HomeMy WebLinkAboutPermit Building 2011-1-3
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00569
IVR Number: 811199899683
www.ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
ISSUED:
APPLIED:
01/03/2011
10/22/2010
Issued
01/03/2011
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenler@cLspringfield.or.us
EXPIRES:
VALUE:
07/02/2011 '
$166,130.38
SITE ADDRESS: 746 66TH ST, SPRINGFIELD, OR 97477
ASSESOR'S PARCEL NO: 1702341300204
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
Single family residence - same as com2010-00235 752 66th St
PROJECT DESCRIPTION:
Phone Number: 541-746-0194
OWNER:
ADDRESS:
BLANKENSHIP MIKE
8063 THURSTON RD
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION ~
Contractor Type Contractor Name Lie Type lie No Lie Exp Phone
Plumbing Contractor DOUGS PLUMBING INC PLUMBING 20-162PB 07/01/2011 541-688-3385
Electrical GERARD ELECTRIC ELECTRICAL 20-284C 07/01/2011 541-741-2596
Mechanical Contractor COMFORT FLOW HEATING CO CCB 460 06/27/2011 541-726-0100
General Contractor MIKE BLANKENSHIP CORP CCB 78966 01/09/2012 541-746-0194
# of Units:
BUILDING INFORMATION ~
# of Stories: 1
Height of Structure: 18.5
Type of Heat: Forced Air Electric
Water Type: Electric
Range Type: Electric
Hazmat:
o
Occupancy Type
Construction Type
Occupancy Type
R3 Residential
Type VB
U Utility &
Miscelllaneous
Structures
Type VB
Construction Type
# of Bedrooms:
Sprinkled Building:
Fire Alarms:
Energy Path:
Electrical Specialty Code Edition:
Springfield Fire Code Edition:
Mechanical Specialty Code Edition:
Municipal I Development Code:
Plumbing Specialty Code Edition:
Residential Specialty Code Edition:
Structural Specialty Code Edition:
3
Path 2A Certified
performance-tested
duct system
Lot Size: .
Sq Ft 1 st Floor: ,1406
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage: 715
Sq Ft Carport:
Sq Ft Other: 82
Occupancy Load:
2008
I
Site Information
I
-'..r:~"",
NOTICE: ' THE WORK
THIS PERMIT SHALL ETXHP\\SR~~~MIT \S NOT "
AUTHORIZED UNDER
COMMENCED OR IS ABANDONED FOR" . '
ANY 180 DAY PERIOD.
Engineered Fill: '(vv8~88-00B- ~ S! JalUaO
Fill Volume: UO!IBO!l!ION lil!l!ln u06aJO a41 JOj Jaqwnu
Flood Hazarde-J~~dalal a~o:alON) 'JaIUaO a41 BU!llBO
land Hazarfr.,At<t~;1J a41 jO ~\l!doO U!BlqO liBW no" '0600
Retaining We~O-GS6 I:NO ~QnOJ41 0 ~OO- ~00-GS6l:J\fO U!
Soils Repoql~Yil!O@<!:1B s8)JOJ a8041 'JalUao UO!IBO!I!ION
lil!l!In UOB8JO a41 liq P8ldopB S81nJ MOIIOj
01 noli s8J!nb8J Mel u06aJO :NOI1N3il\f
Springfield Building Permit
1/3/2011
2:16:49PM
Page 1 of 6
SPRI..N.::- FIE~
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JZ''''''OJ'i OREGON
www.cLspringfield.or.us
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00569
IVR Number: 811199899683
225 Fifth SI
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenler@ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
ISSUED:
APPLIED:
01/03/2011
10/22/2010
EXPIRES:
VALUE:
07/02/2011
$166,130.38
01/03/2011
SITE ADDRESS: 746 66TH ST, SPRINGFIELD, OR 97477
ASSESOR'S PARCEL NO: 1702341300204
PROJECT DESCRIPTION:
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
Single family residence - same as com2010-00235 752 66th St
Frontyard Setback:
Interior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
12
5
16.96
42.29
1.25
DEVELOPMENT INFORMATION I
Overlay Dist:
# StreetTrees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure
to north property line:
o
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
Yes
28.1
18.5
PUBLIC IMPROVEMENTS
I
Street Improvements:
Storm Sewer:
Storm Sewer Available:
Speciallnstructon:
Subdivision Accepted:
Notes:
Sidewalk Type:
Downspout/Drains:
Valuation Description
~
Descriotion
R-3 1 & 2 family
U Utility, misc.
