MWMC
A REIMBURSEMENT COST:
INUMBER OF FEU's I , ICOST PER FEU
I 0 I $91.61 = $0.00 11054
B. IMPROVEMENT COST: I
INUMBER OF FEU's I , ICOST PER FEU
, 0 I $961.52 = $0.00 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) 50.00 1054
MWMC AbMINISTRA TIVE FEE $0.00 11056
ITEM 4 TOTAL. MWMC SANITARY SEWER SDC = I $0.00 I
-
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $346.72 I
5, ADMINISTRATIVE FEF.;
I SUBTOTAL , I ADM. FEE RATE 1= CHARGE
I $346.72 I 5% I $17.34
TOTAL SANITARY ADMINISTRATION FEE: 17.34 11079
TOTAL TRANSPORTATION ADMINISTRATION FEE: $0,00 1078
Jeff Prociw 9/19/2006 TOTAL SDC CHARGES = , $364.06 I
PREPARED BY DATE II
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
r--- YEAR
I ANNEXED
CREDIT RATE/$l,OOO
ASSESSED VALUE
$5.29
$5.29
$5.19
$5.12
$4.98
$4,80
$4,63
$4.40
$4.07
$3.67
$3.22
$2.73
$2.25
$1.80
$1.59
$1.45
$1.25
$1,09
$0,92
$0.72
, $0.48
$0.28
$0.09
$0.05
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
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 FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
~ ,
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
TOTAL MWMC CREDIT
=
2
2
1979
$0.00
o
$0.00
I'
I
N ro/'\ I L.:~
q,-Z;S-OfO
rn '5 r~
&PRINCii.....e.~D .J
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ... - ,.,
ELECTRICAL PERM,(T APPLICN-ION q ~
City Job Number t '1 0 , 1.\ (Yo Date .. - ')... ~ - do
1. ~,'~focA.,~.._',..".....',:~..T1,..'.:9._^T.OF..iN$__T.{i..':~3710N~,~~ ~>~"..,.,." ",t.. ~. -. -,r' ...~,,:.......'Ii '>-"''''''''''';J::.,:-J>~(: ~~"~' flj;;','~
_..... _ _.' _ 3. t.m~p.y;rE.!:!.fs...CII~D.l!.P'J&!i2!f<,":"r,~, '\j "..',,/
'LD?fJ J.tQJ(oor , 1\r.
~
Owners Name AH. -C{CYi ~
Address Q M ~ rf\ lr( E. ~-i~~ll~'ri~~~s (~~~y!~~(~~a~~~~'V~I~~~~~~tEI~tD!i~J~~
City C;; ~ V'I PI\ p/.. A' ,hone ~~ taf15'L1- Pum;:;;:al~O~''''-'"~'-''''''''~--- $ 50'.'~;-"--"""~-'
~ Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited Energy/Residential $ 25.00
The installation is lng made on propeny I own which Limited Energy/Commercial $ 45.00
is not intended fof sak. lease or rent.. Minimum Electric Permit Inspeelion Fcc Is $45.00 + Surcharges
O S"T 4 '~tjBTOT~ OF~o:E;}I',~/;~:\,:~,!j';:...:~:::;:/"L: ~Qi tV'\
wners Ign re: ." "..,"..' ,.. , '"..." ,J",};' ,..;' ,',.'..,,;..- ~) .ro'lV
f,)~iIt,............1..~.~ .. _~.$,,~~,-:..tj ..Iillw~,-.....~;.'i..;j~~,.....f
8% State Surchurge
I 10% Administrative Fee f\ ()O
.....9'1'... ~ 1J...r:I) .
Shured Drivc(T:)lBuilding FOnnslE'lef"~PliC~~..5;{)
LEG\~{)3\\I;y9t Dfl30D
JOB DESCRIPTION
~ f\\) c:: ~ _ r()Q[)
PermIts,are non-~ansferabIe and expire If work Is
not started within 180 days of Issuance or If work Is
Suspended for 180 da)'s.
