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Home My WebLink AboutPermit Building 2007-1-18 . . CITY OF SPRINGFIELD. Building/Combination Permit Status In Review PERMIT NO: COM2007-00083 ISSUED: APPLIED: EXPIRES: VALUE: 01/18/2007 08/12/2007 $ 25,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 3332 Gateway St ASSESSOR'S PARCEL NO.: 1703222001900 Springfield TYPE OF WORK: Tenant In fill TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Sleep Country Tenant Infill Owner: 3346 GA TEW A Y LLC Address: 840 BELTLlNE RD STE 202 SPRINGFIELD OR 97477 Phone Number: 541-746-8444 I CONTRACTOR INFORMATION I Contractor Type General Electrical Plumbing Contractor License Expiration Date MEGA PACIFIC CO AnENTJOI'J:\!i~jg8Jn law (t:l4u,PJiJliG9% NEW WAY ELECTRIC INC follow rules adetqMj by the Or6~7Gl\t1v RA YMIE JASON HOYT Notification Cenil.?'17MfI!:A r1\!A'" lJa;y.;pP'x.., I BUILDI~fj~oRM..m-em>through OAR 952-001 JJ!..V. I"J~"UI LJ,l.'n copiesofthe rules bl # of Stoal!inQ the center. (Note: thel!()~ne. . HeiglilllirSte.ilOOe':!e Oregon Utility Iiffififil1l!tf~r: Type of HeatCenter is 1.800-332-2~Jf,t 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft GaragelCarport Energy Path: Sq Ft Other: Sprinkled Building: nla Occupant Load: Phone 503-238-3772 541-686-2365 541-689-4235 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: M II1B Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELORMEN>f.INFORMATION I THIS PERM REQUIRED PARKING IT SHALL EXPIRE IF THE ~verlt~~ilt: WORJq-otal: #.~~el,J;~e,islkW~IPER THIS PERMIT IS N01Handicapped: ~aveil~if,JI~fii4I!R IS ABANDONED FOR Compact: o/.I'.YfUlfJ<fMVrIlftlil/OD. I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutslDrains: Notes: ~ Paee 1 of 3 . In Review 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . CITY OF SrK11~t"11ELD' Building/Combination Permit PERMIT NO: COM2007-00083 ISSUED: APPLIED: EXPIRES: VALUE: 01118/2007 08/12/2007 $ 25,000.00 I Valuation Descriotion I I III Description Tvpe of Construction Bid Amounl Use Bid Amount $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 25,000.00 Value Date Calculated $25,000.00 $25,000.00 01/18/2007 . Total Value of Project Fpp< ~ Fee Description Plan Review CommlIndlPublic + 10% Adminislralive Fee + 5% Technology Fee + 8% State Surcharge Fixture Amount Paid $145.86 $7.00 $3.50 $5.60 $70.00 Total Amount Paid $231.96 Date Paid Receipt Number 1200700000000000040 3200700000000000099 3200700000000000099 3200700000000000099 3200700000000000099 1/18/07 2/12/07 2/12/07 2/12/07 2/12/07 I Plan Reviews I Fire Department Review 01/23/2007 Initial Review 01/19/2007 01/20/2007 Initial Review 01/22/2007 01/22/2007 Plannin2 Review 01/23/2007 01/24/2007 Public Works Review 01/23/2007 01/24/2007 Structural Review 01/19/2007 02/05/2007 SUB Review 01/2212007 02/05/2007 APP LLH Square footage calculated on shell permit. No additional fire fee required. APP LLH Received energy forms and drawing to forward to SUB APP EMM APP JHJ Allached SDC Worksheet. No new SDCs. (JHJ) WE JMP Received 1/23/2007 with more projects. See allached documents for 10 structural comments faxed 10 David P. Jones. APP JF 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. ~ Rlfl4nllliri~r\Jnsnections I SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighling Pa!!e 2 of3 . . CITY OF SPRINGFIELD Building/Combination Permit Status In Review PERMIT NO: COM2007-00083 ISSUED: APPLIED: EXPIRES: VALUE: 01118/2007 08/12/2007 $ 25,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SUB Exterior Lighting Framing Inspection: Prior to cover and after all rough in inspections have heen approved. Wall Insulation: Prior to cover. Ceiling