HomeMy WebLinkAboutPermit Building 2010-1-22
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-00068
ISSVED: 01/22/2010
APPLIED: 01/19/2010
EXPIRES: 07/22/2010
VALUE: $ 166,000.00
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Status
Issued
225 Fifth Street, Spriuglield, OR
54 ]-726-3753 Phone
54]-726-3676 Fax
541-726-3769 luspection Line
SITE ADDRESS: 5793 MICA ST
ASSESSOR'S PARCEL NO.: ]802033304200
SPRINGFlETYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: New single family dwelling lot 289 Jasper Meadows
I PUBLIC IMPROVEMENTS I
AnENTION: Oregon law r~~.
Fully I mprovefbllow ",'es adopted by the Q!'egon Uti .
\Notification Center. Thoserulelcar6mR ains:
Storm water to curb vilmOADtI9820001-G010throughOAR962.0CI1.
0090. You may ".",; copies of Ih8 ruIe8 br
calling the center. (Note: Ih8 tetephont
I!\imb8r for the Oregon UtIlity NotIlllIItlDlt
Center Is 1-80()..332.2344).
Owner: HA YDEN HOMES LLC
Address: 2464 SW GLACIER PL STE 110
REDMOND OR 97756
I CONTRACTOR INFORMATION I
Contractor 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
BUILDING INFORMATION I
# of Uuits: , ] #'of Stories:
Primary Occupancy Group: R-3 Height of Structure ]5.50
Secondary Oecupaucy Group: U ' Type of H'eat: Forced Air Gas
Primary Construction Type VB Water Typ.~: Gas
Secondary Coustruction Type: ..,,/,.Rang~':rype: ~ : Electric
# of Bedrooms: t.lO,.\Cf.~ ,U~~l EX?\R~ &ntsE.~\D&1i~g' No
,~ __I nor c:..l" ~A rf&Uff'fS .
1H'1:';ORiiEn \lNO~Sl'\ 1i~(;llt'leMi~ INFORMATION I
AU CeD 01\ I ." "
COMMf.N .. \00. . .;, '. ' '
Front yard Setback: MW 180 OA'4f.~ Overlay Dist:
Side I Setback: 5.63 # Street Trees Rqd:
Side 2 Setback: ]0.00' Paved Drive Rqd:
Rearyard Setback: 24.00 % of Lot Coverage:
Solar Setbacks: 0.00
Street Improvements:
Storm Sewer Available:
Spt'ciallnstruction:
Notes:
'.,
Paee ] of 4
I
Residential
Expiration Date
07/2912011
09/29/2010
03/2512010
05/] 2/20 I 0
Phone
54]-228-6935
54]-317-1998
54] -672-951 0
541-928-8942
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basemeut:
Sq Ft Garage/Carport
Sq Ft Other:
, Occupant Load:
4,647
1,031
400
REQUIRED PARKING
2
Yes
30.80
, Total:
Handicapped:
Compact:
2
Cu rbside 7'
Curb and Gutter
_S~~J_~~,~I,~~~_. .,"~~jj,~
If
~7
~
Status
Issued
225 Fifth Street, Springlield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Type of Constrnctiou
Garaee/Misc
SFlDulllex
U VB Utilitv
R-3 VB ]&2 Familv
Fee Description
+ ]2% State Surcharge
+ 5% Technology Fee
]st Appliance
2 Baths One or Two Family
Addressing Assignment
Appliancc Vent
Building Permit
Credit - Trans Improv SDC
Curbeut Permit
Dryer Vent
Exhaust Hoods
Fire SF Fee - Residential
Gas Outlets ]-4
Piau Review Major - Plauniug
Plan Review Same As
PW Disc - 2nd Permit
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sanitary Sewer - Improvement
Sanitnry Sewer - Reimbursement
SDC MWMC Administrlltion
SDC MWMC Compliance Charge
SDC MWMC Improvement
SDC MWMC Reimhursement
SDC Sanitary/Storm Admin
SDC Tran Reimburs-Residential
SDC Trans Improvement-Resident
SDC Transportation Admin
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
Total Amount Paid
'"
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00068
