HomeMy WebLinkAboutPermit Building 2007-6-6
.
.CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00307
ISSUED: 06/06/2007
APPLIED: 02/28/2007
EXPIRES: 12/06/2007
VALUE: $ 2,667,000.00
Iss u ed
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone.
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3320 Gateway St
ASSESSOR'S PARCEL NO.: 1703222001700
Springfield
TYPE OF WORK: Retail
TYPE OF USE: New
Commercial
Owner:
Address:
PROJECT DESCRIPTION: Sbell for two lease spaces
.\(\~~
NEWGATELLC ,\~'v'S~'V'
840 BEL TLINE RD STE 2~2~'<- \<;; c.~{:.. '\ ~~
SPRINGFIELD OR 9741,.7.'\ 9,'<-\' <'V \
. \ \,.: .,Co. ~....\'T.
. ~'('- \" ~v'
~,\\rv\~~'\ \~'V'<-~ ~~~~ I CONTRACTOR INFORMATION I
~ ,''!} \"L,<-'V ^ (0'\- ~'V' ,0
Contractor Ty;pe ~\f~!'>m!,a~tflt~ Licen~e~,,'I Expiration Date
General ~'0'\ ~~EG~\I.'ACIFIC CO . 631()8\0~ \0<0-'0" 01/16/2008
Electrical ~~~ l'\~W-\v A Y ELECTRIC INC \e5~~8? e c,e''J;<.J<.J ",q6/27/2007
Mecbanical ~~oJMICHAEL GRIFFIN ,'?>~ 450189\ ~ C?:,"" ",ec' 01/23/2008
Plumbing RA YMIE JASON HOYT ~o.O~ ",'I >>:!577J;!>'?'.",e \V",0<c-'hf17/2007
BUILDlNG\INFO~M'}Ti0Nlp O'e \,0-'O~,cr
., ,- 'O-~ 'U" \l' 0" . 'S' ~O ,
(..~ ,e"" >:-" Rl" G ",e' .",,,, b.~'
~lko,f !\Wries:e ,.\j ",<iP0 \~O . ,0' h~ Lot Size:
~ ~.....<\......{\ X) "^ v ..... v
Helgnl\ofStructure: e\' ",' 0" 3~;OO Sq Ft 1st Floor:
"n_ . ("V "')V ~,,~, r.>~.') ,;'v:l
Type'of,Heat:<;> c.eFo!Jed,Air Gas Sq Ft 2nd Floor:
\., ~'( ......~ 0 e ,;u
Wat~r Type: 'S' >IS' .~ . . Sq Ft Basement:
Ril%f'Ty;p.eR> e\\O\ ~e\ . Sq Ft Garage/Carport
Energy'Pat!,:? (;e Patb I Sq Ft Other:
Sprinkle~Building: nla Occupant Load:
Pbone Number: 541-284-0624
Phone
503-238-3772
541-686-2365
541-942-8339
541-689-4235
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Conslruction Type:
# of Bedrooms:
B
M
IIIB
42,075
1,201
, DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Selback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslOrains:
Notes:
Paee I of 5
Status
Issued
225 Fifth Streel, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Estimate
Pavine
Tvpe of Construction
Estimate
Use Bid Amount
Fee Description
Plan Review Comm/lnd/Public
SDC Transpo Reimbursement
-Mechanical Issuance Fe.....
+ 100/0 Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Addressing Assignment
Backflow Device
Boiler/Comm 15-30 HP
Boiler/Comm Over 50 HP
Building Permit
Fire SF Fee - Non-Residential'
Fixture
Gas Outlets 1-4
Gas Outlets 4+
Miscellaneous Plumbing
Paving
Plan Review Comm/lndlPublic
Plan Review Fire & Life Safety
Plan Review Fire & Life Safety
Sanitary Sewer - 1st 50 Feet
Sanitary Sewer Each Addtll00'
Sewage Ejector Pump
Storm Sewer - 1st 50 Feet
Storm Sewer Each AddtllOO'
. Water Line - 1st 50 Feel
Water Line - Each AddtllOO'
Tolal Amount Paid
Fire Department Review
.
