HomeMy WebLinkAboutPermit Building 2005-10-25
Status: Issued
225 Flfth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
. 541-726-37691nspection Line
.
*
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-01395
ISSUED: 10/25/2005
APPLIED: 10/06/2005
EXPIRES: 04/25/2006
VALUE: $ 75,080.00
" SITE ADDRESS: 2434 MAlA LP
ASSESSOR'S PARCEL NO.: 1703251404100
Springfield TYPE OF
Manuf Home w
Garage/Carport Private Lot
New Residential
TYPE OF USE:
PROJECT DESCRIPTION: Manufactured home with Carport on private lot
Owner: MARGARET SHANNON
Address: 915 65TH ST
SPRINGFIELD OR 97478
Phone Number: 541-744-8051
I CONTRACTOR INFORMATION' .
1"'\1 H_I" I I"""'''' ..........::J..... '...... ._~ulresyouto
Contractor follow rules adopte(I!l~~l1spregE1~jj!ation Date
HARRISON JACOBSO*,iNccation Center.. T6'6447 rules are 5605707'72007
MAG ELECTRIC INC in OAR 952-001-001 Ot'4'98j~lh OAR 95~-2Yt'3i2005
HARRISON JACOBsorANe.. You may obtai'6644,'es of the rUloStli7i2007
HARRISON JACOBSON INGlIing the cen~r.. l!644r.~he .t~!~ph'Q5r07l2007
Contractor Type
General
Electrical
Manuf Home Inst
Plumbing
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
Front yard Setback:
Side 1 Sethack:
Side 2 Setback:
Rearyard Setback:
, Solar Setbacks:
Street
Storm Sewer Available:
Special Instruction:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
% or Lot Coverage: 35..40
N01\~E:, ~uAlI ~XP\RE If iH~ ~~~~
I 7.J;-_" fr..P.i . "iH\S I'tl'lW11I i...r..-.
IPUBLIC IMPROY~Jill'!l~ UNDEn OON~O FOR
COMMENCED O~JS.A~~ype:
Fullv Improved 80 DAY PE.Ri'Cltr.
Yes AN'l 1 Downspouts/Drains
1
R-3
U
VN
29..00
7..00
7..00
10.00
0.00
Phone
541-689-7762
541-461-0387
541-689-7762
541-689-7762
'1'~"11.':-" ~'~'.H~';""''''H''''''''''} .._u..__~._"
I BUILDING lNF.ORM.t\TdONI32-2344)..
2
# of Stories:
Height of
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled
nla
1
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
560
1,387
'orced Air Electric
Electric
Electric
I DEVELOPMENT INFORMATION'
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
o
Curb and Gutter
i
Notes: Storm drainage piped into system 10/10/2005 CAS
1 of 3
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-01395
ISSUED: 10/25/2005
APPLIED: 10/06/2005
EXPIRES: 04/25/2006
VALUE: $ 75,080.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
Carport
Foundation Onlv
Manuf Home
Carport
Use Bid Amount
Manufactured Home
$ Per Sq Ft
or multiplier
$18..00
$1.00
$LOO
Square Footage
or Bid Amount
560.00
5,000.00
60,000.00
Value
Date Calculated
10/06/2005
10/06/2005
10/0712005
Description
Type of Construction
Total Value of Project
$10,080.00
$5,000.00
$60,000.00
$75,080.00
L.Fpp, P~WJ
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Residential $100..23 10/6/05 1200500000000001470
+ 10% Administrative Fee $62.66 10/25/05 1200500000000001601
+ 7% State Surcharge $43.86 10/25/05 1200500000000001601
Add, Alter, Extend Circ Ea Add $3.00 10/25/05 1200500000000001601
Addressing Assignment $31.00 10/25/05 1200500000000001601
Foundation Permit $68.40 10/25/05 1200500000000001601
Garage/Carport $115.20 10/25/05 1200500000000001601
Manuf Home State Issuance $30.00 10/25/05 1200500000000001601
Manufactured Home Conn - Plmb $45.00 10/25/05 1200500000000001601
Manufactured Home Feeder $50.00 10/25/05 1200500000000001601
Manufactured Home Placement $160.00 10/25/05 1200500000000001601
Manufactured Home Service $50.00 10/25/05 1200500000000001601
Plan Review Major - Planning $150.00 10125/05 1200500000000001601
Fo' Sanitary Sewer - 1st SO Feet $45.00 10/25/05 1200500000000001601
Sanitary Sewer - Improvement $362.33 10/25/05 1200500000000001601
Sanitary Sewer - Reimbursement $476.33 10125/05 1200500000000001601
SDC MWMC Administration $10.00 10/25/05 1200500000000001601
SDC MWMC Improvement $865.31 10/25/05 1200500000000001601
SDC MWMC Reimbursement $82..03 10125/05 1200500000000001601
SDC Sanitary/Storm Admin $105.75 10/25/05 1200500000000001601
SDC Transpo Admin $68.18 10/25/05 1200500000000001601
SDC Transpo Improvement $805.70 10/25/05 1200500000000001601
SDC Transpo Reimbursement $182.69 10/25/05 1200500000000001601
Storm Drainage Impervious Area $694.22 10/25/05 1200500000000001601
Storm Sewer - 1st 50 Feet $45.00 10/25/05 1200500000000001601
Water Line - 1st SO Feet $45.00 10/25/05 1200500000000001601
Wlllamalane Manuf Home Private $1,000.00 10/25/05 1200500000000001601
Total Amount $5,696.89
I Plan Reviews I
Initial Review
Plannin!! Review
10/07/2005
10/1lI2005
10/0712005
10/1712005
APP LLH
APP TAJ
2 of 3
.
