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Home My WebLink AboutPermit Building 2008-4-15 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01122 ISSUED: 04/15/2008 APPLIED: 09/09/2004 EXPIRES: 10/15/2008 VALUE: $ 204,288.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1085 F ST ASSESSOR'S PARCEL NO.: 1703351401700 Springfield TYPE OF WORK: Fire Damage TYPE OF USE: Repair PROJECT DESCRIPTION: Fire Damage. Plans submitted to reconstruct single family residence 100705. Residential Owner: ASSAEL SALOMON Address: 2550 APPLAN WAY PINOLE CA 94564 Phone Number: 541-741-7627 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER License 8699 Expiration Date 12/18/2010 Phone 541-747-6638 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 5 # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building 2 21.00 Wall Heat Electric Electric Path 1 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 1 R-3 VN I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 24.00 14.00 14.00 55.00 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 2 Yes Total: Handicapped: Compact: 2 Street Improvements: I PUBLIC IMPROVEMENTS,," AI , O~: O'19q.n law requires you. Fullv Improved follow rure~Wal!~l~L t~,eihe Oregon UtIIIIr Yes Notification O~nspolits/Jl)1'aiIn!es are s~\J.l~ld Gutter In OAR 952-001-001 0 throl,gh OAR 952-001- 0090. You may obtllln cOpies of the rules by tilling the cen~er (;\~ote, the telephone ....ber for the Oreger, r...:tllity Notification Center IS 1 800-3322344). Storm Sewer Available: Special Instruction: NOT~ClE: r- r Tllr \A/I'-ClIC. Notes: "ffl~etfrnMfi1t~'tM..fi~t{fe~ISD(C Fee1l-U/lIU/2005 AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. - . Pa2e 1 of 4 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01122 ISSUED: 04/15/2008 APPLIED: 09/0912004 EXPIRES: 10/15/2008 VALUE: $ 204,288.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description ~ Description $ Per Sq Ft or multiplier $96.00 Square Footage or Bid Amount 2,128.00 Tvpe of Construction Dwellinl!:s V Wood Frame Total Value of Project ~ Value Date Calculated $204,288.00 $204,288.00 10/07/2005 Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $589.49 10/7/05 1200500000000001483 -Mechanical Issuance Fee- $10.00 4/15/08 2200800000000000460 + 10% Administrative Fee $107.79 4/15/08 2200800000000000460 + 12% State Surcharge $129.35 4/15/08 2200800000000000460 + 5% Technology Fee $58.15 4/15/08 2200800000000000460 Building Permit $906.90 4/15/08 2200800000000000460 Dryer Vent $6.00 4/15/08 2200800000000000460 Exhaust Hoods $9.00 4/15/08 2200800000000000460 Fixture $126.00 4/15/08 2200800000000000460 Minimum/Adjustment Mechanical $30.00 4/15/08 2200800000000000460 Plan Review Minor - Planning $85.00 4/15/08 2200800000000000460 Total Amount Paid $2,057.68 I Plan Reviews I Initial Review Notifv Appli Plan Deficie 10/10/2005 10/10/2005 10/10/2005 10/10/2005 APP LLH 10 DJB Public Works Review 10/10/2005 10/10/2005 APP CAS Planninl!: Review 10/10/2005 10/17/2005 APP TAJ Pal!:e 2 of 4 Steve Keating (engr.) said to call him if and when we need any thing else. He is aware of our requirement to have an on-site meeting before any work commences. Steve and the owner agree the house is to be demolished down to the first finish floor and that the first finish floor and foundation may remain if the floor and foundation are deemed acceptable after evaluation by engineer and building official. Rebuild on footprint ,no additional fixtures no SDC fee 10/10/2005 CAS Planning review is based on plot plan labled "assumed residence location". 2 street trees are required unless they are already in. Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01122 ISSUED: 04/15/2008 APPLIED: 09/09/2004 EXPIRES: 10/15/2008 VALUE: $ 204,288.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Structural Review 10/1 0/2005 11/02/2005 APP DLM Owner intends to reuse existing foundation and main floor framing. Evaluation by engineer required for foundation before proceeding with reconstruction. 11/2/05dlm Plan Review Comments 04/14/2008 04/14/2008 10 DLM In early 2006, shortly after the building plan review was completed, the applicant requested that the project be placed on hold until critical cronic health issues could be resolved. The applicant has now asked to obtain the permit 4/14/08dlm. 