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Home My WebLink AboutPermit Electrical 2004-10-13 .~{~~ r':i~..i~,;fl~"~'",l!~" . _,~: "'," I 't\ ".~: ~<,.. .~- ,';lc., r.... .".. ".:.",:', . >;c.... "'~'-"":'l~I.""'r '!O'" '".1' ~ -~~ r~;\y"~'~\',;",,';~,,,(>-"":..;'i",, ;~m~,jeJM>'& ~~~OOG:Fmu:.ID "'~Rlli~@~ ,'l-ti".l f.', "/i' "::,! >:~;;\'~~!.:r~\;:~':;g,1'~~~?~::f;',^~j';:';!,:t,..<~Jli;r', ,,~;,~:d~:''',.~:':."'';', ,"~,:,:.' ~;'.\,.; <<>." 5 'f I," ..",,:'!~ :;:';'i-:~S'.>'-:~~'" ,~I,:;''1~~' ~ . 9.:; 215 FIFTH STREET. SPRINGFIELD, OR 97477 0 PH:(541)726-3753 0 FAX: (54fQ,.,1"~j~ .. f'I1J~ ~ 0- ELE~'lKlCA..li\r..l!..~T AP~CATION O~~ ~/ "0':,0-"0' City Job Number ~)Ub Dare _/'1,1. ~~.I".00.;' ~.~ O.'~~'" L;1{!i!r~1~rra'J;;:'iNsr~lrlY:4iJ(iM'0rr..."\;;'~f 3. T(;i5Mii!jff.F3:'it~:$~'qJ.. ""'ii).' ';at(~~}l(<!~1 l Q1,CIfd"~1\~b6"~~ ... ",. ""~'-'" ..- """"'>;Z: .<~ '''''':C~~i~. ,- - ~\i dtfc' ~~ 2. A. i!;N~~~l{~id;fiti~i'4:siitrl;i;~~':; "'~i1tr/'~"'-fo"'~-"^~<':uri'{t:;~~~; c LDEsCJTION ,,,,,"''''''.''. .,.'.... "g,., .",. '" "". ~~g".",u XcI?J .~ ' ~. r.... ~~ S~;:';::~:;;:;:;;""'""'" '.. ><'~<>:";~'''';' JOB DESCRlP 'ION'~ ~\ 1000 sq, It o,les, ' 00 \f>lo. ~f\r\\O,1 . ~ll\dffirP. t 1Q~~0~~~:~15oosqh ~ \5t..ci) -=;:~non-tranSfera and expire if work is Each Manufact'd Home or not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder $50.00 2. ![~~~l[~l[~r.Re~t~~~i~i~ I Electrical Contractor ~;$ 15ltc:tR.~ Address t>.(). ~ A , ..'!~~~~~~~~;~';c;~~~WWit*~}~~~~: '" ,~O~~!~'i1fli.~localJon,:,'.,;:.;,!. ~j"d,ti!~..;f!M~~liJ.~T,;.~J~?:~:.~ilit,;,,j,t~IJI\\~j. City f"A\\ L~_ Phone -T~ -18'1) 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/V 0115 Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Supervisor License Number ~ 351-5 10/ OJ /0'/ Installation, Alteration or Relocation , 200 Amps or less \ Constr. Contr. Number J 0 ~ :s 1 <0 201 Amps to 400 Amps ~ I J '" 401 Amps to 600 Amps Expiration Date I 0 !..!?~J Over 600 Amps or 1000 Volts see "Bn above. ~l'g'~ature of S"pervl'sm' g Electn'cl'an D, !:~Brjlh~~'Cit'e'ui{' . _ u Ioo!i l~', '1.t1,"'f'...U~.\.';;14'~::-.."'-~,j;..;I'. ~ iP J J ~ New Alteration or Extension Per Panel ~ I!J/U~ _ One Circuit -!l \ ~ ti - Eaoh Additional Ci,cuit 0' with Own." ~am. ROC f\W t ~ IlP .l~ hntt S'~iC:.:~:~::, :::;";' '" ,,",,",,,,w..,,~,3: <,,'" " ,v' Wi Address~;O \.4laD ~~ _l!tl\O ~ E. ;,~!l~~.~!~!l.~'?~:.(~,~~~~~t,r~~~~f.~~.O!,~~,~,~~~.~~:~f.~C?,!~~.~~~~~~n:; City flYlOnO . Pb0n(~ \Q~ C\.l\ \aD Pump or inijgit)~CE: " $ 5.0.00 , ---, > :..: SignJoutlinllamha~Mn SHALL EXPIRE lf5~~d5 WUKI\ OWNER INSTALLATION . t. Limited EnAWMB~lUNDER THIS PEiWHolS NU r 'rb ., , ,-...,~...o"nn\~W reqLlir~~~~\l\.~t.... Limited En~Wx~M~QlOR IS ABANDUS~60K e !O~~'lj:l'u~'i~llHBOe' otrgtf'i~)%Bu<~'V'r"~l f:I=R1nU is not ~<<:\~<M~~'\it1~P~n'r~e \es are set iorlh Minimum Electr~~~rbfiPIRh~cti(jn Feels $45.00 + Surcharges ..~~~ a~lon center. Those ru", OAR 952-001- ;~t!I'!, "l'~';'.:.';,w'..~.i'.'i1:"~j:~f~'1t.."'.:~~i~r'.:'::;, :'.;,1:'-'i'I,..., ~~," O\.vn~'t M~ .. ~ 1-0010 thfOLlg" \ b\/ 4. ;;:s(~rQ.T9L.,QF;AIJQ,.. .1:"", vLJ \~~~~'{o:~~y obtain(~~~~~~h~ ~:\~~~~;e 1 i& ~:~!~::~:~:;::::;:;~i",i';~!