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Home My WebLink AboutPermit Building 2008-8-8 -~~~ Status Issued 225 F,fth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 FdX 541-726-3769 InspectIOn Lme SITE ADDRESS 3325 PHEASANT BLVD ASSESSOR'S PARCEL NO 1703221202200 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO' COM2008-01036 ISSUED 08/08/2008 APPLIED. 07/10/2008 EXPIRES: 02/0812009 VALUE: $ 10,13500 Sprmgfield TYPE OF WORK Smgle Family ReSIdence TYPE OF USE PROJECT DESCRIPTION Add carport, laundry room and rewire house Owner Address AddltJon Resldent..l Phone Number 541-953-6461 HANNA TAMSIN 1144 WILLAGILLESPIE RD # 32A EUGENE OR 97401 Contractor Type General Electncal MechaOlcal Plumbmg I CONTRACTOR INFORMATION I LIcense ExpiratIon Date Phone Contractor OWNER BEAR MOUNTAIN ELECTRIC LLC OWNER OWNER # of UOItS Pnmary Occupancy GI oup Secondary Occupancy Group Pnmary Con,tructlOn Type Secondary Constl uctlOn Type # of Bedroom, R.3 U VB Frontydrd Setback S,de I Setbdck SIde 2 Setbdck Redryard Setback Soldf Setbacks 4400 500 5200 136298 08/06/2009 541-741-8844 DVILulNG INFORMATION I # of Stones HeIght of Structure Type of Heat Water Type Rdnge Type Enel gy P dth Sprmkled BUlldmg No Lot Size Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load 281 6,970 43 I DEVELOPMENT INFORMATION I REQUIRED PARKING OverldY Dlst Totdl # Street Trees Rqd 0 _ 'e" rAql,Hjtndroapped ~TEt'T'ON 'eq01." - "t Paved Dnve RqiI' _ - j "y the 01 !)(tnnplillt, Y ., 'JIM 'ld'), 01 ., ~ tf th % of Lot Cove"age ,/ t 16-2~se rules are se or No, f,r "lion Ce.l 0' 'I \ gh OAR 952-001- .n no.H ')':-)2~OOI~OOI0 t lroU ~1. ~........ .."Ioe hv I PUBLIC IMPROVENJ.ENTS1~:e';;e~~~;"(N~r~-th~ telephone .- J ... ("\'<'Ii\OR~:llitY Notlhcatlon number for ",mew~~~H 2 2344) Center IS 1-800- - . Downspoutsmrams Street Impr'Mtrl'fllt: Storm SeweifWl6llfll!>f<MIT SHAll EXPIRE IF TN~ WORK Spec..l InstWSI/?!fJ R IZED~P~"fffi~~R'lvWn~tN'\'l1ystem Notes #7j~\~J6N{~~y~~~&NDONED FOR Page I of 3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO. COM2008-01036 ISSUED: 08/08/2008 APPLIED' 07/10/2008 EXPIRES: 02/08/2009 VALUE: $ 10,135.00 225 FIfth Street, Sprmgfield, OR, 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme I ValuatIOn DescrmtlOn I Caroort Dwellines Tvpe of ConstructIOn Carpurt V Wood Frame $ Per Sq Ft or multlpher $20 00 $10500 Square Footage or Bid Amount 28100 4300 Value Date Calculdted DescriptIOn Total Value of ProJect $5,620 00 $4,51500 $10,13500 07/10/2008 07/10/2008 L.Fpp<. p,,'oIU , Amount PaId Ddte Paid ReceIpt Number Fee DescnptlOn Plan RevIew Residential $82 69 7/10/08 2200800000000001063 -Mechdnlcallssuance Fee- $20 00 8/8/08 1200800000000000856 + 10% Admm"trdtlve Fee $4744 8/8/08 1200800000000000856 + 12% State Surcharge $54 99 8/8/08 1200800000000000856 + 5% Technology Fee $28 86 8/8/08 1200800000000000856 Dryer Vent $700 8/8/08 1200800000000000856 File SF Fee - ResIdential $1620 8/8/08 1200800000000000856 Fixture $64 00 8/8/08 1200800000000000856 GaragelCarport $12722 8/8/08 1200800000000000856 Mmlmum/AdJustment MechdOlcal $43 00 8/8/08 1200800000000000856 Plan RevIew Mmor - Pldnnmg $11900 8/8/08 1200800000000000856 ResIdence Wiring 1000 Sq Ft $11700 8/8/08 1200800000000000856 Sdnltary Sewer - 1st 50 Feet $50 00 8/8/08 1200800000000000856 SDC SaOltarylStorm Admm $639 8/8/08 1200800000000000856 Storm Drdmdge ImpervIOus Area $12772 8/8/08 1200800000000000856 Water Lme - 1st 50 Feet $50 00 8/8/08 1200800000000000856 Total Amount PaId $96151 I Plan Reviews I 100tIal RevIew 07/1112008 07/11/2008 APP LLH Pubhc Works Review 07/1112008 07/1412008 APP LKW Storm water to Splash block Planmne: Review 07/1112008 0712 112008 APP TAJ Structurdl RevIew 07/11/2008 07/29/2008 APP DLM To Request an mspectlOn call the 24 hour recordmg at 726-3769. All inspectIOns requested before 7:00 a.m. Will be made the same workmg day, inspectIons requested after 7.00 a m wIll be made the followmg work day. Paee 2 of3 -Wi"~ CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2008-01036 ISSUED: 08/08/2008 APPLIED- 07/10/2008 EXPIRES 02/08/2009 VALUE $ 10,13500 225 F,fth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme ReoUlred InsnectlonsJ Footmg After trenches are excdvated FOllndatlOn After forms are erected but pnor to concrete placement Shear Wall NaIling Before covenng sheathmg with 1i00sh matenals Frammg InspectIOn Prior to cover and after all rough m mspectlOns have been approved Fmal BUlldmg After dll reqUIred mspectlOns have been requested and approved and the bUIldmg IS complete Underslab Plumbmg Pnor to filling the trench and mcludmg requlIed testmg Rough Plumbmg Pnor to cover and mcludmg reqUIred testmg W dter Lme Pnor to filling trench and mcludmg requited testmg SaOltdry Sewer Lme Pnor to fillmg trench and mcludmg requited testmg Fmal Plumbmg When all plumbmg work IS complete Rough MechaOlcal Pnor to Cover Fmal MechaOlcal When all mechaOlcal work IS complete Rough Electnc PrIOr to Cover Fmal Electllc When dll electrical work IS complete By sIgnature, I state and agree, that I have Cdl efully exammed the completed applicatIOn and do hereby certlly that all mformatlOn hereon IS true and correct, and I further cerllfy that any and all work performed shall be done m accOl ddnce with the Ordmdnces of the CIty of Sprmgfield and the Laws of the State of Oregon pertammg to the work descnbed herem, and thdt NO OCCUPANCY WIll be made of any structure wIthout permIssIOn of the CommuOlty ServIces DIVISIOn, BUlldmg Safety I further cerllfy that only con II actors and employees who are m compliance wIth ORS 701 005 will be used on thIs project I further agree to ensure that all reqUired mspectlOns are requested at the proper time, that each address IS readable from the street, that the permIt card IS located at the fl ont of the propel ty, and the dpproved set of pldns will remalll on the sIte at all limes dUllng ~# Ph /og ow/:.,tractOls SIgnature Dare / Pa2e 3 of3 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER NAME OR COMPANY LOCATION TAX LO f NUMBER DEVELOPMENT TYPE NEW DWCLLlNG UNITS I STORM ORAINAGE - COM2008-0 I 036 Tamsm Hannah 3325 Pheasant 1703221202200 