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Home My WebLink AboutPermit Building 2009-11-20 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01660 ISSUED: 11/20/2009 APPLIED: 11/1712009 EXPIRES: OS/20/2010 VALUE: $ 174,000.00 Status .Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5795. MICA ST ASSESSOR'S PARCEL NO.: 1802033304300 SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single family residence - SAME AS COM2009-01511 5774 Orchid Owner: 1-1 A YDEN HOMES LLC Address: 2464 SW GLACIER PL STE 110 REDMOND OR 97756 I CONTRACTOR INFORMATION I Cont'ractor Type General Electrical Mechanical Plumbing Contractor HA YDEN ENTERPRISES TOP NOTCH ELECTRIC INC ' PACIFIC AIR COMFORT INC STUTZMAN SERVICES INC License 92208 172366 39237 31747 I BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure 15.50 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Electric Energy Path: Sprinkled Building: n/a 1 R2 U VB 3 I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 18.00 12.00 15.65 24.00 0.00 Overlay DiSl: # Street Trees Rqd: Paved Drive Rqd: 0/0 of Lot Coverage: Residential Expiration Date 07/29/2011 09/29/2010 03/25/20 I 0 05/12/20 I 0 Phone' 541-228-1081 541-317-1998 541-672-9510 541-928-8942 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carp~rt Sq Fl Other: Occupant Load: 1,148 400 3 Yes 26.30 " REQUIRED PARKING Total: 2 Handicapped: Compact: Subdivision Not Accepted I PUBLI<'>IMPR<:>VEMENTS I Street Improvements: . Sidewalk Type' Fully Improved 1\1' 0 qQn law requires YOlCu)-bside 7' Storm Sewer Available: Yes ATTE~~nS~88r~~ffl"\YjI~i1e Ore,.,('Jjj1riita'iilt Gutter Special Instruction: Storm water to curb via weep hole/Drh,eway apflr\\~~'Rb~ell'n{~~PRj"/l~!l(hj'lmlat'Mlf(;~AAion NOTICE: by Ken Vogeney Notlflca Ion 01 0010 through OAR 952-001- Notes: THIS PERMIT SHALL EXPIRE IFTHE WORK In ~~R .J:;~ay -obtain copies 01 the rules by AUTHORIZED UNDER THIS PERMIT IS NOT OOCaliing the center. (Not~:.r; ~e~~~~:'~n COMMENCED ORIS ABANDONED FOR number for the orego~I2344) ANY 180 DAY PERIOD.' Center 18 HIO - . Page I of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01660 ISSUED: 11120/2009 APPLIED: 11/17/2009 EXPIRES: OS/20/2010 VALUE: $ 174,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Oescrintion I 'j Estimate Estimate $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 174,000.00 Value Date Calculated Descril>tion Tvpe of Construction Total Value of Project $174,000.00 $174,000.00 ' 11/17/2009 ~ Fee Description Amount Paid Date Paid Receipt Number + 12% State Surcharge $208.55 11/20109 1200900000000001275 +5% Technology Fee $104.75 11120/09 1200900000000001275 1st Appliance $79.00 11/20/09 1200900000000001275 2 Baths One or Two Family $337.00 11120/09 1200900000000001275 Addressing Assignment $38.00 11120/09 1200900000000001275 Appliance Vent $9.00 11/20/09 1200900000000001275 Bnilding Permit $1,009.93 , 11/20/09 1200900000000001275 Credit - Trans Improv SDC $-931.65 11/20/09 1200900000000001275 Cnrbcnt Permit $88.00 11/20/09 1200900000000001275 Dryer Vent $9.00 11120/09 1200900000000001275 Exhanst Hoods $13.00 11/20/09 