HomeMy WebLinkAboutPermit Building 2006-4-27
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6127 Fernhill Lp
ASSESSOR'S PARCEL NO.: 1702343407400
.=ITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2006-00270
ISSUED: 04/27/2006
APPLIED: 03/06/2006
EXPIRES: 10/27/2006
VALUE: $ 284,839.00
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Mt Gate subd lot 66
Residential
ATTENTION: Oregon law requires you ~Phone Number:
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
-.---".............1
in OAR 952-UU1-UU I U lll! UU\:JII Vr\1 I vv'- vv ,
(e',OI~1)JM,€r'R0.R)IN:F.(j)R(M>A'$I(!JNn ~ rules by
calling the center. I\101e: lit It: ~~ho.~e
Contractor number for the Oregon lli:Ce.i1seJtlfICCE;liljjiration Date
RIVER VALLEY BUILDERS lfN('iter is 1-800-:.i:.3a56644). 04/15/2007
G & E ELECTRIC INC 54468 09/15/2007
MIDWAY MECHANICAL INC 154166 01/30/2007
ALAN DOUGLAS HAlMA 163929 03/29/2007
Fully Improved
Yes
Owner:
Address:
RIVER VALLEY BUILDERS
PO BOX 832
SWEET HOME OR 97386
Contractor Type
General
Electrical
Mechanical
Plumbing
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
10.00
13.80
5.30
46.40
0.00
Subdivision Not Accepted
Street Improvements:
Storm Sewer Available:
Special Instruction:
541- 726-0330
Phone
541-760-7881
541-967-7045
541-928-2423
541-967-7686
BUILDING INFORMATION I
1
R-3
U
VN
11,634
2,151
440
3
# of Stories: 2 Lot Size:
Height of Structure 29,.00 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 GaragelCarport
Energy P'~~l\CE: Path 1 ,,~,~tffl~l\NORK
Sprinkledl~~dPl~MIT S\1ML'a EXPIl"6dfup~~tltO~~JT
-1- llil"rr iUI~ PFRf\I\\
I DEVELOPMENf\~t.QR~ 'ABANDONED FOR
~61,",,~, DAv PERIOD REQUIRED PARKING
ANY 180 ,\ .
Overlay Dlst: Hillside
# Street Trees Rqd: 3
Paved Drive Rqd: Yes
% of Lot Coverage: 34.90
691
Total:
Handicapped:
Compact:
2
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
Downspouts/Drains:
To Storm Sewer
Notes: No hook-up to city infrastructure until subdivision has final acceptance.Storm drainage piped to existing
stu b.3/13/06JLP
Paee 1 of 4
.
:ITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: cOM2006-00270
ISSUED: 04/27/2006
APPLIED: 03/06/2006
EXPIRES: 10/27/2006
VALUE: $ 284,839.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
A.C. - Residen
Dwellines
Garaee
Type of Construction
AC - Residential
V Wood Frame
Garaee
$ Per Sq Ft
or multiplier
$4.00
$99.00
$26.00
Square Footage
or Bid Amount
2,591.00
2,591.00
691.00
Value
Date Calculated
Description
Total Value of Project
$10,364.00
$256,509.00
$17,966.00
$284,839.00
04/24/2006
03/06/2006
03/06/2006
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $737.36 3/6/06 1200600000000000257
-Mechanical Issuance Fee- $10.00 4/27/06 1200600000000000562
+ 10% Administrative Fee $163.59 4/27/06 1200600000000000562
+ 8% State Surcharge $130.87 4/27/06 1200600000000000562
3 Baths One & Two Family $306.00 4/27/06 1200600000000000562
Addressing Assignment $31.00 4/27/06 1200600000000000562
Appliance Vent $6.00 4/27/06 1200600000000000562
BoilerlComp Up To 100,000 btu $12.00 4/2 7/06 1200600000000000562
Building Permit $1,166.90 4/2 7/06 1200600000000000562
Curbcut - Additional Driveway $40.00 4/27/06 1200600000000000562
Curbcut Permit $80.00 4/27/06 1200600000000000562
Dryer Vent $6.00 4/27/06 1200600000000000562
Furnace - up to 100,000 btu $12.00 4/27/06 1200600000000000562
Gas Fireplace $15.00 4/27/06 1200600000000000562
Gas Outlets 1-4 $4.00 4/27/06 1200600000000000562
Mountaingate Impervious Area $1,487.09 4/27/06 1200600000000000562
Plan Review Major - Planning $150.00 4/27/06 1200600000000000562
Plan Review Residential $21.13 4/27/06 1200600000000000562