>';;4';:1t '_ 'L_ '_ - ~!:l\\lng (lid ce~~,:,r. Ut'\\i\" NU~~\catlon m' "'" h OregonJ 10% Administrative Fee , numberfOf t et _ 00-332-2344). -m- Inspection RequG~nW6~~6~ TOTAL . .:Jljl Expiration Date $ 50.00 $ 69.00 $100.00 ~OP{) $ 43.00 Shared Dri'ie(T:)lBuilding Fonns/Electrical PCnl'.it Application I-03,doc CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01103 ISSUED: 10/13/2004 APPLIED: 09/03/2004 EXPIRES: 04/13/2005 VALUE: $ 330,903.00 ;' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 729 Aspen Street Springfield TYPE OF WORK: Single Family Residence ASSESSOR'S PARCEL NO.: ASPEN PARK SUB LOT: TYPE OF USE: PROJECT DESCRIPTION: Single Family Residence, Aspen Park lot 3 Owner: RODNEY & RENE STEWART Address: C/O 1460 BEEBE LANE EUGENE OR 97404 I CONTRACTOR INFORMATION' Contractor Type General Electrical Mechanical Plumbing Contractor DONALD D ELLIOTT L YNNS ELECTRIC COMFORT FLOW CHAPIN ENTERPRISES INC License 43148 102316 460 81994 BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U-l VN # of Stories: 2 Height of Structure 31.50 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Gas Energy Path: Path 1 Sprinkled Building: n/a 4 I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.00 8.00 5.00 23.00 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS. Sidewalk Type: Curbside 5' Curb and Gutter Fullv Improved Yes New Residential Phone Number: 541-689-7160 Expiration Date 11/14/2005 10/14/2007 06/27/2005 05/06/2008 Phone 541-698-7160 541-726-7895 541-726-0100 541-485-1146 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 8,475 1,940 1,313 1,248 2 Yes 37.60 REQUIRED PARKING Total: 2 Handicapped: Compact: Downspouts/Drains: Notes: No hookup to Public Facilies until subdivision has been accepted by City. Pal!e 1 of 4 _SPRING.,ELDdij WIL.. i Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01103 ISSUED: 10/13/2004 APPLIED: 09/03/2004 EXPIRES: 04/13/2005 VALUE: $ 330,903.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Valuation Descrintion , Dwelline:s Garae:e Tvpe of Construction V Wood Frame Garae:e $ Per Sq Ft or multiplier $92.40 $24.30 Square Footage or Bid Amount 3,253.00 1,248.00 Value Date Calculated Description Total Value of Project $300,577.20 $30,326.40 $330,903.60 09/03/2004 09/0312004 ~ Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $855.66 9/3/04 2200400000000001122 -Mechanical Issuance Fee- $10.00 10/13/04 2200400000000001284 + 10% Administrative Fee $200.64 10/13/04 2200400000000001284 + 7% State Surcharge $140.45 10/13/04 2200400000000001284 3 Baths One & Two Family $306.00 10/13/04 2200400000000001284 Addressing Assignment $31.00 10/13/04 2200400000000001284 Appliance Vent $6.00 10/13/04 2200400000000001284 Building Permit $1,316.40 10/13/04 2200400000000001284 Curbcut Permit $75.00 10/13/04 2200400000000001284 Dryer Vent $6.00 10/13/04 2200400000000001284 Exhaust Hoods $9.00 10/13/04 2200400000000001284 Furnace - up to 100,000 btu $12.00 10/13/04 2200400000000001284 Gas Fireplace $15.00 10/13/04 2200400000000001284 Gas Outlets 1-4 $4.00 10/13/04 2200400000000001284 Plan Review Major - Planning $103.00 10/13/04 2200400000000001284 PW Mult Disc - 2nd Permit $-30.00 10/13/04 2200400000000001284 Residence Wiring 1000 Sq Ft $106.00 10/13/04 2200400000000001284 Residence