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Home My WebLink AboutPermit Building 2005-7-15 '. , ,\ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 125 J St > ASSESSOR'S PARCEL NO.: 1703352202103 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00797 ISSUED: 07/15/2005 APPLIED: 06/24/2005 EXPIRES: 01115/2006 VALUE: $ 164,055.00 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: Single family residence Owner: WILLIAM JACKSON Address: PO BOX 10067 EUGENE OR 97440 Contractor Type General Electrical Mechanical Plumbing Nort;t. ,,' '. ft 'MIT SHALL EXl3hone\Nuni6e.i:I05fH-344-5274 THIS PFR I !IlL I '''~ 'I. , ' AUTHORIZED UNDER THIS PERMIT IS NOT _ _ .. .r.,r.rn no I~ (\I={MJn()NFD FOR vVIVIIVIL"V~~ -. '. - I CONTRACTORINFORNlA.~'Fi'ONf\OD. Contractor . OWNER SCOFIELD ELECTRIC HOME COMFORT HEATING & AIR HOME COMFORT HEATING & AIR INC # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VN Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 20.00 11.00 5.00 17.00 0.00 Street Improvements: Storm Sewer Available: Special Instruction: License Expiration Date Phone 38702 84164 84164 541~686-8612 541-345-2838 541-345-2838 12/21/2005 06/25/2007 ' 06/25/2007 I BUILDING INFORMATION I 3 # of Stories: 1 Lot Size: Height of Structure 19.00 Sq Ft 1st Floor: Type of Heat: Forced Air Gas Sg ;ft,MtA Floor: Water Type: '(~~EG-G~~g-~ ~~11W~l\'t~liU Range Type:UO!lB~!J!lON Al!\!l((j;W~6aJCS ~l earlYtMfeyport Energy Path: aUOl-\da\al a4lp.illflll) 'J~ 1R f>~her: .~l Sprinkled ~~",~J a4l!0 Sa(.dt:>~ U!elG~cf.p\lhPB~aUpOO . .; '."'_/ ~n'1lL\.-' ~:~," "I' ? 1('1('1-1 nn-;7C::f) HVO U! I DEVELOPMENT.~!Q~J IS041 'JalUa~, uoqeO\!qoN . AlII'ln uo5aJO 84l Aq paldope S~~D PARKING Overlay Dist:oi 'noA saJ!nbaJ Met uo5aJO :Nort~n11V' 2 # Street Trees Rqd: 2 Handicapped: Paved Drive Rqd: Yes Compact: % of Lot Cover~ge: 29.90 6,534 1,512 495 384 I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains: Fully Improved Yes Curbside 5' Curb and Gutter Notes: Storm drainage piped to curb face 6/28/2005 CAS Pae:e 1 of4 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Deck/Balconv Dwellines Garaee Deck V Wood Frame Garaee Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge 2 Baths One or Two Family Addressing Assignment Appliance Not Listed Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Furnace - up to 100,000btu Gas Fireplace Gas Outlets 1-4 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 Storm Sewer Each Addtll00' Temp Power 200 amps or less Vent Fan WilIamalane Single Family I Valuation Descriotion I $ Per Sq Ft or multiplier $17.00 $96.00 $25.00 Square Footage or Bid Amount 384.00 1,512.00 495.00 Total Value of Project ~ Amount Paid $504.99 $10.00 $134.49 $94.14 $254.00 $31.00 $9.00 $776.90 $80;00 $6.00 $9.00 . $12.00 $15.00 $4.00 , $103.00 $-30.00 $106.00 $57.00 $383.88 $504.84 $10.00 $865.31 $82.03 $121.20 $63.91 $772.49 $175.13 $80.00 $908.46 $28.00 $50.00 $18.00 $1,000.00 Date Paid 6/24/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 7/15/05 Paee 2 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00797 ISSUED: 07/15/2005 APPLIED: 06/24/2005 EXPIRES: 01/15/2006 VALUE: $ 164,055.00 Value Date Calculated $6,528.00 $145,152.00 $12,375.00 $i64,055.00 06/24/2005 06/24/2005 06/24/2005 Receipt Number 2200500000000000824 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 22005000000Q0000941 2200500000000000941 2200500000000~00941 , 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 , 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 2200500000000000941 ~Wt~~!'"