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Home My WebLink AboutPermit Building 2010-1-27 CITY OF SPRINGFIELD Status Issued Building/Combination Permit PERMIT NO: COM2010-00099 ISSUED: 01/27/2010 APPLIED: 01125/2010 EXPIRES: 07/27/2010 VALUE: $ 168,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541,726-3769 Inspection Line SITE ADDRESS: 5765 MICA ST ASSESSOR'S PARCEL NO,: 1802033303800 SPRINGFIETYPE OF WORK:SingleFamily Residence , TYPE OF USE: New PROJECT DESCRIPTION: Single family residence- SAME AS COM2009-00970 5775 Mineral Residential Owner: HAYDEN HOMES LLC Address: 2464 SW GLACIER PL STE 110 REDMOND OR 97756 ____ ._.~., ""'.._~.~.... I....,.. ..",,...,llroc:: \/('11 to :J-'.~ I ..... ':~_' '~~l.+_+:'...\ h" tho nr:.p[!nn Utility I e.?NTRl\CTOR:IJ'o;'FORMAITJ,<?~el forth i~-6AR 952,001,0010 throuqh OAR 952-001-. . Contractor 0090 You may obtain co~etIlIve rul~~lratlOn Date HAYDEN ENTERPRI~~il1g the center. (N. ot!9~~tel~~ho~e 07/29/2011 TOP NOTCH ELECT~fn!!llffor the Oregon Lltttil\t;!Jlotlflcation 09/29/2010 PACIFIC AIR COMFORT INltenter is 1-800-33lJ!z~44). 03/25/2010 STUTZMAN SERVICES INC 31747 05/12/2010 BUILDING INFORMATION I' "-,,-,,.",,~.,..'" ,-.. ;;';;::''';;~;:~:,,_~.. . .........' --''-~._'''' '.~,. Phone 541-228~6935 541-317,1998 541-672-9510 541-928-8942 Contractor Type General Electrical Mechanical Plumbing 3 # of Stories: l' Lot Size: "Height o(Structure 15.50 Sq Ft 1st Floor: Type of Heat: Forced Air Gas Sq Ft 2nd Floor: "OTI c~~ter Type: Gas Sq ft Basement: !, ,~ ~~l1~f Txet~LL EXPIRE lrEWlt:iWOR~q Ft Garage/Carportj THIS PE~,~~f P\i~W~ ERMJI IS NOllq Ft Other: f ~~,~,~~~~~~J.l~~u,~!Nfr;~~nNEl)'~OR Occupant Load: , I DEWEbGIIME!'\Ilr:IPIXID.RMATlON I I REQUIRED PARKING 1,148 / I /400 # of Units: Primary Occupancy Group: ~ Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I R-3 U VB Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18,00 5.00 5,00 24.00 0,00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 2 / Yes 34.40 Total: Handicapped: Compact: 2 I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fullv Improved Yes Storm water to curb via weep hole . ,'.r.". ,"-" Sidewalk Type: Downspouts/Drains: Curbsi'de'?, Curb and Gutter Notes: " \ \ \ /\ Page I of 4 -Wl:~I;~}~~!iI!;J,i;~' , , ",,,' ., - ...'_.' Status Issued 225 Fifth Street, Springfield, OR 541-726,3753 Phone 541-726-3676 Fax 541-726,3769 Inspection Line , Description Tv"e of Construction Fee Description + 12% State Snrcharge + 5% Technology Fee 1st Appliance 2 Baths One or Two Family Addressing Assignment Appliance Vent Building Permit Credit - Trans Improv SDC Curhcut Permit Dryer Vent Exhaust Hoods Gas Outlets 1-4 Plan Review Major - Planning Plan Review Same As PW Disc, 2nd Permit Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer - Improvement San!tary 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 Amount Paid '. I Va.I~~tio~ Descr!Dtion I $ Per Sq Ft or multiplier Square Footage or Bid Amonnt Total Value of Project l..Ppn\fWU Amount Paid Date Paid $205.62 $103.53 $79.00 $337.00 ' $38.00 $9.00 $985,5 I $-931.65 $88.00 $9,00 $13.00 noo.:/,;,; , $211.00 $250.00 $-30.00 $134.00 $50.00 $507.07 $666.84 ,$10,00 $22.63 $ I ,333,57 $101.97 $153.07 $211.21 $931.65 $18.46 $88.00 $577,26 $63,00 $27.00 $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 