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HomeMy WebLinkAboutPermit Building 2009-10-28 , Status Iss u ed CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01551 ISSUED: 10/28/2009 APPLIED: 10/22/2009 EXPIRES: 04/28/2010 VALUE: $ 180,000.00 225 Fifth Street, Springfield, OR.. '. 541-726-3753 Phone.. . ":- ...:. d 541-726-3676 Fax " ". ,,:,;;,,,),,):\:;',i,,".' 541-726-3769. I~;p~c.tio~'Liiie ':;', . -:"; ~,.., '- " ',:':'::';""'\ -.' \ ,', "",, SITE ADDRESS:';". ':5794 MII.::A SJ ASSESSOR'S PARCEL NO.:" 1802033303500 SPRINGFIETYPE OF WORK: Single Family Residence '. .. TYPE OF USE: New Residential PROJECT DESCRIPTION: NEV\;. SINGI"EF~MIL Y DWELLING- LOT 282 JASPER MEADOWS- SAMEAS " ~77o;MICA ". . ,,~'..'. ;,t';':::".'~'\'" Owner: UX'V'DENHONiES t& Address: 2464.SW GLACIER PL STE 110 REDM<;lND OR 97756 '. I.<:ONTRACTOR INFORMAT~ON , # of Units: 1 Primary Occupancy Gronp:...R-3 " Secondary Occupancy Gronp.:., ,.i( ',i:J U Primary Constr"ction T,ype. ,. ",'1; .~(VB Secondary Construction Type: # of Bedrooms:, : '. !f: I Contractor Type Contractor' '.' Li{alfWlYoU Uixpiration Date Phone General ., . .:~ OWNE~ > . . "moN: oregon law~: Oregon UtilitY Electrical r ':: ,i; -::;:'TOP NOT.CH ELEIl' ~ \lll{es adopted :V ~ ~ e setlortf. 09/29/2010 Mechanical;'" . PACIFIC AIR CO (i! a!\'l!J6 Center. 1 t~~o~6JAR 952-00 03/25/2010 Plumhing .!' '. ".STUTZMAN SERV ~t~2-001-~~~~,\ (,DoiW~th8 ru..'~~~ 05112/2010 ,,,, , , lumALf.1i.i~'"'''' @RIWA.~ N'~ti~cation . 'l ~m!1 gJ...... number lor t e. v 1 ':a00..s32-2344). . '# of ~emar IS . 1 Lot Size: Height of Structure 16.00 Sq Ft 1st Floor: Type of Heat: Forced Air Gas Sq Ft 2nd Floor: Water Type: Gas Sq Ft Basement: Range Type: Electric .h' Sq Ft Garage/Carport Energy Path: . Sq Ft Other: Sprinkled Building: No Occupant Load: 541-317-1998 541-672-9510 541-928-8942 4,950 1,235 400 3 , ~~, . I DEVELOPME:,T INFORMATION' " REQUIRED PARKING ~. - Overlay Dist: '>:i~<!~,~~~'Tf.~;,;':Total: 2 # Street Trees Rqd: ..' '.,^:v^2'" '. ~~dicapped: Paved Drive Rqd: ~'1V'iW' fi~pact: % o\tO~ffrage: ~ t>.\.\. fj."~,,~WI\1 \D :r.I:lIC; "t.\\~i~ ~\l\\\Jt.\\ \\\~;\nn~t.~ fO?> . I PUBLIC l~mfiM~?\~ IS t.W c'\.JI~"U~ " P't.\\IO~' F II I d " < on 1)1\, SIdewalk Type: . ....'. u y ~prove jI,~\ 'o\) ''7-H- No Downspoutsillrains: Storm water to curb via weep hole. u Frontyard Setback: Side 1 Set hack: . Side 2 Sethack:" Rearyard Setback: Solar Setbacks: ri :. I .. . ;1 .. :,18.00 ::.~ ::&~~5.00' - . 10.00" 22.00 10.50 Subdivision Not Accepted Street Improvements: . ~~ :; Storm Sewer Available: Special Instruction: ,. .1, " if .j~ ~ :; Curbside 7' Curh and Gutter Notes: j;. I ~i.tL. \ ,'. .",.1, ...'