HomeMy WebLinkAboutPermit Building 2003-10-10
Status
Issued
.
. \...11 i' OF SPKJ1'1tJN~LD
Building/Combination Permit
PERMIT NO: COM2003-00086
ISSUED: 10/10/2003
APPLIED: 02/14/2003
EXPIRES: 06/24/2004
VALUE: $ 3,663,106.80
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1007 HARLOW RD
ASSESSOR'S PARCEL NO.: 1703223300400
TYPE OF WORK: Medical Office
TYPE OF USE:
PROJECT DESCRIPTION: Medical Office Building, DRC #2002-11-0359.
Temp Occ 1st floor/Cascade Endoscopy only.122903.
New
Commercial
Owncr: WILLAMETTE MEDICAL CENTER LLC
Address: 975 OAK ST # 780 EUGENE OR 97401
Contractor Type
Architect
General
Electrical
Mechanical
Plumbing
I CONTRACTOR INFORMATION I
Contractor
AFFOLTER WEST & JONES
MElLI CONSTRUCTION CO
MUZAK LLC
COMFORT FLOW
ROBINSON PLUMBING INC
License
Expiration Date
Phone
541-342-6511
541-485-1417
800-331-3340
541-726-0100
541-345-6909
63771
142760
460
107124
02/12/2004
05/1112004
06/27/2005
07/13/2005
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Froptyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewcr Available:
Special Instruction:
Notes:
# of Stories:
Height of Structure
. Type of Heat:
Water Type: O~ \0
Range T~\\~eS 'I ~\\\'I
Ene!ill~Th.:^O(\ ~..o(l
0(\ \'i> e ot-ete &8 .1$)'
.~.,,(e~_.:......~: 1.\6~,~fQ5!,_- \
~G~-<;\U r.o>>V'E'bOPMEN(I,\lNEtil.RM'!i"0N I
Y 'e'O . I ..., 1I ,,,.
II' ~ t\)\ Cetv'~. \~\l\ ~ ~\'ifO \'i1''P ~u"
\0\\0 r:~'O.O(\jp'\l.tP ~1-)~~~t~~e ~o'O.f,~
~,O~~",g~~'l~:Sfr~~~~}
.(\ O.-{O ~e08.&lQlta~6lY.8i\ijd:
~ ~\\(\O ~\~ ".~
08 ~et\O ,,.%'6f Lot Coverage:
(\~f:\' ("""
B
1-1.2
VNSpr
3
43.00
Lot Size:
Sq Ft 1st Floor: 7,972
Sq Ft 2nd Floor: 9,090
Sq Ft Basement:
Sq Ft Garagc/Carport
Sq Ft Other: 9,090
Impervious Surface Area:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPR~~ i L EXPIRE If lHE WORK
T~\S ~tKlv~T SH~'9l'lffivl1f:RMIT IS NOT
, AUTHORIZED Ul ~v,~~~d9. fOR
COMMENCED rRP spou .
ANY 180 Df\Y PER~OD.
Paee 1 of9
.