Single family Residence o BUILDING SIZE (SF 358 DIRECT RUNOFF 10 CITY STORM SYSl CM IIMPCRVIOUS S F x I COST PER S F CHARGC 35800 I $0357 I = I $12772 ' I RUNOrF ROUTED TO DRYWCLL DESIGNED AND CONSTRUCTED TO CI fY STANDARDS I IMPERVIOUS S Fix I COST PCR S F I x I DISCOUNT RATE I I I 0 00 I I $0 357 I I 50% I ITEM I TOTAL - STORM DRAINAGE SDC $127 n ~ 2 SANI fARY Sr:WER - CITY A REIMBURSEMEN f COST I NUMBER OF DFU's I x I 0 I B IMPROVEMENT COST I NUMBCR OF DFU's I x I 0 I COST PER DFU $27 67 COS f PCR DFU $2104 3 TRANSPORTATION ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I $000 LOT SIZE (SF) DISCOUNT $000 A REIMBURSEMCN f COST I ADfTRIP RATE I x I 957 I B IMPROVEMENT COST I ADT TRJP RA fE I I 957 I I NUMBER OF UNIl S I x I I 0 I 1 x I NUMBER OF UNITS I x I I 0 I I ~ , ITEM 3 TOTAL - TRANSPORTATION SDC COST PER fRIP 2106 COST PER TRIP $92 89 $000 x INCW TRJP rACTORI I I 00 I x INEW TRIP FACTORI I 100 I 6970 If; liS 10 I~ IW-l -==jl ~ I~ $127 n 11070 $000 I 1091 I 1 1092 I "1 $000 $000 11093 I 11094 ,I $000 4 SANlfARYSEWF.R-MWM( A REIMBURSEMENT COST INUMB"R OF FEU's I x I 0 I B IMPROVCMENT COST INUMBER OF FEU's I o 1 ICOST PER rev I $97 90 x ICOST PER FEU I $1,00917 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEC ITEM 4 TOTAL - MWMC SANITARY SEWER SDC 5 ADMINISTRATIVE rEE SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) I SUBTOTAL x I ADM FEE RATE I~ $12772 5% I TOTAL SANITARY ADMINISTRAflON FEE TOTAL fRANSPORTATlON ADMINISTRATION FEE = $000 1054 Kaye WIlson PREP ARCD BY 7/14/2008 DATE ~ DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE FOR REMODELS CALCULATE ONLY TI-IE NET ADDITIONAL FIXTURES) NO OF FIXTURES DRAINAGE UNIT fIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATIlTUB 0 0 3 = 0 =1 I DRINKING FOUN fAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC 0 0 3 = 0 IiNTERCEPTORS FOR SAND I AUTO WASH I CTC 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTIlESW ASHER I MOP SINK 0 0 3 = 0 ICLOTHI:SWASHER - 3 OR MORE rEA) 0 0 6 = 0 [MOBILE HOME PARK TRAP (I PER TRAILI:R) 0 0 12 = 0 fRECEPTOR FOR REFRIG I WATER STATION I ETC 0 0 1 = 0 RECEPTOR FOR COM SINK I DISHWASHER I ETC 0 0 3 = 0 I SHOWER. SINGLE STALL 0 0 2 = 0 [SHOWER, GANG (NUMBER OF I lEADS) 0 0 2 = 0 I SINK COMMERCiAL/RESIDEN riAL Kli CHEN 0 0 3 = 0 ISINK COMMERCIAL BAR 0 0 2 = 0 SINK WASH BASINIDOUBLE LA V A TORY 0 0 2 = 0 SINK SINGLE LA V A lORY lRESIDENTIAL BAR 0 0 1 = 0 URINAL, STALL I WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 .EDU (EqUIvalent Dwelhng Umt) IS a discharge eqUivalent to~ Sl~~,~~_,~~~!~, dv.::]~~.g umq~o DFlYs) se!_~t ]67 gallons Pf:.r day _.._~~.,-_._,--- n_---l' MWMC CREDIT CALCULATION TABLE BASED ON COUNTY ASSESSED VALUE I YEAR CREDIT RATE/$I,OOO ANNEXED ASSESSED VALUE IS LAND ELGIBLC FOR ANNEXATION CREDIT" 2 I BEFORE 1979 $529 (Enter 1 for Yes, 2 for No) 1979 $529 IS IMPROVEMENT ELGlBLE FOR ANNEX CREDIT" 2 [ 1980 $519 (Enter 1 for Yes, 2 fnr No) I 1981 $512 BASE YEAR 1979 [ 1982 $4 98 I 1983 $4 80 CREDIT FOR LAND (IF APPLICABLE) 1984 $4 63 VALUE I 1000 CREDIT RATE 1985 $440 $000 x $529 ~, $000 