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Home My WebLink AboutPermit Electrical 2005-6-1 l:t D .. iJo.~" 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Co;"'" WoS - 001 tZ Date (/7 -I nS: Each Manufact'd' Home or M?<!~.I~.l2.wfeUing Service or $50.00 . f:eeder ", ~ : Oregon la "',~ . W rpauiUH: I B .s~~"\.'I!'?F'!f07~iI"~'I\;.'~Z\"!I~,.,+;1>: ~'o\fxi~tt wat""''''',' '.;,..., '''''''R'.......I'....>,::''':'fi,'J.,' "lfj ; ,~ }~l"Y;lce~,o~!. ee e~s-; nSla..a ~~~,~;,~""q!C~.~t&C~~~Il;:.?~,~ r, (Nlrj <)52-001_0 les ~eQs.;jJ~~ " 009200\t,\mps or 1..210 through OA rt.S 63.00 lo'~<:""'" . 'o.y uura'n c ' 1- Ci.:ib~[,'\iiI2St%A~c^m'~pres of the rlll"i !l .S 75.00 '2.... >11 >) nU'4dleAfnp".tP.J~~R~~:' ~he te/eohonlJ ~ S125.00 , 601 kn\jlSEtoi~OO!1lS.~I~ty Notification S163.00 PhoneS03 1 ~a ~S'\?1 Over 1000 AmpsIVolts~ 2344). S375.00 Reconnect Only S 50.00 Installation, Alteration ,or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps Ove~6:00:A,mp~ or 1000 Volts see "B" above. D t;B''''\::' ~h;t;C-'''''~;~i:'l!!,''.l'' lIfI.:<(j" '~~"'\Iii:~, "fl'~"iml""""'""''''';'~'''''': . r-..:: ranc .f' IfCUl ~ j" t"" w ~_'" .rnL ".;.:< 7.l"'r.}J.'F.,-~1'f:l; '"Z,:(e.; ~.,..L_ ~IVl, ""'.. '1'<'.'''.;1;'' ~".... ~<""'" N ^A1"-"~'" E . P ~ IrI1HEWORK ew' teratlon:!l!i xtellSlOn. er''i~ne MI r:...,.," - .......u'-il Inf,) rtH T'S "'''T One.G:ltCultENCED OR IS ABANM"-- . S 43.00 Eacli~'ddjtionaJ.Circuit,or.wiili vu"cu rOR ~ ,. _u Vh.lrcnruu /" Service or Feeder l'ennit. $ 3.00 ('9I\<Z- - <; E. ~Mis~lla~~~(S7&~Ji~~'it~lli~d~d)~E;~h;lfirtim~~~1 ~~""""~"~""""''''''"'''''''',~'''''.>':I1',Vf'r~~.~.J\-<1::",=i/'rtIt..",...,,_~ _...".,.,..._.....l.."'.....~' , .. 1. 4'I.ro€A.TfoiViOEiNST.4'j!f, '\4.TiON,~~~ t!i~...._",......._...,~.,.~~~L'7'''''''!\''''''''~''oi:;i.1lH''.'''.'-.~:..-'''''''''.;;.:1.,.. ,J,.;jJfi .. { ?)(") -s;: VA ('A \ II". <J- LEGALDESCRlPTION 1702. '3 S-OO I novA. ~\,)iC'_~_ OLf/OO . JOB DESCRIPTION c.k A17w\ i/?-r 4.\\ ~ Permits are non-transferable and expire if work is ;, not started within 180 days of issuance or if work is Suspended for 180'days. .~-~ r.~oN.fRAcroRT.zNSfATf~tiON:OND~ 2..... ~1')!~'-"P1t.C>';li"J%'..,,"'~"'.J~~~""O~ Electrical Contractor (I") 1'- 'B. if' o...k....o. t2.$ , Address Po Dll'I.. City T 1"11Ora.O Supervisor License Number If-?:>'! 3 Expiration Date 10 ,. 0 I -.?...O67 Constr. Contr. Number -I..\- g s C::,Z- Expiration Date ct ~ ( S -0 (p' '~~~=~r/~ , , -'r OwnersName $f::>P/.-~ M~A.L Address 'Po 2a.< v2f6r City !Iv",,\ k_ IX" Phone f OWNER INSTALLATION The installation is being made on property I own which ' is not intended for sale, lease or rent Owners Signature: Inspection Request: 726-3769 3. ~~~i;iEiCl%iitJ:t:E'BEt'O:ffi';.' ,{i ~~~",~~,.:;..""".;;",..";,~,.."..~~,:C,l>.~ '", "4~' A. 'New;ReSidentiliI~in"le;oriMuIti'Faniily'!p'er;d . unit), " ~;__. '_~~"''''''h>''"''.'. .....' .. _"",...-.,.. -_..-"..C \.." , '~~ . Service Included 1000 sq. ft. or less Each additional 500 sq. ft. ,or portion thereof S106.00 $ 19.00 C. Illrf~""'II';t:~7S~~~iiji.\F"te~~;:;;r"'~:";~~~'~i@l..,J';l;:~C';l ~~r:y<\._... ...~.,....