HomeMy WebLinkAboutPermit Building 2005-9-22
Status
Issucd
225 Fifth Strrr!, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 I n'peetion Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-01177
ISSUED: 09/22/2005
APPLIED: 08/29/2005
EXPIRES: 03/22/2006
VALUE: $ ]54,576.00
SITE ADDRESS: 6030 QUARTZ AVE
,\SSESSOR'S PARCEL NO.: 1802033400185
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New Residential
I'IW.IECT DESCRiPTION: Single family residence- Jasper Meadows 2nd add lot 138. SAME AS COM2005-00896
6057 Pebble Ct
O\\'ner: 11,\ YDEN ENTERPRISES INC
-, Aclcln',,: 1622 SI\' GLACIER PL #110
IU:n'lOND OR 97756
I CONTRACTOR INFORMATION'
Contractor Typc
Ct.'lll'fal
Eh>dl"iclIl
i\ll'l..'lwllkal
PllIlIIhillg
Contractor
HAYDEN ENTERPRISES
THORNTON ELECTRIC INC
JET HEATING INC
.JET MECHANICAL LLC
License
92208
116329
3944
158633
# of Units:
Prilll:lr~' (kt.'Ufl:llll'Y Croup:
St.'l'llnll:lr~' Ol'l'Up::llry Group:
Pl'illlar~' COllstl'Ul'liull Type
Sl'l'4lJlllary Cunstruction Type:
# (If Ikdroollls:
BUILDING IN FORMA TION I
I
R-3
U
VN
# of Stories: I
Height of Structure 17.00
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path: Path 1
Sprinkled Building: n/a
3
1 DEVELOPME" I mrORMATION ,
Fronl""...1 S,'lh"l'k: 18.00 Overlay Dist:
Sicle I Seth"",,, 5.80 # Street Trees Rqd:
Sicle 2 Seth"",,, 6.10. 5 OU t8aved Drive Rqd:
Ih'"ry"nl S~\J;I~J,;:ON' Oregon la\11~llu're y ..lYo of Lot Coverage:
. - fr:T :~N \ I. , - mlregon Utlli,y
Sol"r S'" .Ie <.: I 5 adopted by 113,00 tl rth
.nllnw ru e _' _ _ ...Ioa ",p. se 0
~otilication2_~~;\~~1 0' ;h~~ugh .OA1,puiki~1IMPROVEMENTS I
In OAR 95 . opies oltt,~ . -' .
Sln'r! lI'UU~~~"l\5ot~.:,ay obtain c tEuliyJmiiro~&j1e
." "t\'~ "'enter. (No~. N t'l,""ion
Slorm Se\\<u&Wlula lie:' 0 gon Utility 0 \ InS
Sp,'l'i:lIIIl,t1U\\'lIJG(: lor the. 1re 800-332-2344).
Center IS -
Notl'S: St,,,.!!\ dr:linage piped to curb face 8/31/2005 CAS
Phone Number: 541-228-1081
Expiration Datc
07/29/2007
10/01/2006
05/31/2007
OUIO/2006
Phone
541-228-1081
541-686-4151
503-363-2334
503-363-2334
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft BlIsement:
Sq Ft GlIrage/Carport
Sq Ft Other:
Occupant Load:
5,367
1,506
400
2
Yes
35.50
REQUIRED PARKING
Total: 2
Handicllpped:
Compact:
Sidewalk Type:
Downspouts/Drains:
"
Curbside 5'
Curb and Gutter
....., ,'1 I" . ,~l t;.I'II~l IF l~tE\\J'(!:"
'..J... .'. \ II~,~ I:L: 1.')T:~i'
l ....." , ,,_.1 \.. . ,.j ... \,;J\..),..-LJ j ,;d
",,'( hi" U'IlY I'llll'~t.l.
