HomeMy WebLinkAboutPermit Building 2006-4-21
SITE ADDRESS: 3550 GA TEW A Y ST
ASSESSOR'S PARCEL NO.: t703I5330t700
!lTTIONTION: Oregon law rei\'IYiItE}(}F\.USE: Addition Commercial
PROJECT DESCRIPTION: Carport and Interior allerations,!'xisting)Travelodge.JII'/30/2006 added lobby remodel
t' follow rUle" aUUfllvU uy .. v '~"'- . ,
por Ion. ~I"tifir~tinn Center, Those rules are set forth
, OAR 952-001-0010 tnrougn UMn ",,,c..-w .
1~090. You may obtain copies of the rules by Phone Number: 54t-686-6658
calling the center, (Note: the telephone
, ~ __.......... f'"\.."",..,..,n Iltilit\1 NotIfication
1'...,......""..;-' ' ,:_.. ;;1"\.". 'l')f')_?~A4\
I CON'fRA:CfOR INFORMATION I
Status
Issued
225 Fifth Street, Springfield, OR
54t-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Owner:
Address:
ROD KEMPF
2t21 FRANKLIN BLVD
EUGENE OR 97403
.
.CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00638
ISSUED: 04/21/2006
APPLIED: OS/27/2005
EXPIRES: 10/21/2006
VALUE: $260,500.00
Springfield TYPE OF WORK: Carport
License
Expiration Date
Phone
541-342-8077
54 t -485-6638
54 t -484-5200
541-726-0100
54t-52t-1389
Contractor Type
Architect
General
Electrical
Mechanical
Plumbing
Contractor
ROBERTSON/SHERWOOD/ARCHITECTS
STONEWOOD CONSTRUCTION INC
WIZARD ELECTRIC LLC
COMFORT FLOW
R J PLUMBING INC
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
120103
t52766
460
158500
02/04/2008
09/05/2006
06/27/2007
o t/30/2008
BUILDING INFORMATION I
R-t
A-3
VA
# of Stories: 3 Lot Size:
Height of Structure 35.50 Sq Ftlst Floor:
Type of Heat: Electric Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
NM~fath: ~t1HE ~R<<Other:
1SDI'irpernAlyili/ihglL EXPIR M\11S>f,lil~ant Load:
111" _ T,"rn ,.Ulc:. P
I DEVBl~~~E~fJWF~R~t.~~1NEOfUK
~~~"1BO DAY PERIOD.
'Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
tt9
1,250
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Fullv Improved
Yes
Sidewalk Type:
DownspoutslDrains:
Curbside 5'
To Storm Sewer
Notes: Interior remodel only changing from 119 rooms to 102 rooms SDC credit noted on SDC Worksheet8/t5/2005 CAS
Paee I of6
Status
Issued
225 Fifth Street, Springfield, OR
54t-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Bid Amount
Estimate
Pavine
Use Bid Amount
Estimate
Use Bid Amount
I,
Fee Description
Plan Review CommlInd/Puhlic
+ 10% Administrative Fee
+ 70/0 State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extepd Circ Ea Add
Building Permit
Fixtnre
Plan Review Fire & Life Safety
Plan Review/Com,lnd,Pub Hourly
+ 10% Administrative Fee
+ 8% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Plan Review CommlInd/Public
Plan Review Fire & Life Safety
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 8% State Surcharge
Building Permit
Fixture
Heat Pump
Minimum/Adjustment Mechanical
Paving
Plan Review CommlIndfPublic
Plan Review Fire & Life Safety
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
Total Amount Paid
.
