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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 _~'...R...",.~~...~.~J,E. '..L .iii.,".,.. ..,...[1.' "'~ i' .__. .,~f ,I, 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 _....P.R~:OI':~~ '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;=.~" ; ~~<" '.._-"",..~--"'.'- 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 Page I of I 1/22/20 I 0