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Home My WebLink AboutPermit Building 2010-1-27 i , CITY OF SPRINGFIELD Building/Combination Permit 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2010-00098 ISSUED: 01/2712010 APPLIED: 01/25/2010 EXPIRES: 07/2712010 VALUE: $ 164,000.00 Status Issued SITE ADDRESS: 5761 MICA ST ASSESSOR'S PARCEL NO.: 1802033303700 SPR[NGF[ETYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCR[PTION: Single family residence - same as com2009-0175~ 5781 Mica Owner: Address: HA YDEN HOMES LLC ATTENTION: Oregon law requires to 2464 SW GLAC[ER PL 1tvIloWll'ulesadopted by the Orego::, REDMOND OR 756 ~OJ!~~a!i~!; 9.ent,er. Those rulesare set fo~ - -~- ";VI uVlvlInuuynUANtI:)2-o01. 0090. Ycr:ccm~T&RI~JilVIR8IRIIIQV1 cal/lngr". V\l!., Vt.L!IIMlc\"U,JFiI' number for the Oregon Utility Notifi..........- , Con, actor Center is 1-800-332- 'J~!6lI~e HA' .lIEN ENTERPR[SES 2344). 92208 , TOI-;WTCH ELECTR[C [NC 172366 PAClF[C AIR COMFORT [NC.c, 39237 STUTZMAN SERVICESINC.,'.'c,,:, ..,,,,_~,._31747 Contractor Type General Electrical Mechanical Plumhing # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: BUILDING INFORMATION I Nmr1CE ,.. # of Stories: , , 1 'id: Height or sir~~;u~~": "." [6.50 THIStPERMIT SI1IYP~ <ill4IP~1iitE IF TIfKi.wtl~, Gas AUmJRIZED Uf'MJl!:~r~f'ERMIT IS NOT Gas COMMENCED Ojlit'SI!ABAflIDONED FOR Electric ANY f80 DAY p~tJW Path: .' .......,.-: 'Sp'rn'il<led Building: " "No I DEVELOPMENT [NFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: [8.00 5.00 9.10 24,00 0.00 I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Residential Expiration Date 07/29/2011 09/29/2010 03/25/2010 05/[2/2010 Phone 541-228-6935 541-317-[998 541-672-9510 541-928-8942 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 1.031 400 REQUIRED PARK[NG' I Yes 31.70 Total: Handicapped: \ Compact: \ \ \ I \ 2 Fully Improved Yes Storm water to curb via w,eep hole Sidewalk Type: Downspout~/Drains: Curbside 7' Curb and Gutter Notes: Page 1 of 4 .';'...". " Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description TVDe of Construction . '~ Fee Oes'cription + 12% State Surcharge + 5% Technology Fee 1st Appliance 2 Baths One or Two Family Addressing Assignment Appliance Vent Building Permit Credit- Trans Improv SDC Curbcut Permit Dryer Vent Exhanst Hoods Fire SF Fee _ Residential Gas Outlets 1-4 Plan Review Majoi' - Planning Plan Review Same As PW Disc - 2nd Permit Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 'Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Compliance Charge SDC MWMC Improvement SDC MWMC Reimbursement 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 Amonnt Paid . ';-L ;z;., ~', I Valuation Oescriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Fpp, 'Pqirl I Amount Paid Date Paid $198.51 $100.56 $79.00 $337.00 $38,00 $9.00 $969.23 $-931.65 $88.00 $9.00, $13.00 ' $71.55 $7.00 $211.00 $250,00 $-30.00 $134.00 $25.00, ' $507.07' ';'7' '''', I" r' $666.84 "0,' ',,' $10.00 $22.63 ' $1,333,57 $101.97 $162.76 $211.21 $931.65 . $i7,80 $88.00 $757.84 . $63.00 $9.00 $2,858.00 ' 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 .1/27/10 1/27/10 1/27/10 1/27/10 1/27/1 0 