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Permit Building 2013-5-9
• SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 -C Lay Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00915 www.springtield-or.gov permitcenter @springfield-ar.gov PROJECT STATUS: Issued ISSUED: 05/09/2013 EXPIRES: 11/04/2013 • STATUS DATE: 05/09/2013 APPLIED: 05/09/2013 SITE ADDRESS: 2592 MANOR DR,Springfield,OR 97477 SCOPE: Single Family Residence ASSESOR'S PARCEL NO: 1703233301600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Minimum inspection for adult foster care compliance OWNER: SIMHI ZIV Y Phone Number: ADDRESS: 2592 MANOR DR SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone INSPECTIONS REQUIRED Inspections 1999 Final Building Final Building: After all required inspections have been requested and approved and the building 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 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. :571/ 2rcjsignature Date ATTENT ION: Oregon law requires you to Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001- NOTICE: 0090. You may obtain copies of the rules by THIS PERMIT calling the center. (Note:i the tele hc rules AUTHORIZED SHALL EXPIRE IF THE WORK number for the Oregon Utility Notif cation SOMME UNDER THIS PERMIT IS NOT Center is 1-800-332-2344). ANY 180 D DP R IS ABANDONED FOR • ERIOD. Springfield Building Permit 5/9/2013 8:37:35AM Page 1 of 1 • SPRINGFIELD -ir h`I CITY OF SPRINGFIELD ' +a.. 225 Fifth St `OREGON TRANSACTION RECEIPT Springfield.OR 97477 541-726-3753 811-S P R2013-00915 www.springfield-or.gov 2592 MANOR DR permitcenter©springfield-or.gov RECEIPT NO: 2013000912 RECORD NO:811-SPR2013-00915 DATE:05/09/2013 [DESCRIPTION' ACC.OUNTCODE/TRANS_CODE __AMOUNT DUE 1 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Structural Building Permit Fee 224-00000-425602 1002 80.00 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 I PAYMENT TYPE, : `:,PAYOR�CASHIER:JLARSON ' ,.L.L.L COMMENTS „._y,�.`,_- - .'AMOUNT PAID , Credit Card Ziv Simhi 93.60 113381 TOTAL PAID: 93.60 • • Structural Permit Application SPRINGFIELD ' RE!ARTMENTy USESONLY '. CITy,OFsSPR]NGFIELD OREGON \- . L Permit no.SJ1— '/S 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 OREGON Date: S/q//A3 This permit is issued under OAR 918-460-0030.Permits expire if work is not started within 180 days of Issuance or if work is suspended for 180 days. e ieSeAL4gaii RNMENT;'APP,ROVAIM,= :q': '-iMIES4 'i.£�' FEE SCHEDULE,,,z 'x' ' , ,, . gr72 This project has final land-use approval. a Var l uahoiimfr ctim un ZA y y.fir.,,h S�. 3 Signature: Date: (a)Job description: u a het/ bpi 4.11- 'l f (-2,r!, This project has DEQ approval. Occupancy Signature: Date: Zoning approval verified: ❑Yes El No - Construction type: Property is within flood plain: ❑Yes ❑No Square feet: , il g CATEGORY5F.O STRUCTiON n it �,�kqT Cost per square foot: • .4 Residential ❑Government ❑Commercial Other information: '' )P0.h J08s+ISITE,NF.ORMATION`ANDA)L`OCATIONka-$,.'7'i Type of Heat: Job site address: 'M. a. /lol r- .Energy Path:y City: -'/.r'79 ,� I/ State: Q(" ZIP:q' y7`7 ❑new alteration ❑addition Subdivision: I Lot no.: (b)Foundation-only pemdt? ❑Yes ❑No Reference: I Taxloa Total valuation: $G z ?A PROPilit3WE J 13 ,: Buddngfesl} '" a flX . S r `_s_ Name: 7.(t/ S,,,>k 4, (a)Permit fee(use valuation table): $ Address: qa /� yi 'r /) /: ,ry') (b)Investigative fee(equal to[2a]): $ City: S/),-,�r r'_-(, Ii// State: (7ff ZIP: / 1477 (c)Reinspection($ per hour): `I f� y, (number of hours x fee per hour) $ Phone: 97I-?//4/— 7 9 FaxS �-yhi Q 19 E-mail: (d)Enter 12%surcharge(.12 x[2a+26+2c]): $ l- id (e)Subtotal of fees above(2a through 2d): S Building Owner or Owner's agent authorizing this application: g3F?Plan+review fees y. l'',::::::.... ..;.. r 1 7„j.'{ s ;'`T „��' . (a)Plan review(65%x permit fee[2aJ): $ Sign here: 'C-- _ --� (b)Fire and life safety(40%x permit fee[2a]): $ ❑This installida 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 +4IMr eeHa eons fees t "tom 2ffigtJ' uy,',y.dx'b , "t+ a''." requirements under ORS 701.010 (a)Seismic fee, 1%(.01 x permit fee[2a]): $ ' Sr. fffEirt ry CT ORFiNSTALLATIONe a'+� 'ti's ' Y571 5% 0[J / (b)Technology fee,5/(.05 x permit fee[2a]): $ G� Business name: N 1Y' - TOTAL fees and surcharges(2e+3c+4a+4b): $ 613/O.% Address: / City: State: ZIP: Phone: - - Fax: - - E-mail: CCB license no.: Print name: Signature: . . gt.WCONTRACTORINFORMATION . Name CCB License It Phone Number Electrical Plumbing Mechanical 0 CO V O O O O o O N N r O• co co (co N r co M co In o 3 EA O O o n O N N . a. 0 0 O N coa) U_ >m v Cl) O m J C N \n 'w Q t w w m N T u) N co co) 0 C . a- U 0• O J CO y roc m E O = _ _ -p '- C w w O N V) C O) L.L N C +� C C 7 (0 N 'O a .° Q w O r m O 0 ^ N N O N U > U (0 1.1J Li j 3 0 0 CL 0.. Q 0 O w 2 < o ..?_^.. L: ca 5 ,n a m m N N eL U CL 3 •