HomeMy WebLinkAboutApplication APPLICANT 8/12/2011
City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Site Plan Review Minor Modification
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licant Name: Keith Lockhart
Phone: 541 744-3776
Com an :
Address:
S rin field Utilit Board
223 A Street, Suite B
Fax:
541 744-3654
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S rin field, OR 97477
A Iicant's Re .. Scott Morris
Phone:
302-9790
485-3253
Com an :
Address:
Olson & Morris
Fax:
380 Street, Ste 200 S rin field OR 97477
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Owner: Same as A licant
Phone:
Fax:
Address:
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ASSESSOR'S MAP NO: 17-03-35-41
TAX LOT NO S : 5500
1005 Main Street
0.50
Acres [gJ S uare Feet 0
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Pro osed Name of Pro"ect:
Description of If you are filling in this form by hand, please attach your proposal description to this application.
Pro osal: Construct a roximate 3600 SF structure to ark SUB vehicies
Associated A Iications:
Case No.:
1<; Date: Reviewed b : 'It^('--
'i1.6L:> J.
Technical Fee: $ 0:;:>2>0')
A Iication Fee: $
TOTAL FEES: $
J~S,D~
PROJECT NUMBER: PRJII-oOOl
,. Date Re.c~~ved: ,4,.;.
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Original submittrd
Revised 2/25/11
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Signatures
The undersigned aCknowledges that the information in this application is correct and accurate.
Applicant:
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Signature
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Print
Date: R- IJ. -Q.[) II
If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf.
Owner:
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Print
Date:
,... Date Received: 1...
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Site Plan Review Minor Modification Submittal Requirements Checklist
Application Fee - refer to the Development Code Fee Schedule for the appropriate fee
calculation formula. A copy of the fee schedule is available at the Development Services
Department. Any applicable application, technology, and postage fees are collected at the
pre-submittal and submittal stages.
Site Plan Review Minor Modification Application Form
Narrative explaining the purpose of the proposed development, the existing use of the
property, and any additional information that may have a bearing in determining the
action to be taken, including findings demonstrating compliance with SDC 5.17-125, Site
Plan Review Criteria.
Copy of the Deed
Copy of a Preliminary Title Report issued within the past 30 days documenting
ownership and listing all encumbrances.
Right-of-Way Approach Permit Application provided where the property has frontage
on an Oregon Department of Transportation (ODOT) facility.
PROVIDE THE FOLLOWING INFORMATION UNLESS OTHERWISE DIRECTED BY CITY
STAFF. PLEASE NOTE THAT THE PLANNER ASSIGNED TO YOUR APPLICATION MAY
REQUEST ANY INFORMATION ON THIS LIST DURING COMPLETENESS REVIEW IF IT IS
NOT SUBMITTED WITH THE ORIGINAL SUBMITTAL AND IS NECESSARY FOR
REVIEWING THE APPLICATION.
o Three (3) Copies of the Stormwater Management System Study with completed
Stormwater Scoping Sheet attached - the plan, supporting calculations, and
documentation must be consistent with the City's Engineering Design Standards and
Procedures Manual.
!6( Three (3) Copies of the Modified Plan Sets Including the Following:
gJ All of the following plans must include the scale appropriate to the area involved and
sufficient to show detail of the plan and related data, north arrow, and date of
preparation.
KJ All plan sets must be folded to 8V2" by 11" and bound by rubber bands.
a. Site Assessment of Existing Conditions
!:8l Prepared by an Oregon licensed Landscape Architect or Engineer
IZl Vicinity Map
t5Z1 The name, location and dimensions of all existing site features including buildings, curb
cuts, trees and impervious surface areas, clearly indicating what is remaining and what
is being removed. For existing structures to remain, also indicate present use, size,
setbacks from property lines, and distance between buildings.