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. ~eQuiredJnsDections , Site Inspection: To be made after excavation but prior to setting forms. Vfer 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. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Pal!e 3 of 4 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-01122 ISSUED: 04/15/2008 APPLIED: 09/09/2004 EXPIRES: 10/15/2008 VALUE: $ 204,288.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Mechanical: When all mechanical work is complete. 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 ofany 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 re uested at the proper time, that each address is readable from the street, that the permit card is located at the front of the pr erty, and the approved set of plans will remain on the site at all time, dudng con'zn. ~~1M /7/.~J! ~ Owner YclO" S;gn.tu<c t/ I Date f;/I?'6 Page 4 of 4 ZON ~ fNITIALS l-AJ DATE &.~ \<& .O~ SOURCE "^' ~rt-- 225 FIF m STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689 ELECTRICAL PERMIT APPLICATION CIty Job Number .c.M12.lJOtt:f - aJJ 2-2- 1. LOCA110N OF INS1'ALLA110N: 3. !Ol>S" F c;T. LEGAL DESCRIPTION Cl/)335"/4 ol7btJ - - , JOB DESCRIPTION ~~~/It(e:r 51,1).. ~e_ .., I - . Permits are non-transferable and expire if work IS not started wlthm 180 days of issuance or If work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electncal Contractor Address City Supervisor LIcense Number / EXpiratIon Date Co",tr Contr Numf EXpiration Date SIgnature of SupervIsIng ElectncIan Owners Name SAl~O,t7 AdJ"A~1. Address City Phone 71-1-7"27 )( OWNER INST ALLA nON The InstallatIOn IS beIng made on property I own which IS not Intended fo?le, lease or rent Own", s,gn:: ;1 ~bCF----- / / Inspection Request: 726-3769 Date COMPLETE FEE SCHEDULE BELOW A. New Residentlal- Single or Multi-Family per dwellmg unit. Service Included 1000 sq ft or less Each additIonal 500 sq ft or portIOn thereof Each Manufact'd Home or ' Modular Dwelling Service or Feeder I $117 00 J.L7~ IJ-O $ 21 00 ~_-z, ~ $55 00 B. Services or Feeder~ - Installation, Alterations or Relocation: 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 70 00 $ 83 00 $138 00 $180 00 $4 13 00 $ 55 00 C. Temporary Services or Feeders Installation, Alteration or RelocatIOn ~_..- 200 Amps or less ---P-- $ 55 00 ~ J .;#i - 201 Amps to 400 Amps $ 76 00 401 Amps to 600 Amps $11000 Over 600 Amps or 1000 Volts see "B" above D. Branch Circuits New AlteratIOn or ExtenSIOn Per Panel One CirCUit Each AdditIOnal Circuit or With Service or Feeder Permit $ 48 00 $ 400 E. Mi~cellaneous (Service/feeder not mcluded) -Each In~tanation Pump or lITIgatIOn $ 55 00 Sign/Outline Llghtmg $ 55 00 Limited Energy/ReSidentIal $ 28 00 LimIted Energy/Commercial $ 50 00 Mimmum ElectriC Permit Inspection Fee IS $50.00 + Surcharges / ~,t>oD I 2(. 6?~ / 9, (!J-() · .?"l. ~ -'7.. r . 22:;b ,,~O Shared DflYe(T )/Buildmg Fomls/Electncal Permit Application 1-08 doc 4. SUBTOJ'AL OFABOVE 12% State Surcharge 10% AdmInistrative Fee 5% Technology Fee TOTAL Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Pemnt#:O>m Z-COC-{- OIl Zz... Address I 0 ~ ~ ,:::: ~ ) Issued by' ~/0Jf Date, $P~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requlres residentzal constructzon permlt applicants who are not licensed with the Construction Contractors Board to sign the following statement before a buildzng permlt can be issued, This statement is required for residential buzldzng, electrzcal, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My general contractor is , (N anie) 1 I will instruct my general contractor that all subcontractors who work on the structure must be , I licensed with the Construction Contractors Board. (CCB #) OR ~ 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a general tontractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the t name of the contractor. ; i I hereby certify that the above'information is correct and that I have read and do understand the Information Notice to Property Owners abofu Construction Responsibilities on the reverse side of this form. /i/lJ1Mli- J() 7&0~ (Signature of permit applicant) l / (Date) // (White copy to lssuing agency permit file, pznk cop to aJlicant.) / '/ Property_owner. doc 06-01-04 . Acting a~-Your OWD'General Contractor?