.CITY OF ~rKmt."u'L1J
Building/Combination Permit
PERMIT NO: COM2007-00307
ISSUED: 06/06/2007
APPLIED: 02/2812007
EXPIRES: 12106/2007
VALUE: $ 2,667,000.00
I Valuation Descriution I
$ Per Sq Ft
or multiplier
$1.00
$1.00
Amount Paid
$3,325.17
$10,000.00
$10.00
$1,499.46
$539.35
$761.81
$31.00
$42.00
$150.00
$600.00
$7,884.65
$4,207.50
$322.00
$4.00
$9.00
$180.00
$1,264.40
$2,465.29
$1,517.10
$2,046.26
$45.00
$14.00
$14.00
$45.00
$112.00
$45.00
$56.00
$37,189.99
03/02/2007
Square Footage
or Bid Amount
2,352,000.00
315,000.00
05/31/2007
05/3112007
Value
Date Calculated
Total Value of Project
$2,352,000.00
$315,000.00
$2,667,000.00
Fpp<. PiiiJ
Date Paid
Receipt Number
2200700000000000277
1200700000000000668
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
1200700000000000710
2/28/07
6/1107
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
6/6/07
I Piau Reviews I
0510212007 OK
GRG
See attached documenl for Fire
Departmeut Plaus Review
comments.
Paee 2 of5
. .CITY OF SPRINGFIELD
Building/Combination Permit
Status Issued PERMIT NO: COM2007-00307'
225 Fiftb Street, Springfield,.oR ISSUED: 06/06/2007
541-726-3753 Pbone APPLIED: 02/28/2007
541-726-3676 Fax EXPIRES: 12/06/2007
541-726-3769 Inspection Line VALUE: $ 2,667,000.00
Initial Review 03/0112007 03/0112007 APP LLH
Plan Review Comments 03/29/2007 10 JMP Called and left a voice message for
Wbitney at Sycan B requesting a
completed signature page for tbe
special inspection forms.
Plan Review Comments 04/0412007 10 JMP WE. Received tbe special inspectiou
forms (comment #6) from Wbitney.
Still waitiug on a response to tbe
otber 9 comments. .
Plan Review Comments 05/15/2007 10 JMP WE. Received incomplete responses
10 structural comments. Still
waiting on items 7 and 8
(contractors and valuation).
Plan nine Review 03/0212007 03/08/2007 APP EMM To be built per approved Minor Site
Plan Modification.
Public Works Review 03/0212007 03/26/2007 APP JHJ Attacbed SDC Worksbeet. (JHJ)
Structural Review 05/3112007 05/3112007 APP JMP Received contractor and valuation
information from Whitney Boss.
Structural Review 03/0112007 03/23/2007 WE JMP Received witb 7 otber large projects
plus a large backlog. See attacbed
documents for 10 structural
comments faxed to Jack Kriz.
SUB Review 04/1912007 05/15/2007 APP JF Forwarded energy code forms to
Jack Foster from Wbitney T.
Landes, CP.
SUB Review 03/0212007 03/23/2007 WE JF See attacbed documents for Item #4
on JMP's structural comments
requesting tbe energy code forms
and information.
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. .
L..iliaMirprlln'1rl~tilnln(J
Site Inspection: To be made after excavation but prior to setting forms.
ErosionlGrading Inspection: Prior to gronnd disturbance and after erosion measures are installed.
Rougb Mecbanical: Prior to Cover
Final Gas: Wben all gas work is complete.
Final Mecbanical: Wben all mecbanical work is complete.
Rougb Electric: Prior to Cover
Electric Service: Approval required prior to utility company energizing service.
Final Electric: Wben all electrical work is complete.
Paee 3 of 5
.
.CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2007-00307
ISSUED: 06/06/2007
APPLIED: 02/28/2007
EXPIRES: 12/06/2007
VALUE: $ 2,667,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
Bolts Installed in Concrete: To he done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
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.
Ufer Electrical Ground: Install ground rod at footing and call for inspeclion in conjunction with footing andlor
foundation inspection.
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
Framing Inspection: Prior 10 cover and after. all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Roofing: Prior to installing any roof covering.
Slructural Concrete: In excess of 2500 psi. To be done during conslruction by a State Certified Inspector.
Provide results to City Buiding Inspector
Epoxy Anchors: To be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspeclor.
High Strength Bolting: To be done during construction by a State Certified Special Inspector. Provide inspection
results to City Building Inspector.
