HomeMy WebLinkAboutPermit Building 2006-05-01Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 0510112006
APPLIED: 04/1812005
EXPIRES: 11/0112006VALUE: $ 6,000.00
SITE ADDRESS: 1293 ISTH ST
ASSESSOR'S PARCEL NO.: 1703253403600
PROJECT DESCRIPTION:
Springfield TYPE OF WORK: Office
TYPE OF USE: Alteration Commercial
Adding walls and reception area. Partitioning area into fwo offices: Door A and Door
C. Door C will be future infill tenant.
Owner:
Address:
Contractor Type
General
Electrical
BEAN DENISE M & MICHAEL E
I22O S 69TH PL
SPRINGFIELD OR 97478
Phone Number: 726-0908
outo
nL
1
v
Contractor
PREW CONSTRUCTION
MAG ELECTRIC INC
LLC
Expiration Date
0510212007
1211312009
Phone
541-144-2772
s4l -461-0387
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Overlay Dist:
# Street Trees Rqd:
Paved Drive
o/o of Lot
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
nla Occupant
mpact:
Sidewalk Type:
Downspouts/Drains:
B
VB
PARKING
Notes:
Page I of4
nu\{os'j
001 r\escoIthe
$
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 05/01/2006APPLIED: 04/1812005
EXPIRES: 11/0112006VALUE: $ 6,000.00
Description
Estimate
Type of Construction
Estimate
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
$1.00 6,000.00
Total Value of Project
Amount Paid Date Paid
Value
$6,000.00
$6,000.00
Receipt Number
2200500000000000524
3200s00000000000280
1200500000000000717
3200500000000000280
1200500000000000717
3200s00000000000280
3200s00000000000280
l 20050000000000071 7
2200600000000000541
2200600000000000541
2200600000000000541
Date Calculated
05/03/2005
Fee Description
Plan Review Comm/Ind/Public
+ lDoh Administrative Fee
+ lO'h Administrative Fee
+ 77o State Surcharge
+ 77o State Surcharge
Add, Altero Extend Circ
Add, Alter, Extend Circ Ea Add
Building Permit
+ l0'h Administrative Fee
Renew Building Permit
Renew Electrical Permit
Total Amount Paid
$49.53
$5.50
$7.62
$3.8s
$s.33
$43.00
$12.00
$76.20
$9.00
s45.00
$45.00
5/3/0s
6t2t05
6t2t05
6t2t05
6t2t05
6t2t05
6t2t05
6t2t05
5n106
5nt06
5nt06
$302.03
F ees
Plan Reviews
Paee 2 of 4
Valuation Descrintion I
PRIN
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 0510112006APPLIED: 04/1812005EXPIRES: 1y0y2006VALUE: $ 6,000.00
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-7 26-37 69 Inspection Line
Fire Department Review 05/06/2005 06/01/2005 OK GRG
05/13/2005 APP SB
Plans Review: Addition of walls to
office building. Job
#COM2005-00436. Occupancy
Classification: B. Construction type:
v-8.
Maintain address numbers in
contrasting color from the
background positioned plainly
visible and legible from the street or
road fronting the property (2004
Oregon Structural Specialty Code
501.2 and 2004 Springfield Fire
Code 505.1).
Provide fire extinguishers with a
minimum rating of 2-A:10-B:C
every 75 feet oftravel distance. The
top of the extinguisher(s) shall be
between 3 and 5 feet above finished
floor (2004 Springfield Fire Code
906).
Interior remodel only. No planning
review required. Professional officet
permitted per 16.100(l l)
No new SDCs for Door A. Door C
on hold for future tenant.
Received final internal review.
No issues or inspections.
