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Home My WebLink AboutPermit Building 2005-04-01Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2004-0 1347 ISSUED: APPLIED: EXPIRES: VALUE: 04t0u200s 10t29t2004 r0t0u200s $ 16,396.00 K SITE ADDRESS: 502 S 6th Street Springfield TYPE OF WORI(: Manuf Home w ASSESSOR'S PARCEL NO.: 1703353406500 Garage/Carport Private Lot TYPE OF USE: New Residential PROJECT DESCRIPTION: MH and garage. ***DO NOT FINAL UNTIL SITE TREES ARE PLANTED. See Linda Pauly't*'* Owner: Address: THOMAS GIRVAII 3342 ST TIIOMAS EUGENE OR 97408 PhoneNumber: 541-344-6339 Contractor Type General Electrical Manuf Home Inst Plumbing # 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: Street Improvements: Storm Sewer Available: Special Instruction: Contractor WAY TO GO CONST OWNER MIKE WHEELER MH SET UP OWNER 1 R-3 u-1 \rN License 159552 91504 is.' Expiration Date 04t22t2006 Phone 541-895-4699 05fi4t2005 541-979-8709 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft lst Floor: Electric Ft 2nd Floor: Basement: e,Other: Load: 1 12,197 1,296 576 3 r8.00 13.00 10.00 22.00 0.00 # Vo Fully Improved No Sidewalk Type: Downspouts/Drains: Curbside 5' Drywell - Provide Drywell Engineering Storm drainage issues, access, and fire access to be addressed before linal approvat. Dry well request must berevisited. 121312004 C AS CONTRACTOR INFORMATION REQUIRED P Total: Handicapped: Compact: t$e ES 30.60tso\e\o( o\ ARIilNG ., Notes: Paee I of4 J G Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01347ISSUED: 04/01/2005 APPLIEDT 1012912004EXPIRES: 10/0112005VALUE: $ 16,396.00 Description Type of Construction Foundation Onlv Use Bid Amount Garage Garage Manuf Home Manufactured Home $ Per Sq Ft or multiplier $1.00 $24.30 $1.00 Square Footage or Bid Amount 2,400.00 576.00 25,000.00 Value $2,400.00 $13,996.80 $25,000.00 $41,396.80 Date Calculated 10129t2004 10t29t2004 tu29/2004 Total Value of Project Date PaidFee Description PIan Review Residential + 10Vo Administrative Fee + 7o/o State Surcharge Add, Alter, Extend Circ Ea Add Addressing Assignment Curbcut Permit Garage/Carport Manuf Home State Issuance Manufactured Home Conn _ plmb Manufactured Home Feeder Manufactured Home placement Manufactured Home Service PIan Review Major - planning Sanitary Sewer - lst 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 - lst 50 Feet Water Line - lst 50 Feet Willamalane Manuf Home private Receipt Number 1200400000000001s37 1200500000000000405 120050000000000040s r200500000000000405 r200500000000000405 120050000000000040s 1200500000000000405 1200s0000000000040s 1200500000000000405 1200500000000000405 120050000000000040s 1200s00000000000405 r200500000000000405 1200500000000000405 1200500000000000405 r200500000000000405 r20050000000000040s 1200s00000000000405 1200500000000000405 1200s00000000000405 1200s0000000000040s r200500000000000405 r200500000000000405 r200s0000000000040s r20050000000000040s 1200s0000000000040s r200500000000000405 10t29t04 4/u05 4fit05 4nt05 4n/05 4nt05 4/t/05 4fit05 4nt05 4nt05 4fit05 4nt05 4fit05 4flt05 4nt05 4n/05 4/t/0s 4flt05 4/t/05 4nt05 4/u05 4n/05 4nt05 4ntus 4/u05 4/u05 4/t/05 PIan Reviews Total Amount paid $5,595.53 Pase 2 of 4 Iru|jn Amount Paid $10s.30 $61.r0 $42.77 $9.00 $31.00 $75.00 $162.00 $30.00 $45.00 $s0.00 $r60.00 $s0.00 $103.00 $4s.00 $402.16 $528.88 $r0.00 $86s.31 $82.03 $102.20 $66.20 $772.49 $r75.13 $53r.96 $4s.00 $4s.00 $1,000.00 liees Paid I Building/C ombin ation Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Initial Review tt/0u2004 ttt0u2004 APP SKG Plannins Review 1U0U2004 11t08t2004 wI TAJ Plannins Review 72t06t2004 12t06t2004 APP TAJ Public Works Review 03t25t2005 Bt25/2005 APP sB Public Works Review tt/01/2004 tu0s/2004 wE cAs Structural Review 12/01/2004 12/01/2004 APP DLM To Request an inspection call the 24 hour recording at 726-3769. inspections requested after 7 wiII be made the same working day, PERMIT NO: COM2004-01347ISSUED: 04/01/2005 APPLIED: 10/2912004 EXPIRES: 10/01/2005VALUE: $ 16,396.00 ***DO NOT FINAL UNTIL SITE TREES ARE PLANTED***. See Linda Pauly Tree Felling permit DRC2004_0004g must be approved prior to Bp issuance. Plot plan is based