Tvoe of Construction
VB
VB
Unit Amount Unit TVDe
1,406.00 Sq Ft
795.00 Sq Ft
Unit Cost
96.83
37.72
Value
136,142.98
29,987,40
166,130.38
Springfield Building Permit
1/3/2011 2:16;49PM
Page 2 018
SP~I.N..G. FIE.~D
~!4~_
.~ .ilt4
~~ ,~J7
~~} ~"' OREGON
www.ci.springfield.or.us
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: .811-SPR2010-00569
IVR Number: 811199899683
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
ISSUED:
APPLIED:
01/03/2011
10/22/2010
EXPIRES:
VALUE:
07/02/2011
$166,130.38
01/03/2011
SITE ADDRESS: 746 66TH ST, SPRINGFIELD, OR 97477
ASSESOR'S PARCEL NO: 1702341300204
PROJECT DESCRIPTION:
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
Single family residence. same as com2010-00235 752 66th St
FEES PAID
~
Descriotion Amount Paid Date Paid Recio! #
Same as Plan Review Submittal $250.00 10/22/2010 2010000648
One or Two Family Dwellin!! with Two Bath $374.00 01/03/2011 2<:'11000007
Range hood/other kitchen equipment $13.00 01/03/2011 2011000007
Single-duct exhaust (bathrooms, toilet compartments, utili $27.00. _______01/03/2011 2011000007
Planning - Major Review - City .$211.00 01/03/2011 2011000007
Willamalane fees - Single family detached $3,468.00 01/03/2011 2011000007
SDC: Reimbursement Cost - Storm Drainage $492.92 01/03/2011 2011000007
SDC: Total Transportation Administration Fee $121.73 01/03/2011 2011000007
SDC: Total Sewer Administration Fee $314.05 01/03/2011 2011000007
_._-~-~._.,..~~-~-
SDC: Compliance Cost - MWMC Regional Wastewater SI $22.63 01/03/2011 2011000007
SDC: Improvement Cost - MWMC Regional Wastewater 1 $1,333.57 01/03/2011 2011000007
SDC: Reimbursement Cost. MWMC Regional Wastewat, ~y.!.....-. 01/03/2011 2011000007
SDC: Improvement Cost - Storm Drainage $895.03 01/03/2011 2011000007
SDC: Reimbursement Cost - Local Wastewater $2,549.28 01/03/2011 2011000007
SDC: Improvement Cost - Local Wastewater $1,285.68 01/03/2011 .___ 2011000007
SDC: !3."~mbursement - Tran:!'ortation SDC $426.92 01/03/2011 2011000007
SDC: Improvement - Transportation SDC $1,597.62 01/03/2011 2011000007
Technology fee (5% of permittotal) $75.62 01/03/2011 2011000007
State of Oregon Surcharge (12% of applicable fees) $176.93 01/03/2011 2011000007
Admin fee (10% of applicable fees) $11.02 01/03/2011 2011000007
Permit Fee Adjustment.- State Surcharge. ____...........!::~~____ 01/03/2011 2011000007
Permit Fee Adjustment - Electrical $63.00 01/03/2011 2011000007
Permit Fee Adjustment - Tech Fee _.__...$~~~_. _______ 01/03/2011 ..2011000007
~irst Appliance Fe! $79.00 01/03/2011 2011000007
~<:~ress ~ssignment, e.ach new or change $38.00 01/03/2011 2011000007
Structur~,B.uilding Pe~mit Fee --- $981M--- 01103/2011 2011000007-
Residential Fire (.05 Per Sq Foot) ---- -----.~--.. sm1s-'--'-61103/2011--- -. -. ":261100000-7
SDC Administrative Fee - MW~C Regional Wastewater: $10:-00 ------01/03/2'011 .= :..:.'_:___2~:i.D.~Q()0~
Total Amount Paid $15,040.27
Springfield Building Permit
1/3/2011 2:16:49PM
Page 3 of 6
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00569
IVR Number: 811199899683
www.ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
01/03/2011
10/22/2010
155 ued
01/03/2011
ISSUED:
APPLIED:
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@cLspringfield,or.us
EXPIRES:
VALUE:
07/02/2011
$166,130.38
SITE ADDRESS: 746 66TH ST, SPRINGFIELD. OR 97477
ASSESOR'S PARCEL NO: 1702341300204
SCOPE: Single Family Res~dence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
Single family residence - same as com2010-00235 752 66th St
PROJECT DESCRIPTION:
Plan Review
~
Deoartment
Application Acceptance
Received Due Date Comoleted Result
10/22/2010 10/22/2010 10/26/2010 Application Accepted
Planning Review
10/26/2010 10/26/2010 10/27/2010 Approved
Reviewer
David Bowlsby
Deyelte Kelly
t:SQ;a~?:-;:::_)t~:O/J!~~2~:r:!~~~/29~:~\lr~2:1~,{>~!~~~1ff"":' ~h~iSJ~~rIL~"_ :;. ::',_.:-~'.: ....; j
Public Works Review 10/26f2010 10/26/2010 11/02/2010 Approved Kaye Wilson
Comments: Storm water to drywell
1,\.
eo,,'
'"~
~. ~..' <::"'. ~
Permit Issuance
11/16/2010 11/16/2010 01/03/2011
Issued
Springfield Building Permit
1/3/2011 2:16:49PM
David Bowlsby
Page 4 of 6
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
www.ci.springfield.or.U5
Building I Residential Permit
PERMIT NO: 811-SPR2010-00569
IVR Number: 811199899683
permitcenter@ci.springfield.or.us
PROJECT STATUS:
STATUS DATE:
Issued
01/03/2011
ISSUED:
APPLIED:
01103/2011
10/22/2010
EXPIRES:
VALUE:
07/02/2011
$166,130,38
SITE ADDRESS: 746 66TH ST, SPRINGFIELD, OR 97477
ASSESOR'S PARCEL NO: 1702341300204
PROJECT DESCRIPTION:
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
Single family residence. same as com2010-00235 752 66th St
INSPECTIONS REQUIRED .~
Inspections
1020 Zoning/setbacks
1090 Street Trees
1110 Footing
1118 Footing Drain
1120 Foundation
Footing: After trenches are excavated.
1160 UFER Ground
Foundatjon: After forms are erected but prior to concrete placement.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in
conjunction with footing and/or foundation inspection.
1220 Underlloor framing
1260 Framing
Framing Inspection: Prior to cover and after all rough in inspections have been
approved.
1410 Underiloor insulation
1420 Insulation Vapor Barrier
1430 Insulation Wall
Wall Insulation: Prior to cover.
1440 Insulation Ceiling
1520 Interior Shearwall
Ceiling Insulation: Prior to cover.
Shear Wall Nailing: Before covering sheathing with finish materials.
1530 Exterior Shearwall
1540 Gypsum Board/Lath/Drywall
Drywall: Prior to taping, Lath/Plaster: To be made after all lathing and gypsum
board, interior and exterior are in place, but prior to plastering.
Final Building: After all required inspections have been requested and approved and
the building is complete.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
1999 Final Building
2200 Underfloor Mechanical
2300 Rough Mechanical
2999 Final Mechanical
3130 Footing/Foundation Drains
3170 Underlloor Plumbing
3200 Sanitary Sewer
3315 Water Line
Underfloor Plumbing: Prior to insulation or decking.
Sanitary Sewer Line: Prior to filling trench and including required testing,
3400 Storm Sewer
Storm Sewer Line: Prior to filling trench.
3411 Perimeter Rain Drains
Springfield Building Permit
1/3/2011 2:16:49PM
Page 5 of 6
--
www.cLspringfield.or.us
CITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2010-00569
IVR Number: 811199899683
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@ci.springfield.or,us
PROJECT STATUS:
STATUS DATE:
Issued
01/03/2011
ISSUED:
APPLIED:
01/03/2011
10/22/2010
EXPIRES:
VALUE:
07/02/2011
$166,130.38
SITE ADDRESS: 746 66TH ST, SPRINGFIELD, OR 97477
ASSESOR'S PARCEL NO: 1702341300204
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION:
Single family residence - same as com2010-00235 752 66th 5t
3500 Rough Plumbing
3999 Final Plumbing
4000 Temporary Power Service
4225 Service or Feeder
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
4500 Rough Electrical
4999 Final Electrical
Rough Electric: Prior to Cover
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 or 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 ar requested at the proper time, that each address is readable from the street, that the
permit card is located at the front f th property, and the approved set of plans will remain on the site at all times during
construc.tion.
Owner or Contractor Signature
Springfield Building Permit
1/3/2011 2:16:49PM
Page6of6
2~ willamalane
t\&i Park and Recreation District
Job. No. 5/0 ~ r6 7
SYSTEM DEVELOPMENT CHARGE WORKSHEET
July.1-December 31,2010
NAME: :3c.-'fN/~'::lVrritp PHONE:~
ADDRESS: YOC,7 /1U~J SFt=C-~ STATE~P: 7"?Y?1
LOCATION OF PROPOSED BUILDING SITE:
Street Address: ?7'? #~ j'T fPH-D
Plat Name:
Tax Lot Number:!?".?- J l{/ '3 ~ oX> c.r
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the
back.)
A. Sinale-Family Detached
NO. OF UNITS /
X $3,468 per unit = .
$ ;]Cf6J'
. B. Sinale-Family Attached
"NO. OF UNITS
X $3,538 per unit = .
<I:
y
C. Multi-Family Apartment
NO. OF UNITS
X $2,906 per unit =
$
D. Sinale Room Occu'pancy
NO. OF UNITS
X $1,453 per unit =
$
E. Accessory Dwellina Unit
NO. OF UNITS
X $1,734 per unit =
$
$
WILLAMALANE SDC
2.SDC CRE'DIT (If applicable) SDC payer must fumish proof of
Willamalane Credit approval.)
$IT
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC redu~ed for Credit)
$ ~'f?f
~~
Development Services Department
City of Springfield
"~3 I cC::/1
Date
5
$l4f,1V1.t:.' Irr; 75 Z "+to..
CO-- 2010 -O()~JJ-
Structural Permit Application
I @UW@fI~(On~~~
225 Fifth Street. Springfield, OR 97477 . PH(54 I )726-3753 . FAX(54! )726-3689
DEPARTMENT USE ONLY
yflwo-cc sf:" '7
Penmt no.:
I SP"N."".
~a;
Dale:(6 . ZZ -(0
This permit is issued under OAR 918~460-0030. Permits expire if work is not started within 180 days of issuance or if work is
suspended ror 180 days, -
Date:
D Ves D No
DVes DNo
CATEGORV OF CONSTRUCTION
sidentiiif t
o Government
o Commercial
JOB SITE INFORMATION AND LOCATION
ZIP: 'j'?1f 78
City:
Phone:
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.
Sign here:
CONTRACTOR INSTAllATION
Address:
City:
Phone:
E-mail:
CCB license no.:
Print name:
Signature:
SUB.CONTRACTOR INFORMATION
Name
Electrical
Plumbing
Mecbanical
CCB License Number
Phone Number
FEE SCHEDULE
1. Valuation information
(n) Job description: S,,,,,,, t I~. a1_,/~ 12et....1~...'#.
Occupancy 2..1 '"" ,
Construction type: \/R
Square feet: / CJbe
Cost per square foot:
Other information:
Type oUleat: f:::"t. tt..\ r-_~ ......,~ A,l?
Energy Path: 7A
...er new D alteration D addition
(b) Foundation-only permit? DVes ..ErNo .-
Total valuation: . $ I '70
2, Building rees
(a) Pennit fee (use valuation table): $
(b) Investigative fee (equal to [2a]): $
(e) Reinspection ($ per hour): $
(number of hours x fee per hour)
(d) Enter 12% surcharge (.12 x [2a+2b+2c]): $
(e) Subtotal offees above (20 through 2d): $
3, Plan review rees ,; k1Ae
(a) Plan review (65% x permit fee [2a]): ...;>' Jrc $ ZSC
(b) Fire and life safety (40% x pemd! fee [2alr $
(c) Subtotal offees above (3a and 3b): $
4. MisceUaneous rees
(a) Seismic fee, 1% (.01 x permit fee [2a]): $
TOTAL fees and s,-!fcharges (2e+3C+4a): $
87/CfS-
www.ci.springfield:or.us
TRANSACTION RECEIPT
811-SPR2010-00569
746 66TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000648 RECORD NO: 811-SPR201O-00569 DATE: 10/22/2010
IDES' C"R' fD"FIO'N""':tt".,L''''!,~'~liil~'t~ ;c,=.:,";::.c",,~;~.~~- ,"s('A'C' C' O"U'N"T';C"O"'O"E' ,,",'.i,Y:0A'~' 'A'MOU'NT:O"UE'" i;;",:"~" "o'J
l!~",c_.._^,,< 1:;",. ~~J5C'-""-'~~~'''''0.'~ ", ',' .\-_....,$",..v'.;::.'ii~di:' .v~~_..,_,_..~.......__,.....t<o>~"'+.0',"'0"_.""""',._".._,_,,__ ,",d'--. "'-. .
Same as Plan Review Submittal 224-00000-425602 $250,00
TOTAL OUE: $250,00
t:'~AVMI;.N"F'"FYPE' -," pAV6R','_CASHiER"D80WtS8~- *t~QMME-N"FS';:"t',;"~y2f~"..~~ciS'i;1;''; 'AMOUNT PAID ;~,". fj0;'
Check
13047
MIKE BLANKENSHIP CORP
$250.00
$250.00
. . ' .
S,~~:~G.~E~
~'';'''-Ac
~'i1 01
::t~\ OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00569
746 66TH ST
CITY OF SPRINGFIELO
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenler@ci.springfield.or.us
IlECEIPT NO: 2011000007 IlECOIlD NO: 8 I I -SPR2010-00569 DATE: 01/03/2011
IDESCRiptIO/lf"T?),....',.,".' ':,;'",','., ',:.Z'.''t;?;i1-5JtJ'-':'V'A' 'C"C'O'U"'NT'/C'O'O'E:. !"V:.-;L".,.,:A'M"'O' U"N T"O'" U'E' '.:"i,~,"'.:J
I:.!:!!:_..__.~,""_,~,,,:,~,,;,,;,,;;:;;;~..;, '.' .'..... _;i~_~~~..c-,,=~ ". """" .. .... ill... ". ~~._, '.-'".~. . ......._.;._ .. _.. ___~_._.____-,-J
Residential Fire (05 per Sq Foot) ._,.,_.___,,_~o.O_o.-424005 ___~1~015.
Structural Building Permit Fee 224-00000-425602 $98144
......~--
Address Assignment, each new or change 224-00000-425602 $38.00
First Appliance Fee 224-00000-425604 $79.00
One or Two Family Owelling with.Two Bath 224-00000-425603 $374.00
Range hood/other kitchen equipment 224-00000-425604 $13.00
Single-duct exh~ust (bathrooms, toilet compartments, utility rooms) 224-0000o.-42~604 ____,.......$27,0.0."
Plannin,g - Major Review - City , 100-00000-425002 $211.00
Wlllamalane fees - SI~gle family detached 82,1'00000-21,5023 $3,468.00
SOC: Reimbursement Cost, Storm Orainage 441-00000-448029 $492.92
- "---'~~'''~-~--'"--~-~'-------''''-~-----'~---''-'-
SOC: Total Transportation Administration Fee 719-00000-426604 $12~.
,SOC: Total Sewer Administratio"Fee____. 719-00000-426604 ________ $31..4.:.0.5..
SOC: Administrative Fee - MWMC Regional Wastewater SOC 611-00000-426604 _......!10,0~
SOC: Compliance Cost - MI'!!MC 8egional Wastewater SOC 444-00000-426607 $22.63
SOC: Improvement Cost - MWMC Regional Wastewater SOC 445-00000-448025 $1,333.57
SOC: Reimbursement Cost - MWMC Regional Wastewater SOC 444-00000-448024 $101,97
SOC: Improvement Cost - Storm Orainage 440-00000-448028 $895.03
SOC: Reimbursement Cost - Local Wastewater 442-00000-448024 $2,549.28
SOC: Improvement Cost - Local Wastewater 443-00000.448025 $1,285.68
,sOC: Reimbursement - Transportation SOC 446-00000-448026 $426,92
SOC: Improvement - Transportation SOC 447-00000-448027 $1,597.62
Technology fe~Jli% ~f permit total) 1.00-00000.42:;;.95 .._ __ .~2.~~~_
State of Oregon Surcharge (12% of applicable fees) . _____ 821-00000-215004 $176.93
Admin fee (10% of al'plicable fees) 224-00000-426605 $11,02
Permit Fee Adjustment - State Surcharge 821-00000-215004 $7.56
Permit Fee Adjustment - Electrical 224-00000-426102 $63,00
....> -~
Permit Fee Adjustment - Tech Fee 100.00000-425605 $3.15
TOTAL DUE: $14,790.27
bdl'AYMEN'T.T;YPEf;l;:;;':PAYOR"'7",Ij6'AsHIER DBOW,SBY "'/"COMMENTS;::',+s;'1'1,""", :'-,'ifiATi"'"""AMO"UNT-PA' '1'0 ',;li",''''1'''' ." J
~~_~--.-~ --"'~. 4 'lli^'~----'_~';"'_,,"....... ..,....._..._......,....."''''.. ._, "'..~.......~. H....; .., .-.. .~..' ___ ,'" ",' ,.,,,,e~.'...~'..' ,.J
Check
13147
MIKE BLANKENSHIP CORP
$14,790.27
$14,790.27