HomeMy WebLinkAboutPermit Building 2013-4- SPRINGFIELD - - 225 Fifth St
• j CITY OF SPRINGFIELD Springfield,OR 97477
ht.�\t OREGON Phone: 541-726-3753
Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00769
www.springfielo-or.gov permitce nter @sprin gfielo-or.gov
PROJECT STATUS: Issued ISSUED: 04/16/2013 EXPIRES: 10/13/2013
STATUS DATE: 04/16/2013 APPLIED: 04/16/2013
SITE ADDRESS: 3333 RIVERBEND DR,Springfield,OR 97477 SCOPE: Hospital
ASSESOR'S PARCEL NO: 1703220004102 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Installation of patient lift anchors
OWNER: PEACEHEALTH Phone Number:
ADDRESS: 123 INTERNATIONAL WAY
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION `
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor ALPHA MODALITIES LLC CCB 188783 11/23/2013 800-273-5749
L INSPECTIONS REQUIRED
Inspections
1829 Special 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 or 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.
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Springfield Building Permit 4/16/2013 11:36:38AM Page 1 of 1
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TRANSACTION RECEIPT u'nngfiemnx9nrr
ox Eanw 541-726-3753 811-SPB2013^00769
*ww.^vn"onelu-o'n* 3333 RIVERBEND DR vo«n/tcom°*§s,riow*mv'.00v
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RECEIPT DATE:0*/16/2013
PTm�� 2013000751 RECORD
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[DESCRIPTION_,______.~_^ ': -_`- ��` �, .. -ACCOUNT -'- ' AMOUNT.DUE:.
Building Permit Fee 224'00000-425002 1002 00 00
State of Oregon Surcharge(12%of applicable fees) 821'00000'215004 1099 9.60
Technology fee(5%n/penni,total) 100-00000-425605 2090 4.00
-------- ------ -~------ -'—''----`--
TOTAL DUE: *3.60
Credit Card kirk haskell 93.60
035645
TOTAL PAID: 9160
Structural Permit Application SPRINGFIELD ;DEPARTMENT USE ONLY
:� GIT�OF SPA N11 !-'OREC-,ON ' ' Hw y U1 M1 !_ � .,i.. s...,,., «.�.a � Permit no.:... ty-cie, 7g 7
22cFifth Street*Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: 6 3/3
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days f issuance or if work is
suspended for 180 days.
].,1° :LOCAL;G,OVERNMENT APPROVAL ,,,;-.1;`s " I; t =� .' c -`zF,Et 1SC11 ED_This project has final land-use approval. .1 Valuation mforination a
Signature: Date: (a)Job description: 1- estft1_7 Aricfi'+1/42S
This project has DEQ approval.
Signature:
Date: Occupancy
Zoning approval verified: ❑ Yes ❑No Construction type:
Property is within flood plain: ❑ Yes ❑No Square feet:
+' s 4 �; :rCATEGORY OF CONSTRUCTION Cost per square foot:
S❑Residential ❑ Government l.O—mmercial Other information:
�C�q ( UOB� SITE.'INF.ORMATION`ANDLOCATIONs ?�Y°dJ�.}d` Type of Heat:
Job site address: 3 333 /Cjvdlt &Itin 1] Energy Pa -
City: ��h /r,6-Lp I State: ®R I ZIP:en y¢? ❑new Iteration ❑ addition
Subdivision: Lot no.: (b)Foundation-only permit? ❑Yes NO
Reference: Taxlot: Total valuation: $ G04r="0
,P,ROPERTY:,OWNER µ, 3 Budd[ng;feres y t":A';•i•
Name: �vy Q2e rcces/ Gim.t/ _ (a)Permit fee(use valuation table): $ ,
Address:nJ3? /2y VCyz_ 63v0 (b)Investigative fee(equal to[2a]): $
City: s /s State: 02 ZIP:99y99- (c)Reinspection(S per hour):
Phone::(n)?..p F_ 8532 JI Fax: - - (number of hours x fee per hour) s/Q
E-mail:X'/f4,a< tL&PEyq ce td?LTN - 02G (d)Enter 12%surcharge(.12 x[2a+26+2c]): $ / b
(e)Subtotal of fees above(2a through 2d): $
Building Owner or Owner's agent authorizing this a.plication: 3 Plan review fees e r Vty P;;;,,,,:$ r t• U 'i'
(a)Plan review(65%x permit fee[2a]):
Sign here: (b)Fire and life safety(40%x permit fee[2a]):
❑T s installation is being made on residential or farm property owned by (c)Subtotal of fees above(3a and 3b): $
me or a member of my immediate family,and is exempt from licensing "'4 Miscellaneous fees:, `•'�{ '�" _,i s
requirements under ORS 701.010.
(a)Seismic fee, 1%(.01 x permit fee [2a]): $
° ;°CONTRACTOR INSTALLATION ` >"*.'a 06
' // �yJ - = (b)Technology fee,5%(.05 x permit fee[2a]): $
Business name:/JLpyq //ip/),47 iBY TOTAL fees and surcharges(2e+3c+4a+4b): S S 6
Address:/p�Z "%itocs A. A✓ ,i36
/ 3
City: ,5;-:4—77-i c State: we/ ZIP:9$i 13
Phone: aerio-on_.S7y_ Fax: - -
E-mail:
CCB license no.:
Print name:
Signature: -
t 'r, 1.4 1;;A TSUB:CONTRACTOR,INFORMATION ^Ifft
Name CCB License# Phone Number -
Electrical
•
Plumbing
Mechanical -