HomeMy WebLinkAboutPermit Building 2009-12-1
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: COM2009-01653
ISSUED: 12/01/2009
APPLIED: 11/13/2009
EXPIRES: 06/01/2010
VALUE: $ 7,000.00
SITE ADDRESS: 315 T ST
ASSESSOR'S PARCEL NO.: 1703262400112
Springfield TYPE OF WORK: Garage
PROJECT DESCRIPTION: Add garage to existing house
TYPE OF USE: Addition
Residential
Contractor . 0 I Licen~e_ toExpiration Date
ATTENTION: regon aw requires yuu
OWNER .f,Q1~9~ rJ,l.ll>~;adopted by the Ore.9.C?" Utility .
DONALD MARVNotni'6~ib~'Center. Those rullM'lIfesetforth 07/2512011
OWNER in OAR 952-001-001 o through OAR 952-001.
OWNER 0090. You ma'i obtain co ies of the rules by
. ., ISpnOIllJ
I q, tificallon
, - C~nler is 1-800-332-2344).
# oI"Slones:
Height of Structure
Type of Heat:
-, Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Owner: SCOTT WILLIAMS
Address: PO BOX 2158
JASPER OR 97438
Contractor Type
General
Electrical
Mechanical
Plumbing
# of Units:
Primary Occupancy Gronp:
Secondary Occupancy Group:
Primary Construction Type
Serondary Construction Type:
# of Bedrooms:
Fl'Ontyard Setback:
Side 1 Setbaek:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
R2
U
VB
Phone Number: 541-937-8014
J CONTR.ACTOR INFORMATION'
Phone
54 I -726-902 I
.~,:.<, ~'~.'~
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupanl Load:
384
n/a
Nj;i>iiwioPMENT INFORl\1AJ'lQlS .1.
Th,v r'cnlVlIl' vi I'-l........ ....,,, "".....:t .1.._,wORK
AUTHORI~.D Y,~Qlifi THIS PERMIT IS NOT
;;:~~ COMMENq~~~N~~~~pONED FOR ",
5.00 ANY 180 il~ed'~la,lRqd: . No
21.00 % of Lot Coverage: 19.40
0.00,
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
I PU.BLlC IMPRO~EMENTS I
Sidewalk Type:
Downspouts/Drains:
Paee I of 3
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541 -726-3769 Inspection Line
Descriution
Tvpe of Construction
Estimate
Estimate
Fee Description
Plan Review Residential
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Add, Alter, Extend Circ Ea Add
Fire SF Fee - Residential
Fix tu re
Garage/Carport
Minimnm/Adjustment Plumbing
Perm Serv/Fdr 200 amps or less
Plan Review Minor - Planning
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Temp Power 200 amps 01' less
Total Amount Paid
Initial Review
11/17/2009
Plannin2 Review
11/17/2009
Structural Review
11/17/2009
Public Works Review
11/18/2009
CITY OF SPKIl'lLJ!:'lJ!.LD '
Building/Combination Permit
PERMIT NO: COM2009-01653
ISSUED: 12/01/2009
APPLIED: 11/13/2009
EXPIRES: 06/01/2010
VALUE: $ 7,000.00
I V~luati?~ Descrintion ,I
$ Per Sq Ft
or multiplier
$1.00
Square Footage
. or, Bid Amonnt
7,000.00
Value
Date Calculated
$7,000.00
$7,000.00
11/1312009
Total Value of Project
J;'pp.,< pq:.-l .
I ~II"(, , ....
Amount Paid
$69.39
$52.29
$27.74
$79.00
$48.00
$19.20
$38.00
$106.75
$20.00
$81.00
$119.00
$12.56 .'
$251.24
$63.00
$987. I 7
Date Paid
Receipt Number
11/13/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/09
12/1/0~
12/1/09
12/1/09
1200900000000001257
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
1200900000000001290
11/17/2009
Plan Reviews I
APP SKG
11/18/2009
11/1912009
11/20/2009
APP DDK
Garage replacement is outside of
zone x floodplain. Street is
unimproved so driveway does not
need to be paved.
APP CJC
As noted On plans
APP LKW
Called Scott Williams on 11-19-2009
received answer on 11-20-2009 no
new fixtures. Storm water to tie into
existing systeml storm water to curb.
Paee 2 of 3
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01653
ISSUED: 12/0l/2009
APPLIED: 11/13/2009
EXPIRES: 06/01/2010
VALUE: $ 7,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726"3676 Fax
541-726-3769 lnspeetion Line
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.
Reolli~erllnsnectio,ns I
Footing: After trenches are exeavated.
Foundation: After forms are erected but prior to concrete placement.