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l'iqrtThe name, location, dimensions, direction of flow and top of bank of all watercourses
and required riparian setback that are shown on the Water Quality Limited Watercourse
Map on file in the Development Services Department
I.El The 100-year floodplain and floodway boundaries on the site, as specified in the latest
adopted FEMA Flood Insurance Rate Maps or FEMA approved Letter of Map Amendment
or Letter of Map Revision
IZl The Time of Travel Zones, as specified in SDC 3.3-200 and delineated on the Wellhead
Protection Areas Map on file in the Development Services Department
~ Physical features including, but not limited to trees 5" in diameter or greater when
measured 4 V2 feet above the ground, significant clusters of trees and shrubs,riparian
areas, wetlands and rock outcroppings
,~ Soil types and water table information as mapped and specified in the Soils Survey of
Lane County. A Geotechnical Report prepared by an Engineer must be submitted
concurrently if the Soils Survey indicates the proposed development area has unstable
soils and/or a high water table
b. Site Plan
g] Prepared by an Oregon licensed Architect, Landscape Architect, or Engineer
igJ Proposed buildings: location, dimensions, size (gross floor area applicable to the
parking requirement for the proposed use(s)), setbacks from property lines, and
distance between buildings
~ Location and height of existing or proposed fences, walls, outdoor equipment, storage,
trash receptacles, and signs
C8l Location, dimensions, and number of typical, compact and disabled parking spaces;
including aisles, wheel bumpers, directional signs, and striping
tKl Dimensions of the development area, as well as area and percentage of the site
proposed for buildings, structures, parking and vehicular areas, sidewalks, patios, and
other impervious surfaces
Jgj Observance of solar access requirements as specified in the applicable zoning district
IKI On-site loading areas and vehicular and pedestrian circulation
lRJ Access to streets, alleys, and properties to be served, including the location and
dimensions of existing and proposed curb cuts and curb cuts proposed to be closed
IRJ Location, type, and number of bicycle parking spaces
5?J Location of existing and proposed transit facilities
!Sa Area and dimensions of all property to be conveyed, dedicated, or reserved for
common open spaces, recreational areas, and other similar public and semi-public uses
+Phased Development Plan - where applicable, the Site Plan application must include a
phasing plan indicating any proposed phases for development, including the boundaries
and sequencing of each phase. Phasing must progress in a sequence promoting street
connectivity between the various phases of the development and accommodating other
required public improvements, including but not limited to, sanitary sewer, stormwater
management, water, and electricity. The applicant must indicate which phases apply
to the Site Plan application being submitted,
c. Improvement and Public Utilities Plan
l8J Prepared by an Oregon licensed Civil Engineer
,.. Oate Receivad:
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IZJ Location and width of all existing and proposed easements
~ Location, widths (of paving and right-of-way), and names of all existing and proposed
streets, alleys, dedications or other right-of-ways within or adjacent to the proposed
development, including ownership and maintenance status, if applicable.
1SI Location and type of existing and proposed street lighting
~ Location of existing and required traffic control devices, fire hydrants, power poles,
transformers, neighborhood mailbox units, and similar public facilities
IKI Location, width, and construction material of all existing and proposed sidewalks,
sidewalk ramps, pedestrian access ways, and trails
rgJ Location and size of existing and proposed utilities on and adjacent to the site including
sanitary sewer mains, stormwater management systems, water mains, power, gas,
telephone, and cable TV. Indicate the proposed connection points
d. Grading, Paving, & Stormwater Management Plan
~ Prepared by an Oregon licensed Civil Engineer
~ Planting plan prepared by an Oregon licensed Landscape Architect where plants are
proposed as part of the stormwater management system
1:$1 Roof drainage patterns and discharge locations
~ Pervious and impervious area drainage patterns
~ The size and location of stormwater management systems components, including but
not limited to: drain lines, catch basins, dry wells and/or detention ponds; stormwater
quality measures; and natural drainageways to be retained
[;Q Existing and proposed spot elevations and contours lines drawn at 1 foot intervals (for
land with a slope over 10 percent, the contour lines may be at 5 foot intervals)
IEL Amount of proposed cut and fill
e. Landscape Plan
o Drawn by a Landscape Architect ~ '
o Location and dimensions ofz:andscaPi nd open space areas to include calculation of
landscape coverage
o Screening in accordance . SDC 4.4-110
o Written descriptio , ncluding specifications, of the permanent irrigation system
o Location a ype of street trees
o List i art form the proposed types of landscape materials (trees, shrubs, ground
c er). Include in the chart genus, species, common'name, quantity, size, spacing,
cand method of planting
f. Architectural Plans
!21:: Exterior elevations of all buildings and structures proposed for the development site,
. including height
\'-l \ 1lTI Conceptual fioor plans
g. On-Site Lighting Plan
" Date n~cel\..'ed:
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m Location, orientation, and maximum height of exterior light fixtures, both free standing
and attached.
