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Home My WebLink AboutPermit Building 2007-3-22 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01239 ISSUED: 03/22/2007 APPLIED: 09/27/2006 EXPIRES: 09/22/2007 VALUE: $ 68,904.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2320 LOCH DR ASSESSOR'S PARCEL NO.: 1703251100400 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Addition to single family residence Owner: RYAN GARDIEPY Address: 2320 LOCH DR SPRINGFIELD OR 97477 AI 11::1\11 h.JI\l:....,..;.;,.~:-J., .<.m - - I Phone"Nuinber' 541-747-7181 follow rules adopted by the Oregon Ut". 'i . Notification Center. Those rules am set fa; in f"I./lQ Ol;,)_M1_nn1fllni'(","nh f"\.l\O or:::') nr f'I{)nf'l.. v",. ..".."" "h+"';r "nf)" CIS 0& 'he rule I cONTIiA(:rQin~FOR~TIQN-t v ,,', l:. S _.:..,...~ ...[ ---"-' \' ,--,..: th.:herepnone C t t l7lumb~C" ior tht$Qr~)I"i{:'11 Utili'E'" !\Ir.ltifft;,;'~Yi(,D" t on rac or rt.:> ; ... !~'~~n~.~t ,.,,_,<~p~~a on, a e CALIBER CUSTOM CONSTRUCTION"'C'lfC "158592' ,~3r; ~')""02/06/2008 OWNER OWNER OWNER Phone 541-521-9165 Contractor Type General Electrical Mechanical Plumbing VN BUILDING INFORMATION I III U ID la It : # ofStorT~IS PERMIT SHAYs~tPIR~ot Size: ~;~~h~fo4.t1r~ff~fijJi1 M~ ~fiBtJ~ I S ~:~~~: Water ~MMENGED OR IS ABAND~IjIJ~f1JtWf\nent: Range 'MV: 180 DAY PERlnD Sq FtGa'hge/Carport Energy Path: P'at& 1 Sq Ft Other: Sprinkled Building: n/a Occupant Load: 72 625 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 I DEVELOPMENT INFORM A TION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 15.20 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: 22.50 I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved Sidewalk Type: ' DownspoutslDrains: Curb and Gutter Notes: Storm drainage to existing approved system.JLP Pal!:e 1 of 4 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-01239 ISSUED: 03/22/2007 APPLIED: 09/27/2006 EXPIRES: 09/22/2007 VALUE: $ 68,904.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description $ Per Sq Ft or multiplier $99.00 Square Footage or Bid Amount 696.00 DwelIinl!:s Tvpe of Construction V Wood Frame Total Value of Project ~ Value Date Calculated $68,904.00 $68,904.00 09/27/2006 Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $289.09 9/27/06 1200600000000001455 -Mechanical Issuance Fee- $10.00 3/22/07 1200700000000000306 + 10% Administrative Fee $62.76 3/22/07 1200700000000000306 + 5% Technology Fee $29.64 3/22/07 1200700000000000306 + 8% State Surcharge $47.42 3/22/07 1200700000000000306 Add, Alter, Extend Circ $43.00 3/22/07 1200700000000000306 Add, Alter, Extend Circ Ea Add $15.00 3/22/07 1200700000000000306 Building Permit $444.75 3/22/07 1200700000000000306 Dryer Vent $6.00 3/22/07 1200700000000000306 Fire SF Fee - Residential $34.85 3/22/07 1200700000000000306 Fixture $28.00 3/22/07 1200700000000000306 Minimum/Adjustment Plumbing $17.00 3/22/07 1200700000000000306 Miscellaneous Mechanical $33.00 3/22/07 1200700000000000306 San~tary Sewer - Improvement $79.16 3/22/07 1200700000000000306 Sanitary Sewer - Reimbursement $104.11 3/22/07 1200700000000000306 SDC Sanitary/Storm Admin $10.36 3/22/07 1200700000000000306 Storm Drainage Impervious Area $24.00 3/22/07 1200700000000000306 Vent Fan $6.00 3/22/07 1200700000000000306 Total Amount Paid $1,284.14 Initial Review Planninl!: Review Public Works Review Public Works Review I Plan Reviews I 09/28/2006 09/28/2006 APP LLH 09/28/2006 10/20/2006 APP TAJ 09/28/2006 10/17/2006 WI 10/19/2006 10/19/2006 APP JLP 11/08/2006 12/04/2006 WE TR Structural Review Pal!:e 2 of 4 No Planning issues. Storm drainage to existing approved , system.JLP Fowarded to Tom Rogers for review today 11/8/2006. See attached documents for copy of plan review letter to applicant/owner. Items to be addressed prior to issuance. CITY OF SPRINGFIELD I Status Issued Building/Combination Permit PERMIT NO: COM2006-01239 ISSUED: 03/22/2007 APPLIED: 09/27/2006 EXPIRES: 09/22/2007 VALUE: $ 68,904.