Slab: To be made after all inslab building serviee equipment, conduit piping and other equipment items are in
place but prior to concrete.
Shear Wall Nailing: Before covering sheathing with finish materials.
Framing Inspection: Prior to covel' and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Drywall: Prior to taping.
Final Bnilding: After all required inspections have been requested and approved and the building is complete.
Rough Plumbing: Prior to cover and including required testing.
Underslab Plumbing: Prior to filling the trench and including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanieal work is complete.
Ufor Electrical Ground: Install ground rod at footing and call for inspection in conjuction with footing and/or
foundation inspection.
Electric Service: Approval required prior to.utility company energizing service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application and do ~ereby certify that all
information hereon is true and correct, and I further"certify that any nod 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 structur ithout permission of the Community Services Division, Building Safety.
I further cerf . . t on contractor~ n lor, es who re in compliance with ORS 701.005 will be used on this projeet.
I furthe gree to en I' ,that II reqlii e ins ec ions are equested at the proper time, that each address is readable from the
stree that the per It c I'd '. located . the fr of the pI' perty, and the approved set of plans wiII remain on the site at all
times structi n.
12~/-(o ?
------
Owner or Contractors'Slgnature ,
Date
Paee 3 of3
.~....
- .
~tr~ctural Permit Application
-'-
" - "~~_ >.~ . ," t." ,.,~. D I'" _ ~', ~',' . i
It,. ",__" _ . .. ',.-,"
225 Fifth Streett Sp,ingfie]d, OR 97477. PH(54 ])726-3753. FAX(54 1)726-3689
1,:()~~ARTME,Nt USE(jNl:Y'1
,CO":1Z-00y -OlbS' S
Perri1it no.:
Date: 11- ( ;S ~ c 1
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days'of issuance or if work is
suspended for 180 days. "-
"
"';:;"::,~:.:,I:l\)t'Ai;': <:3GY:E.@r;,.E.~X('t\FiR~'~,VAgl2~j~iif:.;i:M~~"i~(il
I ~~~~;~o;eect has final land-use approvaL Date: I 1:2': .,...,'W.c:,. '::ej';}FmsC@jfiutg';'''C>>:'!,:U:,'>;:::';i'LI
1 This project has DEQ approvaL I 'lii}yii\il~(jli!i-ii1to'..m~H1lR'1if;"j(~:%\\n\f!f;1;1;:'(;f~f\fi~\ii;ii;MH:::;~i~;:;.1
Signature:. Date: (a) Job descript;~n" &/1 ~ I
I Zoning approval verified: DYes D No I Occupancy \'L> / fA I
I Property is within flood plain' DYes D No I Construction type: a..L' GAQ.c.~ "- 1
1~~t~:;~Wriii:c:ATI':QQ~iito.F:E\G.Q.~$;j'RQ(;[iQf.jfi~;l!M:~~\~[~~;1i!!1 Square feet: ~AA "'-0 (=,. I
L ia"Residential I D Government ,I 0 Commercial 1 Cost per square foot: I'
1)f.'1.~;;,(i!,;[;U9~)1S'I~ErfN#PRMAtrQ~J!A~R'UrcQPAifTQJ:lj:il[f~~ji::i)~\\j 1 Other infonnation 1
I Job site address: '3/.<(' r c::;, T: 1 1 Type of Heat: IV ()w(' 1
I City: Sffl.'^1 r....LJ I State: {h I ZIP:fi )<( 1111 I Energy Path: 1
Subdivision: I Lot no.: , I I D D . "" I
It I . I new alteration ~ addition
II Reference lIo1zt; z.." ',' ,T"axlot' ",' _,0<:::> II "L. .' 'I I (b) Foundation-only penn it? . DYes D No I
'., :.. I?ROPERT'COWNER ' 1 I I
I' ..-,..,,\ '(. \' ' ", ., " I Total valuation: $ 70-00
Name: :-.Coll vv, _\
I Address: '\e.1,,"~ ~~.. (l.D I
I City' r...\\ ~'- 'I State: 01\" I zIPQ7f(3k' I
I Phone:S"4f ~ .z,.ILU Fax: I
I E-mail: I
This installation is being made on residential or farm property owned by
me or a mem imr lei) mily, and is exempt from licensing
requiremen nder 711 .