. CITY OF ~t'K1NGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00086
ISSUED: 10/10/2003
APPLIED: 02/14/2003
EXPIRES: 06/24/2004
VALUE: $ 3,663,106.80
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Vah..ation Deseriotion I
, ,
Bid Amount
Estimate
Foundation Onlv
Pavine
Sprinkler Svs
Use Bid Amount
Estimate
Use Bid Amount
Use Bid Amount
Sprinkler Svstem
$ Per Sq Ft
or multiplier
$1.00
$1.00
$1.00
$1.00
$2.60
Square Footage
or Bid Amount
1,121,000.00
2,100,000.00
235,130.00
159,675.00
18,193.00
Value
Date Calculated
Description
Tvpe of Construction
Total Value of Project
$1,121,000.00
$2,100,000.00
$235,130.00
$159,675.00
$47,301.80
$3,663,106.80
08/12/2003
08/06/2003
04/18/2003
04/18/2003
06/30/2003
L.Fpp< PqirIJ
Fee Description Amount Paid Date Paid Receipt Number
Plan Review CommlInd/Public $3,941.93 2/14/03 1200200000000000702
Plan Review Fire & Life Safety $2,425.80 2/14/03 1200200000000000702
+ 10% Administrative Fee $76.07 4/21103 1200200000000001039
+ 10% Administrative Fee $214.13 4121103 1200200000000001039
+ 7% State Surcharge $96.65 4/21103 1200200000000001039
Fixture $112.00 4/21103 1200200000000001039
Foundation Permit $1,007.65 4121103 1200200000000001039
Paving $760.65 4/21/03 1200200000000001039
Planning Final Occy Inspection $118.00 4/21103 1200200000000001039
Sanitary Sewer - 1st 50 Feet $45.00 4/21103 1200200000000001039
Sanitary Sewer Each Addlll 00' $28.00 4/21103 1200200000000001039
Storm Sewer - 1st 50 Feet $45.00 4121103 1200200000000001039
Storm Sewer Each Addlll 00' $70.00 4/21103 1200200000000001039
Water Line - 1st 50 Feet $45.00 4/21/03 . 1200200000000001039
Water Line - Each Addlll00' $28.00 4/21103 1200200000000001039
Refund - Admin Fee $-76.07 4/22/03 VOUCHER # 61288
+ 10% Administrative Fee $591.76 5/14/03 2200200000000000849
+ 7% State Surcharge $414.23 5/14/03 2200200000000000849
Add, Alter, Extend Circ Ea Add $546.00 5/14/03 2200200000000000849
Building Permit $3,883.60 5/14/03 2200200000000000849
Low Voltage - Commercial Indus $45.00 5/14/03 2200200000000000849
Perm ServlFdr 200 amps or less $630.00 5/14/03 2200200000000000849
Perm Serv/Fdr 201 to 400 amps $525.00 5/14/03 2200200000000000849
Perm Serv/Fdr 401 to 600 amps $125.00 5/14/03 2200200000000000849
Perm Serv/Fdr 601 to 999 amps $163.00 5/14/03 2200200000000000849
SDC Sanitary/Storm Admin $637.60 5/14/03 2200200000000000849
Storm Drainage Impervious Area $12,752.04 5/14/03 2200200000000000849
Plan Review Fire & Life Safety $143.58 6/30/03 1200200000000001678
Plan Review Comm/Ind/Public $5,737.34 7/9/03 1200200000000001734
Plan Review Fire & Life Safety $3,387.09 7/9/03 1200200000000001734
+ 10% Administrative Fee $5.60 7/16/03 1200200000000001771
+ 7% State Surcharge $3.92 7/16/03 1200200000000001771
Paee 2 of9
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Addressing Assignment
Storm Sewer Each Addtll 00'
Water Line - Each Addtl100'
Refund - CIIIP Plan Review
Refund - F & L Plan Review
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Appliance Not Listed
Backflow Device
Building Permit
Exhaust Hoods
Fixture
Fixture
Furnace - more than 100,000
Gas Outlets 1-4
Gas Outlets 4+
Not Covered Plumhing
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
Vent Fan
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Low Voltage - Commercial Indus
Temporary Occupancy
Total Amount Paid
.
. Ul i' OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00086
ISSUED: 10/1012003
APPLIED: 02/14/2003
EXPIRES: 06/24/2004
VALUE: $ 3,663,106;80
$8.00
$42.00
$14.00
$-1,144.67
$-560.83
$10.00
$918.37
$642.86
$18.00
$42.00
$7,065.65
$9.00
$84.00
$1,512.00
$45.00
$4.00
$2.00
$360.00
$4,751.57
$6,251.47
$10.00
$361.78
$3,457.91
$1,403.50
$608.03
$20,705.18
$4,692.65
$42.00
$4.50
$3.15
$45.00
$22.90
$16.03
$43.00
$6.00
$180.00
$100.00
7/16/03
7/16/03
7/16/03
8/12/03
8/12/03
9/5/03
9/5/03
9/5/03
9/5103
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5103
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
9/5/03
10/10/03
10/10/03
10/1 0/03
10/29/03
10/29/03
10/29/03
10/29/03
10/29/03
12/29/03
1200200000000001771
1200200000000001771
1200200000000001771
VOUCHER # 65937
VOUCHER # 65937
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069 .