Initial Review
Planning Review
Public Works Review
Structural Review
Structural Review
SUB Review
05/06/2005
05/06/200s
05/06/200s
05/06/2005
06/01/2005
0s/06/2005
05/06/2005
05/10/2005
05/13/2005
06/0u2005
05/r8/200s
SKG
EMM
JMP
JMP
JF
APP
APP
WI
APP
APP
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 Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Reorrired Insnections
Paee 3 of4
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 05/01/2006APPLIED: 04/1812005
EXPIRES: l110112006VALUE: $ 6,000.00
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 timen that each address is readable from the
street, that located at the front of the property, and the approved set of plans will remain on the site at all
times
Owner or Contracto Date
Pase 4 of 4
., :I
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
C:' - of Springfield Official ReceiPt
L- . elopment Services Department
Public Works Department
RECEIPT #: 220060000000000054r Date: 05/01/2006 2:57:58PM
Job/Journal Number
coM2005-00436
coM2005-00436
coM2005-00436
Description
+ l0o/o Administrative Fee
Renew Building Permit
Renew Electrical Permit
Amount Due
9.00
45.00
45.00
Item Total:s99.00
Payments:
Type of Payment Paid By Received By
Check Number
Batch Number Number How Received Amount Paid
Check PREW CONSTRUCTION LLC djb 6166 ln Person $99.00
PaymentTotal: TdT-
cRecernt I Page I of I s1112006
*sR$L&Pl*Ls
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 0610212005
APPLIED: 04/1812005
EXPIRESz 1210212005VALUE: $ 6,000.00
SITE ADDRESS: 1293 18TH ST
ASSESSOR'SPARCELNO.: 1703253403600
PROJECT DESCRIPTION:
Springlield TYPE OF WORK: Oflice
," I r?HE i@titpm g omlnugdqnires lou @mmercial
calling the center. (Note: the telephone
number for the n
Adding walls and reception area. Partitionlng dd8lffi d opbot6gethD@:e$mUDqf
C. Door C will be future infill tenant. 'r:,.,lrratict-t Celtter. Those rules are set forth
00y0. You may obtaPFtBpOwner:
Address:
Contractor Type
General
Electrical
BEAN DENISE M & MICHAEL E
1220 S 69TH PL
SPRINGFIELD OR 97478
Contractor
PREW CONSTRUCTION LLC
MAG ELECTRIC INC
License
164412
149834
Expiration Date
0510212007
12n3t200s
Phone
54r-744-2772
54r461-0387
TION
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building: nla
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
Vo ofLot Coverage:
Lot Size:
Sq Ft lst Floor:B
VB
Sq
Sq
Sq
Ft
Ft
Ft
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
DEVELOPMENT INFORMATION
PUBLIC IMPROVEMENTS
Notes:
Page I of3
m
t ull,f,rNu ll\r (rKrvrryl
F
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 0610212005APPLIED: 04/1812005
EXPIRESz 1210212005VALUE: $ 6,000.00
Description
Estimate
Tvpe of Construction
Estimate
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
$1.00 6,000.00
Total Value of Project
Amount Paid Date Paid
Value
$6,ooo.oo
$6,000.00
Date Calculated
05/03/2005
Fee Description
Plan Review Comm/Ind/Public
+ l0o/o Administrative Fee
+ l0oh Administrative Fee
+ 1Yo State Surcharge
+ 77o State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Building Permit
Total Amount Paid
$49.s3
$5.50
$7.62
$3.85
$s.33
$43.00
$12.00
$76.20
$203.03
5/3/05
6t2t05
6t2t05
6t2tos
6l2l0s
6t2t05
6t2t05
6t2t05
Receipt Number
2200500000000000s24
3200500000000000280
1200500000000000717
3200500000000000280
1200s00000000000717
3200s00000000000280
3200500000000000280
1200500000000000717
tr'ees Pa
Plan Reviews
Fire Department Review 05/06/2005 06/01/2005 0K GRG
05/06/2005 05/06/200s APP SKG
Plans Review: Addition of walls to
office building. Job
#COM2005-00436. Occupancy
Classification: B. Construction type:
v-B.
Maintain address numbers in
contrasting color from the
background positioned plainly
visible and legible from the street or
road fronting the property (2004
Oregon Structural Specialty Code
501.2 and 2004 Springlield Fire
Code 505.1).
Provide fire extinguishers with a
minimum rating of 2-A:10-B:C
every 75 feet oftravel distance. The
top ofthe extinguisher(s) shall be
between 3 and 5 feet above finished
floor (2004 Springfield Fire Code
e06).
Initial Review
Paee 2 of3
Valuation Description I
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 0610212005APPLIED: 04/1812005
EXPIRESz 1210212005VALUE: $ 6,000.00
Planning Review
Public Works Review
Structural Review
Structural Review
SUB Review
0s/06/2005 0s/l0/2005 APP EMM
05/06/2005 05/13/2005 APP SB
Interior remodel only. No planning
review required. Professional offices
permitted per 16.100(11)
No new SDCs for Door A. Door C
on hold for future tenant.
Received final internal review.
No issues or inspections.