~.",_J',~_~" ~'~,~. _C' ,_"~,p'.;;:,,,:t~,,~ _, W~~,<;:, .::&tii $ 50.00 $ 69.00 S100.00 Pump or irrigation S 50.00 Sign/Outline Lighting S 50.00 Limited EnergylResidential S 25,00 Limited Energy/Commercial S 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ~.~,to'?'.:Aijb.'''f:~~~'~,~;r'~~~;;j I .~...~'1;L, , ~,,-;~~~.~~~~.;Wi;'~~\. ~.~~ lV~ I.{ If / bJO 737/ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)lBuilding Fonnsl8ectrical Permit Application 1-o3.doc _G~I1.I.!~~m~'...~' ~ ~",~ ~.:_ y i . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00182 ISSUED: 04/19/2005 APPLIED: 02/15/2005 EXPIRES: 12/0112005 VALUE: $ 12,850.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone , 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 7305 MAIN ST Springfield TYPE OF WORK: Cell Tower - Communication ASSESSOR'S PARCEL NO.: 1702350004100 Tower TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Antenna collocation and 100amp service for C1earwire cell site Owner: SPFLD MEMORIAL GARDENS Address: % SCI MNGT CORP-PROP TAX PO BOX 42165 HOUSTON TX 77242 I CONTRACTOR INFORMATION , Contractor Type . Applicant General Electrical Contractor License PACIFIC TELECOM SERVICES NEW HORIZON COMMUNICATIONS INC 136818 OK BROTHERS ELECTRICAL CONSTRUCT49562 Expiration Date Phone 206-464-4412 09/24/2007 541-389-4203 09/15/2006 503-780-5524 # of Units: , Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: U I BUILDING INFORMATION I 1'\1 1 t:N IIUN: Oregon law requires you to # of.s~~JUles adopted by the oregMi~~' ~gliliofililJ1Y~er. Those fules all!K/IIOOr: T&'P0JmI~-oOl-0010 through OA ~ . Ioor: \'1lI!9tjf~8ij may obtain copies of th t. sement: Ranll~ili/'i~"fhe center. (Note: the tel~..\I, @Vage/carport Enfj'i!lx,ba 'or the 0 Ilt!I' N ~I/ Fl'8ther: , SprinklelI lildine: regon 'fIill1ty OIOEalpnt Load: entells 1-800-332-2~44\ , DEVELOPMENT INFORMATION I REQUIRED PARKING VB Front yard Setback: Side 1 Setback: , Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: NOTICE: DownspoutslDrains: THIS PERMIT SHALL EXPIRE IF THE WORK, AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD, Notes: Paee 1 00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Estimate Type of Construction Estimate Fee Description Plan Review CommlIndlPublic + 10% Administrative Fee + 7% State Surcharge Building Permit Plan Review CommlIndlPublic Plan Review Minor - Planning SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement + 10% Administrative Fee + 7% State Surcharge Perm ServlFdr 200 amps or less Total Amount Paid Fire Department Reyiew . . CITY OJ< ~rRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00182 ISSUED: 04/19/2005 APPLIED: 02115/2005 EXPIRES: 12/01/2005 VALUE: $ 12,850.