HomeMy WebLinkAboutPermit Building 2003-11-4
'f'
'I
Status
Issued
225 Fifth Street. Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
.
-
CITY OF SPRl~t.t<1J!,LJJ
Building/Combination Permit
PERMIT NO: COM2003-00988
ISSUED: 11/04/2003
APPLIED: 09/30/2003
EXPIRES: 05/04/2004
VALUE: $ 186,800.00
SITE ADDRESS: 811 River Knoll Way
ASSESSOR'S PARCEL NO,: 1703234311500
PROJECT DESCRIPTION: SFR
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE:
New
Residential
Owner: FUTURE B INC
Address: PO BOX 7425 EUGENE OR 97408
"
Contractor Type
General
Electrical
Mechanical
Plumbing
Contractor
FUTURE B INC
DEANS ELECTRIC
JUNG ENTERPRISES INC
CHAPIN ENTERPRISES INC
Phone
541-744-2660
541-935-5303
541-741-0002
541-485-1146
1 # of Stories: 1 Lot Size:.,
~ ~
R-3 Heigh! of Structure 26.00 Sq Ft 1st ~Ioor:
U-l <. ''WI!4r Heat: Forced Air Gas Sq.I;:t~n~$IQar:
VN ,,-,,W 1:' T G S'~ B'" -'- -~)
,\'1.'", ,ater ype: as vq~~ ~s~~,~ot:",
~ ~ ~Ranje Type: Gas ,0<8q\Ft Ga'rage/Ca~ort
~~ ~<',8' ~<$o'ergy Path: Path,~~ ~s'ci~Ft'ottier:,'v' o~~ o~
,,<<; "-.~S .1;::;\5 o~ 'Q~ -.: Iri;p~Fi'o~'f!Iff~~e~rea:
.",\,; ....." ""'" ....o:i)r,. e,.'<J,~ 0 ~O'i ~~"
..~. ....~ S~~'\)'<.-{o "~DEVELOPMENT INFORMAUON...:,~,:,,<,-~U~~,0~~0,--\~U~t>0'
SETBACK8~" k-<<;.......x.,'\) '\)<<;. o..~~ ~,~ 'l>- ~0 >:>'<:;)' ~ v.::,.(y-0 ~Q!;!IRED PARKING
~~ S ~ ~'\: \.'\) ",<IY . ,,:<:- ~0<" 00 5:J ~~ ~- ~v (,,<"1
Front yard Setbacle ~ y;-\5 ~\.) 10,00 Overlay Dist: -0"'" ,'> ;:. r;:p' d> -0" ~o 1;Otal: 2
Side 1 Setback: "\ ~"\ ~~<<: $:I '\)5.00 # Street Trees Rqd:.p~ ~o b'l: 'l>~ iF 0,0 'l<:'Haodicapped:
Side 2 Setback: ,,\5 _\,~ 11.00 PavedDriveRqd:.y~,v~<?i ,,~ra~es0 .co"'. Compact:
~' _\.0 ~ -\.0 '$' <. "
Rearyard Setback: ~ 32.00 % of Lot Coverage:~ 0 g,<:;)' ~l>;' ~2l5J~~
Solar Setbacks: 0.00 <:;)<::5 v~~'Q0 (
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
..
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
~
I CONTRACTOR INFORMATION I
License
36499
99579
102455
81994
Expiration Date
05/18/2004
06/20/2004
10/04/2004
05/06/2004
BUILDING INFORMATION I
7,500
1,926
517
".
I PUBLIC IMPROVEMENTS I
FullV Improved
Yes
Sidewalk Type:
Downspoutsillrains:
Curbside 5'
Curb and Gutter
Pa2e 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
Dwellines
Caraee
V Wood Frame
Caraee
Fee Description
Plan Review Residential
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
2 Baths One or Two Family
Addressing Assignment
Appliance Vent
Backnow Device
Building Permit
Curbcut Permit
Dryer Vent
Exhaust Hoods
Furnace - up to 100,000 btu
Cas Fireplace
Cas Outlets 1-4
Plan Review - Planning
PW Mult Disc - 2nd Permit
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
Total Amount Paid
.
