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Home My WebLink AboutPermit Building 2009-10-7 . i :.. ~ . ~:: _" "; :' . ! Status '. ... Issued.!.."",., ...... "'.' _ -~" : -",' .~ -> .',- "",:'. 'I," . ,'. -,,, 225 Fifth Street, Springfield; OR:', 541-726-3753 Phone .. 541-726~3676 Fax 541-726-3769 Inspection Line CITX OF ~r KlJ"IuFIELD Building/CQmbination Permit ii .. PERMIT NO: COM2009-00947 ISSUED: APPLIED: EXPIRES: VALUE: 06/29/2009 02/14/2010 $,187,000,00 'SITE ADDRESS:" " 1627 S ST SPRINGFIETYPE OF WORK: Single Family Residence :: ASSESSOR'S PARCEL-NO.: 1703252402403 i ~ROJECTn~:~~~;;~N:"Sitgl~ family residence _ _ DO NOT FlNALTJ~~l~~~~E~as b~~:P~i<<O~"'ReSidential i <I Phone Number: 541-954-8636 Owner: Address: WILLIAM ROBERTSON 744 N VAN DUYN. :,;;.;i;,. . EUGENE 'OR 97401' 'ii': c. I, CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing .:i' I,; ':-, ;:1 J 51 .,U. t , Contractor WILLIAM CABELL ROBERTSON STEVE HAUCK,) ANGEL FAUSTINO ORTIZ ANGELES . ~ RICHARD ALAN ROUNDS License 98264 147618 174821 141736 .. 7 II .,: , .~I . r if of Units: '~". .dl'~ ~~ .~', Primary Occupancy Group: . Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Jl\ ; ;;. ~. ~i . _, 't .~L"'( "t Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: ..\ BUILDING INFORMATION I I .,R-3 VB # of Stories: I Height of Structure 16.00 Type of Heat: orced Air Electric Water Type: Electric Range Type: Electric Energy Path: . Sprinkled Building: n/a ':,1.;. 3 , DEVELOPMENT INFORMATION' ,. . Overlay Dist: #. Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 18,00 5.00 13.00 10.00 ~... I' "'~ !~O.OO , :;,1 \ Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS' , 'j Expiration Date 04/07/2011 04/30/201I ~: 03/16/201I 02/19!2010 Phone 541-484-5542 541-221-2665 541-653-0297 541-726-5448 Lot Size: , Sq Ft 1st Floor: . j' Sq Ft 2nd Floor: Sq Ft B~sement: Sq Ft Garage/Carport Sq Ft Other: Occupa1nt Load: j~ 6,778 1,430 393 'I / REQUIRED PARKING Yes 33.00 Total: Handicapped: Compact: 2 Sidewalk Type: , Partially Improved / Yes ATTENTION: OrElgon law requires you to follow rules adopted by the Oregon Utility ..'la." '",..,...,Noti,ficat.icW.Center. Those rules are set forth ,Ii, i' ::in OAR 952'001-0010 through OAR 952-001- " ' 0090. You may obtain copies of the rules by . ',::" ;/ , .;'. calling the center, (Note:. the telephone 11 ." number for the Oregon Utility Notification . .C~nter is 1-800-332-2344). . hHl~4 Downspouts/Drains: i, !I NOTICE:: I . THIS PERMIT SHALdEXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT \ COMMENCED OR IS :A.BANDONED FOR ANY 180 DAY PERIOD. . ,ii " " Notes: " (; Drywell - Provide Drywell Engineering . < Status' Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541 726 3676 F. .,:,,~.}. - - ax." . '...,'..,,,. '. 541-726-3769 Inspectioii:Line>!(;.\;~ ':~ ,~, "; n~ ,"', .' ".,/ .". .....i' ~" \ .:..".. Description Tvpe. of Construction Use Bid Am~u~t : "~::::f/~,~~' ': \. Bid Amount " ; ( j, ~ ,. Fee Description SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement ,j; ..,~" - + 12% State Surcharge. ' " + 5% Tecbnology Fee 1st Applia'1ce. . 2 Baths One or)'wo Family Addressing Assignment Building Permit Dryer Ven! Exhaust Hoods Fire SF Fee - Residential , :>: , .. Lien for Deferred Pymnt Agmnt " Plan Review Major,- Planning Plan Review Residen tia! Residence Wiring 1000,Sq Ft,,, " Residence Wiring Ea Addtl 500 Sanitary Sewer - IIT~provement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin SDC Transpo Improvement SDC Transpo Reimbursement SDC Transportation Admin Storm Drainag~ Impe~ious Area Temp Power 200 amps 'or less Vent Fan ' . WiIlamalane Single Family Total Amount Paid ~> 1 ~; .