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Home My WebLink AboutPermit Building 2005-12-23 e- . CITY OF ~rKll'\j\..d'lELD . Building/Combination Permit PERMIT NO: COM2005-01630 ISSUED: 12/23/2005 APPLIED: 11/22/2005 EXPIRES: 06/23/2006 VALUE: $ 29,820.00 Status Issued : 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1243 PIEDMONT ST . ASSESSOR'S PARCEL NO.: 1703264114700 Owner: Address: HARPER GERALD L & MICHELLE M 1243 PIEDMONT ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK:,~!rg!e,Faniily Residence , ':, "','.' fCl, n Utili\,! - 'nn 0'C(10" th ^- TYPE OF USE:'" Reinode\.t lor" Residential r< , . - \es Cl'O;;;...'"' Il' 'n\JI. -\\1~ser\0f\R952-001- ~.' 0" --:-" "r\iO throug ,.ho ,,,Ies by ir. c.', ''{~~-l~~'i obtain Nco~PhO~e\NuniJ)'CF:e 541-741-7570 OOS:1.. l.l tDe cer\ter. \ 0 u,\;\y- NotilicatiOn calling Oregon \ \ ) .. .~hp.r lor the ,nnn_~32-2344. Cefil\:H I.... . I CONTRACTOR INFORMATION I PROJECT DESCRIPTION: Garage Conversion Contractor Type General Electrical Mechanical . Plumbing Contractor OWNER OWNER OWNER OWNER License Expiration Date Phone VB BUILDING INFORMATION' # ofStories:uf1CE: Lot Size: Height of ~ir.Ysti'(eRMIT SHALL EXPI~ ji r.JtI~IWP:RK Type of H~~THORIZED~f\llTHI9>ij~~lliI i&MGlT Water TYI1~DMMENCED ~~"f5~j:\BA~m~@lVlt: ' Range Typ :NY 160 DAY EI.'lS\nFl. Sq Ft Garage/Carport Energy Pa . · 'I'~ Ii' Sq Ft Other: Sprinkled Building: n/a Occupant Load: . # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 , DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: , Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved No Sidewalk Type: DownspoutslDrains: Setback 5' Curb and Gutter Notes: No SDC fee interior remodel only no new fixtures 11/23/2005 CAS Pal!e 1 00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Description Tvpe of Construction Garaee Conver. Garaee Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Miscellaneous Plumbing Perm ServlFdr 200 amps or less Total Amount Paid . . CITY OF SPRINGFIELD" Building/Combination Permi( PERMIT NO: COM2005-01630 ISSUED: 12/23/2005 APPLIED: 11/22/2005 EXPIRES: 06/23/2006 VALUE: $ 29,820.00 I Valuation Descriotion I $ Per Sq Ft or multiplier $71.00 Square Footage or Bid Amount 420.00 Value Date Calculated Total Value of Project $29,820.00 $29,820.00 11/22/2005 Fpp<, PllilLI Amount Paid Date Paid Receipt Number 2200500000000001608 2200500000000001739 2200500000000001739 2200500000000001739 2200500000000001739 2200500000000001739 2200500000000001739 2200500000000001739 $164.87 $41.97 $29.38 $43.00 $15.00 $253.65 545.00 $63.00 11/22/05 12/23/05 12/23/05 12/23/05 12/23/05 12/23/05 12/23/05 12123/05 $655.87 I Plan Reviews I Initial Review 11/23/2005 11/23/2005 APP LLH Plannine Review 11/23/2005 12/14/2005 APP TAJ No Planning issues. : Public Works Review 11/23/2005 11/23/2005 APP CAS No SDC fee Interior remodel only no new fixtures 11/23/2005 CAS Structural Review 11/23/2005 12/21/2005 APP DLM See documents for plan review comments. To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. IRp~ FoundatIon: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after aD rough in inspections have been approved. WaD Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Paee 2 of3 . . CITY OF .,nur\jld'l~LD . Building/Combination Permit PERMIT NO: COM2005-01630 ISSUED: 12/23/2005 APPLIED: 11/22/2005 EXPIRES: 06/23/2006 VALUE: $ 29,820.