....,:. " ':; ,';; ,. 'U', ~ ~ " . ,,:..: fi:.- Pal!e 1 of 4 .., .-...._~ .' . " Status. IsSued "_ .', ". . ,~,,;":.u::-~<jJ...:.~:;.'~" "'d' .,.? "~ 225 Fifth Street; Springfield;:Q~i::: :,^ 541-726-3753 Phone' .', Jr':J' ' 541-726-3676 Fax' 541-726-3769 Inspection Line :". ,,'"-;;; ,':~;:J>',~'i!~Y , ;~t."~~:i'1;~1~?:.~'(;.,:.. : \f'r~:., .-- ,/ ' ':0g:;;j:/i:. "d';";: ' , 'Description " ,., Tvpe of Co.i1~t~,\,~!.ion , ',"" .:;. .,~..,. . - . ":-, ,. . Use Bid Anionnt.~. U VB Utility ,R-3 VB 1&,~ F:aini!v. " " I. '\~':'~:'~~~,\'~>'~';'" ~.~ .,' Bid Amount Gara!!elMisc SF/Duplex ,{" ,J . '.,', . ~ ! :', j , .... '~" ; .!a~Jl"!It.:jh,r.i:..i. . . !: ~...1i' . .; -'. ~'"; .", CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01551 ISSUED: 10/28/2009 , APPLIED: 10/22/2009 EXPIRES: 04/28/2010 VALUE: $ 180,000.00 I Valuati?" Descriotio" , $ Per Sq Ft or multiplier $1.00 $37.72 $96.83 Square Footage or Bid Amount 180,000.00 400.00 1,235.00 Value Date Calculated $180,000.00 $15,088.00 $119,585.05 $314,673.05 10/22/2009 1012212009 10/22/2009 Total Value of Project };~p~, ~ " '.: , Amount Paid Fee Description " , + 12% State Surcharge + 5% Technology Fee 1st Appliance ." , . c" " 2 Baths One or;.Two'Fa~i1y .:"'" ": Addressing As;'ig~meni " Appliance ~ent!"" ... Buil~ing PerIp!t~~..1[..",;:ic*>- ""..._..'~~, ,:; Credit - Trans Improv SDC '.' -J; .~. Curbcut Permit ,; ,,' Dryer Vent Exhaust Hoods Fireplace (Listed) , ^ . .J..., l ....; ,_8'., 1."'" "-.7f.l,,jl"ll Gas Outlets 1-4' ';,. ,'" ",' ,,' , . ;!. ..'. -~ Plan ReviewM!ljor;- Planning Plan Review Same As . ' PW Disc - 2nd Permit,'; . , " Residence Wiring 1000 Sq Ft ',. Residence Wiring Ea Addtl 500" . Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration" ',f, " ..',\.: SDC MWMC Improvement ..: '" SDC MWMC ~eimbursement '. SDC Sal!itary/Storm Admin SDC Tran'Rein;ilU~~-Residential SDC Trans Improvement-Resident SDC Transportation Admin . Sidewalk Permit Storm Drainage Impervio,!s Area Co Temp Power 2QO amps !lr less :e :11\ Vent Fan ;;,: 1 I " 5:' . "..:.:1 <.f' . I. , Willamalane Single:Family I ' " . 'Totai;Amou'!t Paid , \ , .' $213.88 -$106.97 $79.00 $337.00 $38.00 $9.00 $1,034.35 $-931.65 $88.00 $9.00 " $13.00 $20.00 $7.00 $211.00 $250.00 $-30.00 $134.00 $50.00 $529.11 ' '$695.83 $10.00 $1,044.54 $101.97 $153.75 $211.21 $931.65 $16.02 $88.00 '$802.70 . $63.00 $27.00 $2,858.00 $9,171.33 , , Date Paid Receipt Number 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1209900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 