- " . '.... "\ Ci~ \~\\~- , '. - f.:ll . - I ~, . . INFORMAtiON NOTICE TO PROPERTY OWNERS A~quj:~'GM~TRUCTION RESPONSIBILITIES, \.... '., .. "'-\ . . NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are actIng as your own contractor to construct a p.ew home or make a substantial improvement to an eXlstmg structure, you can prevent many problems by being aware 0'[ the follOWIng responsIbIlitIes and concerns. Employer Responsibilities You ~ll, m,most Instances, be ruled to be an "employer" anc,l the contractors you contract with WIll be "employees" If you use contractors not lIcensed WIth the ConstructIon Contractors Board.to do labor In constructIng or to assist In the constructIOn or.improvement of a reSIdentIal structure:. A~ the ~mploycr, you must comply with the follow~ng: Oregon's Withholding Tax Law: As an employer, you must WIthhold Income taxes from employee wages at the tIme employees are paid. You will be lIable for the tax payments even If you don't actually Withhold the tax from your employees. For more informatIon, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are reqlnred t6 pay a tax for unemployment msurance purposes' " on the wages of all employees. For more InfOrmatIOn, call the Oregon Employment Department at 503-947-1488. ~ '. The Oregon Business IdentIficatIOn Number (BIN) is a combIned number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/forrnsoav htmll for the appl vpnate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtam workers' compensatIon insurance for your employees. If you fall to obtam workers' compensatIOn msurance, you could be subject to penaltIes aIld be liable for all claim costs If one of your employees IS injured on the Job. For more mformatIon, call the Workers' CompensatIon DIviSIOn at the Department of Consumer and Business ServIces at 503-947-7815. U.s. Internal Revenue Service: As an employer, you must WIthhold federal Income tax: from employees' wage~. -" You WIll be lIable for the tax: payment even If you dIdn't actually Withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or VISIt their web SIte at WWW.IrS.gOv. Other Responsibilities and ~Areas of Concerns , Code Compliance: As the permIt holder for thIS proJect, you are responsIble for resolVIng any faIlure to meet code reqUIrements that may be brought to your attentlOn thr~ugp mspectIOns. Liability and Property Damage Insurance: Contact your msurance agent to see if you have adequate msurance coverage for aCCIdents and omlSSlOns such as falling tools, pamt over spray, water damage from pIpe punctures, fire or work that must be redone. Time: Make sure you have sufficient time to superVIse your employees. Expertise: Make sure you have the skins to act as y~ur . own -general 'conti~cior; to coordmat~ the work of rough-m and fimsh trades, and to notIfy bUIldmg offiCIals as the appropnate tImes so they can perform the reqUIred InSpectIOns. If you have addItIonal questIons call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052. Property_ ovvner.doc 06-01-04 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR lOB NUMBER C0M2005-0] ]22 NAME OR COMPANY. Salvatore Assael LOCATION 1085 F St TAX LOT NUMBER ] 70335]40] 700 DEVELOPMENT TYPE SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF: 0 LOT SIZE (SF) o C/) ~ Q o U ~ ~ E-< C/) ....... o ~ I STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS SF x I COST PER S F CHARGE - j 000 $0323 1 = $000 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F I x 1 COST PER SF I x DISCOUNT RATE I DISCOUNT o 00 I I $0 323' 50% I $0 00 ITEM 1 TOTAL - STORM DRAINAGE SDC 2 SANITARY SEWER - CITY A REIMBURSEMENT COST NUMBER OF DFU's x o $0.00 $0.00 I 11070 .,,-- '-' - COST PER DFU $25 07 $0.00 11091 B IMPROVEMENT COST I NUMBER OF DFU's x , 0 $]907 $0.00 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $0.00 3 TRANSPORTATION A REIMBURSEMENT COST 1 ADT TRIP RATE x NUMBER OF UNITS x 1 COST PER TRIP x INEW TRIP FACTORI I 957 0 I $1909 I 100 $0.00 1093 B IMPROVEMENT COST, I ~ ADT TRIP RATE I x NUMBER OF UNITS x 1 COST PER TRIP x NEW TRIP FACTOR 957 I 0 I $8419 100 $0.00 1094 ITEM 3 TOTAL - TRANSPORTATION SDC =, $0.00 -, -- - 4 SANITARY SEWER - MWMC A REIMBURSEMENT COST NUMBER OF FEU's I x COST PER FEU 0 $82 03 = $0.00 I 1054 B IMPROVEMENT COST. NUMBER OF FEU's I x ICOST PER FEU 0 I 1 $865 3] = , $0.00 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) =1 $0.00 1054 MWMC ADMINISTRATIVE FEE = , $0.