HomeMy WebLinkAboutPermit Building 2003-04-03Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Rax
541-7 26-37 69 Inspection Line
Building/Combination Permit
PERMIT NO: COM2003-0017 4ISSUED: 0410312003APPLIEDz 0311712003
EXPIRESz 0412912004VALUE: $ 20,697.00
SITE ADDRESS: 434 S 37TH ST
ASSESSOR'S PARCEL NO.: 1702314302700
PROJECT DESCRIPTION:
Owner: CLAy pARJ(ER
Address: 434 S 37TH ST SPRINGFIELD OR 97478
Springfield TYPE OF WORI(: Garage
TYPE OF USE: New Residential
Garage. Owner to provide letter that says he will not sublet garage or use in any
manner not specifically approved by the BO prior to any electrical inspections.DB
PhoneNumber: 541-726-3978
Contractor Type
General
Plumbing
Contractor
CLAY PARI(ER
CLAY PARKER
License Expiration Date Phone
541-726-3978
54r-726-3978
CONTRACTOR INFORMATION
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
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/o of Lot Coverage:
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
1,056
Curbside 5'
Curb and Gutter
25.00
70.00
106.00
s.00
Fully Improved
Yes
Applicant is planning to take
and using existing weep hole for
u-1
VN
(1 a n +s r i c 1 -8 o0-332 -2B4n9rvious Surface Area:
Yes
6.00
ERMIT SHA
RIZED UND
FtiilEt't6
WORK
IS NOIIHIS P
AUlHO E
private storm drain line
permit is required if
a new weep hole. SDC's include one foot roof overhang.
DEVELOPMENT INFORMATION
Notes:applicant decides to core drill
Pase I of3
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-726-37 69 Inspection Line
OF
Building/Combination Permit
PERMIT NO: COM2003-00174ISSUED: 0410312003APPLIEDT 0311712003
EXPIRESz 0412912004VALUE: $ 20,697.00
Description
Garage
Type of Construction
Garage
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
$19.60 1,056.00
Total Value of Project
Amount Paid Date Paid
Value
$20,697.60
$20,697.60
Date Calculated
03n7t2003
Fee Description
Plan Review Residential
+ l0o Administrative Fee
+ 7o/o State Surcharge
Garage/Carport
Plan Review - Planning
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Storm Sewer - lst 50 Feet
Storm Sewer Each Addtl 100'
+ l0oh Administrative Fee
+ 77o State Surcharge
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or Iess
Total Amount Paid
$125.58
$25.22
$17.6s
$193.20
$s9.00
$16.86
$337.27
s45.00
$14.00
$8.10
$s.67
$18.00
$63.00
$928.ss
3n7103
4t3t03
4t3t03
4t3t03
4t3t03
4t3t03
4t3t03
4t3t03
4t3t03
10t29103
10t29t03
10t29t03
10t29t03
Receipt Number
1200200000000000835
2200200000000000691
2200200000000000691
220020000000000691
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
1200200000000002384
1200200000000002384
1200200000000002384
1200200000000002384
tr'pps Peid
Plan Reviews
Initial Review
Planning Review
Public Works Review
Structural Review
03/18/2003
03/18/2003
03/18/2003
03/18/2003
03t2U2003
04t0U2003
APP
APP
APP
LLH
AJD
VRJ
Not verifying status of "Lot A"
Applicant is planning to take storm
sewer to street, connecting to
existing private storm drain line and
using existing weep hole for
drainage to street. An
encroachment permit is required if
applicant decides to core drill the
curb for a new weep hole. SDC fees
include I foot over hang on building
for impervious surface.
03n8t2003 04t03t2003 APP TCM
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.
Page 2 of 3
D
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: COM2003-00174ISSUED: 0410312003APPLIEDz 0311712003
EXPIRESz 0412912004VALUE: $ 20,697.00
Reou
I Footing: After trenches are excavated.
2 Foundation: After forms are erected but prior to concrete placement.
3 Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
4 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
5 Final Building: After all required inspections have been requested and approved and the building is complete.
6 Storm Sewer Line: Prior to filling trench.
7 Rough Electric: Prior to Cover
8 Electric Service: Approval required prior to utility company energizing service.
9 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.