.CITY OF SPRI~l..l' IJ!.LD
Building/Combination Permit
PERMIT NO: COM2005-00638
ISSUED: 04/21/2006
APPLIED: OS/27/2005
EXPIRES: 10/21/2006
VALUE: $ 260,500.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
$1.00
$1.00
Square Footage
or Bid Amount
10,500.00
200,000.00
50,000.00
Value
Date Calculated
$ t 0,500.00
$200,000.00
$50,000.00
$260,500.00
12/2112005
Ot/30/2006
03/08/2006
Total Value of Project
FpP~, ~
Amount Paid
$409.92
$35.52
$24.86
$43.00
$t5.00
$tt5.20
$t82.00
$46.08
$90.00
$6.70
$5.36
$43.00
$24.00
$578.92
$356.26
$tO.OO
$t40.43
$82.69
$890.65
$98.00
$t2.00
$33.00
$370.65
$t05.63
$65.00
$tO.OO
$3,090.84
$330.56
$171.57
$7,386.84
Date Paid
Receipt Number
5/27/05
to/4/05
10/4/05
to/4/05
to/4/05
10/4/05
10/4/05
10/4/05
10/14/05
1/20/06
1/20/06
1/20/06
1/20/06
1/30/06
1/30/06
4/21/06
4/21/06
4/21/06
4/21/06
4/21106
4/21/06
4/21106
4/21106
4/21/06
4/21/06
4/2l/06
4/2l/06
4/2l/06
4/21/06
3200500000000000259
220050000000000t371
2200500000000001371
220050000000000t37t
220050000000000t371
220050000000000137t
220050000000000137t
220050000000000137t
2200500000000001447
t200600000000000065
1200600000000000065
1200600000000000065
t200600000000000065
2200600000000000t44
2200600000000000t44
t200600000000000526
t200600000000000526
t200600000000000526
t200600000000000526
t200600000000000526
t200600000000000526
t200600000000000526
t200600000000000526
1200600000000000526
1200600000000000526
1200600000000000526
t200600000000000526
t200600000000000526
t200600000000000526
Paee 2 of6
. .Llll OF ~t'Kll'i'-'NELD
Building/Combination Permit
Status Issued PERMIT NO: COM2005-00638
225 Fifth Street, Springfield, OR ISSUED: 04/21/2006
541-726-3753 Phone APPLIED: OS/27/2005
541-726-3676 Fax EXPIRES: 10/21/2006
541-726-3769 Inspection Line VALUE: $ 260,500.00
I Plan Reviews I
Fire Department Review 0210212006 03/22/2006 OK GRG See attached Fire Department
Comments.
Fire Department Review 05/3112005 07/05/2005 OK GRG Plan Review: Exterior and interior
remodel-exterior canopy and
interior conference room. Job
#COM2005-00638. Occupancy
Classification: R-1. Construction
Type: V -A Sprinklered.
Maintain fire extinguishers with a
minimum rating of2-A:tO-B:C
every 75 feet of travel distance. The
top of the extinguisher(s) shall be
I between 3 and 5 feet above finished
I 1100r (2004 Springfield Fire Code
906).
I' Extend sprinkler coverage to canopy
(NFPA 13-2002, 8.14.7.t).
If more than 20 sprinkler heads are
added or require relocation, submit
sprinkler plans and calculations to
Springfield Fire Marshal's Office fOI
review and approval. Ifless than 20
sprinkler heads are relocated,
provide submittal showing
relocation of sprinkler heads and
ensure system maintains compliance
with NFPA 13 requirements.
Fire Department Review 08/05/2005 10/07/2005 OK GRG Revised plans.
Plan Review: Revision - Exterior
and interior remodel and interior
conference room. Job
#COM2005-00638. Occupancy
Classification: R-1. Construction
Type: V-A Sprinklered. Canopy is
not being installed. See plans review
comments from 7/5/05. Revision
reviewed by mfechtel. Supervised by
Gilbert Gordon.
Initial Review 05/3112005 05/3112005 APP LLH
Initial Review 0210212006 02/0212006 APP SKG Lobby addition
Plan nine: Review 0210212006 02/03/2006 APP EMM
Paee 3 of6
. .CITY OF SPRINGFIELD'
Building/Combination Permit
Status Issued PERMIT NO: COM2005-00638
225 Fifth Street, Springfield, OR ISSUED: 04/2 1/2006
541-726-3753 Phone APPLIED: OS/27/2005
541-726-3676 Fax EXPIRES: 10/21/2006
541-726-3769 Inspection Line VALUE: '$ 260,500.00
Plan nine Review 05/31/2005 06/24/2005 APP Steve Robinson will bring in revised
site plan showing two additional
parking spaces. Received revised
pl~t plan on 6/24/05.
Plannine Review 08/05/2005 08/12/2005 APP EMM Revised plans.