1200900000000001275 Fire SF Fee - Residential $77.40 11120/09 1200900000000001275 Gas Ontlets 1-4 $7.00 11/20/09 1200900000000001275 Plan Review Major - Planning $211.00 11120/09 1200900000000001275 Plan Review Same As $250.00 11/20/09 1200900000000001275 PW Disc - 2nd Permit $-30.00 11120/09 1200900000000001275 Residence Wiring 1000 Sq Ft $134.00 11/20/09 1200900000000001275 Residence Wiring Ea Addtl500 $50.00 11/20/09 1200900000000001275 Sanitall' Sewer - Improvem~nt $507.07 11120/09 1200900000000001275 Sanitary Sewer - Reimbursement $666.84 11/20/09 1200900000000001275 SDC MWMC Administration $10.00 11/20/09 1200900000000001275 SDC MWMC Improvement $1,044.54 11/20/09 1200900000000001275 SDC MWMC Reimbnrsement $101.97 11120/09 1200900000000001275 SDC Sanitary/Storm Admin $149.38 11/20/09 1200900000000001275 SDC Tran Reimburs-Residential $211.21 11/20/09 1200900000000001275 SDC Trans Improvement-Resident $931.65 11120/09 1200900000000001275 SDC Transportation Admin $16.23 11120/09 1200900000000001275 Sidewalk Permit $88.00 11/20/09 1200900000000001275 Storm Drainage Impervions^rea $770.55 11/20/09 1200900000000001275 Temp Power 200 amps or less $63.00 11120/09 1200900000000001275 Vent Fan $27.00 11120/09 1200900000000001275 Willamlllane Single Family $2,858.00 11/20/09 1200900000000001275 Total Amount Paid $9,109.42 Page 2 of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01660 ISSUED: 11/20/2009 APPLIED: 11/17/2009 EXPIRES: OS/20/2010 VALUE: $ 174,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 5~ 1-726-3676 Fax 541-726-3769 Inspection Line man nine: Review 11/17/2009 Plan Reviews , 11117/2009 APP nDK Public Works Review Structural Review 11/17/2009 11/1712009 11/17/2009 APP 11117/2009 APP LKW KLK Access restricted to 1 driveway/lot. I Streei tree on Mica and 2 street trees on 58th Street. Follow Street tree plan. Storm water to curb via weep hole To Request an inspection call the 24 hour recording at 726-3769. All inspections 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. l...P-eollirerUnsnections I Site Inspection: To be made after excavation but prior to setting forms. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to tloor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with linish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and IiUer cloth is installed but prior to backfill. Undertloor Plumbing: Prior to insulation or decking. Underlloor Drain: Prior to cover or placement of concrete. Rongh Plumbing: Prior to cover and including required testing. Water Line: Prior to tilling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including reqnired testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Page 3 of 4 :, CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2009-01660 ISSUED: 11/20/2009 APPLIED: 11/17/2009 EXPIRES: OS/20/2010 VALUE: $ 174,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phonc 541-726-3676 Fax 541-726-3769 Inspection Line Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance inchiding required testing. Presure test done at this poin\. Rough Mechanical:' Prior to Cover Final Mechanical: When all mechanical work is complete. Temporllry Electric: Approval reqnired prior to Utility Company energizirg pole. Rough Electric: Prior to Covcr Electric Service: A~proval required prior to utility company energizing service. Final Electric: When all electrical work is complete. . ' Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. I' Corbcut - Standard: After forms are erected bnt prior to placement of concrete. 