Owner or Contractors Signature Date
Pase 3 of3
I *f.
2ISFIFTHSTREET . SPRINGFIELD, OR 97477 c PH:(547)726-3753 o FAX:
ELECTRICAL PERMIT APP LICATION
City Job Number Civtz ?J,os- OO I 7 Date /Z7 3
1.
t/3Lt
= 37+L-S "t-
LEGAL DESCRIPTION
lToz 3iLl3 OZ7O.
O*l,Y?"fr;1-lfr3projecr as submitted has the foltowins
;:urirng. and does not require specific land use
?-
3.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dweiling Service or
Feeder
200 Amps or less
201 Amps to 400 AmPs
401 Amps to 600 AmPS
601 Amps to 1000 AmPs
Over 1000 Amps/Volts
Reconnect Only
follow rules
,)09001/
cedi
n
D
RIZED
7% State Surcharge
l0% Administrative Fee
TOTAL
approval
Zoning
li Jirtoflzed Signature
$ 106.00
$ 19.00
$s0.00
$ 7s.00
$12s.00
_ $163.00
$37s.00
$ s0.00
SE les are
52-oo
copies ol the rules$l5o.o0
ote: the tetePho-nft os.oo
UtilitY r.tolfiiEaftcgloo.oo
above
$ 43.00
s 3.00
A.
JOB DESCRIPTION uLECt{ZLur<.
Permits are non-,transferable and exPire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1
Electrical Contractor
Address
Phone
Supervisor License Number
Expiration Date o ;
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name Po*[ce,n
Address 3 S 3-zlt- s
city S-(ft) Pno""
t'i
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
B.
i
City
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with /
Service or Feeder Permit O tg
E.
D OR IS ABA r'lD0lEq F$S.oo
$ 50.00
$ 25.00
ERlo0.
Limited Energy/Commercial $ 45'00
Minimum Electric Permit Inspection Fee is $45'00 + Surcharges
8l
s6-7
Bto
?tt z7
Inspection Request: 726-3769
4.
Shared Drive(T:)iBuilding Fonns/Electlical Pennit Application 1-03.doc
per dwelling unit,, ',
Construction Contractors Board Permit #: CouueO\--. -'C>O l-11
700 Summer St I\E Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-3784621
WebAddress:ryfu1!g[94
,/ SV S 37+r S IAddress:
Issued by:\6 oate. to/Z r/"5
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensed wtth the Construction Contractors Board to sign the following statement before a building
permit can be issued. This statement is requiredfor residential building, electrical, mechanical and
plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under
ORS 701.010(7), need not submit this statement. This statement will befiled with the permit.
Fill in the appropriate blanks and initial boxes I md2, and either box 3A or 3B:
K f . I own, reside in, or will reside in the completed structure.
-W 2. I understand that I must become licensed as a construction conffactor if the structure is sold or
offered for sale before or on completion.
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
Dl' gg. I will be my own general contractor.21
If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
licensed with the CCB and will immediately notiff the office issuing this building permit of the
name of the conhactor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Responsibilities on the reverse side of this form.
/o"A q - 05
(Signature applicant)
(llhite copy to issuing agency perunitfile, pink copy to applicant.)
(Date)
Property_owner.doc 03/ I I /03
Aettmg *s Ysur $wm G*meral Contr*ctor?
'ruT*RMATISN
T'{*T!EX TS PRSPERTY *WNtrffi$
AS0L,T CSru$TRti*TtOt{ ffi ffi Sp&N${ffi !i_tTIE$
AJST-fr': Illis fi:f*nn*#on Alclfce fo Pr"op*rfy Owners afuo*i Cansfrucf*:n Respons;*difies iar*s deveJop*d Sy f**
Consfrucfian Crrfraelors Soard in accardance wrlh CIfrS 701"055f5j, passed &y fhe f $$$ Oregan legrslalure"
If y*u are a*ling as y{}Lir c}wn {.rontractor t$ ccnstruct a new h*me cr make a substantial ir*provem*nt l* e* *xisting
s{rltctur*, yot} can pr*\renl *mny problerns by heing a*'are *f t}'l* {iri}*wr*g resp*xsihilitics and c*nc*rns.
