HomeMy WebLinkAboutPermit Building 2009-11-20
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01660
ISSUED: 11/20/2009
APPLIED: 11/1712009
EXPIRES: OS/20/2010
VALUE: $ 174,000.00
Status
.Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5795. MICA ST
ASSESSOR'S PARCEL NO.: 1802033304300
SPRINGFIETYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - SAME AS COM2009-01511 5774 Orchid
Owner: 1-1 A YDEN HOMES LLC
Address: 2464 SW GLACIER PL STE 110
REDMOND OR 97756
I CONTRACTOR INFORMATION I
Cont'ractor Type
General
Electrical
Mechanical
Plumbing
Contractor
HA YDEN ENTERPRISES
TOP NOTCH ELECTRIC INC '
PACIFIC AIR COMFORT INC
STUTZMAN SERVICES INC
License
92208
172366
39237
31747
I BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure 15.50
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path:
Sprinkled Building: n/a
1
R2
U
VB
3
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
18.00
12.00
15.65
24.00
0.00
Overlay DiSl:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Residential
Expiration Date
07/29/2011
09/29/2010
03/25/20 I 0
05/12/20 I 0
Phone'
541-228-1081
541-317-1998
541-672-9510
541-928-8942
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carp~rt
Sq Fl Other:
Occupant Load:
1,148
400
3
Yes
26.30
" REQUIRED PARKING
Total: 2
Handicapped:
Compact:
Subdivision Not Accepted I PUBLI<'>IMPR<:>VEMENTS I
Street Improvements: . Sidewalk Type'
Fully Improved 1\1' 0 qQn law requires YOlCu)-bside 7'
Storm Sewer Available: Yes ATTE~~nS~88r~~ffl"\YjI~i1e Ore,.,('Jjj1riita'iilt Gutter
Special Instruction: Storm water to curb via weep hole/Drh,eway apflr\\~~'Rb~ell'n{~~PRj"/l~!l(hj'lmlat'Mlf(;~AAion
NOTICE: by Ken Vogeney Notlflca Ion 01 0010 through OAR 952-001-
Notes: THIS PERMIT SHALL EXPIRE IFTHE WORK In ~~R .J:;~ay -obtain copies 01 the rules by
AUTHORIZED UNDER THIS PERMIT IS NOT OOCaliing the center. (Not~:.r; ~e~~~~:'~n
COMMENCED ORIS ABANDONED FOR number for the orego~I2344)
ANY 180 DAY PERIOD.' Center 18 HIO - .
Page I of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01660
ISSUED: 11120/2009
APPLIED: 11/17/2009
EXPIRES: OS/20/2010
VALUE: $ 174,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Oescrintion I
'j
Estimate
Estimate
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
174,000.00
Value
Date Calculated
Descril>tion
Tvpe of Construction
Total Value of Project
$174,000.00
$174,000.00 '
11/17/2009
~
Fee Description Amount Paid Date Paid Receipt Number
+ 12% State Surcharge $208.55 11/20109 1200900000000001275
+5% Technology Fee $104.75 11120/09 1200900000000001275
1st Appliance $79.00 11/20/09 1200900000000001275
2 Baths One or Two Family $337.00 11120/09 1200900000000001275
Addressing Assignment $38.00 11120/09 1200900000000001275
Appliance Vent $9.00 11/20/09 1200900000000001275
Bnilding Permit $1,009.93 , 11/20/09 1200900000000001275
Credit - Trans Improv SDC $-931.65 11/20/09 1200900000000001275
Cnrbcnt Permit $88.00 11/20/09 1200900000000001275
Dryer Vent $9.00 11120/09 1200900000000001275
Exhanst Hoods $13.00 11/20/09 1200900000000001275
Fire SF Fee - Residential $77.40 11120/09 1200900000000001275
Gas Ontlets 1-4 $7.00 11/20/09 1200900000000001275
Plan Review Major - Planning $211.00 11120/09 1200900000000001275
Plan Review Same As $250.00 11/20/09 1200900000000001275
PW Disc - 2nd Permit $-30.00 11120/09 1200900000000001275
Residence Wiring 1000 Sq Ft $134.00 11/20/09 1200900000000001275
Residence Wiring Ea Addtl500 $50.00 11/20/09 1200900000000001275