!foo~cTOR'1N~oN;;6Nzl~ '
2. Gi&.:l!:"~~::-"'~' d, l.o-!".ffUXtll~~"",w'ln.l'li'l<"'~>OIl'!!""'<l~;..1tiI"I41it
ElectricalContraelor ,fbh:s E/("clnc ..L/1C
Address ..f?(J){J" d 1'd J
City ~(O:I'Je
Phone 10 t'6 ~<)$I~<1
Supervisor Licens~ Number
'7'- 7t/0 S
Expimtion Dale
//) -/ z17
Constr. Conlr. Numb.r
/50&:7 7J?
,f' -/'/ -c 7
Expimtion Date
Signature of Supervising Electrician
Inspection Request: 726-3769
A. "'Ne~;'R'J'id~nli~I::'Sing~ ~l{~~i~Failill~:~-fd~"elllng ~;Jr.~
~~~~'J;:...........,:.......~::CI"'~ ' ~.....::.,l>"L.~'~IIll;\i.tII;:Ul;.I.i~_....;.o...W.I~:';:':;
Service Included
1000 sq. ft. or less
Each additional 500 sq.. fl. or
ponion thereof
$106.00
$ 19.00
Each Manufaet'd Home or .."':"\
Modular Dwelling Service or aw .. U f' '- Y' >>.,"no t:::./\ l.XJ
F JM.II::N IIU~;Un::yutll '';4 I ~ ~~"''''' ~.
B ~~~P~itl1~~"~~'~'~~I~"liiII~~~:'''~.~~~~:~~I~1i<il''i!li 'i1!Il!i1"l
.' ",......~ On~Cu.la",~ IDS anon ~~~tat1GnS~Or!Rcloca on:.~~~~
in ~OAR9~2:Od'f.6o'1'O'th"t8tl\jrfO~j:f~d01""''',,"''''''IliJI1;~
~M~p.~'W'inay obtain copies 01 theS'63:oob~
201 ommltg ~1l\H>Il)l1ler. (Note: the telel$~OO
40 ht'J1'I~tt<I ~~ ~m~fegon Utilitv No!ifPI~~iOO1
601 Amps tc{JOOOfNrltpS1-aOO-332-2344).$163.00
Over 1000 AmpsNollS $375.00
Reconnect Only $ 50.00
~:'. "',WJ~),:~ ,., '.-:>,\". :!f ii1:.'(;\'f'JjJH",'::q;-!,1;'iii.'.li'~Hi,:.!lItti!llir:i!' -';'r:,:/'~',!'A.t~
C. r~T~mporal:1' Scryl.ces (I1\F~_ers .-1).~~.(;' '~_,:~;{l1~<1t~;~r';t~1,~~,~ti 'lh'::\~~~:l.~l;j
~.......~~..__....__~,_w;;.(,~ ....:..,""'~.,.;.-li'.'"ij.l ~"""''''''~",'l~'''~
Installation, Alteration or Relocation
N@lVIOO~ or less $ 50..00
T~fl:l pr/j\AY Aq,.PJ'X\1ijS $ 69.00
UYH~mp.~'lo 169~~1hPs EXPIRE Ir I Nt vvCSlIlo.oo
~~~i1f~%J;.~~(~li~;~~,,~~~~~ri;:~*iWM~i,:r.'i"i'~f)
AI~ , '181rf1AYP tRlrTtf"i:Iill"~":~\J"",.~....~""""",-_.-,,,,"'4'-""
New Alteratiun or E'ilchslon Per Panel
One Circuit $ 43..00
Each Additional Circuit or with
Service or Feeder Permit
$ 3.00
(8.
. .
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.
Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
pennit#~ ~ -0110 :S
Address:;;)037 Ah_1'ho.v D2-.
ISSUedby:J _ /)taJ,a~ Dale: VOlWo,6
~
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensed with the Construction Contractors Board to sign the following statement before a building
permit can be issued. This statement is required for residential building, electrical, mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt from licensing under
ORS 701_010(7), need not submit this statement. This statement will be filed with the permit.