ISSUED: 0112212010
APPLIED: 01119/2010
EXPIRES: 0712212010
VALUE: $ 166,000.00
I v al~ation Oescriotion I
$ Per Sq Ft
or multiplier
$37.72'
$96.83
Square Footage
or Bid Amount
400.00
],031;00
Value
Date Calculated
Total Value of Project
$] 5,088.00
$99,831;73
$]]4,9]9.73
01/1912010
01/19/20]0
Fpp<, p"iiLI
Amount Paid
Receipt Number
Date Paid
$201.64
$]01;87
$79.00
$337.00
$38.00
$9.00
$977.37
$-931;65
$88.00
$9.00
$13.00
$71;55
$7,00
$2] 1;00' .':':
$250.00 '
$-30.00
$]34.00
$25.00
$507.07
$666.84
$]0.00
$22.63
$1,333.57
$101;97
$]59.56
$211.2]
$931;65
$]8.00
$88.00
$697.83
$63.00
$27.00
$2,858.00
1/22/]0'
1/22/] 0
1/22/10
1/22/] 0
1/22/10
1/22/] 0
1/221] 0
1/22/10
1/22/] 0
1/22/]0
1/22/]0
1/22/10
1/22/]0
1/22/10
1/22/]0
1/22/] 0
1/22/] 0
1/22/] 0
1122/] 0
1122/] 0
1/22/] 0
1/22/]0
1/22/10
1/22/1 0
1/22/10
1/22/] 0
.1/22/] 0
1122/] 0
1/22/]0
1/22/] 0
1/22/] 0
1/22/10
1122/] 0
]20]000000000000067
]201000000000000067
120]000000000000067
]20]000000000000067
120]000000000000067
]20]000000000000067
120]000000000000067
120]000000000000067
120]000000000000067
1201000000000000067
]201000000000000067
]201000000000000067
]201000000000000067
120]000000000000067
]20]000000000000067
120]000000000000067
]20]000000000000067
]20]000000000000067
]20]000000000000067
120]000000000000067
120]000000000000067
1201000000000000067
120]000000000000067
1201000000000000067
1201000000000000067
1201000000000000067
120]000000000000067
]20]000000000000067
]20]000000000000067
120]000000000000067
120]000000000000067
]20]000000000000067
]20]000000000000067
$9,287.11
I ~-I
, Pa2e 2 of 4
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20IO-00068
ISSUED: 01/22/2010
APPLIED: 01/19/2010
EXPIRES: 07/22/2010
VALVE: $ 166,000.00
225 Fifth Street, Springfield, OR
54]-726-3753 Phone
54]-726-3676 Fax
54] -726-3 769 Inspectiou Liue
Plan nine Review
01/19/2010
I Plan Reviews I
OIlI9/20]0 APP DDK
Access restricted to one
driveway/lot. Follow street tree
piau.
Public Works Review
Structural Review
0]119/20]0
01/19/20]0
01/21120]0
OIl21/20]0
APP
APP
LKW
CJC
Storm water to curb via weep hole
As noted on plans '
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.
Rflrllirp:~lP,..tior'i.i
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
foundatiou inspection.
.,.""1
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to floor insulation or decking.
Floor Insulation: Prior to decking.
Shear Wall Nailiug: Before covering sheathiug with finish materials.
Framing Inspection: Prior to cover and after all rough in inspections have beeu approved.
'''all Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Drywall: Prior to taping.
Masonry:
Final Buildiug: After all required inspections have been requested and approved aud the huildiug is complete.
'I".
"
Perimeter Fouudation Drains: After gravel and filter cloth is installed but prior to backfill.
Underfloor Plumbiug: Prior to iusulation or decking.
~nderfloor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing,
Water Line: Prior to filling trench and including required testiug.
Sanitary Sewer Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench,
Final Plumbing: When all plumhing work is complete.