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Building: After all required inspections have been requested and approved and the building is complete. Final Plumbing: When all plumbing work is complete. 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 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 Springfield 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. ~~ ~~ (J.-f~~los Owner or Contractors Signature Date Pal!e 3 of3 , :'~~L0'=>~"~"'~ .' 'r e' 225 FIFTH STREET 0 SPRINGFIELD, OR 97477 . PH:(~41)726-3753 0 FAX: (541)726-3689 ~r~\rt~' -~~.:' .:;~ ELECTRICAL PERMIT APPLICATION ~- ' . , "". City Job Number c..1"-OItt. T'!) Dale "/rll/l>"i "~' ",.,. Y"i"'_";~''''~"l''''''''''' ~'-""""''''~~''''-'.J'''''~-'''--''''''.~ A. :.,f' ~1~'_,~,~s~d~~ ~~~~7.2l~~~~~ Q;r. ~'~.?lt~~ F.~~~}.!{~ei ;~f~~ -~~~.~~Y~J. I M1'r#,I',6\H/ 3.v:I !;'\tnJ - J Service Included Vol~ Ul p", 1'- ATooO~JJ.lftl~Jr Rif-,gon law requires y~,~,,~. $106.00 lttM to 'StILI rI'~OE"~'" '''il' g orlIG5-00~rl Ofl" the Or(,,;v,, v,..", Pt~ !~ Ben au ItlOna '59.. or NO'pbflidh:m.f'e<lf,ter. Tnose ruleS are set fort~ 19.00 in 0<\8 952.001;0010 through 0,.\1, ,,:'<'-001- Eac~anuTact d Home or. f th les by OO'M" I d "\" D~avlloo1:S~,lI CuRies 0 e ru . 0 ar we mg ervlce or I I h <F~ijeQ the cemer. (Note: t 1e te eo one $50.00 nUJ]}9f?';' 'P(~tw, 9~!(,2.9D'!;!:~~'~~i-':~&g~.$~,?:,2"i ;1""1";.,,-\".' ,': ':(:~ B. :Ser\'iS~:R~~~deoCQiDstall2tion)AlteratlOns or RelocatIOn::,:' ' -i.l.-. z-:..',.w.....';."...-".. _,,;,;,,.;;_~-::",",,,h1.ir"';"-:--I:':;;f,;,V... ,fi,; .l.',;-.:l":i,..'.. ~ .l'..~.2."_'.i~....,:.,.~'. ,,;:~.;~, 1- I. :'~ocA'riO~(JF nVSTALLA110N,\.~:\.: . "." _~ .' ...... ,'~ _... . ".. ., l.,"',,<, . ,. . <.. '.. .-.:\~ ,,,. ... Ii.. IJII1, IlUln,{(l,,:J-oJl- ~Iw LEGAL DESCRIPTION to/- 'J'l/ 131 DcJt:. ~ JOB DESCRIPTION ~1.IfI- Ct\I. vG-~....\'V\ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. :.. .... ~ ...(....,,~"~.:~.o;: ">~i;t.. '.1.-<., ,', ~"{':~.' ,.~,..:t~;.' ..~ . 'coN'niAcroR INS7'ALLA'fJON dNLY . ~".~':..\,I.'.::_""i~.'-~':;';",-'''::'':~e~: ;~;"",.:.:...l..':".", .:....~t.:.ld_;...-~~!>.~,~_. I' ". .," ,..," ...._~..~..r~ ......" ........~ ........':';'-..<......'~_.\'.~'.'I.......:"..,~.;'" 3.; CO~f1~;~qIf,1.'Ef;,~C;!!.EBPf~!!E~.91':':;~;::i:s~\f;(\~~~:::1i! / 200 Amps or less ~I/.d;tl4Pl!t- -- $ 63.00 u:> " .DI) / 20 I Amps to 400 Amps $ 75.00 Address / 40 I Amps to 600 Amps $125.00 ~ 601 Amps to 1000 Amps $163.00 City Phone Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 NO !ltion, Alteration or Relocation T . .pr.Jess $ 50,00 A~I 10'l!\'MIJ"\,,fJ<PIRE IF THE WOR1(69.00 "", ~~Y'rJ.i1i=I~~;;J:'3~,,; ~:': " New Alteration or Extension Per Panel One Circuit ~ $ 43.00 ~ Each Additional Circuit or with -...", It?"'" t!Jl,~ Service or Feeder Pennil (g./.:> $ 3.00 .Y> r 0 Expiration Date Owners Name YJtt,cJ1dlt"_ ~Vpc:V Address l2,L/ Q f\ eA rVlt5Yl t J (- City StIXld Phone 1L/ 17StO I OWNER INSTALLATION )(; The installation i"s being made on property I own which is not intended for sale, lease or rent. Owners Signature: ~~fttlt~'" kA / Inspection ReqUest~~6W: ~ r;c '1.~:'b:'~ ~,ff.~ -'V',~ '.,",>:-:;'-<l'~. ,~~'.....':.J'......':~:'"":r-:\1r1'C'~~-n-~.n: ...~.~.;~,--'~ C. i: Te~iporar)' Ser5;ices. pi, F~eders'-~.i:~,~~ ~~~~\,~,~:~ ~~ft~',~i.~ ,~..!:~~~j..~: :1,'2 .... ~ .._::.;:_ .J__.__.._~.~..\-_. i.