HomeMy WebLinkAboutPermit Building 2007-2-2
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2006-01621
ISSUED: 02/02/2007
APPLIED: 12/18/2006
EXPIRES: 08/02/2007
VALUE: $ 239,982.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1422 S 58th St
ASSESSOR'S PARCEL NO.: 1802030002000
Springfield
TYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Jasper Meadows 3rd add ph 4 lot 154
Same As COM2006-00976 1455 S 58th St
Owner: HA YDEN ENTERPRISES
Address: 2622 SW GLACIER PL #110
REDMOND OR 97756
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Mechanical
Plumbing
Contractor
HA YDEN ENTERPRISES
M & W ELECTRIC INCORPORATED
PACIFIC AIR COMFORT INC
MASTER PLUMBING
BUILDING INFORMATION I
License
92208
67362
39237
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
1
R-3
U
VB
# of Stories: 2
Height of Structure:
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path: Path 1
Sprinkled Building: n/a
3
I, DEVELOPMENT INFORMATION .
Frontyard Setback: 33.50 Overlay Dist:
Side 1 Setback: 20.00 # Street Trees Rqd:
Side 2 Setback: 5.00 Paved Drive Rqd:
Rearyard Setback: 33.00 % of Lot Coverage:
Solar Setbact&TTENTIUN:UregOlO.'ffijIV r~4ullt=., yuu lU
f:Y.~,~: r~ .Ioe! ':.tn,\nton h~ thA ()r~.Q,QD.1ltilit~
Notification Center. Those rUI~I;j~l,N1IfR.OVEMENTS ,
St t I irJ~A\Ra52"()()1-0010through ~6~-uu I
ree mp 0090. You may obtai~ies~Mq~ rules b'
Stor~ Sewer t~ili\ti~hecenter. (Note: thet~~ho~e-
Special Instrr.'UWfOerforthe Oregon Utility NotificatIon
Notes: Storm H20<(S'P~il t~~Wkm-2344).
Residential
Phone Number: 541-228-1081
Expiration Date
07/29/2007
06/19/2007
03/25/2010
Phone
541-228-1081
541-754-6171
541-672-9510
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
1,154
664
480
4
Yes
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
NOTIC~~O
TllIG PCRMIT v: IA-LL [)~rmC Ir TII[ WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
C~'C1!'fp@:R IS ABANDON~u~gnde 5'
ANYowi.liPfMY/HFRn~D .
Pal!e 1 of 4
Curb and Gutter
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Garal!e
Tvpe of Construction
Garal!e
Fee Description
Plan Review Same As
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
3 Baths One & Two Family
Addressing Assignment
Appliance Vent
, Building Permit
Copies - Ea AddtI @ 50 Cnts Ea
Copy 6th @ 75 cents
Curbcut Permit
Dryer Vent
Exhaust Hoods
Fire SF Fee - Residential
Fireplace (Listed)
Furnace - up to 100,000 btu
Gas Outlets 1-4
Plan Review Major - Planning
Plan Review/Residential Hourly
PW Disc - 2nd Permit
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: cOM2006-01621
ISSUED: 02/02/2007
APPLIED: 12/18/2006
EXPIRES: 08/02/2007
VALUE: $ 239,982.00
I Valuation Description I
$ Per Sq Ft
or multiplier
$26.00
Square Footage
or Bid Amount
480.00
Value
Date Calculated
Total Value of Project
$12,480.00
$12,480.00
12/18/2006
~
Amount Paid
Date Paid
Receipt Number
$200.00
$10.00
$177.36
$98.13
$130.77
$306.00
$31.00
$6.00
$1,020.65
$24.50
$0.75
$80.00
$6.00
$9.00
$138.90
$15.00
$12.00
$4.00
$198.00
$67.50
$-30.00
$106.00
$76.00
$593.72
$780.80
$10.00
$961.52
$91.61
$146.89
$68.14
$836.32
$189.58
$80.00
$837.03
$50.00
$24.00
12/18/06
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
2/2/07
1200600000000001769
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164'
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
2200700000000000164
Pal!e 2 of 4
Building/Combination Permit
PERMIT NO: cOM2006-01621
ISSUED: 02/02/2007
APPLIED: 12/18/2006
EXPIRES: 08/02/2007
VALUE: $ 239,982.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Willamalane Single Family
$1,000.00
2/2/07
Total Amount Paid
$8,357.17
I Plan Reviews I
Initial Review
Planninl! Review
12/21/2006
12/21/2006
12/21/2006
01/30/2007
APP
APP
NJM
TAJ
Public Works Review
Public Works Review
Structural Review
Structural Review
12/21/2006
01/12/2007
02/02/2007
12/21/2006
01/04/2007
01/12/2007
02/02/2007
02/02/2007
WI
APP
APP
APP
JLP
JLP
DLM
DLM
CITY OF SPRINGFIELD -
2200700000000000164
1 backyard tree is required to be
planted per agreement between
Mark V and Andy L dated 7/21/06.