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 $9,319.54 Paee 2 of 4 CITY OF SPRINGFIELD ~ Building/Combination Permit PERMIT NO: COM20IO-00098 ISSUED: 01/27/2010 APPLIED: 01/25/2010 EXPIRES: 07/2712010 VALUE: $ 164,000.00 Value Date Calculated Receipt Number 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 2201000000000000077 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued ,.ii. . PERMIT NO: COM2010-00098 ISSUED: 01127/2010 APPLIED: 0112512010 EXPIRES: 07/27/2010 VALUE: $ 164,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Plan Reviews , Initial Review 01/26/2010 01/26/2010 DON DJB Plannin2 Review 01/26/2010 01/26/2010 APP DDK Access restricted to 1 driveway/lot. Follow street tree plan. Puhlic Works Review 01/26/2010 0\126/2010 APP LKW Storm water to curb via weep hole Structural Review 01/26/2010 01/26/2010 APP CJC 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.' . I, Rr~lrPrlln<nections I Erosion/Grading Inspection: Prior to ground (jisturb~nce and after erosion measures are installed. . Sidewalk - Curhside: After forms are erected hut prior to placement of concrete. Curhcut - Standard: After forms are erected but prior to placement of concrete. Ufer Electrical Ground: Install ground rod at footing and callfor 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 11001' 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, Drywall: Prior to taping. Masonry: ,",~.!>l, ; ~,;;. . Final Building: After all required inspections have' b~J,n requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and liIter cloth is installed but prior to backfill, Underlloor Plumbing: Prior to insulation or decking, Underlloor Drain: Prior to cover or placement of concrete, Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to lilling trench and including required testing, Sanitary Sewer Line: Prior to 1iIling trench and including required testing. Pa2e 3 of 4 " , CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2010-00098 ISSUED: 01/27/2010 APPLIED: 01/25/2010 EXPIRES: 07/27/2010 VALUE: $ 164,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726,3769 Inspection Line ";' Storm Sewer Line: Prior to filling trench, !". Final Plumbing: When all plumbing work is,complete, Underfioor Mechanical. Prior to insulation 0'1' decking and including required testing. Underfioor Gas: After line is installed, and required testing and capped if not attached to an appliance. 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 including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. FiualMechanical: When all mechanical 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 energizing service. Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully ex~mined 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 fro~l the street, that the permit card is located at the front of the property, and the appr9ved set of plans will remain on the site at all times during construction. ~~~~ O",ner o~ Co~tractors Signat&' /-d6-~/O Date ,~ , , ..~ i~ ;, Paee 4 01'4 - . . Electrical Permit Application. .' 225 Fifth St;eettSpringfield, OR'97477+PH(541)726,3753+ FAX(541)726,3689 'lit'~r~'B~ji~B],ti~~lr!