Wiring Ea Addtl 500 $152.00 10/13/04 2200400000000001284 Sanitary Sewer - Improvement $584.96 10/13/04 2200400000000001284 Sanitary Sewer - Reimbursement $769.28 10/13/04 2200400000000001284 SDC MWMC Administration $10.00 10/13/04 2200400000000001284 SDC MWMC Improvement $865.31 10/13/04 2200400000000001284 SDC MWMC Reimbursement $82.03 10/13/04 2200400000000001284 SDC Sanitary/Storm Admin $183.12 10/13/04 2200400000000001284 SDC Transpo Admin $59.05 10/13/04 2200400000000001284 SDC Transpo Improvement $772.49 10/13/04 2200400000000001284 SDC Transpo Reimbursement $175.13 10/13/04 2200400000000001284 Sidewalk Permit $75.00 10/13/04 2200400000000001284 Storm Drainage Impervious Area $1,584.10 10/13/04 2200400000000001284 Temp Power 200 amps or less $50.00 10/13/04 2200400000000001284 Vent Fan $24.00 10/13/04 2200400000000001284 Willamalane Single Family $1,000.00 10/13/04 2200400000000001284 Total Amount Paid $9,552.62 Pae:e 2 of 4 ~$.FA. .LNGF..IfiU......n. iij............. . , .~....:.. W;L-h i -,~._,-~. . ... ,.,.,-~~-~ .. : Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01103 ISSUED: 10/13/2004 APPLIED: 09/03/2004 EXPIRES: 04/13/2005 VALUE: $ 330,903.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Planninl! Review 09/07/2004 09/07/2004 I Plan Reviews I 09/0712004 APP 09120/2004 APP LLH TAJ Aspen Park Plat recorded on 8/18/04. 9/10/2004 - Subdivsion not yet accepted. No hookup to public facilities until subdivision is accepted by the City. - MS See documents for plan review comments. Public Works Review 09/07/2004 09/10/2004 APP MS Structural Review 09/07/2004 09/2812004 APP DLM 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. l..ReouiredJnsnections I Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. 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. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and including required testing. Shower Pan. Prior to covering 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. 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. Pal!e 3 of 4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01103 ISSUED: 10/13/2004 APPLIED: 09/03/2004 EXPIRES: 04/13/2005 VALUE: $ 330,903.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. 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. Sf). ~,. .,~:' b ,/ J~. "-' ,. ~7 /, ,,"7 ~/ '" p--'--- , ",,:7 ~ - Jo-/3/"OY Owner or Contractors Signature Date Pa2e 4 of 4 CITY OF Sh~INGFIELD SYSTEMS DEVELOPMEN"1~ORKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY: , LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS I. STORM DRAlNAG~ DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. ' x I COST PER S.F. CHARGE I 5110.00 I $0.310 I = I $1,584,10 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. x I COST PER S.F. x DISCOUNT RATE I 0.00 I $0.310 50% = I COM2004-01103 Rodney Stewart 729 Aspen Street 17033422 Tax Lot 01400 SINGLE FAMILY RESIDENCE I BUILDING SIZE (SF' o LOT SIZE (SF): 8475 r:/J ~ Q o u p::: ~ E-< r:/J ...... o gz DISCOUNT $0.00 ITEM I TOTAL - STORM DRAINAGE SDC 2, SANITARY SEWER - CITY $1,584.10 $1,584.10 J 1070 A. REIMBURSEMENT COST: NUMBER OF DFU's I x COST PER DFU 32 $24.04 $769.28 109] B. IMPROVEMENT COST: I NUMBER OF DFU's I x I 32 I $18.28 $584.96 ]092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =,1 $1,354.24 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADTTRIP RATE I x I NUMBER OF UNITS x I COST PER TRIP x NEW TRIP FACTOR I 9.57 I I I I $]8.30 1.00 $175.13 ]093 B. IMPROVEMENT COST: I ADT TRIP RATE x I NUMBER OF UNITS x I ' COST PER TRIP x I NEW TRIP FACTOR I 9.57 I 1 I $80.72 I 1.00 $772.49 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = 1 $947.62 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's ' x ICOST PER FEU I I I $82.03 = $82.03 ]054 B'. IMPROVEMENT COST: NUMBER OF FEU's x ICOST PER FEU I I $865.3 I = $865.31 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 I ]054 MWMC ADMINISTRATIVE FEE $10.00 ]056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =1 $957.34 SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $4,843.30 5. ADMINISTRATIVE FEE: I SUBTOTAL x I ADM. FEE RATE CHARGE I $4,843.30 I 5% $242,17 TOTAL SANITARY ADMINISTRATION FEE: 183.12 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $59,05 ]078 =1 \ Matt Stouder 9/] 0/2004 TOTAL SDC CHARGES $5,085.47 PREPARED BY DATE t t.;. DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 2 0 3 = 6 IDRINK.ING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 I LAUNDRY TUB 1 0 2 = 2 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0 SHOWER, SINGLE STALL 2 0 2 = 4 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LAVATORY 2 0 2 = 4 SINK: SINGLE LAVATORY /RESIDENTIAL BAR 1 0 1 = 1 IURINAL, STALL! WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 32 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$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 ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR o o 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE /1000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0,00 x $5.29 o TOTAL MWMC CREDIT $0,00 = 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ........ty of Springfield Official Receipt tvelopment Services Department Public Works Department Job/Journal Number COM2004-01103 COM2004-01103 COM2004-01103 COM2004-01103 COM2004-0 1103 COM2004-01103 COM2004-0 11 03 COM2004-01103 COM2004-01103 COM2004-01103 COM2004-01103 COM2004-0 1103 COM2004-01103 COM2004-01103 COM2004-01103 COM2004-0 11 03 COM2004-01103 COM2004-01103 COM2004-0 11 03 COM2004-01103 COM2004-01103 COM2004-01103 COM2004-01103 COM2004-0 11 03 COM2004-01103 COM2004-01103 COM2004-01103 , COM2004-0 11 03 COM2004-01103 COM2004-01103 COM2004-01.103 Payments: Type of Payment CreditCard 10/13/2004 RECEIPT #: 2200400000000001284 Date: 10/13/2004 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 Major - Planning Building Permit 3 Baths One & Two Family Furnace - up to 100,000 btu Vent Fan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee " ;: .."!' Paid By CAROL ELLIOTT Item Total: Check Number Authorization Received By -Batch Number Number How Received dim 013721 In Person Payment Total: Page 1 of 1 3:28:04PM Amount Due 31.00 1,000.00 106.00 152.00 50.00 75.00 75.00 (30.00) 1,584.10 769.28 584.96 175.13 772.49 82.03 865.31 10.00 183.12 59.05 103.00 1,316.40 306.00 12.00 24.00 6.00 9.00 6.00 ' 4.00 15.00 10.00 140.45 200.64 $8,696.96 Amount Paid $8,696.96 $8,696.96