Paee 3 of 4
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'i~!
*..:;...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: COM2010-00068
ISSUED: 01/22/2010
AP.PLIED: 01/19/2010
EXPIRES: 07/22/2010
VALUE: $ 166,000.00
Underlioor Gas: After line is installed and required testing and capped if not attached to au appliance.
Rough Gas: After line is ius tailed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed aud line has been connected to a miuimum of one appliance including required
testiug. Presure test done at this point.
Underlioor Mechanical. Prior to insulation or decking and including required testiug.
Rough Mechauical: Prior to Cover
Final Gas: When all gas work is complete.
Final Mechanical: When all mechauical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
Rough Electric: Prior to Cover
Electric Service: Approval required prior to utility company euergizing service.
Fiual Electric: When all electrical work is complete.
By signature, I state and agree, that I have carefully examined the completed application aud do hereby certify that all
iuformation hereon is true and correct, and I further certify that any and all work performed shall be doue in accordauce with
the Ordinances of the City of Spriugfield 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 Commuuity 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 iuspections are requested at the proper time, that each address is readablc from thc
street, that the permit card is located at the front of the property, and the approved set of plaus will remain on the site at all
times during construction.
~OA+
Owner or Contractors Signature
'j- 01;;2 -/0 -
Date
~' ~:'
"
Paee 4 of 4
225 Firth StreeUSpringfield, OR 97477+PH(541)726-3753t FAX(541)726-3689
- I"'l:'::r;,:'-'."'~,'" "':~""'i;:--."~.',ii',.'j-,'-~(:~. ;/~:"". '.~'''I/t"'~,''';o.:o';;'~~.,'''' ~''''''' ';;:'''''''''~'':'l
~3i';J;'DE:~ARljMENtlUSE;0N8X~~
o;r-';,..;..t.:.,<......,..}" :-:.' ...ti,;h;>:,,""r"';~1'7~t~%-"'''~~~'
I pennitnod/~'=~i" "'1
I Date: )/ICf/IO I
Electrical Permit Application
D
,
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for ]80 days.
l~lijlll~lli~1'!ij[(;)~~1"~Q'.Z.EBNM~N[>if~gP.Rg)V:~~~~j '~~~:f.~ji~!r- '-~B.i;l\lJili!!J;'
I Zoning approval verified? DYes DNo I ~~~.. - - -:,i)W~Q~~~~i&o L~
I~' -l<l~'"'~' >"""'-E-'G' "O"R-v.ii!e-Cl'i"-0'N-'S' "'-R' 'j""'T.I"O'N'~'<:"'l\iJ' -'~I 'k..' .. ,,,,,,l,.~,.";f& ,-g;.,~'" ir:i'&?~~~<\ ~;~
. ,,,'" . .~~ '.' '~I::\ll\r " C ,_ ',Ifill ~ ~~ '.,. lr!, ~~~It. > ,: .' :n~M~<:U I -.
..~c<J:. ..or ~-'--~-'----- ~- ,_. _._~. ...---~._..~~ ""---.-"---., '" '.~"""",. Residential, per unit, service include'd: I
_i~:~~.ir.a.l._. _.~_. ,L.[] ?o;enl1I1.",~~"t,.,'_)._c::J c...?mm._,. :~. ~a,l,,~ I 11000 sq, ft, Dr less (4) ',' $134,00 $ /""/1
_I' Job s;t~~:::::I::I~~~R:;:tf~;a:NJ;J:<\IQQJ~'J1;;Jj'g)~j""'lf!;;~!!i I i~~~:fditional 500 sq ft, or portion , $ 2500 $;) I
I City:sy".,~-C'\,,.lot I State: oR I ZIP: '17'1'78' I I Limited energy (2) $ 32,00 $ I
I.SUb,di~~si,on: };Irs~~~~E~W~I:.~ ~o::~~~~.. ,...1 I ~~~~I~~S~~~~~~~ fe~~:r (~)odular $ 53.00 $ I
-I~ ~-_./'."~-." .__'__.il..., -R-~'lii!~~11 I Services Dr ,reeders: installation, alteration, relocation I
n~_ lA)J'C""_ f~""'D .