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CITY OF SrK1j~ljt<lJ!,LD
Building/Combination Permit
PERMIT NO: COM2003-00988
ISSUED: 11/04/2003
APPLIED: 09/30/2003
EXPIRES: 05/04/2004
VALUE: $ 186,800.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$90.60
$23.80
Square Footage
or Bid Amount
1,926.00
517.00
Value
Date Calculated
$174,495.60
$12,304.60
$186,800.20
09/30/2003
09/30/2003
Total Value of Project
Fpp< P1ilLl
Amount Paid
$551.46
$10.00
$139.94
$97.96
$254.00
$8.00
$6.00
$14.00
$848.40
$75.00
$6.00
$9.00
$12.00
$15.00
$4.00
$59.00
$-30.00
$106.00
$57.00
$413.04
$543.36
$10.00
$34,83
$332.86
$112.84
$50.45
$727,42
$164.89
$75.00
$1,039,36
$50,00
$18.00
$1,000,00
$6,814.81
Date Paid
Receipt Number
9/30/03
11/4/03
11/4/03
11/4103
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03 '
11/4/03
, 11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
11/4/03
1200200000000002238
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
2200200000000001717
Paee 2 of 4
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CITY OF ~nul~uNJ!,LD
'.
Status
Issued
Building/Combination Permit
PERMIT NO: COM2003-00988
ISSUED: 11/04/2003
APPLIED: 09/30/2003
EXPIRES: 05/04/2004
VALUE: $ 186,800.00
225 Fifth Street, Springfield. OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Initial Review
Plan nine Review
Public Works Review
Structural Review
09/30/2003
09/30/2003
10/03/2003
09/30/2003
I Plan Reviews I
09/30/2003 APP
10/15/2003 APP
10/06/2003 APP
10/17/2003 WE
LLH
TAJ
VRJ
DLM
Called Jerry Braunberger &
requested revised foundation plan
showing the layout for the proposed
post & beam framing. Called
architect and requested lateral
calculations for the building shear
walls.
Structural Review
11/03/2003
11/03/2003
APP TCM
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.
~prtinn~J
I Curbcut- Standard: After forms are erected but prior to placement of concrete,
2 Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
3 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
4 Footing: After trenches are excavated.
5 Foundation: After forms are erected but prior to concrete placement.
6 Post and Beam: Prior to Iioor insulation or decking,
7 Floor Insulation: Prior to decking.
8 Shear Wall Nailing: Before covering sheathing with finish materials.
9 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
10 Wall Insulation: Prior to cover,
II Ceiling Insulation: Prior to cover,
12 Drywall: Prior to taping.
13 Hold Downs Installed: Special Inspection performed prior to placement of concrete, Provide report to City
Building Inspector.
14 Final Building: After all required inspections have been requested and approved and the building is complete.
IS Underlioor Plumbing: Prior to insulation or decking.
16 Underlioor Drain: Prior to cover or placement of concrete.
17 Rough Plumbing: Prior to cover and including required testing.
18 Water Line: Prior to filling trencb and including required testing.
19 Sanitary Sewer Line: Prior to filling trench and including required testing.
20 Storm Sewer Line: Prior to filling trencb.
21 Final Plumbing: When all plumbing work is complete,
22 Backliow Device: Prior to covering and provide a copy of the test report on site at the time of inspection.
23 Underlioor Mechanical. Prior to insulation or decking and including required testing.
24 Rough Gas: After line is installed and required testing and capped if not allached to an appliance,
25 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.
26 Rough Mechanical: Prior to Cover
Paee 3 of 4
Co -iiir~
.
_ CITY OF SrKll"lut<lJ!,LD
Building/Combination Permit
PERMIT NO: COM2003-00988
ISSUED: 11/04/2003
APPLIED: 09/30/2003
EXPIRES: 05/04/2004
VALUE: $ 186,800.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
27 Final Gas: When all gas work is complete.
28 Final Mechanical: When all mechanical work is complete,
29 Temporary Electric: Approval required prior to Utility Company energizing pole,
30 Rough Electric: Prior to Cover
31 Electric Service: Approval required prior to utility company energizing service,
32 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.
~",..,,""
fI J+) () 3--
t
Date
Paee40f4
. .'
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'Job. NO.loo\ t'}J)~'<if6
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME: \{1~-kllQ., ~.~J.V
ADDRESS: ~. ~~
PHONE: t44 .~toO
STATE: DlL ZIP: aWl
LOCATION OF PROPOSED BUILDING SITE:
Street Address: _P,l\ . Q~~ 'U\nH \ L1lu!