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
1200200000000002069
2200200000000001642
2200200000000001642
2200200000000001642
1200200000000002390
1200200000000002390
1200200000000002390
1200200000000002390
1200200000000002390
2200200000000001920
$90,304.62
I Plan Reviews I
Paee 3 of9
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fire Department Review
.
0212112003
03/18/2003
OK
Paee 4 of9
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00086
ISSUED: 10/10/2003
APPLIED: 02/1412003
EXPIRES: 06/24/2004
VALUE: $ 3,663,106.80
GRG
COM2003-00086. Plan Review:
Medical Office Building: Type V-N
Sprinklered: Band 1-1.3 Occnpancy.
Shell plan only.
Submit sprinkler plans to
Springfield Fire Marshal's Office fOl
review and approval
Submit fire alarm plans to
Springfield Fire Marshal's Office fOl
review and approval
An emergency generator shall be
installed and tested in accordance
with NFPA no. Testing
documentation 'shall conform to
NFP A 110 and be provided to the
Springfield Fire Marshal's Office for
approval prior to occupancy.
Duration of power supply shall be
not less than 90 minutes (OSSC
308.9)
Provide special inspection
certification and testing
documentation to Springfield Fire
Marshal's Office from an
Oregon-registered electrical
engineer verifying egress lighting
meeting the 1 footcandle
requirement along paths of egress
per 1998 Oregon Structural
Specialty Code Section 1003.2.9.
Test shall be completed prior to final
occupancy.
Submit infill plans for review and
approval by Springfield Fire
Marshal's Office and Springfield
Building Official
Submit electrical plans for review
and approval by the Springfield Fire
Marshal's Office and Springfield
Building Official
Entry road shall be widened to 24
foot two way with no parking on
either side as stated in the Site Plan
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Fire Department Review
.
04/30/2003
05/07/2003
OK
Paee 5 of9
. LI1 t OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00086
ISSUED: 10/10/2003
APPLIED: 02/1412003
EXPIRES: 06/2412004
VALUE: $ 3,663,106.80
Review dated February 26, 2003
(Journal #DRC2002-11359-Finding
#12)
GRG
Provide address numbers plainly
visible and legible from the street or
road fronting the property (OSSC
502 and Springfield Uniform Fire
Code 901.4.4)
6 revised drawings.
COM2003-00086. Revised Plan
Review: Medical Office Building;
Type V-N Sprinklered; Band 1-1.3
Occupancy. Shell plan only.
Plans show correction of entry road.
Road widened as directed in Sitc
Plan Review (February 26, 2003)
and Firc Plan Review (March 18,
2003) to 24 feet.
All other plan review comments
mentioned earlier (March 18 and
April 16, 2003) still apply.
. . CITY OF SPRINGFIELD
Building/Combination Permit
Status Issued PERMIT NO: COM2003-00086
225 Fifth Street, Springfield, OR ISSUED: 10/10/2003
541-726-3753 Phone APPLIED: 02/14/2003
541-726-3676 Fax EXPIRES: 06/24/2004
541-726-3769 Inspection Line VALUE: $ 3,663,106.80
Fire Denartment Review 07/10/2003 07/31/2003 OK GRG Plan Review: Inml plans for B/I-1.3
medical center. Construction Type
V-No Job #COM2003-00086.
Plaus show location of fire
extiuguisher to he within 75 fcet
travcl distance on each 1100r. Fire
extiuguishers shall be a minimum
rated 2-A:10-B:C. Will verify on
inspection.
Obtain Knox Box application from
City of Springfield Deputy Firc
Marshal Gilbert R. Gordon
(541-726-2293). Iustall Knox box on
right side of maiu eutrance at 8 feet
above finished 1100r.
Owner/occupaut shall supply a
grand master key to be put in Knox
Box.
Above the main exit door, provide
sign stating "THIS DOOR MUST
REMAIN UNLOCKED DURING
BUSINESS HOURS" (OSSC
1003.3.1.8, exception I).
Paths of egress data provided in
lighting calculations book. Will still
need report verifying measurements .
as noted in Plan Review dated
3-18-03.
Fire Department Review 10/17/2003 10/27/2003 OK GRG Plan Review: Fire Alarm System for
Gateway Medical Center. Job
#COM2003-00086. Plans appear to
meet code requirements.