""""""', .,"""""..~.L""".<"""""" "', OR<o'nE' ~R"'="'''0-'W-'N'E'R'''''~M:''';H~.,,*, . ",...-.y..-.J!11 'II 220001 amto 4Posooam' lepsss ((22)) $ 81,00 $ II
~sr~~~~~,,-~'.5i__-~-,-~I~_.__'_-"---,-_==~~.>';;.'A~Ja.~~""'~~::~;ffC: . $ 95.00 $
I Name: l-l.'I'd",,- Kevv--t' <;, I I 401 to 600 amps (2) $158,00 $ I
I Address: :;t.;CG( <'I-J h("'cler I 1601 to 1,000 amps (2) $205,00 $ I
I City: r< <>ol vV!cvt vi I State: 6 Q I ZIP: 'i'775"G, I lOver 1,000 amps Dr volts (2) $469,00 $ I
I Phone: 5LII- 218- '::'')::>5" . I Fax:S?'/I-?'!I- .;;>5-;'7 ' I Reconnect only (2) $ 63,00 $ I
I_E-mail:' . I Temporary services or feeders: installation, alteration, relocation .j
This installation is being made on residential or farm property I 200 amps or less (2) $ 63,00 r{p"7 I
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, excbange, lease, or rent. OAR I '
479,540(1) and 47~.560(1), 401 to 600 amps (2) $126,00 $ I
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above I
l~e~NJt~:GjtL€iR1Uil~IfrJX.~-(ilXl1IQ:t)j~~~.t~1}~~1 [Branch circuits: new, alteration, extension per panel [
I Business name: "To'r \\lith F I pC I I a, Fee for branch circuits with purchase ofa service Dr feeder ree: I
I Address: .-JOIS A (OV("'1 (t-, I I Each branch circuit I I $ 6,00 I $
I City: &,,01 I S~ate: 6R I ZIP: I I b, Feeforbranch circuits without purchase ofaservice or feeder fee:
I Phone:::l\i -311-/911:' I Fax: I I First branch circuit (2) I $ 55,00 I $
I E-mail: I I Each additional branch circuit I $ 6,00 I $
I CCB license no.: 1Y- 3fOC [BCD license no.: {:l2r1. [[ Miscellaneous fees: service or feeder not included
I Signing supervisor's license no,: '--/ ~ 54 ~<S I I Each pump or irrigation circle (2)' $ 63,00 $
I Print name of signing supervisor: \f ~ \ s+...'l ,,--\<.l~ I I Each sign or outline lighting (2) $ 63,00 $' I
',I Signature of signing supervisor: \. n, IJ" 0 0-1- ., /I /lhl I Signal circuit Dr a limited-energy panel, I $ 63,00 $ I
1. ~"""\( ~ ~\ alteratIOn, or extensIOn (2)
I Each additional inspection: (I) I $58,00 $ I
~~JL~figwi.€~'Nff.ltli!~!;~~~~~~'il1
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (,12 x [A))
I (C) Technology Fee (5% of[A))
I TOTAL fees and surcharges (A through C):
I
~~
C\:~
~~;Q
\W ~
~~
$L'L...,t..-
$ 7!,,":.!.1
$ "1./ ..,
$ 2 5 ~ 1'r1
440-2584.J(9108ICCJI<Q
StruI ~ Permit Application
--
225 Fifth Street. Springfield, OR 97477. PH(541)726.3753. FAX(54 1)726-3689
DEPARTMENT USE;: ONLY
SPRINGFIEL.D !.:a:;;';'~:1'.>
~. .~ 1, . .~~ ;', .J:rfi'w~;~
'''''''.. iU>.el.fMi.__~".~<v":;;
fe,,'''''''''' to p,,"-
~~-,~~ ..'-..,
i~i~:.:.. . 1 .~
permitno{!11J - ~f
This permit is issued 'under OAR 9]8-460-0030, Permits expire if work is not started within 118~:t:yS 1:'U:~~~fwork is
suspended for 180 days.