>.l,/.,J, .r}.r.,__~"""'" - - ..,..:.:..._,.J..,,1;,.,__l , '. . ',":..;, '. " '.n''; ~.:; "~'..;y.-,' ,.' ~..~ ',,~'.~"I.":"i.;",.~.;' -, -:. ".... .....".:.;\~ -.. ....'..' ,..'.' '.-'.' E. ,Miscellaneuus (Ser\'iet!/feed.r,notiiiduded)'':Each Installation" ::.'''~,~_ :..w- ..._....;..-...~:.....~.;.~,,'\_-;""'.'.w""....;...--"" .~ '., ~ ,".,f... ,,-.. Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 l\tlinimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ',: S,!UBTO,TA.L O.FiB"oiiE:';1~~.'.:)d':j,?Q~ . ._. .'.,~___~,'." .'..-~. _........<''""'~. ./~~Jr . . 7% State Su'rcharge 817. 10% Administrative Fee -/ .L2 I ~r\ ) TOTAL l7?-/,5;~ Shart:d Drivt:(T:)/Building Fonns/Elt:ctrical Penllit Application I.OJ.doc . CITY OF StIINGFIELD SYSTEMS DEVELOPMEAORKSHEET JOURNAL OR JOB NUMBER: COM2005-01630 NAME OR COMPANY: Michelle Hamer LOCATION: 1243 Piedmont TAX LOT NUMBER: 1703264114700 DEVELOPMENT TYPE: SINGLE F AMIL Y RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF: 0 LOT SIZE (SF): L STORM DRAINAGE ,. o DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I I 0.00 I $0.323 = I $0.00 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I 0.00 I I $0.323 I 50% ~ I ITEM I TOTAL - STORM DRAINAGE SDC $0.00 ~ 2, SANITARY SEWER - r.tTY DISCOUNT $0.00 SO.OO A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 0 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 0 I COST PER DFU S25.07 $0.00 S19.07 SO.OO ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $0.00 3, TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRlP RATE I x I NUMBER OF UNITS I x I COST PER TRlP x INEW TRJP FACTORI I 9.57 I I 0 I I $19.09 I LOO I B. IMPROVEMENT COST: I ADTTRJP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRJP FACTORI 9.57 , I 0 I I $84.19 I LOO I ITEM 3 TOTAL - TRANSPORT A nON SDC = , SO.OO 'I Ig,j 10 18 I~ I!=: ,c/) C3 ~ 11070 -, 11091 1092 SO.OO 11093 I SO.OO 11094 4, SANITARY SEWER - MWMr: A. REIMBURSEMENT COST: INUMBER OF FEU's I x o I B. IMPROVEMENT COST: INUMBER OF FEU's I x I 0 I ICOST PER FEU I $82.03 = SO.OO ICOST PER FEU I $865.31 = $0.00 SO.OO SO.OO MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE \ ITEM 4 TOTAL - MWMC SANITARY SEWER SDC .L \ SUBTOTAL (ADD ITEMS 1,2,3, & 4) I ~ )C ADMINISTRATIVE FEE: ~SUBTOTAL I x I ADM. FEE RATE , SO.OO I I 5% T'TAL SANITARY ADMINISTRATION FEE: TJTAL TRANSPORTATION ADMINISTRATION FEE: \ Cl')eryl Slaymaker 11/23/2005 PREPARED BY OATE I = I $0.00 = I SO.OO I~ CHARGE I $0.00 . I #DlV10! #DlV 10! =, TOTAL SDC CHARGES $0.00 \ 11054 I 1055 1054 11056 I 1079 1078 . . , DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE 1 NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAlNAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 0 0 3 = 0 IDRlNKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER I MOP SINK 0 0 3 = 0 ICLOTHESWASHER - 3 OR MORE (EM 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRlG I WATER STATION I ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK I DISHWASHER I ETC. 0 0 3 = 0 I SHOWER, SINGLE STALL 0 0 2 = 0 SHOWER, GANG (NUMBER OF HEADS). 