1200900000000001198 10128/09 10128/09 10128/09 10128/09 10/28109 10128109 10/28109 10128/09 1 0128/0~ 10128/09 10/28109 10/28/09 10/28109 10/28109 10128/09 10/28/09 10/28109 10128109 10/28/09 10128/09 10/28/09 10/28109 10/28/09 10128/09 10128/09 10/28109 10128109 10/28/09 10128109 10/28109 10/28109 10128109 Pa!!e 2 ,of 4 , , . . . ,..' ;;~ t~~ iY CITY OF SPRIl'ltJJ:<1.1!.LlJ Building/Com bination Permit '-.. ''', , PERMIT NO: COM2009-01551 ISSUED: 10/28/2009 APPLIED: 10/22/2009 EXPIRES: 04/28/2010 VALUE: $ 180,000.00 . . '1-',.,:;,,:- 3/....' ~, .'" ,":'.' ':::;~~';- ':' . :;' ~.}. " ~".,~ ,'," ;,'" ':.' . i\:", 1 ::. " i .;~; :, :~ Planninl! Revie~' : . 'i~. iil/2212009 ,. '-',j.;; 1012212009 . 1012f/2009" '" ~ ;,' .~1'":~~~1\j~~, " ~ I Pla.~. Revie,:s , 10/22/2009 APP DDK Access restricted to 1 driveway/lot. Follow Street Tree plan. Storm water to curb via weephole. As noted on plans Pnblic Works Review Structnral Review 10/22/2009 APP 10/2212009 APP LKW CJC _ ," . '".'.-J" Jr, ""'::.O'~-""'" 0,,""" _/..,,;, .>:,.,"'" to Request ap inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be maile the same working day, inspections requested after 7:00 a.m. will be made the following , .' :]':".~ ...... ., work day: ~r' ;) Jf " t,~ :'. r: " ,. :.. 'f t. ~pnll;rprlJnsnections , Ufer Electrical Gronnd: I~si~1I grou7.d rod at footing and call for inspection in conjunction with footing and/or foundati9,n i~~p~~tio~...:.;::.4i "':P: : ''', ' '. "'"~.''' . " '.. . \: Footing:~Afte;" irenches are excavated. Fonndation: -After forms are erected bnt prior to concrete placement. ..if. ~ .)..:\f' t.'. i:, , Post and Beam: Prior to floO! insulation or decking. " . Floor Insulation: Prior to decklng. .. Shear Wall Nailing: Before covering sheathing with finish materials. Framing.~nsJle~t~on: Prio.r, t(icover and after all rough in inspections have been approved. .... '. ". Wall Ins~lati~n: 'Prior to cover. . ' Ceiling Insnlation: Prior to cover. L ; ~ :. . Drywall: Prior to taping..~, "_ ',. , Masonry: Final Building: After all required inspections have been requested and approved and the building is complete. Perimete,r Fo~n.d~tionnra.in~: After gravel and filter cloth is installed hut prior to backtill. underoofr.p!nnibing: Prio~'to insnlation or d'ecking. Underfloor Drain: Prior to cover or placement of concrete. ." ! ~L-ti ,i~ t .'; \ . ~:' "; I Rough Plnmbing': "Prior to cover and inclnding required testing. Water Line: Prior to filling treoch and including reqnired testing. ' Sanitary Sewer Line: Pri~r t~ filling trench and including required testing. Storm Sewer Line: Prior ,to flIling trench. ~:. ~.'