Choose a tree from page 6-3 from
the street tree handout for planter
strips 8-12', at least 2' caliper trees.
No occupancy is allowed until the
tree is planted. Contact Tara Jones
736-1003 when ready to inspect.
Waiting in order rcvd for rvw.JLP
Storm H20 to curb & gutter.JLP
Same-as permit
Same-as permit
To Request ~n 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.
L-Reouire.:unsnections I
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 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.
Pal!e 3 of 4
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: cOM2006-01621
ISSUED: 02/02/2007
APPLIED: 12/18/2006
EXPIRES: 08/02/2007
VALUE: $ 239,982.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
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.
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 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
times during construction.
---z.(/)/UU~
Owne~ or Contra'ctors Signature U
-.:J-2- - 67
Date
Pal!e 4 of 4
CITY OF SP'~GFIELD SYSTEMS DEVELOPMENl'j~RKSHEET
JOURNAL OR JOB NUMBER: C0M2006-01621
NAME OR COMPANY: Hayden Ent
LOCATION: 1422 S 58th St
TAX LOT NUMBER: ' JsprMdwsLot#154 .
DEVELOPMENT TYPE: . SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS 1 BUll-DING SIZE (SF' 1720 LOT SIZE (SF):
7066
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUSS.F. x I COST PER ST CHARGE
2494.00 I $0.336 I = $837.03
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSlRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. x I COST PER S.F. x DISCOUNT RATE DISCOUNT
;1 0.00 I $0.336 50% $0.00
ITEM 1 TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x
I 30 I
$837.03
COST PER DFU I'
$26.03 I
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 30 $19.79
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
I
I
=,
$1,374.51
COST PER TRIP. x I,NEW TRIP F ACTORI
$19.81 I 1.00 I , $189.58 1093
COST PER TRIP x I NEW TRIP FACTOR
$87.39 . I .1.00 $836.32 1094
$1,025.90
3, TRANSPORTATION
A. REIMBURSEMENT COST:
ADT TRIP RATE I x
9.57 I
B. IMPROVEMENT COST:
ADT TRIP RATE x
9.57
I NUMBER OF UNITS I x
I 1 I
I NUMBER OF UNITS' x
I I
ITEM 3 TOTAL - TRANSPORTATION SDC = ,
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
NUMBER OF FEU's x
I
ICOST PER FEU
I $91.61
B. IMPROVEMENT COST:
INUMBEROF FEU's' x
I I
'COST PER FEU
I $961.52
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I
SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) = I
5. ADMINISTRATIVE FEE:
I SUBTOTAL x ADM. FEE RATE
I $4,300.57 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
$1,063.13
$4,300.57
CHARGE
$215.03
. .-
'-'-
. Jeff Prociw
TOTAL SDC CHARGES
1/12/2007
PREPARED BY
. DATE
~- -- -~.. ~-
"---"-"
$837.03
$780.80
$593.72
=
$91.61
=
$961.52
$0.00
$10.00
, 146.89 1079
'.._....$68..1~_ 1078
= I $4,515.60
----j
tZl
~
Cl
o
u
p:::
~
E-<
tZl
.-
o
~
1070
1
'1091
1092
1054
1055
I
11054
1056
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTIJRES x UNIT EQUN ALENT = DRAINAGE FIXTIJRE UNITS
(NOlE: FOR REMODELS, CALCULAlE ONLY TIIE NET Aul.J1110NAL FIXTIJRES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE I
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
--... ~..~---~
BA1HTUB 2 "I 0 3 = 6 I
DRINKING FOUNTAIN 0 0 1 = 0
FLOOR DRAIN 0 0 3 = 0
I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
LAUNDRYTUB 1 0 2 = 2
CLOTHESW ASHER / MOP SINK 1 0 3 = 3
CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3
I SHOWER, SINGLE STALL 0 0 2 = 0
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
SINK: COMMERCIAL BAR 0 0 2 = 0
SINK.: WASH BASlN/DOUBLE LAVATORY 1 0 2 = 2
I SINK: SINGLE LAVATORY /RESIDENTIAL BAR 2 0 1 = 2
IURINAL, STALL / WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 30
*EDU (EQuivalent Dwelling Unit) is a discharge equivalent to a single flUl1ily dwelli1!~ uniJ.f!J.,~FU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$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 ELGIBLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
2
2
1979
II
r
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
=
ZON L~
INITIALS N-N\
DATE rolrxs J d[ .
SOURCE~/~
225 FiFTH STRIEET e SPRINGFIELD, OR 97477 . PFI:(541)726-3753 e FAX: (541)'726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CIJu4 ~ ..... (!) J /;?:2-1 Date
3. 10fe~~~~.if~I~~f!i;~~~~!{q~;:~t"i~~t:W~~t~~;f~;
l";.:Jf9~rtqJ.t,Q~~.s:r1f~7te~;~J;~\~ill~1~ti'
/4-qiiq"y.q, S~ 7!t s r; ",
LA~/~f
LEGAL DESCRIPTION
~#.)#~~f
JOB DESCRIPTfON
.)/J.k,U ~_ );1CS'I@JrX~
I
Permits are non-transferable and expire if work is.
not started wllthin 180 days of issuance or if work is
Suspended for 180 (lays.
