HomeMy WebLinkAboutPermit Building 2006-7-14 (2)
_.CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2006-00758
ISSUED: 07/14/2006
APPLIED: 06/20/2006
EXPIRES: 01114/2007
VALUE: $ 133,284.00
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. Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4590 Daisy St
ASSESSOR'S PARCEL NO.: 1702324309600
TYPE OF WORK: Single Family Residence
I
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Andrews Acres lot 3
Residential
# of Units: 1 # of Stories: 1
, Primary Occupancy Group: R-3 Height of Structure 16.50
Secondary Occupancy Group: U Type of Heat: orced Air Electric
Primary Construction Type .. VN Water Type: _ Electric
-- -
Secondary Construction Type: . Range Type: Electric
# of Bedrooms: 3 Energy Path~l ' Path 1
,
ATTENTION: n,,::,ro,....~ ,. Sprinkled Building: n/a
j\:~::~~~/UIC~ adOpted by-thi;OEYEEQPMENT INFORMATION I
, l, L..<.:! Ion Center Th '~~""'Y
'~l (:~\n ?>2-001-00'1 0 t~r.~e rules are set forth . ,
Frontyard Setbac,k:l.nJ m','y bt ' l1.00Jgh OAR 90~elil,ay Dlst: ,
" 0 am ~ ~ , . v Vv 1- 4
Side 1 Setback:; }" !~) the center (~~;ooes of the n!1/~~r~}L Trees Rqd:
Side 2 Setba~~,:ltniJ; j for th ' 8100: the te/ep~~rr~(J urive Rqd: : Yes
Rearyard Setback: C,.., t ~ Oreg(}I1I.OO.ility Notific?7o, of Lot Coverage:i NOTlC~~.70
Solar Setbacks: uil er IS 1-80CO~0.02-2344) cHlon .': THIS PERMIT SH
. .\1 , AI t !:vnlnr-...._I
I PUBLIC IMPROVEME~TS 12~~~UE~~~D UNDER THIS' PE'RM;YCI~v~;;
:, ANY SidewalkOT9.~e!S ABANDONED F,DQ .
Fully Improved J I uv Uf\Y ~f:RIOD (5i1tbslde 5'
Yes 'Downspouts/Drains: Curb and Gutter
Owner: MIKE BLANKENSHIP
Address: 8063 THURSTON ROAD
SPRINGFIELD OR 97478
I. CONTRACTOR INFORMATION I
Contractor Type
General
Mechanical
Plumbing
Contractor
MIKE BLANKENSHIP CORP
JUNG ENTERPRISES INC
DOUGS PLUMBING INC
License
78966
102455
110163
BUILDING INFORMATION I
Subdivision Not Accepted
Street Improvements:
Storm Sewer Available:
Special Instruction:
..
Notes: No connection to Sanitary/Storm Sewer until Council acceptance of project
Pae:e 1 of 4
Phone Number: 541-747-0145
Expiration Date
01/09/2008
10/04/2006
11/24/2007
Phone
541-912-4582
541-937-2688
541-688-3385
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
5,219
1,236
420
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
,
_~"'i~N,g!lI~~' " "
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Dwellines
Garaee
V Wood Frame
Garaee
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
Heat Pump
Plan Review Major - Planning
PW Disc - 2nd Permit (Street)
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Admin
SDC Transpo I~provement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
Total Amount Paid
.
I Valuation Descri~tion I
$ Per Sq Ft
or multiplier
$99;00
$26.00
Square Footage
or Bid Amount
1,236.00
420.00
Total Value of Project
~
Amount Paid
Date Paid
$439.50
$10.00
$112.00
$82.97
$254.00
$31.00
$676.15
$80.00
$6.00
$9.00
$82.80
$12.00
$12.00
$198.00
$-30.00
$381.40
$501.40
$10.00
$865.31
$82.03
$116.09
$66.92
$805.70
$182.69
$80.00
$831.64
$50.00
$18.00
$1,000.00
6/20/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
7/14/06
$6,966.60
Paee 2 of 4
.CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00758
ISSUED: 07/14/2006
APPLIED: 06/20/2006
EXPIRES: 01114/2007
VALUE: $ 133,284.00
Value
Date Calculated
$122,364.00
$10,920.00
$133,284.00
06/20/2006
06/20/2006
.