~mJI"~ l<ie~t~900 9 %'1 I Date: /- Z ~ - 10 I This permit is issued under OAR 918-309-0000. Permits are noutransferable. Permits expire if work is not started within 180 days of issuance or if work is suspe)lded for 180 days. 'f1M~1'i!0e)l[~"!"C30""ERNJiiiENilt1P;EgR0'V,' ,~"~~C l(f"",)__~". ,.. ,.,_Il:l.. .,_<, .-",..... _e<"JtL,.__.. '..." ,Ml'!!11t,~"MI,~1i!1 \~;~~;~~2~~~~&G1f.i~iN~~~~~i1Jjgri;'1tJ!WI,~~J .1 Residential, per unit, ser:;'c:included: I I 0:Residential I D Government I D Commercial I 1~1!)"Gl~j~~jm:8J:1jNi;Jil:RM~ml~1\l1lA'~t;>1i(]!Q:(\J~ill~N1!l!~j;~,\,~ '11,000 sq, ft, or less (4) I $134,00 $ I I Job site address: 57iC I '/l1 ,i-"-. I I ~~~~oafdditional 500 sq, ft, or portion $ 25,00 $ I I City:SY.."",~"...lol I State: oR. I ZIP: 97'178' I I Limited energy (2) $ 32,00 $ I 1~~~lri~~~f~W~~~~t~~i I ~~~71~~~~~~r~~ fe~~:r(~)odular $ 63,00 $ I I I '/: I I Ser-vices or feeders: installation"alteration, relocation I /-hu"'- W;J.-.- 7"'..,..... EI' ' I " I '1' 200 amps orless (2) $ 81,00 $ I 1~~"i\'f_'i!i}~BR].!ig~gi!it(~~w&.f'~W{!~~Si~f,'?~~;;'bf~W I 201 to 400 amps (2) $ 95,00 $ I I N \ I , Ir I I 40 I to 600 amps (2) $158,00 $ I ame: --'k'-/t<.tV\ r\CVv-o'" ". Address: :JL;Cr'./ 5w !'-.("",'Rr I I 601 to 1.000 amps (2) $205,00 $ I n I Cl77 1,1 Ove; 1,000 amps or volts (2) $469,00 $ I City: . K ",0{ v>1CVl vi State: 0 Q ZIP: , S'G, I I I I Reconnect only (2) $ 63,00 $ I Phone:5""-22~-c;,")-;'5' Fax:5Z/r-7'1I' .;1572. I E-mail: . 1 I Temporary services or feeders: installation, alteration. relocation .1 This installation is being made on residential or farm property 200 amps or less (2) J $ 63,00 $ I owned by me or a member of my immediate family, This 201 to 400 amps (2) $ 87,00 $ I property is not intended for sale, exchange, lease, tir rent. OAR I 479.540(1) and 479,560(1), I 401 to 600 amps (2) I $126,00 $ SignahIre: lOver 600 amps or 1,000 volts, see services or feeders 'section above " I 11I!1t$W~j1ilj1""',r0-'JIl"m;b'^~i?;r.""R""I~I'S':m' ""'$ii!'A'''"'I' '0'151' 'lli"""fli1J.t":~~,'ii;:;""1 I Branch circul'ts', new, alterat,'on, extensl'on per panel I ~~,Ii~.:W",,,!,,~~1-~, .., ,_!.L,~,2.\!ts:I.c_',-'fiiiI.~~__" J ,I;\CL::I;\'j:g._ ,,"",I~~~.;gr~',,~Ar.if, ' I Business name: 'To'r \\l,t(~ F I pC I I a. Fee for hranch circuits with purchase of a service or feeder fee: I I Address: ..JO<;S 70 (OVe<-f C t, I I Each hranch circuit I I $ 6,00 I $ I I City: & ,,011 I S~ate: oR I ZIP: : I I b, Fee for branch circuits without purchase of a service or feeder fee: I I Phone:S< Ii -311- /'11" I Fax: I I First hrancb circuit (2) $ 55,00 $ \, I E-mail: I I Each additional branch circuit $ 6.00 $ -I I CCB license no,: IV 3roc' I BCD license no,: (' .::>2rJ, I I Miscellaneous fees: service or feeder nofincluded I I Signing supervisor's license no,: 4 ().5"4 _<)' I I Eacb pump or irrigation circle (2) $ 63,00 $ I I Print name of signing supervisor: '\l U 1 51r1 ~(..e r I I Each sign or outline lighting (2) $ 63,00 $ I 'I Signature of sigriing supervisor: ~ ), II A'I_ fY1 nJ, I Signal circuit or a limited~energy panel, $ 63,0'0 $ I ' \ ~ .===--~..t:V"_.~ alteratIOn, or extensIOn (2) I Each additional inspection: (I) 'I $58,00 $ I 1&-!4''''W:~'iJr~'f'';Btli!!'~I'''J;''''N'''''",rrrS''E~''''~F,~.' "'~""""I lit'~J2\~~~tl~.!e,~.