HomeMy WebLinkAboutPermit Building 2008-1-18
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01855
ISSUED: 01/18/2008
APPLIED: 12/14/2007
EXPIRES: '07/18/2008
VALUE: $ 378,096.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6196 JADE AVE
ASSESSOR'S PARCEL NO.: 1802032202600
SPRINGFIETYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Mt Gate west lot 55
Residential
Owner: ROBERT DEVEREAUX
Address: . PO BOX 51258
EUGENE OR 97405
Phone Numb...: 541-689-6696
I CONTRACTOR tNFORMATlON I
~
Contractor Type
General
Electrical
Mechanical
Plumbing
Contractor
OWNER
BILLS ELECTRIC
MARSHALLS INC
TOMS PLUMBING SERVICE INC
License
Expiration Date
Phone
21351
25790
159425
04128/2008
1212312009
05/1212008
541-501-5650
541-747-7445
541-607-8879
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
ATTENTIO~~r."'.~.....!!f&lfr ·
follow rules adopted by ffie ~j \ I I
Notific!ation Cente'l.oTli09!lllllles are set forth 2
In ~-R 952_001-0~0fJ.Sh-.QMI-~2.oo1. 28.00
0090~You may o~ ofll!€lftpf t\I~cWlllflPllectric
df~g the centwat(-bl~.J~e tel~phone Gas
number for the l1ll/l\g'i!lt mty Notlllcatlo'\;lectric
3 Center ilE~&ll .~). Path I
Sprinkled Building: nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
12,662
2,124
1,236
688
I DEVELOPMENT INFORMA TlON I
REQUIRED PARKING
Fronlyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
19.00
30.00
'8.00
56.00
40.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Hillside
6
Yes
19.40
Total:
Handicapped:
Compact:
2
Subdivision Not Accepted
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS.
':
Sidewalk Type:
DownspoutslDrains:
Curbside 5'
To Storm Sewer
Fullv Improved
Yes
Notes:
. NOTICE: .
For this parcel in Mt. Gate West, it is the recommendatilJ~op~J!\IDIm,tti~fREt'W fHEWOOll4'r:"that no
connections shall be made to sanitary or storm H2 syst~ITrA5~12W'ij~B~If'tAIS'~Wffii~6funcil".
. COMMENCED OR IS ABANDONED FOR
. ANY 180 DAY PERIOD.
Pa2e I of 5
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
A.C. - Residen
Dwellin2s
Gara2e
AC - Residential
V Wood Fral1)e
Gara2e
Fee Description
Plan Review Residential
-Mech Iss 2+ Appliances-
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
3 Baths One & Two Family
Addressing Assignment
Appliance Vent
Boiler/Comp Up To 100,000 btu
Building Permit
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
Plan ReviewlResidential Hourly
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 SanitarylStorm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Storm Sewer Each Addtll00'
I Valuation Oescriotion ,.
$ Per Sq Ft
. or multiplier
$4.00
$103.00
$27.00
Square Footage
or Bid Amount
3,360.00
3,360.00
688.00
Total Value of Project
~ Fpp. P~iriJ
Amount Paid
$877.23
$40.00
$261.41
$289.40
$\39.33
$337.00
$35.00
$7.00
$14.00
$1,621.66
$85.00
$7.00
$10.00
$202.40
$17.00
$14.00
$5.00
$205.00
$176.85
$50.00
$117.00
$147.00
$652.93
$858.67
$10.00
$990.39
$95.35
$156.09
$69.82
$862.25
$195.48
$85.00
$853.20
$32.00
Date Paid
12/14107
1118108
1118108
1118108
1118108
1118/08 '
1118/08
1118/08
1118/08
1118/08
1118/08
1118/08
1118108
1118/08
1/18/08
1118/08
1118/08
1118/08
1118/08
1118/08
1/18/08
1118/08
1118/08
1118/08
1118/08
1118/08
1118108
1118108
1118/08
1118108
1118108
1118108
1118108
1118/08
Pa2e 2 of 5
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-0I855
ISSUED: 01118/2008
APPLIED: 12/14/2007
EXPIRES: 07/18/2008
VALUE: $ 378,096.00
Value
Date Calculated
$13,440.00
$346,080.00
$18,576.00
$378,096.00
0111512008
0111512008
0111512008
Receipt Number
2200700000000001844
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067.