.."-.:: .,..,. ~'.' ~~' . Final Plu'mbi~g: 'i'When all plumhing work is complete. ';"".' . , . UnderOoor Mechanical. Prior to insnlation or decking and including required testing. .! .I~ -, .~ ;'. Underfloor Gas: jAfter Ii,!~ i~ installed and required testing and capped if not attached to an appliance. . Pace 3 of 4 -,' ,. -Z' ~ ~~: jL:~,~~~;';<' CITY OF SPRINGFIELD .'-1\' ,. Building/Combination Permit .~;. " Status Issued ., 'ii ' ~I ;lJ. ,'- . 225 Fifth Street, Springfield, ORY',';::'<., . 541- 726-3753 Phone,; 'L~'~:< ::;,j!.C(.:'if,c,f1ii'i;:i" 541-726-3676 F~ic Ii '(-'(tjr'" ';', { 541-726-37691~spe<ti~~ Line . ...... ~:. 'f: b PERMIT NO: COM2009-01551 ISSUED: 10/28/2009 APPLIED: 10/22/2009 . EXPIRES: 04/28/2010 VALUE: $ 180,000.00 :) ,: '~~t~ '-~"~~; >:;::'i. ";,,r.':', k" ... _ ' Rough Gas: After line'j~ i~staUed a.nd required testing and capped if not attached to an appliance. . -~~, ? . Gas Service: After line is instaU~d and line has heen connected to a minimum of one appliance including required testing. Presure test doneatt!tispoin,t. . _....:.'.:./~'r ~. " Rough Mechanical:~rioiito;'Cover {, ';~f~';: . ~::I""/f4;rj: ;,:k~~'~';~~~~~' :.:f,,:, ,j Final Gas: When-aU gas work is complete. .' 'T"';: 'i"," Final Mechanical: When aU mechanical work is complete. .'- ,,' .~ .'t:.,: ,\~ :..... ~ ;~, - . Tempo"h'y'Electric: Appro~al reqnired prior to Utility 'Company energizing pole. Rough Electri~:~ Prior to Cover Electric Service: Approval requiredyrior to ntility company energizing service. Final Ele.~tric:,'Y,hen aU ~!ec!rical work is complete. "~:~~~".,_J;'~~~ ,'" .41:.. Curbcui'~ Standard: After forms are erected but prior to placement of concrete. '!'~~r,'~' . Sidewalk.-.C~rhside: After forms are erected but prior to placement of concrete. . ~l' ~ ~ ~: Erosion/Grading'Inspection: Prior to ground disturbance and after erosion measures are instaUed. By signature, I state and agree, that 1 have carefnUy examined the completed application and do herehy certify that aU information hereon is true and corr.e~t, and.I further certify that any and aU work performed shaU be done in accordance with the Ordinances of the City .of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and that NO OCCUPANCYwill be m-ade 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 nsed on this project. 1 further agree!o en~ur~ that aU required inspections are requested at the proper time, that each address is readahle 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 aU times during con'strri'ction.. 