1/27110 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 , 1/27/10 1/27110 1/27/10 1/27/10 1/27/10 1/27110 1/27/10 1/27110 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 1/27/10 '.., ':', ~';' . $9,127,74 " j:f~!" Paee 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM201O-00099 ISSUED: 01/27/2010 APPLIED: 01/25/2010 EXPIRES: 07127/2010 VALUE: $,168,000.00 Value Date Calculated Receipt Number 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 220]000000000000078 2201000000000000078 2201000000000000078 220]000000000000078 220]000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 2201000000000000078 _ &~IilII~IIllEiI!l",1;! b , Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-00099 ISSUED: 01127/2010 . APPLIED: 01125/2010 EXPIRES: 07/27/2010 VALUE: $ 168,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Plan nine Review 01/26/2010 01/26/2010 I Plan Revie~s I 01/26/2010 DON 01/26/2010 APP DJB DDK Access restricted to I driveway/Iot. Follow street tree plan, Minimum setbacks - see letter attached in documents. Per LKW As noted on plans Public Works Review Structu fa) Review 01/26/2010 01/26/2010 01/26/2010 APP 01/2612010 APP .-' . f1'... CJC CJC To Request an inspection call the 24 hour recording at '(26-3769. 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.R.m~ Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are .installed. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placeinent of concrete. Ufer Electrical Ground: Install ground rod at footing and call for 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: Final Building: After all required inspections have been, requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and tilter cloth is installed ~ut prior to backfill, Underlloor Plumbing: Prior to insulation or decking. Undertloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing, Water Line: Prior to tilling trench and inclnding required testing. Paee 3 of 4 _6Jj!~IN~I\'I~D; , I' CITY OF SPRINGFIELD Building/Combination Permit Status Issued .-' '.'~ , PERMIT NO: COM2010-00099 ISSUED: 0112712010 APPLIED: 01/25/2010. EXPIRES: 07/27/2010, VALUE: $ 168,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54] ,726-3676 Fax 541-726-3769 Inspection Line Sanitary Sewer Line: Prior to tilling trench and inclnding required testing, Storm Sewer Line: Prior to filling trench, Final Plumbing: When all plnmbing work is complete. Underlloor Mechanical. Prior to insulation or decking and including required testing. Underlloo)' 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, Rongh Mechanical: Prior to Cover FinalGas: When all gas work is complete. Final Mechanical: When all mechanical wor~,f~ complete. Temporary Electric: Approval required prio~Jo Utility Company energizing pole, Rough Electric: Prior to Cover Electric Service: Approval reqnired prior to utility company energizing service. Final Electric: When all electrical work is complete. By signature, I state and agree, that] 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, Bnilding Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I fnrther agree to ensure that all reqnired,inspections are reqnested 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 dudng construction. -/(/kk~ O:ner or Con-;;-;;;ors Signat& /07G- /,0 Date ~- ,',,;' ,Of:, ;. Page 4 01'4 SliME 115 S77S' I'1lh'-"",,! (7-170 , Permit Application - Stru( DEPARTMENT USE ONLY (OHo1 ZCI 0- Pem1it 'no.:' DOO / i I Date J- Z. ~ - I 6 This permit is issued under OAR 918"460-0030, Permits expire if work is not started within 180days of issuance Or if work is , suspended for 180 days, , , !;, ~';;;'1I1QCAL'c;c5YE~N M~N'tl.'