Grid: After drywall approval but prior to cover. Final Fire Department. After all requirements of the Fire Departmenl have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required tesling. Final Plumbing: When all plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not altached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Rnugh Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, Ihat I have carefully examined the completed application and do hereby certify thaI all information bereon is true and correct, and I further certify that any and all work performed sball be done in accordance witb the Ordinances of tbe City of Springfield and tbe Laws of tbe State of Oregon pertaining to the work described herein, and tbat NO OCCUPANCY will be made of any structure wilbout permission of tbe Community Services Division, Building Safety. I further certify tbat only conlractors and employees who are in compliance witb ORS 701.005 will be used on tbis project. I furtber agree to ensure tbat all required inspections are requested at the proper time, tbat eacb address is readable from tbe street, tbat the permit card is located at Ibe front of tbe property, and tbe approved set of plans will remain on the site at all times during construction. ~-~) '2- - /2--07 Owner or Contractors Signature Date Paee30f3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ~~~~E!:!!,_ ~'l ~-I caof Springfield Official Receipt _Iopment Services Department Public Works Department Job/Journal Number COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 Payments: Type of Payment CreditCard cReceiot I RECEIPT #: Description Fixture + 10% Administrative Fee + 8% State Surcharge + 5% Technology Fee Paid By SCOTT REID 3200700000000000099 Date: 02/12/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 070086 In Person Payment Total: Page 1 of I 2:33:09PM Amount Due 70.00 7.00 5.60 3.50 $86.10 Amount Paid $86.10 $86.10 2112/2007 . .CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00083 ISSUED: 02/23/2007 APPLIED: 01118/2007 EXPIRES: 08/23/2007 VALUE: $ 125,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 3332 Gateway St ASSESSOR'S PARCEL NO.: 1703222001900 Springfield TYPE OF WORK: Tenant Infill TYPE OF USE: Alteration Commercial PROJECT DESCRIPTION: Sleep Country Tenant Infill Owner: 3346 GA TEW A Y LLC Address: 840 BEL TLINE RD STE 202 SPRINGFIELD OR 97477 Phone Numher: 541,746-8444 I CONTRACTOR INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Selback: Solar Setbacks: Contractor License MEGA PACIFIC CO 63108 NEW WA Y ELECTRIC INC 51088 MICHAEL SCOTT GRIFFIN IQ "'1/'1 150189 RA YMIE JASON HOYT VOJ',3'Oh,. ~/'15J734 BUlLDINGl.i~FORMI\;fIONt. '--, .V "'6:' l,.' e'O "'!,o, f) . h \? 6'1) rot. v, # of S~rie-!(;~ 0" 'Gb,r. \"6'1' 6'0'6' '." .!-ot Size: Height:/6'f~Jr~!~~:'?Y '00,,' ~O "~Sq:R Ist Floor: Type of Heat:o e "6 o.~41' 0'-1 is'6' I: 'Sij)).;t '20~ Floor: Water TYP~",r-~6 1),6'1' rl) c r-o,,~ "/S9 n."1J1.~Dl5ut: Range Type~ "6'1'1 q.o.:, ~O 0.0/& ~~;<Ft;ct.~{Jj~!fGarport Energy Path: is' 'i:"~ '/8,"-1 is' OJ"~~&OtlJ'~:~ Sprinkled Building: 00-..;> 4ff}}, $ ,&,l;)~9ugB\iP"ad: ~ ...~ 'YA, ,~_ v/_ V.- I DE>V&0fMENT INFORMATION'''~.?~6~/~I)~'''6 4U ''.r A <:' . q~ol) REQUIRED PARKING C'a 0a~~r. Dist: . Total: 44'y ~4to ~~5l'{tJfLees Rqd: Handicapped: I&, 4'i!'lI"e"t9ffv.fRqd: Compact: YJ () o/t?Mi~9.~ef'.m: . '4YA ~ {r 'Y ~ ~f' ~L>. A." ~o /r- I PUBLIC IMjl.Rb~~N.1'Siijf' Ih "Yf'b,.() {s> ~~6Jtwalk Type: YJ,s> C)9.;wnspoutslDrains: Expiration Date 01/16/2008 06/27/2007 01/23/2008 11/17/2007 Phone 503-238-3772 541-686-2365 541-942-8339 541-689-4235 Contractor Type General Electrical Mechanical .. Plumbing '/! # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: M IIIB Street Improvements: Storm Sewer Available: Special Instruction: Notes: Paee 1 of4 .. . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00083 ISSUED: 02/23/2007 APPLIED: 01/18/2007 EXPIRES: 08/23/2007 VALUE: $ 125,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Bid Amount Bid Amount Tvpe of Construction Use Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $1.00 $1.00 Square Foolage or Bid Amount 25,000.00 100,000.00 Value Date Calculated Descriptiou Total Value of Projecl $25,000.00 $100,000.00 $125,000.00 01118/2007 02/22/2007 L.Fppo P~irIJ Fee Descriptiou Amount Paid Date Paid Receipt Number Plan Review Comm/lnd/Public $145.86 . 1118/07 1200700000000000040 + 10% Administrative Fee $7.00 2/12/07 3200700000000000099 + 5% Technology Fee $3.50 2/12/07 3200700000000000099 + 80/0 State Surcharge $5.60 2/t 2/07 3200700000000000099 Fixture $70.00 2/12107 3200700000000000099 -Mechanical Issuance Fee- $10.00 2/23/07 1200700000000000199 + 10% Administrative Fee $70.49 2/23/07 1200700000000000199 + 5% Technology Fee $35.24 2/23/07 1200700000000000199 + 8% State Surcharge $56.39 2/23/07 1200700000000000199 Addressing Assignment $31.00 2/23/07 1200700000000000199 Appliance Not Listed $36.00 2/23/07 1200700000000000199 Appliance Vent $6.00 2/23/07 1200700000000000199 Building Permit $646.90 2/23/07 1200700000000000199 Gas Outlels 1-4 . $4.00 2/23/07 1200700000000000199 Plan Review CommlInd/Public $274.63 2/23/07 1200700000000000199 Vent Fan $12.00 2/23/07 1200700000000000199 Total Amount Paid $1,414.61 I Plan Reviews I Fire Department Review 01123/2007 See Revised Plan review by GRG for approval Initial Review 01119/2007 01120/2007 APP LLH Square footage calculated on sbell permit. No additional fire fee required. Initial Review 01122/2007 01122/2007 APP LLH Received energy forms and d'rawing to forward io SUB Plan nine Review 01123/2007 0112412007 APP EMM Public Works Review 01123/2007 01124/2007 APP JHJ Attached SDC Worksheet. No new SDCs. (JHJ) Paee 2 of 4 . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00083 ISSUED: 02/23/2007 APPLIED: 01118/2007 ExpiRES: 08/23/2007 VALUE: $ 125,000.00 . Status Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line Revised Plan Review - Fir 02/20/2007 02/20/2007 OK GRG Slructural Review 02/22/2007 02/22/2007 APP DLM Structural Review 01/1912007 02/0512007 WE JMP SUB Review 01/2212007 02/05/2007 APP JF Plans Review: Tenant in fill of a portion of Shell Building B (see 3346 Gateway Street plans review dated 8/14/06). Job #COM2006-01577. Occupancy Classification: M. Construction Type: III-B non-sprinklered. Infill size: 6,087 sq. ft. (4,468 sq. ft. for sales area: 1,619 sq. ft. for associated storage space). Occupant load: 155 (149-sales area: 6-storage area). Emergency egress ligbting sbown on Plan Sbeet 3.2.1. A special inspector's report verifying emergency egress illumination meeting 2004 OSSC 1006.2 (not less thaD 1 footcandle) will he required prior to any occupancy being granted. Duct smoke detector details shown on Plan Sbeet M1. Will verify on inspection. See documents for Plan review comments Received 1/23/2007 with more projects. See attacbed documents for 10 structural comments faxed to David P. Jones. 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. ~lrI 'n{',nl~li"tilw SUB Final: After all required energy inspections bave been requested and approved. SUB Mecbanical: Following City Rough Mechanical inspection approval and prior to any cover. SUB Ceiling Grid: Interior Lighting SUB Exterior Ligbting Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Grid: After drywall approval but prior to cover. Final Fire Department. After all requirements of tbe Fire Department bave been met. Paee 3 of 4 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00083 ISSUED: . 