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Home My WebLink AboutPermit Building 2007-5-22 (3) -wrr:J1Il1I.!'I~~~' \ , , , - . . CITY OF SPRIN<"t<lJ'.LU Building/Combination Permit PERMIT NO: COM2007-00729 ISSUED: OS/22/2007 APPLIED: 05122/2007 EXPIRES: 11/22/2007 VALUE: $ 19,776.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2655 GAME FARM RD ASSESSOR'S PARCEL NO.: 1703224406400 Springfield TYPE OF WORK: Family Room TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Addition to existing single family residence Owner: DARRELL ZENT Address: 2655 GAME FARM RD SPRINGFIELD OR 97477 Phone Number: 541-988-9923 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Contractor OWNER OWNER OWNER License Expiration Date Phone # of Units: Primary Occupaucy Group: Secondary Occupancy Group: Primary Constructiou Type Secondary Construction Type: # of Bedrooms: ..........- . ...... . .~_. fOllOW J BumDlJl;G,INFORMA nON I lJotifIClilti~~ ~Cv QooPte9 by th 'Q'-lU1res You t In O~~ 9 fllilf6l!OfYiS: 9 Oregon . . OJ o~. y, S2-CCHe!c9llotJ't~1i'cfiire:3 are U~~!50 cwr au meyrljjl'Jl3rHe'~~gh OAR W.nf mmt n~" rng the c~fW eP/es of th 2-00 ber for th~,Jl,eJ<<t:J: the tie rUles I En~r~(jl';jMilitv N e ~~hOng.th I Sprink1elI 'BlIjl~.'l~~tlfICatiC',l{a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: 192 I Dc. cLvPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: NOTle Overlay Dist: Urhan Fringe 28.0O,HIS E:# Street Trees Rqd: A PERMlaved Drive Rqd: UTHORIZEY <WI'A>!f~~rage: o~oIfJMMENf'r:" ~NOER !I.J~~E IF THf: IAI,,_ .r'r I ~IPU1n'Iii~;;",,,,,,j~'li',~fSl: IS NO; '''uu\\.u tOn . 11 Sidewalk Type: DownspoutsfDraius: Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee I of 3 -~4'i Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Dwellines V Wood Frame Fee Description + 10% Administrative Fee + 5% Techuology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Buildiug Permit Fire SF Fee - Residential Plan Review Minor - Planning Piau Review Residential SDC SanitarylStorm Admin Storm Drainage Impervious Area Total Amount Paid Iuitial Review Plan nine Review Public Works Review Structural Review 05/22/2007 05/2212007 05/22/2007 05/22/2007 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00729 ISSUED: OS/2212007 APPLIED: OS/22/2007 EXPIRES: 11122/2007 VALUE: $ 19,776.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $103.00 Square Footage or Bid Amount 192.00 Value Date Calculated 05/22/2007 $19,776.00 $19,776.00 Total Value of Project Fpp\', tIi4.I Amount Paid Date Paid Receipt Number $24.40 $17.32 $18.75 $43.00 $6.00 $185.40 $9.60 $112.00 $120.51 $6.44 $128.88 5/22107 5/22/07 5/22/07 5/22/07 5/22/07 5/22/07 5/22/07 5/22/07 5/22/07 5/22/07 5/22107 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 1200700000000000604 $672.30 I Plan Reviews I 05/22/2007 OS/22/2007 05/22/2007 APP LLH APP T AJ APP JLP Plan through "express" route (Express Permit) Storm tied to existing system. Applicant has been notified of the LC req. to aquire a septic responsibility form. Don Moore to handle auy follow-up on LC form. JLP APP 5/22/07 05/2212007 APP DLM 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. Rpn~ Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Paee 2 of 3 _Wtra1,!AI,N~~~' 'i ,'" ~ , . . CITY OF SPRINul'lJ!.LD Building/Combination Permit PERMIT NO: COM2007-00729 ISSUED: OS/22/2007 APPLIED: OS/22/2007 EXPIRES: 11/22/2007 VALUE: $ 19,776.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Walllnsulation: 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. 