1986 $4 07 1987 $367 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) ]988 $322 VALUE I 1000 CREDIT RATE 1989 $273 $000 x $529 0 1990 $225 1991 $180 1992 $159 TOTAL MWMC CREDIT = $000 1993 $145 1994 $125 1995 $109 1996 $092 1997 $072 1998 $048 1999 $028 2000 $009 2001 $005 I 0 - I CPR'NCPlIlU> LON ~v ^.tQlJlIIf@W~~~ ~^~ INITIAL' . ~. DATE - -\'\-Cfi:' n"I-WI H 51 HH r . ~1)RL\GHFl () OR 9747i . PH (~I)726-3i'::;3 . F,\\. ("41)i26-3689 ~ ~ SOl;RCE iu... ~(V ElJECTRICAL p1fBrr A PPUCATION s:?)^ 7) ~ CII) Job Number -\~ Dale ~ Og ~~~Ol~~ffi~MN 3 COMPLEl'EFEF SCRrfJUT.E BELOW ---- - LEG\.;{(~_ ~.CR1~:2:~'" rvI tl ,..", .\ !\'e" Re"uenhal- SIngle o. Mnlt!-Falllllyper u"ellfng: unit . I J:J \. 1.,. \..) J;.LlJ...J Sen Ice Included ~JOB DE(OS_CRIPTlON _ ~lL)'( 1000 sq ft or less l 511700 J)'1.aJ ~ ch addlllonal 500 sq ft or Ion Ihereof 5 21 00 Permits a-re non transferable and nplre If work. IS Each Manufact d Home or not started \\-lthm 180 da\s of.",suance or If",ork IS Modular Dwellmg Se"lce or Suspended fOI 180 day" Feeder Pump or Irrigation $ ')5 00 Slgn/Outlllle Llghtlllg S '::;"j 00 Limited Energ)/ResldentJal S 28 00 Llmlled CIlt'Tb')/Commerclal S ';;0 00 \lIn1mum ElectriC' Permit Inspection Fee IS $50 00.,... Surcharges 4 SUBTOrALOFAROVE lil 11s-o Stalt ,urchargc . 11'1~ 10% A.dmllllstrallve fee I 70 NOTICE: 5% fechnoloh" Fee ,58$'" InspectIOn RequTJilIS,ftffiMlT SHALL EXPIRE IF THE W~~~.\L $/'18 5' AUTHORIZED UNDER THIS PERMIT IS 'h,,,o Om" I ,'H",lo'"g I "'"~'I leu,"" P,m,,' ,\pph:o""o '417 00, r.O~ftMENCED OR IS ABANDONED FOR "v 18D DAY PERIOD 2 COI'/TRACTORINSl'AI..LATJON,ONLY Electncal ContraclO' f:9JR. /!J{))t1/lI1/AJ E~c AddresS~g% /)/u.J/1Y) flaESS I?D ClllEU(OE/I.J{;.. Phone 2!lJ.::t?tjtf 1//0 tj() ') /0/10 Ij(P;{q % E\plratlo Date 11 &/ ()!! Slg~reJf i~fIS~g ~Iectnclan jI~ ,__ Il/) I L .J"____ Owners Name~t .lY$\{\(\_.J ~ddress 2ibCf:> $'t\~~ Cll\~..6I'1- Phone a.~\6\lo\ - \\"-~ OW"'ER ''''ST ALLA TIOi'o SupervIsor License Number Expiration Date Constr COllrr Number The IflstaJlatlon IS belllg made 011 propert) I own \'.hILI1 IS 110t 1I1tended for sale lease or n:nt 0\\ neTS SIgnature 555 00 B Sen.l('e~ or Veederc,.-ln..taIJatlon, Altcl dtlon~ 01 RcloCd110n 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 o\mps 601 Amps to 1000 Amps Over 1000 AmpslVolts Reconnect Onh S 70 00 S 83 00 513800 5180 00 541300 555 00 c fcmporal") Servn:es or Feeders In"lallatlon. AlterdtlOn or Relocation 200 Amps or less $ \5 00 20 I Amps to 400 Amps S 76 00 401 AmpSlcAfj(H\1liiiis')r~ (,P( ., 51[200 follow tor I. .J j '"' ... I ~~ J ~ Over 600 Amnsror I OOO''<'Olls see "B' above' , ' I - ''VOll lcatrcn Ccn;'.;lt I t~ . _ ..., t D BranChlfl'o:).t~<;9C:2_00~' l. .u~- "'...1' ~ art C;'" "C UI nnn ~ 1-001Otn,ollnr," I;) (\1 ,~. "'ew Alte""",,1l o1{:J1UllI!I!!