~8}jti'QV~~{';.7*:ii,;\::ti~!)i;{tl I ~~~~~~O:e~ct has final lalld~use approvaL I Date: I 1:,;?"":,/,,.,~>~~;:~~~:~)'-~::~~:\~~::\::~g~'r'}\Fg~'~:S'gH~'pUr~:\;""::,':~: I :~~~~o:eect has DEQ approvaL Date I 1;~~;~!~td::~f~:;::';rjn~iiq#'i;JQ't"*f:;il"i;5i;;'/ I Zoning approval ver~fied: 0 Yes 0 No I I Occupancy I Prope~:is \Vit~_i,nf1ood p[ain:""~Yes,, [~"_NO,, ,'_ ,', I I Construction type: l~jtl~;~,~;;i~?;~!jKGAtE;G9ti~~QF,;~cQ@;r~jJ(;[I~N;';far;.iiiiiiNi'[i:.!~id 1 ,Square feet /1'1'8' I- ~O G 11,~.-:"~.",.~.".~.,id..,,~.2-~i'~,lq,,.._;,i'," _ ..'. _ "', , .L_~,". ,,"?~~,e,",m. ..~.e., ~,', ~_,'''''.',' '.' """"_.1. ,~."c",.,.~m. ,.,~.e,_".'.~:.'~~:.]'0._:'; ".' :':'-'..11 I Cost per square foot: miidi?',',1;UQElt,'SI;rE! INI;QRMAT!ON},!\NPtl1o.8A'f:I()J:l';';J;)\"~"Wf;" I Other information I Job site address: S 7" 5' ' td1, -Ce.. 1 1 City:, )~r''13.(i~/oI I'State: Of? I ZIP: 97'{7S'- I I SubdivIsion: ::'h,e>-c, I Lot no,: t'2l?'\ 1 Reference: /862...03J7 1 Taxlot: 03~Oo. I' I, :P.ROPERTVOVlNER; .' ,I I Name: /-k..,rlo<'V\ Jk.,.,_ < 1 1 Address: ~q~4 <;LJ f-;/a ','d ' I I City: Red""Mlrj State: OQ 1 ZIP177'1c" I IPhone:~/'.22\'~"l"5' Fax: , I E.mail: 1 This installation is being,made on residential or farm property owned by me or a member army irnmediate family, and is,exempt from licensing requirements under ORS 701.010. Sig'n here: ~ /2//L I " ',' CONTRACTOR INS~llLATI()N' ,,', . ,,;1 I Business name; /.k.I/,A"^ flc,J-vr,.- c::.. I 1 Address: .:JJII."I Sc.v /.V"<I -r ' I' I City: RLdf'Y1cJnPi. State: tJR., 'J ZIP;'1'7;><>c;, 1 1 Phone:-5<1t 'XIfc' c-''i..." ,Fax:.:1-11 .i<i, ...2572 I 1 E.mail I 1 CCB license no,: 1J1 01\ I I Print name: I I Signature: I 225 Fifth Sueet . Springfield, OR 97477. PH(54])726~3753 . FAX.(541)726-3689 :;~:t;~~i;;~:::IS0El'CO;!~~~:e~~.~~r:~~;MAlJ~~~1~~~)~~:;,,;\~\t::i;;1 I Electrical J7.2,u, I I Plumbing 31747 I I Mechanical 3'1:;. 37 1 ~_PR;:G.~.I,:::' :~~;,:f_~, t ''<>;;c'''-~&~'~<c~-;:;,_,r;".~ tNgl~~:~i'~~ '-..;',,:'-~ ,-,' I I 1 1 1 I I 1 1 I (b) Fo'undation-only permit? DYes DNa 1 1f:.;;~~~~i~a;:;;~~;i!:'~!"~I;FJiif\~;~it\i~~~i:;,;;'t;i,'!'",:'hl,,:. ~fr:~~,;{l I (a) Permit'ree (use valuation table): $ I (b) Invest'gativefee (equal)9 [2a]): $ 1 I' (c) Reinspection ($, ' per hour): I (number of hours x fee per hour) $ I (d) Enter 12% surcharge (,12 x [2a+2b+2c]): $ I (e) Subtotal of fee, above (2. through 2d): $ I (Ta~,~!RI3'tI~-Fe~it~w"': 'i<;'i~:~-s'(~~;-~;;;rt;::j*l!;~W;J;'!&~fhK'f.ti1:t!f'~'-'i;f\'-':; "'-~~:'f,tS,~t(1"i(".,;.2';:.g~'.J!l.:;Et;~.;.t.~-<{1 i __"'1',,_\,, ,",:;,:...' ..,.' -_;&;__._",Sg'~(;i,!>'tL:;:'h::/!:;:;,-::f';"i,~',_:;":~:;:: , ' '-(~:;;~,;cti:"}H:-:);~~~J~;;:1:'d%7,,:;_ (a) Plan review (6S% x permit fee [2a]): '";> ~ $ Z.S 0 'I I (hi Fir~ and life safety (40%x permit fee [2a]); $ I I (c) Subtotal of fees above (3a and 3b): $ I ,I I Type of Heat: (= So Energy Path: r9.A ' [XI new 0 alteration D addition ) (a) Seismic fee, 1%(,01 x permit fee [2a)): I $ .TOTALfees and surcharges'(2e+3c+4a): S ,4 225 Fifth Streett Springfield, OR 97477tPH(54~)726-3753t FAX(541)726-3689 1~1[~;:R~R~~~M:~~~il~N~~~'1 1~~t~f20Cu9~ -, ~''''"'U'I I Date; f-z'!; - / a I Electrical Permit Application o 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 wor,k is suspended for 180 days. 1~~tr~~~G~If:f;g~tillf;!il[~~gFll~~V!