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Home My WebLink AboutPermit Building 2006-6-30 , CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00666 ISSUED: 06/30/2006 APPLIED: 06/0112006 EXPIRES: 12/3012006 VALUE.: $ 196,954.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2360 Clear Vue Ln ASSESSOR'S PARCEL NO.: CLEAR VUE ESTATES S Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION: Single Family Residence, Lot 16 Clear Vue Estates Owner: PHILLIP SHELLEY Address: 1021 WEST N STREET SPRINGFIELD OR 97477 Residential Phone Number: 541-746-2235 REQUIRED PARKING Overlay Dist: Total: 2 # Street Trees Rqd: 2 Handicapped: Paved Drive R9.~lnCE' Yes E If_weRK % of Lot Cov~~!iflgtl: PERM\! S\-\~iilfuXPIR ERMli IS NOi 1\-\\~ UNDER 1\-\IS P .^ \ ITHORIZED n ',:) M~~t\\ll()NED FOR I PUBLIC IMPROVEJ9IE~liii~Ct~ ~ERIOD, AN'! IOU DAI . F II I d Sidewalk Type: u y mprove Yes Contractor Type General Electrical Mechanical Plumbing I CONTRACTOR INFORMATION I. S ,/OU to C'..r'. laW requIre Utili\,! Contractor _ -~',-:::" ,. cre~ Llf~u~sore~'1r~f{W Date REGAL HOMES BY SHELLEY y ':' 1/:\OplGr~8o~J rules are S~2~O~ff)08 BA TEMAN ELECTRIC INC , ' ~ 311teC f?~~Mu91l O,L\R 9'O()4~'tijJ08 CRYSTAL CLEAN AIR INC '_ j'\ ,0019,6~h~pies ot tile rO~~W~2007 DONALD CLEWIS \ ,y,-,\j obt~3Q~~,te: tile tele,ro)2wa\007 BUILDING INFORMAiION'11I \Jti\i~i~~~)':'-' .,~' 'v' ", 1_~UQ~332. # of Sto~ies: C8n'C:~r IS 1 Lot Size: Height of Structure 18.00 Sq Ft 1st Floor: Type of Heat: orced Air Electric Sq Ft 2nd Floor: Water Type: Gas Sq Ft Basement: Range Type: Electric Sq Ft Garage/Carport Energy Path: Path 1 Sq Ft Other: Sprinkled Building: n/a Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB 3 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 25.00 12.00 10.00 32.00 15.00 Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: " '. Downspouts/Drains: Phone 541 998-3897 541-998-7187 541-484.2286 541-688-1931 1,790 484 Curbside 5' Curb and Gutter Notes: No hook-up to City infrastructure until Public Improvement accepted by the City; storm drainage piped to curb face 6/5/06 CAS Pal.!e 1 of 4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction AC - Residential V Wood Frame Garal!e A.C. - Residen Dwellinl!s Garal!e Fee Description Plan Review Residential ~Mechanical Issuance Fee~ + 10% Administrative Fee + 8% State Surcharge 2 Baths One or Two Family Addressing Assignment Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Fire SF Fee - Residential Furnace - up to 100,000 btu Gas Fireplace Gas Outlets 1-4 Heat Pump Plan Review Major - Planning PW Disc - 2nd Permit (Street) Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 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 Sidewalk Permit Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan Willamalane Single Family I Valuation Descriotion I $ Per Sq Ft or multiplier $4.00 $99.00 $26.00 Square Footage or Bid Amount 1,790.00 1,790.00 484.00 Total Value of Project ~ Amount Paid $572.59 $10.00 $153.76 $113.91 $254.00 $31.00 $880.90 $80.00 $6.00 $9.00 $113.70 $12.00 $15.00 $4.00 $12.00 $198.00 $-30.00 $106.00 $57.00 $495.82 $651.82 $10.00 $865.31 $82.03 $149.12 $63.75 $805.70 $182.69 $80.00 $1,164.09 $50.00 $18.00 $1,000.00 Date Paid 