Sanitary Sewer - Improvement $553.03 4/27/06 1200600000000000562
Sanitary Sewer - Reimbursement $727.03 4/27/06 1200600000000000562
SDC MWMC Administration $10.00 4/27/06 1200600000000000562
SDC MWMC Improvement $865.31 4/27/06 1200600000000000562
SDC MWMC Reimbursement $82.03 4/27/06 1200600000000000562
SDC SanitarylStorm Admin $173.62 4/27/06 1200600000000000562
SDC Transpo Admin $62.02 4/27/06 1200600000000000562
SDC Transpo Improvement $805.70 4/27/06 1200600000000000562
SDC Transpo Reimbursement $182.69 4/27/06 1200600000000000562
Storm Sewer Each AddtI 100' $28.00 4/27/06 1200600000000000562
Temp Power 200 amps or less $50.00 4/27/06 1200600000000000562
Vent Fan $30.00 4/27/06 1200600000000000562
Willamalane Single Family $1,000.00 4/27/06 1200600000000000562
Total Amount Paid $8,948.37
Paee 2 of 4
.
':::ITY OF SPRINGFIELD.
Status
Issued
Building/Combination Permit
PERMIT NO: cOM2006-00270
ISSUED: 04/27/2006
APPLIED: 03/06/2006
EXPIRES: 10/27/2006
VALUE: $ 284,839.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review
LDAP Review
03/07/2006
03/07/2006
I Plan Reviews I
03/10/2006 APP
03/07/2006 10
LLH
VRJ
Plannine Review
03/10/2006
04/06/2006 APP
TAJ
Full review LDAP submitted by
Mr.Larkin 3-6-2006 and is under
review. $600.00 due at issuance.
Fence vegetation easement with
orange construction fencing and
keep all construction activity out of
this area.
No hook up until city accepts
subdivison. Storm drainage to
existing stub.3/13/06JLP
See documents for Plan review
comments
Public Works Review
03/10/2006
03/1312006 APP
JLP
Structural Review
03/10/2006
04/2412006 APP
DLM
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.
~eouiredJnsDections I
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Curbcut - Overwidth: After forms are erected but prior to placement of concrete.
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.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
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.
Final Building: After all required inspections have been requested and approved and the building is complete.
Underfloor Plumbing: Prior to insulation or decking.
Underfloor Drain: Prior to cover or placement of concrete.
Paee 3 of 4
.
':ITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: cOM2006-00270
ISSUED: 04/27/2006
APPLIED: 03/06/2006
EXPIRES: 10/27/2006
VALUE: $ 284,839.00
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.
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.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
Temporary Electric: Approval required prior to Utility Company energizing pole.
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.
Drywall: Prior to taping.
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical work is complete.
Water Line: Prior to filling trench and including required testing.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Rough Electric: Prior to Cover
Final Gas: When all gas 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 0 any structure without permission of the Community Services Division, Building Safety.
I further certify that only contra rs a d employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to e ure that requir, d inspections are requested at the proper time, that each address is readable from the
street, that t e p it card i ocate t t front of the property, and the approved set of plans will remain on the site at all
times duri struction.
~'
Owner or Contractors Signature
4-cP7-- tJ h
Date (
Paj!e 4 of 4
~PR'NR~RP - ^r.
"J\\; rr<\ \ \Y\
~~K
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMII AJQ>LICATION
City Job Number ~ .1\ 0 .rL: I U Date
3.