~~~~. I'Z~ning approval verified? 0 Yes D No 1~~i1f[:~.lliEGJiIR\),;i(SjJ:A@~NSJ]RtJJ.:GliiLQ&l~~\ti.~~ '-,;lI; I Residential,:per unit, service included: ) ~=~~;~.Jio~~II~~;;;:o~~:'(:'"'~,;o" ~ ;'::: i I City:'i:Y""~("'''' iol r State: oR. 1 ZIP: '17'178' I I Limited energy (2) $ 32,00 $ I ~~~~~~~~}! ~~~~~;::::::~'~M":~":::: ! 1.i!i.1t-~lF'~,~~,~oR-~ai'1'ERliiY,,<1!0WNE'R"'<":~,ilfi7,W,!c';;1"!\~,.:.,;n:'i'1 I 201 to 400 amps (2) $ 95,00 $ 1 i>!il"h___~'"""~"""'"" . ... ._.....~_,",~_"".wJ1ig"",Y...d"''''!''''''.',,.,,'-~'d,' Name: \-L'I'J,"" Kc;-vr.-e 0;, I I 401 to 600 amps (2) $158,00 $ I Address: YL;Ci; 51.--J IJ",r:pr II 601 to 1,000 amps (2)1 $205,00 $ I In I <>77 I I Dve; 1,000 amps or volts (2) $469,00 $ I City: ' K ",0{ v"'lcvt c-1 State: 11 Q ZIP: I S'G. I I I I Reconnect only (2) $ 63,00 $ I Phone: SL/i-2i.t- iP"1-:>5' Fax.:5Cli.7'11- ;J57? ' \ . E-mail: ~ 1 I Temporary services or feeders: installation, alteration, relocation .[ This installation is being made on residential or farm property 200 amps ?r ~es~ $ "63,00 $ 1 owned by me or a member of my immediate family, This 201 to 40Nn~ $ 87,00 $ 'I property is not intended for sale, exchange, lease, or rent. OAR 479,540(1) and 479,560(1)" 1 401 to 600 anlps(2) $126,00 $ 1 Signatur~: lOver 600 amps or 1,000 volts, see services or feeders section above I Iml~ii[([Gi~iIl~~:r@.B.il~~smJ,l!~WAmt(Sj.!i[-i~~'1f{;,*w;JJ I Branch circuits: new, alteration, extensian per panel ' ,I I Business name: "'To'r \\l:.rr\-\ F I pC I I a, Fee for branch circuits with purchase of a service or feeder fee: I I Address: ..JO~ A (oveo-r C t- I I Each branch circuit 1 I $ 6,00 1 $ 1 I City: & ,,01 , State: DR. I ZIP: I I b, Feefor branch circuits without purchase ofa service or feeder fee: I I Phone:S< 11-31/ -/91.. 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,; ~JY 30C I BCD license no.: ( ..22(], I I Miscellaneous fees: service or feeder not included I I Signing supervisor's license no,: 4(XS-4.5 I 1 Each pump or irrigation circle (2) $ 63,00 $ 1 I Print name of signing supervisor: V f!..... l '~+r )c.k I ~ ~ I 1 Each sign or outline lighting (2) $ 63,00 $ 1 I SIgnature of 51 g SU ervlSOT' U /J ~ 11 c-; _.IL I Signal, circuit or a li!llited~energ~ panel, $ 63 00 I $ I . . ' "gnin p . . l ~r'Y( M<~ . _----;~ alteration, or extension (2) , ....v ~ additional inspection: (1) , '. $58,00 1 $ I ," "3!i~~"i'.;\-'''''"Sn'ilil'H''''i'i5':tiif!;~S'-E''''--'''lif-''' ""af'>!!1i''''''''''''=! :: ',_":~~~~ffl.I;;,_J;--,"",~~'~l~lH~;~~,~~~~~~~~~ (A) Enter subtotal of ahove fees (Minimum Permit Fee $58,00) 1 (B) Enter 12% surcharge (,12 x [AD (C) Technology Fee (5% of [AD TOTAL fees and surcharges (A through C): ~~ ~ '^ o-.,\\) C\:V ~fD ~tp~ ~~ $ $ $ $ 440.2584,) (9/08/CDM) . 2~willam.al~"e" ',t~ , ,Park and Recreation District , Job.'No.' (!./O-9r _, .,""''' ~~ 0, "", __ SYSTEM DEVELOPMENT CHARGE WORKSHEET :_,c____, .,~,~nuary 1-June 30, 2010, , PHONE:91i."2-i.~'7.r5" STATE:JL ZIP: q~'lr~ NAME: H-A" .DE"-' . *oMe:S. , ADDRESS:~6t) ~ i!ci0iii. ' CITY~....