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HomeMy WebLinkAboutPermit Electrical 2004-6-21 ?l3- 03~~ - 0 I . ,~P"'U"'(:."'I!':LD" " :..::,;~ .;: t .... .'; ZlS FIFfH STREET . SPRINGFIELD. OR. 97477 . PH:(541)726-37S3 . FAX: (54~A,,~Q~ ~pJ .~[::;:;,~,,~~"~!~;kfJfu.:; .IIIo'l{TVli/ ....08 ,~Jh.., .,." ...~".~ ELECl'RlCALPERMITAPP/fCATION f . ,'. ; I~' qui, 'ttedh . CityJobNumberCOl4-1Z-003- 01/4'0 Date 10 -/8-6/f .Dele 0l1il19 /Ill especi;Slhe'OI/ . .4lJ - L!;.. Ie land OWi!) 1.~:iQ~itO.N'~al.lNSf4iiXhON'0~:~~!~;q 3 ifcO!JiliiE:Jii::iiSf:'IIJ!fr;ii'Jf.B' . ,., . ":,;,,:"" ':'1, ii',' ;:\~s,e~. 9 '"w~''' <'.L..,),.",....,~,',...,.,..l:'~..:t,'Io"......l,oj;,I.......':!l',~,::,.. ~.l1:.Il..'.,~:;.:J1~:tfugtJilltl'.:I'i.'!'1t . jl(~:~.:7;~,':':Ii:,~:~ .~4:i:.:~.;., .":~ ..~'.- ."J ,.,~.:.:~8tf.i;e ,~:.,.'. ';;Ji;;~~ ::~ ,::." '~\.;:. ..~/f~:.i. _"18C>f:Z\ MA IA.) ~e E't>I LEGAL DESCRIPTION f 70 L. 33lJ 1 (.AlAi ?;/?FF'AJ< /:)~ bOO' JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended lor 180 days. . ff~~~'~' '".l..lt/i:m' (;.', , . '~h '.,....:~., >'1lf~I:'ll:;'PN~~. ".W'~JY:"~"~'. 1. ~;gy'~" .R:~" ::.:":'1U,':,:A, 'T1",9~~JVr.:~1 ~._:>.....I..iIJ-~"."tw""", .~_.~__~.",;!.;;:r;;:i1:~ii\,~_~ Electrical ContruclOr AnT <:: F c.. lJ P. ITY 200 Alnps or less $ 63.00 201 Amps to 400 Alnps $ 75.00 Address I.Jh/.O MAwM'. ~~~ 40lAmPSlOQ ~~'-N~~~ $125.00 ~----mm"~ \'t~~k~\ ~\g~gl $163.00 CitySPfl.rJ.Jl.FI€Lf) Phone " IS, E.O ~ij-tl'60o l ..' 1'9~ $375.00 III tAtAE.~CE.O~\I'S . . $ 50,00 Supen'isorLicenscNumber 3!2 7/ Lr~ 'laG O~~ mfJ.~mi.m~"~~!~:~~D 7h/"", ~F A LAf/'\ tAJ.<:IALA-nNJ_ Expiration Date , CODSlI', Conb'. Number -= 1:)9 9 'I c{. - ,,\/(l~ Eltpiration Date e 'P,;> ~{;'J ( 1.II.c.ViIIMVlvrlG= ~ Address "737 1M /Jrtl.-~ r S( CityG (L~(~. Wt4Phone ; OWNER INSTALLATION The installation is being made 0'; property I own which is not intended for sale. lease or renL OWners Signature: Inspection Request: 726.3769 As? ~\. Ol L:l9NI~dS lOll (;0 3911d ServIce Included 1000 sq. ft. or less Each additional SOO sq. ft. or portiou thereof :~tEi.i' ~...~ ,j;~vt~}.".... ':';I.;'I:~i*:'::':'I!.J;oI ,'!:.M'",_ ~\,;..,; :i1"::t,.~t'~:I.;':" .. ,:.~1.":.. .:. ......;,.,~. A. " e iJJ~dent.lal:i. ."or;M !i:-Fa'iiiJi'..... 'n' u ..,.\: 4". _,<t'1tj'(...~t. ,'t:"t""~';e.~;~,'~",',~ ~:w~~,.;). i,.,:l:r..~.-;.!t..;o..., :.'. G,. ."~..'Hr.... $106,00 ~ S 19.00 ~O,OO Each Manufuct'd Home or Modular Dwelling Service or Feeder " - -.,,-- ~'rif'~!~.", ;]1..it!l~I.1:. '~~;~~iJ ~,~~~~p.;lI.r~l~"'~~:!r-~",~~~.;!'::!Jf:m!I." .'f\!"'oIllf,I~::$il~)r.~~'~'i.r,i..:;~~~~:~:til.. B. ~b1ceS' ,': ."~~'. . . tl . ":MEe . tl~l\s'r ReI " "tIiiti:!:'''- .. .'" ...'P .. ..,... '_'.. .,.I'!'.;. . .... ,. .. .......~ .'. ~ 1~'II~'" ,~I.. ..11. .,.!lIlllC.::,..,,*,.,..lll)U.\1t',rti\,,'\t.llt~,,.. 3 ~.'l:.;l:!:i:::.~":.". ;;Jf.~If}Jfi':..':. installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Alnps . Over 600 Amps or 1000 VoJlll see "B" above. ;"'f.~;;'i:~~)3i'i!iiIP\Jib""':t~iiJi'~}i~.jp:'P'.:i!<iI!~"i;tiiliTmr.j D. [B._~1;~I~ .. '!~~N~1~ni@!.~r~lt~tlJ~1~fi"~tl;;~:;:trIJ(~'j<<'~~i~.%r~t: NeWAlleratiOn~rExteDsion~~~.. . One Circuit ~~Ot<OftO\\~~,OO ~~\1'C~~~ . are 6"\ ~ ~~\8~~~, .~. ">":':'>~!ilS\~~""".""k:"'O':!'l''''''!~'' E. .... . Mt"Elich'WtaUa '61i~ . ..1'''''''' . ,^:.,~, "..;.' .'''J,."..;,,,,~l!-,.".", ~!lrifR\1~. ~;;~\\\'INo\I $50.00 Signl~\'i~~~tInlt ()t~t)~~). S 50.00 Limi~~~A1lI~al S 25.00 Limited Energy/CotnDlcrcial X $ 45.00 Lf -) MInimum Electrk Permit inspection Fee Is $45.00 + Surcharges &:>1' . '1~~,...'~t~~P'~"'~IIioY"'::;\;'"J'b~~~i'Ii" .:#rn:JI!::ff~7?)ifo 4)"'-- 4.'