~;~ Y . l' Planning Review \ Pnblic Wo~ks Review Structural Review 06/2912009 06/29/2009 06/29/2009 il. "r.o.: .,.' u .. CITY OF SPRINGFIELD Building/Combination Permit II PERMIT NO: COM2009-00947 ISSUED: APPLIED: EXPIRES: VALUE: 06/2912009 02/1412010 $1187,000,OO I Val~~~ion nescrillti~n I $ Per Sq Ft ...or multiplier " $1.00 Squar~ Footage or Bid Amount 187,000.00 06/2912009 . Value Date Calculated Total Value of Project $187,000.00 j: $187,000.00 Fpp<, P.iWJ Amount Paid Date Paid ,Receipt Number 'ii 2200900000000000788 2200900000000000788 220~900000000000788 220~900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 220~900000000001150 2200900000000001150 220~90000000000f150 2200900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 2200pOOOOOOOOOOl150 2200900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 2200'900000000001150 2200900000000001150 2200900000000001150 2200900000000001150 II ii, il " $10.00 $1,146.50 $101.97 $212.98 $99.29 $79.00 $337.00 $38.00 $1,062.84 $9.00 u $13.00 $91.15 $62.00 $211.00 $690.85 $134.00 $50.00 $529.11 $695.83 . $145,05 $931.65 $211.21 $79.40 $862.71 $63.00 $27.00 $2,858.00 7/13/09 ,7 !l3/09 7 !l3/09 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 1017109 $10;751.54 I Plan Reviews I 06/3012009 APP 06/3012009 APP 06/3012009 APP " Approve~ as shown on plans. DDK EW CJC as noted on plans/review letter J! it Page 20f 4 l... .,- .., , ~,t :: ;~ . CITY:! OF SPRINGFIELD ]1 Building/CJ1mbination Permit I . Status Issued PERMIT NO: COM2009-00947 225 Fifth Street, Springfield, OR::. )" " ISSUED: 541-726-3753 P~(lDe,.",~.: :/ :'~, " APPLIED: .06/29/2009 541-726-3676 Fax '..t.',;',' )' .,"" EXPIRES: 02/14/2010 541-726-3769 In'spec'iio'n Line VALUE: $ :'187,000,00 ,", Il ,.. '. y. . II To Request an inspection call the 24 hour recording at 726-3769, All inspections r~:quested 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", " " ." " .:1:'-: ~n'~ Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. " , "~> ;.'~- . )" . /! Footing: After trenches are excavated. . " Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor In~.~lation:,'prior to decking. ',-I "'.'1 ' Shear WalINailing: Before covering sheathing with finish materials. , Framing Inspection: Prior to cover and after all rough in inspections have been approved. Ii, , ,!i:-;, ti . ~ 1., . Wall Insulation: . Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping, "- Underground Plumbing: Prior to filling the trench and including required testing. .t '. 'i. I I_I Perimet~r I;o!lndation Drains: After gravel and filter cloth is installed but prior to backfill.i' Und~rfloor Plumhing: Prior to insulation or decking. .. " ' Underflo'or Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required te,sting. Water Line: Prior to'filling trench 39d including required testing. Sanitary S~~!" .J,.!ne: }>ri'1~ 10 filling trench and including required testing. . ' . Storm S~werqn~: Prior to filling trench. Final,Plul"bi~g: ,When all plumbing work is complete. ~; I Underfloor Mechanical. Prior to insulation or decking and including required testing. Rough Mechanical: Prior to -Cover Final Mechanical: When all !"echa,\~cal work is complete. Tempor~ry E;lectric: ,App[~Yl'l required prior to Utility Company energizing pole. Underground EleCtric: Prior to cover .. I" .. Rough Electric: .Prior to Cover " , Electric Service: ,Approval required prior to utility company energizing service. Final Electric:. When all electrical work is complete. Final Building: After all required inspections have been requested and approved and the building is complete. '. " On :~l., , , Page 3 of 4 " Electrical Permit Application 22S Fifth Streett Springfield, OR 97477 t PH(541)726-3753 t FAX(S41)726-3689 II ji IA}:X;;:~':'~i',;",;":::::~:~e-,,,,,",""(I:~::"""~~1a-~~~.d""" _"':-1. . '};:';;i,OERARTMENT{.USE'0N~Y:c <'i\ "j-";,,~'-,":...:,;:,,,:,,;,';""''i'~''',:.''~<'.r"if.:'t.':+!:~~~-ii#,;;;;'..._...: ., I Pe~it nb/~n1Uro-9~Jp17 ID.~ I This permit is issued under OAR 918-309-0000. Permits are nontransferable. 'Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. ~~Z-W.o;~nm': mg"~a~p' "p.l!ir,lDo'v=~a'/i.I"'~v~e'n,:Gfi"'I."e0d~V.?' :"'BNI"[l:0:NiTIY~e'tj.s'~RR<DN';6;0"~"'N'~OC~~j~l;E.lS=081:C5JJI!lI:--~ I ";&).~'i~~iI.~ill}l11 1~~~~~mEG~RYI!iI!'>l7Jlc:QN$)tB!!J,!:}illIQN~d~~ "hGS'", ~'bY"eA, '" .~!'!l~!,;':'. I I Residential, per unit, service inclu~ed: 1 D Residential D Government I D C~rnmercial - ~Q13I$]iIfl:jlJNJiQR:I\Il!8mI0N~ANC5iI!Q(';p,.'I)IQN~~~1. 11,000 sq ft or less (4) / $134.00 $ I 1 Job site address: ~.;<'7 :;;: S''Tf!