}"oll\w,fanJjI,8 ~,?I' vv~-U') ,- One CIrCUli Calling the center (,::;,,~ "tSh~t~1J~les by Each Add,tllMmllwcfl!lrcthe'0regon Uti lit N P VII" Service or Feeder pClJIIfter IS 1-800_33"_:3~~~atlon E ~11<;cellancou<; (St..n.lcufcedc.. not .ntlU(lcd) -each lustall:J.tl?n - 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 Pernut#C8" 0 \ 03(0 1 ~t\BAS>A-fSl Date 8- JQ is/oJ Address '3 '3 2-..S Issue~A /'(\i I I l Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUIres resldentzal constructIOn permit applicants who are not licensed with the ConstructIOn Contractors Board to sign the followmg statement before a bUIldmg permit can be Issued This statement IS reqUired for resldentzal bUlldmg, electrzcal, mechanical and plumbmg permits Licensed architect and engmeer applicants, exempt from llcensmg under ORS 701010(7), need not submit thiS statement This statement will bejiled with the permit FIll m the appropnate blanks and ImtIal boxes I and 2, and either box 3A or 3B dl I own, reside In, or Will resIde m the completed structure o 2 I understand that I must become lIcensed as a constructIOn contractor Ifthe structure IS sold or offered for sale before or on completIon o 3A My general contractor IS (Name) (CCB #) I wIll mstruct my general contractor that all subcontractors who work on the structure must be lIcensed With the ConstructIon Contractors Board OR [gf 3B I wIll be my own general contractor , , In hIre subcontractors, I Will lure only subcontractors lIcensed with the ConstructIon Contractors Board If I change my mmd and lure a general contractor, I wIll contract with a contractor who IS lIcensed with the CCB and Will munedJately notIfy the office Issumg thiS bUlldmg permit of the name of the contractor I hereby certify that the above mformatIon IS correct and that I have read and do understand the InformatIon Nottce to Property Owners about ConstructIon ResponslbllIttes on the reverse Side of thIS form. ~~ A*1/~/cA ~ (Signature ofpem'irt applIcant) (Pate) / - (WhIte copy to Issumg agency permit jile, pmk copy to applicant) Property_owner doc 06-01-04 ..: ~ _ Acting as Your 'oWn General Contractor? , - 1 ' .. , '~-' " INFORMATION NOTICE TO PROPERTY OWNERS ABOUT ,CONSTRUCTION RESPONSIBILITIES \ ...J_I,.... ~ , -, , , NOTE This InformatIOn Notice to Property Owners about Construction ResponSlbllllles was developed by the ConstructIon Contractors Board In accordance wJth ORS 701 055(5}, passed by the 1989 Oregon Legislature , If you are actmg as your own contractor to construct a new hom~ or make a substantial Improvement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responslbllIttes and concerns Employer Responsibilities You WIll, m most mstances, be ruled to be an "employer" and the contractors you contract wIth wIll be "employees" tf you use wntractors not lIcensed wIth the Construction Contractors Board to do labor m constructing or to assIst m the constructIOn ~r Improvement of a reSIdentIal structure As the employer, you must comply :!Vlth the following: ,,'''' \ , ~ , Oregon's WIthholdmg Tax I~aw: As an employer, you must WIthhold mcome 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 mformatlOn, call the Department of Revenue at 503-378-4988 - \ Unemployment Insurance Tax: As an employer, 'you are reqUIred (0 pay a tax for unemployment msurance purpose\; , on the wages of