Pnblic Works Review 08/05/2005 08/t 5/2005 APP CAS Revised plans. Interior remodel
only; changing 119 rooms to t02
rooms SDC credit noted on
worksheet
Public Works Review 05/31/2005 03/13/2006 APP SB SDCs added. No LDAP.
Public Works Review 0210212006 031l3/2006 APP SB SDCs added. No LDAP required.
Structural Review 10/14/2005 I Oft 4/2005 APP JMP Revisions to the ADA suite.
Structural Review 0210212006 02109/2006 WE JMP Lobby addition. See attached
documents for 5 structural
comments faxed to James M.
Robertson.
Structural Review 06/24/2005 06/24/2005 10 JMP Left a message with Corrine for Jeff
Morton asking for a status update
on scheduled revised set.
Structural Review 08/05/2005 08/15/2005 WE JMP Jeff Morton delivered revised plans.
See attached documents for 6
structural comments faxed to Jeff
Morton.
Structural Review 03/08/2006 03/08/2006 10 JMP WI. Received contractor and
valuation data from John Bramwell.
Structural Review 03/13/2006 03/t 3/2006 10 JMP WI. Received pluming count
verification from Rob at RJ
Plumbing.
Structural Review 03/24/2006 03/24/2006 APP JMP Received final internal review.
Structural Review 05/3t/2005 06/t 0/2005 WE JMP Met with Jeff Morton who said to
place the job on hold until they
decide how extensive they want to
make a revised set. Also requested
the 4th set and the 2 sets of energy
code forms for SUB's approval.
Structural Review 08/25/2005 08/2512005 10 JMP WE. Received revision for ADA
restroom--relocated the toilet. Still
waiting on the balance of the
responses to the comments.
Structural Review 09/29/2005 09/30/2005 APP JMP Received response to structural
comments from Josh Shafer.
Forwarded energy code forms to
David Harris. Received final
internal review.
SUB Review 09/30/2005 09/30/2005 APP DH No energy code issues or inspections
on the suite conversions which is the
only portion to be permitted at this
time.
Paee 4 of6
.
.CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2005-00638
ISSUED: 04/2112006
APPLIED: OS/27/2005
EXPIRES: 10/2112006
VALUE: $ 260,500.00
Status
Issued
225 Fifth Street, Springfield. OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SUB Review
02/02/2006
02110/2006
WE
JF
Revised plans. JMP left a message
for Jeff Morton requesting energy
code forms and worksheets.
, JMP left a voice mail message for
John Bramwell requesting the
missing HV AC and Lighting code
forms.
WE. Received HV AC forms.
Lighting forms still outstanding.
JMP called John Bramwell to notify
him. John said that he is working
with the electrician to get those
forms turned in.
SUB Review
08/05/2005
08/12/2005
WE
JF
SUB Review
02117/2006
02/17/2006
10
JF
SUB Review
03/06/2006
03/0612006
APP JF
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 Rpnllirptllnli',"~
Framing Inspection: Prior to cover and after all rough in inspections have heen approved.
Drywall: Prior to tapiug.
Final Fire Department. After all requirements of the Fire Department have heen met.
Final Building: After all required inspections have been requested and approved and the huilding is complete.
Rough Plumbing: Prior to cover and iucludiug required testiug.
Final Plumhiug: When all plumhing work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
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.
Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
Shear Wall Nailing: Before covering sheathing with finish materials.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Paee 5 of6
.
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00638
ISSUED: 04/21/2006
APPLIED: OS/27/2005
EXPIRES: 10/21/2006
VALUE: $ 260,500.00
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54t-726-37691nspection Line
Roofing: Prior to installing any roof covering.
Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Bnilding Inspector.
Roof Sheathing/Nailing: Before covering sheathing with finish material.
Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to
placement.
Ceiling Grid: After drywall approval but prior to cover.
Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City
Building Inspector.
Rough Grading: After gravel is in place but prior to placing concrete.
Final Paving: After paving is complete.
SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection.
SUB Final: After all required energy inspections have been requested and approved.
SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
SUB Ceiling Grid: Interior Lighting
SUB Exterior Lighting
I
I
I
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 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' located at the front of the property, and the approved set of plans will remain on the site at all
times during constr on. /
~
D'~/;
I,
//
Owner ~~ Signature
Paee 6 of6
, ,
.