on Lot 16 of Valley View Add and does not include Lot 15. Tree Felling permit DRC2004-0004g has been approved with conditions. Please note Condition 2: prior to issuance of final building oc.upar.y. the applicant shall plant g replacement trees on tax lot 6500 or 6400. The full wording of Conditions 2 and 3 are attached to the building permit site plan. Stormwater issues have been resolved with plp. Access issues have been resolved with plp. FIre department requires new hydrant before trailer is moved to lot. Storm drainage issues to be resolved. Access, fire access issues are to be resloved. lZ/3/2004 CAS See documents for plan review comments. AII inspection requested before 7:00 a.m.:00 a.m. will be made the following workday. Footing: After trenches are excavated.Foundation: After forms are erected but prior to concrete pracement.Framing rnspection: prior to.or.r urJui,ur.arl rough trH;;;;j;rs have been approved.Manuf Home set Up: when insta,uti- oi"rr piers i rt"ra.'ii "orpr"tu. irll,PifiIlil:ii+',',lllffi'.'"4'?LT,','#}:ili,fi:*;+;::T*nd approved and porches, skirting, frlt"',]l,y$.*.",Ttii;;lffii:f."mil'1::i:T.:H:ilf and approved and the buirding is comprete. Sanitary sewer Line: prioi to lirin; ;;en; and incruding requireo testing.Storm Sewer Line: prior to fiIing,i*.ir. .^ Manuf Home plumbing: After ho'me has been connected to water and sewer.Rough Electric: prior to Cover Final Electric: When all electrical work is complete.MH Service: Approvar required p.irii, ,iility company energizing service.MH Electric: when blocking' tttup"nJprumuing iorp."ti*.iro" u..n approved and the home is connected tothe panel. Pase 3 of4 :L-l Building/ C ombination P ermit Status Lssued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676F.atx 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-0134? ISSUED: 04/01/2005 APPLIEDI 1012912004 EXPIRES: 10/01/2005VALUE: $ 16,396.00 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 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 times during construction. Owner or Contractors Signature Date Paee 4 of 4 SF'ITi'GF!6LD 225 FIFTH STREET . SPRINGFIELD, OR 97477 t PH:(541)726-3753 o FAX:(s4r)72G368e E LE CTRI CAL P ERMIT AP P IJCATTON CityJobNumber Cr, ZOOq -CsljY.l Date o 4- "6(-os 3. @ 1. lo A I>t 4,Z\oE 3, +. J/1. tAltF z/xwrY oie'? LEGAL DESCRIPTION Permits are non-transferable and expire if work is i not started within 180 days of issuance or if work is Suspended for 1E0 days. 7 Electical Contactor Address Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiratiou Date Signature of Supervising Electrician IN zTt portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder ,'7 200 Amps or less 201 Amps to 400 Amps aOl Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only Installationo 200 Amps or 201Amps Over TOTAL ORT AS PLANM oot ,lrrp erv R PfTlvTbF -tCc-,zz F6P I lu, 'FO, JOB DESCRIpTION haHE, O?YA) Dfl>rrc U c}nr,-ra(,€ oN aFat?amaiau^fia> laT Each fL Servicelncluded Eb 1000 sq. ft or ko r06.00 Panel lhe $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 s100.00 s 43.00 $ 3.00 fi B. City Tttorrns V f loY ,r. &f,VeN Owuers Narnre ROAAr C C p*nr t ng;t Address 3.r{Z Sf. +rrraas citv Ettc ,tj 6p. Pb""" l)\:A?fry 3 OWNER TNSTALLATION The insallation is being made on property I own which is not inteuded for sale, lease or rent. Owners Signature: Pump or irrigation Sign/Outline Lightiug LiE ited EnergylResidential Linited Energy/Commercial Minimum Electric Permit Inspection Fee is $45.00 * Surcharges $ 50.00 $ 50.00 s 25.00 $ 45.00 ,04 7%Stato Surcharge 7,63 l0% Administrative Fee 0 ?o T, {3Inspection Request 7264769 4. Shared DrivdT:VBuilding FormVElectrical Permit Application l43.doc 9,rc ):;$" Construction Contractors Board 700 Summer St ItlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Penrrit *' COr4?lsct-|, -O I jLt 7 Address:so L s, Grq Issued by:J urtf Date: O Q-o \-oS Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not Itcensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: tr l. I own, reside in, or will reside in the completed structure. E 2. I understand that I must become licensed as a construction conhactor if the structure is