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
2200800000000000067
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01855
ISSUED: 01118/2008
APPLIED: 12/14/2007
EXPIRES: 07/18/2008
VALUE:' $ 378,096.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
1/18/08
1/18/08
1/18/08
$55.00
$28.00
$2,303.00
-Total Amount Paid
$1l,905.46
Plan Reviews I
Initial Review
Public Works Review
12/17/2007
12117/2007
LLH
LKW
APP
APP
12117/2007
12/1712007
Plan nine: Review
01/0812008
TAJ
12117/2007
APP
Structural Review
01/1612008
DLM
. 1211712007
APP
2200800000000000067
2200800000000000067
2200800000000000067
For this parcel in Mt. Gate West, it
is the recommendation to the
Building Division by the City
Engilleer:"that no connections shall
be made to sanitary or storm H2
systems, until the subdivision is
accepted by City Council".
Fence off the treed area at the rear
of the lot with orange construction
fencing and keep all construction
activity out of this area.
Choose street tree species from the
list of "Native Trees in Hillside
Development" in the Street Tree
Handout.
See documents for Plan review
comments
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 workin.g day, inspections requested after 7:00 a.m. will be made the following
work day.
I 'Rpllllirprl Insnections I
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
UferElectrical Ground: Install ground rod at footing and call for inspection in conjunction with footing andlor
foundation inspection.
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to 11001' insulation or decking.
Floor Insulation: Prior to decking.
Pa2e 3 of 5
-_ "ig~!N,9.,~I~t::Si' '~f'1fi!!->'r,fIl,,'\\t
I '
!"
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued'
PERMIT NO: COM2007-01855 .
ISSUED: 01/18/2008
APPLIED: 12/14/2007
EXPIRES: 07/18/2008
VALUE: $ 378,096.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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.
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.
Underlloor Plumbing: Prior to insulation or decking,
Underlloor Drain: Prior to cover or placement of concrete.
Rnugh Plumbing: Prior to cover and including required testing.
Shower Pan. Prior to covering and including required testing.
Water Line: Prior to tilling trench and including required testing.
Sanitary Sewer Line, Prior to tilling trencb and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Underlloor Mechanical. Prior to insulation or decking and including required testing.
Underlloor 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.
Pa2e 4 of5
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01855
ISSUED: 01/18/2008
APPLIED: 12/14/2007
EXPIRES: 07/18/2008
VALUE: $ 378,096.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 OCCUP ANCY 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 cnmpliance with ORS 701.005 will be used un 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 apprnved set of plans will remain on the site at all
. times dU;2.~ctsn. . ;)
.(L./ ~ J - 1?-rJ '?
Owner or Contraftors Signature Date
,
Pa~e 5 of 5
~~ "0" :
''''I .' .
~ .~ Willamal.a.,e
t . ,Park & Recreation Dlstnct ..
Job. No. .
fJl ~ 1'b5:S
;
SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2007
NAME: \\\J'ff& \W~er fUDl PHONE: \ Q ~C\ -lolMLP
ADDRESS: ~D ~,~\I)}j'6 STATE:~IP: ~14tp
LOCATION OF PROPOSED BUILDING SITE:
Street Address: \O\C\\.o "Sc..Af.. ~\\~
Plat Name: "-\.\- D.Mt'../
.
Tax Lot Number:
\~nWB"LLfJ2JdJ
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the
back.)
A. Sinale-Familv Detached
"
aJ
.$ ~J
NO. OF UNITS
~
X $2,303 per unit =
B. Sinale-Familv Attached
NO. OF UNITS
X $2,426 per unit =
$
C. Multi-Familv Aoartment
NO. OF UNITS
X $2,032 per unit =
$
D: Sinale RoomOccuoancv
NO. OF UNITS
X $1151.50 per unit = $
WILLAMALANE SDC
$ ~03.CO .
J;;3T'
Q.Cf)3. cP
2. SDC CREDIT (If applicabie) SDC payer must furnish proof of
Willamalane Credit approva!.)
$
3. TOTAL WILLAMALANE NET SDC ASSESSED
. ~~u:edforcre~ ..
Deveioprnent serV~~rnent .
City of Springfield
--1-/
Date
$
~
f'6/ ;:'008
>
'{f
"
-
~W~~
lP~-
~ .'"