'f. \ .~ ';'_~ . ~/7../k2- ( /{J-dY-01, Owner or cont~acto,r~s:gnatu~e;,~':f:;' Date 1'.1 'H: ',._, .(i/' ? .: .' _ ~". I l' ' ; 1: ".!: ~. ,,~' . ,I '\;" : ",'" .' ; " i: ~~_:-;~_; \1 '1' . '.~,;:~~~~l:;};j ~'~' . ..".. :~.;.,.,~.. '. ^' ~"1' . l' ;, '~ i ~ '_~;'::;,!; . '/.:,' . ,f,.), . l,c ;~: ~,{ .j ..:.1.' u ."h.ti: . ' .;' ..j,,;," o .~ ): Paee 4 of 4 .225 Fifth Street. Springfield, OR 97477.PH(541)726,3753+ FAX(541)726,3689 /<;5)'/ 10 (i."2-IO r Electrical Permit Application ) This permit is issued under OAR 918"309-0000. Permits are nontransferable. Permits expire jfwork is not started withiu 180 days ofissuance or if work is suspended for 180 days. ~1f0~@~p~i;g!\l.t~fI;Nit;!l':4;eRR9)17ki~~I!i[~1~1 I Zoning approval verified? . 0 Yes 0 No.. 1~~~~~tr~6~'R~~;~~~~[:E~~ff~0~~::;~~1 1 Residential, per unit, service included: 1 g1ili1!D'@(3JfSJiiL~1JINi1]5,R.]ji'~liJQNrji;1'lIf)!1.IfQ)::AillfQN1i!"~~!1 1,000 sq. ft. ~r less (4) $134.00 $ ~t..( I I 1 Each additional 500 sq. ft. or portion r-71 I Job site address: .$7<1L/ MIC"'- therenf '2r- $ 25.00 $;;1..... 1 City:S'x,..,~.c'e iol I State: 6R I ZIP: '17'1715' I 1 Limited energy (2) $ 32,00 $ ,I "~=~~~~~~~~~Wfi"W~~;'~;~~~4~ I ~~~il~:"S~~~:r~~ ~e~~:r (~)odular $ 63,00 $ I I IA_ /~ . I 1 Services or feeders: installatfon, alte'ration, relocation 1 I ~, OJ-o."II, r-Cl.V.IU_,/~, :''{'/'/- 6?1,~_.~ I I' U l"t..l/J~<.J ~ _ ,\200 amps or)e" (2) $ 81.00 $ 1~"""''''''1lf,j1('';'''''o/'''''A:;i:i'R.'-0i:fEofi'V''0W'N"'ER';'~';''';r;jti;W,,,",')',f"jg{"J,,,' 1 201 to 400 amps (2) $ 95.00 $ I ~f;q:Ji~'~.1k.~~~~,*&,'-!il=_.,~,~, _,~~~~I~",.C=w.0-_..,%-.;:'t"~<:~"f"~Wt~~~%~~l:~..,,,!joC-1 I Name: l-k'-/JN\ Kcvy--e <;. 'I 1401 to 600 llIpps (2) $158.00 $ I I Address: ;JL;CC./ $G-J (.,(c./;,,^ 1 -I 601 to 1,000 amps (2) ,$205.00 $ 1 1 C. nil S /) I <;>77 Y' I lOver 1,000 amps or volts, (2) , $469,00 $ 1 tty: K <"0\ VVl"'" .0 tate: 6 .<. ZIP: I 5'0- I Phone: 5<1i-2iif- (;,'))5. I Fax:S>/I-?'!!' ,;577, 1 1 Reconnect only (2) $ 63.00 $ I IE-mail' . . " . s vou;o I Temporary services -or feeders: installation, alteration, relocation .1 .' . . .- __......... l<;lW reQUire . .. This installation is being.ma,He\d~',~~~~d'~41i~t~rd'Wl'nlp~pell.9n Ul i~ 200 amps or less (2) .' \- $ 63.00 $ {(J~ I owned by me or a mem"eriOfmY'lTI1mI:~ate~r1.i\>i$ are set J '201 to 400 amps (2) I property is not intendedj[<lJ;s;1le\Ce5!:c'liiill r.\1ftfu8ulJWtJ~1ll52.')0. , $ 87.00 $ 479.540(1) and 479.56R(1,1rAR 952-001- 0 . I ',es otthe rU'EB l\ylOl to 600 amps (2) , $126.00 $ 1 " y obtain cop . Signature: 009~.. y~u ma nter, (Note: the,~el~~hO ~e Over 600 amps or 1,000 volts, see se!'VlCes or feeders section above 1 l~::~:;N~:~'~!:!