. CITYOFSPRIL'ItJt<IELD
Building/Coinbination Permit
PERMIT NO: cOM2005-01395
ISSUED: 10/25/2005
APPLIED: 10/06/2005
EXPIRES: 04/25/2006
VALUE: $ 75,080.00
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Public Works Review
10/0712005
10/10/2005
APP CAS
Storm drainage piped to system
10/10/2005 CAS
Structural Review
10/0712005
10/19/2005
APP RJB
To Request an inspection call the 24 hour recording at 726-3769. All inspection 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.
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
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.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Manuf Home Set Up: When instaliation of all piers or stands is complete..
Final Manuf Home Set Up: After ali required inspections are requested and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc. have been installed.
Final.Building: After all required inspections have been requested and approved and the building is complete.
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.
Manuf Home Plumbing: After home has been connected to water and sewer.
Final Plumbing: When all plumbing work is complete.
MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to
the panel.
MH Service: Approval required prior to utility company energizing service.
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 wiD 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 ofthe property, and the approved set of plans wiD remain on the site
at all ~s dU7'~~n:t~:~iOn.
~ NtA/vvvo-. (0 ' ZS -0 r
Owner or Contractors Signature
Date
3 of 3
, 'CITY OF StIINGFIELD SYSTEMS DEVELOPMEreORKSHEET
JOURNAL OR JOB NUMBER: COM2005-01395
NAME OR COMPANY: Margaret Shannon
LOCATION: 2434 Mai. Loop
TAX LOT NUMBER: 1703251404100
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF' 1635 LOT SIZE (SF):
I. STORM DRAINAGE
5500
Ii
o
u
~
LLl
f-<
'"
a
~
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F. x I COST PER S..F. CHARGE
I 2149.28 I $0.323 I = I $694.22 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
0.00 I $0.323 I I 50% I = I
ITEM I TOTAL - STORM DRAINAGE SDC $694..22
DISCOUNT
$0.00
$694..22
1070
- -
2 SANITARY SEWER - r:ITY
A. REIMBURSEMENT COST:
I NUMBE~~F DFU's I x COST PER DFU
$25.07 $476.33 I 1091
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 19 $19.Q7 $362.33 1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $838.66
1 TRANSPORTATION
A. REIMBURSEMENT COST:
[ ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI
[ 9.57 ! I I I $19.09 I 1.00 I $182..69 1093
B. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRlP x INEW TRlP FACTORI
[ 9..57 I I I I $84.19 I 1.00 I $805..70 1094
ITEM 3 TOTAL - TRANSPORTATION SDC = , $988.39
4 SANITARY SEWER - MWMr:
A. REIMBURSEMENT COST:
[NUMBER OF FEU's I x
[ I
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I $865.31
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
ICOST PER FEU
$82.03
=
$82.03
1054
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = ,
SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) = ,
.5 ADMINISTRATIVE FEE.
I SUBTOTAL x I ADM. FEE RATE 1=
I $3.478.61 I 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Cheryl Slaymaker
10/1 012005
PREPARED BY
DATE
. .
.. "
'.
.:,.... ' ;!"
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIX11JRES x UNIT EQUlV ALENT .. DRAINAGE FIXTURE UNITS II
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTIJRES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 1 0 3 = 3 I
DRINKING FOUNTAIN 0 0 1 = 0 I
WLOOR DRAIN 0 0 3 = 0 I
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0 I
!INTERCEPTORS FOR SAND I AUTO WASH I ETe. 0 0 6 = 0 I
ILAUNDRY TUB 0 0 2 = 0 I
ICLOTHESWASHER I MOP SINK 1 0 3 = 3 I
ICLOTHESWASHER - 3 OR MORE (EAl 0 0 6 = 0 I
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I
I RECEPTOR FOR REFRIG I WATER STATION / ETe. 0 0 1 = 0
IRECEPTOR FOR COM. SINK / DISHWASHER / ETe. 0 0 3 = 0
I SHOWER. SINGLE STALL 1 0 2 = 2
I SHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0
ISINK: COMMERCiAURESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
I SINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
I SINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 = 2
IURlNAL. STALL / WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET. PRIVATE INSTALLATION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 19
~EDU (Eouivalent DweIlin~ Unit) is a disc~e eauivalent to a sincle familv dwellinR unit (20 OFlfs) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
BEFORE 1979
1979
1980
1981
1982
1983
\984
1985
\986
1987
1988
1989
\990
\99\
\992
1993
1994
1995
1996
1997
1998
1999
2000
200\
I~REbYj- RATE/$I,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
YEAR
ANNEXED
I]
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(En\er I for Yes, 2 far No)
IS IMPROVEMENT ELGlBLE FOR ANNEX.. CREDIT?
(Enter I far Yes, 2 forNa)
BASE YEAR
2
2
1979
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
. .
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~~6-g8.llll/ b..', '.
ELECTRICAL PERMIT APPLICATION ' 'OQQ V-./. '0' , ,
City Job Number ,~~ 'l~(\ c:; Date '" ,'0 ./ c:,\Q,,,'O'~'.. ~
- (''0 eO t.
. ,(\'1,; "
1. ~:j;()CAtioNOF:lNSi.;..i:r:4Ti6N '.<.~: ,1 3. r-99MPi,Eri:FEE8..ciIiililfM'Jlj;LO"",c":';;f;-i: :;'..,'..' 'j
1t\~ 1_@Jj'L)
LEGAL DESCRIPTION A. ~~.y;B:.e:;ide~i!~I_!' ~i;;g!~?(M~m'fa,!!iiy;petd_~!!~gg"uli)i/J
l'l O~2S\ 4. M\OJ Service Included
JOB DESCRIPTION
1000 sq.. ft.. or less
'::1.1-__ , ~ Each additional 500 sq. ft..or
~'w.-: portion thereof
Permits are non-tr erable and e:re If work Each Manufact'd Home or
not started within 180 days of issuance or If work is Modular Dwelling Service or
Suspended for 180 days. . T"NTIO ~eeder
- I . urennn l::l1Af ro,... .:....._ _'_
2 ~,i::ONiRAdr6R INstAfi..4.TI6N6Niy:~)'N rulCR: ~ls#vice;;f~;:F;'eOder.:;";I~:~ilati';i1:.Alte~~ti;;~r~;Reiocaiio;':
. r . .: -", ". '.--~r ,,'" . ,"", " "..,. ...-1"-tio Ce'~ ",,; 'I'" ~1""",,,,,,!::!....'lUUlil11'. - '__,'.,'...._ .._
Il _ rj,~.;b:~a n . 'I< r. J nose rules are set forth
Electrical Contractor l/UlI,,(}!.I:ltIJ WI'M/~,;952-0:!OOrAhips(6rrls~'Jh OAR 952-001- $ 63..00
UU::IU. You m'201l~lnp' s tojIllI\,AmpSh $ 75..00
rvJ.. C'~ / 'IY."'b'\7 , e rules t
Address 06f_:i~ a/~ b I JtJ C...,[ g the 1l011l\:mplrtM99!<t1lY%lephone 1 $125.00
u",ber for t"'~ 1:\00 '" ' '
C 6\11 'Amps:t6 J.UOO~~!jfication $163..00
Phone ~/-(}35?1 enl~~ l00g(Aln~tl;t). $375..00
Reconnect Only $ 50.00
$106..00
$ 19..00
'L
$50.00
\CD.oJ
,J
City ~~L,
Supervisor License Number
1-(7r/c!t5
/0 -I-/)7
/qt}-f3~
1:2-1.'3- ~
c. pt~i!!P:o!,~'ry's,~rvi~'e~ or F~ed~~~:~.~..1 :;:'.
'J~'::
"0',
.
~. ;,.,,'.'
Installation, Alteration or, Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
.over 600 Amps or 1000 Volts see "B" above.
Signature of Supervising Electrician D.. I_Br~n'-b;tii'cuits . . , ", . ' '_ ..' I
I ~ ./ ~ . New Alteration or Extension Per Panel
'-'1vI .lie. '/-r One Circuit ,,~, $ 43.00
., ,t"V\t\'~ l ~. i~~;;m~t~~~ol \ $ 3.00 ~ci>
Owners Name ...".' \\1. A ~, ' tI.\~~ Pl~\1l ~{\ " ,
Addr:sn ~ \ ~~\ o. ~\ ~t\o~:~~f.ei:ler not included) ::'~~~h Installatio~ I
City :<\(\('1 .ljphone W"'(' . _~tion $50.00
\ \ Sign/Outline Lighting $ 50.00
OWNER INST ALLA nON Liniited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45..00
Minimum Electric Permit Inspection Fee is 545..00 + Surcharges
4. r~~Or1f'~f:Mqvl> '. /', :;] UJ~ CO
I).'lJ
u'") . '?,o
it() ~l
Expiration Date
Constr. Contr.. Number
$ 50.00
$ 69.00
$ 1'00.00
Expiration Date
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
7% State Surcharge
10% Administrative Fee
luspection Request: 726-3769
TOTAL
Shared Drive(f:)/Building FormslElectrical Pennil Application I-03.doc:
.
.
'~\\O~\ng,
MANUFACTURED HOME LAND USE AGREEMENT
As required by tIie City of Springfield Development Code, 1 agree that w!lh the aJJpro;::N,of l!1e a~hed
permits, one of the following manufactured homes will be placed at ~ L\:\.... - U1\rUc., ~
Springfield, Oregon, City Job Number ( l'\t\ ~~ -Q\'!.c;c;- \
. Type 1 Manufactured Home.. A multi-sectional (double wide or wider) unit with an enclosed
floor area of not less than 1,000 square feet, that has a nominal roof pitch 00 feet in height for each 12
feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to
have an exterior thermal envelope meeting performance standards which reduce heat loss to levels
,equivalent to the performance standards required of single family dwellings constructed under the State
Specialty Codes..
_ Type 11 Manufactured Home. A unit of not less than 12 feet in width with an enclosed floor area
of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width
and that has no bare metal siding or roofmg..
The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6
percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the
home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of
the enclosing material exposed above grade..
I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60
days of the date of issuance of the manufactured home set up permit These requirements may include, but
are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on
your approved set up plans and/or permit and your partition approval if applicable:
. Street Trees
. Paving Driveway
. Minimum 32 square foot storage structure
. Completion of partition approval
. Removal of any existing structures as noted on your partition approval
. Signing and recording of any required partition, easement, improvement agreements, etc..
. Final lot grading
. City Sidewalk and curbcut installation
. Any outside agency approval as required Le.., Division of State Land approval.
By my signature below, I agree to complete the above mentioned land use requirements..
'Owner Signature
tJllnil';"-
Contractor Signature
Date
IO-'Z.S"~c!;;
Date
225 Fifth Street
SJTringfield, Oregon 97477
541-726-3759 Phone
.
~
Job/Journal Number
COM2005-0 1395
Q>M2005-0 1395
COM2005-0 1395
"
COM2005-01395
,
COM2005-01395
j
C.oM2005-0 1395
COM2005-0 1395
COM2005-0 1395
COM2005-0 1395
COM2005-0 1395
COM2005-0 1395
COM2005-0 1395
COM2005-0 1395
cpM2005-01395
COM2005-01395
COM2005-01395
COM2005-01395
COM2005-01395
CbM2005-01395
CbM2005-01395
CPM2005-0 1395
CbM2005-01395
CbM2005-0 1395
COM2005-0 1395
COM2005-0 1395
COM2005-0 1395
Payments:
Type of Payment
GreditCard
"
'I
:!
'i
:1:
V
~
"
;\
ii
10/2512005
RECEIPT #:
1200500000000001601
Description
Addressing Assignment
Willamalane ManufHome Private
Manufactured Home Feeder
Manufactured Home Service
Add, Alter, Extend Circ Ea Add
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 SanitarylStorm Admin
SDC Transpo Admin
Plan Review Major - Planning
Foundation Permit
Garage/Carport
Manufactured Home Placement
ManufHome State Issuance
Sanitary Sewer - I sl 50 Feet
Water Line -.1st 50 Feet
Storm Sewer - 1st 50 Feet
Manufactured Home Conn - Plmb
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
WILLIAM HARRISON
Cheek Number
Batch Number
Reeei ved By
djb
I of I
...IlJ.ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
Date: 10/25/2005
1:13:07PM
Item Total:
AuUJorization
Nu rnber How Received
Amou nt Due
31..00
1,000..00
50..00
50.00
3..00
694..22
476.33
362.33
182.69
805.70
82..03
865..31
10..00
105..75
68..18
150..00
68.40
115.20 '
160..00
30..00
45.00
45..00
45.00
45..00
43..86
62..66
$5,596.66
Amount Paid
053502 In Person
Payment Total:
$5,596..66
$5,596.66