2.'!~qe~~t'R~.;fci*!~~~g~:~~19~
Electrical Contractor lfY)tt.tJ flJ~c ."1\1\(....-
Address
.;zCj'3g4 H r.-V'{ ~ L{ ;; vJ
City AlkV\,\
Phone Sl.f/-7SL(-CiI7{
Expiration Date
1:.('::?,74S
10/{J7'
Supervisor License Number
Constr. Contr. Number [17 /::/..p '2-
Expiration Date (v.iJe,/.;:x;;d7
Signature of Supervising Electrician
IA--
Owners Name ~Q 1 ~ 7~t .
Address lU{?-6. S ~ $[
City ~\~_,V PhODe~2S -\D~
OWNER INMDALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
.~~ .:;~~~~~~,~i~~i~~~~~'~~fu~~it~~Jii:~~f:'~~'~~~~:~~0~L~,
Service ]lnclude~1
1000 sq. ft. or less
E,ICh additional 500 sq. ft. or
portion thereof
. Each Manufact'd Home or
Modular Dwelling Service or
F~:eder
~. $ 106.00
4- $ 19.00
I tJh ~
1~
$50.00
B. ~.;i~~r~~~i"~g:1[~~~~!f.2I-~~~~i~~~~~~1~~~~1,~;~~t~~fi?~Lttjt
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75,00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over lOOOr1!:p,ffY~: Olegonlaw reQlJil'S7J~~ to
R("A:onne~If6riJYrUles adopted by the Ore~60.~lhty
C. !i~~~~. .' ~i~~~; U'l are set forth . ",j
0090 You may obtain copies of t e ru e
Instauatl(b\I1tN~1t&e~t'M}o~9: the tel~~ho~e
200 AmP~6f,\~er for the Oregon UWity ~~.ij9-tion.70 trO
201 Amps to 400 -&8R~el is 1.800-332.23"'\4~.oo
'401 Amps to 600 Amps $100.00
Over 60,0 Amps or 1000 V 0118 see "B" above.
D. ~;~F~~5g~:';:r . .
'New A1~:ratiolil or Extension Per Panel
. . ". . '. ..,'., """ ;,',~. \ ,. >; .
One Circuit $ 43.00
Each Additional Circuit or with
N, f'\\ii"Serv:ice or Feeder Permit $ 3.00
V}UD~lb.
l~~~~~~~;j~t tif~l~~~~I~~f~tii~~~:~~i~ii~~1i!if\' .
COM~1fni'~Iof-DniI1iJ~ ABANDONED FOR $ 50.00
ANY s' RnJ;1^linv or-n}l0.n $ 50.00
19i1l-.Ylit e bl.g itmg . .
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric F'ermit Inspection Fee is $45.00 + Surcharges
4. ';I:fB~:~~i'~Ja~l~i'~:i~l~~t_
Z~2~
)~.S-~
?~ .21)
. .I /, ~ 0
8% State Surcharge
10% Administrative Fee
Wl'Al:r
.$'% rttll ft$
,,/
Shared Drive{T:)/BuiJding FonnslElectrical Permit Application 1-o6.doc
, io-T.4l. ;2~s:g~
alald~NrHdS dO XLI3 6~9~9GLrrg x~d 60:01 aaL 90/II/LO
IOO~
.
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-01621
CO M2006-0 1621
CO M2006-0 1621
COM2006-0 1621
COM2006-0 1621
CO M2006-0 1621
COM2006-0 1621
COM2006-01621
COM2006-0 1621
CO M2006-0 1621
COM2006-01621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
CO M2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
COM2006-0 1621
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
{';......, of Springfield Official Receipt
... elopment Services Department
Public Works Department
2200700000000000164
Date: 02/02/2007
Description
Fire SF Fee - Residential
Sidewalk Permit
Curbcut Permit
PW Disc - 2nd Permit
Storm Drainage 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
Addressing Assignment
WilIamalane Single Family
Plan Review/Residential Hourly
Building Permit
3 Baths One & Two Family
Furnace - up to 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
Fireplace (Listed)
-Mechanical Issuance Fee-
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Copy 6th @ 75 cents
Copies - Ea Addtl @ 50 Cnts Ea
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
HA YDEN HOMES
Item Total;
Check Number Authorization
Received By Batch Number Number How Received
lkw 046778 In Person
Payment Total:
Page 1 of 1
3:12:55PM
Amount Due
138.90
80.00
80.00
(30.00)
837.03
780.80
593.72
189.58
836.32
91.61
961.52
10.00
146.89
68.14
198.00
31.00
1,000.00
67.50
1,020.65
306.00
12.00
24.00
6.00
9.00
6.00
4.00
15.00
10.00
106.00
76.00
50.00
0.75
24.50
98.13
130.77
177.36
$8,157.17
Amount Paid
$8,157.17
$8,157.17
2/2/2007