Sanitall' Sewer - Improvem~nt $507.07 11120/09 1200900000000001275
Sanitary Sewer - Reimbursement $666.84 11/20/09 1200900000000001275
SDC MWMC Administration $10.00 11/20/09 1200900000000001275
SDC MWMC Improvement $1,044.54 11/20/09 1200900000000001275
SDC MWMC Reimbnrsement $101.97 11120/09 1200900000000001275
SDC Sanitary/Storm Admin $149.38 11/20/09 1200900000000001275
SDC Tran Reimburs-Residential $211.21 11/20/09 1200900000000001275
SDC Trans Improvement-Resident $931.65 11120/09 1200900000000001275
SDC Transportation Admin $16.23 11120/09 1200900000000001275
Sidewalk Permit $88.00 11/20/09 1200900000000001275
Storm Drainage Impervions^rea $770.55 11/20/09 1200900000000001275
Temp Power 200 amps or less $63.00 11120/09 1200900000000001275
Vent Fan $27.00 11120/09 1200900000000001275
Willamlllane Single Family $2,858.00 11/20/09 1200900000000001275
Total Amount Paid $9,109.42
Page 2 of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01660
ISSUED: 11/20/2009
APPLIED: 11/17/2009
EXPIRES: OS/20/2010
VALUE: $ 174,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
5~ 1-726-3676 Fax
541-726-3769 Inspection Line
man nine: Review
11/17/2009
Plan Reviews ,
11117/2009 APP
nDK
Public Works Review
Structural Review
11/17/2009
11/1712009
11/17/2009 APP
11117/2009 APP
LKW
KLK
Access restricted to 1 driveway/lot.
I Streei tree on Mica and 2 street
trees on 58th Street. Follow Street
tree plan.
Storm water to curb via weep hole
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
l...P-eollirerUnsnections I
Site Inspection: To be made after excavation but prior to setting forms.
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to tloor insulation or decking.
Floor Insulation: Prior to decking.
Shear Wall Nailing: Before covering sheathing with linish materials.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Final Building: After all required inspections have been requested and approved and the building is complete.
Perimeter Foundation Drains: After gravel and IiUer cloth is installed but prior to backfill.
Undertloor Plumbing: Prior to insulation or decking.
Underlloor Drain: Prior to cover or placement of concrete.
Rongh Plumbing: Prior to cover and including required testing.
Water Line: Prior to tilling trench and including required testing.
Sanitary Sewer Line: Prior to filling trench and including reqnired testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Page 3 of 4
:,
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-01660
ISSUED: 11/20/2009
APPLIED: 11/17/2009
EXPIRES: OS/20/2010
VALUE: $ 174,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phonc
541-726-3676 Fax
541-726-3769 Inspection Line
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimum of one appliance inchiding required
testing. Presure test done at this poin\.
Rough Mechanical:' Prior to Cover
Final Mechanical: When all mechanical work is complete.
Temporllry Electric: Approval reqnired prior to Utility Company energizirg pole.
Rough Electric: Prior to Covcr
Electric Service: A~proval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
. '
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
I'
Corbcut - Standard: After forms are erected bnt prior to placement of concrete.
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 Springtield 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.
- ~D//~
Owner or Contractors Sign~:~
II-cJo- 131
Date
Page 4 of4
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within i80
days of issuance or if work is suspended for 180 days.