225 FIFTH STREET e, SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PE)!.MIT ~PLICATION
City Job Number l \;' \ ' \ 't> ~
. 200 Amps or less
20] Amps to 400 Amps
40] Amps to 600 Amps
60] Amps to 1000 Amps
Phone Slf/ SD!SC;r-O Over]OOOAmpsNolts
Reconnect Only
CfR () ~~~~~=:~~i~~~WiPNders -- --'-----,
Notification Center.-Those'rules'afe set forffi - -- ,- - - ,- - - J
In OAR 952-001 ~WItlWilUMQAa~R~i-ClO.k'cation
UOW TOO may ~~Jc COllle,s 01' ffie rUle56'i' \
caJilng the ce .~tFJb'tll: ffia telepho~e $ 55.00
......d"J for the litJlll't'lYlifiW t!f!Yll~catlon $ 76.00
Center 1W\-800s:38Ml344jps $I10.00
Over 600 AmI'S Dr 1.QOO Vohss~e_"S:'above,_._ ___
D. ~r.nch C~r~uitsu___ ,_ _ _ _ _ u_ _____n_~-,~ . -1
New Alteration or Extension Per Panel
One Circuit "
Each Additional Circuit or with
, Service or Feeder Permit
~~?;;~~
Owners rh><< _, ere(ill(
Address !3:-Q ~ . E.[ ~i~;~ane,,-';~se~ice;ie~';-e~ ~~t ~n~IUde~) ~Ea~hTn~;llationJ
City f,~ Phone. [)5 Pump or irrigation $ 55.00
~ SignlOutline Lighting $ 55.00
OWNER INSTALLATION NOTICE~MIT SHA\:'~E'J{\:IfRElWIlWiIt\WRK $ 28.00
The installation is being made on property i1J;l)R~~tED.V.N.dr!Ri1fflI&'Pti\ml'~S-OOT $ 50.00 -;:?'" q !'-'J
IS not IOtended for sale, lease or rent. ~~~MENCED"~~"Jl.WA"~VlifOQpection_~~ ~!50.00_+ ~ur~~:, /
Owners Signature: ANY 180 DAYfEItIQyY.TOTALQFABOVE I ti: \ . ;~.
1 ~State Surcharge ,~~'.:',z;i> ~ .
10% Administrative Fee :2 -,-:<f"o .
~ 5% Technology Fee 71:.u
;\.,' -;:;m ,",~ ",,""""'" c.,~",,", ..." ,.12 ;1';?
'\~\)Y
1. GfC\\~~~;rci:IO~ JI
LEThlJifB3'r1.. nOlro
BD""'~~ ~~~
Permits a non-transferable ~Pire if work is .
not started within t 80 days of issuance or if work is
Suspended for 180 days.
.2. ICOmRAC!'ORINS!.ATT4TIONONLi]
Electrical Contractor -N" Lf's ~-/:
Address ?f'//SO ~)A'" /.7 0....
City
2",,'1
r
Supervisor License Number
Expiration Date I 0 - I ~ 0 7
Constr. Contr. Number ';j ( 3 S- (
Expiration Date ~::2... Y - riP'
Date
3. I COMPLKI'E FEE SCHEDULE BELOW __n_ ___ ,.--.J
A. [N~wlte-,identi.l- Single or Multi~;;-';'i2:-pe--,:~_w-:llin~-;'nit:--l
Service Included
1000 sq. ft, or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
\
'l<ZS
~~
i47p.c
$] 17.00
$ 21.00
.
$55.00
B.I Services or F'eede~ -Installat,i~~, ~~~at~ons__o~ ~~~~~~;~~--l
$ 70.00
$ 83.00
$138.00
. $180.00
$413.00
$ 55.00
~~~
$ 48.00
$ 4.00
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
'n-r:-
ICl
10
I~
I~
.~
<ZJ
~
"
gj
JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
J STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S,F. x I COST PER S.F. CHARGE]
I 2465,75 I $0.346 I = I $853,20
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUSS,F, I x I COSTPERS.F. I x I DlSCOUNTRATE ] I
. 0,00 I I $0346 I I 50% 1 ~ I
Com2007-01855
Robert Devereaux
6196 Jade Avenue
1802032202600
Single Fillnilv Residence
I BUILDING SIZE (SF: 3263
LOT SIZE (SF):
12662
DISCOUNT
$0,00
I
I
11070
ITEM I TOTAL- STORM DRAINAGE SDC
- -
2, SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x
I 32 I
B. IMPROVEMENT COST:
I NUMBER OF DFUs I
32 I
$853.20
J
$853.20
COST PER DFU
$26.83
$858.67
1091
x
COST PER DFU
$20.40
1092
$652.93
3 TRANSPORTATION
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
= ,
$1,511.60
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI
I 9.57 I I I I 20.43 I 1.00 $195.48 1093
B. IMPROVEMENT COST:
I ADTTRIPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x 'NEW TRIP FACTOR I
I 9.57 I I I I $90.10 I 1.00 I $862.25 1094
ITEM 3 TOTAL - TRANSPORTATION SDC ~ I $1,057.73
...- -~,---_.