Structural Welds: To be done during construction by State Certified Special Inspector. Provide inspection test
results to City Building Inspector.
Final Fire Department. After all requirements of the Fire Department have been met.
Final Building: After all required inspections h'ave been requested and approved and the building is complete.
Rough Grading: After gravel is in place but prior to placing concrete.
Final Paving: After paving is complete.
Rough Plumbing: Prior to cover and including required testing.
Waler 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.
Backtlow Device: Prior to covering and provide a copy of the tesl report on site at the time of inspection.
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.
Paee 4 of5
.
Status
Issued
225 Fiftb Street, Springfield, OR
541-726-3753 Pbone
541-726-3676 Fax
541-726-3769 Inspection Line
.CITY OF SPRIN\JI1lJ<.LlJ
Building/Combination Permit
PERMIT NO: COM2007-00307
ISSUED: 06/06/2007
APPLIED: 02/28/2007
EXPIRES: 12/06/2007
VALUE: $ 2,667,000.00
By signature, I state and agree, that I bave carefully examined tbe completed application and do hereby certify tbat all
information bereon is true and correct, and I furtber certify that any and all work performed sball be done in accordance with
tbe Ordinances of the City of Springfield and tbe Laws of tbe State of Oregon pertaining to tbe work described berein, and
tbat NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify tbal only contractors and employees wbo are in compliance with ORS 701.005 will be used on tbis project. I
furtber 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.
~~/~- --
L,
Owner or Contractors Slgnat.tr:;
Paee 5 of5
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Con[;f"Clc I Gtlnire ! Grout Moriar
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SMOKE CONTROL:
Leakage tesf tog.
Coirtml Verification
ROOFING:
Insttlntion h\stallnlioiI/R.-Vaiuc'"
:Test st:Tipsfs~s
SPEcIAL iNSPECTioN AND TEStiNG S",.wwut-E "
I. ~~teTcst of Mix Des~ri
ReinforctnJ!: Test .
I Mix DeSij:ii- WeiS!:hmas;ter Cert..
ReinfDrcine Placement
I C{]ntilllious Batch Plant lnsoect
fo:soect Placim~
Cast Samples
S E1..d1 DIes (mck.uD/DeJi vcred)
Com Di"es!i:ion Tesf..
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i A~~ateTests
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I T.cndor. Test
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_ fnsert Placemen(
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~ Concref.ePI:1l".em-c:i1t
IlnstallationJnSnectiOTl
. CsstSilmolcs
I Ph::!c':'uo Samnles
I Cornnressjon Tests..
1.-
FrltEP1l00VlNG:
. Pl~cemtnt inspection
bemi:y tcst;J
'thicl~nes.!. tests
lnspeet blitching
,,', 1
I GRADING, EXCAVA'I10N. AND F1LJ..
~ Acceptance tests ... PSF
',; '~I -, BstabJlshfinnlgTBde
, {, --4-- Fill pla.cement inspeciion/comimitHls
1 6 Soli Density
,
STRUCTURA.LsmiILi\vEJ..DjNG:
Sample. and resr(listspecific mernbe.n;; bell>w)
Shop in:ntciinl identification (inHl cert)
Weld Inspection -1S.-Shop ~Pleld
UJtrasonic irlspectioll _Sbop _Fie.rd
Higli Strength Bet'ill~Sbop -x"-Pleld
A3Z5 ~N _x
. A490 _N _x
Metal deck Welwng inspeclton
Reinforcrng Steel welding inspe:c.llotl
Reinfon:ingsteel mill ceJtlficate
Metal stud Welding inspection
Concrete mse.1: Welding inspectiml
Moment res:is:ring.steel.frameS
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I STRUCnIRAL WOOD:
I ",",. r Sheonvali nailing lnspeclion
J '. ~ Shear wall aochors
J ' ~ Inspection ofGIu-lam. fab. .. )'iC psj
J .~," , Inspection OftroSSjOlSl fab.
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ADDJTWNAL tNsimCTIONS, OTHER TIi:ST, & INSPECTioNS: .11 :.:.,... Ferm t:omptet.d by, ~~$ 'fet.Ji..l\r D.,. 2../ q,P"l
c..:.T&AJ-h....vW'(", .1"..-l"\"7i!-lnt?i'b k~~ <;~A' ~.I,:O... rm.. WiIi'~O~\M, 1P~,,~..ct\tW> 6<tlr.7 iMV
_wtXn-.w, ~nn~t1W?'\'if-41M.l:.\..J~'re"..m,~ ~.Lli~.Atl ~ c;.l,,_o 4JV?W~ ~
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'PRoviDE STRENGTH REQUIRED BY ARCHITil.cr OR ENGINEER OR CONTRACT DOCUMENT LOCATION OFVALl1ES .
.
.
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET
JOURNAL OR JOB NUMBER C0M2007-00307
NAME OR COMPANY: New_ate LLC (Shell BuUdin_)
LOCATION: 3320 Gatewa~ St
MAP & TAX WTNUMBER; 1703222001700
DEVEWPMENT TYPE: New_ate LLC (Shell BuUdin.!!!
NEW DEVEWPED AREA (S.F.): 42.070.00
EXISTING DEVEWPED AREA (S.F.).
TOTAL IMPERVIOUS SURFACE (S.F.):
Reference COM200~0858
lTE:
lTE:
WT SIZE (S.F.):
Referenee COM2006-00858
822
1 STORM T1RATNACiF
IMPERVIOUS SQ. Fr.
x
No New Impen'ious Area
S 0.336 PER SF
TOTAL STORM DRAINAGE SDC:I
Will Submit With Tenant lotill
Referenee COM2006-00858
x 5 26.03 PER DFU
2. SANITARY SEWRR-CITY (seerever.;e side)
A. REIMBURSEMENT COST:
NUMBER OF DFU's
B. IMPROVEMENT COST:
NUMBER OF DFU's
o
x 5 19.79 PER DFU
TOTAL LOCAL WASTEWATER SDC:, 5
o
Credit 89920.46-641.48=89278.98 remaining
l TRANSPORTA110~
BLOG AREA TGSF x TRIP RATE x COST PER ADTx NEW TRIP FACTOR
NEW:
A REIMBURSEMENT COST:
42.07 x 67.91
B. IMPROVEMENT COST:
42.07 x 67.91
EXISTING:
A REIMBURSEMENT COST:
0.00 x 0
B. IMPROVEMENT COST:
0.00 x
0.45
NTF
525,468.49 \
x
S 19.81 PER TRIP
.x
x
5 87.39 PER TRIP
x
0.45
NTF
SI 12,351.92 ~
x
S 19.81 PER TRIP
x
NTF
SO.OO I
o
o
5 87.39 PER TRIP x 0 NTF 50.00 I
TOTAL TRANSPORTATION REIMBURSEMENT SOC:I
TOTAL TRANSPORTATION IMPROVEMENT SOC:
TOTAL TRANSPORTATION SDC:I S 137,820.411
x
4 SANTTARY SEWER _ MWMr.
NEW:
A. REIMBURSEMENT COST:
NUMBER OF FEU's 42.07 x S52.46 PER FEU S2,206.99 1
B. IMPROVEMENT COST:
NUMBER OF FEU's 42.07 x S550.38 PER FEU S23,154.49 1
EXISTING:
A. REIMBURSEMENT COST:
NUMBER OF FEU's 0.00 x #N/A PER FEU 50.001
B. IMPROVEMENT COST:
NUMBER OF FEU's 0.00 x #N/A PER FEU SO.OO 1
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL MWMC REIMBURSEMENT FEE:
TOTAL MWMC IMPROVEMENT FEE:
MWMC ADMINlSTRA 1lVE FEE:
TOTALMWMCSDC:, S 25,371.481
SUBTOTAL (ADD ITEMS 1.2.3. & 4) 1 S163.191.89 ,
5 AOMTNISTRA.TIVE FEES-
BASE CHARGE (SUBTOTAL ABOVE)
5
163.191.89 x 5% , 58,159.59
TOTAL SEWER ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE: 5
Jesse Jones
Civil Engineer, EIT
3/26/2007
DATE
TOTAL SDC CHARGES
>>
'2
80 >>
5u.,u J=',
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1-0,__'
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'~-8
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l:GU
50.00
50.00 1178
SO.OO 1183
SO.OO 1184
50.00 ~
S25.468.49 1173
SII2.351.92 1094
S137.820.41 ~ :
50.00 1054
S2,206.99 1186
S23.154.49 1187
510.00 1189
S25,371.48 ~, . . '
50.00 1175
8.159.59 1190
SI7I,:15l.48,
.
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS. CALCULATE ONL Y THE NET ADDITIONAL FIXTURES)
NewJ<llle LLC (SheU Buildio~)
FIXTURE TYPE
BATHTUB
DRINKING FOUNTAIN
FLOOR DRAIN. FLOOR SINK
INTERCEPTORS FOR GREASE/OIUSOLlDSIETC.
INTERCEPTORS FOR SAND/AUTO WASH/ETC.
LAUNDRY TUB
CWTHES WASHERlMOP SINK
CWTHES WASHER - 3 OR MORE (EA)
MOBILE HOME PARK TRAP (I PER TRAILER)
RECEPTOR FOR REFRIGERA TORIW A TER ST A TlONIETC.
RECEPTOR FOR COMMERCIAL SINK! DlSHW ASHERlETC.
SHOWER, SINGLE STALL
SHOWER, GANG (NUMBER OF HEADS)
SINK: COMMERCIAL, RESIDENTIAL KITCHEN
SINK: COMMERCIAL BAR
SINK: WASH BASINIDOUBLE LAVATORY
SINK: SINGLE LAVATORYIRESIDENTIAL BAR
URINAL. ST ALUWALL
TOILET. PUBLIC INSTALLATION
TOILET. PRIVATE INSTALLATION
MISCELLANEOUS:
NUMBER OF EDU'S'
FIXTURES UNIT
NEW OW EOUIV ALENT
3
I
3
3
6
2
3
6
12
I
3
2
2
3
2
2
I
5
6
3
DRAINAGE
FIXTURE
UNITS
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
'0
TOTAL DRAINAGE FIXTURE UNITS ~ I 0
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling (20 DFU) set 81167 gallons per day
CREDIT CALCULA TION TABLE: BASED ON ASSESSED VALUE
IF IMPROVEMENTS OCCURRED AITER ANNEXATION DATE IN TABLE. CALCULATE CREDITS SEP ARA TEL Y
YEAR
ANNEXED
] 979 or before
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
RATE PER 51.000
ASSESSED VALUE
55.29
55.19
55.12
$4.98
$4.80
$4.63
$4.40
$4.07
53.67
5322
52.73
52.25
Sl.80
CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE
IMPROVEMENT (IF AITER ANNEXATION DATE)
YEAR
ANNEXED
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
RATE PER 51.000
ASSESSED VALUE
51.45
51.25
51.09
50.92
50.72
50.48
50.28
50.09
50.05
50.00
50.00
50.00
x
x
CREDIT TOTAL
50.00
50.00
50.00
2;:5 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
..~~
C~f Springfield Official Receipt
.opment Services Department
Public Works Department
Job/Journal Number
COM2007-00307
COM2007-00307
COM2007-00307
COM2007,00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007,00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
COM2007-00307
Payments:
Type of Payment
Check
cReceint I
RECEIPT #:
1200700000000000710
Date: 06/06/2007
Description
Plan Review Fire & Life Safety
Addressing Assignment
Fire SF Fee - Non-Residential
Fixture
Sanitary Sewer - 1st 50 Feet
Sanitary Sewer Each Addtl 100'
Water Line - 1st 50 Feet
Water Line - Each Addtll 00'
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addtl 100'
Sewage Ejector Pump
Backflow Device
Miscellaneous Plumbing
Paving
Building Permit
Plan Review CommllndlPublic
Plan Review Fire & Life Safety
Boiler/Comm 15-30 HP
Boiler/Comm Over 50 HP
Gas Outlets 1,4
Gas Outlets 4+
-Mechanical Issuance Fee-
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
J
Paid By
NEWGATE, LLC
Item Total:
l:heck Number Authorization
Received By Batch Number Number How Received
jmp
5369
In Person
Payment Total:
Page I of I
11:35:12AM
Amount Due
2,046.26
31.00
4,207.50
322.00
45.00
14.00
45.00
56.00
45.00
112.00
14.00
42.00
180.00
1.264.40
7,884.65
2,465.29
1.517.10
150.00
600.00
4.00
9.00
10.00
539.35
761.81
1,499.46
$23,864.82
Amount Paid
$23,864.82
$23,864.82
616/2007