-€:.t,r I ~~~~:ritionaI500 sq. ft. or portion c:2 $ 25.00 $ I I City: e /iZZtt-/~I-.dJ 1 State:;rxt- I ZIP:QY111 Limited energy (2) $ 32,00 $ I i=;~~t1E$=qB.IRml~N~QF.lW,J~~~~~~1 I ~~~~I~:"S~~~~r~~ ~e~~:r (~)OdUli' $ 63.00 $ I I ~ll/ /t;l,()~- I ! Services or feeders: installation"al~~ration, relocation I I , t 200 amps or less (2) $ 81.00 $ 1 1~'1lll'~BR~RE;Rm,y.t0WNI:~jii~ilril)~~~'I;:"N~r;;'I1 I 201 to 400 amps (2) $ 95,00 $ 1 1 Name: bz;a 46'ttZ'-c,{'QIJ 1 40tto 600 amps (2) $158.00 $ 1 1 Addres;: 7Y'c,? t-IM,) IJvw ,_5:Z::~~;7 1 601 to 1,000 amps (2) $205.00 $ I 1 City: ~t.--, I State: /11!--1 ZIP:-91~ ( lOver 1,000 amps or volts (2) $469.00 $ 1 I Phone; i-r//4.t(-R& 2, C; I Fax: 1 Reconnect only (2) $ 63.00 $ 1 I E-mail: I Temporary services Of feeders: installation, alteration, relocation I Tbis installation is being made on residential or farm property 1 200 amps or less (2)11 . /. $ 63.00 $ 1 owned by me or a member of my immediate family. Tbis 1201 t0400amps(2)il $ 87.00 $ 1 property is not intended for e, exchange, lease, or rent. OAR 479.540(1)~d 79.5 0(1) / - 1 401 to 600 amps (2) $126.00 $ I Signature;:; __ ~ lOver 600 amps or 1,000 volts, see se.rvices or feeders section above I , - -. - - ~ \.. '- 1~~G~~Nlli~c:m.O~a.il(\,l$m~Ull!fl,(mIQN~~i;~_~,:ttlfi~( I Branch circuits: new, alteration, ex~~nsion per panel I I Business name:' 5'TEUf. Mf.Xl:- I I a. Fee for branch circuits with purch~e ofa service or feeder fee: I Address: P Q. 50)( 1B6/ I 1 Each branch circuit 1 $ 6,00 I $ 1 City: Guh-- 1 State: orz 1 ZIP: '71'/0/ ,lib. Feeforbranchcircuitswithoutpu\chaseofaserviceorfeederfee: 1 I Phone: _5",._ ~ ,- GI~b5 1 Fax: " -S'If - HI- I ogs I. 1 First branch circuit (2) I I $ 55.00 I $ I 1 E-mail: SSJ-fllucJ.-@..C<hOIST.Mo_. 1 1 Each additional branch circuit" $ 6.00 $ I 1 CCB license no.: /'-1=1'0/8 1 BCD license no.: 20- '172- c. I 1 Miscellaneous fees: service or feedet not In~luaedl 1 Signing supervisor's license no.: ;;;51 f 5 I Each pump or irrigation circle (2) ii $ 63.00 $ 1 I Print name of signing supervisor: S,EVE Hf.JlkJ(. I Each sign or outline lighting (2)" $ 63.00 $ I I S. f Akr ffi I "Signal circuit or a limited-energy part.',el, $ 63.00 $ I Ignature 0 signing supervisor: . .~Z'" :,"",. !. 1tJL: alteration, or extension (2) . i! 1 Each ad~ional inspection: (1) II j $58.00 $ I ~~~~~j~]~,il1!:l~Nrr!(ij_SE;~~ (A) Enter subtotal of above fees I' (Minimum Permit Fee $58,00) II (B) Enter 12% surcharge (.12 x [A]) I! , 1 (C) Technology Fee (5% of[A]) Ii 1 TOTAL fees and surcharges (A through C): ~~, .~~ '$~ \O~f:r Y-=\j\ 440~2584-J (9/08/COM) $ $ $ $ Structural Permit Application _,"',.,',"',.,"''''',.'c"'-''',u., ~ ,," '~.".... . " .. I'" D D' O. . ' , ,_ _ __R.' 225 Fifth Street t Springfield. OR 97477 t PH(541)726-3753 t FAX(541)726-3689 1.%~plRA!'~T~ENiUSE;RN"~Y!' c.tioM~oo T-CO't'l7 Ie. Permit no.: I Dat~: b - Z ., ~ 0 ~ , This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 1~9:fl~'A::~~{i~t~i;,,~~QP~A~,;:9'QY'g:8NM~t{!~~~~JiB"@Sl.A,~]~4~];r;jJt~f~~~ii~1 I T~is project has final land-use approval. I Signature: Date: I This project has DEQ approval. I Signature: Date: Zoning approvaJ'verified: DYes D No I . Property is within flood plain, CI Yes D No I I ~~Jl'2;i1,t{~,~~cATEd0RY'1.0~i'c0N1ffRHC[10N~111\!iii:'iC~d::;-.',\Ji(1 I.' ,:,rt21}!.g;~.~'i!l_-, ,~ .. ..~_._...,.,_._._,.__.w_m_~~2It_..~..n.' ..... ".,-'-,' -,'.,,-,.,,' ._".. h....'"..,_;;')'5'i._,:*.h.,.~\'tll::'~s\'#,_ 11...D,',"'~,'""~,:',",,id, ;;:~~,~ 'f'...." ... "I.9..G,.", ~~;,.~"~m,.:,, ~:,..,.,...,., .,.." .,.., ,I,5~_C, .,~:n,..~,;;~,~~, ~~"".,',,.,II 1 !l?,aiMI::~~(~QBr(SI:rE:':;1 N !iClRrvI"TI(:J~~"toJ p~li(:J_CATI()Ni~l+!!olil;!"i~!, 1 I Job site address I 6>;7,7.:s oS ;(;ljJ;/ ,. , '\ I citycfld-urkhk--C>!l I State ,::}(L I ZIP "1'IY7,? I Subdivi;;on/70~Z$ Z4 I Lot no. Ode/b."-?' VI I Reference: I Taxlo~: . I :'~:::e "l~;l,' '~1:;~:(1~MR;'!:;t;i',t~!!f' 'I I Address 7l$_/JA<() dJr)V/J , .J 1 I City~l/.t5bJy . State: /'2I'L I ZIP97k / I I PhoneIWt7J'f-JUc, Fax, IE-mail ~h..!7f{t/d2C.hl.it!A:J.7. AJf"7 This installation is being made on residential or farm property owned by me or a member of my' immediate/jrnily, and is exempt from licensing r~qUirements ~nd'r ORS 701.01~:/ / / . Sign here/! /lI~ ~U'--" t "/ -L,.