Initial Review 02121/2003 APP RJB
Initial Review 04/03/2003 04/03/2003 APP LLH Only two sets submitted, both given
to pearson
Initial Review 07/10/2003 07/10/2003 APP LLH
Medical Gas Piau Review 08/04/2003 08/04/2003 WE SKG Resubmittal of euginecred plans,
specifications, and calculations.
Medical Gas Plan Review 10/17/2003 10/17/2003 WE SKG Deferred Submittals: Medical Gas;
'Fire and Smoke Protectiou; and Fir<
Alarm Pia us. Gerry with Robinson
Plumbing will submit 2nd, 3rd 1100r
and mechanical room addendums
pcr conversation 10/30/2003.
Medical Gas Plan Review 12/ll/2003 121ll/2003 OK SKG Received revised plan 12/8/2003
Paee 6 of9
. . CITY OF ~rKII~ut<lJ<.,LD
Building/Combination Permit
Status Issued PERMIT NO: COM2003-00086
225 Fifth Street, Springfield, OR ISSUED: 10/10/2003
541-726-3753 Phone APPLIED: 02/14/2003
541-726-3676 Fax EXPIRES: 06/24/2004
541-726-3769 Inspection Line VALUE: $ 3,663,106.80
Plannine Review 02121/2003 04/2112003 APP EMM Sarah Summers Planner. Final Site
Plan Submitted. Development
Agreement Signed.
Call Sarah for final inspection
726-4611
Plan nine Review 07/10/2003 07/1l/2003 APP EMM
Public Works Review 04/18/2003 04/18/2003 APP PJO APPROVAL IS FOR
FOUNDATION ONLY
Public Works Review 04/18/2003 05/0512003 WE PJO Sent Memo requesting plumbing
plans for 2nd and 3rd Ooors.
Public Works Review 05/05/2003 . 05/09/2003 APP PJO SHELL APPROVAL ONLY
Public Works Review 05/09/2003 TO PJO Reassigned to Steve Barnes
Public Works Review 07/10/2003 08/07/2003 APP SB 7/30/03 - Ken Vogeney routed plans
to Steve Barnes to review. .
Structural Review 02/2112003 03127/2003 WE JMP Document attached with 20 listed
issues was faxed to architect today.
Structural Review 04/03/2003 04/18/2003 APP JMP
Structural Review 04/30/2003 05/10/2003 APP JMP 6 revised drawings.
Structural Review 07/10/2003 08/0112003 WE JMP See attached document faxed to
Linn West requesting medical gas
documents.
Structural Review 08/06/2003 08/06/2003 APP TCM Still need SUB approval, engr.
stamped medical gas plans.
Structural Review 08/07/2003 08/07/2003 WE JMP On 8/7/2003 jmp left a voice mail for
Gary Meili requesting dollar values
of site work, paving, shell, tenant
in fill, and grand total for the
project. Jmp also left a voice mail
for Linn West asking for an
explanation of revisions made to the
the final site plan that was submitted
to Sarah Summers. Left followup
messages for both on 8/14/2003.
Structural Review 10/17/2003 10/21/2003 APP JMP Deferred Submittals: Medical Gas;
Fire and Smoke Protection; and Fire
Alarm Plans.
SUB Review 02121/2003 05/01/2003 APP JF P~r conversation with John Pearson:
architect plans to build shell only at
this time. Building envelope, hvae
and lighting spees to be determined
later. Code forms to be received
when specs become available. City
to issue permits for building shell
only. Energy code forms to be
provided as building occupied. See
email.
SUB Review 07/10/2003 08/07/2003 POK JF Fails lighting energy code
compliance. Contractor will rework
lighting to comply with code.
Pa!!e 7 of9
.
. CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-00086
ISSUED: 10/10/2003
APPLIED: 02/14/2003
EXPIRES: 06/24/2004
VALUE: $ 3,663,106.80
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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
~~ .