Sign H e: ,
I ZIP:
I
I
1
I I (a) Seismicfee, 1%(.01 x permit fee [2a]):
II
I
I
I
J (a) Pemlit "fee (use valuation table): $
I (b)Investigative fee (equal to [2a]): $
,I (c) Reinspection ($ per hour), $
(number of hours x fee per hour)
I (d) Enter 12% surcharge (.12 x (2a+2b+2c]), $
I (e) Subtotal ofJees above (2a through 2d): $
1~3f:RiaIH,f~i~\~Nfe~s~~i1~,"::~~f;:!0j?!f~;0~~I~\t~;ti~~t~t1}~~i~t~€)~17Ji4~,~ll\;t~~,. ~
.. .......... .._._--~'. '-"'-,"0"'_- ".,\,__~. "'~_"'"".''''.' '>;,,,n ',~'~"h'L-,",..,,,.;;h,,:,:.; "_"'~_"h'C'~"'.",o,!:"" _'~'T'4" ..."'- ,," ."'~ r
I (a) Plan review (65% x pe;mit fee [2a]): I $ fo 1'-
I (b) Fire and life safety (40% x permit fee [2a]): I $
I (c) Subtotal offees above (3a and 3b): $
I.
CONTRAC'rPRI@T'ALLAfl9N
D WN f::.YL
I Business name:
I Address:
I City:
I Phone:
I E-mail:
I CCBlicense no.:
I Print name:
I Signature:
I State:
I Fax:
$
'1
I
I
T01;'AL fees and surcharges (2e+3c+4a): $
If\f[:/i;'~;:~'':~?J~~T~~G$-V~~.G.eNm~AG1t~OR'INF.Ql~M!\rtlQN!ill~i~~~W~~~j1
I Name CCB License Number Phone Number I
I Electrical I
I Plumbing I
Mechanical /
225 Fifth Street. Springfield, OR 97477tPH(541)726-375HFAX(541)726-3689
It:\;,D~~~BT~ENfu~E,oNLX: .,>'
I permft ~o~ 'Z-OO r - , 0 I b s:. ~
I Date JZ-.-(....() 'l'
Electrical Permit Application
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permiis ~xpire if work is not started within 180
days of issuance or if work is suspended for 180 days.
I 'P i":',1[~OC,',A', l:.,';.',GO V'E"R N"MENT""'A'D,, "R,O ,V"A' ,,,,,,,,.:1:;,:",';,;'"'~"!"'~,',",',~,"[','..,.'1 l[\;il\'i'?!?""''P.'i/;iI''''''-\\''$!I'FE E' ~'S'C'H' EDU"E'PifljiM9e;itt11.<t'''
''''",tJJi>il1\;!
.. _.. .. .'. . .... r;:r:. . L:: .' ',' . ,: ,.';\'Yf~I~~_'.'::",~'..:;."I,p,il?:A~:::,'_' .;:.. .. ..'C;l. " ," _',' L:, . :'i;:;f'!l"'~':fF,~\~~.5~.'f~1.~"?;:~i!:1
I Zonlllg approval verified? , ,DYes 0 No , I I;N;IIn,~~!qk;?~P,~~ti~:~!;'~;~r.i~~(\';;iIQt~.I::J~o~!.';l)r6ta~::1
1~~j!14i:\~;;"~ii;~;C~'IEGORYNCir,:\CONS'T:RUCT;ION~~:<':>j!>::;:1 I R~;;~:~;;a:, ~;r:n';;:rs:;~I~e ;:~IU~:;:",>.,.ea.,., '" cost. "
i~:;~~~~~lmEjlIN~&R~;;~;~~;~NPM~~C~;;~~~~~iilll'OOO sq. ft. or less (4) .~ $134.00 $ I,
I' ~ ' ", , I I Each additional 500 sq. ft. or portion $ 25.00 $ I
Job sIte address: :::of ~ r s r thereof .
I City: sp~1 State: fl", I ZIP: tJ vJ 1 I Limited energy (2) $ 32,00 $ I
I Reference: \ '70:l2--b'Z.-l( I Taxlot.: 0011 2.. I Each manufactured home or modular I
"","" ...:",'DESCRIRTlON"OF)I\lO~K"';~''i''::;'\'''''';4r:Ji::''f dwelling service or feeder (2) $ 63.00 $
A f'>r' , .~ .. ~ '" I Services orfeeders: installation. alteration,relocation I
.tJllL.uu f1/4oN"'-] - ~.471;' .