\ ,.;c~NTRAdbitiNS1:'AtLATI6N;/.<':.;,::.;.i;.::., , ,~".: .~ss::{:~. -. ._.-~ ..-, .. "-""'-'.'~'~"""""~ .' -,,-, ,...."..,'-.., ,-.---.,...,....-...".-,."."....,.,...-."". T>"," . -<S'Us=-n~1c-~"n.....!c" i',,).,';;/.0-~ I 'Address 7!1(t !JA-n 1-1Ji)jI;i!(7)'.U/' .'/ I I City ~:L(,JhJt- , I State:,,~ I ZIP4'7;co ( I Phone;r#40~~'?G Fax: - - I E-mail:' ,/ ICCBlicenseno.: Qfa26(,? ,(J I Print name It)f/I Z"4h'/;) /'. ,h~ f- tLrl' c.() I Signature // fiJfl f..iz/~-, :;~'!\l~i,tuf~::~B$O[l'F0~~;~;;~~~~~:~~~Mk:'t~~::~:~~~gj\ I Electrical C'7.1i:')f,~ ~/-02~tPS'- I I Plumbing ):'<:.<(/1.,.') ,t""1.5: (d,o - ?oU,J I I Mechanical //Met O1l71'C- /.. ,- < '-6,7?7 I 1~;t:>;l::~:;~~;t~~~~~;}g~;,~i:~hrJfiff,~'~,~J'~,'~HIRQl2'~:n~~?}r~~:~~~;S,21:~I,;~',~:;~::~7~~~?1~ \ 1.;."l."I~~V-~';-tl'~;'"l.:,;'.'''"T:,'J.,.-'''..',;;"t;'''i"';<J;i!'\0;''1;',}~F':V::~''i>'! ,\;.;r'(::X",',;t:3'r" fi'i:.t,i' i',{i,','''; '~':.~i'I ;":i:~l~'i}. '"j 'I ','- .]~~" JL~~J,~Qml.I)JOIJllll,!~Q,Q:it~~!~]:;,!,!'tt4!iq'ix;t);~!~wt~:~S,~~,\fJi;:/rW~~'fj'~~~~~; (a) Job description: - Si", tJIr i=;._ i/. Occupancy ~ '3 I: I IIrs Construction type: Square feet: Cost per square foot: I I I I I I 1 1 1 $IB~ 18Z3 Other information: t=Le-c. / If" Energy Path: S- ~ew 0 alteration I (b) Foundation-only permit? 'I Total valuation: Type of Heat: D addition Dyes 'MNo I I I I I (0) Subtotal nffees above (2a through 2d): $ I l~~:;~il:!::~~:~~::~!ii:;:~~;~f;;~~~~~~~~~) 1 Cb) Fire and life safety (40% x permit'.fee [2a]): $ I I (c) Subtotal of fees above (3a and 31,): S I (a) Permit ofee (use valuation table): oil I (b) Investigative fee (equal to [2a]): ' I (c) Reinspection ($ per hour)::! . (number of hours x fee per hour) I (d) Enter 12% surcharge C. 12 x [2a+2b+2c]): $ $ $ $ I (a) Seismic fee. 1% (.01 x permit fee [2a]): I $ , TOTAL fees and surcharges (2e+3c+4a): $ \~. ~ :-\,0 \O'~~ 0-. ~ Willamalane Park & Recreation District Job. No, 121- 9y7 SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 NAME: l1,j,/?FX/..!L:> tV ADDRESS: 'JIp. Y";+,V -)/1v"t! CITY ruc::, I: PHONE: 9c1<Y -rt <~ I' STATE:@IP: 7'7'/J/ I ' I, LOCATION OF PROPOSED BUILDING SITE: 'Street Address: /t'l Z '7 )\ r Plat Name: /'/CY} "/~;:. r Tax Lot Number: ./7'/')",,'1 1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type d'efinitions are on the back.) .' A. Sinale-Familv Detached \ NO_ OF UNITS I X $2,858 per uriit = . $1 .:2F5f B. Sinale-Familv Attached NO. OF UNITS X $3,100 per unit = $ , C. Multi-Familv Aoartment NO. OF UNITS X $2,641 per unit = $ .0, Sinale Room Occuoancl/ NO. OF UNITS X $1,321 per unit = $' E, Accessorv Dwellina Unit NO. OF UNITS WILLAMALANESDC X $1,550 per unit = '$ $ 2. SDC CREDIT (If applicable) SDC p'ayer must furnish proof of .. Willamalane Credit approval.) , $ 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) $QFff ~--- Development Services Department City of Springfield ? I 5d I :~ff ' Date _ """'. _ 1 '. ("\'1 lli-, \Li '1-0- \ . , 5 ~, :' ,.- (' ..... " '. \ CITY OF SPRINGFIELD 'i , Building/C~mbination Permit ,> PERMIT NO: COM2009-00947 ISSUED: Ii APPLIED: 06/29/2009 EXPIRES: 02/14/2010 VALUE: $.,187,000.00 Issued . - .' ,~~ :',~~. . 225 Fiftb Street;.Sprillgfield;OR'U~( < 541-726-3753 Ph'~ue:;!;". .'.--- .. - 'i- .~ . 541-726-3676 Fax. . .: 5.41-726-3769 Inspec'tioirLine , ' . ',!ri- ,:' ';:.: ,,':.,~ ' ';. \ Status By signature, I state and agree, tbat I have carefully examined the completed application and do h~rehy certify thatall information hereon is true and correct, and] further certify that any and all work performed shall'be done in accordance witb the Ordinances of the City ofSpri~gfield and the Laws of the State of Oregon pertaining to the wo'rk described herein, and that NO OCCUPANCY,will be made of any structure without permission of the Community Services Division, Building Safety. , ..n .. " '\ ' I further certify:thai'only contractors and employees who are in compliance with ORS 701.005 wilibe used on this project. . I further agree ioensurethat all required inspections are requested at the proper time, that each address is readable from the , street, that the permit c~rd is located at the front of the property, and the approved set of plans wil'l remain on thesite at all '~;;~. /O~~ Owner or Contractors Signature, . Dt ";/ ".i.:" i;~',;c;;:, ' ~ ,\,,:., .1.... V .,~ ;_. . --' i: . '.1- ,.I " I '!11,l" . , . . ~i, _ 1i_:'~,. ~I . , , L .,!.. i :";;'.'1.1"', :'I ,", I. ... . " 'fl" i ''L' ",;."