Hrnptroyer Re$pollsibilities
Y*u will, in most inslances. be ruled to be an '"empioyer" and the contractors y*u conkact rvith rvill be "ernployees" if
you use conkactors n*t licensed with the Conskuction C*nkactors Board ro do labor in ccnstructing or to assist in the
ccnstructicn or irnpr*vement of a residential structure. As the employer, yoil must eomply with the following:
()regon's Withholdimg Ynx Law: As an empl*yer, yoi; must withhq:ld jncome taxes tr*m empk:yee wages at the time
ernploy*es are paid. Yt:u u,ill be liai:Ie fr:r th* tax payrn*nts even if ycu don't actually witXihald the tax frr.:m yaur
empl*yees. For a Sta|e lSusiness II) number, call the Business lnf*rmatran {leriter at 5{i3-9S5-22*#.
Uncmploymcnt Insuramce Tax: As an rr*p1oyer, you are required t* pay a tax fl*r unen:plaSment insur*nce purpose$
r:n the wage$ af ail employees. F*r more infirrmation, call the Oregon Ernplo3rnent l)ep*rtment at 503-94?-1488.
lVarkers' Compensation Insurance: As an employer, you are subject to the Oregan Workers' Compensation Lar*",
and must obtain workers' compensation iRsurance fcr your emplnyees. trf ytru faitr to obtain work*rs' uompensation
'insurance, you c*uld be subject to penalties and be liabie for all claim ccsts if one of your employees is injured on the
job. Fcr more informalion, call the Wsrkers' Compensation Divisia* at the ilepartment of Consumer and Business
Services at 503-947-78 15.
LI'$" Internal *.evemw* $*rvice: As an en'ploycr* you must :vithhcld lbderatr inc*rn'* tax from emptroyees' wages.
You rvi]1 be hable f*r the tax payxrent even if yi:r: didn't a*tually rvilhh*l<J the tax. F*r a Federal fiIli numbcr, **]l ihc
Xi{S at 86S-816-2S65 *r {br ttrem at 8*1-{2CI-?115.
*ther R*spomsibitities and Aren$ sf Coneerms
Ccde Cornpliane*: As the permit h*lder f*r: this project" y*u are respcnsible far resolving any f*ilure to meat *ode
req*irements that rnay be trrnught to yo*r attenti*n tlxougli inspecti*ns"
Liability nn$ {'rap*rty X}amage }ns$rane*: Ccntart yourir:suranre *gent to $*e if" y*u have ad*q*a{e rnsura$ce
$$verage for aseidents and omissicns such as falling tcols, painl over spray, water <iamage from pipe punctures, fire or
work that must be redone.
Time: Make sure you hal"e sufficient time t* supervise your employees
Expertise: Make sure you have the skiils to act e$ your own general conkactrr, to caordinate the w*rk of r*ugh-in
and finish trades, aud tc notifti iruilding officials as the appropriate times so they can pe,rfona the required inspections.
If you have additional questions call the Construction Contractors Board (5CI3-3?8-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052.
Property_,orurer.doc 031 I 1 i03
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Rdceipt
Development Services Department
Public Works Department
Date: I
coM2003-00174
coM2003-00174
coM2003-00174
coM2003-00174
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 1oh State Surcharge
+ ljYo Administrative Fee
63.00
18.00
5.67
8.10
Item Total:$94.77
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid
Check CLAY PARKER djb In Person
Payment Total:
s94.17
$94.77 (
{
City of Springfield
225 Fifth Street, Springfield, Ox^97477
541-726-3759 Phone
541-726-3676Fax
September 25,2003
PARKER
434 S 37TH ST
SPRINGFIELD
Job Number:
Location:
oR 97478
coM2003-00174
434 S 37TH ST
CLAY
Project:Garage
Dear Permit Holder:
The Springfield Building Safety Code Administrative Code provides that in order for a permit to
remain valid, the work which has been authorized by the permit must begin wthin 180 days of the date
of issuance, and an inspection must be requested at least every 180 days.
According to our records, you obtained a permit for a project at 434 S 37TH ST which is set to expire
on 10/312003. Our records indicate that you have not requested an inspection within the past five (5)
months. This letter is written to notify you that your permit(s) will be expiring shortly. If you are ready
to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do
not request an inspection prior to the expiration date, your permit(s) will expire and additional permit
fees will be required in order to complete your project.