. , - ~
Plat Name:' Q.i\1&I? C:l\eJ\4~ax Lot Number: ,\'1Do134~ \\."')Of)
1 ~ 'DEVELOPMENT TYPI; (Check appropriate dwelfing(s). SOC calculations and dwelfirig I
, yt>e definitions are on the back.)
A. ,Sinnle-FAmilv DetAched
NO. OF UNITS
Manufactured home not in a park '
X $1,000 per unit =$ :JD"':D . ~
\ Single Family home
\
B. Sin'nle-FAmilv Attached.
NO. OF UNITS
X $924 per unit ' =, $,
C. Multi-Familv Aoartment
NO. OF UNITS
X .$692 per unit - $ ·
D. ,MAnufAduferl Homfl PAns.
NO. OF UNITS
,'WILLAMALANE SDC
X $699 per unit
'= $
-
$~.OO
2. SDC CREDIT (ll appficable) soc-payer must lurnlsh prool 01 ,,.(
Willamalane Credit approvaL See sac Credit Worl<sheet. $ fl.l
3; TOTAL WILLAMALANE NET SDC ASSESSED
(il SDC reduced lor Credit)
$ '\ r"{)n pi)
~) )\t"N\n~)
Oevelopme~t~Oepartment
City of Springfield
\\ I + ,Ja
Date
CITY OF INGFIELD SYSTEMS DEVELOPMEAoRKSHEET
JOURNAL OR JOB NUMBER: Com2003-00988
NAME OR COMPANY: Future B homes
LOCATION: 811 River Knoll
TAX LOT NUMBER: 17032343 tl 11500
DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF' 1926 LOT SIZE (SF):
J. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S,F, x I COST PER S,F. CHARGE I
I 3584,00 I $0,290 I = I $1.039.36
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S,F, I x I COST PER S,F, I x I DISCOUNT RATE I I DISCOUNT
I 0,00 I $0,290 I I 50% I ~ $0.00
ITEM I TOTAL - STORM DRAINAGE SDC $1,039.36 ,
2, SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU
I 24 I I $22,64
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x COST PER DFU
I 24 $17,21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = ,
3, TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I
I 9.57 I I I
B. IMPROVEMENT COST:
I ADTTRIPRATE I x I NUMBER OF UNITS I
I 9.57 I I I
ITEM 3 TOTAL - TRANSPORTATION SDC
$956.40
x I COST PER TRIP x INEW TRIP FACTORI
I $17,23 1.00 I
x I COST PER TRIP x INEWTRIP FACTOR I
I $76,01 1.00 I
= , 5892.31
7500
t/.l
~
o
o
u
~
~
E-<
4a
~
$1,039.36
1070
5543.36
11091
5413.04
I 1092
5164.89 1093
I
5727.42 11094
J
4, SANITARY SEWER - MWMC
A, REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $332,86
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I $34,83
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC
= , 5377.69
~ , 53,265.76
CHARGE
$163,29 '. '
[ SUBTOTAL (ADD ITEMS 1,2,3, & 4)
I
I
=
5332.86
1054
=
534.83
50.00
510.00
1056
1055
1054
5, ADMINISTRATIVE FEE:
ISUBTOTAL I x I ADM. FEE RATE 1=
I $3.265.76 I 5% I
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Virginia Jurasevich
PREPARED BY
10/6/2003
TOTAL SDC CHARGES
DATE
-I
I
112,84 11079
550.45 11078
I
=, $3,429.05
.
.