~~~_~ .~~ I':r;::~~:i:::~~ ::;~~~t:~:::r~~~:s~~na:::i::e~r feederfe~: I' 1 Address: ,.)O<rS 7'1 (ove.., C -t. I 1 Each hranch circuit 1 1 $ 6.00 1 $ I 1 City: \5<:.1"\0\ 1 State: oR 'I ZIP: I -I b. Fee for branch circuits without purchase ofaservice or feeder fee : 1 I Phone:Sl q-3i1-19qq I Fax: .\'\ FirstbraI\ch circuit(2) '. '1 I $ 55.001 $ I I E-mail: I I Each addItional branch CIfCUlt : I $ 6.00 $ I ) CCB license no.: -;Y 3fOc' I BCD license no.: ( ..22(J. 1 ' I Miscella~eous fees: service or feeder notincluded I 1 Signing supervisor's license no.: ''105 'i5 I 1 Each pump or irrig~tion circle (2) $ 63.00 $ . 1 1 Print name of signing supervisor: Ved ~("clcle{ . I 1 Each Sign gr,outline Itting,(Z) $ 63.00 $ I I ,;",,~""_,ro,~"., v",10f,;clfiL j' r~c",="':~\, '",00' I , it\C~" ~f>.,-,- ~' ,- ~r~pecti~: (I) ",^ $58.001 $ 1 \\~\~ ?t.?\fI\~ ~~IJt.? "'~f41~JiIR6'b;~[~O:S~~~__ ~ ("~Q'\\"\ -:i"lji\-\Q?\l'\1J Q? \~ I, A) Enter subtotal of above fees :Jfl(" .\V CQ\fI\fIt.~C r>-'1 ~'t.?\Q )~Minlmum Permit Fee $58.00) $ 2c.f) /l.~'1 '\ BO IJ I (B) Enter 12% surcharge (.12 x [A]) $ l~ t, I( I ~ t . C".~) ,...(\ - t (C) Technology Fee (5%0f[A]) , $ I ~'.~S' \Y,'\"'~ tlQ l)'\ '.1 TOTAL fees and surcharges (A through C): $-pn. 0/ 7 ,\\).-V~~ ,," 440"2584-J (9108/COM) ~ ~ ',', , . .'.( f'J ?. Willamahine " t Park & Recreation District Job. No. {!fl- />)"'! SYSTEI'v1 OEVELOPMENT CHA.RG~ INORKSHEETFQR 2009 NAME: HN/ DEN' H,oM.E':5 PHONE: ?-"2.0 G'jYS- ADDRESS:J.<-("4 Sw 4.t..f,c/f:'YP( tZ-PM#J1> STATE~IP: q '74')6 LOCATION OF PROPOSED BUILDING SITE: Street Address: . ~?9c'/ ~cA' Plat Name: Tax Lot Number:/.!dz'"n7 C$SW 1. -DEVELOPMENT TYPE (Check . appropriate dwel/ing(s). Dwelling'type definitions areori the . " '"back,) " . , ( '-, A. SinalecFamilv Detached NO. OF UNITS ( X $2,858 per unit = $ :l-fTd B. .Sinale~Familv Attached NO. OF UNITS X $3,1.00 per Linit = $ C, Multi-Familv Abartmemt NO, OF UNITS X $2,641 per un!t = $ D. Sinale Room Occuoancv NO. OF UNITS X $1,321 per.unit = $ E, Accessorv Dwellina Unit NO. OF UNITS X $1,550 per unit = "$ $ WILLAMALANE SDC ,2. SDC CREDIT (If. applicable) SDC payer must furnish proof of Willamalane Credit approvaL) $ 3.. TOTAL WILLAMALANE NET SDC ASSESSED . (if SDC reduced for Credit) $ 2,.3S!) "~ /tI I .:z 2--t " , "'-,~Date ~~. .-----:.-:_--.:------ --.~-...---.-.----~--.-.~-.-..~.- ---- ....:- :"':--'Devel6'pment'SeiVices' De-paftmeiif City of Springfield ." 