HomeMy WebLinkAboutPermit Building 2007-7-20
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00790
ISSUED: 07120/2007
APPLIED: 06/01/2007
EXPIRES: 01/2012008
VALUE: $ 380,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5810 MAIN ST
ASSESSOR'S PARCEL NO.: 1702334102300
Springfield
TYPE OF WORK: Commercial Miscellaneous
TYPE OF USE: Addition
Commercial
PROJECT DESCRIPTION: Remodel and addition to existing structure
Owner: AMIGOS III LLC
Address: 32929 ROBERTS CRT
COBURG OR 97408
Phone Number: 541-726-8795
I CONTRACTOR INFORMATION I
Contractor Type
Architect
General
Electrical
Mechanical
Plumbing
Contractor
RON THIENES
CASCADE VIEW CONSTRUCTION INC
JB ELECTRIC
COMMERCIAL AIR INC
TWIN RIVERS PLUMBING INC
License
Expiration Date
155174
104929
110075
17695
04/16/2009
03/14/2008
12/18/2007
03/11/2008
Phone
541-726-8795
541-912-1412
541-687-5770
541-461-4821
541-688-1444
BUILDING INFORMATION'
# of Units: # of Stories: 1 Lot Size:
Primary Occupancy Group: M Height of Structure: 19.50 Sq Ft 1st Floor: 1,705
Secondary Occupancy Group: Type of Heat: Electric Sq Ft 2nd Floor:
Primary Construction Type VB Water Type: Sq Ft Basement:
Secondary Construction Type: Range Type: Sq Ft Garage/Carport
# of Bedrooms: Energy Path: Path 1 Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
I DEVELOPMENT INFORMATION.
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
~ma~t.O-:==,. .. feuiiiii-.-;Je.-..... .
foHow ruIeI ad .:..:.:..: -. - - ~-=.: NTS
Notification Center. I
Street Improvements: tn OAR esa.G01.oo10through OAR 152..001.
Storm Sewer Available: 1080. Youmayobtalftcoplesoflherufe8br
Special Instruction: calling 1he center. (Note: the telephone
.... ..th. OregOn UIII~IO"
Notes: Center II t.fJOO.l3l
Sidewalk Type:
N9JJt'~~uts/Drains: ORK
THIS PERMIT SHALL EXPIRE IF THE W
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Pa2e 1 of 6
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Estimate
Pavin2
Estimate
Use Bid Amount
Fee Description
Plan Review Comm/Ind/Public
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Backflow Device
Boiler/Comp Up To 100,000 btu
Building Permit
Fire SF Fee - Non-Residential
Fixture
Furnace - up to 100,000 btu
Miscellaneous Plumbing
Paving
Plan Review Fire & Life Safety
Sanitary Sewer - 1st 50 Feet
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addtll00'
Vent Fan
Water Line - 1st 50 Feet
Water Line - Each Addtll00'
Total Amount Paid
I Valuation Description I
$ Per Sq Ft
or multiplier
$1.00
$1.00
Square Footage
or Bid Amount
299,149.00
80,851.00
Total Value of Project
~
Amount Paid
Date Paid
$959.17
$10.00
$236.17
$109.56
$135.97
$14.00
$12.00
$1,215.65
$170.50
$196.00
$36.00
$45.00
$491.55
$590.26
$45.00
$45.00
$14.00
$18.00
$45.00
$14.00
6/1/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
7/20/07
$4,402.83
I Plan Reviews I
Pa!!:e 2 of 6
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00790
ISSUED: 07/20/2007
APPLIED: 06/01/2007
EXPIRES: 01120/2008
VALUE: $ 380,000.00
Value
Date Calculated
$299,149.00
$80,851.00
$380,000.00
07/03/2007
07/03/2007
Receipt Number
1200700000000000670
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
1200700000000000948
CITY OF SPRINGFIELD
Building/Combination Permit
Status Issued PERMIT NO: COM2007-00790
225 Fifth Street, Springfield, OR ISSUED: 07120/2007
541-726-3753 Phone APPLIED: 06/01/2007
541-726-3676 Fax EXPIRES: 01/20/2008
541-726-3769 Inspection Line VALUE: $ 380,000.00
Fire Department Review 06/04/2007 07/02/2007 OK GRG Plans Review: Remodel car wash to
three tenant space commercial
building. Job #COM2007-00790.
