HomeMy WebLinkAboutPermit Building 2005-3-8 (2)
.
Status
Issued
*
~
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
. CITY OF ~rK11'luFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01/20/2005
EXPIRES: 09/08/2005
VALUE: $ 62,779.00
SITE ADDRESS: 2638 MAlA LP
ASSESSOR'S PARCEL NO.: 1703251405700
Springfield TYPE OF WORK: Manuf Home w
Garage/Carport Private Lot
New Residential
TYPE OF USE:
PROJECT DESCRIPTION: Maia park lot 34 - MH on lot witb garage & covered deck.
Owner: JOHN GARRETT
Address: 2638 MAlA LOOP
SPRINGFIELD OR 97477
Pbone Number: 541-672-6088
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Manuf Home Inst
Plumbing
Contractor License
HARDACKER & OLEARY DEVELOPMENT 79496
CHRIS MILLERS ELECTRIC INC 62377
HARDACKER & OLEARY DEVELOPMENT 79496
HARDACKER & OLEARY 79496
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
1
R-3
U
VN
# of Stories:
Heigbt of Structure
Type of Heat:
Water Type:
Range Type:
Energy Patb:
Sprinkled Building:
Expiration Date
02119/2007
12/21/2006
02/19/2007
02/19/2007
Phone
54 I -895-4307
541-895-3660
541-895-4307
541-895-4307
1 Lot Size:
13.00 Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Otber:
n/a Occupant Load:
572
160
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
< Solar Setbacks:
23.00
12.00
10.00
17.00
0.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
, PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Fully Improved
Yes
Notes:
Stor~TIldr,fi~'m~\'t,~CJrt~~~~J~~~Ej91~Jftl~~UOUt<I~Ot
TO low rures aoopleo oy me ttregon I I Y
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001.
0090. You may obtain copies of the rules b}
calling the center. (Note: the telephone
number for the Oregon Utility Notification Pa!!e 1 of 4
Center is 1-800-332-2344).
REQUIRED PARKING
Yes
37.80
Total:
Handicapped:
Compact:
2
Sidewalk Type:
Downspoutsffirains:
Curbside 5'
Curb and Gutter
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Status
Issued
I
225 Fiftb Street, Springfield, OR
54 I -726-3753 Pbone
54 I -726-3676 Fax
541-726-3769 Inspection Line
Descrintion
Tvpe of Construction
Carport
Foundation On Iv
Garae:e
Manuf Home
Carport
Use Bid Amount
Gara!!e
Manufactured Home
Fee Description
Plan Review Residential
+ 100/0 Administrative Fee
+ 7% State Surcbarge
Addressing Assignment
Garage/Carport
Manuf Home State Issuance
Manufactured Home Conn - Plmb
Manufactured Home Placement
Plan Review Major - Planning
Sanitary Sewer - 1st 50 Feet
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
Storm Drainage Impervious Area
Storm Sewer - 1st 50 Feet
Water Line - 1st 50 Feet
WiIlamalane Manuf Home Private
Total Amount Paid
Initial Review
Planoin!! Review
Public Works Review
01/25/2005
01/25/2005
01/25/2005
.
. CITY OF ~rK11~GFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01120/2005
EXPIRES: 09/08/2005
VALUE: $ 62,779.00
I Valuation Descrintion J
$ Per Sq Ft
or multiplier
$18.00
$1.00
$24.30
$1.00
Square Footage
or Bid Amount
160.00
3,000.00
572.00
43,000.00
Value
Date Calculated
$2,880.00
$3,000.00
$13,899.60
$43,000.00
$62,779.60
03/07/2005
01120/2005
03/07/2005
01/20/2005
Total Vaiue of Project
F"".. PiiaJ
Amount Paid
$ I 05.30
$52.54
$36.78
$31.00
$185.40
$30.00
$45.00
$160.00
$103.00
$45.00
$402.16
$528.88
$10.00
$865.31
$82.03
$128.15
$63.19
$772.49
$175.13
$990.76
$45.00
$45.00
$1,000.00
$5,902.12
Date Paid
Receipt Number
1/20/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8105
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
1200500000000000083
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304 '
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
I Plan Reviews I
01/25/2005
02115/2005
01/27/2005
APP SKG
APP TAJ
APP CAS
Storm drainage piped to curb face
1/2712005 CAS
Pa!!e 2 of 4
.