5 225 Fifth Str.eet It ... i' Spr.ingfield,_Oregon' 97477, 541-726-3759 Phone.. ! ~.} i,,' City of Springfield Official Receipt Development Servi,ces Department Public Works Oepartment ~,; ~; ':." \' 't ,'iu:CEIP1}#;; 1200900000000001198 ,,:, '.. '-:'3-'.'"',' ,'-'-, Job/Journal Nurnber.:~~ .;,~Des:cfiptiori: . COM2009-01551, ,J, '/ f,'Plall Review Major - Planning C()~2009-0)5.5.I.,;'fi;;~:':ih:~B}l:~vie~~'!H'e As . C0M2009-01551' )\:\"IBuild(ri 'PeTIIlit', . ,. . ' -" '" "-., .g.~ -',.,~, -, -'~ \ COM2009-01551 .. "AdctressingAsslgnl11ent COM2009-01551 ..' Willamalan~"Sin~k Family COM2009-01551 :2 Baths,One9r.J;~'.'Fa.mily " ~~~~~::~: ~~: 'i::"E:',;y:~~t~~~!~\:l~~~:~?;';_:' ' , " . COM2009-01551"~:};;'Appliance Vent C0M2009-0 1551 " ,/""" ,'.Exhaust Hoods ! .... . . -~':'.~T:~,,':t,~:~i;:_,_:~' ..;;':"- .... COM2009'01 55 1.,..';!i(i'J?'-',Dryer \I~nt"" COM2009-0 1551'!.'Gas'Outi~d'i~4>:, . COM2009-01551 '!'Fireplace (Li~t;d)'" COM2009-0155I Residence Wiring 1000 Sq Ft COM2009-0155I Residence Wiring EaAddtl500., COM2009-01551 ."!,;, ,iTemp power 20~ amps or less COM2009-0155 I .;;._! !fSidewalk Permit C0M2009-0155I '. 'Curbcut Permit . ,.1 ~ ,. _', . COM2009-0 1551~r; ;p~ pisc ~ 2~~ ~ermit COM2009.0155 I , Storm Dr~inageJmpervious Area C0M2009-0155 I Sanitary Sewer !Reimbursement COM2009-0 1551 Sanitary Sewer - Improvement COM2009-01551 SDC Tran Reimburs-Residential COM2009-0155 I SDC Trans Improvement-Resident COM2009-0155I (.', j',Cre'ait -,Trans lipprov SDC COM2009-0155 I i'. iSDCMWMCReimbursement C0M2009-015511l iSDCMWMC Improvement COM2009-01551 ~,'" ISDG MWMC Administration COM2009-0 1551 SDC Sanitary/Storm Admin COM2009-01551 SDC Transportation Admin COM2009-01551 + 5% Techoology Fee ,) COM2009-0155 I + 12% State Surcharge <. ":,' .~;L$::" ~~:d\"."';.f1 j~' Date: 10/28/2009 9:16:59AM Payments: Type of Payment CreditCard ,';'!. " Paid By HAYDEN H()MES INC \,' -":.it; , . Item Total; Check Number Authorization Received By Batch Number Number How-Received Amount Due 211.00 250.00 1,034.35 38.00 2,858.00 337.00 79.00 27.00 9.00 13.00 9.00 7.00 20.00 134.00 50.00 63.00 88,00 88.00 (30.00) 802.70 695.83 529.11 211.21 931.65 (931.65) 101.97 1,044.54 10.00 153.75 16.02 106.97 213.88 $9,171.33 Amount Paid djb 084435 In'Person Payment Total: , $9,171.33 $9,171.33 " ,- ",.0.1 ...;;1 -oJ),' .!;.~.:.;.!~~~~ll'"'~ . :.:.';: .... '" r ' " i ..: ,;; , \ \ ;... ,\~ ...... ;1 ; I~ .' .'_~l;" 1._ .-' . . I ~,:ll ). ,t:; 1 '. . .-;<, ,! i: ~;';;)f-~ 'l !. :ti! :_~;: :. :~; ~{7,:lJ " '.) cReceint 1 .{ \ ", ,~ ,\r I ,~ -;~. 'I~'~'" Page I of I 10/2812009 '1 ~ < , \'\ ;: