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Home My WebLink AboutPermit Building 2005-9-26 (3) . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01069 ISSUED: 09/26/2005 APPLIED: 08/08/2005 EXPIRES: 03/2612006 VALUE: $ 57,500.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 3125 Gateway St ASSESSOR'S PARCEL NO.: 1703222003100 Springlield TYPE OF Tenant Inlill TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Partial Tenant inlill- Gateway Bistro (restrooms only). Additional plans submitted for inlill 091205. Owner: Address: BENTON PROPERTIES L TO 980 WlLLAME'ITE ST EUGENE OR 97401 ~ ~\;S sS- _-&.c..~ 'v:\.' ~ ~:f:!,. ~ (:,;~TRACTUR INFURMAT~ 9..~ q,,~ *,- Contr~~..p~\;S License GAR.~~~CHITECT gfA'MBEl{S ~NSTRUCTION 114258 ,0 05130/2007 ~. '~~~~ECTRlC 17252 ....O~#' f.$' 02/08/2007 ~ q,,~CQMto~:NLOW 460 ~0c, 0<:- e;. ,0 <:)~'06/27/2007 ~.:t? '-f-~iN ~VERS PLUMBING INC 1:7695ZQ) _,<Q <; 0.'0'1;. o,il3ft 1/2007 '~~~....<O"" , BUILDING INFURMA11U\'li~<Q'? o'i>:~i~(l"~o~ " ~ _ ~ ,,'Q' ~'b ~ & ;z;.0 ,~,v'lf ~ . ,<Q"o,s~",::;. #ofStones:,0 Q,0 "''<::';s!>o '~0 ~<Q ",Lot, SIZe: Heightof^~' 00 n" ,c::," vO~,i:-:,~""Scil'Ft1stFloor: -'v 'If ,,~'" '>:- 0' _,~ ('- Type of;Heat: r cP<:' <:)" ,,/-' ~ 'V n'Sq Ft 2nd Floor: ~ ,- ",,'"' v ,: ..~v x ~ ~v Watei:'Type: ~ <:)\:) ({> V' & ",'" Sq Ft Basement: Raiige,Typ~? b'1; ""'I>.... <Q~ 0,0 ';0<::5 Sq Ft Garage/Carport ..n' ......' q) " C; q" '" Ener~(fath;. 4,0'::';s:-<Q ~ ~-!;> Sq Ft Otber: SprinkJep'" ~' ,>:-CiJ ,do ~<Q nla Occupant Load: .~ "q) * o~ ...(1, IDEVELUPMENl.'IN'~VRMA1'lUN , ~.~ctl t*\ Contractor Type Architect General Electrical Mechanical Plumbil'lg Expiration Date Phone 541-343-3658 687-9445 541-343-7297 541-726-0100 541-688-1444 # of Units: Primary Occupancy Group: Secondary Occupancy, . P'rimary Construction ~ Secondary Construction # of Bedrooms: A-2 VB REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: fl'UBLlC IMPRUVEMENTSI Street Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutsIDrains Notes: I of 4 . Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Description Estimate Estimate Type of Construction Estimate Estimate Fee Description Plan Review CommlIndlPublic Plan Review CommlIndlPublic -Mechanical Issuance Fe.... + 10% Administrative Fee + 7% State Surcharge Backflow Device Building Permit Fixture Furnace - up to 100,000 btu Gas Outlets 1-4 .. Minimum/Adjustment Mechanical Plan Review CommlIndlPublic Plan Review Fire & Life Safety Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Fire Department Review Fire Department Review 09/13/2005 08/09/2005 Initial Review Plannine Review 08/09/2005 .09/13/2005 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 25,000.00 32,500.00 Total Value of Project Fpp<. PlWLI Amount Paid $ll 5.44 $176.28 $10.00 $35.34 $24.74 $14.00 $224.40 $70.00 $12.00 $4.00 $17.00 $30.42 $89.76 $266.92 $351.03 $30.90 $12.00 $1,484.23 Date Paid 8/8/05 9/12105 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 9/26/05 I Plan Reviews I 09/01/2005 08/09/2005 09/16/2005 OK APP SKG APP EMM 2 of 4 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01069 ISSUED: 09/26/2005 APPLIED: 08/08/2005 EXPIRES: 03/26/2006 VALUE: $ 57,500.00 Value Date Calculated $25,000.00 $32,500.00 $57,500.00 08123/2005 . 