HomeMy WebLinkAboutPermit Electrical 2005-9-2
Date
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225 FIFTH STREET. SPRINGFIELD, OR 97477 - PH:(541)726-3753 - FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number cc;:.. t> lotJ4
1. LOCA110N OF INSTALI..A110N
iJV hrYl hliLLl
LEGAL DESCRIPTION
I +oZ-3i.f 3i.f n'1-'5.ClO
JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. CONTRACTOR INSTALLATION ONLY
EI'~Contr"to' /
Address "" /
City
Expiration Date
\
\
\
',--- l
Owners Name l).f\~ bJ r Dl?5CIVAJ J-I-
Address -JB >,1. &:AaI~Vl k~
City f.~./V~ Phone '4'"etf '-00'110
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3. COMPLETE FEE SCHEDULE BELOW
A. New Residential- Single or Multi-liamily per dwelling unit.
Service Included
1000 sq. ft. or less $106.00
Each additio~1jT~bJlcl.CfN.M)regon law requires ~ou to
portion the~~~?W ~ules adopted bv thA O.regb?iqgtilif,.
lNotrflcq!ion Center Tho I "I
Each Ma~fa)~?i~<g!:l,e or . se ru es are set forth
Modular ()~'elli'~~'S;~(v-idQbf001 ~ thro~gh O~&&?-001.
Feeder 90., ou may obtalr. Cui::m:;$-oftl1e rules oy
calling the center. (Note: the tele hn
B, ServicesmJlm~ff~r~teJJfJJoo...l~It~r.tati..Qn~ WI' 'K~~cation:
. . .. 8\,)11 DIlII Y NOIlficatlon
Center is 1-800-332-2~d\
200 Amps or less "'$'(j~~00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts $375.00
Reconnect Only $ 50.00
L - i..;, l t( "/~"
C. Teri{~~'tar.d;ervices or lieeders
Aut ',:"if"11 T S I j ,
('."! HOiTi/:--~) I' Ii, ,f / Cvr,
Installa tio n~:-A1te,,'ationl or~Relocatio,n~ IF
"',v/eND -"UtH ., e T.
2004}..%'pf8r,les!D Oli/S 11 THIS PM); J/fS.~(()9ii/sDl 00
U I/II\{ ",. 1"'811" -, II"IIT '0 v '\
201 Amps to 40()!l'\mP.~110D I '11V/J0;~1':-:_ $~~1P8t
401 Amps to 600 Amps' L:.U F($);OO.OCl
Over 600 Amps or 1000 Volts see "B" above.
D. Branch CiJ'cuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
CD,oo
'5, r-o
_Coo
.Q ~ ..~D
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)fBuilding Fonns/Electrical Pennit Application I-03,doc
!:
'I'
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: COM2005-01049
ISSUED: 09/02/2005
APPLIED: 08/03/2005
EXPIRES: 03/0212006
VALUE: $ 286,559.00
SITE ADDRESS: 6111 Fernhill Lp
ASSESSOR'S PARCEL NO.: 1702343407300
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - MountainAlf'fEm~~ ~regon law requires you. ~o
, lull.:.,.. tJ!3~...rlf"\rtorl h~, thp. Oreaon Utlht~
Notification Center. ThoSlPli'6We'5rWi~B~t.!orMh-484-0070
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
callmg me Celllt:ll. \1'lJlG. t:..:. t:I~~~7~':'
I CONTRACTOR ~Jf~!\)TI~egon Utility Notification
Center IS -800-332-2344).
