HomeMy WebLinkAboutPermit Building 2005-7-20
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 6333 Fernhill Ct
ASSESSOR'S PARCEL NO.: 1702343403900
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00711
ISSUED: 07120/2005
APPLIED: 06/10/2005
EXPIRES: 01120/2006
VALUE: $ 341,992.00
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Mountaingate subd lot 28
Owner:
; Address:
GREG LARKIN
PO BOX 832
SWEETHOME OR 97386
Residential
Phone Number: 541-726-0330
:,\~ ~'~'~iE:
TL.lIC nCn~itfT ("'I 11\1 I
...- , -, ....., ~'" ....... ".1\1 IIIL II' I nt '/VUM"
I. I I -,- I I rl ,....,. ,-; r+"'" .. ~ ._.- _ ~,_ . \
I CONTRACT0R IN'F6RM:4::fION IHIS PER/vIlT IS ~jOT
VUIV"VILr~uLU un Iv f-li:3,i-1j\1DOi\lED FOR
Contractor AIW 180 DAYIfi~ense. Expiration Date
RIVER VALLEY BUILDERS INC 134566 04/15/2007
G & E ELECTRIC INC 54468 09/1512007
MIDWAY MECHANICAL INC 154166 01130/2007
MIDWAYPLUMBINGINC 4687 07/25/2008
I BUILDING INFORMATION I
Fullv Improved
Yes
Contractor Type
General
Electrical
Mechanical
Plumbing
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
; Secondary Construction Type:
# of Bedrooms:
1
R-3
U
VN
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
18.20
8.50
5,40
33,40
0.00
Subdivision Not Accepted
Street Improvements:
Storm Sewer Available:
Special Instruction:
Phone
541-367-1618
541-967-7045
541-928-2423
541-928-7927
3
# of Stories: 2 Lot Size:
Height of Structure 30,00 Sq Ft 1st Floor:
Type of Heat: Forced Air Gas Sq Ft 2nd Floor:
Water Type: Gas Sq Ft Basement:
Range Type: Gas Sq Ft Garage/Carport
Ene.rgy Path~T!ENTION: c:f~%h lau~~..Ft pther:
Sprmkled ~~~:~~~~~~~i~d by ;~f~~~G~!~,
I DEVELOPMENlhINl\tlQM-A1.)OI~G,' I hose rules are set forth
0090 Vi 0 through OA~~D PARKING
'. ou may obtain copies of tha..r' b
Overlay Distf-alll.ng the center Hillside, th t / TQ~alr y 2
, '\,"VlC, e e e..onnt1p.
# Street Tnfes1iRiqd:r for the Oregon I:j\'/'t N ,fl.an'41capped:
. - uti I y otltrr.::ttrrm
Paved Dnve Rqd: Cenier is 1-308~€J2-23 Compact:
% of Lot Coverage: 44) ,
10,640
2,162
824
788
I PUBLIC IMPROVEMENTS I
Sidewalk Type:
DownspoutslDrains:
Curbside 5'
To Storm Sewer
'Notes: No hook-up to City Infrastructure until Public Improvements accepted by the City. Storm drainage piped to Stub
provided 6/16/2005 CAS
Paee 1 of 4
_.If?~I!U~9,J~I!S'~,,;;
"\;
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
A,C. - Residen
Deck/Balconv
Dwellinl!s
Estimate
Garal!e
AC - Residential
Deck
V Wood Frame
Estimate
Garal!e - Masonry
\ Fee Description
Plan Review Residential
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
3 Baths One & Two Family
Addressing Assignment
Appliance Not Listed
Building Permit
Curbcut - Additional Driveway
Curbcut Permit
Dryer Vent
Exhaust Hoods
Furnace - up to 100,000 btu
Gas Fireplace
Gas Outlets 1-4
Gas Outlets 4+ .
Mountaingate Impervious Area
Plan Review Major - Planning
Plan Review Residential
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 Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Sewer Each Addtll00'
Temp Power 200 amps or less
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2005-00711
ISSUED: 07/20/2005
APPLIED: 06/10/2005
EXPIRES: 01120/2006
VALUE: $ 341,992.00
I Valuation Descriution I
$ Per Sq Ft
or multiplier
$4.00
$17,00
$96,00
$1.00
$29.00
Square Footage
or Bid Amount
2,986,00
330,00
2,986,00
14,930.00
788.00
Value
Date Calculated
$11,944,00
$5,610.00
$286,656.00
$14,930,00
$22,852,00
$341,992,00
06/21/2005
06/21/2005
06/21/2005
06/21/2005
06/21/2005
Total Value of Project
~
Amount Paid
$807.07
$10.00
$188,12
$131.68
$306,00
$31.00
$18,00
$1,352,15
$40,00
$80,00
$6.00
$9.00
$12,00
$15,00
$4,00
$1.00
$1,329.90
$103.00
$71.83
$-30.00
$548.40
$721.iO
$10.00
$865.31
$82.03
$165,05
$60,17
$772.49
$175,13
$80,00
$84.00
$50,00
Date Paid
Receipt Number
1200500000000000817
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
2200500000000000955
6/10/05
7120/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7120/05
7120/05
7/20/05
7/20/05
7/20/05
7/20/05
7/20/05
7120/05
7/20/05
7/20/05
7/20/05
7120/05
7/20/05
7/20/05
Pal!e 2 of 4
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2005-00711
ISSUED: 07/20/2005
APPLIED: 06/10/2005
EXPIRES: 01/20/2006
V ALUEi $ 341,992.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Vent Fan
Willamalane Single Family
$24.00
$1,000,00
7/20/05
7/20/05
2200500000000000955
2200500000000000955
Total Amount Paid
$9,123,53
I Plan Reviews I
Initial Review 06/15/2005 06/15/2005 APP SKG
Initial Review 06/28/2005 06/28/2005 10 LLH Received revised site plan from
Virginia Jurasevich/Public Works
Planninl! Review 06/15/2005 07/05/2005 APP TAJ A waiting resolution of coverage
problem. Otherwise, this has no
other Planning issues,
Place construction fencing to
protection the Vegetation easement.
Protect trees in the Vegetation
easement that are too close to the
retaining wall, See MountainGate
Development Plan Restrictions for
Tree Protection guidelines,
Public Works Review 06/15/2005 06/16/2005 APP CAS No hook-up to City Infrastructure
until Public Improvements accepted
by the City; Storm drainage piped t<
stub provided 6/16/2005 CAS
Structural Review 06/15/2005 06/16/2005 10 LLH Forwarded to Jason Bush for review
Structural Review 06/16/2005 06/17/2005 APP JB Approved as noted on plans
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,
Sidewalk - Curbside: After forms are erected but prior to placement of concrete,
Rough Mechanical: Prior to Cover
Final Gas: When all gas work is complete,
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.
Pal!e 3 of 4
CITY OF SPRINGFIELD'
Status
Issued
Building/Combination Permit
PERMIT NO: COM2005-00711
ISSUED: 07/20/2005
APPLIED: 06/10/2005
EXPIRES: 01120/2006
VALUE: $ 341,992.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Curbcut - Overwidth: 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.
Drywall: Prior to taping.
Final Building: After all required inspections have been requested and approved and the building is complete.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill,
Vnderfloor Plumbing: Prior to insulation or decking,
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,
Storm Sewer Line: Prior to filling trench,
Final Plumbing: When all plumbing work is complete.
Vnderfloor Mechanical. Prior to insulation or decking and including required testing.
Vnderfloor 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,
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 OCCVP ANCY 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_~ co::rL5 /
-~I r-~ -=-- /--20-cJ5
Owner or Contractors Signature
/
Date
Pa2e 4 of 4
4
::?FFtniC ~H"ltted has the following
project as sonm peciiic land use
does not requIre s
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541;9!2~S36W
approval.
ELECTRICAL PERMIT APPLICATION Zoning"
CYDO~'
City Job Number
1. LOCATION OF INSTALLATION
r;51> ~jjll cr;-
LEGAL DESCRIPTION H/)ill\~, Wv PiJ-l
l'10t34'34 O!;qCO ~J!, klD:28
JOB DESCRIPTION
k;;Y/ /JOfli,tjI
Permits are n~n-tranfrerable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
CONTRACTOR INSTALlATION ONLY
/
/
City
Expiration Date
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
~~I:~~.:::i,7'
Date
3.
[,a\":' - -
, 'n.._S-'a.nature--
COMPLETE ~FEE SCllE>D1!J1]1!'151h,u'J;tT
-
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq, ft. or less $106,00
~~<(~ ~gditi.-onal 500 sq, ft, or"?\RE IF THE \NOR:(
p?~IP-Y th~fj~9,f!\1 SH!\~L t1'~I'S Fn.:.;.lT Ie: r~O~.OO
',,'. - ~ n _L] \\\ 0 t R n \ L I \"". .-
Ef19D N,1:cicia'ra'etJ_CIFl9IlJe\Or i\Biil"OOI~ED FOR
M d) ",- .,Co))' I' SIQ ''-\ M n''\l
8,PUHIjV~WY rug ervlce or $5000
Fe~1{y '\ BO DAY PERIOD, '
B. Services or Feeders - Installation, Alterations or Relocation:
200 Amps or Jess
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63,00
$ 75.00
$125,00
$163,00
$375.00
$ 50,00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less { $ 50.00 (:lJtoo
201 Amps to 400 Amps $ 69,00
401 Amps to 600 Amps $100,00
Over 600 Amps or 1000 Volts see "B" abovffres you to
D. Bran~ENffftON: Oregon lawhre6~egon Utility
I, S adooted by t e t t rth
New AlfEll~UM.b'tEExtenf~~~ ff\~.ge~lles are se 0 _
One CtFhUlttlcatlon ce~ -0010 t\"1rouah o~~:b~-0~_1. I
Each, AiqtpfflM?ifGlfc&\~or 'f.Ngin copies ot the rules uy
Servlce~o'!)~~evllem\1l1 0 r "~ui"" ~~,8 t~\l0t9.Gone
calling the cent~, (." I ~n;t" NCA\~\Cat\on
'kr /......I,:.nO\\\...,."
E. Miscell~.~~!\l!~JS~r~"icetfee~et~~n.i;l!r}~~II~~~~), rEach I nstallatio n
(~.::.i~\tc;r is \ -0,... ....',./".;.- ,...
Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50,00
Limited Energy/Residential $ 25,00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
<;;0 i eo
'5/ S-o
~JOO
$:>It>ISO
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Dlive(T:)/Building Fonns/Electrical Pennit Application )-03,doc
. ....
. CITY OF sf~NGFIEi...6 SYS!EMS DEVELOPME~~ORKSHEET'
JOURNAL OR JOB NUMBER:COM2005-00711
NAME OR COMPANY: River Valley Builders
LOCATioN: 6333 Fernhill Ct
TAX LOT NUMBER: MountainGate Lot 28
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS . I BUILDING SIZE (SF: 3764 LOT SIZE (SF):
1. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUSS,F, x I COST PER S,F, CHARGE
I 4290,00 I $0.310 = $1,329.90 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S,F, x I COST PER S,F, x I DISCOUNT RATE I
I 0,00 I $0,310 . I 50%
ITEM 1 TOTAL - STORM DRAINAGE SDC 1 $1,329.90 ' I
2, SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x
I 30 I
DISCOUNT
$0,00
COST PER DFU
$24,04 .
B. IMPROVEMENT COST:
I NUMBER OF DFU's x
I 30
$18.28
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
=1
$1,269.60
I
3, TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE x
I 9,57
B. IMPROVEMENT COST:
I ADTTRIPRATE
I 9,57
I NUMBER OF UNITS' x I
I 1 I
COST PER TRIP
$18,30
x INEWTRIPFACTOR
I 1.00
x ,I NUMBER OF UNITS I x I
I I I I
=1
COST PER TRIP I x NEW TRIP F ACTORI
$80,72 I . 1.00 I
$947.62 r
ITEM 3 TOTAL - TRANSPORTATION SDC
4, SANITARY SEWER - MWMC
. A. REIMBURSEMENT COST:
INUMBER OF FEU's x
I 1
ICOST PER FEU
I $82,03
B. IMPROVEMENT COST: .
INUMBER OF FEU's x
I I
,
ICOST PER FEU
I $865.31
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL -MWMC SANITARY SEWER SDC' = I
SUB TOT AL (ADD ITE,MS 1, 2, 3, & 4) = I
.$957.34
$4,504.46
5, ADMINISTRA TTVE FEE:
SUBTOTAL x . I ADM, FEE RATE
$4,504.46 .1 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
1=
I
CHARGE
$225,22
Cheryl Slaymaker
6/16/2005
TOTAL SDC CHARGES
PREPARED BY
'DATE
10640
$1,329.90
$721.20
$548.40
$175.13
$772.49
=
$82.03
r:/:J
p:.1'
o
o
u
~
p:.1
,E--<
r:/:J
6
~
1070
1091
1092
r
I 1093
1094
r=
1054
= $865.31 lOSS
$0.00 1054
$10;00 1056
I
I
I
=,
165,05
$60,17
$4,729.68
-.-~. ~
.,_.,-
1079
/1078
I
"
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO, OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
I BATHTUB 2 0 3 = 6
I DRINKING FOUNTAIN 0 0 1 = 0
I FLOOR DRAIN 0 0 3 = 0
!INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETC, 0 0 6 = 0
I LAUNDRY TUB 1 0 2 = 2
!CLOTHESWASHER/MOP SINK 1 0 3 = 3
ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0
I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRIG/WATER STATION /ETe. 0 0 1 0
I RECEPTOR FOR COM. SINK / DISHWASHER / ETe. 0 0 3 = 0
I SHOWER, SINGLE STALL 1 0 2 = 2
ISHOWE~ GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0 II
I SINK: WASH BASIN/DOUBLE LA V A TORY 2 0 2 = 4
I SINK: SINGLE LA V ATORY/RESIDENTIAL BAR 1 0 1 = 1
URINAL, STALL / WALL 0 0 5 = 0 I
TOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDD'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 30
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
]987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
CREDIT RATE/$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 ELGlBLE FOR ANNEXATION CREDIT?
(Enter 1 for Yes, 2 for No)
IS IMPROVEMENT ELGlBLE FOR ANNEX, CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
2
2
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0,00 x $5,29
= I
$0,00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0,00 x $5,29
o
TOTAL MWMC CREDIT
$0,00
=
225 Firth Street '
Silringfield, Oregon 97477
541-726-3759 Phone
iiir:~
City of Springfield Official Receipt
~velopment Services Department
Public Works Department
Job/Journal Number
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
COM2005-00711
CpM2005-00711
COM2005-007ll
CbM2005-007ll
CbM2005-007ll
COM2005-007ll
COM2005-00711
Payments:
Type of Payment
CreditCard
'.\
7/20/2005
RECEIPT #:
2200500000000000955
Date: 07/20/2005
Description
Addressing Assignment
Willamalane Single Family
Temp Power 200 amps or less
Sidewalk Permit
Curbcut Permit
Curbcut - Additional Driveway
PW Disc - 2nd Permit (Street)
SDC MWMC Administration
Plan Review Residential
Building Permit
3 Baths One & Two Family
Storm Sewer Each Addtl 100'
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Dryer Vent
Gas Outlets 1-4
Gas Outlets 4+
Gas Fireplace
Appliance Not Listed
-Mechanical Issuance Fee-
Plan Review Major - Planning
SDC Sanitary/Storm Admin
SDC MWMC Improvement
SDC MWMC Reimbursement
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
Mountaingate Impervious Area
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
RIVER VALLEY BUILDERS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 260419 In Person
Payment Total:
Page 1 of 1
2:40:45PM
Amount Due
31.00
1,000.00
50,00
80,00
80.00
40.00
(30.00)
10,00
71.83
1,352.15
306,00
84,00
12.00
24,00
9.00
6,00
4.00
1.00
15,00
18,00
10.00
103,00
165.05
865.31
82.03
548.40
721,20
1,329,90
60.17
772.49
175,13
131.68
188.12
$8,316.46
Amount Paid
$8,316.46
$8,316,46