Paee 1 of 4
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Slatus
Issued
225 Fiflh Slrrd, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
~41-72(i-:\7()9 I TlSPl'l'tion Line
Iksl'rintion
Tvpe of Construction
I hn-lIiIl1!S
V Wood Frame
Garaee
C:lrat!c
Fl'C f)l'srrintioll
Pia II Rn'kw Saul(' As
-'\ll't'h~lUicallsSllillll'C Fce-
+ 10.1., t\dlllinistrafivc Fce
+ 7.1., Slate Sun.'hnrgc
2 B:llhs Ont.' or Twu Family
t\ddrl'~sill:~ t\s~;!g!lllll'nt
,\pplialll'c 1\'ot Listed
Building Permit
Curlll'lIl Permit
DrYl'f \'1.'n'
J':xhaJlq HUllds
Fllrll;','r - "l' to 100.000 bIn
G:l'" Oath.'ls 1-4
Phlll I'c,-il'w ~Ia.i(lr - Planning
P\V J):Sl' - 21lt! Pl'rmit (Stn'ct)
I{l'-; id "Ill'(' \\'iri 11', I COO Sq Ft
Hcsitl,,,It'c \Viring Ell AddtlSOO
Sanilar.\' SCWl'!" - Improvement
Sallit:!,.~. Sew('r. Rdmbursement
SllC t\ ''y,', Ie Administration
snc "~',\'.\IC !mpru\'cment
S')C .\!".:\IC I-~!'jlllhursl'mcnt
S')C ~.'1!l;taryl~;I(Jrll1 Admin
S')e Tnlllspo .\dlnin
SDC TnIIlS)Hl 1'1111rll\'l'mcnt
:-)I>C Trall'ipo Pl.'illlhurSl'lItrnt
Sitll'w'dk Pl'rmol
S:lll"llI Draill:lgl' Impervious Area
Vl'lIl Fall
"','ill:lI11ahllc S:l1glc Family
Till." .\!lIllllnt Paid
.
. CITY VI< M'KlNGFIELD .
Building/Combination Permit
PERMIT NO: COM2005-01I77
ISSUED: 09/22/2005
APPLIED: 08/29/2005
EXPIRES: 03/22/2006
VALUE: $ 154,576.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$96.00
$25.00
Square Footage
or Bid Amount
1,506.00
400.00
Vulue
Date Calculated
$144,576.00
$10,000.00
$154,576.00
08/29/2005
08/29/2005
Total Value of Project
Fppo PllilLI
Amount Paid
$100.00
$10.00
$120.94
$84.66
$254.00
$31.00
$18.00
$744.40
$80.00
$6.00
$9.00
$12.00
$4.00
$150.00
$-30.00
$106.00
$38.00
$400.47
$526.47
$10.00
$865.31
$82.03
$115.67
$66.97
$805.70
$182.69
$80.00
$780.05
$18.00
$1,000.00
$6.671.36
Date Paid
Receipt Number
8/29/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9122/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9122/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
9/22105
9/22/05
9/22/05
9/22/05
9/22/05
9/22/05
2200500000000001180
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
2200500000000001313
Paee 2 of 4
'1~
A\.. (') '<J
.
. Ull' OF SPRIr'lljl'IELD
Building/Combination Permit
1_ :::lI______._
Status
IsslIcd
PERMIT NO: COM2005-01177
ISSUED: 09/22/2005
APPLIED: 08/29/2005
EXPIRES: 03/22/2006
VALUE: $ 154,576.00
225 Fifth Sfn'"" Sprillgfield, OR
S~I-726-37SJ I'hlllle
S~I-726-J676 Fax
S~I-726-J7m IIl'I,,'rlillll Line
Initial Re"il''''
1)lannim.!. Rc\'iew
I)ublic \Vurks Rt','icw
08/30/2005
08/31/2005
08/31/2005
I Plan Reviews I
08/31/2005 APP
09/15/2005 APP
08/31/2005 APP
LLH
TAJ
CAS
Storm drainage piped to eurb faee
8/31/2005 CAS
Same as 6057 Pebble Court
Structurallh'dl'\\'
08/31/2005
08/3112005 APP
JB
To Reqlll'sl ,", ill', ~ccti()n call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be madc the snllC working day, inspections requested after 7:00 a.m. will be made the following work
day.
Uf"r ["'rlrkal Ground: Install ground rod at footing and call for inspection in conjunction witb footing and/or
fOlllldatiol! inspection.
Fnoling: Alh:' In'IIt.'hes are excavated.
FOUlIlhltiun: ..\l'tl'r forms are erected but prior to concrete placement.
Post .1IHllkalll: Pdor to floor insulation or decking.
Floor Insulnlion: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials.
Fr'"";II': 11l':I"'Clioll: Prior to cover and after all rough in inspections have been approved.
\\',llllllsu(atiun: Prior to cover.
Cl'Hill:!, Insuhllion: Prior to cover.
Drywall: PriOI' to taping.
Final Bllilding: After all required inspections have been requested and approved and the building is complete.
Perimeter FUlIllllation Drains: After gravel and filter cloth is installed but prior to backfill.
Untf{'rl1ollr !Jlulllhing: Prior to insulation or decking.
Ruugh Ilul1l~;ing: Prior to cover and including required testing.
\V.ltl'f I.ine: l'riur tn filling trench and including required testing.
Sallit:lr~' ~'il'WlT Lil1l': Prior to filling trench and including required testing.