.
ATTACHMENT A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET
JOURNAL OR JOB NUMBER C0M2005-00638
NAME OR COMPANY: 9!!,ality Inn & Suites
LOCATION: 3550 Gateway St
MAP & TAX LOT NUMBER: 1703153301700
DEVELOPMENT TYPE: Motel addition
NEW DEVELOPED AREA (S,F,):
EXISTING DEVELOPED AREA (S,F,):
TOTAL IMPERVIOUS SURFACE (S,F,):
2.125.00
lTE:
ITE:
LOT SIZE (S,F,):
320
1 STORM ORAlNAGE
IMPERVIOUS SQ, IT,
x
$ 0,323 PER SF
TOTAL STORM DRAINAGE SDC:}
2 SANITARY SEWER-CITY
A. REIMBURSEMENT COST:
NUMBER OF DFU's -16
B, IMPROVEMENT COST:
NUMBER OF DFU's -16
(SEE REVERSE SIDE)
..m
8 ~ ",:~,~
tr:l u 0 ::I: -':60:0'
q;o '" 4> cl ~u ,
0'" '" "', ,,~.
-=-I~
$0,00 1,1,78
$0,00
$0,00
$0,00
fY
x $ 25.Q7 PER DFU ($401.18) jJ
x $ 19,07 PER DFU ($305,06)
$ 44,14
TOTAL WCAL W ASTEW A TER SDC:, $0,00 I ($706.24)
NTF $0,00 I
NTF $0,00 , J2f
0 NTF $0,00 ~
0 NTF $0,00 ~
:' TRANSPORT ~ Motel Trips are added for only new rooms.
BLOO AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR
NEW
A. REIMBURSEMENT COST:
0.00 x 9,11
B, IMPROVEMENT COST:
0,00 x 9,11
EXISTING
A. REIMBURSEMENT COST:
0,00 x 0
B, IMPROVEMENT COST:
0,00 x
x
$ 19,09 PER TRIP
x
x
$ 84.19 PER TRIP
x
x
$ 19,09 PER TRIP
x
o
$ 84.19 PER TRIP
$ 103.28
x
x
TOTAL TRANSPORTATION REIMBURSEMENT SDq
TOTAL TRANSPORTATION IMPROVEMENT SDq
TOTAL TRANSPORTATION SDq $ I
4 SANITARY SEWER - MWMC
NEW:
A. REIMBURSEMENT COST:
NUMBER OF FEU's 2.13 x $155.56 PER FEU $330,56 I
B. IMPROVEMENT COST:
NUMBER OF FEU's 2,13 x $1,454,51 PER FEU $3,090,84 I
EXISTING:
A. REIMBURSEMENT COST:
NUMBER OF FEU's 0.00 x $0.00 PER FEU $0,00 I
B. IMPROVEMENT COST:
NUMBER OF FEU's 0.00 x $0,00 PER FEU $0,00 I
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL MWMC REIMBURSEMENT FEE:
TOTAL MWMC IMPROVEMENT FEE:
MWMC ADMINISTRATIVE FEE:
TOTALMWMCSDq $ 3,431.40
SUBTOTAL (ADD ITEMS 1,2,3,&4} $3,431.40 I
:li AOMTNlSTRATJVE FEES'
BASE CHARGE (SUBTOTAL ABOVE)
$
3.431.40 x 5% , $171.57
TOTAL TRANSPORTATION ADMINISTRATION FEE: $
TOTAL SEWER ADMINISTRATION FEE: $
&:.... /'.(/. ~ a.......
SDC COORDINATOR
31912006
DATE
TOTAL SOC CIIARGES
1 SteveCOMBuildSDCJUL200S.x1s
$0,00
$330.56
$3,090,84 -
$10,00
$3,431.40
.
~I
171.57 ;1<190,.,.
$3.602,97
1 JUt y 2004
.