Occupancy Classification: M.
Construction Type: V-B. Existing
structure: 2,439 sq. ft.; addition:
1,707 sq. ft.; total addition and
remodel: 4,142 sq. ft. Three retail
spaces divided into 1,412 sq. ft.,
1,275 sq. ft. and 1,308 sq. ft.
Provide or maintain address
numbers and suite numbers or
letters in contrasting color from the
background positioned plainly
visible and legible from the street or
road fronting the property.
Numbers shall be a minimum of 4
inches high (2007 Oregon Structural
Specialty Code 501.2 and 2007
Springfield Fire Code 505.1).
Provide fire extinguishers with a
minimum rating of2-A:I0-B:C
every 75 feet of travel distance. The
top of the extinguisher(s) shall be
between 3 and 5 feet above finished
floor (2007 Springfield Fire Code
906).
Above the main exit door, provide
sign stating "THIS DOOR MUST
REMAIN UNLOCKED WHEN
BUILDING IS OCCUPIED" if key
locking hardware is employed. The
sign shall be in letters 1 inch high on
a contrasting background (2007
OSSC 1008.1.8.3, exception 2.2).
Initial Review 06/01/2007 06/01/2007 APP LLH
Initial Review 06/19/2007 06/19/2007 APP LLH Complete Revised Sets
Plan Review Comments 07/03/2007 10 JMP WI. Received responses from Ron
Thienes.
Plannin2 Review 06/04/2007 WE Needs signed Development
Agreement. Linda Pauly Planner -
DRC2007-00015 Site Plan Review
Minor Mod.
Public Works Review 06/04/2007 06/05/2007 APP JHJ Attached SDC Worksheet. No New
SDC's. (JHJ)
Pa2e 3 of6
CITY OF SPRINGFIELD'
Building/Combination Permit
Status Iss u ed PERMIT NO: COM2007-00790
225 Fifth Street, Springfield, OR ISSUED: 07/20/2007
541-726-3753 Phone APPLIED: 06/01/2007
541-726-3676 Fax EXPIRES: 01120/2008
541-726-3769 Inspection Line VALUE: $ 380,000.00
Revised Plan Review - Fir 06/19/2007 07/14/2007 OK GRG Plans Review: Revised submittal for
remodel of car wash to three tenant
space commercial building. Job
#COM2007-00790. Occupancy
Classification: M. Construction
Type: V-B. Existing structure: 2,439
sq. ft.; addition: 1,707 sq. ft.; total
addition and remodel: 4,142 sq. ft.
Three retail spaces divided into
1,412 sq. ft., 1,275 sq. ft. and 1,308
sq. ft.
Provide or maintain address
numbers in contrasting color from
the background positioned plainly
visible and legible from the street or
road fronting the property.
Numbers shall be a minimum of 4
inches high (2007 Oregon Structural
Specialty Code 501.2 and 2007
Springfield Fire Code 505.1).
Provide fire extinguishers with a
minimum rating of2-A:10-B:C
every 75 feet of travel distance. The
top of the extinguisher(s) shall be
between 3 and 5 feet above finished
floor (2007 Springfield Fire Code
906).
Above the main exit door, provide
sign stating "THIS DOOR MUST
REMAIN UNLOCKED WHEN
BUILDING IS OCCUPIED" if key
locking hardware is employed. The
sign shall be in letters 1 inch high on
a contrasting background (2007
OSSC 1008.1.8.3, exception 2.2).
Note: These comments replace the
original plans review submittal
comments dated 7/2/07.
Revised Plan Review - Pia 06/19/2007 06/21/2007 APP EMM Development Agreement received
6/21/07. To be constructed per
approved Minor Site Plan Review.