... . .11;Q~:9",~"'XA(;,M,i:fJmi.," !f:~'i;~~f;;;'-:; . :'iii:Jl;J~:~(;.~~1ilI1:'" ~_~.~,~Jiul!"'~~'lI'-~:jj~ 1[:,;(,11 ~.,;f!'IIi',' 7? 7% State Surcharge ;> u[? 10% Administrative Fee ., TOTAL ~'1:J .Le; $ 50,00 $ 69,00 $100.00 S~am1 Driv<(T:)IBllilding Fo.....rele<tricnl Permit Applicolion I ~3.doc 996P9ELl:P9 LE:El: P00(;/9l:/90 . . CITY OF SP1Ul'lul'U,LJ) Building/Combination Permit Status Issued PERMIT NO: COM2003-01146 ISSUED: 02/11/2004 APPLIED: 11/14/2003 EXPIRES: 12/15/2004 VALUE: $ 1,199,986.00 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5807 Main St ASSESSOR'S PARCEL NO.: 1702334103600 Springfield TYPE OF WORK: Slore TYPE OF USE: New Commercial PROJECT DESCRIPTION: Walgreens Owner: POWELL-MCMINNVILLE LLC Address: 737 MARKET STREET KIRKLAND W A 98033 Phone Number: 425-828-4444 I CONTRACTOR INFORMATION I Contractor OLSON & MORRIS POWELL CONSTRUCTION CO-NWASHING .,11 ,\-"l,,' . CRA WFORD ELECTW~C<O INC '\ .RELIA~1.~~(j\fNS~\' \'2> ~lJ 145234 t\(\1\C~:Jg,~~~~IM~ro.~~~I~<;:iJ'" 133472 '\\\\S ~~~\'t.'\) \i~~\s' t>.~~\:-BUiLDING INFORMATION I t>.\}\ ~~C't.'\) ~\Q'\). # of Units: CQ~\-l\ '\)(1.,'( \'~ # of Stories: Primary occupanc~wP~~~ M Height ofStruclure Secondary Occupancy Group: Type of Heat: Primary Construction Type VNSpr Water Type: Secondary Conslruclion Type: Range Type: # of Bedrooms: Energy Path: Sprinkled Building: Contractor Type Applicant General Electrical Mechanical Plumbing License Expiration Date Phone 541-302-9790 425-828-4774 541-812-1300 06/29/2006 360-693-7379 0112712005 541-607-6163 1 28.00 Lot Size: Sq Ft 1st Floor: 13,553 Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: , DEVELOPMEN 1 IJ'I'vn.J>1ATION I 1I.~~;. REQUIRED PARKING Overlay Dist: ~~()t6Qof\\YI1i\o1'<<' Total: # Street Tree,s~(fl\ ~~ _e1e~..m\. Handicapped: pav~~~ ~~'l\~~~"compacl: ~~b~_~. :.;"ot\\1lJ d\~ ~\u" l\ V'" ~O'U"-', 0S ~"""f:~O r l\t\\sIJ'r\"rP~ ,me ~.:.; I pUBdtj~i)fPIiQ.-\{lilME~JiS.1 ~~~\\\!~). ""~,,. """ . o~e9,O n"-?.:JiT' , \IV ~\\(\9, "':'" \'l\6 .&olStaeWalk Type: ~ et''''' \$ \ t\\l((l~ ce~ Downspoutsffirains: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of8 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01146 ISSUED: 02111/2004 APPLIED: 11/14/2003 EXPIRES: 12/15/2004 VALUE: $ 1,199,986.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description Bid Amount Bid Amounl Pavine Tvpe of Construction Use Bid Amount Use Bid Amount Use Bid Amount. $ Per Sq Ft or multiplier $1.00 $1.00 $1.00 Square Footage or Bid Amount 1,019,891.00 25,095.00 155,000.00 Value Date Calculated Total Value of Project $1,019,891.00 $25,095.00 $155,000.00 $1,199,986.00 12/04/2003 12/04/2003 12/04/2003 l..Fpp< PIilU Fee Descripllon Amount Paid Date Paid Receipl Number Plan Review CommlIndlPublic $2,691.42 11/14/03 2200200000000001770 Plan Review Fire & Life Safety $1,656.26 11/14/03 2200200000000001770 -Mecbanical Issuance Fee- $10.00 2/11/04 1200400000000000196 + 100/0 Administrative Fee $521.21 2/11104 1200400000000000196 + 7% State Surcharge $312.74 2/11104 1200400000000000196 Addressing Assignment $8.00 2/11104 1200400000000000196 Appliance Not Listed $9.00 2/11104 1200400000000000196 Appliance Vent $6.00 2/11104 1200400000000000196 BackOow Device $42.00 2/11104 1200400000000000196 Building Permll $3,555.65 2/11/04 1200400000000000196 Fixture $448.00 2/11104 1200400000000000196 Furnace - more than 100,000 $30.00 2/11104 1200400000000000196 Furnace - up to 100,000 btu $36.00 2/11104 1200400000000000196 Gas Outlets 1-4 $4.00 2/11104 1200400000000000196 Gas Outlets 4+ $2.00 2/11104 1200400000000000196 Paving $744.40 2/11104 1200400000000000196 Sanitary Sewer - 1st SO Feet $45.00 2/11104 1200400000000000196 Sanitary Sewer Each Addtll00' $14.00 2111/04 1200400000000000196 Storm Sewer - 1st SO Feet $45.00 2/11104 1200400000000000196 Storm Sewer Each Addtl 100' $140.00 2/11104 1200400000000000196 Vent Fan $18.00 2/11104 1200400000000000196 Water Line - 1st SO Feet $45.00 2/11104 1200400000000000196 Waler Line - Each Addlll00' $28.00 2/11104 1200400000000000196 + 10% Adminlstralive Fee $5.00 2/19/04 2200400000000000158 + 7% Stale Surcharge $3.50 2/19/04 2200400000000000158 Temp Power 200 amps or less $50.00 2/19/04 2200400000000000158 + 10% Administrative Fee $107.70 3112/04 1200400000000000305 + 7% State Surcharge $75.39 3/12/04 1200400000000000305 Add, Alter, Extend Circ Ea Add $519.00 3/12104 1200400000000000305 Low Voltage - Commercial Indus $45.00 3/12/04 1200400000000000305 Perm ServlFdr 601 to 999 amps $163.00 3/12/04 1200400000000000305 Sign - Outline Lighting Each $50.00 3/12/04 1200400000000000305 Temp Power 200 amps or less $300.00 3/12/04 1200400000000000305 + 10% Administrative Fee $7.80 3/22/04 1200400000000000354 Paee 2 of8 v-~ Status Issued 225 Fiflh Slree!, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspeCtion Line + 7% Slate Surcharge Minimum/Adjustment Electrical + 10% Administrative Fee + 7% State Surcbarge Low Voltage - Commercial Indus Total Amount Paid Fire Department Review Fire Department Review . 03/03/2004 04/01/2004 55.46 578.00 $4.50 53.15 $45.00 511,874.18 3/22/04 3122/04 6/18/04 6/18/04 . 6/18/04 I Plan Reviews I 03/03/2004 04/01/2004 OK OK Paee 3 of8 . CITY OF ~rKll'lL.1<lJ!,L1J Building/Combination Permit PERMIT NO: COM2003-01146 ISSUED: 02/11/2004 APPLIED: 11/14/2003 EXPIRES: 12/15/2004 VALUE: $ 1,199,986.00, 1200400000000000354 1200400000000000354 2200400000000000812 2200400000000000812 2200400000000000812 GRG Plan Review: Riser stub-in for sprinkler system. Job #COM2003-01146. Plans by Mike Tennant/Omlid and Swinney. Plans appear to meet code requiremenls. Plan Review: Sprinkler plans-gridded we! system for Walgreens project. Job #2003-01146. Contractor: Om lid and Swinney. Designer: Mike Tennant. Plans checked per NFP A 13-1999. GRG Relief valve required for gridded system per NFPA 13-1999 4-1.2. -ir- . . CITY OF ~rKll~td'lELD Building/Combination Permit Status Issued PERMIT NO: COM2003-0II46 225 Fifth Street, Springfield, OR ISSUED: 02/1112004 541-726-3753 Phone APPLIED: 11114/2003 541-726-3676 Fax EXPIRES: 12/15/2004 541-726-3769 Inspection Line VALUE: $ 1,199,986.00 Fire Department Review 05/ll/2004 051ll/2004 OK GRG Plan Review: Alarm submittal for monitoring sprinkler water flow and tamper swilches. Job #COM2003-01146. HV AC smoke detectors also being monitored as part of submittal. Proposal by ADT Tyco Fire and Securliy. Contact: Pal Patridge (800-722,7078, ext. 7222). Tbis is a non-required alarm system per Springfield Uniform Fire Code. Provide listed electronic bell or listed water motor gong for exterior signalling device meeling NFP A 13-1999; 5-15. The exterior bell or gong shall be located on the same wall closest to the fire sprinkler system riser (NFPA 13-1999; A-5-15.1.5; Springfield Uniform FirE Code 1003.3.2) Provide approved sign stating "Sprinkler Fire Alarm/When Bell Rings Call 9-1-1 " to be located near exterior alarm bell or gong (NFP A 13-1999 A-5-15.1). Another sign shall be attached near the horn/strobe located at the entrance ofthe slore. Fire Department Review ll/18/2003 12122/2003 OK GRG See attached document for Fire . Department Plan Review Comments. Initial Review 1l/17/2003 