Receipt Number
1200600000000000915
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
1200600000000001070
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.CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2006-00758
ISSUED: 07/14/2006
APPLIED: 06/20/2006
EXPIRES: 01/14/2007
VALUE: $ 133,284.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review
Planninl! Review
06/22/2006
06/23/2006
I Plan Reviews I .
06/23/2006 APP
07/12/2006 APP
LLH
TAJ
Existing Street trees may be counted
for the required street trees
Public Works Review
Structural Review
06/23/2006
06/23/2006
07/06/2006
07/05/2006
APP
OK
JAP
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.
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 req~ired testing.
Water Line: Prior to filling trench and including required testing.
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.
Underfloor Mechanical. Prior to insulation or decking and including required testing.
Rough Mechanical: Prior to Cover
Pae:e 3 of 4
.
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.'
.CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2006-00758
ISSUED: 07/14/2006
APPLIED: 06/20/2006
EXPIRES: 01114/2007
VALUE: $ 133,284.00
Status
Issued
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.
Curbcut - Standard: After forms are erected but prior to placement of concrete.
Sidewalk - Curbside: After forms are erected but 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made ofany 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 tha II required inspections are requested at the proper time, that each address is readable from the
street, that the permit car is ocated at the front of the property, and the approved set of plans will remain on the site at all
times during constr
7/rr/b
I
Date
Owner or Contractors Signature
Pae:e 4 of 4
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. ZON . L.,lX-
INITIALS. I\J M.
DATE 1-1 y..-~
SOURC~fQ \ 5
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number I"'CJ.-... 7~ -(J)? sg
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1. ,~i.l:,PS1Ilg~qfJ/X~TN1J1!JJ!.9lfe~~\g:1~:~tsR?~~~
LEGAL DESCRIPTION 11 D~ 3~ 430'1bOo
. t/s1,l) 'PA'~ y . .
JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
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~"CONTRA.'CTOR'INSTALEATION<() . LY,\';
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Electrical Contractor
Address
/
~ne
City
Date
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3. I<JJQll,!PLET,E-FE,EBQHE,DpLE.B :LQI1.:"J'<'?;:,; .,'.<.'c;,N;K~o.:",:: ~\1
ll'....:...'!:;.~~w.:t..~f...'!!.7:: ~_.;.<~ .~.,:.. 'M.~~~i..'.'~~~.J<~~"4 .;:..;-,..^:':'. _:.';';,";;..1., .~,,~..'~''l' ..;.~:. ..;.. ':",~_-;.;.~~~"'\:X~;.t~"".1..1"~ ~::'i.l~::, \-.i..,,; ..~lf >..;)~. ;'l'~
~~::.',\:t~ <:~~~~;~':.~;";'~''J;';~l::~r-, :~;::..t\r~:rt,~\~~~~ry;':;'l;';"'i''''-*~:r&~j''~ ;: :;J ~)~,:::~'l::~'.\:~~:'~: ~:':~~,Y':"1J~-t"':r;r' ~.'''i~'''-~~ "
A. ~}~,e":'R.~sid.t;ri t!~L,::~ i.ilg'~..o~..l"Iu!t,FF:a ".1, ily';per~(J ,,'eIJ !hg ~~!t;{.i'
........;.......~,.tt:....:,....,:.:... ~..I_\"",.....,..~...t-':.., l_.~......,...~... .~.~....__,~.... ~!:;....."........!..:. wM..').;....t.............'-...;~?'_..)j,.:j."'t.'-..-:.._;,,!,..... .' .. . .;.'.._",:,,-,Jr.
Service Included
1000 sq. ft. or less
Each additional 500 sq, ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19.00
$50,00
. Ff/~~:!'~':~:.':.\~.~:;~:;&;tP:~{.'<(.~~:ir::~~f; <~~,;:~~5}\;'~~!;'c'" t:; j,\:E;'i~'i~;r:::;i:\' .~?~C':.~.t~,: r;;~~~,:-;t.:'\' ~:~: ~t ~~J,,\:~;"i'Q:/i~.--:':'~ -:r';
B. r;~Ser,;ices' o[,Feede'ts":J rfst.:i II atioJf;Altera,tioi~s'or,Rel ocat ioil: "/ ~~~:
~i~~~~~~,,-?>'_1 ~~~~ k'".. . :..::')i.:('!~;~t!..:~,:.,.;~~,'iJ:.: ~;::.:::; ~,.,:\1 :....\.,<~~..:. '\j;'Z.lb~' :1.u'S~",'''' .~"l: ~~ .: '".il':? :~,2.'\.::,~'/,ttL~.:: ~ ~, ?::+~~:\~J:" ,,;'.!..:. ~{,
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Re 1h,.:.~~efi1y
$ 63.00
, $ 75.00
$125,00
$163,00
$375.00
$ 50.00
")
Expiration pate
constr~ntr, Number
//
.....Expiration Date
Signature of Supervising Electrician
Owners Name ,N1 LltL
Address . -C<~~ 3
City --:$./W '
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~lf'/~/9'r
Phone
OWNER INST ALLA nON
The installation is being made 0 property I own which
is not intended for sale, lease rent.
Inspection Request: 726-3769
rct.:?s\"~"'~"'~'t~:.t,.-~~':""1"~~~:rs'1'fI'r':.'~1'=S{' .(.""-:U:.R,~"\,, ,....;..~'r"\~ r-:''.;:I''~ ':...."""':...:-:-' .;",,"~""""",:r:-:"'l-';'7.;""""""J'~'-'''''''''''';:1
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~'emporarv' elWlcesor ee ers .".,'10" \"'''' :.ii"'.''''-'' y~," .. "..'0
-. ~r:...,,:,. _, . ".;~'.~ '.. .._ .;.-i.'-"""....! :'41'" ...... ; .".- .>.J.....~. ',......... ~ ~,. ""_ '\'?-,::,;" ~\)~. .,)'. '!.'r,,~'~.:1., '(~ ..,;,<-'~,~,::'>~'7i:>,1: 1;~r.t;i i,:\,,\:,~,~ i
~1;..l,~.':::h~~"~.~~''''''''I,..:_{''-;",,,_.~~..........~.............;........,,:,::~.-o.,l,.:.t-.'-,~"'' ...\.o_.l.~. ,:I........:,......",. ..._..,.~,.;l.._~ ""....... - "--,t'<ol-........-...',.:...." ............~
Im:tllIllltion, Altp.."'ti9o-orIte1ocation '(
200 Amps or less
20 I Amps to 400 Amps
, 40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above,
"', . ""';"~.'If"'.~' ,'''' H" :., ~">'j','>~"i{,v;:~r'\ ,. 1;":' ,..!".,,:;~~t-"';C'Y'.'1""""~.),.'4/J-.,,,"";"'~\~'~~~V"''''1'::r'''''' .~~(.,::t:".r-rl
!:/ "":''-"..;' '<,'.':' .~.....\. . .:~.;.,~~i,';"~" '..t~"i&"\" ':~'~;;:~" t .,'t:,.J/:'> .~')f.!V:..-'t .J;.;>~~~,'-i~ 'l!~,j:'f~' l'';''''f<:<:'-'O;>';~ '\, ...,,~ ' : .
D ,"'.Branch,GlrcUlts !;-,j," J:l"",,,".'it?'..;,,:,,~,\.,\.,,,,,, "'Y.'~"i './ :,.;.,:;,,r ,'''\;'''J~~'''':l
. ~~'tU~~'~~,,:~'.~;~ .~:i::.t;.~~w~\.<~~:S%;{ 't 'r~~G~~\~E.C} .~~:i!(~~:~v~~:S.:t~'i}:._tt}:~...~'.2! ~!r:~L~Yi:~L.
$ 50.00
$ 69.00
$100,00
New Alteration or Extension Per Panel
. One Circuit
Each Additional Circuit or with
Service or Feeder Pennit
$ 43.00
$ 3.00
fi~~?'~;J~~.';~ ~~~l"'-:J<<~~'~;~'!,~i~~t~t :~\~{~F5:~}~~~s"t;,\;}.! '~;;'~:~:;:(~'~'J--..::~,;~':.~' ':~~~S'.~. t~,:_,,~.-:;,r~;~".-,~
E. trMisceHaIle6u.s,J S~rvi~e/f eeder ,nofincl ude~);':Ea'ch. Ili'sta Ua tion .'.
;;,,:,',;6. ':~~4.!'~."':":tir~t:.~~:-!;'.~1~:"""..J,;:.ll';:' _",}.>o.~'i.:.:.~':.: ,._l:.~~.~~~,,:...::~'::'t.r.....t.;..4-,"~"C ~;:;I':,:.:J.~ ..:.":.~G~:~;:1I.~~':"'~-l..1'~
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50,00
$ 25,00
$ 45,00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
~~;f .X~~~~ ;:A';;.~':~ ~~!,~~~~~~~~;?;~;f~~~,J;:r?f;t~~(~:~~A::~[~P.,~~~.~)~~~::~??~~
4. i~BU1JT.OTALJJJt.A,BOYE ';i':.~:)~".,;' <,4.r~""'<'I:,'~"I."~
ih~~,,-ti?~~':;::-;;i;:.~.;:~.~)'~~~~J~~~~~,t;;ti;ft~ ~:~: '!;;-,~::f~tl,-1Ll\~2,~;~;;=.1~i~~ :}:"~l:'{:i:~-"
CJl) .00
~,() 0
c:; ,cO
S~_OV
8% State Surcharge
. 10% Administrative Fee
TOTAL
Shared Drive(T,)/Building Fonns/Electrical Pennit Application I-06,doc
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DRAINAGE FIXTURE UNIT (DFU) CALCULA nON TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT; DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONL Y THE NET ADDITIONAL FIXTURES)
NO, OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIV ALENT UNITS
I BATHTUB 1 0 3 = 3
IDRINKING FOUNTAIN 0 0 1 = 0
IFLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
LAUNDRY TUB 0 0 2 = 0
CLOTHESW ASHER / MOP SINK 1 0 3 = 3
CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRIG / WATER STATION / ETC, 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3
ISHOWER, SINGLE STALL 1 0 2 = 2
ISHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 = 0
SINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2
ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1
IURINAL, STALL! WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INST ALLA TION 2 0 3 = 6
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 20
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE
I
I
I
I
I
I
I
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$I,OOO
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
IS LAND ELGIBLE 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
o
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0,00 x $5,29
= ,
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0,00 x $5.29 = ,
o
TOTAL MWMC CREDIT
=
,
$0,00
. .
. .
225 Fifth Street
Spribgfield, Oregon 97477
541-726-3759 Phone
*. f Springfield Official Receipt
opment Services Department
Public Works Department
RECEIPT #: 1200600000000001070 Date: 07/14/2006 1 :09:15PM
Job/Journal Number Description Amount Due
COM2006-00758 Addressing Assignment 31,00
COM2006-00758 Willamalane Single Family 1,000,00
COM2006-00758 Temp Power 200 amps or less 50,00
CO M2006-007 5 8 Fire SF Fee - Residential 82.80
CO M2006-007 58 Building Penriit 676,15
COM2006-00758 2 Baths One or Two Family . 254,00
COM2006-00758 Vent Fan 18,00
COM2006-00758 Exhaust Hoods 9,00
COM2006-00758 Dryer Vent 6.00
COM2006-00758 Heat Pump. 12,00
COM2006-00758 Sidewalk Permit 80.00
COM2006-00758 Curbcut Permit 80.00
COM2006-00758 PW Disc - 2nd Permit (Street) (30,00)
COM2006-00758 Storm Drainage Impervious Area 831,64
COM2006-00758 Sanitary Sewer - Reimbursement 501.40
COM2006-00758 Sanitary Sewer - Improvement 381.40
COM2006-00758 SDC Transpo Reimbursement 182.69
COM2006-00758 SDC Transpo Improvement 805,70
COM2006-00758 SDC MWMC Reimbursement 82,03
COM2006-00758 SDC MWMC Improvement 865.31
COM2006-00758 SDC MWMC Administration 10,00
COM2006-00758 SDC Sanitary/Storm Admin 116,09
COM2006-00758 SDC Transpo Admin 66,92
CO M2006-007 58 Plan Review Major - Planning 198,00
COM2006-00758 Furnace - up to 100,000 btu 12,00
COM2006-00758 -Mechanical Issuance Fee- 10,00
COM2006-00758 + 8% State Surcharge 82,97
COM2006-00758 + 10% Administrative Fee 112,00
Item Total: $6,527.10
Payments: Check Number Authorization
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
Check MIKE BLANKENSHIP Ikw 10259 In Person $6,527,10
Payment Total: $6,527.10
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