I ,- ., ,-, ,,;);,~6CAL:i:i9Y~B~MEN't.t-M;iJ{RQ:V~~'<,;,:h~;\'i~~:1
I ~~~~~~o:eect has final land.useapprovaL Date ] I':",::;:/:'F.~E (SCH'EpiJLE:')":'';' ." I
I ~~:~~~;e~ct has DEQ approvaL Date I :'i~')~:;ti~:~;~:i:~J'iITl~tiQil);'iiijj)j'1;,,y0i;;;::ii,,)~i;::n:Ji~~:ii/?:",:~J;;'r?:'1
\ Zoning approval verified: DYes 0 No I I" Occupancy
I Property is within flood plain: Dyes D No I I Construction type: -
Iwlii.~,;t'2;<1i(Jg:Atgi;;Q~Y,'\1,9~\i(;,0@)T@(;Ij9~~B;-;.U;;;~);:,J:;;,;;21 i Square feet 1031 - 400 6<......,.:.
11}~..R".,e..,...:i~e2".:i'~.'~';1." ,_ .' !c.!.~~~,.~.~_m."',~."~._~c""._''',','_'''''',L,..g,,~~..o.,~,.~..::~.~~]."..,,; ""'.' II 1 Cost per square foot:
t.'ii',)~;;'::';;!('l:JQB~'_SI;rE!: INfc0,R,IVIAT-IQN-'fAN[J:~l(o.C:;A'TIP~F;,,!c:;i"}/: I Other information:
I Job site address: ,~7 'I." 1\11 ,Y<L I I Type or Heat: h
I City:. )~r,' ",fi~/d I State: OR I ZIP: 97'f7S'- II Encrgy Path: "'" <,
I SubdivISion: ;b.p", I Lot no.: ,JS<t I I IV1 D r9-A.
I I 0 ..... .."..l. lAJ new alteratlon
I Reference: Taxlot:/& '2- tJJ)) 'i ~ I . ,
I . -,,' .' - I (b) FoundatIOn-only permit?
.,., p,R0PER'TY' OWNER>,- ' .
4.;,1"""
,
,<I.J f.:/aroyr,
I State: OQ
Fax: -
$
This installatlb'on iSfbeing maddcon ~esidlentialdor farm proPrerty lowned by I (d) Enter 12% surcharge (12 x [2a+2b+2c]): $/10 ~
me or a mem er 0 my lmme _ late laml y, an IS exempt rom Icenstng
requirements under ORS 7010 I O. 1_ (e!,S~.btot~~,o,ff~~s~~~v~~2a~h~,~u~~,2~):w ,_ .., ~., . , '
Signhcre: ~ ~//t.- ,'..,., _ l~;~;P:I:~:~;~~~~~~';'~::~~f=~~:;:~~r~~:~~T~~~.~~R~t~~
I', ,__, '" :.', CONTRACIOR,I~~':6,h_ATIONi'"":,,,:,-, 'I )1"1"'" r; /,'
1 I (b) Fire and life safety (40% x permit fee [2a]): $
I Business name: J.k. t~'^ IIrHvv c::.. I (c) Subtotal of fees above (3a and 3b): $ I
" Address: ,;!JIf.q 5"", ..4/a'''I''r. I II 1:;4)MisEeli~rieoiis'f€es:i';~~!1~~Fjj~7l;;~};:M:'!'i"5,~';,1
I ~~t~ne~~:~=~~ ~:e;:I~~I_.2:~~"(.1 1'(~)S~~;~i~~~~:;;~(~I':'~:~it;~: r;a))- ".; .' ""1
I E-mail: I I TOTAL fces and surcharges (2e+3c+4a), $ iLl 1(/ ~
I CCB license no" "f.:Jd. of? I
I Print name: I
I Signature: I
D addition
DYes
DNo
lii(\::!,!t~;!;:!??li;:fi:;SlJ~:~0NJjRA~:t!9RINF,O,fir-ilA;j;IQN~k'!,;ii'!i!-l;~~;21V'1
I Name I CCB License Number Phone Number II
I Electrical !7.J)w,
I Ptumbing I 3i 7/{7 II
I Mechanical 3'i;). 37
e~ willamalane
'~ Park andRecreation District'
Job. No. {!JIJ - (,JA
, '
. '
- .----- .......-. ...... .".. -, -~ --- .- ,-----. -_.~~ ----- ._--_.~-_.. -. - ..- - ----~_. .---." - -----------
SYSTEM DEVELOPMENT CHARGE WORKSHEET
January 1-June 30, 2010
NAME: H-^"I.DE:l-.'~OMe:~' . PHONE: 9t1-;).z.F- ~7~~