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 0210212007 0210212007 APP LLH Plans reviewed by Neil Streech with Rogers Engineering under contract with the City of Springfield. Plans had been on hold from December 4 pending additional information needed from the owner/contractor. Information was received and plan review completed. Forwarded to Don Moore for packet completion. Completed permit documents 2/5/07dlm Sent to Tom Rogers for Review today 11/8/2006 Structural Review 09/28/2006 11/08/2006 10 LLH 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. ~eouiredJnsnections I 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 Nailing: Before covering sheathing with finish 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. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Paee 3 of 4 Status Issued CITY OF SPRINGFIELD I Building/Combination Permit PERMIT NO: COM2006-01239 ISSUED: 03/22/2007 APPLIED: 09/2712006 EXPIRES: 09/22/2007 VALUE: $ 6~,904.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 ti"':j);ng C07!in. . 3/:>>-/0 7 ow:~ontractors Sign Dati I Pal!e 4 of 4 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COW\."Z-o-c. h -- <::::> I Z 3 ~ 1. LOCATION OF INSTALLATION: 3. COMPLETE FEE SCHEDULE BELOl-V ~.1.:/() keN )12I!f€ JPIU> {JtZ 971/-77 Date A. New Residential- Single or Multi-Family per dwelling unit. LEGAL DESCRIPTION: / 7-0 3 - r2 S - /1- 00 l..foO JOB DESCRIPTION: dmE ~/TJpV ~/Z ~/t;.-PY ~/W Service Included 1000 sq, ft, or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $106.00 $ 19.00 $50,00 2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: . . . 200 Amps or less . ' " '. JU : n ;4.1 ! !~!' . :~ 201 Amp,s to 40.oAIpW~ ' . UtP" follow WiESS Jb'II<)f~ep' ~?t~~OO '~;;",s,e:r~1s~tlfn:' \\otmcation Cemer. lllo"e Hm!)'.;> C4 ~ C I ')1 OAR 952~cR9~ _OOI(~tft11iQ%lt;~11@AR 952-00 " --0 y' OU rrn"Q~y.ebffl2t~r~81~@t~f the rules \ JV~. I I 'it t (,)nlu h t ~ · e calling th:a &'W&f. \J'1"'{t'lie: .t. e, e,~~110~ . ,^ , / (\ mb~dnr tbe 0, f~Q, 0, n l, Jtll!ty"NO, ~"If.Cat,or, .1'\ - U cc. . TCIJ.lRl!I'l!~,)\.~e~t~.S'...~~Feeders ~v amens,. t'h.".,..',J'--"', , .) j/' Installation, Alteration or Relocation 0" / 200 Amps or less $ 50,00 / 201 Amps to 400 Amps $ 69,00 p 401 Amps to 600 Amps $100,00 NO"l:C,~:600 Amps or 1000 Volts see "B" above. THI6. PfBt~Clh~uitsEXPIHE IF THE WORK AUTHrQAI~Q~NJiffl I~~RWM~Tplli.tNOT COM~~tJ<9i~iPR IS ABANDONED FORI l\NY a6h[JAtdiR~I@lj)-~uit or with ( r-) Service or Feeder Permit X'/ $ 3.00 , Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name \2-..,..~ Address 2 '3 LO City s? ~ ~ G--0-~(~v' 1_0 c..l...... 'b.d. Phone 74 7 - 7 (8/ . E. ' Miscellaneous (Service/feeder not included) -Each Installation Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergyIResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SlJBTOTAL OF ABOVE OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. 7J S,gn~ _ ~ 5 8% State Surch~rge 10% Administrative Fee 5% Technology Fee Inspection Request: 726-3769 TOTAL Shared Drive(T: )/Building Fonns/Electrical Pennit Application 8-06,doc $ 63.00 $ 75,00 $125,00 $163,00 $375,00 $ 50,00 $ 43,00 '11. (!O I ~ Of) CITY OF S11~GFIELD SYSTEMS DEVELOPMEN . JOURNAL OR JOB NUMBER: C0M2006-01239 NAME OR COMPANY: Ryan Gardiepy LOCATION: 2320 Loch Dr TAX LOT NUMBER: 1703251100400 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING, UNITS 0 BUILDING SIZE (SF: 71,5 "ORKSHEET LOT SIZE (SF): .. 