License Expiration Date Phone
49169 10/16/2008 503-484-0070
? Owner:
, Address:
Springfield TYPE OF WORK: Single Family Residence
Residential
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,
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ANSLOW & DEGENEAULT INC
1953 GARDEN AVENUE
EUGENE OR 97403
Contractor Type
General
Contractor
ANSLOW & DEGENEAUL T INC
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
,# of Bedrooms:
't
"
I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Subdivision Not Accepted
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
18.00
11.00
16.00
42.00
0.00
I BUILDING INFORMATION I
1
R-3
U
VN
# of Stories: 2 Lot Size:
Height of Structure 29.50 Sq Ft 1st Floor:
Type of Heat: Forced Air Gas Sq Ft 2nd Floor:
,Water Type: Gas Sq Ft Basement:
Range Type: Gas Sq Ft Garage/Carport
Energy Path:': \ 'I,;,: . Path. 1 PIR Sqff-Oth'ctORK
Sprinkled\B\~iiding:,\'\\1 SHP'\n. YatX pOCCUp.~~t:ioadf
\ \ v , ~ ~ ,_', II,dr,CQ 1HIS tK\\JI\ \ Iv Illu I
I DEVELOPMENi;INF.ORMATION\~1 ABANOOl~EO rUK
ANY" BG UAY PtRIUO. REQUIRED PARKING
Overlay Dist: Hillside Total: 2
# Street Trees Rqd: 3 Handicapped:
Paved Drive Rqd: Yes Compact:
% of Lot Coverage: 29.50
10,019
1,794
894
607
3
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
Downspouts/Drains:
Fully Improved
Yes
To Storm Sewer
No hook-up to City Infrastructure until Public Improvements accepted by the City;storm draiange piped to stub
provided 8/8/2005 CAS
Description
Type of Construction
I Valuation DescriPtion'
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pal!:e 1 of 4
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. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01049
ISSUED: 09/02/2005
APPLIED: 08/03/2005
EXPIRES: 03/02/2006
VALUE: $ 286,559.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
A.C. - Residen
Deck/Balconv
DwellinfS
Garafe
AC - Residential
Deck
V Wood Frame
Garafe
$4.00
$17.00
$96.00
$25.00
2,688.00
152.00
2,688.00
607.00
$10,752.00
$2,584.00
$258,048.00
$15,175.00
$286,559.00
08/25/2005
08/25/2005
08/03/2005
08/25/2005
Total Value of Project
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $735.25 8/3/05 1200500000000001135
-Mechanical Issuance Fee- $10.00 9/2/05 2200500000000001216
+ 10% Administrative Fee $165.54 9/2/05 2200500000000001216
+ 7% State Surcharge $115.88 9/2/05 2200500000000001216
3 Baths One & Two Family $306.00 9/2/05 2200500000000001216
Addressing Assignment $31.00 9/2/05 2200500000000001216
Appliance Not Listed $27.00 9/2/05 2200500000000001216
Building Permit $1,173.40 9/2/05 2200500000000001216
Curbcut Permit $80.00 9/2/05 2200500000000001216
Dryer Vent $6.00 9/2/05 2200500000000001216
Exhaust Hoods $9.00 9/2/05 2200500000000001216
Furnace - up to 100,000 btu $12.00 9/2/05 2200500000000001216
Gas Fireplace $15.00 9/2/05 2200500000000001216
Gas Outlets 1-4 $4.00 9/2/05 2200500000000001216
Gas Outlets 4+ $1.00 9/2/05 2200500000000001216
Mountaingate Impervious Area $1,160.56 9/2/05 2200500000000001216
Plan Review Major - Planning $150,00 9/2/05 2200500000000001216
Plan Review Residential $27.46 9/2/05 2200500000000001216
Sanitary Sewer - Improvement $514.89 9/2/05 2200500000000001216
Sanitary Sewer - Reimbursement $676.89 9/2/05 2200500000000001216
SDC MWMC Administration $10.00 9/2/05 2200500000000001216
SDC MWMC Improvement $865.31 9/2/05 2200500000000001216
SDC MWMC Reimbursement $82.03 9/2/05 2200500000000001216
SDC Sanitary/Storm Admin $151.32 9/2/05 2200500000000001216
SDC Transpo Admin $63.58 9/2/05 2200500000000001216
SDC Transpo Improvement $805.70 9/2/05 2200500000000001216
SDC Transpo Reimbursement $182.69 9/2/05 2200500000000001216
Storm Sewer Each Addtll00' $28.00 9/2/05 2200500000000001216
Temp Power 200 amps or less $50.00 9/2/05 2200500000000001216
Vent Fan $24.00 9/2/05 2200500000000001216
Willamalane Single Family $1,000.00 9/2/05 2200500000000001216
Total Amount Paid $8,483.50
I Plan Reviews I
Initial Review
08/08/2005
08/08/2005
APP SKG
Pal!:e 2 of 4
. CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2005-01049
ISSUED: 09/02/2005
APPLIED: 08/03/2005
EXPIRES: 03/02/2006
VALUE: $ 286,559.00
"-
I
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
LDAP Review
08/1612005
08/16/2005
APP VRJ
LDAP Review
08/03/2005
10 VRJ
Plannin!!: Review
08/0812005
08/25/2005
APP TAJ
Public Works Review
08/08/2005
08/08/2005
APP CAS
Structural Review
Structural Review
08/23/2005
08/03/2005
08/24/2005
08/11/2005
APP JB
WE JB
LDAP is ready to issue and located
at the front counter. $600.00 due at
issuance.