~~~~~,I; .~ , 11' . ! " 'w . . ,._'---....--~~4-_T :I - . ,,,.- . " '. .,~.. ">" . .,..: > . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00797 ISSUED: 07/15/2005 APPLIED: 06/24/2005 EXPIRES: 01115/2006 VALUE: $ 164,055.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Amount Paid $7,239.77 I Plan Reviews I Initial Review Planninl! Review 06/27/2005 06/27/2005 06/27/2005 07/14/2005 APP APP SKG TAJ Parcel 2 of Partition Plat SUB 2004-00041 recorded on 8/27/04. I returned the file to Cheryl for resolution of an easment problem. Storm drainage piped to curb face 6/28/2005 CAS Approved as noted on plans Public Works Review 06/27/2005 06/28/2005 APP CAS Structural Review 06/27/2005 07/0112005 APP JB 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. Curbcut - Standard: After forms are erected but prior to placement of concrete. 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 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. Underfloor 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. Paee3 of 4 .. ! Status Issued CITY OF SPRINGFIELD, . Building/Combination Permit PERMIT NO: COM2005-00797 ISSUED: 07/15/2005 APPLIED: 06/24/2005 EXPIRES: 01115/2006 VALUE: $ 164,055.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 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. ' 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 during construction. Q~c, U-J~~~~ Owner or Contractors SignaturV - ' 7/(..5.-/0 S-- , . Date Paee 4 of 4 225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . ~~~4.'l)72 ' 1-0 ~o'q 1,0 ELECTRICAL PERMIT APPLICATION . 'b-~~ City Job Number t:~m7;J-c;9- Date 1. 12~ J" S-r- LEGAL DESCRIPTION I t-o 3 'J S-ZZ- 02./03. JOB DESCRIPTION )N,IG- ~Jt.., tulrlnA/ ~ J ~/AO Perm:ts are non-t..{nsferable a~d ~xpire if work i: not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electiical Contractor SCOFIELD ELECTRIC CO. Address PO BOX 2765 CityEUGENE, OR 97402 Phone 686-8612 Supervisor License Number 508-5 Expiration Date 10-1-2007 Constr. Contr. Number 38702 Expiration Date 12-21-2005 Signature of Supervising Electrician &AN~ /) 1/ wnersNam~ 0\\\.~-Mr~ Addr ~-W \\)()tof} ./ City f .~ Inspection Request: 726-3769 3. A. Service Included ~ \:,ln~l\ ^ 1000 sq. ft. or less .~ J 'i= \\~$106~OO' /CX:.~oo Each additional 500 sq. fL?,r:L-l '(.1$ \~:s"- c' ,,) '1:\\"\ \S\\\OI . h ' 1101 -'\.'I'CJC\\\' n- portton t ereof:.:' ,\. u'': II:', \ f\,)' ,- \J$:::f9\OO I DO ,IV '! \ II UL- .! \ v' . ", ,.' ,;",-:'u' ,[ I'juv\'c- Each M!ll1ufact''d.Home-otj\-\ \S ABA Modular~~elliIig:'Setvi~et.o[f\\ClD. $5000 Feeder . ! .. t)" $1-\1 . i',',," 1 \ .; B. 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN 0115 Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. Installation, Alteration or Relocation 200 Amps or less I $ 50.00 S-O, c;x::) 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps o~ ~9,QQ,.\?ol,~-s:eeg'B"qMrJ~aQ D. N Alt ::-..G....\E-1 t::lIIl.:alOpN Dt. 01 '0600 ew er:alllon, or x enston eru...