ll/I8/2003 APP LLH Planninl! Review ll/18/2003 WE Ashley Deforest waiting on additional information needed before Development Agreement can be signed. Will need to obtain LDAP also. Public Works Review ll/18/2003 01/14/2004 APP SB Eric Walters reviewed plans 1/13/04. Signed off approved. Zero SDC charges on this project. In fact, the following additional SDC credits exist and are available for the Second Phase of this project, if initiated before December 2005: Impervious Drainage= ($4,092.19); Sanitary Sewer-Ci1y= ($5,300.05); . Transportation=($3,673.05); MWMC=($6,980.09) Pal!e 4 of8 . . CITY OF SPRlNGFu'LlJ Building/Combination Permit Status Issued PERMIT NO: COM2003-01146 225 Flftb Street, Springfield, OR ISSUED: 02/1112004 541-726-3753 Pbone APPLIED: 11/14/2003 541-726-3676 Fax EXPIRES: 12/15/2004 541-726-3769 Inspeclion Line VALUE: $ 1,199,986.00 Revised Plan Review - Fir 01127/2004 01127/2004 OK GRG Plan Review: Revised submittal of new construction of 13,305 square foot big box retail store. Occupancy classification: M. Construction type: V-N-sprinklered. . Applicant responded to comments from plans review of December 15, 2003 for address numbers, main door sign (OSSC 1003.3.1.8 exception I), and fire extinguisber requirements. Requirements written In general notes on Sbeet AO.O. Will verify on inspection. Addilion to Sbeet El.l sbows added emergency egress Iigbting. Special inspectors report will still be required as noted in tbe December 15,2003 plan review. Applicant noted in general noles on Sbeet AO.O for Knox Box and CAD drawing requirements. Fire department operations request for access door revoked due to low number of occupants in training room and employee room and not being a code requiremenl. Revised Plan Review - Str 01120/2004 01120/2004 APP JMP Puee 5 of8 . . CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2003-0I146 225 Fiflh Street, Springfield, OR ISSUED: 02/11/2004 541-726-3753 Phone APPLIED: 11/14/2003 541-726-3676 Fax EXPIRES: 12/1512004 541,726-3769 Inspection Line VALUE: $ 1,199,986.00 Structural Review 11/18/2003 11/19/2003 WE JMP 11/19/2003 see altached fax from JMP to Scolt Morris requesling completion of Special Inspeclion forms. SCOlt forwarded SI forms to contractor, said no buildings will be moved (3 will be demolisbed), itemization ofvalues will be supplied for fee computations, and conlractor data will be supplied when it is determined. 11/26/2003 Scolt delivered value itemizations. 12111/2003 received Powell Construction's fax with 3 Special inspection forms. 12119/2003 see altached fax and structural comments sent to SCOlt Morris. 12/22/2003 GRG delivered the fire plan review. Called SCOlt Morris to tell him about the 20' curb radius requirement. Also told him about exiting questions for the architect (office closed this week). SCOlt said. the contractor may be able to answer and lefl voice mail for him. 12/3012003 Carl Pirscher from CDA Architects Inc. called to review aliI: points in the structural review and said they would be addressed shortl) with changes to tbe documents. 1/15/2004 Clarice May faxed Walgreens' lelter with information on planned occupant load of training and employee rooms. SUB Review 11/18/2003 12/29/2003 APP DH 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. IRPnI~ Site Inspection: To be made afler excavation but prior to selting forms. Erosion/Grading Inspection: Afler all erosion measures are In place. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: Afler trencbes are excavated. Slab: To be made afler all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Framing Inspection: Prior 10 cover and afler all rougb in inspections have been approved. Wall Insulation: Prior to cover. Paee 6 of8 -iir . . CITY OF SPRINGFIELD Building/Combination :permit PERMIT NO: COM2003-01l46 ISSUED: 02/11/2004 APPLIED: 11114/2003 EXPIRES: 12/15/2004 . VALUE: $ 1,199,986.00 Status Issued 225 Fiflh Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Ceiling Insulation: Prior to cover. Roofing: Prior to installing any roof covering. Drywall: Prior to taping. Musonry: Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to City Building Inspector. Structural Concrete: In excess of 2500 psi. To be done during construction by a State Certified Inspector. Provide resulls to City Buiding Inspector Ceiling Grid: After drywall approval but prior to cover. Epoxy Anchors:. To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector. Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test results to City Building Inspector. Structural Masonry: To be done during construction by a Slate Certified Special Inspector. Provide resulls to City Building Inspector. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and Ihe building is complete. Rough Grading: After gravel is in place bul prior to placing concrete. Final Puving: After paving is complete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required lesting. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. Rough Mecbanical: Prior 10 Cover Final Mechanical: Wben all mecbanical work is complete. Rough Electric: Prior to Cover Final Electric: Wben all eleclrical work is complete. SUB Insulation Vapor Barrier: To be called for at the same time as tbe SUB fruming inspection. SUB Final: Afler all required energy inspections have been requesled and approved. SUB Plumbing: Following City Rough Plumbing inspection approval and prior to cover. SUB Mechanical: Following City Rougb Mechanical inspeclion approval and prior to any cover. SUB Ceiling Grid: Interior Ligbling SUB Exterior Lighting Temporary Electric:. Approval required prior 10 Utility Company energizing pole. Electric Service: Approval required prior to utility company energizing service. Sign Eleclrical: After connection is made but prior to energizing Low Voltage: Prior to cover. Paee 7 of8 . . Ltl r,OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01146 ISSUED: 02/11/2004 APPLIED: 11/14/2003 EXPIRES: 12/15/2004 VALUE: $ 1,199,986.00 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 Ihe completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and aU work performed shall be done in accordance with Ihe 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 tbe Community Services Division, Building Safety. I further certify Ihal 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, thai each address is readable from the street, tbat tbe permit card is located at tbe front of the property, and Ihe approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Pal!e 8 of8 . J~;:.'~ l!A.., ~.; 225 Fifth Street Springfield, Oregon 97477 541.~726-3759 Phone Job/Journal Number COM2003-01146 COM2003-01146 COM2003.01146 Paymenls: Type of Payment . Check 6118/2004 RECEIPT #: Jiii..ty of Springfield Official Receipt .elopment Services Department Public Works Department 2200400000000000812 Date: 06/18/2004 Description + 7% State Surcharge + 10% Administrative Fee Low Voltage -'Commercia1 Indus Paid By Received By TYCO FIRE AND SECURITY djb Page 1 of 1 Item Total: t:beck Number Autborlzatlon Batcb Number Number How Received 13836 In Person Payment Total: 10:48:57AM Amount Due 3.15 4.50 45,00 $52.65 Amount Paid $52.65 $52.65