Revised Plan Review - Pu 06/19/2007
Revised Plan Review - SU 06/19/2007
Structural Review 06/19/2007 06/19/2007 10 JMP Complete revised sets. See attached
documents for 9 structural
comments faxed to Ron Thienes.
Pa2e 4 of6
CITY OF SPRINGFIELD'
Status
Issued
Building/Combination Permit
PERMIT NO: COM2007-00790
ISSUED: 07120/2007
APPLIED: 06/01/2007
EXPIRES: 01/20/2008
VALUE: $ 380,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Structural Review 07/19/2007 07/1912007 APP JMP Received final internal approval.
Structural Review 06/0112007 06/19/2007 WE JMP Received 6/4/2007. See attached
documents for 9 structural
comments faxed to Ron Thienes.
SUB Review 07/03/2007 07/1812007 APP DH See attached documents for
approval memorandum
SUB Review 06/04/2007 06/1912007 WE DH See attached documents for Item 5
of JMP's structural comments for
requested energy code forms and
information.
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.
~eouire<Unsnections 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.
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection.
SUB Final: After all required energy inspections have been requested and approved.
SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
SUB Exterior Lighting
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.
Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
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.
Roofing: Prior to installing any roof covering.
Roof Sheathing
Pal!e 5 of 6
r--
CITY OF SPRINGFIELD'
Building/Combination Permit
Status
Issued
PERMIT NO: COM2007-00790
ISSUED: 07/20/2007
APPLIED: 06/01/2007
EXPIRES: 01/20/2008
VALUE: $ 380,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
Glu-Lam Beams: Inspection Certificate by an approved agency to be provided to City Building Inspector prior to
placement.
Ceiling Grid: After drywall approval but prior to cover.
Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector.
Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test
results to City Building Inspector.
Final Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Grading: After gravel is in place but prior to placing concrete.
Final Paving: After paving is complete.
Rough Plumbing: Prior to cover and including required testing.
Water Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plumbing work is complete.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Rough Mechanical: Prior to Cover
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 aU 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 aU
tim~ d~L4~ I'-Zo.o1
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Pa2e 6 of 6
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Cemmunity SetYw Diviaiflh
22S Y't1ll1 Street
Springfiild, OR 91411
TuJephone: (541) 126-315'
Fux: (541)126-36&9
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SPECIAL li'iSPECTION AND TESTING SCHEDULE
I R~illf(Jrced :oncrete, Gunile, Groul and Morlar:
Cuncrete Guoite . Grout I Mcrtar
X
GRADING, E.."\CAVATlON, AND FILL
Acceptance tests · . PSF
Establ ish fj nal grade
Fill pLacemcl'll inspection/continuous
Soil Density
_ ~t!.ate Test of Mix Design
. Reinforcin.g Test
Mix Desi~n-WeighmRSler Cert,.
Reint"orcin~ Placement
~ Continuous Batch Planllnspec.l.
I Inspect Placing
Cast Sarnutcs
Samules {P il: kUP/Deliveredl
I Com')ression Tesl*
1
STRUCTURAL STEEL.f\VEL DING:
Sample imd test (lislspccilic members bdow)
Shcp material identificalion {mill cerl)
Weld iflspectlofl 7> Shop
Ultrasonic inspection Shop
High Strength BDlting ShoJ}_
AJ25 _N
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Metal deck. welding inspection
Reinforcing Steel welding inspeclinn
R;:,j ntorcing $tee I mill certittc ate
Metal 5tud welding inspection
Concrete insert welding illSpel.:tioll
MOffiWl resisting steel trilmes
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. J'recDwPre-slressed Concrete:
Piles J>osl-"rens Pre-Tens
Claddinl.'
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Reinfof(:ing Tests
Tendon Test
Mi:'( Desj~s*
Rdntorcin~ Placement
I Insert Placement
Concrete Batcbing
Concrete Placement
T nslall atiool nspecl ion
Cast Somples
Pick-up Samples
. Compression Tests
I
STRUCTURAL WOOD:
She3r walll1ailing inspection
Shear wall anchors
IllspeCtion orGlu-lam fab. .. TIC psi
Inspection 0 f truss joist fab.