~~~,J.Ii:li~.~_",;;:_~~m~~l2:;j!~ (A) Enter subtotal of above fees (Minimum Permit Fee $58,00) I (B) Enter 12% surcharge (,12 x [AD I (C) Technology Fee (5% of [AD I TOTAL fees and surcharges (A through C): ~#?6-:'-O ~~~ ~\O Y;~Q- ~ $ $ $ $ 440,2584.J,(9/08/COM) !JA M. f AS. 5781 f\t1,cc.. C'H7S'{ Stru( , Permit Application ~~,'D"o;,.':.,d"">" . ,.~ .'" 225 Fifth Street. Springfield, OR 97477 . PH(54 1)726-3753 . FAX(541)726-3689 DEPARTMENT USE ONLY COM 2..0,0 - Pelmitno.: c>c>o9~ I Date: This permit is issued under OAR 918-460-0030. Permits expire if vmrk is not started \vithin 180,days of issuance or if work is suspended for 180 days, ',', :~OCALG6YER@ENTAP~R6:VAlii;f>' ":'/;:1 I I I I 1 I I I ::/:'1 I ~~::;~:f:::a:t~::ot I I Type of Heat: (-,c. "- II Energy Path: ()'A ' I I [Xl new 0 alteration ::\ I (b) Foundation-only permit? I Total valuation: I I ZIP~/7.,c., I I I I This project has final land-use approval. Signature: I This project has DEQ approval.. Signature: I Zoning approval ver[tied: I Property is within flood plain: Date: Date: DYes DYes DNo DNo I ~ Residential I 0 Go'vemment J 0 Commercial !i:i.>2\.':.i,iJQ~Y:$ITE:"iN#ORMATii:)N/ANp."~9dAI(QaU';itJ! Job site address: 5?C I JI1 ,,,... City. <;Dr"M.(.'~ld leState: OR I ZIP: 971(7... I .j I Subdivision:~~c>-r, I Lot no,: ,;2r?L./- I Reference 18oZ.D3~3 I Taxlol: 0370<:::' I ',PROPERTY OWNER I Name: lL;rI."" L~ < I Address: dq&q<;l,J '<!a~,,,,{. I City: R.c-d <MflnrA State: 0' Q I Phone: ~/I -.l2t" t;q '>5' Fax: I E"mail: This installation is being made on residential or farm property owned by me or a member army immediate family, and is exempt from licensing requirements under ORS 701.010. Sig"n here: -L ~tt/L I' ',' 'CONTRACJOR,I~Sl'ALLAIIQN:,:. I Business name: /-k ,[d,^ }-/o,......... <.. I Address. ,,})ffAq 5 w '/';f" ,r'/ ' I CitY R.::dMon.d. ,State: 6K_ I ZIP:'l7;>'>4 I Phone:5t/l'.:u<c-{,'1,"\~ Fax::J.Ih"il-..25';Q I E-mail: I CCB license no,: 1...:.J;J of? .1 Print name: I Signature: li::{.i,:r;,:'?NiHs(JE\'c;oNXR'Ac;IORiiNFORr<1j(!'tIQN';'Pi'i.:)K('i)i'Wf::' ! Name CCB License Number Phone Number I Electrical J7J)u, I Plumbing 3/7'1? , I Mechanical 3'1;) 37 . .' FEE;SCHEbUlE I:;i\;y~tlt~~((o-ffii~t o:-r.~'~,n9R: ';~;}N": ~::'\,.~-~<:.:_, I (a) Job description: I Occupancy I I I I I Construction type: Square feet: It) ~ / -f 'YO'O ~r"''''_ J o addition DYes DNo I I I. I (a) Permit 'fee (use valuation table): I (b) Investigative fee (equal to [2a]): I. (c) Reinspection ($ 'per hour): (number of hours x. fee per hour) I (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ I (e) Subtotal of fees above (2a through 2d): $ liJ~;;j:iH~:~~,t~yJ~:Wrt~:~*~1,~j!{~:k~'~i~~i;'f~:m:~:j~i.~~~il~iriifj~f~~~\!:~~~;~J{~Nf}~WJ.~:~ I (a) Plan review (6S% x permit fee [2a])::> IT> $ Z 5<::::> I (b) Fire and life safety (40% x permit fee [2a]): $ I I (c) Subtotal of fees above (3a and 3h): $ $ I $ $ (a) Seismic fee, ]% (,01 x permit fee [~a]): $ TOTAL fees and surdiarges'(2e+3c+4a): $ 2~willamalane ' 't-w, Park and Recreation District, "":,/. Job. No. ' 't:;()- 7; ',~ .. .. ',-, '-,- , SYSTEM DEVELOPME;NT CHARGEWDRKSHEET ". ", January1:June 30, 2010 , ~^~P~~,' ~~M~~' ."" PHdNE:9i,.I2.i.