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 Springtield 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. - ~D//~ Owner or Contractors Sign~:~ II-cJo- 131 Date Page 4 of4 This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within i80 days of issuance or if work is suspended for 180 days. 1~"'iE0e-p:H""'Ge~ERN'MENiltt;\'A'ReR0V7A@"'l"''''"@;'''~1 ~~___"_",,,""'_~~~_.'"_'"__OJ~,-,,-__,__ ___~_,_~~_)I!-,"._L.._~..:L,~._~~lQ~-,_Wf.~' I Zoning approval verified? 0 Yes 0 No I 1~'Il[<;;~:liE;'<3~0RY&.0.J;ljfg;~0N$.iTIRl!)P-,i]LQM.~~.\'liA~1 I 0.Residential ' I o Govemment " ~rnmercial, ,I i~~~~:;:~l[E~~~;:~~:l~R$~Ii~B~W;r;IQN~l I City:'iY"'0-C'rioi ,I State: oK I ZIP:'17'-178' I ~~~~:;~~~wJ~~~i~~~J I Ho..h'c IM're /;;;",(/.. I I /Bol.Os33 045(50 I Ir~~~-'j[.'*.r~P.R0RERlliF0WNER"\"'!'1'1i'~\\':'?'~~i:;,,,,,,,",,~1 ~';'t~~~-;."~....t",,,,_k,__ ~R.___ "_"__'Z.:~__"_=____'_ :;r,ff~~~l"1~%'~_~1..~&;l I }jame: l-l.'-/Ju"\ Kevr.t' <.. I I Address: .JL;CG( Sw (.,(c..ri"- I I City: Q ",0( V"'lcv> <-1 I State: 6 R I ZIP: 'i'775'G. I I-Photie: 5'/1- 2?~- .0'1:>5 . I Fax:S>/I- 7</1- ,;J57;? , I I E-mail:' I This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: ~G:(,)Nm.~GmQRIINSJl1lXm@'8'J1i,QN~~-ilj~Jfi;W!fil I Business name: "Tor \\\;~(~ F' pC I I Address: ..)O~ 7'1 (OVi?<1 C +- I I City: &. ",0\ I State: 6R I ZIP: I Pho~e:5',,-311-{11'i? I Fax: I E-mail: I CCB license no.: [-p.3CjG I BCp lic~ns..e no.: ( .;l2()_ I Signing supervisor's license no.: 'L/;JJj-j(;i,; /..t'n~ I Print name of signing supervisor: 'v('('Y c;-/i i'CK Ie I Sr ,I Signature of signing supervisor: Electrical Permit Application . D 225 Fifth Street. Springfield, OR 97477.PH(541)726-375H FAX(541)726-3689 ~~.O' ~~~ ~\Y' ~ ~~, 440-2584-J (9/08/COM) ~';:t''::':';';'~i>'.' ~;:,\" '1;.;.~I';''-''''.t;~-'.'.>~'"'''(~:>'';.~_A~.~~-*,_:,~j~:~~<~' ,,,mpr;pARl'MEN'f4US'SNIhY." o~ _.,~_._".._~.;,,",...,..,.-- -.;- '1;.ll_;;;::t't.f'!;;'~'.'1;:t~*';~H'<;~"1- I p~~Z069-0'b60' I Date: /(//7/0 C, SPRINGI"IELD . ~ ! ~... ;..;;.,"-~~ t.1;:b ~~ I $134.00 I $/3 Y Z $ 25.00 I $$01 Limited energy (2) $ 32.00 $ I I Each manufactured home or modular I dwelling service or feeder (2) $ 63.00 $ 1 Services or feeders: installation, alteration, relocation I. ,I 200 amps or less (2) $ 81.00 $ I [ 201 to 400 amps (2) $ 95.00 $ I I 401 to 600 amps (2) $158.00 $ I I 601 to 1,000 amps (2) $205.00 $ I lOver 1.000 amps or volts (2) $469.00 $ I I Recunnect only (21- I $ 63.00 $ I .1 Temporary services or [eeders: installation, alteration, relocation . J I 200 amps or less (2) / $ 63,00 $ b3 I 20i to 400 amps (2) $ 87.00 $ I 40 I to 600 amps (2) $126.00 $ lOver ,600 amps or 1,000 volts, see services or feeders section above I