., .~i -;' ; '. u ., " f' ji ,- l :' . , Page 4 of 4 " ~ " 5P5'00..= =---- \F; .~p~ '\ \ \"l '" .' ~'':~*,''.ltf' AP*~:~~:':~=: ~ C....C" The own~of e property shown below hereby apply to the City of Springfield to pay the fees and charges of $ " eferred until final building occupancy is requested, In the event that the real property on which the fees have een deferred pursuant to Ordinances 6233 and 6234 is sold or conveyed, the fees or charges deferred shall become immediately due and payable to the City of Springfield. Sale or conveyance includes either actually selling, conveying or assigning any or all of the property or any or all o~the 0 ,. terest in the property. The owner,s hereby apply for and consent to the voluntary imposition ofa lien for $ . ~u'pon the following described land in the City of Springfield, Lane County, Oregon: . q4 C\ 0 .01 U" \. \~: c> q . . w-a'L 7(IB 1111 MAP AND TAX LOT 11 ()::;:;,x-d1<1 od)~.3 SITE ADDRESS /&.;27 ,<: .!,'7tf..u:-;r 7AK/{cq.'#/?~0/0(' ClTy,STATE,zip(~...k~ /'~ ~;/71 PROPERTY DESCRlPTI~ . / . / > I ) (? "N6btffcxJ 9-- ~, t..~~t.Lz:rCJ4J ?'0 /:14../ 1/WJ(J {'[#{:,7 , cP,//Ae-'< /{-- A2- ~~ -{tAJf1 BILLING NAME BILLING ADDRESS CITY STATE TOTAL LIEN ZIP 47yO/ q 4C' '3 .b' , -, Ll"L!:}.... J ~ W \,\~'D.q $ '-..:::r,- -J\ ....>, ~,"1I.1(1~70e, $ - lo2.00 f.J./"- q 0,,'\0 \ .b\ u..\ ,,\""'b' 0 $ -\':). lv~1 .::." ~fPdL 1//7,./0' FEES AND CHARGES DEFERRED RECORDING FEES In addition to the fees and charges indicated above, we agree to pay the fees associated with record.ing the lien and removal of the lien at Lane County Deeds and Records, , We are all of the legal owners of the described land or all of the contract purchasers of record of the described land to which these fees and charges are applicable. We. waive any and all irregularities or defects,jurisdictionai, or otherwise, in any proceedings to impose, calculate and collect these fees and charges, and in the imposition and collection of the lien consented to in this application, We promise to pay these fees and charges when,final building occupancy is requested or at such time the real propertY is sold or conveyed, The charges may be paid in full at any time without penalty., We understand that if there is a subsequent failure to pay the fees and charges the City shall have the right to enforce payment of the amount due in any manner provided by the general law of the State of Oregon, or, by the Springfield Municipal Code, including but not limited to foreclosure of the land. In the event of any proceeding to enforcecollection or to foreclose, the entire unpaid balance and any fees shall be considered delinquent and due. We also agree to pay the city's cost of collection or foreclosure and any attorney fees necessary for such collection or foreclosure. -;~~~ I 7 ~ J-Y/-0y.,trf5?, ~;/~ Pj).one # . -; /,,/05 S{jI-,<)d..I-~3IS Date Phone # 4- if)tName of Owner . Print Name of Owner Signature of Owner Date Phone # Print Name or Owner Signature of Owner Date Phone # STATE OF OREGON ) ) ss, County of Lane ) OFFICIAL SEAL DEVETTE KELLY NOTARY PUBLIC. OREGON COMMISSION NO, 420351 ' MY COMMISSION EXPIRES AUG, 15, 2011 day of\. )~ ' ;).oD'1 . The foregoing instrument was exec~rd before me this i-H"" M~mmiSSion expires: g liS II DUPiiL J/jj/y~ ' Notary Pub!\L: of Oregon '~'-:'~- 0 v:\cornmon\accnting\as~essmt\Deferred fees contract.doc IE CASCADE ESCRDW 06/17/2009 WILLIAM C. ROBERTSON 744 V AN DUYN STREET EUGENE, OR 97401 BUYER: WILLIAM C. ROBERTSON and RHONDA L. ROBERTSON SELLER: KELLY V. SULLIVAN ESCROW NO: EU09-1707 fROPERTY ADDRESS: TAX ACCT. #1826104, MAP/TAX LOT #17 03 25 24#2403 LANE COUNTY Deaf Bill & Rhonda, We afe pleased to inform you that the above numbefed escrow bas closed and we enclose hefewith the following items: [] HUD-I Settlement Statement [ ] Amended Closing Statement ~al Closing Statement [ ] Closing Statement [ ] Deposit feceipt fOf proceeds [ ] OUf check in the sum of $ [] Alternative Form 1099-S (THE 1099-S WILL NOT BE MAILED AT THE END OF THE YEAR, SO PLEASE RETAIN THIS FOR YOUR RECORDS.) 