0.. VJ ~ Ci o u ~ ~ ,- 'f-'< .VJ ...... o :~ 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S,F. x COST PER S,F. CHARGE 71.50 $0.336 I = I $24,00 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F, x I COST PER S.F. x I DISCOUNT RATE I I I 0.00 I $0.336 I 50% , = I ITEM 1 TOTAL - STORM DRAINAGE SDC 1 $24.00 I DISCOUNT $0.00 $24.00 1070 2, SANITARY SEWER - CITY A. REIMBURSEMENT COST: NUMBER OF DFU's x COST PER DFU 4 $26.03 $104.11 109] B. IMPROVEMENT COST: I NUMBER OF DFU's x 4 $19,79 $79.16 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =1 $183.27 I . -.-. 3, TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x NUMBER OF UNITS x / COST PER TRIP x /NEW TRIP FACTORI I 9.57 0 1 $19,81 I 1.00 I $0.00 1093 B. IMPROVEMENT COST: I ADT TRIP RATE x NUMBER OF UNITS x 1 COST PER TRIP x INEW TRIP FACTOR I 9.57 0 I $87,39 / 1.00 $0.00 1094 ITEM 3 TOTAL - TRANSPORTATION SDC =1 $0.00 n.. 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's x COST PER FEU 0 $91.61 = $0.00 ]054 B. IMPROVEMENT COST: INUMBER OF FEU's I x COST PER FEU I 0 I $961.52 = $0.00 ]055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 11054 MWMC ADMINISTRATIVE FEE $0.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =1 $0.00 , ...- SUBTOTAL (ADD ITEMS 1,2,3, & 4) = 1 $207.27 5, ADMINISTRATIVE FEE: , SUBTOTAL x 1 ADM, FEE RATE CHARGE $207.27 I 5% $10.36 TOTAL SANITARY ADMINISTRATION FEE: 10.36 ]079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $0.00 11078 ....- -,.. ..- .- Jeff Prociw 10/19/2006 TOTAL SDC CHARGES =, $217.63 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUlV ALENT = DRAINAGE FIXTURE UNITS -- (NOTE'FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO, OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS BATHTUB 0 0 3 = 0 DRINKING FOUNT AlN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH /ETC, 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 0 0 3 = 0 CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRlG / WATER STATION / ETC, 0 0 1 = 0 I RECEPTOR FOR COM, SINK / DISHWASHER / ETC. 0 0 3 = 0 ISHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) , 0 0 2 = 0 I SINK: COMMERClAL/RESIDENTlALKrfCHEN 0 0 3 = 0 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 SINK: SINGLE LAVATORY/RESIDENTlAL BAR 1 0 1 = 1 URINAL, STALL / WALL 0 0 5 = 0 TOILET1 PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRlV ATE INSTALLATION 1 0 3 = 3 MISCELLANEOUS DFU TYPE NUMBER OF EDD'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 4 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family d':".t:IJing unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 198] 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO ASSESSED VALUE $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 ELGlBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX, CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE/1000 CREDIT RATE $0,00 x $5.29 = I $0,00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0,00 x $5.29 o TOTAL MWMC CREDIT $0,00 = Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.1is ~ Permit #:,C'(b Address::!3 -:> 0 J..1m ~'t& Issued by: /"v .aCr ",(. U 1:23 7 L.6 Uf lY2- 3/:):d. ) 67 Date: . Statement: Information Notice to Property Owners About Construction Responsibilities' Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction 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: . 0' 1. I own, reside in, or will reside in the completed structure. D 2;' I understand that I must become licensed as'a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My general contractor is (Name) (CCB #) I will instruct my general contract?r that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed 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 Con ruction Responsibilities on the reverse side of this form. -fhignature OfP~ ~ applicant) 31:A 7 (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04' "'.'.. . '--..... ,. Acting-,: a:s ,'~o~~. 