09/12/2005 Receipt Number 1200500000000001151 1200500000000001334 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 1200500000000001399 GRG Plans Review: Partial Tenant infill for Gateway Bistro. Job #COM2005-01069. Restrooms only. Additional information to be submitted at later date. Occupancy Classification: A-2. Construction type: V-B. Plans appear to meet code requirements. ..... needs final site Inspection before occupancy. Several site items for center, still need to be completed. . . CITY OF SPRINGFIELD. Building/Combination Permit Stat~s: Issued PERMIT NO: COM2005-01069 225 Fifth Street, Springfield, OR ISSUED: 09/26/2005 541-726-3753 Phone APPLIED: 08/08/2005 541-726-3676 Fax 'EXPIRES: 03/26/2006 541-726-3769 Inspection Line VALUE: $ 57,500.00 Plannlne Review 08/09/2005 08/16/2005 APP EMM Public Works Review 08/09/2005 08/17/2005 APP SB Permit for restrooms only. No restaurant plumbing covered under tbls permit. SDCs added for bathroom fixtures. Public Works Review 09/13/2005 Structural Review 08/23/2005 08123/2005 10 JMP WE. Received structural response from Brian Erickson. Still waiting for item 3 (Heavy Duty ceiling grid literature and design). Structural Review 08/25/2005 08/25/2005 10 JMP WE. Received better information from Brian Erickson on the Armstrong heavy-duty suspended ceiling. Left a voice mail for bim about the clips wbich bave not been approved and the special report that requires special inspections. Told him he needs to complete the Special Inspection and Testing forms. Structural Review 09/08/2005 09/08/2005 10 JMP WE. Received incomplete special Inspection and testing forms from Brian Erickson and left a voice mail message asking him to complete the signature sheet. Structural Review 09/09/2005 09/09/2005 10 JMP WI. Received missing information from Brian Erickson and forwarded energy code forms to Jack Foster. Structural Review 09/13/2005 Structural Review 08/09/2005 08/1812005 WE JMP See attacbed documents for 4 structural comments faxed to Gary Moye. Structural Review 09/21/2005 09/21/2005 APP JMP Received linallnternal approval for the restroom portion of this TI. SUB Review 08/10/2005 08/12/2005 WE JF JMP calied Debi at Chambers to leave a message for Brian to supply the HV AC forms. SUB Review 09/21/2005 09121/2005 APP JF SUB Review 09/1312005 To Request an inspection caD 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. wiD be made the following work day. I Reouired I nsoections I Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Drywall: Prior to taping. 3 of 4 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01069 ISSUED: 09/26/2005 APPLIED: 08/08/2005 EXPIRES: 03/26/2006 VALUE: $ 57,500.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone .. 541-726-3676 Fax 541-726-3769 Inspection Line Firewall: Located and constructed according to plans. Ceiling Grid: After drywall approval but prior to COver. Final Fire Department. After all requirements of tbe Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. SUB Insulation Vapor Barrier: To be called for at the same time as the SUB framing inspection. SUB Final: After all required energy inspections have been requested and approved. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. SUB Plumbing: Following City Rough Plumbing Inspection approval and prior to cover. Rough Gas: After line is Installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. SUB Mecbanical: Following City Rough Mechanical inspection approval and prior to any cover. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. SUB Ceiling Grid: Interior Lighting SUB Exterior Lighting 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 wiD be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees wbo 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 eacb address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans wiD remain on the site ~cfg~~yCA,-' 9-70;-05 Owner or Contractors Signature Date 4 of 4 co '" " co "" " NO CO CO to ~ ... '" ... ... ~ .., >< " ~ z o "" ... to NO ~ CO CO '" City ofDI'.;"~eld Comm1lllity Services Division 22S Fillh Street Springfield, OR 1)7477 Telephone: (S4I) 726.3759 Fax: (541) 726-3689 Go~2.00~ - O\Ocoq q (I \e? BulJdinspermit# Date -r~IJANT !1JFI........ - Gp;:n::w~(~lsrl/l PIojcct Title ::3'o1Z-? ~AI'tr1 sr. Pm,iect Acidm.sI SpednllDapeetlo.n IIJId TIlStInIl TotlJ'llliellllU of~llI'equbiJlaspeoiDllII!pOC1ianor!l:slingll!petScctlon 1701.5 D!lhoOn:gooSwClllllll SpecitJty Code. P1w'm1~lheinfOllllat/onbelo",. Wbenyoulmve fiuisllM, adolawledgo an IIDdcrsl8ndiog oflh. blIbJm1lllon by si8f1Ins belllW, md.e\um Ibis tbJlll tIItho City. JlU'ORE A l'EJlMll CAN lIE JS8llED: 11le owner or OWII..'I "r-_~v" on lb. a4vico of tho nspllOJJblo ProlOGI BmgIne<r 01' AId1Iteo~ sboII complete, sIgo, lU>Ii submltto 1M Cily fbrn:vl..,.1IJld 1JlP'1l",) tIis fOlIll complcled on bo1h thefmnlllllll bock. The ewoer IlIId Omml C_Ior, whm 1JlPlleob1o, oboll we Cl:\". ,,'..19 tho follmrina ccmdiliollS appIicoblo to Speolal !JISpeotiDII andlorTcstlna. L C ..., ;'".. Is respDDS1b1e for propunOliJicallllll ilrthe Inspecllon orT.mgofllcms1isled. '2. TOIIirlg laIJ""""'Y Jhat/ IIkD tIJlIllllp%iale _pI.. JIIld.InII!pOrt tb<m to their IabD'atoJ)' Cor proper oV81""Uoo or lesIIe8. . Coplu of olI JabeMm1l'OJ1011:1ll1loIo1JlCCl1llD8 on: to be lenl 10 lb. CIty by Iho T.sIIog AgeDcy. 3. Spodal ImpcellonAameyil to Sllbmil_ and qulliIIClIIicma of....8i1ll SpeolalInspmorslD!he Cityftl1 opproval 4. Sp.....1T.'P....,'....aIJ pmvIda 1ll5JlfdIllDnpGJII \0 Ih<> bu!IdiIIg.1liclal m,D lILlpot1loo ..liviu.s. 5. CoJlJnl:totIs,espanslltl. "'Mew lheCily .""., .(plaa8foraddltlolllllin!pel1lianorleJlingreqWrPll1llsthatmay bcllDlea. ,,41v......A ",-......CATEOJ'OCctJPANCY WILL BE IllSlJED: TheSpeeiaJ Iorpct:ticn.Aplcy Bballsubmit 10 th, Building Oftkialulalemmllhaloll ilenlsrequ\riJIg lmpccllon bn been filll1l\ed 8IId roporhllllllld were to lh. bOIl cf1hc ~Clllo"lIlmowlfllge, In amformana. wiIh the llppIIlvc:d pJIIIIS, lIJl",lfIcatimlJ ilia opplicabl. WlIlkmoncbip pl'Ovlsion.o. Thosa it;mu IKllltlJl1cl andfor lIIspectl:O cIWJ be DDIod in !be sla/erDIIIII. Thorepotl is tD buubmille6lD lb. CIty prior In 8 tOfJllGSl for IilIa1lDspecUons. .. ~~. Lb~~~~ c..... ........ Jl"hk-t . fl'< \ -=..~ ~~ ~1Ir~1IIII(PllM1) ~Il . ~L....~. ~~ ~ " ~~ /' FIStT75TftJl:+TH5f> -..)?J.'t,f)....,. ,_:..._ 'I..~,~r . \ Iq'UI\, .~. . - ~ 'n:dI;LUmIlIay~~ Ti11iIIcJ.~:,'=.LJ.R~ ll\lllIllII~tprIM) . ~dMdiI.~ '" !' '" '0 co <D '" '" --. " " '" ,0 co ex> iQ) ~ --. " '" 0 0 '" !tTl '" '" U1 ... .... '" 0 ... -. (Jl to N ... ... J>. ! '" .." ,,," 'l>< co to U1 ;~ ... J>. .... .... ..... '" '" (Jl "" co ex> 1..... ... J>. '", '" ~!~ ~ i l:J '" n o :a '" o-j 'C') == "" t:i '" '" '" C') o Z '" .., . iBI ;g g Ill~ N 0 co ",NO '" --. '" '" SPECIAL INSPECTION AND TESTING SCHEDULE o <D , o ."" I' .0 '''' Reinforced ';oncrete. Gunite. Grout IlIId Mortar: Concrete Gunite Grout Mortar GRADING, EXCAVATION, AND FILL Acceptance tests . PSF Establish final grade Fill placement inspection/continuous Soil Density "l ,>- l~ '" .... ,.... '''' ''''' '.... '<D .... .~ I.... .'" ,.. '''' :.... A~~~ate Test of Mix Desi~n Reinforcin;z Test ,Mix Desi~n-Weighmaster Cert,' Reinforcin:z Placement Continuous Batch Plant Inspect 1n..,ect Placin~ Cast Sarn2les SarnDles (j'icku;l/Deliveredl Com:Jles9ion Test. I I I I ~ STRUCTURAL STEEL/WELDING: Sample and test (list specific members below) Shop material identification (mill cert) Weld inspection _Shop _Field U1lrasonic inspection _Shop _Field High Strength Bolting_Shop _Field A325 _N _X A490 N X Metal deck wel~;ng inspection - Reinforcing Steel welding inspection Reinforcing steel mill certificate Metal stud welding inspection Concrete insert welding inspection Moment resisting steel frames C'l 0:: >- '" '" '" '" '" C'l o Z '" .., Claddin~ _F _F I PrecastlPre-stressed Concrete: . I Piles Post.Tens Pre-Tens I I I I j I I I I I I A~H"egate Tests Reinforcin;.! Tests Tendon Test Mix Deshms* Reinforcin~ Placement Insert Placement Concrete Batchin.! Concrete Placement Insta1lation InsJection Cast Samples Pick-uo Samnles Comnression Tests STRUCTURAL WOOD: Shear wall nailing inspection Shear wall anchors Inspection of G lu-lam fab. " TiC psi Inspection of truss joist fab. Sample and test components Fabrication welding of steel accessories SMOKE CONTROL: Leakage testing Control Verification FIREPROOFING: . ROOFING: Insulation instalJationIR- Value' Test strips/seams ,Placement