g] Type and extent of shielding, including cut-off angles, and type of illumination,
wattage, and luminous area
t-.I J~Photometric test report for each light source
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Additional Materials That May be Required
D
Where a multi-family development is proposed, any additional materials to
demonstrate compliance with SDC 3.2-240
Riparian Area Protection Report for properties located within 150 feet of the top of
bank of any Water Quality Limited Watercourses (WQLW) or within 100 feet of the
top of bank of any direct tributaries of WQLW
A Geotechnical Report prepared by an engineer must be submitted concurrently if
there are unstable soils and/or a high water table present
Where the development area is within an overlay district, address the additional
standards of the overlay district
If five or more trees are proposed to be removed, a Tree Felling Permit as specified
in SDC 5.19-100
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D A wetland delineation approved by the Oregon Division of State [ands must be
submitted concurrently where there is a wetland on the property
D Any required federal or state permit must be submitted concurrently or evidence
the permit application has been submitted for review
D Where any grading, filling or excavating is proposed with the development, a Land
and Drainage Alteration permit must be submitted prior to development
D Where applicable, any Discretionary Use or Variance as specified in SDC 5.9-100
and 5.21-100
D An Annexation application, as specified in SDC 5.7-100, where a development is
proposed outside of the city limits but within the City's urban service area and can
be served by sanitary sewer
,. ' Date Rcrce:ved: 1';,
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Site Review Modification Narrative
This narrative is for a site review modification application on one parcel located within
the Springfield Utility Board electric facility at lOth and Main, in Springfield, Oregon.
The requested modification is in addition to the final site plan equivalent application that
is being submitted concurrently that includes all 12 parcels under their ownership at this
location.
Applicant / Owner
Springfield Utility Board
Altn: Keith Lockhart
223 A Street, Ste B
Springfield, OR 97477
(541) 744-3776
Proiect Location
Address:
Tax Lot:
1005 Main Street
17-03-35-41 T.L. 5500
Existing Use of Site
The site is currently used for traffic circulation between Main Street and South' A' Street
and has a large area in the middle that is used for parking of SUB vehicles. The site is
100% paved (impervious) and has existing utilities (storm, sanitary, electric, water)
running through the site.
Proposed Modification
The applicant is proposing to construct a 3600 square foot structure on the parcel to park
SUB vehicles. This will replace the current outdoor parking on the parcel.
Land Use
The parent zoning of the property is Community Commercial, with a general land use of
Utilities. The land uses of the abutting properties is:
North: Community Commercial - existing use is a parking lot for LRAP A
East: Community Commerical - existing paving and buildings used by SUB
South: Heavy Industrial - Manufacturing facility
West: Community Commercial - existing electric sub station facility
The proposed modification to the site meets the land use requirements J.h. e ID t R -' 'ed"
development code given the abutting land use zoning and uses. . a e .ec'OJl\i "
AUG l'~ Z~:l
Original submitt~l.
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Site Access
There are existing driveways to the site from Main Street and South' A' Street. These
access points will be maintained, and the proposed structure will not hinder the existing
traffic circulation pattern between the public streets.
Grading
The existing site has an approximate 2 foot grade break in the pavement. The proposed
structure will be constructed to reduce the high area on the site and match the existing
grade of the driveway that connects to South 'A' Street.
Waste water System
The proposed building will have no sanitary facilities, and no changes to the existing
waste water system is proposed.
Storm Water System
The existing storm water system on the site is a series catch basins collecting the run off
and directing the water to the public system in lOth Street. The proposed project will not
change the locations of any catch basins, and the existing drainage areas will be
maintained. Due to grade changes required for the new structure, there will be some
additional piping and one trench drain installed.
The proposal is to install a new trench drain at the south end of the new structure to
collect run off water prior to entering the new building. This drain will be piped to the
existing storm pipe on the north side of the building (where this area currently drains to).
The roof drainage will be collected in a perimeter drain that is connected to the trench
drain discussed above and ties into the existing pipe north of the building. See sheet C2
of the plans for details on the proposed changes to the storm drainage system.
The site is currently 100% paved and is used for outdoor parking of SUB vehicles. The
proposed structure will provide covered parking for these same vehicles. Roof area is
much cleaner than paved surfaces, therefore the water quality run off from this 3600
square feet of replacement will have substantially improved water quality.
Because of this, there are no additional pollution control facilities proposed.