I 200 amps or less (2) / $ 81.00 $ K / I
I : 'PROP,ERTY:OWNER:" '. I 201 to 400 amps (2) $ 95.00 $ I
\ Nanie: ~-rt""' 1^..h,"I\,~j !401t0600amps(2) $158.00 $ I
I Address: '!.~tc..'~ 'Phu (2J) I 1601 to 1,000 amps (2) $205.00 $ I
I City: ~ State:O", I ZIP: q)<I1 f' I lOver 1,000 amps or volts (2) $469.00 $ I
I Phone: S'l1 b"21 -Z4/u I Fax: I I Reconnect only (2) $ 63.00 I $ I
I E-mail: I I Temporary services or feeders: installation, alteration, relocation
This instailation is being made on residential or farm property I 200 amps or less (2) I $ 63.00 $ fa 'J>
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $ I
.property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1). 1401 to 600 amps (2) $126.00 $ I
Signature: lOver 600"arnps or 1,000 volts, see services or feeders section above I
.}C0NTRACTOR'~;INST.a:lL.a:'flON: I Braneh circuits: new. alteratIOn, extension per panel I
I Business name: D m lot ~~.e 1 I a. Fee for branch circuits with purchase of a service or feeder fee: 1
I Address:?lit? !';. _ ~7 TH sf/'"Ur I I Each branch circuit ,I I $' 6.00 I $ I
I City: ~;l;~;: '" 'I State' 0 IZ I ZIP: 'l7"f7& I b. Fedor branch circuits without purchase ~f a service or feeder fee: I
I Phone - , s I Fax:5'i '-7..3t,- J ~l...- I First branch circuit (2) $ 55,00 $
I E-maIl: I I Each additional branch circuit '><' $ 6.00 $ L( 8
I CCB license no.: l\1~'2.. \ I BCD license no.:Zt:I-q~ I Miscellaneous fees: service or feeder not included
I Signing supervisor's license no.: 4'5t) 4 S I Each pump or irrigation circle (2), , $ 63.00
I Print name of signing supervisof:l)gro. 1"1'\. -Ho~- Each,signoroutlinelighting(2) , $ 63.00
I Signature of si'gning superviso~," I 1 '\ 1-- '1 Signal. circuit or a li~ited-energy panel, $ 63.00 $
. ^" M_o ~... ~, alteratIOn, or extensIOn (2)
"'<Aft > I Each ad~itional inspection, (I) . $58.00 I $ I
. ~~ ,....(A. Ir~~~1~,l>>4r~%~~\@fl\{;i~)\'R'~tfcAN1;~~jj$-E~~~111t~(i~(l~i:if~~~'~]f~~~
Wf\ 0 _ "' (A) Enter subtotal of above fees
\~<r'l ~~;::::::::::::::"[~1I : I I~ la~
,~~ I (C) Technology Fee (5% of[A]) $ 96"1
\.Y I TOTAL fees and surcharges (A through C): I $ Z- 7 }( ~
$
$
~~
/\.':iJ
440-2584-J (9/08/COM)
Plumbing Permit Application
17 0"3 z,.c,'Z.. <{ OOJJ2.
If"'~T7D'Ep'ARTME'NT(!trsE?ONiSYJ{;f1i\;1
".~' :'!; . "-,',.,",, "_".,,' ":::.:' ";'_ ;..~,'.c._. ~1,:;"'." .....,.,!s'!;,.."
I Permit no. C Cf ~ /<. '5') I
I Date: II/ J '1./ D' I
225 F,fth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits
expire if work is not started within 180 days of issuance or if work is suspended for 180 days. '
1.",,".,""""'" "0''''' "p " " RN' EN' T'"'' '0' '-'~-""'='-~~" I' -"".,,,,,.,,.g"'~'"~"'~""EE"S'" .. '-.'" "''''.'"",,''''''''-
i1~,i"Y;f.";",.2.iE,,,,Al1,';GOV,E M : "ARI?R 'VAl!"#~,;;:f1l"'iit:'.i., iil{:"'11",",)d'>c1i);'ic,,!?k.r:;,, ,~,...HEDlJEE'i;{iJ$;~,,;;;tji1~~~;ifit,'4llii'f!&
I Zoning approval verified? DYes D No ~B:~~.~t1.et~:~i~~~ft~~~~~t~~i~i~l~t~~.~~J~~~I~~~~~!t{~l~f~.~1~~1~1
I Sanitation approval verified? 0 Yes 0 No New residential
I' ,. , CATEGORV:'OF,: CONSTRUCTION'.' I bathroomll kitchen (includes,first
CJ Residential I 0 Government I 0 Commercial I J 00 feet of water/sewer lines, hase
l.JII. . . bibs, ice maker, under floor low-point
\~~ifiP:f!;'!JOBJiSI;r;E'INf:.()~MAr:I()NifAND1iiII()GA'IiI()N);J)1?\'A&'iji drains and rain-drain packages)
Job site address: '3' s- . -r ~T 1 2 bathrooms!1 kitchen $374.00
I City: SpR.l....... ~~1l> I State: 01.1- I ZIP: q 7lf7 7 I 13 bathrooms/I kitchen $439.00
I Each additional bathroom (over 3) $95.00
~~;~~~~;~~E~iDESCRle.T1~N;roFT~wJ~~~~;~~;~;~'!)~Wj~)II~i : ~::~d:~~:~~;':~ ~i~:~;:I~or:e;i~~ludes plan reVieW)$95.00
....(Y\.\\\ l'f1 n W I.}.J(A.llJL ' .... w ~ NA. ~ I I 0 to 2,000 squarefeet $58.00 I $
1 ,.",.., ';PROPERlC:Y;i:OWNE~;~f,i",:1:)~J\~r~,~~i~[(;;.}\!j I ~:~~: :: ~:~~~ :~~:: ~::: :~~::~~ 1 :
I Name: Seo1r' A . I. I,ll """,S I I 7.201 square feet and greater $232.00 I $
-~- - - I8lill I Manufactured'dwelling or pre-fab (circle one)
I Address:~__ .' '3f{/(..J(> t'/1"tr4.. rl.o I Connections to building sewer and I I $5800 I $
I City: ["...I.\.. r___ k.. I Stat~: ()I\- I ZIP: 'l) '-{ ~K water supply .