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
II NUMBER OF NEW FIXTURES x. UNIT EQUIVALENT "" DRAINAGE FIXTURE UNITS
(NOTE, FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO, OF FIXTURES
UNIT
FIXTURE TYPE NEW OLD EQUIVALENT
I BATHTUB 2 0 3 I =
IDRINKING FOUNTAIN 0 0 1 =
IFLOOR DRAIN 0 0 3 =
IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 =
IINTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 =
ILAUNDRY TUB 0 0 2 =
ICLOTHESW ASHER / MOP SINK 1 0 3 =
ICLOTHESWASHER - 3 OR MORE (EAt 0 0 6 =
IMOBILE HOME PARK TRAPp PER TRAILER) 0 0 12 =
IRECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 =
IRECEPTOR FOR COM, SINK / DISHWASHER / ETC. 0 0 3 =
ISHOWER, SINGLE STALL 1 0 2 =
ISHOWER. GANG (NUMBER OF HEADS) 0 0 2 =
ISINK: COMMERClAURESIDENTIAL KITCHEN 1 0 3 =
I~;]NK: COMMERCIAL BAR 0 0 2 =
ISINK: WASH BASIN/DOUBLE LA VATORY 2 0 2 =
ISINK: SINGLE LA V A TORY/RESIDENTIAL BAR 0 0 1 =
I URINAL. STALL/WALL 0 0 5 =
ITOILET, PUBLIC INSTALLATION 0 0 6 =
ITOILET, PRIVATE INSTALLATION 2 0 3 =
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 =
TOTAL DRAINAGE FIXTURE UNITS
.EDU (Equivalent Dwellin~ Unit) is a dischar~e equivalent to a sin~le family dwel1in~ unit (20 DFIJ's) set al167 ~Ilons ~ day
DRAINAGE
FIXTURE
UNITS
6
o
o
o
o
o
3
o
o
o
o
2
o
3
o
4
o
o
o
6
-'I
,
,
o
24
-.II
MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
,-
CREDIT RA TE/$ 1,000
ASSESSED VALUE
$4,92
$4,92
$4.83
$4.77
$4,64
$4.47
$4.30
$4.09
$3,78
$3.4'
$2,98
$2,52
$2,06
$1.64
$1.45
$1.31
$1.13
$0,97
$0,82
$0,63
$0,41
$0,22
$0,04
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT?
(Enter \ for Yes, 2 for No)
BASE YEAR
BEFORE 1979
1979
t980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
t998
1999
2000
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0,00 x $0.4\
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE /1000 CREDIT RATE
$0.00 x $0.41 = ,
TOTAL MWMC CREDIT
= ,
=
o
o
1998
$0,00
o
$0,00
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003.00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
Payments:
Type of Payment
CreditCard
CreditCard
.;
iF~i;
City of SpHngfield Official Receipt
Development Services Department
Public Works Department
Date: 11/04/2003 11:29:44AM
Receipt #: 2200200000000001717
Description
Addressing Assignment
Willamalane Single Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Sidewalk Permit
Curbcut Permit
PW Mult Disc - 2nd Permit
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
Plan Review - Planning
Building Permit
2 Baths One or Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Appliance Vent
Dryer Vent
Gas Outlets 1-4
Gas Fireplace
-Mechanical Issuance Fee-
Backflow Device
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
JERRY BRAUNBERGER
JERRY BRAUNBERGER
Received By
jmp
Jmp
Check Number
Batch Number
000211
000211
Amount Paid
Item Total:
8.00
1,000,00
106,00
57,00
50,00
75,00
75,00
(30,00)
1,039.36
543.36
413.04
164,89
727.42
332,86
34,83
10.00
112,84
50.45
59,00
848.40
254.00
12.00
18.00
9,00
6,00
6,00
4,00
15,00
10,00
14.00
97.96
139.94
$6,263.35
e
e
Authorization Number
How Received
In Person
In Person
Payment Total:
Amount Paid
084887
036592
$5,263.35
$1,000,00
$6,263.35
225 Fifth Street "
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
COM2003-00988
Payments:
Type of Payment
CreditCard
CreditCard
....~~."~',F1~,'''~ ,",_ "..,
WI,'.,'
~. "
",". .,,' .,'....,,- ."
City of Springfield Officiai Receipt
Development Services Department
Public Works Department
Date: 11/04/2003 11:29:44AM
Amount Paid
Receipt#:2200200000000001717
Description
Addressing Assignment
Willamalane Single Family
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Temp Power 200 amps or less
Sidewalk Permit
Curbcut Permit
PW Mult Disc - 2nd Pennit
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
Plan Review - Planning
Building Permit
2 Baths One or Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Appliance Vent
Dryer Vent
Gas Outlets 1-4
Gas Fireplace
-Mechanical Issuance Fee-
Backflow Device
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
JERRY BRAUNBERGER
JERRY BRAUNBERGER
Received By
jmp
Jmp
Check Number
Batch Number
00021I
000211
Item Total:
8,00
1,000.00
106.00
57,00
50.00
75.00
75.00
(30.00)
1,039.36
543.36
413,04
164,89
72 7.42
332,86
34,83
10,00
112,84
50.45
59,00
848.40
254,00
12,00
18,00
9.00
6.00
6.00
4.00
15.00
10.00
14.00
97.96
139.94
$6,263.35
e
e
Authorization Number
Amount Paid
How Received
In Person
In Person
Payment Total:
$5,263.35
$1,000.00
$6,263,35
084887
036592