~'7.f.r NAME: ADDR~S$:2V~'1 'ii-JJ;uft.td CrrY~<!.Wb . 'sTATE:8L ZIP:..1.!7?r~ , ' LOCATIONOFPROPOSW'BUIL:DING SITE: ',Str~etAd~ress: ",' r-7h/ 1. ; " ...."~ .~~:: .. .. '; 4111)::;' .' ,".f .1.','---',' .,.-" Plat Name: . " . Tax Lot "iumbe~: / J(}~ J 33~1,)cJO , L DEVELOPMENT TYPE (Check appropriate.dwelling(s), Dwelling tYP,e,definitfons are on the back.)" " .' ' , , : ' ,. - . '..,.. A. Sinale-Familv Detached NO, OF UNITS ! 'X $2,858 per. u~it = , $,,2;; s-rr' B. Sinale-FamilvAttached, NO" OF,UNITS ' ,+ , X$3,100perunit = $ 'c. Multi-Famiiv' Aoartment '.NO. OF UNITS " ,x $2,641 per unit = '$ .' ". , D..,Sinale.RoomOccuoancv'" NO,OFLJNITS ...x~~, '~c?2.R~~,~n~ "';_~~~_______.._, . .. _ -- ..---.----.-.-. ...-...---.-. ...--.-"" -~-----------,-~ , . . --..---...._..,- ----'--,-----~----------------'._-_.- --~- -- -~ . . '- .' - , " ,E;",A.ccessorv 61ivellina Unit NO.:OFUNITS" . X $1,~50 perimit = . ' $ $' '-.", ;,. < WILLAMALANESDC , ,l, . . ~ ' ' 2. SDC CREDIT (If applicable) SDC payer mustfumish.proof of 'Willamalane C\edit approval.) $. . ~.-- "';: - -; 'c ,"'- -"-=---_ ,-:'~ ':_: ~~.-: ~_=~~:~~~.~_~~::~ "~-~'~'''-'~~~':' -~~=---" ." :" -- ~~:.-, ,~.. ", '::'~-'~~_' :":'c~~:-::,.;:.:--,~:.:",:~::'~::;:,~~~,~:": ': -,. . ,:' . ,-" '3. 'TOTALWILLAMALANE~NET'SD(YJi:SSESSED'~'''~'-''~c' ., .. , , '. '(ifsjjc're-d~ce(no~credit) ,-, . .', $ :2'i'.s:F _.. ..-.._~ ".._-~ ~< '-',-' . - " - - ~ ~"'" , , , -' " ,,- ' , . " ' . . " . . .' -.', , Development Services Department , City of Springfield '/ Date' l~ It! ,'f?('\ . '.!.... 5 225 Fifth Street Springfiefd, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM20 I 0,00098' COM20 I 0,00098 COM20 I 0,00098 COM20 I 0-00098 COM2010,00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0-00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0,00098 COM20 I 0,00098 COM20 I 0-00098 COM20 1 0-00098 COM20 I 0-00098. COM20 I 0-00098 COM20 I 0-00098 COM20 I 0-00098 . COM20 I 0-00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0,00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0-00098 COM20 I 0-00098 COM20 I 0,00098 COM20 I 0,00098 COM20 I 0,00098 Payments: Type of Payment Cred itCard cReceintl RECEIPT #: 2201000000000000077 Date: 01127/2010 Description Plan Review Major - Planning Curbcut Permit Sidewalk Pennit PW Disc - 2nd Permit Storm 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 M"':MC Improvement SDC MWMC Administration SDC Sanitary/Stonn Admin SDC MWMC Compliance Charge SDC Transportation Admin .. Plan Review Same As Building Pemlit 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 Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Fire SF Fee - Residential + 12% State Surcharge + 5% Technology Fee " r .'.' Item Total: Paid By TIM DREILING Check Number Authorization Received By Batch Number Number How Received cjc 056719 In Person Payment Total: Page I of I 8:29:27AM , Amount Due 211.00 88,00 88,00 (30,00) 757,84 666,84 507.07 211.21 931,65 (931.65) 101.97 1,333,57 10.00 162,76 22,63 17,80 250,00 969.23 38,00 2,858,00 337,00 79,00 9,00 9.00 13,00, 9,00 7,00 134.00 25,00 63.00 71.55 198,51, 100.56 $9,319.54 Amount Paid' .$9,319,54 $9,319,54 1/27/2010