........ I Commercial, industrial, and dwellings other than one- or ' I
I Phone: ~ 1- ~z../' 2.IUf I Fax: two-family
IE-mail: 1 Minimum ree I J $58.00 I $1
I Each fixture $19.00 $ J 8'::1-
This installation is being made on residential 01' farm property
owned by me or a member of my immediate family, and is I Miscellaneous fees I
exempt fro~ repuMrents under OAR 91 8-695-0020, 1100' storm, sewer, water line $76.00 $ I
Slgnatur~J\ lJ.. ~\, .1 Each fixt,ure, appurtenance, and'piping $19.00 $ I
I. <",! ~TRACl\ORANSTAlLJl.TION\".',.J I Storm water retention/detention facility $19.00 $ I
. I Business name: I !lrrigation systems $19.00 $ I
I Piping or private storm drainage $ I
I Address: I Systems exceeding the first 100 feet $19.00
I City: State: I ZIP: 'I I Specialty fixtures $19.00 $ I
I I' I Reinspection (no, ofhrs. X fee per hr.) $58.00 $
Phone: Fax:
Special requested inspections (no, of $58.00 $
I E-mail: I hrs, x fee per hr,)
./ CCB license no.: I BCD license no.: I 'I Each ad~itional inspection: (1)
, Plumbing license no.: I
I Print name: I
I Signature: I.
$i38.00
$58.00 $
$
I
I Enter value of installation and equipment $ _. I
1",:~:;;"~~";:~~~~:~I~ti~~,.a~~t.:q,~:" ~e~t;;:",',W1I.,wl'~i&'l!>iCJll'''''11
r~~{jik2€'k~:'1~G,~~~,~~I,CIf.NjJ"~tJ.S.E~4~*~~~~
I (A) Enter subtotal of abave fees ~fI!J I
(Minimum Permit Fee $58.00) $ :> 0"""""-
I (B) Investigative fee (equal.to [AJ) . $ 1
I (C)Enter 12% surcharge (.12 x [A+BJ) $ I
(D) Technology Fee (5% of[AJ) $ --.-J
1 TOTAL fees and surcharges (A through D): $1I'l~
M~nimum fee
440,2500-J (11/08/COM)
$
$
$
$
$
1
I
1
1
1
1
1
1
1
I
225 Fifth Street
Springfield, -Oregon 97477
54 1-726-3759 Phone
.-n:~':".' ".'-" ..:..'.:
JIL-'Al.i, ' .
- ~'
", .<T....................... " ....J -.
City of Springfield Official Receipt
Developmellt Services Department
Public Works Department
Job/Journal Number
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-0 1653
COM2009-01653
COM2009-0 1653
COM2009-0 1653
Payments:
Type of Payment
Check
cRcccintl
RECEIPT #:
Date: 12/01/2009
1200900000000001290
Description
Fire SF Fee - Residential
Plan Review Minor - Planning
Fixture
Minimum/Adjustment Plumbing
1 st Appliance
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Garage/Carport
Temp Power 200 amps or iess
Penn Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SCOTT WILLAMS
Item Total:
Check N umber Authorization
Received By Batch Number Number How Received
cjc 1074 In Person
Payment Total:
Page I of 1
2:27:19PM
Amount Due
19.20
119.00
38.00
20.00
79.00
. 12.56
251.24
106.75
63.00
.81.00
48.00
27.74
52.29
$917.78
Amount Paid
$917.78
$917.78
12/1 /2009