6/1/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 6/30/06 Pal.!e 2 of 4 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2006-00666 ISSUED: 06/30/2006 APPLIED: 06/0112006 EXPIRES: 12/30/2006 VALUE: $ 196,954.00 Value Date Calculated $7,160.00 $177,210.00 $12,584.00 $196,954.00 06/01/2006 06/01/2006 06/01/2006 Receipt Number 1200600000000000767 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 1200600000000001006 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2006-00666 ISSUED: 06/30/2006 APPLIED: 06/01/2006 EXPIRES: 12/30/2006 VALUE: $ 196,954.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Amount Paid $8,217.19 I Plan Reviews I Initial Review 06/0112006 06/01/2006 APP LLH Planninl.! Review 06/01/2006 06/26/2006 APP TAJ Public Works Review 06/01/2006 06/05/2006 APP CAS No hook-up to City infrastructure until Public Improvements accepted by the City; Storm drainage piped t( curb face 6/5/06 CAS Structural Review 06/01/2006 06/13/2006 OK RJB 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. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Curbcut - Standard: After forms are erected but prior to placement of concrete. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Vfer 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 floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish 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. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building is complete. Vnderfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Paee 3 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00666 ISSUED: 06/30/2006 APPLIED: 06/01/2006 EXPIRES: 12/3012006 VALUE: $ 196,954.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. 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 including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. 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 ring construction. 6.-3~.-tJ6 Owner or contrfors Signature Date Pal.!e 4 of 4 225 FIFTH STREET. SPRIN\si'u!..LD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELE\...l.KlCAL PERMIT APPLICATION City Job Number ~.t~ \~ Date _.,..",...,-=:;y.~'':' ,~:~. T" .~""';lc' ,'=..-'c"', ., -................' ,.-.-.~-' ".. -.'--,- A. ~ New-Resul~lrtial::singI~~fMiilii-Familyc:perdwelling unit.. ~';., :.~~-.::.o,;.~i...~--:..._~o.:..;..'- .~...___~.~ ~_:~ . "~.....'l',.;:_,.:"'._~;;""::''''''::: _'__.. .- .,-.;'"", ..Mi. _..:.,_..../c.:;. ~.~ .... ,_. Service Included JOB DESCRIPTION 1000 sq. ft. or less ~ ~. .'. ~~" . \..n€1\ ~ch additional 500 sq. ft. or ~ )~~ ~tD~ ~.\~~OOfu~f P~D-traDSferabl. ODd Ire ifwo,"" Is Each ManufiIct'd Home or not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder 2:co~Crojaiw~~ B. '~W!~';;~~W]J;;,;;;~'\i,:~...ti~,;;c~~Rcl~~~ti.~, ~I.:':I~':"': "P';','-~;j'j;::'!::rk"c! tiGoo::::'>-'~ ,"-~ ..... ->-V;~Ilo-'" - , X\", 201 Amps to 400 Amps '''; ~'$"'~.:j~.rth I ". '..-"). \ \ ~ :T.OO' Address" ~_ ~t I C) \ U \(Y".O')',-,~,,\ ...... 4?1 Amps to 600 Amps v l ,:' ',': ~--, ,,' ,,'\ s~~ (t , . 6Qk,&nPsto,IOOO.Anlps-jil Co,~;85 0\ trler~t63~~ c;J UnC -\1 0 y\ (j' -<{Phone ~q 9- - 4ii ~ Ov<>tM1OO~3f. (Neie: "tile lele~iS~'i'5:oo \..J RecMJl~~J~r tne Oregon Utility \\lulI.lCflStP.& 1') Db! __ c ,'<:. ''''c"C'Mnt~r,i.~1:;,89,Q=9.