02123/2007 APPLIED: 01118/2007 EXPIRES: 08/23/2007 VALUE: $ 125,000.00 Status Issued 225 Fiftb Street, SpriDgfield, OR 541-726-3753 PbODe 541-726-3676 Fax 541-726-37691DspectioD LiDe FiDal BuildiDg: After all required iDspectious bave beeD requested aDd approved aDd tbe buildiDg is complete. Rougb PlumbiDg: Prior to cover aDd iDcludiDg required testiDg. Fiual PlumbiDg: WbeD all plumbiDg work is complete. Rougb Gas: After liDe is iDstalled aDd required tesliDg aDd capped if Dot attacbed to aD appliaDce. Rougb MecbaDical: Prior to Cover Final Gas: Wben all gas work is complete. Final Mechanical: WbeD all mecbaDical work is complete. Rougb Electric: Prior to Cover FiDal Eleclric: Wben all electrical work is complete. By sigDatnre, 1 state aDd agree, tbat I bave carefnlly examiDed tbe completed applicatioD aDd do bereby certify tbat all iDformatioD bereoD is trne aDd correct, and I fnrlber certify tbat any and all work performed sball be done iD accordance with the Ordinances of tbe City of Springfield and tbe Laws of tbe State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made ofany structure witbont permissioD oftbe CommuDity Services Division, Building Safety. I further certify that oDly COD tractors aDd employees who are iD compliaDce with ORS 701.005 will be used OD this project. I further agree to ensure that all required iDspectioDs are re e d at the proper time, that each address is readable from the street, that tbe permit card is located at the 0 t of the 0 ty, aDd the approved set of plans will remain on the site at all times during construction. ,~./. /.lI: Owneror~ure - OJ~J~7 ./ -- Date Pa2e 4 of 4 . . CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET JOURNAL OR JOB NUMBER COM2007-00083 NAME OR COMPANY: SI<::"P Countrv \!eoantlnftll) LOCATION: 3332 Gatew;!V SI. MAP&TAXWTNUMBER: 1703222001900 .DEVELOPMENT TYPE: Sleep Countrv (Teoantlnftll) (Landlord Portion) NEW DEVEWPED AREA (S.F.): EXISTING DEVEWPED AREA (S.F.): TOTAL IMPERVIOUS SURFACE (S.F.): 1 STORM DRAINAGE IMPERVIOUS SQ. FT. 2_ SANITARY SFWFR..c.ITY (see reverse side) A. REIMBURSEMENT COST: NUMBER OF DWs 14 B. IMPROVEMENT COST: NUMBER OF DFU's 14 Credit 89920.46-641.48~89278.98 n:maining o 4 SANITARY SFWER _ MWMC' NEW: A. REIMBURSEMENT COST. NUMBER OF FEU's B. IMPROVEMENT COST: NUMBER OF FEU's lTE: lTE: WT SIZE (S.F.): ,,., 88 .._u. ~ "" IE Q)of' '0008 o::i~:&3: _.,~ 8 Previously Paid on COM2006--00858 x 5 0.336 PER SF TOTAL STORM DRAINAGE SDC:, Reference COM2006-00858 x 5 26.03 PER DFU x S 19.79 PER DFU TOTAL LOCAL WASTEWATER SDC:J x 5 19.81 PER TRIP x .1....IRtNSPORT.ffiM Previously Paid on COM2006-00858 BLDG AREA TGSF x TRIP RATE x COST PER ADT x NEW TRIP FACTOR NEW: A. REIMBURSEMENT COST: 0.00 x 0 B. IMPROVEMENT COST: 0.00 x 0 EXISTING: A. REIMBURSEMENT COST: 0.00 x 0 B. IMPROVEMENT COST: 0.00 x o NTF 50.00 ~ SO.OO ~ x S 87.39 PER TRIP x o NTF x S 19.81 PER TRIP x o 50.00 ~ x NTF' 5 87.39 PER TRIP x 0 NTF , 50.00 ! TOTAL TRANSPORTATION REIMBURSEMENT SOC:I TOTAL TRANSPORTATION IMPROVEMENT SOC:' TOTAL TRANSPORTATION SDC:, S I Previously Paid on COM2006-008SS 50.00 SO.OO 1178 S364.42 1183 S277.06 5641.48 SO.OO 1173 50.00 1094 50.00, 0.00 #N/A PER FEU 50.00 I SO.OO I x 0.00 #N/A PER FEU x EXISTING: A. REIMBURSEMENT COST: NUMBER OF FEU's 0.00 B. IMPROVEMENT COST: NUMBER OF FEU's 0.00 MWMC CREDIT IF APPLICABLE (SEE REVERSE) x #N/A PER FEU SO.OO I 50.00 ! x #NI A PER FEU TOTAL MWMC REIMBURSEMENT FEE: TOTAL MWMC IMPROVEMENT FEE: MWMC ADMINISTRATIVE FEE: TOTAL MWMC SDC:I 5 ~-~_I SUBTOTAL (ADD ITEMS 1.2.3, & 4) I SO.OO I .i...AOMTNISTRATTVF FEES. BASE CHARGE (SUBTOTAL ABOVE) 5 x 5% I SO.OO TOTAL SEWER ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: 5 TOTAL SDC CHARGES Jesse Jones Civil Engineer, Ell 2/2312007 DATE 50.00 1054 SO.OO 1186 SO.OO ,1187 SO.OO 1189 50.00 I -' 50.00 1175 1190 50.00 . . DRAINAGE FIXTURE UNIT (DFU) CALCULA TION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY TIlE NET ADDI1l0N~ FIXTURES) Sleep COImtrv Cfenanl Inflll) (Landlord Portion) FIXTURE TYPE BATHTUB DRINKING FOUNTAIN nDOR DRAIN. nDORSINK INTERCEPTORS FOR GREASElOIUSOLlDSIETC. INTERCEPTORS FOR SAND/AUTO WASHlETC. LAUNDRY TUB CWTIlES WASHERlMOPSINK CWTIlES WASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (I PER TRAILER) RELu, V" FOR REFRlGERATOR/WATER STATIONIETC. RECEPTOR FOR COMMERCIAL SINK! DISHWASHERlETC. SHOWER, SINGLE STALL SHOWER, GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTIAL KITCHEN SINK: COMMERCIAL BAR SINK, WASH BASINIDOUBLE LA V A TORY SINK: SINGLE LAVATORYIRESIDENTIAL BAR URINAL. ST ALUW ALL TOILET. PUBLIC INSTALLATION TOll..ET, PRIVATE INSTALLATION MISCELLANEOUS: FIXTURES UNIT NEW OLD EOUIV ALENT 3 I 3 3 6 2 3 6 12 I 3 2 2 3 2 2 2 I 5 6 2 3 NUMBER OF EDU'S' DRAINAGE FIXTURE UNITS o o o o o o o o o o o o o o o o 2 o o 6 o TOT AI. DRAINAGE FIXTURE UNITS - , 8 -EDU (Equivalent Dwellin~ Unit) is a dis~~: equivalent to a sin~e family dwelling (20 DFU) set 81167 gallons per day CREDIT CALCULA nON TABLE: BASED ON ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE IN TABLE. CALCULATE CREDITS SEPARATELY YEAR ANNEXED 1979 or before 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 RATE PER SI.OOO ASSESSED VALUE 55.29 S5.19 S5.12 $4.98 $4.80 $4.63 $4.40 $4.07 53.67 53.22 52.73 S2.25 51.80 YEAR ANNEXED 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 . 2002 2003 2004 CREDIT FOR PARCEL OR LAND ONl. Y IF APPLICABLE IMPROVEMENT (IF AFTER ANNEXATION DATE) RATE PER SI.OOO ASSESSED VALUE x x CREDIT TOTAL SI.45 SI.25 51.09 $0.92 SO.72 S0.48 SO.28 50.09 SO.05 $0.00 SO.OO SO.OO 50.00 SO.OO' SO.OO 225 Fifth 8treet Springfi.eld, Oregon 97477 541-72'6-3759 Phone . <a,of Springfield Official Receipt _Iopment Services Department . Public Works Department Job/Journal Number COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007,00083 COM2007-00083 COM2007-00083 Paymenls: Type of Payment Check Cash Job/Journal Number COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 COM2007-00083 Payments: Type of Payment Check Cash cReceint I RECEIPT #: 1200700000000000199 Date: 02/23/2007 Description Addressing Assignment Plan Review Comm/Ind/Public Building Permit Vent Fan Gas Outlets 1-4 Appliance Not Listed -Mechanical Issuance Fee- Appliance Vent + 5% Technology Fee + 8% State Surcharge. + 10% Administrative Fee Paid By 3346 GA TEW A Y LLC 3346 GA TEW A Y LLC Item Total: L'heck Number Authorization Received By Batch Number Number How Received djb 1687 In Person djb In Person Payment Total: Description Addressing Assignment Plan Review CommlIndlPublic Building Permit Vent Fan Gas Outlets 1-4 Appliance Not Listed -Mechanical Issuance Fee- Appliance Vent + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By 3346 GATEWAY LLC 3346 GATEWAY LLC Item Total: <'::heck Number Authorization Received By Batch Number Number How Received djb djb 1687 In Person In Person Payment Total: Page I of I 2:09:06PM Amount Due 31.00 274.63 646.90 12.00 4.00 36.00 10.00 6.00 35.24 56.39 70.49 $1,182.65 Amount Paid $1,182.62 $0.03 $1,182.65 Amount Due 31.00 274.63 646.90 12.00 4.00 36.00 10.00 6.00 35.24 56.39 70.49 $1,182.65 Amount Paid $1,182.62 $0.03 $1,182.65 1 2/23/2007