Water System
The proposed building is an open air structure that is not required to be sprinkled. There
are also no proposed facilities within the new buil~ing that will reqUireJ.......me[jcraw~l". "'." d'
Therefore, there are no proposed changes to the eXlstmg water system.' a e ,,\;;_is.\:e .
. AUG 1 2 2na
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Original Submitted
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Electric System
The building will have interior lighting and exterior wall packs that will require electric
service. The proposal is to extend a utility trench from the existing electric transformer
shown on sheet C2 of the site plan. There will be a circuit panel installed within the
building to serve the lighting needs.
. Site Lighting
The proposal is to install wall pack lighting on the exterior of the building to provide
lighting to the site. The wall pack locations are shown on the attached elevations for the
structure. The lights will be designed and aimed to not allow any light trespass off the
SUB owned property.
Landscape
The lot is currently 100% impervious with no intemallandscape. However, the sub
properties as a whole have perimeter landscape that includes trees, shrubs, and
groundcover. This particular parcel is also currently screened from public view and
neighboring properties by an existing chain link fence with slats and existing buildings
around the site.
It is not feasible to add interior landscape to the project due to the traffic circulation
needs, and there is no apparent benefit since the perimeter of the site is currently
landscaped and screened.
Therefore, there is no new landscape features proposed as part of this project.
Drinking Water Protection
The proposed lot is located outside the 20 year time of travel zone for drinking water
protection. This coupled with the fact that the site is currently 100% impervious and that
is not proposed to change, there should be no further requirements regarding drinking
water protection. .
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Date Received:
AUG 1 2 2~il
Original S,,::';;.:;;~,:
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1651 Centennial Blvd. . Springfield, OR 97477
P.O. Box 931 . Spnngfield, OR 97477
Phone: 541.741.1981
Fax: 541.741.0619
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TITLE INSURANCE SERVICES. ESCROW CLOSINGS
625 Country Club Rd' Eugene, OR 97401
P.O. Box 10211 . Eugene, OR 97440
Phone: 541.687.9794
Fax: 541.687.0924
July 13,2011
Order No. 11-4673
PRELIMINARY TITLE REPORT
Olson and Morris
380 "a" Street Ste 200
Springfield, OR 97477
Alln: Larry Olson
e-mail: larry@olsonmorris.com
Dear Larry Olson:
Partiai Biiiing
Additional Chain
$200.00
TOTAL
$200.00
We are prepared to issue on request and on recording of the appropriate documents, a policy or policies
as applied for, with coverage's as indicated, based on this preliminary report.
LEGAL DESCRIPTION:
SEE EXHIBIT"A" ATTACHED HERETO
Showing fee simple title as of July 05, 2011, at 8:00 a.m., vested in:
City of Springfield, acting by and through the Springfield Utility Board, its succssors and assigns
Subject only to the exceptions shown henein and to the terms, conditions' and exceptions contained in the
policy form. No liability is assumed until a full premium has been paid.
't,
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/Date Rec:aived:
AUG 1 2 2C~1
Order No.: 11-4673
Page 1 of4
Original Subrri;,~:
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SCHEDULE B
GENERAL EXCEPTIONS
1. Taxes or assessments which are not shown as existing liens by the records of any taxing authority
that levies taxes or assessments on real property or by the public records; proceedings by a
public agency which may result in taxes or assessments, or notices of such proceedings, whether
or not shown by the records of such agency or by the public records.
2. Facts, rights, Interests or claims which are not shown by the public records but which could be
ascertained by an inspection of the land or by making inquiry of persons In possession thereof.
3. Easements, or claims of easement, not shown by the public records; reservations or exceptions in
patents or in Acts authorizing the issuance thereof; water rights, claims or title to water.
4. Discrepancies, conflicts in boundary lines, shortage in area, encroachments or other facts which a
correct survey would disclose.
5. Any lien, or right to a lien, for services, labor, material, equipment rental or workers ccmpensatiln
heretofore or hereafter fumished, imposed by law and not shown by the public records.
CURRENT EXCEPTIONS:
6. 2011-2012 taxes, a lien not yet due or payable.
7. The reai property taxes for the fiscal year 2010-2011 are exempted by virtue of city ownership.
The company assumes no liability should the exempt status be lifted and taxes levied. (Map No.