all employees For more mformatlon, call the Oregon Employment Department at 503-947-1488 " " . The Oregon Busmess Idehtlficatlon Number (BIN) IS a combmed number for both Qregon Wljhholdmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or WW\\ dor stdte or us/formsoav htmll for the appHJj-'Uate forms Workers' CompensatIOn Insurance: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtam workers' compensation msurance for your employees If you faIl to obtam workers' compensatIon - I msurance, you could be subject to penaltIes and be ltable for all claIm costs If one of your employees IS mJured on the Job For more mformatlon, call the Workers' Cvu'l'''usatlon DIVISIon at the Department of Comumer and Busmess ServIces at 503-947-7815 , U.S. Internal Revenue Service' As an employer, you must wIthhold federal Income tax from.employces' wages ~ You WIll be ltable for the tax payment even If you dIdn't actually WIthhold the tax For a Federal EJN number, call the IRS at 1-800-829-4933 or VISIt theu web sIte atwwWI1S!lOV j Other Responsibilitie~ and Areas of Concerllls Code Compliance' As the perrrnt holder for thIS proJect, you are responSIble for resolvmg any faIlure to meet code reqUIrements (hat ~ay be brought to your attentIOn through m_spectlOns " LmbllIty and Property Damage Insnrance Contact your msurance agent to see If you have adequate msurance coverage for aCCIdents and onusslons such as falhng tools, pamt over spray, water damage from pIpe punctures, fire or work that must ~e redone ' \ > , - \ ' '\ ~ - Time: Make sille'you have suffiCIent time to supefV1se your employees' , , -:....:,..... ~ ,- '. Exper1ne' Make sure you have' th~ skIlls to act as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to notIfy bUlldmg offiCIals as the appropnate times so they can perform the reqUIred mspectlons If you have addItIOnal questions call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 c.- Property_owner doc 06-01-04 225 FIfth Street Spnngfield, Oregon 97477 541-726-3759 Phone ~ CIty of Sprmgfield OffiCIal Receipt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-0 I 036 COM200S-01036 COM200S-0 I 036 COM200S-0 I 036 COM200S-0 I 036 COM200S-0 I 036 COM200S-0 I 036 COM200S-0 1 036 COM200S-0 1 036 COM200S-0 I 036 COM200S-01036 COM200S-0 I 036 COM200S-0 I 036 COM200S-0 1036 COM200S-0 I 036 Payments Type of P dyment Cred\ICard cReccmtl RECEIPT #. 1200800000000000856 Date: 08/08/2008 DeSCription File SF fee - ReSidential Storm Drainage ImpervIOUs Area SDC SamtdrylSlorm Admin GaragelCarport Fixture Samtary Sewer - 1st 50 Feet Water Line - 1st 50 Feet Dryer Vent Minimum! Adjustment Mechamcal ReSidence Wiring 1000 Sq Ft Plan ReView Minor - Planning -MechaOlcallssuance Fce- + 5% Technology Fee + 12% State Surcharge + 10% Admlnlslrallve Fee PaId By TAMS1N HANNA Item Total Check Number AuthOrizatIOn Received By Batch Number Number How Received nJm 774069 In Person Payment Total Page I of I 24019PM Amount Due 1620 12772 639 ]2722 6400 5000 5000 700 4300 11700 119 00 2000 2S S6 5499 4744 $878 82 Amount P~ud $S7S S2 $878 82 S/S/200S