Saml1le nnd lest compOllenls
Fabrication welding ofsteelllccessories
SMOKE CONTROL:
Leakage testing
Control Verification
FIREPROOFING:
Field
field
Field
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ROOFING:
T mulat 101'1 i nstallaliorYR -Val ue*
Test strips/seams
Placement inspection
. Density tests:
Thit::kness teslS
Inspect baldling
MASONRY
Special illspeclion stresses used* r m .fg
Preliminary act:eplance tests (maso11l')' 1m;t5, wall prism~}
Subsequent tests {mortar, grout, field wall prisms)
P I ace ment inspection I) r units; and rein fmcement
~'rasunry. mortar, grout, und reinforcing sl<:eI cerWkales
ADDITIONAL JNSRUCTJONS, OTHER TEST, & INSPECTIONS:
Form Compleled by:
....PROVlDE STRENGTH REQUIRED BY ARCHlTEC1' OR ENGINEER OR CONTRACT DOCUMENT LOCATION OFV ALVES
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET
JOURNAL OR JOB NUMBER C0M2007-00790
NAME OR COMPANY: Amigos III Car Wash Remodel
LOCATION: 5810 Main St.
MAP & TAX LOT NUMBER: 17 02 33 41 02300 2800
DEVELOPMENT TYPE: Remodel Car Wash into Specialty Retail
NEW DEVELOPED AREA (S.F.): 4,146.00
EXISTING DEVELOPED AREA (S.F.): 2,439.00 5 stalls
TOTAL IMPERVIOUS SURFACE (S.F.):
I. STORM DRAINAGE
IMPERVIOUS SQ. FT.
ITE:
ITE:
LOT SIZE (S.F.):
814
947
No New Impervious Area
x $ 0.336 PER SF
TOTAL STORM DRAINAGE SDC:1
2. SANITARY SEWER-CITY (see reverse side)
A. REIMBURSEMENT COST:
NUMBER OF DFU's -16
B. IMPROVEMENT COST:
NUMBER OF DFU's -16
x $ 26.03 PER DFU
x $ 19.79 PERDFU
TOTAL LOCAL W ASTEW A TER SDC:1 $
3. TRANSPORTATION
BLDG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR
NEW:
A. REIMBURSEMENT COST:
4.15 x 44.32
B. IMPROVEMENT COST:
4.15 x 44.32
EXISTING:
A. REIMBURSEMENT COST:
-5.00 x 108
B. IMPROVEMENT COST:
-5.00 x 108
0.75
NTF
$2,730.08 1
$12,043.48 1
x
$ 19.81 PER TRIP
x
x
$ 87.39 PER TRIP
x
0.75
NTF
NTF
($6,953.31)1
x
$ 19.81 PER TRIP
x
0.65
x
$ 87.39 PER TRIP x 0.65 NTF ($30,673.89)1
TOTAL TRANSPORTATION REIMBURSEMENT SDC:
TOTAL TRANSPORTATION IMPROVEMENT SDC:
TOTAL TRANSPORTATION SDC:I $
4. SANITARY SEWER - MWMC
NEW:
A. REIMBURSEMENT COST:
NUMBER OF FEU's 4.15 x $26.17 PER FEU $108.50 1
B. IMPROVEMENT COST:
NUMBER OF FEU's 4.15 x $274.72 PER FEU $1,138.991
EXISTING:
A. REIMBURSEMENT COST:
NUMBER OF FEU's -2.44 x $261.75 PER FEU ($638.41)1
B. IMPROVEMENT COST:
NUMBER OF FEU's -2.44 x $2,747.20 PER FEU ($6,700.42)1
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL MWMC REIMBURSEMENT FEE:
TOTAL MWMC IMPROVEMENT FEE:
MWMC ADMINISTRATIVE FEE:
TOTAL MWMC SDC:I $
SUBTOTAL (ADD ITEMS 1,2,3,&4) I $0.00 I
5. ADMINISTRATIVE FEES:
BASE CHARGE (SUBTOTAL ABOVE)
$
x ~ , moo
TOTAL SEWER ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE: $
TOTAL SDC CHARGES
Jesse Jones
Civil Engineer, EIT
6/5/2007
DATE
$0.00
($529.91 )
($5,561.43)
$0.00
($6,091.34)
$0.00
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
Remodel Car Wash into Specialty Retail
FIXTURES
NEW OLD
UNIT
EQUIVALENT
3
1
3
3
6
2
3
6
12
1
3
2
2
3
2
2
1
5
6
3
FIXTURE TYPE
BATHTUB
DRINKING FOUNTAIN
FLOOR DRAIN, FLOOR SINK
INTERCEPTORS FOR GREASE/OILlSOLIDS/ETC.