17-03-35-41-05400, Code 19-99, Account No. 0316909; 17-03-35-41-05500, Code 19-99,
Account No. 0316917)
8. Easement, including the terms and provisions thereof, by instrument Recorded Oelober 1,1946,
Book 332, Page 432, lane County Oregon Records.
9. Grant of Easement and Right-of-Way, granted to the City of Springfield, a municipal corporation,
of the State of Oregon, including the terms and provisions thereof. by instrument Recorded
November 10, 1955, Reception No. 70405, Lane County Oregon Reccrds.
10. Easement, 9ranted to the City of Springfield, a municipal corporation in lane County, Oregon,
inclUding the terms and provisions thereof, by Instrument Recorded June 2, 1969, Reception No.
66187, lane County Oregon Records.
11. Downtown Urban Renewal Plan and Report, including the terms and provisions thereof, by
instrument Recorded December 7, 2007, Reception No. 2007-081042, lane County Oregon
Records.
NOTE: The address of the property to be Insured herein is:
Unknown Main Stree~ Springfield, OR 97477.
1005 Main Stree~ Springfield, OR 97477.
NOTE: A JudgmenVLienlBankruptcy Search was done for the name(s) City of Springfield, acting
by and through the Springfield Utility Board, and as of July 05, 2011, none were found.
NOTE: As of July 5, 2011, there are no liens for the City of Springfield.
INFORMATIONAL NOTE: EVERGREEN LAND TITLE COMPANY FINDS NO NOTICE OF
RESCISSION RECORDED IN THE LAST 24 MONTHS. J. .
. Date R!3celved:
Order No.: 11-4673 . AUG 1 'L 2011
Page 2 or 4
Original Subrn:lt~i
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INFORMATIONAL NOTE: The current vesting deed and all changes back to the deed which
vests ownership 24 months ago are as follows:
QUITCLAIM DEED RECORDED DECEMBER 29, 2009, FROM THE CITY OF SPRINGFIELD,
OREGON, TO THE CITY OF SPRINGFIELD, ACTING BY AND THROUGH THE SPRINGFIELD
UTILITY BOARD, RECEPTION NO. 2009-071590.
Very truly yours,
EVERGREEN LAND TITLE COMPANY
HOME OFFICE
By:
,
Joseph M. Silence
Title Officer
cc:
NO LIABILITY IS ASSUMED HEREUNDER UNTIL POLICY IS ISSUED AND PREMIUM PAID. IF FOR
ANY REASON THE REPORT IS CANCELLED, A MINIMUM CANCELLATION FEE OF $200.00 WILL BE
CHARGED.
J
Date Received:
AUG 1 f. 2811
Original SubmiiU
Order No.: 11-4873
Page 3 014
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EXHIBIT "A"
LEGAL DESCRIPTION.
Beginning at the Northeast corner of lot 12, WASHBURN'S ADDITION TO SPRINGFIELD, LANE
COUN1Y, OREGON; running thence South along the East line of said lot to the Southeast corner
thereot, thence in a Northwesterly direction to the Southwest comer of said Lot; thence North to a point
200 feet South of the Northwest comer of said Lot; thence East 85 feet; thence North to the North line of
said Lot; thence East to the Place of Beginning, all in Lane County, Oregor'l.
ALSO: Begir'lnir'lg at a poir'lt 180 feet South of the Northwest comer of Lot or Tract No. 12, ir'l
WASHBURNE'S ADDITION TO SPRINGFIELD, LANE COUNTY, OREGON, as platted and of record Ir'l
said County; and running thence South 20 feet; thence East parallel with the North line of said Lot or
Tract No. 12, to the East line of said Lot or Tract No. 12; thence North along the East line thereof 20 feet;
thence West to the Place of Beginning, in Lane County, Oregon.
RESERVING THEREFROM a right-of-way for road purposes 12 feet wide over the East 12 feet thereof, 1
and granting a right-of-way for road purposes over the East 12 feet of the North 150 feet of said Lot or
Tract No. 12, all in Lane County, Oregon.
EXCEPT that portion of the above described properties lying within the right-of-way of South "A" Street In
the City of Springfield, Lar'le County, Oregon. .