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 iuformation hereou is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinauces of the City of Springfield and the Laws ofthe State of Oregon pertaining to the work descrihed hereiu, aud that NO OCCUPANCY will be made of any structure without permission of the Community Services Divisiou, 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 "m71A~:7i~!Jf Owb;r or c~ntract&gnature s -;;-~- 07 Date Paee 3 of3 CITY. OF SiNG FIELD SYSTEMS DEVELOPMEraORKSHEET JOURNAL OR JOB NUMBER: COM2007-00729 NAME OR COMPANY: Darrell Zent LOCATION: 2655 Game Fann Rd TAX LOT NUMBER: 0 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF: 384 LOT SIZE (SF): I. STORM DRAINAGE o rFJ W o o u e<: w f-< rFJ G gj DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I CHARGE I I 384.00 I SO.336 = I $128.88 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I I 0.00 I I SO.336 I 50% = I DISCOUNT $0.00 I ' ITEM I TOTAL - STORM DRAINAGE SDC 2 SANITARV SEWER - CITY 5128.88 5128.88 1070 A. REIMBURSEMENT COST: I NUMBER OF DFU's I x COST PER DFU I 0 526.03 $0.00 ]09] B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 0 519.79 $0.00 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =, 50.00 3 TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRJP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRJPFACTORI I 9.57 o I I $19.8] . 1.00 I $0.00 1 ]093 B. IMPROVEMENT COST: I I ADT TRJP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRJPFACTORI , I I 9.57 I I 0 I $87.39 I 1.00 I $0.00 11094 ITEM 3 TOTAL - TRANSPORT A nON SDC =, $0.00 I 4. SANITARY SEWER - MWMC II A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU 1 I 0 I I S91.6] = $0.00 1054 B. IMPROVEMENT COST: INUMBER ~F FEU's I x ICOST PER FEU I S961.52 = $0.00 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMlNlSTRATNE FEE $0.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, 50.00 SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , 5128.88 5 ADMINISTRATIVE FEE, I SUBTOTAL x I ADM. FEE RATE 1= CHARGE ~ I S128.88 5% $6.44 TOTAL SANITARY ADMINISTRATION FEE: 6.44 11079 IOTAL TRANSPORTATION ADMINlSTRATION FEE: SO.OO 11078 Jeff Prociw 5/22/2007 TOTAL SDC CHARGES =, $135.32 PREPARED BY DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (Nom FOR REMODELS. CALCULATE ONL V ruE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE F[XTURE TYPE NEW OLD EOU[V ALENT UNITS IBATHTUB 0 0 3 - 0 = IDRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE I OIL I SOLIDS I ETe. 0 0 3 = 0 IINTERCEPTORS FOR SAND I AUTO WASH I ETe. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER I MOP SINK 0 0 3 = 0 ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRlG I WATER STAT[ON I ETe. 0 0 1 = 0 I RECEPTOR FOR COM. SINK I DISHWASHER I ETe. 0 0 3 = 0 I SHOWER. SINGLE STALL 0 0 2 = 0 I SHOWER. GANG ~ER OF HEADSl. 0 0 2 = 0 ISINK: COMMERClAURESIDENllAL KITCHEN 0 0 3 = 0 ISINK: COMMERC[AL BAR 0 0 2 = 0 SINK: WASH BASINIDOUBLE LA V A TOR Y 0 0 2 = 0 SINK: SINGLE LAVATORY/RESIDENllAL BAR 0 0 1 = 0 URINAL. STALL I WALL 0 0 5 = 0 :rOlLET. PUBLIC INST ALLA nON 0 0 6 = 0 TOILET. PRIVATE INSTALLAT[ON 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 -EDU (EQuivalent Dwellil1Jl. Unit) is a disc~ eQuivalent to a sin~e familv dwellin~ unit (20 DFLrs) set at ]61 JmlJons per day - MWMC CREDIT CALCULA TION TABLE: BASED ON COUNTY ASSESSED VALUE - YEAR CREDIT RATElSI,OOO ~ ANNEXED ASSESSED VALUE [S LAND ELGlBLE FOR ANNEXA T[ON CREDIT? 2 BEFORE 1979 $5.29 (Enter I for Yes, 2 for No) 1979 $5.29 IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? 2 1980 $5.19 (Enter [ for Y os, 2 for No) 1981 $5.12 BASE YEAR 1979 1982 $4.98 1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) I 1984 $4.63 VALUE I 1000 CREDIT RATE I 1985 $4.40 SO.OO x S5.29 ~ , SO.OO I 1986 $4.07 I 1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXA nON) 1988 $3.22 VALUE I 1000 CREDIT RATE I 1989 $2.73 $0.00 x $5.29 0 I 1990 $2.25 I 1991 $1.80 I 1992 $1.59 TOTAL MWMC CREDIT = SO.OO I 1993 $1.45 I 1994 $1.25 I 1995 $1.09 I 1996 $0.92 I 1997 $0.72 I 1998 $0.48 ~ 1999 $0.28 2000 $0.09 I 2001 $0.05 I I I I I I I ~ -. . . \" ,.J '. ,,' .' . 