. CITY OF oSrlOrlihHJ!.LD
Building/Combination Permit
Status
Issued
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01/20/2005
EXPIRES: 09/08/2005
VALUE: $ 62,779.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Structural Review
01125/2005
03/0712005
OK
DLM
Missing the proposed foundation
drawing for the M.H. Called
contractor & requested that he
bring in the needed drawing before
obtaining permits. 3/7/05 dim
Standard comments for M.H. &
Garage. All other commnets are on
hte drawings.
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.
I ll'pnl.1rp,! rn.np~.lnn. II
Ir~
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 piacement.
Shear Wall Nailing: Before covering sheathing with finish materials.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
Manuf Home Set Up: When installation of all piers or stands is complete.
Final Manuf Home Set Up: After all 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.
Undertloor Drain: Prior to cover or placement of concrete.
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.
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.
MH Pedestal: Approval required prior to utility company energizing service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Pal!e 3 of 4
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54 I -726-3676 Fax
541-726-3769 Inspection Line
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01120/2005
EXPIRES: 09/08/2005
VALUE: $ 62,779.00
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 ofthe 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 c"}'struction.
o.",,!i.~ .....:~
Pal!e 4 of 4
---
'3--/3-05
Date
A. ~~\fenti~i~'in
~'--- ~- ".~
Service Included
1000 sq. ft. or less
Each additional 500 sq. It .or
portion thereof'
"J,,\T,f\.rl
. Permits are non-transferable and expire if work Is Each Manufact!d Home or
~ not started within 180 days of Issuance or if work Is MOdul3iiQweUih'giSernce,bt EXPIRE~. THE ORK
Suspended for 180 days. Feed~UTHORIZED UNDER THI: ~~; :~~:: 1~51~m
~-'''''''''''~'-'''''''''~--~<>-::il ~~_~,,(i.<~~;~;t..~"':!,'tb ". .
2 ,GONFRACxOR/INSTA.1JIM.'TIOMONriJ!.J . B. S~ices,or;ne(1e's ~liistanation~~A'Itei'al1onslor.Reloca 'on:
. ..'"....:.-.~~~~~~~_..N,:... '" .. ,"'.. ...,... .--.--',.
",. .....
ElectricalContractor{U,tJ;~ /tf/L?M ~~Ampsorless
201 Amps to 400 Amps
/('/ 401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsIVolts
Reconnect Only
1. ~6i:i:ATtON?tiE100~~.' -. ".
r,o",. ...~.............""",~'i'w'-iil . ''''=-
'7._ 6:?8" /JfA//! /...D6 P
LEGrtfo~~, D5100
JOB DESCRIPTION
/U. ~ d~.
~
~-
Address -??52P' / l)fZ,; .:J /'~
City~".JL~<=- Phone fiit?(' -:""S!:(j"O
"32-"2- 5';5
C/ -Zoo 7
{,2;]77
/2/ Z/ /260.('
I
Signature of Supervising Electrician
Supervisor License Number
Expiration Date / /S
Constr. Contr. Number
Expiration Date
~-<4-L
Owners Name C:;#4A' /.t'/ /".
Address 2 i. '?x m /'9/ /l M6>/
. Ci~9.('L-b Phone (17_ - 6cfJ?
!/~
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent. .
Owners Signature:
Inspection Request: 726-3769
~" .....~~,J. ~ ~,~p.~:.:.'K.f~~~?~~~~~ ~~..:.: :~~>:
SPRINQFlELD
"
3.
goD
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.~1ii"'~r\i~s~-='f.1F~'
...-l"',...",':::;.I.'.~.,. ""'_'~~'''-''__ " -_ '.~ '.
Installation, Alteration or Reiocation
200 Amps or less
20 I Amps to 400 Amps.
401 Amps to 600 Amps
A T@liiillo(]l)MnIjls01l!dtm~Q~
ff)) 'm~1i"~' .... 1 :~., ' . . ?', .' ~,
Notifi Ion' n er. op'e ru e!i>l\f~,\wJ forth
In O~'!lSi~~P-'1tMf> rl'l~fg~nOAln)"5~~Oo1.
oosl9.nn:.\iWl'Jt. obt~in co lies olf th . " $ 43.00
~~Arlrli Y .1' t 'tb '" 'U'''u ,,'/
c ,ffi 1Tffi' Rre .p1IN!l/1 ?f:'tfle telephone $ 3 00
c or ee r Penm .
nUl I er for! <(5regon Jtility Notification
~~lZheruel;!)!;~l'>~~Q~::>:il!!til~"""""~'~ '-~\.I"o-~
E. ~~~i<L~l~~~~!!!!.lli:ift'f.!!!.~l~~Cn.i!ns:tan~tioIi
$ 50.00
$ 69.00
$100.00
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $25.00
Limited Energy/Commercial $ 45.00
Mbtlmum Electric Permit Inspection Fee Is $45.00 + Surcharges
4. ~UBfgLA!!O~O~. '. .... ~~,r7\ t:D
rA.'""",>>"I<,~~4..liitJ~~~ ." ~ ~(J
3-.)-0
{;OU
~.szJ
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:YBuilding Forms/Electrical Pennit Application I-oJ.doc
Status ' Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 2638 MAlA LP
ASSESSOR'S PARCEL NO.: 1703251405700
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01120/2005
EXPIRES: 09/09/2005
VALUE: $ 62,779.00
Springfield TYPE OF WORK: Manuf Home w
Garage/Carport Private Lot
New Residential
TYPE OF USE:
PROJECT DESCRIPTION: Maia park lot 34 - MH on lot with garage & covered deck.
Owner: JOHN GARRETT
Address: 2638 MAlA LOOP
SPRINGFIELD OR 97477
Contractor Type
General
Electrical
Manuf Home Inst
Plumbing
NOTli:t: Phone Number: 541-672-6088
THIS PERMIT SHALL EXPIRe IF I Ht WOHK
AUTHORIZED UNDER THIS PERMIT IS NOT
___ __.~ ....................,,....,.... ,...1"'1....
\JVlVtlVILl'iVLU UIIIU ,n..'''......'''''.......... .......
, CONTRACTOR INFORMA:n0Ntl~luD.
Contractor License
HARDACKER & OLEARY DEVELOPMENT 79496
CHRIS MILLERS ELECTRIC INC 62377
HARDACKER & OLEARY DEVELOPMENT 79496
HARDACKER & OLEARY 79496
BUILDING INFORMATION I
Phone
541-895-4307
541-895-3660
541-895-4307
54 I -895-4307
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
23.00
12.00
10.00
17.00
0.00
Street Improvements:
Storm Sewer Available:
Special Instruction:
Expiration Date
02/19/2007
12/21/2006
0211912007
02/1912007
1
R-3
U
VN
# of Stories: 1 Lot Size:
Height of Structure 13.00 Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: ~ Sq Ft Basement:
Range Type: Sq Ft Garage/Carport 572
Energy Path: Sq Ft Other: 160
Sprinkled Bulldina:TENTIO. nla. ... Occupant Load: to
K1 N: ure"onlaw reqUires YOU
I DEVELOPMENT INFbW n'oii-iopted by the Oregon Utility
, Bu_ _.. _ _ _ otero Those rulE"RF.'iftliml&1IluuoNG
in OAR 952-001-0010 through OAi1952-001.
Overlay D1st: 0090. You may obtain copies aiq!lI!:rules by 2
# Street ~rees R'I1!illling the center, (Note: th~g!ffl!l!ll~,d:
~/avefdLDncve Rq~iumber for the Or~~vn Utility<;~ffiR1U'Jiion
/00 ot overage: Center is37'~~0-332-2344).
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
DownspoutslDrains:
Fully Improved
Yes
Curbside 5'
Curb and Gutter
Notes: Storm drainage piped to curb face 1/27/2005
Pal!e I of4
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone,
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Carport
Foundation Onlv
Garal!e
Manuf Home
Carport
Use Bid Amount
Garal!e
Manufactured Home
Fee Descrintion
Plan Review Residential
+ 10% Administrative Fee
+ 7% State Surcharge
Addressing Assignment
Garage/Carport
Manuf Home State Issuance
Manufactured Home Conn - Plmb
Manufactured Home Placement
Plan Review Major - Planning
Sanitary Sewer - 1st 50 Feet
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
Storm Drainage Impervious Area
Storm Sewer - 1st 50 Feet
Water Line - 1st 50 Feet
WilIamalane Manuf Home Private
+ 10% Administrative Fee
, + 7% State Surcharge
Manufactured Home Service
Totai Amount Paid
Initial Review
Plannlnl! Review
01/25/2005
01/25/2005
.
. CITY OF ~noNGFIELD
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: ' 03/08/2005
APPLIED: 01120/2005
EXPIRES: '09/09/2005
VALUE: $ 62,779.00
I Valuation Descriotion ,
$ Per Sq Ft
or multiplier
$18.00
$1.00
$24.30
$1.00
Square Footage
or Bid Amount
160.00
3,000.00
572.00
43,000.00
Value
Date Calcuiated
Total Value of Project
$2,880.00
$3,000.00
$13,899.60
$43,000.00
$62,779.60
03/0712005
01/20/2005
03107/2005
01/20/2005
)?pp< Pilil1.l
Amount Paid
Date Paid
Receipt Number
1200500000000000083
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000304
1200500000000000341
1200500000000000341
1200500000000000341
$105.30
$52.54
$36.78
$31.00
$185.40
$30.00
$45.00
$160.00
$103.00
$45.00
$402.16
$528.88
$10.00
$865.31
$82.03
$128.15
$63.19
$772.49
$175.13
$990.76
$45.00
. $45.00
$1,000.00
$5.00
$3.50
$50.00
1/20/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/8/05
3/17/05
3/17/05
3/17/05
$5,960.62
I Plan Reviews I
01125/2005
02/1 5/2005
APP SKG
APP TAJ
Pal!e 2 of4
.
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01/20/2005
EXPIRES: 09/09/2005
VALUE: $ 62,779.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Public Works Review
01125/2005
01127/2005
APP CAS
Storm drainage piped to curb face
112712005 CAS
Missing the proposed foundation
drawing for the M.H. Called
contractor & requested that he
bring In the needed drawing before
obtaining permits. 3/7/05 dim
Standard comments for M.H. &
Garage. All other commnets are on
hte drawings.
Structural Review
01125/2005
03/07/2005
OK DLM
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.
Deer Electrical Ground: Install ground rod at footing and caU 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.
Shear Wall Nailing: Before covering sheathing with finish materiais.
Framing Inspection: Prior to cover and after all rough In inspections have been approved.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
ManufHome Set Up: When installation of all piers or stands Is complete.
Final Manuf Home Set Up: After all 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 compleie.
Underf)oor Drain: Prior to cover or placement of concrete.
Water Line: Prior to mllng 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.
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.
MH Pedestal: Approval required prior to utility company energizing service.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Pal!e 3 of 4
.
. CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2005-00080
ISSUED: 03/08/2005
APPLIED: 01120/2005
EXPIRES: 09/09/2005
VALUE: $ 62,779.00
Status
Issued
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 OCCUPANCY wlII be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are iu compliance with ORS 701.005 wlII 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 wlII remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Pal!e40f4
225-F:ifth Street
Springfield, Oregon 97477
. \
541-726-3759 Phone
Job/Journal Nnmber
COM2005-00080
COM2005-00080
COM2005-00080
Paymeats:
Type of Payment
CreditCard
./
:j
3/17/2005
"
.
RECEIPT #:
Description
Manufactured Home Service
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
CHRIS MILLER
.~"""'...._;
IIIE. ...,..=....,......-. ...M............... ;.............
, ."..,-"," ..
t " ,
"'- ,
i' .. j
;-' '- i
"..., h
,_........................... ..,' h-....r.'. '"
~ of Springfield Official Receipt
.elopment Services Department
Public Works Department
1200500000000000341
Date: 03/17/2005
Item Total:
Check Number" Authorization
Received By Batch Number Number How Received
ddk 984866 In Person
Payment Total:
Page I ofl
10:45:27AM
Amount Due
50.00
3.50
5.00
S58.50
Amount Paid
$58.50
S58.50