~ne~ kew n ^ 41- \0 5aldO~ I l'-l ""0 UI One Cirp,~i~S8\nJ : ,,/ \ f) '. OJ '\- ~~ 00-1l!0$G4'3fOb\ v . Each. Ad~~9nsG61t1l:Ulvor\w'iln 4 'Ja+ua~ UO\1-'88!t\,\-UN ServIce 01M~~bRet.fu'it3\nJ 85041 'J 1a3.lqoM()\~0l y t aLj1- Aq paluu\-, \' , E. 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. 7% State Surcharge 10% Administrative Fee 2-/310D 1 Lf/1/ 'Lt 30 $J_~ TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc CITY OF ~7'rNGFIELD SYSTEMS DEVELOPMEN ORKSHEET JOURNAL OR JOB NUMBER: . NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x 1 COST PER S.F. CHARGE I 2930.50 I $0.310 = I $908.46 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. I x I COST PER S.F. x 1 DISCOUNT RATE 1 0.00 I I $0.310 I 50% = I ITEM 1 TOTAL - STORM DRAINAGE SDC '$908.46 C0M2005-00797 Raymond Jackson I25 J Street 1703352202103 SINGLE FAMILY RESIDENCE, 1 BUILDING SIZE (SF: 2391 LOT SIZE (SF): 6715 rJ) P-l Q o U P::: P-l f-< rJ) ...... o gz DISCOUNT I $0.00 J $908.46 11070 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: 1 NUMBER OF DFU's I x COST PER DFU 1 21 . $24.04 $504.84 1091 B. IMPROVEMENT COST: I NUMBER OF DFU's x I 21 $18.28 $383.88 1092 ' ITEM 2 TOT AL- CITY SANITARY SEWER SDC = , $888.72 3. TRANSPORTATION A. REIMBURSEMENT COST: ADT TRIP RATE x NUMBER OF UNITS x I COST PER TRIP x NEW TRIP FACTOR 9.57 ' 1 I $18.30 1.00 $] 75.13 /1093 B. IMPROVEMENT COST: I ADT TRIP RATE x I NUMBER OF UNITS I x COST PER TRIP x INEW TRIP FACTOR r 1 9.57 1 1 I $80.72 1 1.00 $772.49 r 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = , $947.62 I 4. SANITARY SEWER - MWMC I A. REIMBURSEMENT COST: I INUMBER OF FEU's x COST PER FEU I 1 $82.03 = $82.03 I 1054 B. IMPROVEMENT COST: I INUMBER OF FEU's x ICOST PER FEU I 1 1 $865.31 = $865.3] ,11055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 11054 MWMC ADMINISTRATIVE FEE $]0.00 11056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I $957.34 SUBTOTAL (ADD ITEMS ], 2, 3, & 4) ~I $3,702.]4 ' I 5. ADMINISTRATIVE FEE: I SUB TOT AL x ADM, FEE RATE CHARGE I $3,702.14 5% $]85.1 ] TOTAL SANITARY ADMINISTRATION FEE: ] 21.20 1079 , TOTAL TRANSPORTATION ADMINISTRATION FEE: $63.9] 11078 Cheryl Slaymaker 6/28/2005 TOTAL SDC CHARGES.' =1 $3,887.25 PREPARED BY DATE .~._-_._~~.- . RO" .._..._ DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXIlJRES x UNlT EQUIVALENT = DRAINAGE FIX1lJRE UNlTS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS BATHTUB 2 0 3 = 6 I DRINKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 'I INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC. 0 0 3 = 0 I IINTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 0 I I LAUNDRY TUB 0 0 2 = 0 I I CLOTHE S WASHER I MOP SINK 1 0 3 = 3 I I CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 I I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I IRECEPTOR FOR REFRlG I WATER STATION IETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK I DISHWASHER I ETC. 0 0 3 = 0 I SHOWER SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 I SINK: SINGLE LA V A TORY /RESIDENTIAL BAR 1 0 1 = 1 URINAL, STALL I WALL 0 0 5 = 0 TOILET, PUBLIC INST ALLA TION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 21 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE ] 979 ]979 1980 ]98] ]982 ]983 ]984 1985 1986 ]987 ]988 ]989 ]990 199] ]992 ]993 ]994 ]995 1996 ]997 ]998 ]999 2000 2001 CREDIT RATE/$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 I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE $0.00 x $5,29 =1 $0,00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDIT RATE $0.00 x $5,29 o = $0.00 TOTAL MWMC CREDIT l'."04(llf"b.' ('..:1 ,I() EASEMENT --------- THIS, INDENTURE MADE and eIltered int<,' this g /If.:!;7 day of ~ J/ , 196b , by and betweeo/hl3/}/-~[J LA:-:~::;'.5:5'/:;:L..l. i{..?:ki')?