LDAP submitted 8-3-05. Full revie"
LDAP. $600.00 due at issuance.
Tree Felling Permit required if more
than 5 trees with a dbh of 5" or
greater are felling within the
minimum setback areas.
The Vegetation Easement to be
fenced with construction fencing.
No construction activity or tree
removal in easement.
No hook-up to City Infrastructure
until Public Improvements accepted
by the City; storm piped to stub
provided 8/8/2005 CAS
Approved as noted on plans
Need additional information to
complete review.
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.
UeouiredJnsnections I
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Curbcut - Standard: After forms are erected but prior to placement 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 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.
Final Building: After all required inspections have been requested and approved and the building is complete.
Underfloor Plumbing: Prior to insulation or decking.
Pa!!:e 3 of 4
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. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01049
ISSUED: 09/02/2005
APPLIED: 08/03/2005
EXPIRES: 03/02/2006
VALUE: $ 286,559.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Sanitary Sewer Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Underfloor 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.
Final Mechanical: 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 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 0 CUP ANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I furt r r ify a only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I fur e ag e 0 e ure that all required inspections are requested at the proper time, that each address is readable from the
stret, t ~t e per it card is located at the front of the property, and the approved set of plans will remain on the site at all
tims d, I co str ction.
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/ I vi D~
Dat~ I {
Pal!e 4 of 4
. CITY OF SijrI~GFIELD SYSTEMS DEVELOPME&RKSHEET
JOURNAL OR JOB NUMBER: COM2005-01049
NAME OR COMPANY: Anslow & Degeneault
LOCATION: 6111 Femhill Lp
TAX LOT NUMBER: 1702343407300
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS l' BUILDING SIZE (SF, 3380 LOT SIZE (SF):
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS S.F. x I COST PER S.F. 'I CHARGE,
3593.06 I $0.323 = I $1,160.56
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F. I x' I . COST PER S.F. I x I DISCOUNT RATE I
0.00 " I $0.323 I I 50% I
ITEM 1 TOTAL - STORM DRAINAGE SDC '$1,]60.56
2. SANITARY SEWER - CITY
"A. REIMBURSEMENT COST:
NUMBER OF DFU's x
27
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 27 I
COST PER DFU
, $25.07
$19.07
ITEM 2 TOTAL.- CITY SANITARY SEWER SDC
3. TRANSPORTATION
A. REIMBURSEMENT COST:
ADT TRIP RATE x
9.57
=,
$1,191. 78
I NUMBER OF UNITS" x I
I 1 I
COST PER TRIP
$19.09
B. IMPROVEMENT COST:
I ADTTRIPRATE x
I 9.57
I NUMBER OF UNITS
I 1
, x I
I
=,
COST PER TRIP
$84.19
$988.39 '
ITEM 3 TOTAL -TRANSPORTATION SDC
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
NUMBER OF FEU's x
1
ICOST PERFEU
I $82.03
B. IMPROVEMENT COST: .
NUMBER OF FEU's I x
1 I
COST PER FEU
$865.31
I
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
, MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SE\\TER SDC
- ,
'-
'."'.'-
= ,
$4,298.07
$957.34
SUBTOTAL (ADD ITEMS 1, 2,3, & 4)
5. ADMINISTRATIVE FEE;
, ISUBTOTAL x ADM. FEE RATE 1=
I $4,298.07 5% I
TOTAL SANITARY ADMINISTRATION FEE:
CHARGE
$214.90
TOTAL TRANSPORTATION ADMINISTRATION FEE:
, DISCOUNT
, $0.00
x I NEW TRIP FACTOR"
I 1.00
I 'x
I
I
NEW TRIP FACTOR
1.00
10063
$1,160.56
$676.89
$5]4.89
I _ $182.69
$805.70
=
$82.03
r:n
i:Li
c:l
o
.U
~
i:Li
t-<
r:n
......
d
~
1070
1091
11092
1093
11094
.1.
1054
1055
1054
1056
:i
I
I
1079
8/8/2005
.