Slurlll Sf'\\'I.:!" : ;lIl': Prior to filling trench.
Final I'll. ill!' illg: \\'hell all plumbing work is complete.
Underlluor .\",chankal. Prior to insulation or decking and including required testing.
Rongh C"s: ,\fter lille is installed and required testing and capped ifnot attached to an appliance.
Cas Sa, ;ce: Ai'ler Ii Ill' is installed and line has been connected to a minimum of one appliance including required
tl'slillg. :'a"w":: (l'st done at this point.
Pa2e30f4
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.
. CITY OF SPRINGFIELD
Building/Combination Permit
'"
Status
Issued
PERMIT NO: COM2005-01177
ISSUED: 09/22/2005
APPLIED: 08/29/2005
EXPIRES: 03/22/2006
VALUE: $ 154,576.00
225 Fifth Stn'l't, SJlrin~lield. OR
541-726-3753 Phone
541-726-3676 Fa"
541-726-37(,9 ''''I"'elion Une
Rough :\ 't'l'ht'.lit.:al: Ilrior to Cover
Final G:.: '.\':'l'1I all gas work is complete.
Final ,\I....hll lIi..II I: When all mechanical work is compicte.
Rough 1::C,,'trk: Prior to Cover
Elrctric ~;en'il't,: Approval required prior to utility company energizing service.
Fin:lI Ekclrk: ""hl'n nil electrical work is complete.
Erosiu 1I!~; 1":1 {': ng I nspcction: Prior to ground disturbance and after erosion measures arc installed.
Sidew:I!', - C '!'b"ddl': After forms are erected but prior to placement of concrete.
Cllrhelll - St,. ',....1: After forms are erected but prior to piacement of concrete.
By signallln', I "'1",' ,"'d IIgn'e. that 1 have carefully examined the completed application and do hereby certify tbat all
illformatioll hI"'''''' j, trlle II lid correct, and 1 further certify that any and all work performed shall be dOlle in accordance with
Ihe Ordillllllce, ur the Cily or Springfield and tbe Laws of the State of Oregon pertaining to the work described herein, and
Ihal NO OCCU'.\:;CY will he made of any struclure wilhoul permission of the Community Services Division, Building Safety.
I further certir~' tl,"t ' dy l'lHltractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further ugn'l' '" I'" 'ure lhlll IIi1 required inspections are requested at the proper time, that each address is readable from the
slreet, that thc PI':' .: ..IIrd is located at the front of the property, and the approved set ofpians will remain on the site at all
times during l'r"l'''' ,'(inll.
/.---uO~
OWller Of COII!":lf'~(t:.., Slglllllure
'7~ .22 -oS-
Date
Paee 4 of 4
Community Services Division
. .-, .-
DEVELOPMENT SERVICES DEPARTMENT
Notice to Permit Applicant
Soils stabilization required for subdivision sites
Name of Owner ~ \ 'R~ Permit: (\~'~\11'
Address of Project \.ot)2f> ~~1 '.
Tax Map: \q.D'll)?>~ Tax Lot: (j)l~ SUbdivision~~.ijL ~
The building site at the above address is located on property that has soils prone to shrink-swell or
other potential movement. Excavations, placement of fill materials and drainage for this site must
be done under the direct supervision of a properly licensed Professional Engineer or Architect to
verify the stability of the resulting building pad and the site.
The, owner, or the owner's qualified agent, is responsible to obtain the services of the appropriate
professional engineer or architect (design professional). The design professional shall provide
direction for the stabilization methods to be used for the building pad (and surrounding site, when
site stabilization is also necessary). The geotechnical report, which was prepared for this
subdivision, may be utilized to provide appropriate guidance for the methods of stabilization and
required compaction for the specific site.
The engineer or architect shall prepare a report to be submitted to the City stating how the soil
stabilization is being accomplished, including requirements not yet completed (if any). A signed
and stamped report from the engineer or architect must be received and approved bv this office
before footin!! or foundation insoection approval will be !!ranted bv the Citv Buildin!! Insoector.
ACKNOWLEDGEMENT: The undersigned acknowledges the forgoing requirements for
soil stabilization, including excavation, fill, soil compaction and drainage, as provided in the
geotechnical report for the subdivision. The stabilization will be accomplished under the
direction of a licensed professional engineer or architect as noted above.