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 12,850.00 Total Value of Project F 1'1" PlIilLI Amount Paid Date Paid $69.8 I $13.08 $9.16 $130.80 $15.21 $59.00 $0.21 $3.45 $0.78 $6.30 $4.41 $63.00 2/15/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 6/1105 6/1105 6/1105 $375.21 I Plan Reviews , 02/16/2005 03/14/2005 OK GRG Initial Review 02116/2005 02/16/2005 APP SKG Plan nine Review 02116/2005 02/17/2005 APP EMM Public Works Review 02/16/2005 02123/2005 APP SB Structural Review 02116/2005 02/24/2005 WE JMP Structural Review 03/18/2005 03/18/2005 10 JMP Structural Review 04/08/2005 04/08/2005 10 JMP Structural Review 04/14/2005 04/14/2005 APP JMP Value Date Calculated $12,850.00 $12,850.00 04/08/2005 Receipt Number 1200500000000000204 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 1200500000000000713 1200500000000000713 1200500000000000713 Plan Review: Addition of antennas to existing tower. Job #COM200S-00182. Plans appear to meet code requirements. SDCs added ($4.44). See 5 structural comments faxed to Sean Bell. WE. Received response from Curtis Holloway to Item 2 of comments. WE. Sean Bell emailed contractor and cost/value data. Received fax from Sean Bell addressing 5 structural comments. 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 ~nuNGFIELD Building/Combination Permit PERMIT NO: COM2005-00182 ISSUED: 04/19/2005 APPLIED: 02/15/2005 EXPIRES: 12/0112005 VALUE: $ 12,850.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Rl'llUirl'r1lnsD~ Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Final Building: After all required inspections have been requested and approved and the building is complete. Electric Service: Approval required prior to utility company energizing service. 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 Diyision, 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 Paee 3 of3 225 Fifth Street ,I, Springfield\ Oregon 97477 541-726-3759 Phone . ...~--; . WI' "'~'-'''-, 4 -'".., ".. ,.., ...'.., I; ",..', ~ ..-... I ~, , . j ^ { ~~"'.~.n<;...,7C.. .. i <'~'F. '" Job/Journal Number COM2005-00182 COM2005-00 182 COM2005-00 182 Payments: Type of Payment Check L : ~.., : L : 6/112005 RECEIPT #: ~ty of Springfield Official Receipt .velopment Services Department Public Works Department 1200500000000000713 Date: 06/0112005 Description + 7% State Surcharge + 10% Administrative Fee Perm ServlFdr 200 amps or less Paid By Received By OK BROTHERS ELECTRICAL djb Page I of I Item Total: Check Number Authorization Batch Number Number How Received 1511 In Person Payment Total: 3:30:52PM Amount Due 4.41 6.30 63,00 $73.71 Amount Paid $73.71 $73.71 / Status Issued . . CITY OF ~rKll'\jt.FIELD Building/Combination Permit PERMIT NO: COM2005-00182 ISSUED: 04/19/2005 APPLIED: 02/15/2005 EXPIRES: 10/19/2005 VALUE: $ 12,850.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ~ SITE ADDRESS: 7305 MAIN ST ASSESSOR'S PARCEL NO.: 1702350004100 Springfield TYPE OF WORK: Cell Tower - Communication Tower TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Antenna collocation. Owner: SPFLD MEMORIAL GARDENS Address: % SCI MNGT CORP-PROP TAX PO BOX 42165 HOUSTON TX 77242 ...... I CONTRACTOR'INFORMATION I ,\'0'" "S ,~ Contractor ~<<~ ~# \:)~ PACIFIC TELECOM'SER~IC!'S "< ...-..,..., ".... ....,"'" NEW HORIZ01~\~qM\\1l!NIC;;ATIONS INC 136818 ~. ~ S":.~(i BuiLDING INFORMA nON I <.:-'\J.~~ <v '0 R,'\~ ~<v' # of Units: \\.~ S <<,'<; ~\.~ <,'\) '0 ~<:f$ # of Stories: Lot Size: Primary Occupancy Group'~ ~~'0 &.