11078
Cheryl Slaymaker
PREPARED BY
I'
I
$865.31
$0.00
$]0.00
151.32
$63.58
DATE
TOTAL SDC CHARGES' =, $4,512.97
-_--:'-:~,-,-,~-:::_J
. )
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNlT EQUN ALENT ~ DRAINAGE FIXTURE UNlTS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
!BATHTUB 2 0 3 = 6
I DRINKING FOUNTAIN 0 0 1 = 0
I FLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
\ LAUNDRY TUB 0 0 2 = 0
ICLOTHESWASHER/MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0
I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
I SHOWER, SINGLE STALL 1 0 2 = 2
I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
I SINK: COMMERCIAL BAR 0 0 2 = 0
I SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2
I SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 = 2
IURINAL, STALL/WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
'TOILET, PRlV ATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 27
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
I
I
.1
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$l,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 1 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
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
o
TOTAL MWMC CREDIT
$0.00
=
<.,. (
f\.'~W"'1 ' I' '
~ ~!:.- 1_ ama ane
-..I" " j Park & Recreation District Job. No. f"'", (:wIOLf1
"'. SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME: ,~~ DCi6r~.'JJ~ PHONE: LfBLf :'-GOTf-O
ADDRESS:--1:1~3 Ew~/t,' lirJvSTATE: t)fC ZIP: ~ffo<
tOeA TIQN OF PROPOSED BUILDING SITE:
Street AQdress: 4?l II rlj~V1A}Jl W,
.t
",Plat Name:
Tax Lot Number: -.f]-o2:r'iri.f 07-"'].00
1,. 'OEVELOPMENT TYPE, (Ched< appropriate dwetring(s). sac calculations and dwelling t
, we definitions are on t~e back) ,
A 0in91p,-F3mi!~ Detached
, V Single 'Family home
NO. OF UNITS
Manufactured home not in a park
} ,X $1,000 per unit == $' ,) 000
B. ,Sinale-Family Attached.
NO. OF UNITS
,X .$924 per unit
$
e. Multi-Famil~ Aoartment.
NO: OF UNITS
,X .$692 per unit == $
. D. .Manufactumd Horne Park
NO. OF UNITS
WILLAMALANE SDC
X '$699 per unit. . = $
$ I,{}oo
3~ TOTAL WILLAMALANE NET SDC ASSESSED
0f sac reduced for Credit) $
r7J
r-'
) .6.:>0
2. SDC CREDIT (if appUcab(e) SOG-payer mustfumlsh proof of
Vlillamalane Credit approval. See SOC Credit Worksheet. , $
De~rvlces Department
City of Springfield
q/'tl05
Date
2'25 Fifth Street
-Springfield, Oregon 97477
541-726-3759 Phone
\ )
ili:ji
.-ty of Springfield Official Receipt
velopment Services Department
Public Works Department
'"
,
.
,
Jqb/Journal Number
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-01049
COM2005-01049
COM2005-01049
COM2005-01049
COM2005-01049
COM2005-01049
COM2005-0 I 049
COM2005-0 1 049
C.PM2005-0 1 049
C,OM2005-0 1 049
GOM2005-0 1 049
COM2005-0 1 049
C6M2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
CbM2005-0 1 049
COM2005-0 1 049
COM2005-0 1 049
COM2005-0 I 049
'4
RECEIPT #:
2200500000000001216
Date: 09/02/2005
Description
Addressing Assignment
WiIlamalane Single Family
Temp Power 200 amps or less
Curbcut Permit
Mountaingate Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transpo Admin
Plan Review Major - Planning
Plan Review Residential
Building Permit
3 Baths One & Two Family
Storm Sewer Each Addtl 100'
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
Gas Outlets 4+
Gas Fireplace
Appliance Not Listed
-Mechanical Issuance Fee-
+ 7% State Surcharge
+ 10% Administrative Fee
P:ayments:
r<:rpe of Payment Paid By
GeditCard GORDON ANSWLOW
,'1
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm 005686 In Person
Payment Total:
,
i
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:.,
f,
)
:t
;[
'I
9/2/2005
Page 1 of 1
2:12:09PM
Amount Due
31.00
1,000.00
50.00
80.00
1,160.56
676.89
514.89
182.69
805.70
82.03
865.3 I
10.00 ,
151.32
63.58
150.00
27.46
1,173.40
306.00
28.00
12.00
24.00
9.00
6.00
4.00
1.00
15.00
27.00
10.00
115.88
165.54
$7,748.25
Amount Paid
$7,748.25
$7,748.25