inspection .Density tests .Thickness tests .inspect batching MASONRY Special inspection stresses used" rm rg PreliminaIy acceptance tests (masonry units, wall prisms) Subsequent tests (mortar, grout, field waIl prisms) Placement inspection ofunilS, and reinforcement Masonry, mortar, grout, and reinforcing steel certificates ADDmONAL INSRUCTlONS, OTHER TEST, & INSPECTIONS: Fonn Completed bY' Dat' CB\L-10h Gi2\O iE>I o o '" 'PROVIDE STRENGTH REQUIRED BY ARCHITECT OR ENGINEER OR CONTRACT DOCUMENT LOCA nON OF VALUES ~ ATIACHMENTA CITY ~NGFIELD SYSTEMS DEVELOPMENT_CHARGE a-SHEET JOURNAL OR JOB NUMBER C0M2DD5-DI069 =w- NAME OR COMPANY: Gateway Bistro LOCA llON: 3125 Gatewav St (Pacific Village Shopping Center) MAP & TAX LOT NUMBER: 17 03 22 20 03100 DEVEWPMENT TYPE: Shell bathrooms for restaurant in Pacific Village shopping Center NEW DEVELOPED AREA (S,F.): 1.560.00 Transportalioo ITE: 821 NEW DEVELOPED AREA (S.F.): 1.560,00 MWMC ITE: 932 TOTAL IMPERVIOUS SURFACE (S,F,): LOT SIZE (S,F,): . ~ t ~ tl~{t' .R ~o 12-- lrW och~ =: u llTORM DRAINAGE Previowlly paid OD COM2Q04..01378 IMPERVIOUS SQ, IT, . S 0,323 PER SF x TOTAL STORM DRAINAGE SIX:' $0,00 1070 (. SANITARY SEWI'R-CITV A. REIMBURSEMENT COST: NUMBER OF DFU's B, IMPROVEMENT COST: NUMBER OF DFU's (SEE REVERSE SIDE) 14 x S 25,07 PER DFU 14 x S 19.07 PER DFU S 44,14 TOTAL LOCAL WASTEWATER SOC'J $ 617,96 3 TRANSPORTATION Previously paid OD COM2004-01378 BLOG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR NEW A, REIMBURSEMENT COST: 0.00 x 86,56 x S 19,O9 PER TRIP x 0.35 NTF $0,00 ~ B. IMPROVEMENT COST: 0,00 x 86.56 x S 84,19 PER TRIP x 0,35 NTF $0,00 ~ EXISTING S 103,28 A, REIMBURSEMENT COST: 0,00 x 127,15 x S 19.09 PER TRIP x 0 NTF $0,00 ~ B, IMPROVEMENT COST: 0,00 X 0,8 X S 84.19 PER TRIP X 0 NTF $0,00 ~ TOTAL TRANSPORTATION REIMBURSEMENT SIX:' TOTAL TRANSPORTATION IMPROVEMENT SIX:! TOTAL TRANSPORTATION SOC'I $ I 4 SANITARY SEWER - MWMC NEW: A, REIMBURSEMENT COST: NUMBER OF FEU's 1.56 X S2,D99,76 PER FEU $3,275,62 ~ B. IMPROVEMENT COST: NUMBER OF FEU's 1.56 X S7,471.D8 PER FEU $11,654,89 ~ EXISTING: A, REIMBURSEMENT COST: NUMBER OF FEU's -1.56 X SI81.08 PER FEU ($282.49)~ B. IMPROVEMENT COST: NUMBER OF FEU's -1.56 X $495.30 PER FEU ($772,67)~ MWMC CREDIT IF APPLICABLE (SEE REVERSE) TOTAL MWMC REIMBURSEMENT FEE: TOTAL MWMC IMPROVEMENT FEE: MWMC ADMINISTRATIVE FEE: TO ~ paid by cnd user (Gateway Bistro) TOTAL MWMC SOC,' $0,00 I $617,961 SUBTOTAL (ADD ITEMS 1,2,3. & 4) ~ADMINISTRATlVE FEES' BASE CHARGE .(SUBTOTAL ABOVE) S 617.96 X 5% , $30,90 TOTAL TRANSPORTATION ADMINISTRATION FEE: $ TOTAL SEWER ADMINISTRATION FEE: $ $351,03 1091 $266.92 1092 $617,96 $0,00 1093. $0,00 1094 $0,00 $0,00 $2,993.14 $10,882,21 $10,00 $13,885,35 1054 1054 1055 1056 1078 30,90 1079 steve", W, ]<.eQu"rl:j ]<.Qr...es c~!lloll~ bislro,3125 Gateway SUds TOTAL SOC CHARGES $648.85 8/1712005 DATE 1 JULY 2004 . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS (NOTE FOR REMODELS. CALCUl.A TE ONLY THE NET ADDmONAL FIX11JRES) Gateway Bistro FIXTURE TYPE BATHTUB DRINKING FOUNT AlN FLOOR DRAIN INTERCEPTORS FOR GREASElOIUSOLIDSIETC. INTERCEPTORS FOR SAND/AUTO WASHlETC, LAUNDRY TUB CLOTHES WASHERlMOP SINK CLOTHES WASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (I PER TRAILER) RECEPTOR FOR REFRIGERA TORIW A TER ST A TIONIETC, RECEPTOR FOR COMMERCIAL SINK! DISHWASHERlETC. SHOWER, SINGLE STALL SHOWER, GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTIAL KITCHEN SINK: COMMERCIAL BAR SINK: WASH BASIN/DOUBLE LA V ATORY SINK: SINGLE LAVATORY/RESIDENTIAL BAR URINAL, STALUWALL TOILET, PUBLIC INST ALLA TION TOILET, PRIVATE INSTALLATION MISCELLANEOUS: FIXTURES NEW OLD 2 2 NUMBER OF EDU'S. UNIT EQUIVALENT 3 1 3 3 6 2 3 6 12 1 3 2 2 3 2 2 I 5 6 3 TOTAL DRAINAGE FIXTURE UNITS= ~DU (Equivalent DwcllinJ!. Unit) is a disc~ eQuival~t to a sincle familv dwcllin.e. (20 OFlJ) set at 167 wUlons per day DRAINAGE FIXTURE UNITS o o o o o o o o o o o o o o o o 2 o 12 o o o o 14 CREDIT CALCULATION TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFfER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY YEAR RATE PER $1,000 YEAR RATE PER $1,000 ANNEXED ASSESSED VALUE ANNEXED ASSESSED VALUE - 1979 or before $5,29 1992 1980 $5,19 1993 $1,45 1981 $5,12 1994 $1.25 1982 $4.98 1995 $1,09 1983 $4,80 1996 $0,92 1984 $4.63 1997 $0,72 1985 $4,40 1998 $0.48 1986 $4,07 1999 $0.28 1987 $3.67 2000 $0,09 1988 $3,22 2001 $0,05 1989 $2,73 2002 $0,00 1990 $2,25 2003 $0,00 1991 $1,80 2004 $0,00 CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE X $0,00 IMPROVEMENT (IF AITER ANNEXATION DATE) X $0,00 CREDIT TOTAL $0,00 C0M2005-01069,gateway bistro,3125 Gateway SUds 1 JULY 2004 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone e 8['A"'~._C-~."!!'i'-". '..' _. _ '.'.. liar", i , " ..W; City of Springfield Official Receipt evelopment Services Department Public Works Department Job/Journal Number COM2005-0 I 069 COM2005-0 I 069 COM2005-0 I 069 COM2005-0 I 069 COM2005-0 1069 COM2005-0 I 069 COM2005-0 I 069 COM2005-0 I 069 COM2005-0 I 069 COM2005-0 I 069 CbM2005-0 I 069 COM2005-0 I 069 COM2005-0 I 069 COM2005-0 1069 COM2005-0 I 069 Payments: TWe of Payment Check :i " :, :(' " " , -, " '( '( , '. 9/26/2005 RECEIPT #: 1200500000000001399 Date: 09/26/2005 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Fixture Backflow Device Furnace - up to 100,000 btu Vent Fan Gas Outlets 1-4 Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Plan Review CommlInd/Public Plan Review Fire & Life Safety Building Permit + 7% State Surcharge + 10% Administrative Fee Paid By Received By BENNElT MAQNAGEMENT jmp CO LLC I of 1 Item Total: Check Number Aulllorizatlon Batch Number Number How Received 19198 In Person Payment Total: 2:13:29PM Amou nt Due 351.03 266.92 30.90 70.00. 14.00 12,00 12.00 4.00 17.00 10,00 30.42 89.76 224.40 24.74 35.34 $1,192.51 Amount Paid $1,192,51 $1,192.51 .