Signature
Name
-L- J:)/I/- L.--
if
Date
f~2'Z..-or
AffIliation to owner
CITY OF _INGFIELD SYSTEMS DEVELOPME&ORKSHEET
JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
COM2005-01177
Hayden Homes
6030 Quartz
1802033400185
SINGLE FAMILY RESIDENCE
I BUILDING SIZE (SF'
1900
LOT SIZE (SF):
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S.F. I CHARGE
I 2415.00 I $0.323 = I, $780.05 I
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 $0.323 I 50% I =
ITEM I TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
$780.05
DISCOUNT
$0.00
5367
5780.05
I"
I~
10
,0
u
<:<:
~
18
~
1070
.
.
DRAINAGE FIXT~ UNIT (DFU) CALCULAT!ON TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIY ALENT - DRAINAGE FIXTlJRE UNITS
(NOTE: FOR REMODELS. CALCULA TE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES
UNIT
FIXTURE TYPE NEW OLD EQUIVALENT
BATHTUB 2 0 3 =
DRJNKING FOUNTAIN 0 0 1 =
FLOOR DRAIN 0 0 3 =
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 =
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 =
ILAUNDRY TUB 0 0 2 =
CLOTHESW ASHER / MOP SINK 1 0 3 =
CLOTHESW ASHER - 3 OR MORE (EAl 0 0 6 =
,MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 =
IRECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 =
i!tECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 =
ISHOWER SINGLE STALL 0 0 2 =
!SHOWER GANG (/'lUMBER OF HEADS) 0 0 2 =
!SINK: COMMERClAuRESIDENTIAL KITCHEN 1 0 3 =
SINK: COMMERCIAL BAR 0 0 2 =
SINK: WASH BASINIDOUBLE LAVATORY 1 0 2 =
SINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 =
URINAL, STALL / WALL 0 0 5 =
ITOILET, PUBLIC INSTALLATION 0 0 6 =
ITOILET, PRIVATE INST ALLA TION 2 0 3 =
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 =
TOTAL DRAINAGE FIXTURE UNITS
DRAINAGE
FIXTURE
UNITS
6
o
o
o
o
o
3
o
o
o
o
o
o
3
o
2
1
o
o
6
o
21
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a sinJUe family dwellinR unit (20 DFU's) set at 167 ~lons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR CREDIT RATE/$I,OOO
ANNEXED ASSESSED VALUE IS LAND ELGlBLE FOR ANNEXATION CREDIT? 2
BEFORE 1979 $5.29 (Enter I for Yes, 2 for No)
1979 $5.29 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2
1980 $5.19 (Enter I for Yes, 2 for No)
1981 $5.12 BASE YEAR 1979
1982 $4.98
1983 $4.80 CREDIT FOR LAND (IF APPLICABLE)
1984 $4.63 VALUE/1000 CREDIT RATE
1985 $4.40 $0.00 x $5.29 ~ , $0.00
1986 $4.07
1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 $3.22 VALUE / 1000 CREDIT RATE
1989 $2.73 $0.00 x $5.29 0
1990 $2.25 I
1991 $1.80
1992 $1.59 TOTAL MWMC CREDIT = $0.00 I
1993 $1.45 I
1994 $1.25
1995 $1.09 I
1996 $0.92
1997 $0.72
1998 $0.48
1999 $0.28
2000 $0.09
2001 $0.05
CITY OF SPRINGFIELD, OREGON
<2lS\
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541~~!19-0\ ,e'
ELECTRICAL Pf1JMIT APPLICATION ~'\\e\O~~ e(\o ooe
City Job Number ~t;:), \ \1l 1.<t;:::.,"~\, ~~(\\(\\l \
?ffi"" _ ~ '-'~
3. I COMPLETE FEE SCl!,!'~lUPE()W
\)00' eo' =--.)
,,\\\\\o~,1.