0s/06/200s
06t0u2005
05t061200s
05/13/200s
06t0y200s
05/r8/2005
WI
APP
APP
JMP
JMP
JF
To Request an inspection call the24 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 Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections have been requested and approved and the building 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 Springlield 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 c,onstruction.
tfuZ*,u 0 )
or Contractors Signature Date
Paee 3 of3
l(eourre(l InsDecuons I
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
:velopment Services Department
Public Works Department
RECEIPT #: 3200500000000000280 Date: 0610212005 1:25:1ePM
Job/Journal Number
coM200s-00436
coM2005-00436
coM200s-00436
coM2005-00436
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7Yo State Surcharge
+ l0Yo Administrative Fee
Amount Due
43.00
12.00
3.85
5.50
Item Total:$64.3s
Payments:
Type ofPayment Paid By
CheckNumber Authorization
Received By Batch Number Number How Received Amount Paid
CreditCard LISA D GRAY/CROW
VALLEY ELECT
njm 052501 Fax
Payment Total:
$64.3s
$64.3s
612/200s Page I of I
re*
gFRl'{GEIEIII City of Springfield
Development Services DePartment
Community Services Division, Building Safety
541-726-3759 Phone
541-726-3676Fax
January 24,2006
BEAN DENISE M & MICHAEL E
I22O S 69TH PL
SPRINGFIELD, OR 97478
Date Permit Issued:
Permit Number:
Location:
6121200s
coM200s-00436
1293 18TH ST
Adding walls and reception area. Partitioning area into two offices:
Door A and Door C. Door C will be future infill tenant.
Project Description:
Dear Permit Holder:
As stated on your permit and/or approved plans, work authorized under the permit issued will
expire if the work is not commenced or is abandoned for any 180 day period. Because you
did not contact us to request an inspection or to call us to verify that progress has continued to
be made on the project, your permit(s) has expired. This letter is a reminder that the above
referenced permit(s) expired on 121212005. Please contact our office at Springfield City Hall,
225 Fifth Street, Springfield, Oregon between 8:00 a.m. and noon or between 1:00 p.m. and
3:00 p.m. Monday through Friday, excluding holidays prior to continuing work on your
project. There are additional permit fees that are due in order to complete your project.
Lisa Hopper
Building Safety Supervisor
Dave Puent, Community Services Manager
Code Enforcement
cc
CITY OF SPRIhIGFIELD. OREGON
225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)72G3753 o tr'AX: (541)72G3689
ELE CTRI CAL PERMIT APPLICATION
City Job Date
3.
LEGAL DESCRIPTION A.
34 oeQa)Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
JOB DESCRIPTION
and expire if work is
$106.00
$ 19.00
Permits are
not started within 180 days of issuance or if work is
Suspended for 180 days.
)
Electrical Conkactor
Address
H::$TP#Tet+Tfi.fsfl lE"""Jn r a wrs$rircsydrQdo
B.
in'(roug
City Phone %/fi8-
Superrrisor License Number r7/.5
Expiration Date .//)- /- aa
Constr. Contr. Number
Expiration Date ,0-,13-4f
Signature of Electrician
Owners
200$mns sr.lespr a v o I r t a i n co p ies_ollhe fr.f 60ty_
20I Amps tu 400sA6s7e1eL (Note;JhejeJeftfl*0
40 I 4{ps.to 600 rttnpO re g o n Uti I ity Notif ft,4000
60 I Amps to OOOtreritr 1 -800-332-2344). $ I 63.00
Over 1000 AmpilVolts $375.00
Reconnect Only $ s0.00
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 or 1000 Volts see "B" above.
c.
D.
72e -oqoP Pump or imgation
Sigr/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
7%o State Surcharge
l0% Administrative Fee
TOTAL
n3 P
16o
{2
€. r-;
New Alteration or Extension Per Panel
One Circuit ,/ $ 43.00
Each Additional Circuit or with
Service or Feeder Permit a $ 3.00
E.
Phone
OWNER INSTALLATION
The installation is being made on properfy I own which
is not intended for sale, lease or rent.
Owners Signature:
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
_$
.........._$
_$
$
50.00
50.00
25.00
45.00
5.5c:
3sInspection Request: 72G3769
4.