~2,-.2.34,~).,_.::,"." ~ Ib' ~ c. T.~p'~r~ft.s..~T~!!~~!'~j~it~~:ib~;""~.'~(;'J~~:~'- .' ID-\-bL? Signature of Supervising Electrician -.. '.,.~,_. ,,'.J /. ~ r New Alteration or Extension Per Panel ,/jA//L#~ (~/-a>~ ~Vl\hit. $43.00 sItklis:~m~~f~XA~tt~IRE IF THE WGfOt} OwnersName ~L ~~\\tu AI.lIHD.RllED~UNDfRJHIS PEBtv1IIl~,_NOT._ ,,--' Address \n4L\ V"). t() ~Pt' r . E. OO~~~(~~~~a~ -EacliinstalIation City~t\rvl.a/)In. Phone ~lo. '1.!l.SS,',' P&n;'YoJ~J~~h PERIOD.' . . - - $ ~0.~0' .,- . .- ~ Sign/Outline Lighting $ 50.00 OWNER INST ALLA TION Limited EnergylResidential $ 25.00 The installation is being made 00 property I own which Limited Eoergy!G"'.,..,ercial $ 45.00 is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 1. LOCATIONOFiNsTA~iT;i/niiijX;:::;'..:---; rL'b\-QO-'. '~~~-\tUi;~"" LEGAL DESCRIPTION ~ A$S\~~ Supervisor License Number Expiration Date Constr. Contr. Number \ C:; \ 0\ '\ I /'{, .--'1 t _ () 0" , \C} 6--'; 1- t.', Expiration Date Owners Signature: Inspection Request: 726-3769 SPRINOFtS1.D ~~f:~~~:;~~!,Jr~".':'\ ,,..:;-.."-';,,,,,!.',..'~ &.~. "J '.;l~~ ~JU ;'_.....: ~;~~.:'y,~'!',~t~'!i~~~~..,~"'r~-'~'..~;~-.,.~~"~"""::..'^. --i-::'~~'-''''''~''~''' '~~'~.' --::~. . ~-~- :':' 3.;gOlJ1!!:.f!5J,,!.1.f1gt~'i:!!!,~_'Jq9!~Eo.if.L:--'- '..' -,,-.'.' .. .._,~::.: j \ ~ ~~ f!J ~'} $106.00 $ 19.00 $50.00 'i InstaUation, Alteration or Relocation 200 Amps or less \ 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1 000 Volts see "B" above. --,-,". ...- - '-'.- . "'- ~'. --"<...._-_.~ D. Branc.hCireuitS'; .' : ' fJ){IJ $ 50.00 $ 69.00 $100.00 .- --,~.-.'.., ~- .' . - - .' . .__....,--:''''...._.~. . ." ..~ .. "'"Z;~" -'-~,"-::--,,:r-,-'_ 4. s(JBTO'.l'AL QFilBOVE ': ',~. -., '. i . - ,:',.. ' .~__."i *,~1.....: _.. ..,:-.....:.......:. ....:.._"--,~(~#.~ .;o.:.~...~.~ 2/1 J 7 oc.j ZI '30 ?SJ ~ 7% State Surcharge 10% Administrative Fee TOTAL ,.... ... ~ ., ~:_ _ r.___1'C'1....--:.....1 D~;t A"ftlil"~rinn l-03.doc CITY OF ~_INGFIELD SYSTEMS DEVELOPMErf1'wORKSHEET JOURNAL OR JOB NUMBER: COM2006-00666 NAME OR COMPANY: Regal Homes LOCATION: '2360 Clear Vue TAX LOT NUMBER: ' Clear Vue Sub Lot 16 DEVELOPMENT TYPE: ' SINGLE FAMILY RESIDENCE NEW DWELLIN;; UNITS I BUlLDINGSIZE (SF' 2324 LOT SIZE (SF): I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I 3604.00 , I $0.323 = $1,164.09 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. I x COST PER S.F. x I DISCOUNT RATE I 0.00 I $0.323 I 50% = j ITEM 1 TOTAL - STORM DRAINAGE SDC I $1,164.09 8395 r/J i:I..1 Cl o u ~ i:I..1 E-< r/J ....... o ~ DISCOUNT $0,00 $1,164.09 1070 2, SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I 26 I B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 261 COST PER DFU $25.07 $651.82 1091 $19.07 $495.82 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =, $1,147.64 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x I NUMBER OF UNITS x I COST PER TRIP x NEW TRIP FACTORI I 9.57 I I I $19.09 1.00 I I' $182.69 1093 B. IMPROVEMENT COST: I ADT TRIP RATE x I NUMBER OF UNITS x I. COST PER TRIP x I NEW TRIP FACTOR I 9.57 I I I' $84. 19 I 1.00 $805.70 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = , $988.39 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's x COST PER FEU I I $82.03 = $82.03 1054 B. IMPROVEMENT COST: INUMBER OF FEU's x ICOSTPER FEU 1 I I $865.31 = $865.31 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMINlSTRA TIVE FEE $10.00 1056 ITEM 4 TOTAL -MWMC SANITARY SEWER SDC = , $957.34 .. SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $4,257.46 5. ADMINISTRATIVE FEE: /SUBTOTAL x I ADM, FEE RATE CHARGE I $4,257.46 I 5% $212.87 TOTAL SANITARY ADMINISTRATION FEE: 149.12 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $63.75 1078 ..... . Cheryl Slaymaker 6/5/2006 TOTAL SDC CHARGES =, $4,470.33 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUrv ALENT ~ DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBA THTUB 2 0 3 = 6 IDRJNKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER/MOP SINK 1 0 3 = 3 ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3 ISHOWER, SINGLE STALL 1 0 2 = 2 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 I SINK: WASH BASIN/DOUBLE LA V A TORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 3 0 1 = 3 IURINAL, STALL / WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET~ PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDD'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 26 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDIT RATE/$I,OOO ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 2 BEFORE 1979 $5.29 (Enter 1 for Yes, 2 for No) 1979 $5.29 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2 1980 $5.19 (Enter 1 for Yes, 2 for No) 1981 $5.12 BASE YEAR 1979 1982 $4.98 1983 $4,80 CREDIT FOR LAND (IF APPLICABLE) 1984 $4.63 VALUE / 1000 CREDIT RATE 1985 $4.40 $0.00 x $5.29 = , $0.00 1986 $4.07 1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) 1988 $3.22 VALUE / 1000 CREDIT RATE 1989 $2.73 $0.00 x $5.29 = I 0 1990 $2.25 1991 $1.80 1992 $1.59 TOTAL MWMC CREDIT = $0.00 1993 $1.45 1994 $1.25 1995 $1,09 1996 $0.92 1997 $0.72 1998 $0.48 1999 $0.28 2000 $0.09 ,. 2001 $0,05 225 Fifth Street. Springfield.. Oregon 97477 541-726-3759 Phone y of Springfield Official Receipt vevelopment Services Department Public Works Department Job/Journal Number COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 ' COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 COM2006-00666 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200600000000001006 Date: 06/30/2006 Description Addressing Assignment Willamalane Single Family Residence Wiring 1000 Sq Ft Temp Power 200 amps or less Fire SF Fee - Residential Curbcut Permit Sidewalk Permit PW Disc - 2nd Permit (Street) 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 Building Permit 2 Baths One or Two Family Furnace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace Heat Pump ~Mechanical Issuance Fee- Plan Review Major - Planning Residence Wiring Ea Addtl 500 + 8% State Surcharge + 10% Administrative Fee Paid By DOUGLAS SHELLEY Item Total: Check Number Authorization Received By Batch Number Number How Received djb 198417 In Person Payment Total: Page I of I 3:14:04PM Amount Due 31.00 1,000.00 106.00 50.00 113.70 80.00 80.00 (30.00) 1,164.09 651.82 495.82 182.69 805.70 82.03 865.31 10.00 149.12 63.75 880.90 254.00 12.00 18.00 9.00 6.00 4.00 15.00 12.00 10.00 198.00 57.00 113.91 153.76 $7,644.60 Amount Paid $7,644.60 $7,644.60 6/30/2006