1 [] [] [ ] Ofiginal fecorded Completion Notice / We trust that this escrow was handled to your satisfaction. We look forward to being of service to you in your n"ext real estate transaction. Should you have any questions, please do not hesitate to cont~ct the undersigJled. SINCERELY, CASCADE ESCROW ~KIN ESCROW OFFICER BHU MAIN OFFICE' 811 WILLAMETTE ST. * EUGENE, OREGON 97401* PH: (541) 687-2233 FLORENCE * '1901 HIGHWAY 101 * FLORENCE, OREGON 97439 * PH: (541) 997-8417 EUGENE FAX: 485-0307 * E-MAIL: info@cascadetitle.com * FLORENCE FAX: 997-8246 IE CASCADE ESCROW , PAGE I OF I BUYER'S FINAL CLOSING STATEMENT - Escrow No: EU09-1707 SETTLEMENT DATE: 06/17/2009 TO: WILLIAM C. ROBERTSON and RHONDA L. ROBERTSON 744 V AN DUYN STREET EUGENE, OR 97401 WILLIAM C. ROBERTSON and RHONDA L. ROBERTSON (the "Buyer") KELLY V. SULLIVAN (the "Seller") CASCADE ESCROW provides tbis Final Closing Statement to Buyer to reflect the final disbursement of all funds that constituted a part of the escrow. If you have any questions or need any furtber informatioh please feel free to contact your escrow officer shown below. SUBJECT PROPERTY: TAX ACCT. #1826104, MAPITAX LOT #17032524 #2403, LANE COUNTY TITLE ORDER NO.: 0263174 J J ,T~V I PRORATE DATE: 0611712009 I PURCHASE PRICE I PAID TO SELLER OUTSIDE ESCROW I I BUYER DEPOSITS: 1 DEPOSIT TO ESCROW ON 06/16/2009 FROM WILLIAM C. ROBERTSON I I PRORATIONS AS OF Close of Escrow : I REAL TAX (Q) 624.92 paid to 07/01/2009' I I I I ESCROW FEES: I CASCADE ESCROW I ESCROW CLOSING FEE - 50% I I TITLE CHARGES: I CASCADE TITLE COMPANY I OWNER'S STANDARD POLICY I GOVERNMENT SERVICE FEE I RECORD WARRANTY DEED I RECORD RECONVEYANCE I I ADDITIONAL CHARGES & CREDITS: REFUND TO BUYER BALANCE NEEDED TO CLOSE I TOTALS DEBIT $65,000.00 CREDIT 23.97 200.00 I I I 345.00 I 25.00 26.00 26,00 . 1 I I $65,645.97 I ~,. ESCROW OFFICER: DE~A MULLIKIN I I 65,000.00 I I I 645.971 I I I I I I I I I I I I I I I I I I I 1 $65,645.97 I ,.........'......." ..... ...:.............. ...... ...."'='..:'.",,.. ..."....0. if~UUUUa4......... ~ ~ ,. " ., ." ~ I LEGAL DESCRIPTION OF ROADWAY DEDICA nON FOR SULLIVAN " EXHIBIT "A" A twenty-five (25,00) foot wide tract ofland in the northwest one-quarter of Section 25, Township 17 South, Range 3 West, WiIlamette Meridian, City of Springfield, Oregon, more particularly described as follows; Commencing for reference at a 5/8 inch rebar marking the southeast col"l).er of Lot 7 of Ronald Park as platted and recorded in Book 14, Page 13, Lane County Plat Records, Lane County, Oregon; Thence North 89053'15" West 180.16 feet to a point; Thence North 00013'09" East 91.20 feet to a 5/8 inch rebar; Thence North 00004'03" East ]77.53 feet to a 5/8 inch rebar and the TRUE POINT OF BEGINNING; , Thence North 89054'30" West 100,00 feet to a 5/8 inch rebar; Thence North 00004'03" East 25.00 feet to a point on the Centerline of"S" street; Thence South 89054'30" East, along said centerline, I 00.00 feet to a point; 'Thence, leaving said centerline, South 00004'03" West 25.00 feet to THE TRUE POINT OF BEGINNING. 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I' ' I~ I~= .~ 5_, $0' JL 53 ;, . , =-- J ~ ~ 5. -, al: ~~ ..... --- (/) ~l ., ~I~ ~ ~ 1. .~ : ""'''''/-a, , . ~ ~ , " 04/27/2009 12:30 F,\! 5~1 485 0307 CASCADE TITLE III 001 I:' 'I' " :f,i ':1 .~ " ~ \ .~ d ,', ',j " ':1 , " '-:, " " . " '. I "1: . " ,', '" . .: r I ~, t it:, '.' " ~, . ~, I:' " .,' '1:; I, , q:' .' i~: .1:" J ~! ,:t: .1., " Ji: . , r, l: , CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY, LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS C0fl12Q09-00947 Bil( Robertson 1627 "S" Street 1703-25-24-02403 Sin~le Family Residence I BUILDING SIZE (SF: Ii II ~ 10 10 u I~ I~ Ul (3 ~ 1823 LOT SIZE (SF): 6778 I. STORM DRAINAGE DljlliCI Ll..UN~~ 1Q CITY ST01M SYSTEM I IMr>~W 9 S "Sl'. x COST rlill- S.F, I _ I CHARGE I O. I $O.