Br-anch circuits: new, alteration, extension per panel I a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit I $ 6.00 I $ b. Fee for branch circuits 'without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ $ 6.00 $ I Miscellaneous fees: service or feeder not included I Each pump or irrigation circle (2) $ 63.00 I Each sign or outline lighting (2) $ 63.00 Signal circuit or a limited-energy panel, alteration, or extension (2) $ $ $ 63.00 $ Eacb additional inspection: (I) I $58.00 $ ~1'ili":;;'~Jffi"F[I!j'GANf.Jf(ijSEl\\;~1r~~""-l:1if)\1 ~,:""",-,_ , . .~_g._b_____~.__."-'_'~.'--"'_'___.'_"'-~" . ., ~,~'.~ (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Enter 12% surcharge (.12 x [AD (C) Technology Fee (5% of lAD TOTAL fees and surcharges (A through C): $ 247 $d?( t1:? L-( $;;)"-';;5 $..;.0!;~r-'l~ SA ME M.. 577'-1 c. 7- {$; II Structural Permit Application , 225 Fifth Street. Springfield, OR 97477. PH(541)726-J75J . FAX(541)726-J689 ord\\'c{. SPRINGFlEL.O !~;.t-:;;;",';''''''. ~~if~~'g5~J~ ' I' DEPARTMENT USE ONLY I (0""1 ZOO 1- 0''''0 Pennit no.: / ," . . , . I Date 1117/0 <7 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days ofissuand or if work is suspended for 180 days. I:" " , .,; >J.b0CA(Gi;)}iER~M~Ni;:t.:~~R'dYAU~;;; I This Project has finalland~use approval. I Signature: Date: I This project has DEQ approval.. I Signature: . Date: I Zoning approval verified: O-Yes 0 No 1 Property is within flood plain: 0 Yes 0 Nn lr;;i;i";~i;:/~;(Z;;f!i'cAiEGORY!;0i=;'c0NsiliRucifI6Nil!;:.;"",.;: ",:.';.:"".",'",., (~~;~'~i~':~.~;'~;.(."" ,,' ""'-"""'j" ~D-;~~~~~~';~t"""" ,.~.. ,-, ..( 'D"~::-;:'r~';:-]- l1\i".";;';:i:1.J9'B:,'slt~'f r;fi;0RMAf,[QN(p;Ni~,;:;ei:lC5Afi9N;;jg;;:j;;iWJ" 1 Job site address: .57'1<) ,(11",,- _ I City ,.5fll''''f\(I..lrA 1 State. oR I ZIP 'f7<{7'l 1 Subd,vrsJOn -;'\"'~D<< M("~c..J c:. 1 Lot no ../96. I 1 Reference /80t.D'33.31 Taxlot. D'-/Scx:::, I I, ," PROPERTY,OWNER> ' , 'I 1 Name: H~l!v1 J.loWU"<:' - j Addre~ ~/..{ Sw ~( I City: .RftlI'Yj6~ol ' I State: 0(( . I ZIP:Q775'(" I ---,- Phone: -;;l;It- &1'3~ I Fax: '-7'1/- 257;) I I E-mail: _ J This installation is being made on residential or farm property ,owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. I State: Fax: , ZIP: ;;;!:;:;'i::,1-'i';~j I I I j I j I 1 I I 1 Type of Heat: (":A-~ I .. Energy Path: ;). iT - l.:.8new 0 alteration ' 0 addition r (b) Foundation.-only permit? -0 Yes 'Qi! No I , Total valuation; I' $ /70/ I::: ; 1(~2.iiB.ijU4Ipgjt,,~s);1:~;5i~'fH~,~;n&0;j'j,~ii"!':f,:i:;:'" ,'Zi~,.,:}i:~: ',:;,'! I (a).Permit fee(use.valuation table): '. -- "', ;. ',' ! 1 (b) Invesdgat>ve fee (equal to [2a]): . $ I (c) Reinspection ($ . 'per hour): j -(number of hours x fee per hour) $ " Cd) Enter 12% surcharge (.12 x [2a+2b+2c]): $ I 1 (e) Subtotal of fees above(2a through 2d): $, I . :~~~;~~:~:~:~'~~:~;:~:;:~ft1~!:~~;;~~;;~r{;~24~~l 1 (b) Fire and life safety (40% x'permit fee [2a]): I' $$ i .1 (c)Subtotal ufrees above (3:; and 3b): I INjiMis'celia;;~W~,fi~~Yi[;;'G';~;(~';';;;:';::'\;' - " ."'.'