~";b ,'<.\ . , , ' , ' " LOCATIONO(PROPOSED BUILDING SITE: '~'Street Address:' 5:7 h ,5",' ;vu Li'r' . . :<., ,- ",,",' 'Ta~ ~~tN~mber: /rO'2."6~~ 12M Plat Name: ',." 1. DEVELOPMENT TYPE (Ch~ck appropriate dwelling(s), Dwelling ,type definitions are on the :ba?k,) , " " A Sinale~FamilvDetached' I ' ' " 'NO, OF UNITS X $2,858 per unit =' :' $ ;lYS-5 B: ,Sinale-Familv'Attached '. NO, OF U,NITS . ',' " X $3,1 DOper unit = '$' " ,- , '. .~. C. Multi-Familv'Aoartment 'NO, OF UNITS X $2,64 f per unit = , $' , D," Sinale Room Occuoanc\l -'~" ._.-----==.-- - -~-"'-= .~~~~.~lR=r~~~;,~~~- ,,:_~,~.,=.,=.=:--=-,-::' '.. -.-. ""- ------------".-.- --...._~,...- ,....-. ..-,' -, . . .. - ......'~-,.,--'-~ -~.._~"~,-"--~.__. , , NO. 'OF UNITS " 'E AccessorvDwellino Uriit NO:OF:'UNITS , ' , X $1 .550per unit; $ $ , WILLAMALANE SDC . . ,'. . ~ . ' . '2. SDe CRED,IT (If applicable) SDC payer muslfur~ish proof of- , Willa~alane Credilapproval.) ... .- ..-~_ ~:~~;..:- 0~:-'~~;'='~~~';-- ; ~~~~~~:;_;,.. ~~.;.;~~-,~,:~,;:'--~- ;'.-~,~ '-- ";, ".c7,'~ ,.~~~;~~~L~"":,:,~:;:"";;;:::.~:-. /~;7,; '3. TOTALWILLAMALANE NETSDCASSESSED>>" h , (if SDcreducedfor Credit) , .. ." ,$ , , .~.~,: .;.. ....- . '$ 2~.td 0~" ,I / :2-(./ J{J , Date Development Services Department City ofSprin~fjeld ," , , - ,:-' - .,.....-- '_.-.~'";'--,-------._--~-'.".--. . .. _ ._ '--o'-,-_~ ,.__ . . ,,- 5 City of Springfield Official Receipt Development Services Department Public Works Department 225 Fifth Street Sprin,gfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM20 I 0.00099 COM20 1 0,00099 COM20 I 0-00099 COM20 1 0,00099 COM20 I 0-00099 COM20 I 0-00099 COM20 I 0-00099 COM20 1 0,00099 COM2010,00099 COM20 I 0-00099 COM20 1 0,00099 COM20 I 0,00099 COM20 1 0-00099 COM20 I 0,00099 COM20 1 0-00099 COM20 I 0,00099 COM20 I 0-00099 COM20 I 0-00099 COM20 I 0-00099 COM20 1 0-00099, COM20 I 0-00099 COM20 I 0-00099 COM20 I 0-00099 COM20 I 0-00099 COM20 I 0-00099 COM20 I 0-00099 COM20 I 0,00099 COM20 I 0-00099 COM20 1 0,00099 COM20 1 0-00099 COM20 I 0-00099 COM20 1 0,00099 Payments: Type of Payment CrcdilCard cRcccinll RECEIPT #: 2201000000000000078 Date: 01/27/2010 8:35:09AM Description PW Disc,- 2nd Penn it Curbcut Permit Sidewalk Penn it Stonn Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Tran Reimburs-Residential Credit - Trans Improv SDC SDC Trans Improvement"Resident SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC MWMC Compliance Charge SDC Sanitary/Stonn Admin SDC Transportation Admin Plan Review Major - Planning Plan Review Same As Building Pennit Addres,sing Assignment ! ~}t' WiIlamalane Single Family , "" 2 Baths One or Two Family 1st Appliance VentJan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1,4 Residence Wiring 1000 Sq Fr Residence Wiring Ea Add!1 500 Temp Power 200 amps or less +. 12% State Surcharge + 5% Technology Fee Amount Due (3000), 88,00 88,00 577.26 666,84 507,07 211.21 (931.65) 931.65 101.97 1,333,57 10,00 22,63 153,07 18.46 211.00. 250,00 985,5 I, 38,00 2,858,00 337,00 ' 79,00 27,00. 9,00 13,00 9,00' 7,00 134,00 50,00, 63,00 205,62 103,53 $9,127,74 , Paid By TIM DREILING Item Total: <;heck Number Authorization Received By Batch Number Number How Received Amount Paid cjc 026657 In Person Payment Total: $9,127.74 $9,127,74 I,:! -< " ,'" .' " Page I of I 1/27/2010