1 Site Inspection: To be made after excavation but prior to setting forms.
2 Erosion/Grading Inspcction: Aftcr all crosion mcasurcs are in place.
3 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
4 Footing: After trenches are excavated.
5 Slab: To bc made aftcr all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
6 Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
7 Structural Concretc: In excess of 2500 psi. To be done during construction by a State, Certified Inspcctor.
Provide results to City Buiding Inspector
8 Foundation: After forms are erected but prior to concrete placement.
9 Final Building: Aftcr all Conditions have been completed as required on Development Agreement.
10 Rough Grading: After gravel is in place but prior to placing concrete.
11 'Final Paving: After paving is complete.
12 Underground Plumbing: Prior to filling the trench and including required testing.
13 Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
14 Rough Plumbing: Prior to cover and including required testing.
15 Water Line: Prior to filling trench and including requircd testing.
16 Sanitary Sewer Line: Prior to filling trench and including required testing.
17 Storm Sewer Line: Prior to filling trcnch.
18 Underground Electric: Prior to cover
19 Rough Elcctric: Prior to Cover
20 Fire Department Underground Sprinkler System: Prior to cover. Hydro pressure test, fire line flow test.
21 Fire Department Water Supply. Inspcction to assure water supply is available on site for construction. This
inspection is required prior to any combustible construction.
22 Roofing: Prior to installing any roof covering.
23 Masonry:
24 High Strength Bolting: To be done during construction by a State Certified Spccial Inspector. Provide inspection
results to City Building Inspector. .
25 Structural Welds: To be done during construction by State Certificd Spccial Inspector. Provide inspection test
results to City Buildin'g Inspector.
26 Final Building: Aftcr all rcquircd inspections have been requcsted and approvcd and the building is complctc.
27 Framing Inspcction: Prior to cover and after all rough in inspcctions have been approved.
28 Drywall: Prior to taping.'
29 ' Firewall: Located and constructed according to plans.
30 Ceiling Grid: After drywall approval but prior to cover.
31 Sprayed On Fireproofing: To be done during construction by a State Certified Special Inspector. Provide test
res ports to City Building Inspector.
32 Final Fire Department. Aftcr all requircments of the Fire Department have becn met.
33 Final Building: After all rcquired inspections have been requested and approved and the building is complete.
34 Rough Grading: After gravel is in place but prior to placing concrctc.
35 Final Paving: After paving is complete.
Paec 8 of9
.
. CITY Ul' ~rKll'\jGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-00086
ISSUED: 10/10/2003
APPLIED: 02114/2003
EXPIRES: 06/24/2004
VALUE: $ 3,663,106.80
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
36 SUB Insulation Vapor Barrier: 'To be called for at the same time as the SUB framing inspection.
37 SUB Final: After all required energy inspections have been requested and approved.
38 Rough Plumhing: Prior to cover and including required testing.
39 Final Plumbing: When all plumbing work is complete.
40 Backnow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
41 Rough Medical Gas: Prior to cover and including required testing.
42 Final Medical Gas: When all medical gas work is complete and certificate is provided to inspector from verifier.
43 Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
44 Gas Scrvice: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
45 Rough Mechanical: Prior to Cover
46 Final Gas: When all gas work is complete.
47 Final Mechanical: When all mechanical work is complete.
48 SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
49 Rough Electric: Prior to Cover
50 Electric Service: Approval required prior to utility company energizing service.
51 Final Electric: When all electrical work is complete.
52 SUB Exterior Lighting
53 SUB Ceiling Grid: Interior Lighting
54 SUB Plumbing: Following City Rough Plumbing inspection approval and prior to cover.
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 is located at the front of the property, and the approved set of plans will remain on the site at all
timeSdUring~n~~ M/'/ ~I""/ /?- --<7- d~
~, ~ c~
Owner or Contractors Signature Date
Page 9 of9
," 225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00086
Payments:
Type of Payment
Check
,po
Description
Temporary Occupancy
Paid By
MElLI CONSTRUCTION CO.
~~.~~~,"_,C!,~..BLD~,._...,.) ,d..,,,,,,, .,.,.'...
Ilk... !
"'..'..'.-.
...... '"
. I 1
..~"'~'''''h. _~' ...,-.... ....'
Receipt #: 2200200000000001920
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfi~ld Official Receipt,
Development Services Department.
Public Works Department
Date: 12/29/2003 10:15:IlAM
Amount Paid
Item Total:
100.00
$100.00
How Received
In Person
Payment Total:
Amount Paid
$100.00
$100.00
.
.