1~"'iE0e-p:H""'Ge~ERN'MENiltt;\'A'ReR0V7A@"'l"''''"@;'''~1
~~___"_",,,""'_~~~_.'"_'"__OJ~,-,,-__,__ ___~_,_~~_)I!-,"._L.._~..:L,~._~~lQ~-,_Wf.~'
I Zoning approval verified? 0 Yes 0 No I
1~'Il[<;;~:liE;'<3~0RY&.0.J;ljfg;~0N$.iTIRl!)P-,i]LQM.~~.\'liA~1
I 0.Residential ' I o Govemment " ~rnmercial, ,I
i~~~~:;:~l[E~~~;:~~:l~R$~Ii~B~W;r;IQN~l
I City:'iY"'0-C'rioi ,I State: oK I ZIP:'17'-178' I
~~~~:;~~~wJ~~~i~~~J
I Ho..h'c IM're /;;;",(/.. I
I /Bol.Os33 045(50 I
Ir~~~-'j[.'*.r~P.R0RERlliF0WNER"\"'!'1'1i'~\\':'?'~~i:;,,,,,,,",,~1
~';'t~~~-;."~....t",,,,_k,__ ~R.___ "_"__'Z.:~__"_=____'_ :;r,ff~~~l"1~%'~_~1..~&;l
I }jame: l-l.'-/Ju"\ Kevr.t' <.. I
I Address: .JL;CG( Sw (.,(c..ri"- I
I City: Q ",0( V"'lcv> <-1 I State: 6 R I ZIP: 'i'775'G. I
I-Photie: 5'/1- 2?~- .0'1:>5 . I Fax:S>/I- 7</1- ,;J57;? , I
I E-mail:' I
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
~G:(,)Nm.~GmQRIINSJl1lXm@'8'J1i,QN~~-ilj~Jfi;W!fil
I Business name: "Tor \\\;~(~ F' pC I
I Address: ..)O~ 7'1 (OVi?<1 C +- I
I City: &. ",0\ I State: 6R I ZIP:
I Pho~e:5',,-311-{11'i? I Fax:
I E-mail:
I CCB license no.: [-p.3CjG I BCp lic~ns..e no.: ( .;l2()_
I Signing supervisor's license no.: 'L/;JJj-j(;i,; /..t'n~
I Print name of signing supervisor: 'v('('Y c;-/i i'CK Ie I Sr
,I Signature of signing supervisor:
Electrical Permit Application
. D
225 Fifth Street. Springfield, OR 97477.PH(541)726-375H FAX(541)726-3689
~~.O'
~~~
~\Y'
~
~~,
440-2584-J (9/08/COM)
~';:t''::':';';'~i>'.' ~;:,\" '1;.;.~I';''-''''.t;~-'.'.>~'"'''(~:>'';.~_A~.~~-*,_:,~j~:~~<~'
,,,mpr;pARl'MEN'f4US'SNIhY." o~
_.,~_._".._~.;,,",...,..,.-- -.;- '1;.ll_;;;::t't.f'!;;'~'.'1;:t~*';~H'<;~"1-
I p~~Z069-0'b60'
I Date: /(//7/0 C,
SPRINGI"IELD
.
~ !
~... ;..;;.,"-~~
t.1;:b ~~
I $134.00 I $/3 Y
Z $ 25.00 I $$01
Limited energy (2) $ 32.00 $ I
I Each manufactured home or modular I
dwelling service or feeder (2) $ 63.00 $
1 Services or feeders: installation, alteration, relocation I.
,I 200 amps or less (2) $ 81.00 $ I
[ 201 to 400 amps (2) $ 95.00 $ I
I 401 to 600 amps (2) $158.00 $ I
I 601 to 1,000 amps (2) $205.00 $ I
lOver 1.000 amps or volts (2) $469.00 $ I
I Recunnect only (21- I $ 63.00 $ I
.1 Temporary services or [eeders: installation, alteration, relocation . J
I 200 amps or less (2) / $ 63,00 $ b3
I 20i to 400 amps (2) $ 87.00 $
I 40 I to 600 amps (2) $126.00 $
lOver ,600 amps or 1,000 volts, see services or feeders section above
I Br-anch circuits: new, alteration, extension per panel
I a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 I $
b. Fee for branch circuits 'without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
I Miscellaneous fees: service or feeder not included
I Each pump or irrigation circle (2) $ 63.00
I Each sign or outline lighting (2) $ 63.00
Signal circuit or a limited-energy panel,
alteration, or extension (2)
$
$
$ 63.00
$
Eacb additional inspection: (I) I $58.00 $
~1'ili":;;'~Jffi"F[I!j'GANf.Jf(ijSEl\\;~1r~~""-l:1if)\1
~,:""",-,_ , . .~_g._b_____~.__."-'_'~.'--"'_'___.'_"'-~" . ., ~,~'.~
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of lAD
TOTAL fees and surcharges (A through C):
$ 247
$d?( t1:? L-(
$;;)"-';;5
$..;.0!;~r-'l~
SA ME M.. 577'-1
c. 7- {$; II
Structural Permit Application
,
225 Fifth Street. Springfield, OR 97477. PH(541)726-J75J . FAX(541)726-J689
ord\\'c{.