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.us Permit #: (...O/ll/\ z-o. - () 0 7 Z 1 Address: Z h sS'" G-.:AVV\ t! l::..jJa..~ Issued by: ~ ':5 Date: 12- ~I c.) 7 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are 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 befiled with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: a-l. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~ 3B. 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 P erty Owners about Construction Responsibilities on the reverse side of this form. S--.??-cJ ? (Date) ite copy to issuing agency permit file, pink copy to applicant.) Propcrty_owocr.doc 06-01-04 A~ttnlID~ tili~ ~ID!Ir ([J)WlID G~lIDennn Cltrtilid@lf? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by /he 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. lEmJPlnilJlY~Ir Re~JPlilJlnn~n]))nnn~ne~ You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: 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 don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-3784988. Unemployment TInsurance 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. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or w"vw.doLstate.oLus/formsnav.htmll for the appropriate forms. Wor!{erS' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. ' V.S. TImternal Revenne Service: As an employer, you must withhold federal income tax from employees' wages. 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 1-800-8294933 or visit their web site at wW\v.irs,g,o'y. <())tllneIr ffi.e$[pl~;rrn$n\blnnf1l:ne$ mnnilll .hIrelll$ of COnniCeIrnn!l Code Comp!ilmce: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may bc brought to your attention through inspections. I :Liability l:ntl Pi"operty Dl:mage nnsura~ce: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such ~s falling tools, paint over spray, wate,r damage from pipe punctures, fire or work that must be redone. I . I Time: Make sure you have sufficient time :0 supervise your employees. ]Expertise: Make sure you have the skil1~to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notif'y building Of,tia1s as the appropriate times so they can perform the required inspections. If you have additional questions call the Copstruction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Propcrty_owner.doc 06--01-04 .. ZON L~i)'l,; INITIALS N ~ DATE h-;:;rCl.-O( SOURCE (Y15.. 225 FIFTH STREET. SPRINCFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPliCATION City Job Number 0 II - 'J'L C{ Date -5 ' d- d. - Of ,,_.....;~... ......" ....,:"''''' . ~.... 't'-'" ..~'.z..'-, ~.-.~ ,"'." ...~o.~...,.~~~"""t"l I. ;:LOCATiONX)EIiystALtATiO!;Y:~}!J-iC';f;;\};:) .. n"""""'W1r>'~'-"--'~r~""-"'~"'.' _"'~......o:_",~:;':j:4.;J:>...;~;....;l;l; l.lo~~ or\roe_mf<Y\ . \~D3~C~JA t1 cA.CXJ ~."~ .....,::-..p " .:.,..",.~;; ...~,~.,.-:"-~.. ::-. -;: '..~,.'~'.-./. ~".' -"""'-""'''i'1f':I<''''''''','i,-":">,,i.o'{~;'.''''::J 3. rCOMPLETEFEE'Sc;HEDULE BELOW';' -;',,'1. \" '.',,;;f.".4: ~",',",,"......::i; _.; -.....Jl - rl.,,," '~:~~~r..,;,.,o;:;;.,_.....~ .:o-.k.J--:~~...:,:i8:c.'::"'.l...~:;;;t.l~~4':(~~....""".~~' ro" "(7_~:;" ''f'''_f!''.~~~;'tf.:~::- ~_=,<.,:,~, ;1j.~ .'.:fl:':"'1''' ::"~:--"''':<7~,7,-?'fr,; ~H~""f..;~:r/ ~-':;':'-."" 7" 'W: A. r-'~ ~,'r~~sid~I)!iar~'SiI)gJeor MiHti-l\~~ilfp~r dwel!IIJg ~ (1I1il.',": ,~..............",~."...~ __.-...-...._ 1 _''';' --"".../,_,,_'~_,-,.__.~'n:...._~_... ,_,-..,,,,,,,,,__ # Service Included t\;B PESC~.RlP.TION<\-: '~.tW. w' 1000 sq. ft. or less ~ Each additional 500 sq. ft. or ~ portion thereof Permits are non-t nsferahle and expire ork is Each Manufact'd Home or not started within 180 days of issuance or I ork is . Modular Dwelling Service or $50.00 \ s~sre~~~~~f~sr.