0 0 2 = 0 SINK: COMMERCIAURESIDENTIAL KITCHEN 0 0 3 = 0 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 SINK: SINGLE LA V ATORY/RESIDENTIAL BAR 0 0 1 = 0 URlNAL. STALL I WALL 0 0 5 = 0 TOILET. PUBLIC INSTALLATION 0 0 6 = 0 ITOILET. PRIVATE INSTALLATION 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 .EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwellin~ unit (20 DFlTs) set at 167 ~Ions ocr day L I I I I I I I I I I I I I I I I I I MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RAIDS I ,000 ASSESSED V AWE $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4,63 $4.40 $4.07 $3.67 ' $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1,25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0,05 IS LAND ELGIBLE FOR ANNEXA nON CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE SO.OO x S5.29 ~ , SO.OO CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE 11000 CREDIT RATE SO.OO x $5.29 o TOTAL MWMC CREDIT = so. 00 . , Construction Contractors Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us . ' Pennit#: I' ~M& ,1 -6)/~30 Address: J ~ pJJl!il),N(NJ./ Issued b/}.-.!DY/nct() Date/;y';23/';>6/)5 -. . . . . . . ", ,,' '. .,' Statement: Information Notice to Property Owners About Construction Responsibilities \ Note: Oregon Law, ORS 701.055(4) requires residential constroction permit applicants who are not licensed with the Constroction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: J8l1. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR X 3B. I will be my own general contractor. . If I hire subcontractors, I will hire only subcontractors .licerlsed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~~a~o~ (~/:;;jdS- cDate) (White copy to issuing agency permit file, pink copy to applicant.) r-o-- ....n... . . . '. A<t\rui~?) fi~Jtf'()WllIl <GlellIllerr~n CC@llIl~rr~~~@rr? \~'t.......~'1~'lVjA~'oTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . " NOTE: This Informalion Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. JEmmjplloyer Re!JjpoIl1l!Jftlhftllft[ie!J You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor, in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. '-- Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpo~s~." on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. "-."" The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding .i1od " Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.usIformsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wag;;:~ You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call fue .... IRS at 1-800-829-4933 or visit their web site'at www.irs.l!ov. OtllneJr lResjpo1lllsBIbiJillJitJies al!lll[ll Areas olf COIl1lceJrIl1l!J Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremcnts that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the :l.pp.vp.;ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner.doc 06-01-04 I \ . 225 Fjfth Street , . . Springfield, Oregon 97477 541~726-3759 Phone Job/Journal Number COM2005-01630 COM2005-0 1630 COM2005-01630 COM2005-0 1630 COM2005-0 1630 COM2005-0 1630 COM2005-0 1630 . ~ aity of Springfield Official Receipt _evelopment Services Department Public Works Department RECEIPT #: 2200500000000001739 Date: 12/23/2005 9:36:32AM Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Miscellaneous Plumbing Perm ServlFdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Amount Due 43.00 15.00 253.65 45.00 63.00 29.38 41.97 $491.00 Item Total: Check Number Authorization Received By Batcb Number Number How Received Payments: Type of Payment Paid By Check o :r :' ;. 'C :. ... :. 'C 12/23/2005 Amount Paid GERALD & MICHELLE HARPER njm 6254 In Person $491.00 Payment Total: $491.00 Page 10f1