INTERCEPTORS FOR SAND/AUTO WASH/ETC.
LAUNDRY TUB
CLOTHES W ASHER/MOP SINK
CLOTHES WASHER - 3 OR MORE (EA)
MOBILE HOME PARK TRAP (1 PER TRAILER)
RECEPTOR FOR REFRlGERA TORIW A TER ST A nON/ETc.
RECEPTOR FOR COMMERCIAL SINK! DISHW ASHER/ETC.
SHOWER, SINGLE STALL
SHOWER, GANG (NUMBER OF HEADS)
SINK: COMMERCIAL, RESIDENTIAL KITCHEN
SINK: COMMERCIAL BAR
SINK: WASH BASIN/DOUBLE LAVATORY
SINK: SINGLE LA V A TORY /RESIDENTIAL BAR
URINAL, STALL/WALL
TOILET, PUBLIC INSTALLATION
TOILET, PRIVATE INSTALLATION
MISCELLANEOUS:
5
3
3
NUMBER OF EDU'S*
DRAINAGE
FIXTURE
UNITS
o
o
0"
o
-30
o
o
o
o
o
o
o
o
o
o
o
2.
'0
12
o
o
TOTAL DRAINAGE FIXTURE UNITS =, -16
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling (20 DFU) set at 167 gallons per day
CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE
IF IMPROVEMENTS OCCURRED AFTER ANNEXA nON DATE IN TABLE, CALCULATE CREDITS SEP ARA TEL Y
YEAR
ANNEXED
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
RATE PER $1,000
ASSESSED VALUE
$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
YEAR
ANNEXED
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
. }D.021
.'~. 200): ~",
2004
RATE PER $1,000
ASSESSED VALUE
or before
I,
$1.45
$1.25
$1.09
$0.92
$0.72
$0.48
$0.28
$0.09
$0.05
$0.00
"$0:00 .
$0.00
CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE
IMPROVEMENT (IF AFTER ANNEXATION DATE)
x
x
CREDIT TOTAL
$0.00
$0.00
$0.00
225 Fifth Strt;et
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007 -00790
COM2007-00790
COM2007-00790
COM2007 -00790
COM2007 -00790
COM2007-00790
COM2007-00790
COM2007-00790
COM2007 -00790
COM2007-00790
COM2007 -00790
COM2007 -00790
COM2007 "00790
COM2007-00790
COM2007-00790
COM2007-00790
COM2007 -00790
COM2007-00790
COM2007-00790
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Date: 07/20/2007
1200700000000000948
Description
Fire SF Fee - Non-Residential
Plan Review Fire & Life Safety
Building Permit
Paving
Furnace - up to 100,000 btu
Boiler/Comp Up To 100,000 btu
Vent Fan
-Mechanical Issuance Fee-
Fixture
Sanitary Sewer - 1 st 50 Feet
Water Line - 1st 50 Feet
Water Line - Each Addtl 100'
Storm Sewer - 1 st 50 Feet
Storm Sewer Each Addtl 100'
Backflow Device
Miscellaneous Plumbing
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
RONALD THIENES .
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 2419 In Person
Payment Total:
Page 1 of 1
1 :44:46PM
Amount Due
170.50
590.26
1,215.65
491.55
36.00
12.00
18.00
10.00
196.00
45.00
45.00
14.00
45.00
14.00
14.00
45.00
109.56
135.97
236.17
$3,443.66
Amount Paid
$3,443.66
$3,443.66
7/20/2007