#W!Pkp~x1 B. F~ii;~;'~;KW;1m\~:Y~!t~ij~li~~;~ft~f:1Ii;Nf[;J~i~T~~~~ l::~~o::~::~~.r~,,_~~=-~-" 7'=' 2:~A:psorl:~."--" . ..'. ._..~~.:;.~;~~~~~'~.~' \. / 20lAmpst0400Am~buto $75.00 Address\ / =-,"",,,'-r'()N:Ore.-4JlJrWm~'i~~obr~ Utility' $125.00 " /,.... ,_, . .r.A hv thlil or9,gor . / tollow fule& adOPoor ~I'Srl~l~q,o~~t fori $163.00 . \. .Phone .}C.;fl.....tion cenl.erol"~ 1080 ~q1352-o0 $375.00 ',,' /// -O~ft 952'()01-0CR\!?JtlfPd~~JIOf the rules I $ 50.00 In e.y obtain copies 0090. You m "-WIl~~.t~"elenhon~.... '.' ,,",,=-..' -"=', '-' '.",'--- / '""aT 110. ,.I""~"~#\f;IJi ,g ~A~~~_f","'~-;"'~'\.~<'-"1.o1'''1 Superv.sorLlcenseNnmber II'mo,heceUl p an e:nu:.s...on' ders,......"n;~ (_)'.?l~ ~._-}':"'t~~.. t' '-<",' . . /" :u~be,~~rthe o~e~~~.;;~_~;~~I.''''''''' ~_._"-Z: :",",'C=,Lk..&..e....J1~ Expiration oat;.! " . Installation; Alleration.or Relocation / _" 200 Amps or less $ 50.00 Constr. COI)ll". Number" 20 I Amps to 400 Amps $ 69.00 / " 401 Amps to 600 Amps $100.00 Expr.raf 'n Date . Over 600 Amps or 1000 Volts see "B" above. NOTI'if.y-. .....r-~ ',.' T~"';l"'=''l'''''"",.....,''e-.,<p:,'''''':'t.'''''''4'''V .-,;;!i......"" y......~.r{.'-""''''.'~'.'''. .-..-...."...'~~...' ,I> riB' . _;..;tH, h' C" '."3.~i'-"t'."\i("'" 't~'~h<""'~ "0;':~';..'ti,;"':1"'\j_",,,,,,{;,"~, :::11.l1:...... ~.,,"i';,'I','~'~'-. Sign re of Supervising Electrician TH I S PE R ~iT~~ft4~tl'*pm'ttf.~m:wMr~,~'~fil:t!:1~E!;(..~,~,.:),i?:1 AUTHORg~~d!~l)~R'THISXPERMIr IS NaOT I $ 43.00 4...~ ~ J ('OMME~E~~i\JAd!Iit\~MNGiOJ,lKrnIfOH ~ $":CO Owners ~{J)yf~ Ll ~~r ANY .180 S~;:::=:::;;i.t~;~!,~AlR:tT;tt7~~:"~~0~';~ ,...c;.-:;" Address(_4 Q~'-.J r~p .:JY"E. : ,~1Is~5'l\',~~~~rv~~f~ed~ngH~~,~I~ded)~:-~~.f!'.!~t~Ua<h':'J~ ci~N1 ('.L Phone q .qq23 Pump or irrigation $50.00 \." - Sign/Outline Lighting $ 50.00 OWNER INSTALLATION Limited Energy/Residentiai $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 is nol JPtended for sale, lease or rent. . Min~,:.m EI~~!~:~~~ ~~~~C~0,;!~~~:4:5;~~;:surchar~e~b IL~~W rJ 'l~~~1r~O'~;;'ih'~"t'." ~~ Inspection Request: 726-3769 TOTAL 56 :rB $106.00 $ t9.00 City Shared Drive(T:)/Building Forms/Electrical Pennit Application S-D6.doc 225 Fifth-Street , . Springfield, Oregon 97477 541-726-3759 Phone . irii u..-. _._ la, . <A of Springfield Official Receipt .Iopment Services Department Public Works Department Job/Journal Number COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 Payments: Type of Payment Cash CreditCard Job/Journal Number COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 COM2007-00729 Payments: Type of Payment Cash CreditCard cReceintl RECEIPT #: 1200700000000000604 Date: OS/22/2007 Description Plan Review Residential Plan Review Minor - Planning Storm Drainage Impervious Area SDC SanitarylStorm Admin Building Permit Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fire SF Fee - Residential + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By DARRELL ZENT DARRELL ZENT Item Total: l:heck Number Authorization, 'Received By Batch Number Number How Received djb In Person djb 123097 In Person Paymeut Total: Description Plan Review Residential Plan Review Minor - Planning Storm Drainage Impervious Area SDC SanitarylStorm Admin Building Permit Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Fire SF Fee - Residential + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By DARRELL ZENT DARRELL ZENT Item Total: Check Number Authorization Received By Batch Number Number How Received djb djb In Person 123097 In Person Payment Total: Page I of I 9:12:59AM Amount Due 120.51 112.00 128.88 6.44 185.40 43.00 6.00 9.60 17.32 18.75 24.40 .)\J/"'..:tJ Amount Paid $500.00 $172.30 $672.30 Amount Due 120.51 112.00 128.88 6.44 185.40 43.00 6.00 9.60 17.32 18.75 24.40 $672.30 Amount Paid $500.00 $172.30 $672.30 5/22/2007