~'~ - I $0.00 I Rl ~~\~ra ~~DfY~EL7 D~b~~~~f~. CO~~~U'ifsg;&,,!n~~D"'S DISCOUNT 46 I 5.b6 I I J'~,\7 I I 50% I ~ I $862.71 ITEM I TOTAL-STORM DRAINAGE SDC '$862.71 ~ 2. SANITARY SEWER - CITY A.1~lifB~~ft~I~?ST~ I ~1 I B. (~a~~ie(r x I ';r I $862.71 COSl2t~ DFU $695.83 11091 I I COST Pj::)l. DFU I $21:65 $529.11 11092 =, 1 TRANSPORTATION ITEM 2 TOTAL- CITY SANITARY SEWERSDC $1,224.95 A. r2b~l~~ C1ST~ : NUMBER t UNITS I x I COST ~f., TRIP x INEW TffclACTORI I . I I 2. 7 I .0 I B.tm~~ifsr x : NUMBER t UNITS I x I COST PER TRIP x INEW TRIP FACTORI I ,57 I $97.35 I 1.00 I ITEM 3 TOTAL-TRANSPORTATION SDC = , $1,142.86 $211.21 11093 I $931.65 11094 I 4. SANITARY SEWER - MWMC A. ~Jtmh~~~~\Vs CrT~ B. lJ\1rROXEl\1F~T COST: INUMBE1l. OF /:'},Ols I x I I I x :COST \tf~ ~~U $101.97 IOS4 = ICOST fERfEl,J I ~1,U/'.56 = $1,146.50 ! 1055 $0.00 I 1054 $10.00 I 10S6 I " ~ l 145.05 11079 $79.40 11078 =1 $4,713.44 I II MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~,1-=sr.zss~4=1] SUBTOTAL (ADD ITEMS I, 2, 3, & 4) 5, AI)MINlSTRATlV1.:: FEE' ISUBTQTl\L. I ~Hft'8.99 = I $4,488.99 x I ADM, FEE RATE I~ I 5% I 1 CHARGE $224.45 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Eric Walter PREPARED BY TOTAL SDC CHARGES DATE --.-- .-- DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIX11JRES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULA 1FYlt. ~;;}\WUiEf'ONAL FIXTURES) DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EOUIV ALENT_ UNITS BA I 2 0 3 = 6 (TAIN 0 0 1 = 0 : ~8~ ~~1E I OIL I SOLIDS I ETe. 0 0 3 = 0 0 0 3 = 0 .' t AUTO WASH I ETe. 0 0 6 = 0 rti $ 0 0 2 = 0 I~', 'LH'''~ 1 0 3 = 3 IC'i; E ASHER. EA 0 0 6 = 0 I EfOMEPARK lEER 0 0 12 = 0 I I" '&~1W'W ll'l~~~,)"" 0 0 1 = 0 .) ~F i. I ASHER I ETC. 1 0 3 = 3 J Ii:.. \~ ALL 0 0 2 = 0 !"."".D~D.'h",,, 0 0 2 = 0 1 0 3 = 3 SINK: C 0 0 2 = 0 SINK: i'l S~:ifELAVATORY 1 0 2 = 2 SINK~1~ LA T R /RESIDENTIAL BAR 1 0 1 = 1 URIN ,ALL! L 0 0 5 = 0 TOILE}. ~~Rrt ~~~TION 0 0 6 = 0 TOILE . TE LATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 .EDU (Equivalent Dwellinp: Unit) is a dischaJ-Re equivalent to a sin~le familv dwellinp: unit (20 DFU's) set at 167 ~lons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED CREDIT RA TEfS I ,000 ASSESSED VALUE $5.29 $5.29 $5.19 $5.12 $4,98 $4.80 $4.63 $4,40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0,09 $0.05 = SO.OO IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 1979 2 BEFORE 1979 1979 1980 \9&\ 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 199' 1996 1997 1998 1999 2000 2001 2 ~~; !I~/;bLAND (IF ~~~'t~ $0,00 x $5,29 ~ , SO.OO CREDIT FOR IMPROVEMENT (IF AFTER ANNEXA nON) VALUE I 1000 CREDIT RATE $0.00 x $5.29 o , TOTAL MWMC CREDIT ~ I I I II I I I I I I I CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY, LOCATION, TAX LOT NUMBER, DEVELOPMENT TYPE; NEW DWELUNG UNITS I STORM DRAINAGE COM2009-00947 Bill Robertson 1627 "s" Street 1703-25-24-02403 Single Family Residence . I BUILDING SIZE (SF: . 1823 LOT SIZE (SI')' . 6778 DIRECT RUNOI'F TO CITYSTORM SYSTEM I IMPERVIOUS SF x I COST PER S.I'. CHARGE I 0.00 I $0.374 I = I $0.00 I RUNOFI' ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I ,IMPERVIOUS S.I'. I x I COST PER S.I'. I x I DISCOUNT RATE I I I 4615.00 I I $0.374 I I 50%1 DISCOUNT $862.71 , 2 SANITARY SEWER - rTTY ITEM I TOTAL -STORM DRAINAGE SDC A. REIMBURSEMENT COST: I NUMBER 01' DI'U's I x I I 24 I' .1 B. IMPROVEMENT COST: I NUMBER 01' DI'U's I x I 24 I $862.71 $862.71 COST PER DI'U $28.99 $695.83 COST PER DFU $22.05 $529.11 ' ITEM 2 TOTAL - CITY SANITARY SEWER SDC ITEM 3 TOTAL - TRANSPORTATION SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADTTRlP RATE I .x 19.57 I ' B. IMPROVEMENT COST: I ADT TRIP RATE I I 9.57 I = , $1,224.95 1- 1m I~ o u p,; w:l f-< m :0 'g;j 1070 11091 I 1092 11093 I 11094 I 4. ,SANITARY SEWER - MWMC . A. REIMBURSEMENT COST, . INUMBER OF FEU's I x I . I B. IMPROVEMENT COST: INUMBER OF FEU's I x II I I NUMBER OF UNITS I x I I. I I I x INEW TRIP FACTORI I 1.00 $211.21 COST PER TRIP 22.07 x I NUMBER OF UNITS I x I I 1 I I ~ , $931.65 I x INEWTRJPFACTORI I I 1.00 ' I. COST PER TRIP $97.35 $1,142.86 ICOST PER FEU I $101.97 = $101.97 ICOST PER FEU I $1,146.50 1054 = '$1,146.50 1055 $0,00 1054 $10,00 1056 ~ I $1,258.47 ~ I $4,488.99 I~ CHARGE I $224.45 145.05 11079 $79.40 11078 I" TOTAL SDC CHARGES =, ' $4,713.44 I -..