If you have any questions, please feel free to phone me at 541-726-3790.
Sincerely,
Lisa Hopper
Building Safety Supervisor
Um"
City of Springfietd
225 Fifth Street, Springlield, OR 97 477
' 54.1-726-3759 Phone
541-726-3676Fax
April 19,2005
PARKER
434 S 37TH ST
SPRINGFIELD
Job Number:
Location:
Project:
Dear Permit Holder:
Sincerely,
LisaHoPPer
Building SafetY
CLAY
oR 97478
coM2003-00174
434 S 37TH ST
Garage. Owner to provide letter that says he will not sublet garage or
use in any manner not specifically approved by the BO prior to any
electrical inspections.DB
The Springfield Building Safety code Administrative code provides that in order for a permit to
remain valid, the work *ti.t has been authorized by the permit must begin within 180 days of the date
of issuance, and an inspection must be requested at least every 180 days'
According to our records, you obtained a permit for a project at 434 S 37TH ST which is set to expire
on 512312005. Our records indicate that ytu have not requested an inspection within the past five (5)
months. This letter is written to notiff you that your permit(s) will be expiring shortly. If you are ready
torequestaninspectionforyourproject,pleasephonetheinspectionline at54l-726-3769. Ifyoudo
not request an inspection prio. tothe expiiation date, your permit(s) will expire and additional permit
fees willbe required in order to complete your project'
Ifyouhaveanyquestions,pleasefeelfreetophonemeat54|.726-3790,
Supervisor
City of Springfield
225 Fifth Street, Springfield, OR 97 477
541-726-3759 Phone
"547-726-3676 Fax
March 22,2004
PARKER
434 S 37TH ST
SPRINGFIELD
Job Number:
Location:
oR 97478
coM2003-00174
434 S 37TH ST
CLAY
Project:Garage. Owner to provide letter that says he will not sublet garage or
use in any mailler not specifically approved by the Bo prior to any
electrical inspections.DB
Dear Permit Holder:
The Springfield Building Safety code Administrative code provides that jn o{er for a permit to
remain valid, the work *ti.t has been authorized by the permit must begin within 180 days of the date
of issuance, and an inspection must be requested at least every 180 days.
According to our records, you obtained a permit for a project at 434 S 37TH ST which is set to expire
on 412912004. Our records indicate that you have not requested an inspection within the past five (5)
months. This letter is written to notif,i you that your permit(s) will be expiring shortly. If you are ready
to request an inspection for your project, please phone the inspection line at 547-726-3169. If you do
not request an inspection prior to the expiration date, your permit(s) will expire and additional permit
fees will be required in order to complete your project.
If you have any questions, please feel free to phone me at 541-726-3790. l
Sincerely,
Lisa
Building S afety Supervisor
Building/Combination Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-00174ISSUED: 0410312003
APPLIEDT 0311712003EXPIRES: 10/0312003VALUE: $ 20,697.00
SITE ADDRESS: 434 S 37TH ST
ASSESSOR'S PARCEL NO.: 1702314302700
PROJECTDESCRIPTION: Garage
Owner: CLAy pARKER
Address: 434 S 37TH ST SPRINGFIELD OR 97478
Springfield TYPE OF WORK: Garage
TYPE OF USE: New Residential
PhoneNumber: 541-726-3978
Expiration Date Phone
541-726-3978
541-726-3978
541-726-3978
Contractor Type
General
Owner
Plumbing
Contractor
CLAY PARI(ER
CLAY PARI(ER
CLAY PARI(ER
License
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS \(\
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
#of
Dist:
Trees Rqd:
Paved Drive Rqd:
Yo of Lot
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
I
14.00
1,056
2\$
70.00
106.00
5.00 ss
Fully Improved Sidewalk Type:Curbside 5'
Yes Downspouts/Drains: Curb and Gutter
Applicant is planning to take storm sewer to street, connecting to existing private storm drain line
and using existing weep hole for drainage to street. An encroachment permit is required if
applicant decides to core drill the curb for a new weep hole. SDC's include one foot roof overhang.Notes:
Paee I of3
#
u-1
FTE
Building/Combin ation Permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO: COM2003-0017 4ISSUED: 0410312003APPLIED: 0311712003EXPIRES: 10/0312003VALUE: $ 20,697.00
['ees Paid
Type of Construction
Garage
$ Per Sq Ft Square Footase
$19.60 1,056.00
Total Value of Project
Date Pai
Value
$20,697.60
$20,697.60
Date Calculated
03tr7t2003
Amount Paid
Fee Description
Plan Review Residential
+ lLYo Administrative Fee
+ 77o State Surcharge
Building Permit
Plan Review - Planning
SDC SanitarY/Storm Admin
Storm Drainage ImPervious Area
Storm Sewer - lst 50 Feet
Storm Sewer Each Addtl 100'
Initial Review
Planning Review
Public Works Review
$12s.58
$25.22
$17.65
$193.20
$s9.00
$16.86
$337.27
$45.00
$14.00
3tr7l03
4t3t03
4t3t03
4t3103
4t3t03
4t3103
4t3t03
4t3103
4t3103
Total Amount Paid $833.78
Not verifYing status of "Lot A"
Applicant is planning to take storm
sewer to street, connecting to
existing private storm drain line and
using existing weep hole for
drainage to street. An
.n.torchment Permit is required if
applicant decides to core drill the
.uit for a new weep hole. SDC fees
include I foot over hang on building
for impervious surface.
Structural Review 03/18/2003 04/03/2003 APP TCM
To Request an insPection call theZ4hour recording at 726-3769' All insp ection requested before 7:00 a'm'
will be made the same working day, inspections requested after 7:00 a'm'
day
03/18/2003
03/18/2003
03/18/2003
03/18/2003
0312112003
0410u2003
APP
APP
APP
LLH
AJD
VRJ
I Footing: After trenches are excavated'
2Foundation:Afterformsareerectedbutpriortoconcreteplacement.
Plan Reviews
Paee 2 of3
will be made the following work
Description
Garage
Receipt Number
1200200000000000835
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
2200200000000000691
Valuation Description I
Building/Combination permit
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541 -7 26-37 69 Inspection Line
3
Owner or Signature
P_ERMIT NO: COM2003-00L7 4ISSUED: 04t03t2003APPLIED: 03fi7t2003EXPIRES: t0/03 t2003VALUE: $ 20,697.00
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that allinformation hereon is true and correct, and I fu rther certify that any and all work performed shall be done in accordance withthe Ordinances of the City of Sipringfield and the Laws of the State of Oregon pertaining to the work described herein, andthat NO OCCUPANCY wi[ be made of any structure without permission of the Comm unity Services Division,Building Safety.I further certify that only contractors and employees who are in comrpliance 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 thestreet, that the permit card is located at the front ofthe property' and the approved set of plans will remain on the site at alltimes during construction.
4 Framing Inspection: Prior to cover and after all rough in inspections have been approved.5 Final Building: After all required inspections t a"e uZeo.eqrlrt.o and approvea uro tr,e building is complete.6 Storm Sewer Line: prior to filling trench.
+?-o3
Slab: To be made after all inslab building service
place but prior to concrete.
conduit piping and other equipment items are in
Date
equipment,
Pase 3 of3
I
4/3/2003
2:28:52PM
City of Springfield
Development Services Department
Public Works Department
Official ReceiptTi;i#iiiirxs7477
Receipt #: 220020000000000069 I
Date: 0410312003
Line Number
COI'il20$-00174
gg16)aa3'00174
co\n2}$-00174
coM2O$'00174
coM2o03-00174
cor{2003-00174
cow2o$'00174
co\l2oo3-00174
PaYments:
Storm Drainage Impervious Area
SDC Sanitary/Storm Admin
Building Permit
Storm Sewer - lst 50 Feet
Storm Sewer Each Addtl 100'
+ 7%o State Surcharge
+ l0%o Administrative Fee
Plan Review - Planning
Amount Paid
337.27
16.86
t93.20
45.00
14.00
17.65
25.22
59.00
TyPe of Payment Paid BY Received By Check Number Confirm No
Line Item Total:
How Received
In Person
$708.20
Amount Paid
708.20CLAYPARKER
Page 1 of I
Total:$708.20
cReceipt.rpt
Check djb