1.
t O\'}}l. Xf\\\\\\
LEGAL DESCRIPTION
\\ DL~?* O\~oO
A.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
JOB DESCRIPTION
r"\ ~~~Volllf\ I~\\.\
- \
Permits are no -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
r I t -~'rJ
Each Manufact'd Home or 'I
Modular Dwelling Sei:vice or -
Feeder ,:('\1
$50.00
B.
., ,-:', ,,~:';8
200AmpsorJess """ ,.,I~'''''''':r\n
.' _ _, L \; ....... .dIU...AI..u...'
201.Ampsto 400 Amp~ 0;".)'
'. 40,1 Ainps to-600-'Amps-
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
/
~,
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Addres '\
~
City
c.
Installation, Alteration or Relocation
200 Amps or less \
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D'l
~~~PdtU;r. fiH€lltbEi~R ~ lfaJJil E
p.b:erfiirn'UiUED UNDtR THIS PERMIT IS ~.9J~00
~lf5~get9!3t[<i.!)qi;T~UfSOA @{tJWOUNl::UrUR
f1!j\'}ce qr-,Feederrl?ermT1i 0 $ 3.00
d\JY 1(',\, lJl,T FenlIJ .
m~()
$ 50.00
$ 69.00
$100.00
\
Expiraf n Date
Sig tu" of Supecvi,ing Electri'i,n~
Owners Name ~\" ex- ~rl \\e.tA
Address \) 0 ~ ()~ V3'J- \
City&~(+- ~hone \1.lo.o.m
E.
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
OWNER INST ALLA nON
The installation is being made on property I own which
is not intend for sal , eas or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
5) .cD
'\- .00
3c(iY
4.
8% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application I-06.doc
= $865.31. " 1055 .
I
$0.00 I 1054
I
$10.00 11056
$957.34
$4,712.88
CHARGE
$235.64
173.62 1079
$62.02 11078
TOTAL SDC CHARGES =, $4,948.52
U 9' CI:; OF !NG~IELD SYSTEMS DEVELOPME,aORKSHEET
JOURNAL .oR JOB NUMBER: caM2006-00270
NAME .oR CaMPANY: River Valley Builders'
LaCATlaN: 6127 Femhill Lp
TAX LaTNUMBER: 1002343407400
DEVELaPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS ] BUILDING SIZE (SF' 3414 LaT SIZE (SF):
I. STaRM DRAINAGE
DIRECT RUNaFF Ta CITY STaRM SYSTEM
IMPERVIaUS ST x CaST PER S.F. CHARGE
4604.00 $0.323 = $1,487.09
RUNaFF RaUTED Ta DRYWELL DESIGNED AND CaNSTRUCTED Ta CITY STANDARDS
I IMPERVIaUS S.F. x caST PER S.F. x D1SCaUNT RATE
10.00 $0.323 50%
o
D1SCaUNT'
$0.00
ITEM 1 TOTAL - STORM DRAINAGE SDC
. .
$1,487.09
$1,487.09
2. SANITARY SEWER - CITY
A. REIMBURSEMENT caST:
I NUMBER .oF DFU's x
I 29
B. IMPRaVEMENT COST:
I NUMBER .oF DFU's' x
I 29
caST PER DFU
$25.07
$727.03
. $]9.07
$553.03
. ITEM 2 TOTAL - CITY SANITARY SEWERSDC
=1
$1,280.06
3. TRANSpaRTATlaN
A. REIMBURSEMENT caST:
I ADT TRIP RATE x
I 9.57 '
I NUMBER .oF UNITS x
I I
x INEWTRIPFACTaR
I 1.00
caST PER TRIP '
$]9.09
$182.69
B. IMPRaVEMENT caST:
ADT TRIP RATE x NUMBER .oF UNITS x
957 I
x I NEW TRIP F ACTaR
I 1.00
ITEM 3 TOTAL - TRANSPORTA nON SDC
=1
caST PER TRIP
$84.19
$988.39
$805.70
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT caST:
INUMBER .oF FEU's x
I ]
I caST PER FEU
I . $82.03
$82.03
B. IMPRaVEMENT caST:
INUMBER .oF FEU's x
I I
IcaST PER FEU
I $865.31
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =,
SUBTOTAL (ADD ITE~S 1, 2,3, & 4) = 1
5. ADMINISTRATIVE FEE:
, SUBTaTAL x I ADM. FEE RATE
$4,712.88 I 5%
TaTAL SANITARY ADMINISTRATlaN FEE:
TaT AL TRANspaRT A T1aN ADMINISTRA TlaN FEE:
Cheryl Slaymaker
3/13/2006
PREPAREDBY ,
DATE
rF1
~
o
o
u
,~
~
I:"""
i:/J
I...... .