- I MWMC CREDIT IF APpLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE I'EE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE, I SUBTOTAL x I ADM. FEE RATE I $4,488.99 I 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE, Eric Walter PREPARED BY DATE 1-' . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT = DRAINAGE FIXTIJRE UNITS (NOlE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTIJRES) NO. OF FIXTURES DRAINAGE F1XTIJRE UNITS 6 0 0 0 0 0 I 3 I 0 I 0 1 0 3 0 0 3 I 0 I 2' I 1 .1 0 1 O' 1 6 0 24 UNIT FIXTURE TYPE NEW OLD EQUIVALENT BA THTIJB. 2 0 3 = DRINKING FOUNTAIN 0 0 1 = FLOOR DRAIN '0 0 3 = INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = LAUNDRY TUB 0 0 2 = CLOTHESW ASHER / MOP SINK 1 0 3 = CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = IMOB1LE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = I RECEPTOR FOR REFRlG / WATER STATION i ETC. 0 0 1 = !RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 '3 = ISHOWER, SINGLE STALL 0 0 2 = I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = I SINK: COMMERCIAL!RESIDENTIAL KITCHEN 1 0 3 - I SINK: COMMERCIAL BAR 0 0 2 = ISINK: WASH BASIN/DOUBLE LA V A TORY 1 0 2 = SINK: SINGLE LA V ATORYfRESIDENTIAL BAR 1 0 1 = URINAL, STALL / WALL 0 0 5 = TOILET, PUBLIC INSTALLATION 0 0 6 = TOILET, PRIVATE INST ALLA TION 2 0 3 = MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = TOTAL DRAINAGE FIXTURE UNITS _.EDU (F.Quivalent Dwelling Unit) is a discharge equival~ to a sinJ!:1e familv dwelling unit (20 DFV's) set at 167 J!:3.lIons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE --------- ---.-. - 2 II 2 I. 1979 I': , , I $0.00 YEAR ANNEXED IS LAND ELGlBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR BEFORE 1979 1979 1980 1981 1982 ]983 1984 1985 1986 1987 1988 1989 1990 1991 t992 1993 1994 1995 1996 1997 1998 1999 2000 2001'. CREDIT FOR LAND (IF APPLICABLE) VALUE/1000 CREDIT RATE $0.00 x $5.29 ~, CREDIT FOR IMPROVEMENT (IF AFTER ANNEXA nON) VALUE/1000 CREDIT RATE $0.00 x $5.29' o TOTAL MWMC CREDIT $0.00 = ;, 1 225 Fi.fth Street': . Springfield, Oregon 97477, ' , 541-726-3759 Phone , , City of Springfield Official Receipt Development Services Department Public Works Department REcEIPT-#:-' '2200900000000001150 Date: 10/07/2009 1l:29:43AM Job/Journal Number\~;/;~t.l)~~t:r.jption'.'~Y-~;,)\E -',: COM2009-00947 )i.;) ')P)an Review Residential COM2009-00947 ,;;, .'Lien for Deferred Pymnt Agmnt COM2009-00947:<t~y,:;'Plan Review;Major - Planning ~~.""! ~'."~'..' ,. 'r' '. .' . ;\', . COM2009-00947 .... 'StorinDiainage'Jmpervious Area COM2009-00947 Sanitary Se":er:~Reimbursement, C0M2009-00947 Sanitary Sewer -' Improvement COM2009-00947 SDC Transpo Reimbursement .... ,'. COM2009-00947 ;:".,:..,,809 Tr{lllsp.o'I!llprovement ",H J' ".Ii" ";'/ ." ," ., ~ .,. COM2009-00947 . .:;;:'~ ':,jSDC Sanitary/Storm Admin ,~ . ,:", ,- ~.' . C0M2009-00947 ','i;',: 'i'SOt Transportation Admin , ~ ',. . - C9M2009-00917,tid ,;,B~fl~ing Permit;, COM2009-00947 ",' ;"',Addressfug Assignment COM2009-00947 Willamalane Single Family COM2009-00947 1st Appliance COM2009-00947 Vent Fan COM2009-00947 Exhaust Hoods.. COM2009"00947 i~,:":Dryer Vent ,:; COM2009-00947 ' 'Residence Wiring 1000 Sq Ft COM2009-00947 i ,Res.idence Wiring Ea Addtl 500 " . COM2009-00947 'i!'.; ],Temp Power.200 amps or less C0M2009-00947 Fire SF Fee - R~sidential COM2009-00947 2 Baths One or Two Family COM2009-00947 + 5% Technology Fee " COM2009-00947 + 12% State Surcharge , ~ ,II " .' :,~-! !;j Item Total: Check Number Authorization Received By Batch Number Number How Received cjc 075596 In Person Payment Total: Amount Due 690.85 62.00 211.00 862.71 695.83 529.11 211.21 931.65 145.05 79.40 1,062.84 38.00 2,858.00 79.00' 27.00 ' 13,00 9.00 134.00 50.00 63.00 91.15 337.00 99.29 212.98 $9,493.07 ., Payments: TypeDf Payment CreditCard .1 ~1' .. : 'Paid By ,WILLIAM ROBERTSON : J 1 .1 . n-\ i) -', Amount Paid $9,493.07 $9,493.07 ' ., ~ . .'~ ',',,1.. <\_i.',j'~I;';'" l,X.i~'. - ' " : " ~, ~ :. ~jl :';. ' . ., .' ~ . ~';i ;: ';: .t:~: :1 "0' , . j' )" l'.. . .1"~': " ii " ....; " , .r ,~t''' ,/ ,. '. -," , ;,{ . .- " , , Page I of I 10/7/2009