~U' ~ <<, Height of Structure ,0 Sq Ft 1st Floor: Secondary Occupancy Group~ ~~ 0..'0 '\) Type of Heat: ,\O~$'\~Ft 2nd Floor: Primary Construction Type ~'0::\ 'VB Water Type: ,j.\ec, o~ e,\cS!!>'I't Basement: Sccondary Construction Type: ~~ Range Type: \e~O\eC$ ~e CO b'lSllI<)lGarage/Carport # of Bedrooms: Energy Path: ,,'?>~ ~e ec' '1> ~ C!i ~'F~Other: Sprinkled Buil~~~ '0'\'" e \~IJ!,..i:>"?' .;s.e \O~.e!jilt Load: ,I"'o:{. -....u ....~ ,~ ,,\ ,,,~_,,.. ,. - ---~ -,.. _..- '''I ,,- :-.' I DEVELOPMF.m'lNFORMATION:}I,.;s.e ",,0"" . A<<>- ~e" CP' 5)\} '1Y~ -_'o....~',~,\n.I" REQUIRED PARKING .::-' ,,\ i0 Rl' ~"" ~- ~ 'V 2,:" OveJ,I,ay J~,;Sf: 2,:<5 !'>'\ 0 ~e\' ~o ~":> # S'tr"'t'Tre~Rq'iI: re~ O\e n.1:'>1:'> ,0'" t:;:'\' ~ ~v e. ,,v Paved DJive'Rqdi~ ~ >is' '(O % or'iotG6vefr,..~:\0 ^,e\ ov- '/)>. :-1\(;. eo" Co ~'O C; ^'" Contractor Type Applicant General Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: License Expiration Date Phone 206-464-4412 541-389-4203 09/24/2007 Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: DownspoutslDrains: Paee 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00182 ISSUED: 04/19/2005 APPLIED: 02/15/2005 EXPIRES: 10/1912005 VALUE: $ 12,850.00 I Valuation Descriotion I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 12,850.00 Description Estimate Estimate Type of Construction Fee Description Plan Review Comm!1ndlPublic + 10% Administrative Fee + 7% State Surcharge Building Permit Plan Review Comm/IndlPublic Plan Review Minor - Planning SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Total Amount Paid Fire Department Review Total Value of Project FI'I'< PIilLI Amount Paid Date Paid $69.81 $13.08 $9.16 $130.80 $15.21 $59.00 $0.21 $3.45 $0.78 2/15/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 4/19/05 $301.50 I Plan Reviews , 02/16/2005 03/14/2005 OK GRG Initial Review 02/16/2005 02/16/2005 APP SKG PIannine Review 02/16/2005 02/17/2005 APP EMM Public Works Review 02/16/2005 02/2312005 APP SB Structural Review 02/16/2005 02/24/2005 WE JMP Structural Review 03/18/2005 03/18/2005 IO JMP Structural Review 04/08/2005 04/0812005 10 JMP Structural Review 04/14/2005 04/14/2005 APP JMP Value Date Calculated $12,850.00 $ 12,850.00 04/0812005 Receipt Number 1200500000000000204 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 2200500000000000447 Plan Review: Addition of antennas to existing tower. Job #COM2005-00182. Plans appear to meet code requirements. SDCs added ($4.44). See 5 structural comments faxed to Sean Bell. WE. Received response from Curtis Holloway to Item 2 of comments. WE. Sean Bell emailed contractor and cost/value data. Received fax from Sean Bell addressing 5 structural comments. 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 of3 i Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . I ReouirerI TnSDl'ctionsJ . CITY Vi< ~1"K11~t.i<IELD Building/Combination Permit PERMIT NO: COM2005-00182 ISSUED: 04/19/2005 APPLIED: 02/15/2005 EXPIRES: 10/19/2005 VALUE: $ 12,850.00 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Final Building: After all required inspections have been requested and approved and the building 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 tlm~e~ ~~T , rAc-( He I c.t...ECd-( Owne; or Contractors ~ignature Paee 3 of3 Y-I"I-01 Date .... ATTACHMENT A CITY OW'NGFIELD SYSTEMS DEVEWPMENT CHARGE .HEET JOURNAL OR JOB NUMBER: C0M2005-001&2 NAME OR COMPANY: fIearwire LOCATION: 7305 MAIN ST MAP&TAXWTNUMBER: 1702350004100 DEVEWPMENT TYPE: CeIl Tower "J,'/ .