ADDREss:.iY~l/t;l,JI;LI0a CITY~"""......b ' STATE:8L iIP:.,q7?r~-
LOCATION OF PROPOSED BUILDING SITE:
Street Address:
)71 5" fVl reVl
,. -;
Tax'~ot Numbe~: !fo~ 'j'jj3J1UB
Plat Name:
, 1. DEVELOPMENT TYPE. (Check appropriatedwellirig(s), Dwelling type definitions are on the
back,) , '
, '
,A. Sinale-Familv Detached
NO. OF UNITS
/ X $2,858 per unit =
$ 2& S-r '
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 Accessorv Dwellina Unit
NO: OF UNITS'
X$1,550per unit'= '
$ , ' 'cO'
$ ~fF2/~,
$- g'
WILLAMALANE SDC
, , '
2. 'SDC CREDIT (If applicable) SDC payer must furnish proof of
, Willamalane Credtt approval.)
---... ,..-- - .-.-
., -.- ,.
"
, 3li;tA,~:~l~:..~E-tSD"AS~ESSEO .'. ..~.-; ..:z.g nf
()~4~
Development'Services'Department
City of Springfield "
/i~ )0
DateJ~W
5
~r~':'I"G,'.'..,BU>..."""'" .;.....,..
-8 .
. .
:ab;=.~" ;
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'.._-"",..~--"'.'-
City of Springfield Official Receipt
Development Services Department
Public Works Department
225 Fifth Street
Springfield, Oregon 97477
541-726-3159 Phone
Job/Journal Number
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM2010-00068
COM20] 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0.00068
COM20 I 0.00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20]0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
COM20 I 0-00068
Payments:
Type of Payment
CreditCard
cReccintl
RECEIPT #:
1201000000000000067
8:52:21AM
Date: 01/2212010
Description
Plan Review Same As
Building Penn it
Addressing Assignment
Willamalane Single Family
2 Baths One or Two Family
I st Appliance
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
Temp Power 200 amps or less
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Fire SF Fee - Residential
+ ]2% State Surcharge
Plan Review Major - Planning
PW Disc - 2nd Penn it
Curbcut Pennit
Sidewalk Pennit
Stonn Drainage Impervious Area,
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Tran Reimburs-Residential
SDC Trans Improvement-Resident
Credit - Trans Improv SDC
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Transportation Admin
SDC Sanitary/Stonn Admin
SDC MWMC Compliance Charge
+ 5% Technology Fee
Amount Due
250,00
977.37
38,00
2,858,00
337,00
79,00
27,00
9,00
13,00
9,00
7,00
63,00
134,00
25,00
71.55
201.64
2] 1.00
(30,00)
88,00
88,00
697,83
666,84
507,07
211.21
931.65
(931.65)
101.97
1,333,57
10,00
18,00
159,56
22,63
101.87
$9,287,11
I'
Paid By
HA YDEN HOMES
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
DJB 031066 In Person
Payment Total:
$9,287,11
$9,287.] I
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