9wn~General ~,on~ractor? INFORMATION N011CE TO PROPERTY OWNERS ,", ~ \( ABOUT CONST~UCTION RESPONSIBILITIES .' (' NOTE: This Information Notice to Properly 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 iwplovementto an existing " structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities . , ,. You wiU"in.most inptanqes,..be ruled to be an "employer" and the cqntractors,yqu contract with wilr~~"Gmployees" if . ......_ - . -to '. - ' .. . you use contractors,nQt licensed with,the C-on~truciion Contractors Board to do labor in constructing or -to assist in,the construction or'improvem~~ of a residentIal structur~. AS't.he'cPlpioye:r:, you must comply with "thc"following: ~\" . .. 4. .. . . 'to, _.. -. :.. . ~. . .. . ~ '.. - l' .',' l ..". , ' -- 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 do~'t actually withhold the tax from your employees. For more information, call the Departnient"ofRevenue at 503tg78-4988. , , , Unemployment J[nsurance:Tax:.As'an employer, you are required to pay a tax for unemployment insurance purposes';' on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. . . -. ,~ . - ~,f. ,.. i,' ::: >...... ~. ~ ~ . ~ . ""l- The Oregon Business Identification Number (BIN) isa combin~d; nl.pl1b~r- for, both Or.egon Withholding and Unemployment Insurance TaX. To file for a BIN, call 503-945-8091 or \v'ww.dor.state.oLus/formsnav.htmll for the appropriate forms. - - .. WOJrkers' C~mpe~sation Insurance: As an emp10yer;youa:re subject to the Oregon Workers' Compensation Law, and must obtain wqrk~rs' compensation insurance for your employees. If you fail to obtain workers' compensation msurance, you 'coula bb 'subject' to 'p~na1ties and be liable fofali ~laithcosJs if one of your employees is injured on the .. job. For more information, call the Workers; Compertsatiori Divi~16n'at the Departriient of Consumer and Business Services at 503-947-7815. u.s. lfntemal Revenue Service: As an employer, you must"withhold federal'income tax from 'eInplbyees' wag~~':'" You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-'829-4933 or visit their web site at www.ii:s.l!ov. ~".. '.. {))ther Responsibilities and 'Areas of COll1\cerns . Code Compliance: As the permit holder for this project, y~u' are responsible for resolving any failure to'meet code requirements that may b~, brought to your attention through inspections. Liability and rrop~rty' Damage ttinsufllllllce: ' Confact: your insurance' 'agehtto' ~eeif you have adequa!~ insurance coverage for accident,S and omissions such as falling tools, paint over spray, whter d~m~ge '(rom pipe punctures, fire or work that must b,\-red~~~;\ ',~ '.'\ ,,\~'" '/\" ,. 'fi~e: Make s~re you ~i~e sufficient time 'to supe~is~ ;o~~~~ployees. 0 " \ . Expertise: Make sure you'ha~e the skills to act as'your 'oWn genera{contr~ctor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questionscall the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner.doc 06-01-04 225 Fifth Street . Springfield, Oregon 97477 541-726-3759 Phone C;...., of Springfield Official Receipt 1 .:Iopment Services Department Public Works Department Job/Journal Number COM2006-01239 COM2006-0 1239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 CO M2006-0 1239 CO M2006-0 1239 COM2006-01239 COM2006-01239 COM2006-01239 COM2006-01239 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200700000000000306 Date: 03/22/2007 Description Fire SF Fee - Residential Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture Minimum! Adjustment Plumbing Vent Fan Dryer Vent Miscellaneous Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By RYAN GARDIEPY Item Total: Check Number Authorization Received By Batch Number Number How Received 562803 562803 In Person Payment Total: nJm Page 1 of 1 9:36:57 AM Amount Due 34,85 43,00 15,00 24.00 104.11 79.16 10.36 444,75 28.00 17.00 6.00 6.00 33.00 10,00 29.64 47.42 62,76 $995.05 Amount Paid $995.05 $995.05 3/22/2007