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS
(NOTE: FOR REMOOELS. CALCULATE ONLY TIlE NET ADDmONAL FIXTURES)
3550 Gateway St
FIXTURE TYPE
..' BATIlTUB
,_)- DRINKING FOUNTAIN
FLOOR ORAIN, FLOOR SINK
INTERCEPTORS FOR GREASPJOlUSOLIDSlETC,
INTERCEPTORS FOR SAND/AUTO WASIllETC.
r.:..... LAUNDRYTUB
(, \ CLOTHES WASHERlMOP SINK
\ CLOTHES WASHER-3 OR MORE (EA)
. .~". MOBll..E HOME PARK TRAP (l PER TRAILER)
RECEPTOR FOR REFRlGERA TORIW A TER ST A TlONIETC.
RECEPTOR FOR COMMERCIAL SINKJ DISHW ASHERlETC.
SHOWER, SINGLE STALL
SHOWER, GANG (NUMBER OF HEADS)
SINK: COMMERCIAL, RESIDENTIAL KITCHEN
SINK: COMMERCIAL BAR
SINK: WASH BASINIDOUBLE LAVATORY
SINK: SINGLE LA V A TORYIRESIDENTIAL BAR
URINAL, ST ALUWALL
:.....\ TOILET, PUBLIC INSTAllATION
!. \ TOILET, PRIVATE INSTALLATION,
" . l MISCELLANEOUS:
'./ ... NUMBER OF EDU'S'
FIXTURES
NEW 01..0
3
UNIT
EQUIVALENT
3
I
3
3
6
2
3
6
12
I
3
2
2
3
2
2
I
5
6
3
2 3
2 3
TOTAL DRAINAGE FIXTURE UNITS=
_ 'EDU rEauivalent Dwelling Unit) is a dischar~e equivalent 10 a single familv dwelling 120 0FlJ) set at 167 gallons per day
CREDIT CALCULATION TABLE: BASEO ON ASSESSED VALUE
IF IMPROVEMENTS OCCURREDAITER ANNEXATION DATE IN TABLE. CALCULATE CREDITS SEPARATELY
YEAR
ANNEXEO
1979 or before
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
RATE PER SI,OOO
ASSESSED VALUE
'S5,29 "
"".'."........ I
,".S5J9'
:,"S5.12
'$4'.98
$480
. $4,63;
$440,'
. '" $4,07
:-..'-.-.'.''-''''',.1
:' S3,67,'
S3,22',
....$2,73.'
.....S2~5.
."S'1.80.
CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE
IMPROVEMENT (IF AITER ANNEXA TlON DATE)
1 SteveCOMBuildSDCJUL200S,x1s
, .f,. I.
ORAINAGE
FIXTURE
UNITS
.9
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
-I
o
-6
o
o
o
o
-16
YEAR
ANNEXED
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
RATE PER SI,OOO
ASSESSED VALUE
.:.; -,
,...
, , S1.45:
..cc.,. . .'
: -, ',. ':.:':' . S1.25-
.... '.'SI.09,
. - .__SO,~2',
:"" SO,72.
", SO,48 ,
i'.:r;"'- -. ,
, ..SO:28.'
"'ii:'", .....-- -..
:(:.~;I:; ',',:<~'.:_ SO,o9:,:
". SO,05,I
"j.' .,
'.0 <",SO,OO'
.'C-' SO,oo.
" . '_"'SO,oo
x
x
CREOITTOTAL
SO,OO
SO,OO
SO.OO
1 JULY 2004
225 Fifth Street
, ,
Springfit;ld, Oregon 97477
541-726-3759 Phone
. j':Q~;-
~..
C.f Springfield Official Receipt
~opment Services Department
Public Works Department
Job/Journal Number
COM200S-00638
COM200S-00638
COM200S-00638
COM200S-00638
COM200S-00638
COM200S-00638
.COM200S-00638
'COM200S-00638
COM200S-00638
COM200S-00638
COM200S-00638
:COM200S-00638
COM200S-00638
COM200S-00638
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
1200600000000000526
Date: 04/21/2006
Description
Paving
Building Permit
Plan Review CommllndlPublic
Plan Review Fire & Life Safety
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
Fixture
Heat Pump
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
INN4 LLLC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
11023
In Person
Payment Total:
Page I of I
9:49:4IAM
Amount Due
370,6S
890,6S
IOS,63
6S,OO
330,S6
3,090,84
10,00
l7l.S7
98,00
12,00
33,00
10,00
82,69
140.43
$5,411.02
Amount Paid
$S,4l1.02
$5,411.02
412112006