SPRINGFlEL.O !~;.t-:;;;",';''''''.
~~if~~'g5~J~ '
I' DEPARTMENT USE ONLY I
(0""1 ZOO 1- 0''''0
Pennit no.:
/
," . . , . I Date 1117/0 <7
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days ofissuand or if work is
suspended for 180 days.
I:" " , .,; >J.b0CA(Gi;)}iER~M~Ni;:t.:~~R'dYAU~;;;
I This Project has finalland~use approval. I
Signature: Date:
I This project has DEQ approval.. I
Signature: . Date:
I Zoning approval verified: O-Yes 0 No
1 Property is within flood plain: 0 Yes 0 Nn
lr;;i;i";~i;:/~;(Z;;f!i'cAiEGORY!;0i=;'c0NsiliRucifI6Nil!;:.;"",.;: ",:.';.:"".",'",.,
(~~;~'~i~':~.~;'~;.(."" ,,' ""'-"""'j" ~D-;~~~~~~';~t"""" ,.~.. ,-, ..( 'D"~::-;:'r~';:-]-
l1\i".";;';:i:1.J9'B:,'slt~'f r;fi;0RMAf,[QN(p;Ni~,;:;ei:lC5Afi9N;;jg;;:j;;iWJ"
1 Job site address: .57'1<) ,(11",,- _
I City ,.5fll''''f\(I..lrA 1 State. oR I ZIP 'f7<{7'l
1 Subd,vrsJOn -;'\"'~D<< M("~c..J c:. 1 Lot no ../96. I
1 Reference /80t.D'33.31 Taxlot. D'-/Scx:::, I
I, ," PROPERTY,OWNER> ' , 'I
1 Name: H~l!v1 J.loWU"<:' - j
Addre~ ~/..{ Sw ~( I
City: .RftlI'Yj6~ol ' I State: 0(( . I ZIP:Q775'(" I
---,-
Phone: -;;l;It- &1'3~ I Fax: '-7'1/- 257;) I
I E-mail: _ J
This installation is being made on residential or farm property ,owned by
me or a member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
I State:
Fax:
, ZIP:
;;;!:;:;'i::,1-'i';~j
I
I
I
j I
j I
1
I
I
1 Type of Heat: (":A-~
I .. Energy Path: ;). iT
- l.:.8new 0 alteration ' 0 addition
r (b) Foundation.-only permit? -0 Yes 'Qi! No I
, Total valuation; I' $ /70/ I::: ;
1(~2.iiB.ijU4Ipgjt,,~s);1:~;5i~'fH~,~;n&0;j'j,~ii"!':f,:i:;:'" ,'Zi~,.,:}i:~: ',:;,'!
I (a).Permit fee(use.valuation table): '. -- "', ;. ',' !
1 (b) Invesdgat>ve fee (equal to [2a]): . $
I (c) Reinspection ($ . 'per hour): j
-(number of hours x fee per hour) $
" Cd) Enter 12% surcharge (.12 x [2a+2b+2c]): $ I
1 (e) Subtotal of fees above(2a through 2d): $, I
. :~~~;~~:~:~:~'~~:~;:~:;:~ft1~!:~~;;~~;;~r{;~24~~l
1 (b) Fire and life safety (40% x'permit fee [2a]): I' $$ i
.1 (c)Subtotal ufrees above (3:; and 3b): I
INjiMis'celia;;~W~,fi~~Yi[;;'G';~;(~';';;;:';::'\;' - " ."'.'.. "1
JI (~) ~ei;mic fc~, I%(~IX ~~rmi;f~~ [2a]) $1
~ I TOTAL fees and surcharges (2e+3c+4a): $ j
I
I
I
I~>. "FEE'SCHEDiJLf'
':i.:V.al(iMi6~r;n fdrm~iioo:::;;;(,: iJ&~:.;
(a) Job description: 5t... ",Iff ~ i Iv
Occupancy e. 3/ vi..