(:;?.::Jfi-:JI?7 1;,~~/';'j(3'L4,LI;6 hereinafter referred to as the Grantors, and THE CITY OF SPRINGFIELD ,'a F municipal corpora.tion, in l;..ane County, Oregon, hereinafter referred to as the Grantee.. ---------- WIT N E SSE T H Tha.t the Grantors 5 for and in consideration of one dollar to them in hand paid, do hereby grant, bargain, sell and convey' unto the Grantee, a perpetual ea.sement. f: 10 feet in width, ,together with the right . ~o go upon said eassment area hereinafter described for the purpose of constructing, reconstructing, mai.ntaining and using a sanitary sewer ~hich may hereafter be installed on the following describedproperti, . to-wit: ' Beginning at a point South 10046'30" East 25.96 feet and 7.13 feet; South 89037' East from the South East corner of Lot 9 Block 3 Hollo's Addition to Springfield, Oregon; thence North 89037' West 89.13 feet;thence North 10046' 30" West 10.19 feet; thence South 89037 t U&as'.t 89.13 feet; thence South 10046'30" East 10.19 feet to the point of beginning. rc/ I I 225 Fifth Street, . ,. , S.priIlglield, Oregon 97477 , 541-726-3759 Phone City of Springfield Official Receipt :'~$evelopment Services Department Public Works Department RECEIPT #: 2200500000000000941 Date: 07/15/2005 3:33:54PM Job/Journal Number Description Amount Due COM2005-00797 Addressing Assignment 31.00 COM2005-00797 Willamalane Single Family 1,000.00 COM2005-00797 Residence Wiring 1000 Sq Ft 106.00 COM2005-00797 Residence Wiring Ea Addtl500 57.00 COM2005-00797 Temp Power 200 amps or less 50.00 COM2005-00797 Sidewalk Permit 80.00 COM2005-00797 Curbcut Permit 80.00 GOM2005-00797 PW Disc - 2nd Permit (Street) (30.00) COM2005-00797 Storm Drainage Impervious Area 908.46 COM2005-00797 Sanitary Sewer - Reimbursement 504.84 COM2005-00797 Sanitary Sewer - Improvement 383.88 , COM2005-00797 SDC Transpo Reimbursement 175.13 COM2005-00797 SDC Transpo Improvement 772.49 COM2005-00797 SDC MWMC Reimbursement 82.03 COM2005-00797 SDC MWMC Improvement 865.31 GOM2005-00797 SDC MWMC Administration 10,00 COM2005-00797 SDC Sanitary/Storm Admin 121.20 COM2005-00797 SDC Transpo Admin 63.91 COM2005-00797 Building Permit 776.90 COM2005-00797 2 Baths One or Two Family 254,00 COM2005-00797 Stoop Sewer Each Addtl 100' 28.00 COM2005-00797 Furnace - up to 100,000 btu 12.00 COM2005-00797 Vent Fan 18.00 COM2005-00797 Exhaust Hoods 9.00 COM2005-00797 Dryer Vent 6.00 COM2005-00797 Gas Outlets 1-4 4.00 COM2005-00797 Gas Fireplace 15.00 , COM2005-00797 Appliance Not Listed 9.00 COM2005-00797 -Mechanical Issuance Fee- 10.00 (;bM2005-00797 Plan Review Major - Planning 103.00 COM2005-00797 + 7% State Surcharge 94.14 COM2005-00797 + 10% Administrative Fee 134.49 !, Item Total: $6,734.78 Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Amount Paid Check RAYMOND C. JACKSON ddk 4462 In Person $6,734.78 Payment Total: $6,734.78 :.';" 7/15/2005 Page 1 of 1