.. "1 JI (~) ~ei;mic fc~, I%(~IX ~~rmi;f~~ [2a]) $1 ~ I TOTAL fees and surcharges (2e+3c+4a): $ j I I I I~>. "FEE'SCHEDiJLf' ':i.:V.al(iMi6~r;n fdrm~iioo:::;;;(,: iJ&~:.; (a) Job description: 5t... ",Iff ~ i Iv Occupancy e. 3/ vi.. Vii' 1/1-1'6 f tltJeJ tY..ma,'_ '-0 " I Construction type: Square feet: Cost per square foot: Other infonnation: Sign here: I Business name: llo...vd.t.II\ I Address: <filM\:::' , " 1 City: "I Phone: I E-mail: I ces license no.: . I Print name: ! Signature: ,'"CONTRAC'L9R:i,~,~jJ;At,LA:n9T'J,i::. l~oNV'" 111i'~;;;:V\)O;i~i{StlEj'c:o NmR6c,tPRJNF,'QRri1;ti.;i:IQN~'i'1'Yf,%~p;~\i;f1i::j I Name I eeB License Number I Phone Number [ I Electr;cal I D').,)&& :<n-Fiwt I '(oplJdcV\ I Plumbing 161 7'-17 "1)'6'- Ii~ 4;L J 5Ivt2"""'-I-'\. I Mecbanical 34.::rz,1 i (07}--15"IO, ~ A,'(. ' ----- ~~wmamalane ,t Park & Recreation District Job. No. 0,~ - \\o\J'J SYSTEM DEVELOPMENT CHARGE WORKSHEET FOR 2009 h'_h~'"'' ~--_.C- NAME:~.~~'~h\~ y }:\(~'PHONE: Q/l~--loC1.g,S.- ADDRESS:A4 \0 4'771<.> r;'(~ ((Q~\Atln,1,Qtlw:~50 LOCATION OF PROPOSED BUILDING SITE: Street Address: 5\ q S "'^- ~. 0 ~ " , , Plat Name:~fX'" k\fCL _ Tax Lot Number: B(")A. () a~~CA 3C:P 1. DEVEL~~~PE (Check appropriate dwelling(s). Dwelling type definitions are on the back.) A. Sinale-Familv Detached NO. OF UNITS \ X $2,858 per unit = $ !2.Y3Ef3CfJ B. Sinale-Familv Attached NO. OF UNITS X $3,100 per unit = $ C. Multi-Familv Aoartment NO. OF UNITS X $2,641 per unit = $ D. Sinale Room Occuoancv NO. OF UNITS X $1,321 per unit = $ E. p.,ccessorv Dwellina Unit NO, OF UNITS X $1,550 per unit = $ 'B C:x:J $ t 6~.. if $ 2.8~~ $ WILLAMALANE SDC , _ 2._SDC_CREDlI(lfapplicable),SDCpayermustfumish proof of, , Willamalane Credit approval.) h 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit). o..~~~S~~ City of Springfield / / Date, 5 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone .'~'~-~!~~~'"''''~',''' 'I~,.."",.". -1 " : .-;:C., ' , .'.' --"- ......"",.- .....' City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-01660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 COM2009-0 1660 Payments: Type of-Payment CreditCard cRcceintl RECEIPT #: 1200900000000001275 Date: 11/20/2009 Description Plan Review Same As Building Permit Addressing Assignment Willamalane Single Family 2 Baths One or Two Family 1st Appliance Vent Fan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Fire SF Fee - Residential Plan Review Major - Planning Credit -Trans Improv SDC PW Disc - 2nd Permit Curbcut Permit Sidewalk Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Tran Reimburs-Residential SDC Trans Improvement-Resident SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transportation Admin + 5% Technology Fee + 12% State Surcharge .' Paid By HA YDEN HOMES Item Total: Check Number Authorization R~ceived By Batch Number Number How Received njm 046092 In Person Payment Total: Page 1 of I 8:54:52AM Amount Due 250.00 1,009.93 38.00 2,858.00 337.00 79.00 27,00 9.00 13.00 9.00 7.00 134.00 50.00 63.00 77.40 211.00 (931.65) . (30.00) 88.00 88.00 770.55 666.84 507.07 211.21 931.65 101.97 1,044.54 10.00 149.38 16.23 104.75 208.55 $9,109.42 Amount Paid $9,109.42 $9,109.42 11/20/2009