Shared Drive(T:)/Building Forms/Electrical Permit Application I -03.doc
a a/s/atr:
1. LOCATIAN OF
a5
BELOW
or
l,l,L,^ ll r rm q/t\ V,,'' ;hfuL
INSTALIATION ONLY
,4t:lano
-
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/C ombination Permit
PERMIT NO: COM2005-00436ISSUED: 0610212005APPLIED: 04/1812005
EXPIRESz 1210212005VALUE: $ 6,000.00
SITE ADDRESS: 1293 18TH ST Springfield TYPE OF WORI(: Office
ASSESSOR'S PARCEL NO.: 1703253403600
TYPE OF USE: Alteration Commercial
PROJECT DESCRIPTION: Adding walls and reception area. Partitioning area into two offices: Door A and Door
C. Door C will be future infill tenant.
Phone Number: 726-0908Owner:
Address:
Contractor Type
General
Electrical
BEAN DENISE M & MICHAEL E
1220 S 69TH PL
SPRINGFIELD OR 97478
Contractor
PREW CONSTRUCTION LLC
MAG ELECTRJC INC
License
164412
149834
Expiration Date
0st02t2007
12t13t2005
Phone
541-744-2772
54r-461-0387
TION
ILDING INFORMATION
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
#of
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
%o ofLot Coverage:
lawEqulreg
byths Oregon
Size:
lst Floor:
2nd Floor:
Basement:
Garage/Carport
0ther:
B
VB
Load:
REQUIRED PARJ(NG
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
NOTICE:
THIS PERIIIIT SHALL EXPIRE IF THE WORK
AUIHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 1BO DAY PERIOD.
PUBLIC IMPROVEMENTS
Notes:
Page 1 of3
r
Those rules are
{0l0through OAR
00nnBYEftmdy obtain copies olthe
(Note:
F
Status Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 061021200sAPPLIED: 04/1812005
EXPIRESz 1210212005YALUE: $ 6,000.00
Description
Estimate
Tvpe of Construction
Estimate
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
$1.00 6,000.00
Total Yalue of Project
Amount Paid Date Paid
Value
$6,000.00
$6,000.00
Date Calculated
05/03/200s
Fee Description
Plan Review Commflnd/Public
+ l0oh Administrative Fee
+ 7%o State Surcharge
Building Permit
Total Amount Paid
$49.s3
$7.62
$s.33
976.20
$138.68
5/3/05
6t2t0s
6tzt0s
6t2t05
Receipt Number
2200500000000000s24
1200s00000000000717
1200500000000000717
1200s000000000007u
Fees Paid
Plan Reviews
Fire Department Review 0510612005 06t0U2005 OK GRG
05106t2005 05n3t2005 APP SB
Plans Review: Addition of walls to
office building. Job
#COM2005-00436. Occupancy
Classification: B. Construction type:
v-B.
Maintain address numbers in
contrasting color from the
background positioned plainly
visible and legible from the street or
road fronting the property (2004
Oregon Structural Specialty Code
501.2 and 2004 Springfield Fire
Code 505.1).
Provide fire extinguishers with a
minimum rating of 2-A:10-B:C
every 75 feet oftravel distance. The
top of the extinguisher(s) shall be
between 3 and 5 feet above linished
floor (2004 Springlield Fire Code
e06).
Interior remodel only. No planning
review required. Professional officer
permitted per 16.100(11)
No new SDCs for Door A. Door C
on hold for future tenant.
Initial Review
Planning Review
05t06t2005
05t06t2005
0510612005
05/10/2005
SKG
EMM
APP
APP
Public Works Review
Page 2 of3
Valuation Descrintion
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2005-00436ISSUED: 0610212005
APPLIEDz 0411812005
EXPIRESz 1210212005VALUE: $ 6,000.00
Structural Review
Structural Review
SUB Review
05/06/2005
06/01/2005
05/06/200s
05/13/2005
06/01/2005
05/18/2005
WI
APP
APP
JMP
JMP
JF
Received final internal review.
No issues or inspections.
To Request an inspection call the24 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 Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections have been requested and approved and the building 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 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.
'0rr"km ar
Owner or Contractors Signature Date
Pase 3 of3
I{*-
\
t(equrreq tnsDecttons I
225 Biftln Street
SpringfieH, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
:velopment Services Department
Public Works Department
RECEIPT #: 1200500000000000717 Date: 0610212005 9:19:20AM
Job/Journal Number
coM2005-00436
coM2005-00436
coM2005-00436
Description
Building Permit
+ 7Yo State Surcharge
+ l0% Administrative Fee
Amount Due
76.20
s.33
7.62
Item Total:$89.15
Payments:
Type of Payment Paid By Received By
Check Number
Batch Number
Authorlzatron
Number How Received Amount Paid
Check PREW CONSTRUCTION LLC djb 6035 In Person 589.15
Payment total:
-SETIT
6/2/2005 Page I of I