A. I New Residential- Single or Multi-F';~~~i1y per dwelling unit.-l
Service Included
2. I CONTRACTOR INSTALLATION ONLY I B. I Services or Feeders -Installation, Alterations or Relocation:
Electrical Contractor ///LJ~.,{)77) 0 200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
Address ~ /S6y SO '/ l/ 401 AmpsJ0600lAmps $125.00
- , 11 \B'N r8l\\,;1l ~". '~;\lt\l
_ "ION: Olego 60\,Amps:to II 000 All)Jls $163.00
_ <1l.-'l>l ~AA,~"J~b',(\\I v -~ ~"f),\,l
City ~ _ r'.... Phone / <. - ::0~)7 ~ ~J~rJ19QO?Knif';Nolts\. $375.00
CI ,)' . l\ cel\te!. lhOReconneot:0hly)2-0U $ 50.00
..,\ca~~ _001-0010 \hrou'J~' '::;',;"e rules by
~./l -,,?\R\{\>2 t'cc,,'_o- '.-,
Supervisor License Number v<--' / / ~ c.,.,l", maY ob ale..1 ;t:.e"'l!..r~_ry,Services or Feeders
","v . - tel '\,,,.-, t'\'callU"
v . . the cell . \ Jf'IiN No \ I
Expiration Date //;J' // /J &, ca~~\.~~: 'n' \heOleg'i~~"l~~l'!JI\"'lteration or Relocation
\1U Ce\1tellS 1-8f2Bo Amps or less
. ? '2 9 201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. 1 Branch Circuits -
Signature of Supervising ~ectrici(an0' _
.A-1 /J ./-._ '-/ - New Alteration or Extension Per Panel
// L&YA. ~ .15 i.-..d'~ One Circuit
/ J - Each Additional Circuit or with
~, \%r~f\ ~ ""'re~'"",,_' ".00
:;;::s a~ 0 ~~. L ..~. ,;: E.ll\Iiscellaneous (Service/feeder not included) -Each Inslallation I
~ ., '" I!l. -\001 SH~,LL E~hKI: II' I Hl: V!:"HI\
City hone:J../V' U." 'fPump,oritrigationISI""T $50.00
Illl.... I lllou r L! ...111 '<IV
. ' Sign/Outline Lighting $ 50.00
'1""\ t~ 1-', J~l~UUI\jLL,; I u..
OWNER INSTALLATION Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit lospection Fee is $45.00 + Surcharges
4.1 SUBTOTAL OF ABOVE I l44 ,DO
l~'~-
lbf\ 4~
,-~
I. . LOCATION OF INSTALLATION
LEG~~E~~PTI~~~
t~01.03?A OOt<&5
JOB DESCRIPTl~ lC\()(p
- p~~~n_transferable ~~f~rk is
not started within 180 days of issuance or if work is
Suspended for 180 days.
I
I,
Constr. Contr. Number 1/ /l?
Expiration Date /,0 -1- {),b
The installation is being made on t" '"'1-'''' 'J I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
7% State Surcharge
10% Administrative Fee
TOTAL
l
~
lOb_E~
'3a.~
$106.00
$ 19.00
$50.00
$ 50.00
$ 69.00
$100.00
~-----l
$ 43.00
Shared Drive(T:)JBuilding FormslElectrical Permit Application I-OJ.doc
;,
225 Fift.h Street
S~ringfield, Oregon 97477
541-726-3759 Phone
.
~~
~.;
....ity of Springfield Official Receipt
.evelopment Services Department
Public Works Department
Job/Journal Number
CDM200S-0 1177
CDM200S-0 1177
CDM200S-0 1177
COM200S-0 1177
CDM200S-0 1177
CDM200S-0 1177
CDM200S-01177
tOM200S-0 1177
C'DM200S-0 1177
CDM200S-0 1177
CbM200S-0 1177
CbM200S-0 1177
COM200S-01177
CDM200S-01177
COM200S-0 1177
CDM200S-01177
CDM200S-0 1177
COM200S-0 1177
COM200S-0 1177
CbM200S-0 1177
COM2005-0 1177
CDM2005-0 1177
CDM2005-01177
COM2005-01177
CbM2005-01177
,
CbM200S-0 1177
CbM2005-0 1177
ctJM200S-01177
CbM2005-0 1177 '
RECEIPT #:
2200500000000001313
Date: 09/22/2005
Description
Building Pennit
Addressing Assignment
Willamalane Single Family
2 Baths .one or Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Dryer Vent
Gas .outlets 1-4
Appliance Not Listed
-Mechanical Issuance Fee-
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl SOO
+ 7% State Surcharge
+ 10% Administrative Fee
Sidewalk Pennit
Curbcut Pennit
PW Disc - 2nd Pennit (Street)
Stonn 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/Stonn Admin
SDC Transpo Admin
Plan Review Major - Planning
Payments:
Type of royment Paid By
Item Total:
Check Number Authorization
Received By Batch Number Numher How Received
CrcditCnrd
:i
,t
.
;1
'I
}
"
.)
9/22/2005
.,
HAYDEN HDMES
llh
00071S Phone
Payment Total:
Page 1 of I
7:38:SSAM
Amount Due
744.40
31.00
1,000.00
2S4.00
12.00
18.00
9.00
6.00
4.00
18.00
10.00
106.00
38.00
84.66
120.94
80.00
80.00
(30.00)
780.0S
S26.47
400.47
182.69
80S.70
82.03
86s.31
10.00
115.67
66.97
ISO.OO
$6,571.36
Amount Paid
$6,571.36
$6,571 .36