+~/lL/ NEW DEVEWPEDAREA (S,F,): 1& EXISTING DEVEWPED AREA (S.F,): TOTAL IMPERVlOUS SURFACE (S,F,): ITE: ITE: LOT SIZE (S,F,): 170 STORM DRAINAGE IMPERVlOUS SQ, IT, $ 0,310 PER SF x TOTAL STORM DRAINAGE SDq . ' :S ~. t t,~_~':t' ,",]i.:;:: e- 'i c.' .Jif'8 ,_. __ OOr;;;l t-:#l.U ,<';c"'" -,'.-1', ~. . $0,00 1070 2 SANITARY SEWER.cITY A. REIMBURSEMENT COST: NUMBER OF DFU's B. IMPROVEMENT COST: NUMBER OF DFU's (SEE. REVERSE SIDE) o x $ 24,04 PER DFU x $ 1&,2& PER DFU o TOTALWCALWASTEWATERSDC:' $ \ $ $0.00 '~091 $0.00 : 1092 . ~. \,," , . 3 TRANSPORTATION BLOG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR NEW A. REIMBURSEMENT COST: om& x 2.5 x $ 1&,30 PER TRIP x 0,95 NTF 1$ 0.781 B, IMPROVEMENT COST: 0.01& x 2,5 x $ &0,72 PER TRIP x 0,95 NTF 1$ 3.451 EXISTING A. REIMBURSEMENT COST: 0.000 x 0 x $ 1&,30 PER TRIP x 0 NTF 1$ B, IMPROVEMENT COST: 0,000 x 0 x $ &0,72 PER TRIP x 0 NTF 1$ TOTAL TRANSPORTATION REIMBURSEMENT SDq $ TOTAL TRANSPORTATION IMPROVEMENT SDC:' $ TRANSPORTATIONSDC:J $ 4.231 $ 'I, < I'," 0,78 ;i.r9j 3.45 '1094 ! ' 4.23 4 SANITARY SEWER - MWMC NEW: A. REIMBURSEMENT COST: NUMBER OF FEU's 0,000 x $46,&& PER FEU 1$ B. IMPROVEMENT COST: NUMBER OF FEU's 0,000 x $494.46 PER FEU 1$ EXISTING: A. REIMBURSEMENT COST: NUMBER OF FEU's 0,000 x $0,00 PER FEU 1$ B. IMPROVEMENT COST: NUMBER OF FEU's 0,000 x $0,00 PER FEU 1$ MWMC CREDIT IF APPLICABLE (SEE REVERSE) I $ TOTAL MWMC REIMBURSEMENT FEE: $ TOTAL MWMC IMPROVEMENT FEE: $ MWMC ADMlNISTRATlVE FEE: $ TOTALMWMCSDC:' $ ~ $ I, ", , . 1054 1'054 !~oss: 1056 SUBTOTAL (ADD ITEMS 1.2.3. & 4) , $ 4.23 ~ /. = 5 ADMINlSTRA TTVF: FF.~ BASE CHARGE (SUBTOTAL ABOVE) $ 4.23 x 5% S 0.21 TOTAL TRANSPORTATION ADMlNISTRATlON FEE:l $ TOTAL SEWERADMlNISTRATlON FEE: $ steVtV\.. W. 1;.eLHA.dYtj -g."yV\.tS. fiR.\JCm!Wbf9/lu004x1s 2/23120'05 DATE TOTAL SDC CHARGES , $ 0,21 '1078' 0,00 1079. 4.44 1 JULY 2004 . 225 Fifth Street , Springfield, Oregon 97477 541-726-3759 Phone . 8!!~AIN9~~~'",'__' "", ~' " ; --.' ! ~ty of Springfield Official Receipt .velopment Services Department Public Works Department , Job/Journal Number COM2005-00 182 COM2005-00 182 COM2005-00 182 COM2005-00 182 COM2005-00182 COM2005-00 182 COM2005-00182 COM2005-00 182 Payments: Type of Payment Check 4/19/2005 RECEIPT #: 2200500000000000447 Date: 04/19/2005 Description Plan Review Minor - Planning SDC Transpo Reimbursement SDC Transpo Improvement SDC Transpo Admin Plan Review CommlIndlPublic Building Permit + 7% State Surcharge + 10% Administrative Fee Paid By BRADLEY W SMITH Item Total: Check Number Authorization Received By Batch Number Number How Received jmp 8773 In Person Payment Total: Page 1 of I 9:35:32AM Amount Due 59.00 0.78 3.45 0,21 15.21 130.80 9.16 13,08 $231.69 Amount Paid $231.69 $231.69