4 SANITARY SEWER - MWMf:
A, REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $9535 = $95.35 1054
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $99039 = $990.39 1055
MWMC CREDIT iF APPLICABLE (SEE REVERSE) $0.00 . r:=
MWMC ADMINISTRATIVE FEE $10.00 ~-
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~I $1,095.74
SUBTOTAL (ADD ITEMS I, 2, 3, & 4) ~I $4,518.27 I
5 ADMINISTRATIVE FEP.: I
I SUBTOTAL J x I ADM. FEE RATE I~ CHARGE
I $4.518.27 I 5% I $225.91
TOTAL SANITARY ADMINISTRATION FEE: 156,09 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: $69.82 ,1078
-,
Kaye Wilson 12/17/2007 TOTAL SDC CHARGES =, $4,744.18
PREPARED BY DATE
......--.-
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
-
NUMBER OF NEW FIXTIJRES x UNIT EQUlV ALENT = DRAINAGE FlXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTIJRES)
NO. OF FIXTURES
.EDll (Equivalent Dwelling Unit) is a dischar~e equivalent to a single family dwellin&.~~ (20 OFU's) ~~~_~~167 ~Ilons ~r day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
~YEAR .
I ANNEXED
I BEFORE 1979
1979
1980
1981
1982
1983
1984
I
I
I
I
I
I
I
I
I
I
I
I
II
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
IS LAND ELGffiLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0,00 x $0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE I 1000 CREDIT RATE
$0.00 x $0,00 ~ ,
TOTAL MWMC CREDIT
=
~ ,
DRAINAGE
FIXTURE
UNITS
6
o
o
o
o
2
3
o
o
o
3
2
o
3
o
o
4
o
o
9
o
32
2
2
.:
2004 ~I
$0,00
o
$0.00
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-0] 855
COM2007-01855
COM2007-01855
COM2007-0 1855
COM2007-01855
COM2007-0 1855
COM2007-01855
COM2007-0] 855
COM2007-0 1855
. COM2007-01855
COM2007-0 1855
COM2007-0 1855
COM2007-0] 855
COM2007-01855
COM2007-0] 855
COM2007-01855
COM2007-01855
COM2007-01855
COM2007-0] 855
COM2007-01855
COM2007-01855
COM2007-0]855
COM2007-0 1855
COM2007-0 1855
COM2007-01855
COM2007-0 I 855
COM2007-0] 855
COM2007-01855
COM2007-01855
COM2007-0 1855
COM2007-01855
COM2007"0 1855
COM2007-01855
COM2007-0 I 855
COM2007-01855
COM2007-0 1855
Payments:
Type of Payment
CreditCard
Check
cRcccint 1
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200800000000000067
Date: 01118/2008
Description
Addressing Assignment
WiIlamalane Single Family
Residence Wiring 1000 Sq Ft
Temp Power 200 amps or less
Sidewalk Permit
Curbcut 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
3 Baths One & Two Family
Storm Sewer Each Addtl.1 00'
Plan Review/Residential Hourly
Residence Wiring Ea Addtl 500
Fire SF Fee - Residential
Building Permit
Plan Review Residential
Furnace -up to 100,000 btu
.Boiler/Comp Up To 100,000 btu
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas Outlets]-4
Fireplace (Listed)
-Mech Iss 2+ Appliances-
+ 5%, Technology Fee
+ /2% State Surcharge
+ 10% Administrative Fee
Paid By
ROBERT DEVEREAUX
ROBERT DEVEREAUX
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
djb
1160
02398C In Person
In Person
Payment Total:
Page I of2
10:59:40AM'
Amount Due
35.00
2,303.00
117,00
55.00
85.00
85.00
853.20
858.67
652.93
195.48
862.25
95.35
990.39
10.00
156.09
69.82
205.00
337.00
32.00
50.00
147.00
202.40
1,621.66
176.85
14.00
]4.00
28.00
7.00
10.00
7.00
5.00
17.00
40.00
139.33
289.40
261.4/
$11,U28.23
Amount Paid
$9,500.00
$1,528.23
$11 ,028.23
1/18/2008