sold or offered for sale before or on completion. tr 3A. My ganeral conhactor is O.I*rr)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Conffactors Board. OR B 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the nirme of the contractor. I hereby certify that the above information is correct and that I have read and do understand the fnformation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. g Yrrr^ra-' *L (Signature of permit @ate) (White copy to issuing agenq) permitfile, pink copy to applicant.) :) Property_owner.doc 06-0 I -04 t0-zl-D + SPii NFEELD i E tt E ufr F tul ENT SEn vrCES D E PARTMENT MANUFACTURED HOME SET.UP AGREEMENT As required by the City of Springfield Development Code, I understand and agree that with the the attached permits,one of the following manufactured homes will be placed at SoL .S-+(^ Springfield,Oregon, City Job Number (br*Ll -7 I Manufactured ,{ 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 of 3 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 required for single family dwellings at the time of construction. Type II Manufactured Home: X A unit of not less than 12 feet in width enclosing a minimum floor area of 500 square feet, that has a nominal roof pitch of 2 feet in height for each L-2 feetin width, that has no bare metal siding or roofing, *J in"i t * t'"en certified by the ianufacturer to have an exterior therrnal envelope meeting- perfonnauce standards which reduce heailoss to levels equivalent to the performance standards required for single family dwellings at the time of construction. initials 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753' FAX (541) 726-3689 rwww. ci. s p ri n gf i e ld. o r. u s I further state, by my signature below, that I have been provided with the following information: Manufactured Home Blocking, Water Line Connection, Sfeet Tree Standards, Sanitary Sewer Conneqtion' Electrical Connection, and Minimum requirements for permanent steps. I also understand that the manufactured home shall be placed on an excavated and backfilled foundation not to exceed 6 percent slope within l0 feet of the perimeter enclosure,.enclosed at the perimeter wittr stone, brick o, otlr., ,on"r"t. or masonry materialj approved by the Building Official and with no more *ruiq inches of the enclosing material exposed above grade' '/ l,/o Date of D EV E LO P FN E NI SEE!/iCES DE,DAEIII/Ffr'T S8'HEr -riFtELE Date 225 FIFTH STREET SPRII'IGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 MANUFACTURED HOME LAND USE AGREEMENT As required by the City of Springfield Development Code, I agree that with the approval of the attached permits, one ofthe following manufactured homes will be placed at -O Z J, a & 5f . Springfield, Oregon, City Job Number @m ^ ( -a/ 947 ,/' Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed floor area ofnot less than 1,000 square feet, that has a nominal roofpitch of3 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 Specialry Codes. Type II 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 of 2 feet in height for each 72 feet in width and that has no bare metal siding or roofing. The manufactured home shall be placed on an excayated and back-filled foundation not to exceed 6 percent slope within l0 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 than24 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 Gsuance 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 approyed set up plans and/or permit and your partition approval ifapplicable: o Street Trees. Paving Driveway. Minimum 32 square foot storage structure o Completion of partition approval . Removal of any existing structures as noted on your partition approval o Signing and recording of any required partition, €asement, improvement agreements, etc. . Final lot grading . City Sidewalk and curbcut installation . Any outside agency approval as required i.e., Division of State Land approval. By my signature below, I agree to complete the above mentioned land use requirements. X/ ,/ncrA/ fi- Owner Signature / (wa y n) 60 CctruS7 . fnua, Pa<< 6/vE\ oLsoN GAtr. Co"traffir Sigr"tur;Dater JOURNAL OR JOB NUMBER: NAME OR COMPANY LOCATION TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM GITY OF SPr{NGFIELD SYSTEMS DEVELOPMEN', /ORKSHEET Robert Abel 502 6rh St l 703353406500 S FAMILY RESIDENCE BUTLDTNG SZE (SF) 1872 LOT SrZE (SF):0 IMPERVIOUS S.F. x 692.00 RT]NOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F 2048.00 NLIMBER OF DFU's 22 B. IMPROVEMENT COST: NUMBER OF DFU's 22 ADT TRIP RATE 9.57 SUBTOTAL $3,367.96 COST PER S.F $0.3 l0 COST PER S,F $0.3 l0 COST PER DFU s24.04 s 18.28 NTIMBER OF UNITS I NUMBEROF UNITS I ADM. FEE RATE s%o CHARCE $214.52 DISCOUNT RATE 50o/o $531.96 DISCOTINT $317.44 x x x x x x x x ITEM I TOTAL - STOR]VI DRAINAGE SDC 2. SANITARY SEWER - CIry A. REIMBURSEMENTCOST: ITEM 2 TOTAL - CITY SAMTARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: $931.04 COST PER TRIP $18.30 COST PER TRIP $80.72 $947.62 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR t.00 xx xx B. IMPROVEMENT COST: ADT TRIP RATE 9.57 ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A REIMBURSEMENTCOST: NUMBER OF FEU's I x B. IMPROVEMENT COST: NUMBER OF FEU's I MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBToTAL (ADD ITEMS 1,2,3, & 4) 5. ADMIMSTRATIVE FEE: $957.34 $3,367.96 CHARGE $ 168.40 TOTAL SANITARY ADMIMSTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Cheryl 1y5t2004 COST PER FEU $82.03 $531.96 $s28.88 $17s.13 s772.49 $82.03 $8653r $0.00 $3,536.36 I 070 l09l 1092 r 093 1094 I 054 1055 1054 1056 1079 I 078 ar! l-.1o(-) &r!Fa o E] COST PER FEU $865.31 PREPARED BY DATE TOTAL SDC CHARGES FXTI-IRE TYPE MISCELLANEOUS DFU ryPE TOTAL DRAINAGE FXTURE UNITS *EDU lsa BEFORE 1979 DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FXTURES x UNIT EQUIVALENT = DRAINAGE FD(TURE UNITS FOR CALCULATE ONLY THE NET ADDITIONAL NO. OF FIXTURES T]NIT NEW OLD NT]MBER OF EDU'S 20 21979 toa unil set at 167 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FORANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) DRAINAGE FIXTLIRE LTNITS 0 2 1979 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE I 980 I 981 1982 1983 1984 x1985 1986 1987 I 988 1989 I 990 l99l t992 1993 1994 1995 1996 1997 r998 I 999 200 1 $5.29 $5.29 $5.1 I $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 VALUE / 1OOO $0.00 CREDITRATE $5.29 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $5.29 TOTAL MWMC CREDIT$1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 BATHTT]B 2 0 3 b DRINKING FOLNTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LATINDRY TUB 0 0 2 0 CLOTHESWASHER / MOP SINK 1 0 3 3 CLOTMSWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASTIER / ETC.0 0 3 0 SHOWE& SINGLE STALL 1 0 2 2 SHOWER, GANG (NUMBER OF }IEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 3 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: STNGLE LAVATORY/RESIDENTIAL BAR 2 0 1 2 URINAL, STALL/WALL 0 0 5 0 TOILET, PTIBLIC INSTALLATION 0 0 b 0 TOILET, PRIVATE INSTALLATION 2 0 3 6 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 2000 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt :velopment Services Department Public Works Department RECEIPT #: 1200500000000000405 Date: 0410112005 e:13:05AM Job/Journal Number coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-01347 coM2004-0r347 c)otvtzooq-otlql coM2004-01347 coM2004-01347 coM2004-01347 c)M2oo4-01347 coM2004-01347 coM2004-01347 cDM2004-01347 cauzoo4-0t347 Description Manufacfured Home Placement Manuf Home State Issuance Willamalane Manuf Home Private Addressing Assignment 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 Sanitary/Storm Admin SDC Transpo Admin Curbcut Permit Plan Review Major - Planning Sanitary Sewer - lst 50 Feet Water Line - lst 50 Feet Storm Sewer - lst 50 Feet Manufactured Home Conn - Plmb Garage/Carport + 7Yo State Surcharge + l0% Administrative Fee Amount Due 160.00 30.00 1,000.00 31.00 50.00 50.00 9.00 s3 r.96 s28.88 402.16 175.13 772.49 82.03 865.31 10.00 102.20 66.20 75.00 103.00 45.00 45.00 45.00 45.00 162.00 42.77 61.10 Item Total:$5,490.23 Payments: Type ofPayment Paid By Received By Check Number Batch Number Authorization Number IIow Received Amount Paid Check ROBERT C ABEL Jmp In Person Payment Total: s5,490.23 -Ss/-eo-F t4t9 ,t .i 4lt/2005 Page I of I