I:.:J
I~
1'070
]091
]092
I
1093
I ]094
1054
.
.
~ ~ I'
'..
. .
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO, OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 2 0 3 = 6
DRINKING FOUNTAIN 0 0 1 = 0
FLOORDRAIN 0 0 3 = 0
I INTERCEPTORS FOR GREASE / OIL / SOLIDS I ETC 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
I LAUNDRY TUB 1 0 2 = 2
ICLOTHESWASHER / MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
I MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRIG / WATER STATION / ETC 0 0 1 = 0
I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
ISHOWER, SINGLE STALL 1 0 2 = 2
I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
I SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2
ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 = 2
URINAL, STALL / WALL 0 0 5 = 0
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
.TOILET, PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 29
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$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 ELGIBLE FOR ANNEXATION 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 / 1000 CREDIT RATE
$0.00 x $5.29
= ,
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE I 1000 CREDIT RATE
$0.00 x $5.29
o
=
$0.00
TOTAL MWMC CREDIT
.
. of Springfield Official Receipt
elopment Services Department
Public Works Department
225 Fifth Street ,
Spri~gfiel( Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
Payments:
Type of Payment
CreditCard
Check
cReceintl
RECEIPT #:
1200600000000000562
Date: 04/27/2006
Description
Curbcut - Additional Driveway
Addressing Assignment
Willamalane 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
BoilerlComp Up To 100,000 btu
Appliance Vent
Dryer Vent
Gas Outlets 1-4
Gas Fireplace
~Mechanical Issuance Fee~
Vent Fan
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
RIVER VALLEY BUILDERS
RIVER V ALLEY BUILDERS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
djb
12207
151072 In Person
In Person
Payment Total:
Page I of2
IO:23:13AM
Amount DOle
40.00
31.00
1,000.00
50.00
80.00
1,487.09
727.03
553.03
182.69
805.70
82.03
865.31
10.00
173.62
62.02
150.00
21.13
1,166.90
306.00
28.00
12.00
12.00
6.00
6.00
4.00
15.00
10.00
30.00
130.87
163.59
$8,211.01
Amount Paid
$8,000.00
$211.01
$8,211.01
4/27/2006
... I " "'.
'--,
I
'\ -.
Job/Journal Number
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270,
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM200~-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
COM2006-00270
Payments:
Type of Payment
CreditCard
Check
cReceintl
'RECEIPT. 1200600000000000562
.te: 04/27/2006
Description
Curb cut - Additional Driveway
Addressing Assignment
Willamalane Single Family
Temp Power 200 amps or less
Curb cut Permit
Mountaingate Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Imp'rovement
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
Boiler/Comp Up To 100,000 btu
Appliance Vent
Dryer Vent
Gas Outlets 1-4
Gas Fireplace
~MechanicalIssuance Fee~
Vent Fan
+ 8% State Surcharge
+ 10% Administrative Fee
"
Paid By
RIVER VALLEY BUILDERS
RIVER VALLEY BUILDERS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 151072 In Person
djb 12207 In Person
Payment Total:
Page2of1
10:23:13AM
Amount Due
40.00
31.00
1,000.00
50.00
80.00
1,487.09
727.03
553.03
182.69
805.70
82.03
865.31
10.00
173.62
62.02
150.00
21.13
1,166.90
306.00
28.00
12.00
12.00
6.00
6.00
4.00
15.00
10.00
30.00
130.87
163.59
$8,211.01
Amount Paid
$8,000.00
$211.01
$8,211.01
4/27/2006