Vii'
1/1-1'6 f tltJeJ tY..ma,'_
'-0
"
I
Construction type:
Square feet:
Cost per square foot:
Other infonnation:
Sign here:
I Business name: llo...vd.t.II\
I Address: <filM\:::' , "
1 City:
"I Phone:
I E-mail:
I ces license no.:
. I Print name:
! Signature:
,'"CONTRAC'L9R:i,~,~jJ;At,LA:n9T'J,i::.
l~oNV'"
111i'~;;;:V\)O;i~i{StlEj'c:o NmR6c,tPRJNF,'QRri1;ti.;i:IQN~'i'1'Yf,%~p;~\i;f1i::j
I Name I eeB License Number I Phone Number [
I Electr;cal I D').,)&& :<n-Fiwt I '(oplJdcV\
I Plumbing 161 7'-17 "1)'6'- Ii~ 4;L J 5Ivt2"""'-I-'\.
I Mecbanical 34.::rz,1 i (07}--15"IO, ~ A,'(. '
-----
~~wmamalane
,t Park & Recreation District
Job. No. 0,~ - \\o\J'J
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009
h'_h~'"'' ~--_.C- NAME:~.~~'~h\~ y }:\(~'PHONE: Q/l~--loC1.g,S.-
ADDRESS:A4 \0 4'771<.> r;'(~ ((Q~\Atln,1,Qtlw:~50
LOCATION OF PROPOSED BUILDING SITE:
Street Address: 5\ q S "'^- ~. 0 ~ " ,
, Plat Name:~fX'" k\fCL _ Tax Lot Number: B(")A. () a~~CA 3C:P
1. DEVEL~~~PE (Check appropriate dwelling(s). Dwelling type definitions are on the
back.)
A. Sinale-Familv Detached
NO. OF UNITS
\
X $2,858 per unit =
$ !2.Y3Ef3CfJ
B. Sinale-Familv Attached
NO. OF UNITS
X $3,100 per unit =
$
C. Multi-Familv Aoartment
NO. OF UNITS
X $2,641 per unit =
$
D. Sinale Room Occuoancv
NO. OF UNITS
X $1,321 per unit =
$
E. p.,ccessorv Dwellina Unit
NO, OF UNITS
X $1,550 per unit =
$
'B C:x:J
$ t 6~..
if
$ 2.8~~
$
WILLAMALANE SDC
, _ 2._SDC_CREDlI(lfapplicable),SDCpayermustfumish proof of, ,
Willamalane Credit approval.) h
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit).
o..~~~S~~
City of Springfield
/
/
Date,
5
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.'~'~-~!~~~'"''''~',''' 'I~,.."",.".
-1 " :
.-;:C., '
, .'.'
--"- ......"",.- .....'
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-01660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
COM2009-0 1660
Payments:
Type of-Payment
CreditCard
cRcceintl
RECEIPT #:
1200900000000001275
Date: 11/20/2009
Description
Plan Review Same As
Building Permit
Addressing Assignment
Willamalane Single Family
2 Baths One or Two Family
1st Appliance
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Fire SF Fee - Residential
Plan Review Major - Planning
Credit -Trans Improv SDC
PW Disc - 2nd Permit
Curbcut Permit
Sidewalk Permit
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Tran Reimburs-Residential
SDC Trans Improvement-Resident
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transportation Admin
+ 5% Technology Fee
+ 12% State Surcharge
.'
Paid By
HA YDEN HOMES
Item Total:
Check Number Authorization
R~ceived By Batch Number Number How Received
njm 046092 In Person
Payment Total:
Page 1 of I
8:54:52AM
Amount Due
250.00
1,009.93
38.00
2,858.00
337.00
79.00
27,00
9.00
13.00
9.00
7.00
134.00
50.00
63.00
77.40
211.00
(931.65)
. (30.00)
88.00
88.00
770.55
666.84
507.07
211.21
931.65
101.97
1,044.54
10.00
149.38
16.23
104.75
208.55
$9,109.42
Amount Paid
$9,109.42
$9,109.42
11/20/2009