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Date Received:
AUG 1 2 2C11
Order No.: 11-4673
Page 4 of4
Original submittal
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Lan. County D.ad. and R.cords U1J~~
IIIIIIIIIIWIIIIIIIIIIIIII I /11111111I11I11111 III $47.00
BII229822BB90B71S91~20023
RPR-DeED Cnbl 5\no1 cJM~~9 02:17:44 P"
$ID.DO $11.00 $18.00 SIO.OO
'U-?,- t.. "',;.q _ fZ-
After R9<XIrdina Retum to:
Springfi.eld Utility Board
250 A Street
Springfield, OR 97477
Until Requested Otherwise
Send All Tax Statements to:
Springfield Utility Boerd
250 A Street
Springfield, OR 97477
QUITCLAIM DEED
KNOW ALL BY THESE PRESENTS.-thettheClty.of Springfield, Oregon. Grant.~s), do hereby.
remise, release, and forever Quitclaim unto ,the City of Springfield, acting by and through the
Springfleld Utility Board. Grantee, Its successors and assigns, ell the following real property, with the
tenements, hereditaments and appurtenances, situated In the County of Lane, State of Oregon,
bounded and desc!ibed Ei$ fonows:
See Exhibit A attached hereto and IncQrporated herem by reference
TO HAVE AND HOLD, the above described and granted premises unto the said Grantee, its
successors and assigns forever.
THE CONSIDERATION for this conveyance is ather than ":lonetary.
IN Wl)::NESS WHEREOF, the Grantors above named have hereunto set their hands and seals thIs
IIf ' ,dayol il~e"",he.IC ,2009.
Slgnalure: ~ ~
Print name: G no Gnma, 1
City Manager, City of Springfield
STATE OF OREGON )
)55.
COUNTY OF LANE }
BE IT REMEMBERED that on this ~ day 01 D.e l' eM b cr . 2009, belore me, lt1e
undersigned. a notary public In and for said County and State, personally appeared the within
named Gino Grimaldi whose identity was proved to me on the basis of satisfactory evidence and who
by me duly sworn, did say that he Is the City Manager of the City of Springfield and does acknowledge
said Instrumenl to be the lree act end deed 01 said City of Springfield.
'IN TESTIMONY WHEREOF. I have hereunto set my hand and affixed my official seal the day end
year last above written.
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AMYLSOYI'A ~ ... ,~._
NOTARYPUBUC-CREGCIi ~k
CCOIISS"'" 00. """ Nolary Public ~regon
Wc;or.O.lSSKJlEl<PIRESNOI' 22,2013 My Commission Expires: 11-;iJ.~d'1
THE CONVEYANCE set forth in this Instrument ccrlveying title or Interest to the City of Springfield, by
and through the Springfield Utility Board, is hereby approved, and the title or Interest conveyed therein
is hereby eccepted.
SPRINGFIELD UTILITY BOARD
By:
aJz. LL
Rooort Linehan, General Manager
tZ#7/a9
, t1ate Rec$ived:
..1 AU3 1 2 :211
Original Subiilitt,,1
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N:\SUB\Rp!Jl'!'1\Gatew8Y Substallon TIUe lssue\Quitcl!"lm Deed #3. City To SUB.Doc
.
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SPi~;G._=E?ij
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~OREGON
TRANSACTION RECEIPT
www.cLspringfield.or.us
TYP111-00019
1005 MAIN ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
pe rmltcenler@ci.springfield.or.us
100-00000-425605
--~-'---'--
100-00000-425002
-----
TOTAL DUE:
. ;CASfHER:TJONES '-~____~::::'c..Q.~M~~c't~~,;~
~_., -.
Check #186276
Springfield Utility Board
PO BOX 300
Springfield OR 97477
(Check total was $1,491.10 -
$188.05 was applied to
TYP111-00018)
RECEIPT NO: 378277
!DESCRIe,TI()riI~'.;;,j '., . 7' "'."'.:;::" ~" .l.ch:"','
5% Technolo~y Fee
Site Plan Revi~~ Modifications - Minor - City
LtAY~I.l!:f!1J:"
Check
186276
. ~: PAYOR
RECORD NO: TYP111-00019 DATE: 08/12/2011
.,.,~ "'~, .'. .,:AC.COUril:t:tODE' ::::w::'( .:, ';AMOl1NJ,DUE'1.:,:'
62.05
1,241.00
1,303,05
AMOUNTPAID:.J;.',j.
----... ". .. ... ".
1,303,05
TOTAL PAID:
t-
o
I.
f,'
I
1,303,05
Date Received:
AUG 1 2 2011
Original Submittal
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