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, $0.00 SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) =1 $0.00 ,- - .- - 5 ADMINISTRATIVE FEE' SUBTOTAL x I ADM FEE RATE CHARGE $000 I 5% $000 TOTAL SANITARY ADMINISTRATION FEE #DIV/O r 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE #DIV/O' 1078 Cheryl Slaymaker 10/1 0/2005 TOTAL SDC CHARGES =, $0.00 PREPARED BY . DATE ~ .. . '-"-- DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS (N01E FOR REMODELS, CALCULA 1E ONLY THE NET ADDITIONAL FIXTURES) NO OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUlV ALENT UNITS I BATHTUB 0 0 3 = 0 I DRINKING FOUNTAIN 0 0 1 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC 0 0 3 = 0 I INTERCEPTORS FOR SAND I AUTO WASH I ETC 0 0 6 = 0 ILAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER I MOP SINK 0 0 3 0 ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0 IRECEPTORFORREFRlG I WATER STATION IETe. 0 0 1 = 0 I RECEPTOR FOR COM SINK I DISHWASHER I ETC 0 0 3 = 0 I SHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 = 0 I SINK COMMERCIAL BAR 0 0 2 = 0 SINK WASH BASIN/DOUBLE LA V A TORY 0 0 2 = 0 SINK SINGLE LAVATORY/RESlDENTIAL BAR 0 0 1 = 0 IURINAL, STALL/WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 !I *EDU (EqUIvalent DwellIng Urnt) IS a dIscharge eqUIvalent to a smgle famIly dwellIng urnt.czO DFD's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR CREDIT RATE/$l,OOO I. ANNEXED ASSESSED VALUE BEFORE 1979 $529 1979 $529 1980 $519 1981 $512 1982 $498 1983 $480 1984 $463 1985 $440 1986 $407 1987 $367 1988 $322 1989 $273 1990 $225 1991 $180 1992 $159 1993 $145 1994 $125 1995 $109 1996 $092 1997 $072 1998 $048 1999 $028 2000 $009 2001 $005 IS LAND ELGlBLE FOR ANNEXATION CREDIT? 0 (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX CREDIT? 0 (Enter 1 for Yes, 2 for No) BASE YEAR 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE $0 00 x $5 29 = I $000 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE I 1000 CREDIT RATE ~OO x ~~ 0 TOTAL MWMC CREDIT $000 = J25 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 Payments: Type of Payment Check Cash Change Job/Journal Number COM2004-0 1122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-01122 COM2004-0 1122 COM2004-01122 COM2004-01122 COM2004-0 1122 COM2004-01122 Payments: Type of Payment Check Cash Change Job/Journal Number COM2004-0 1122 COM2004-01122 COM2004-01122 COM2004-0 1122 COM2004-01122 COM2004-0 1122 COM2004-0 1122 COM2004-01122 COM2004-01122 COM2004-01122 cRecemtl RECEIPT #: 2200800000000000460 Date: 04/15/2008 DeSCriptIOn Plan ReView Minor - Planning BUlldIng Permit Fixture Exhaust Hoods Dryer Vent Minimum/AdJustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Paid By SOLOMON SOLOMON Item Total: Check Number AuthorizatIOn ReceIved By Batch Number Number How Received 3426 RD223426 In Person In Person In Person Payment Total: Description Plan ReView Minor - Planning BUilding Permit Fixture Exhaust Hoods Dryer Vent Minimum/AdJustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 12% State Surcharge + 10% AdministratIve Fee Paid By SOLOMON SOLOMON Item Total: Check Number AuthorizatIOn Received By Batch Number Number How Received 3426 RD223426 In Person In Person In Person Payment Total: DeSCriptIOn Plan ReView Minor - Planning BUilding Permit Fixture Exhaust Hoods Dryer Vent Minimum/AdJustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 12% State Surcharge + 10% Administrative Fee Item Total: Page I of2 11 :26:34AM Amount Due 8500 906 90 12600 900 600 3000 1000 58 15 12935 10779 $1,468.19 Amount Paid $1,40000 $80 00 ($11 81) $1,468.19 Amount Due 8500 906 90 12600 900 600 3000 10 00 58 15 12935 10779 $1,468.19 Amount Paid $1,40000 $80 00 ($11 81) $1,468.19 Amount Due 8500 906 90 12600 900 600 3000 10 00 58 15 12935 10779 $1,468.19 4/15/2008 Payments: Type of Payment Check Cash Change cReceml1 RECEIPT #: PaId By SOLOMON SOLOMON 2200800000000000460 Date: 04/15/2008 Check Number Authorization ReceIved By Batch Number Number How Received 3426 RD223426 In Person In Person In Person Payment Total: Page 2 of2 11 :26:34AM Amount Paid $1,40000 $80 00 ($11 81) $1,468.19 4/15/2008