Fill in the al'l'>VI,,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B:
Xl.
D 2.
I own, reside in, or will reside in the completed structure.
I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion.
D 3A. My general contractor is
(Name)
(CCB #)
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
OR
K 3B. I will be my own general contractor.
If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If! change my mind and hire a general contractor, I will contract with a contractor who is
licensed with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to, Property Owners about Construction Responsibilities on the reverse side of this form.
A rvWeJAJ 'fZ Wa \0 V q J dd-.! 06
- (Signature of permit applicant) , (Date)
(White copy to issuing agency permit file, pink copy to applicant.)
Property_owner_doc 06-0l-04
Adiirrn~ ~~
\ i., \ .
INFORMATION'NOTICE TO PROPERTY OWNERS
A~OUT ,CQNSTRIJCTION RESPONSIBILITIES
~~r ri~~ G,~rrn~ll"~llC'rrntll"~~t~ll"?
.,
NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the
Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substilntial improvement to an existing
structure, you can prevent many problems by being aware of the following responsibilities and concerns.
Employer ResjploJrnsibilitftes
You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if
you use contra~tors not licensed with the Construction Contractors Board to do' labor in constructing or to assist in the
construction or improvement of a'residential strUcture. A~ the employer, you must comply with the following:
. - '
Oregon's Withholding Tax' Law: As an employer, you must withhold income taxes from employee wages at the time
employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your
employees. For more information, call the Department of Revenue at 503-3784988. - ,
Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes
on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488.
The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and
Unemployment Insurance Tax. To file for a BIN, call 503-945-809l or www.dor.state.or.us/formsnav.htmll for the
appt UpJ. ~ate forms.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' cu.up~usation insurance for your employees. If you fail to obtain workers' compensation
insurance, you could be subject to penalties and be liable for all claim costs if one' of your employees is injured on the
job. For more information, call the Workers' Compensation' Division at the Department of Consumer and Business
Services at 503-947-78l5.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the
IRS at 1-800-829-4933 'or visit their web site at W\\<wjrs.l!ov. '
OtllBer lRes]l)onsibinities a~14.J1 Are~s 'of COilllCerJrnS
Code Compliance: As the permit holder for this project, you are responsible for re'solving any failure to meet code
requirements that may be brought to your attention through inspections.
d. ", _, . <. ....
Liability and Property Damage Insurance: Contact 'your insurance agent to see if you have adequate insurance
coveragc for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire ?r
work that must be redone. . I
... . ~ \ I'
. {' ','
, :
~.
. -
Time: Make sure you have sufficient time to supervise your employees...,
Expertise: Make sure you 'have the skills to act as y6ur o~ gi1neral contra:~tor, to coof.:linate the work of rough-in
and finish trades, and to notify building officials as the a"". UP' ;ate times so they can perform the required inspections.
If you havc additional questions call the Construction Contractors Board (503-378-462l) or write the agency at PO
Box l4l40, Salem, OR 97309-5052.
Property_owner.doc 06-01-04
225 Fifth Street
Spl'ingfield, Oregon 97477
541-726-3759 Phone
. J:Q~;~
~,
Ci!iif Springfield Official Receipt
D.pment Services Department
Public Works Department
Job/Journal Number
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
COM2006-0 II 03
Payments:
Type of Payment
CreditCard
cRcceintl
RECEIPT #:
2200600000000001332
Date: 09/22/2006
Description
Manufactured Home Feeder
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Sanitary/Storm Admin
Plan Review Minor - Planning
Foundation Permit
Manufactured Home Placement
ManufHome State Issuance
Manufactured Home Conn - Plmb
Storm Sewer - 1st 50 Feet
+ S% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
ANDREW WALER
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
NJM
226256 In Person
Payment Total:
~
Page I of I
-,
9:06:45AM
Amount Due
50.00
71.82
156.16
118.74
17.34
112.00
60.60
160.00
30.00
45.00
45.00
23.63
28.85
36.06
$955.20
Amount Paid
$955.20
$955.20
9/22/2006