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HomeMy WebLinkAboutPermit Building 2013-5-10 • SPRINGFIELD-- 225 Fifth St ;Li _ CITY OF SPRINGFIELD Springfeld,OR 97477 Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-00768 www.springfield-or.gov permitcenter@springfield-or.gav PROJECT STATUS: Issued ISSUED: 05/10/2013 EXPIRES: 11/05/2013 STATUS DATE: 05/10/2013 APPLIED: 04/16/2013 SITE ADDRESS: 157 12TH ST,SPC#12,Springfield,OR 97477 SCOPE: Manufactured Home in Park ASSESOR'S PARCEL NO: 1703354100201 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Place manufactured home in park OWNER: FITTERER BRIAN Phone Number: ADDRESS: 19772 MACARTHUR BLVD STE 100 IRVINE CA 92612 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Manufactured Home Installer GARY M LARSEN CCB 39913 04/05/2014 541-389-8227 INSPECTIONS REQUIRED Inspections 5100 Site Inspection Site Inspection: To be made after excavation but prior to setting forms. 5370 MH Installation 5999 Final Manufactured Dwelling 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. v � Ownerntractor Signature Date ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE: Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by 'OMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone number for the Oregon Utility Notification ""v 1 O,0 DAY PERIOD. Center is 1-800-332-2344), Springfield Building Permit 5/10/2013 2:52:49PM Page 1 of 1 • ' SPRINGFIELD-- CITY OF SPRINGFIELD 225 Fifth$t TRANSACTION RECEIPT Spnngfield,OR97477 "` OREGON 541-726-3753 811-SPR2013-00768 www.spnngfield-ar.gav 157 12TH ST, SPC 12 permitcenter©spdngfield-or.gov RECEIPT NO: 2013000928 RECORD NO:811-SPR2013-00768 DATE:05/10/2013 DESCRIPTION L� §,` "° -ra`K a t 'ACCOUNT CODE/TRANS CODE,t-savh7fromprorrai,J Manufactured Home Placement 224-00000-425602 1017 437.00 . Manufactured Home State Issuance 821-00000-215009 1089 30.00 SDC: Improvement Cost- Local Wastewater - 443-00000-448025 1184 339.04 SDC: Improvement Cost-Storm Drainage 440-00000-448028 1176 130.64 SDC: Reimbursement Cost-Local Wastewater 442-00000-448024 1183 694.66 SDC: Reimbursement Cost-Storm Drainage 441-00000-448029 1177 89.68 SDC:Total Sewer Administration Fee 719-00000-426604 1175 51.68 SDC:Total Storm Administration Fee 719-00000-426604 1180 11.02 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 52.44 Technology fee(5%of permit total) 100-00000-425605 2099 21.85 TOTAL DUE: 1,858.01 . _PAYMENTT - _ R . . .� ,,,,.,. �. _ .. - -..T:=1..lea �'`TP.AYMENTTYPE g:t�,r PAYOR� �,cASHIE��R':!tJ�iAR30Ri. ��;Lar�,? 60MMENTS t��,j?Y!� �i?['n�`.�''�t.'�i4MOUNT PAID � Check Springfield Mobile Villa 1,363.52 2795 Check Springfield Mobile Villa 494.49 2782 TOTAL PAID: 1,858.01 • CITY OF SPRINGFIELD, OREGON DEPARTMENT USE_ONLY+ SPHINGFlELO --�-- - 1.:. taatw, it.f Permit no.:S(l , 7/O 2 225 Fifth Street • Sorinefield.OR 97477 • PH(5 4 11726-3 7 5 3 • FAX(5414726-3689 4 Manufactured Dwelling/Recreational-Park Trailer *' Date: / /�6 /S Placement Permit Application / / This permit is issued under OARs 918-500-0105 and 918-525-0370. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVALS• ;;r„, FEE, SCHEDULE Zoning approval verified: ❑ Yes . ❑No Description Qty. Cost each Total Property is within flood plain: ❑Yes ❑No (1)Manufactured dwelling Sanitation approval verified: ❑Yes ❑No (a)Placement(includes placement, '13 / 'CATEGORY: OF CONSTRUCTION electrical feeder,water/sewer ! -1399.717°- $,y77 rg Residential ❑ Government ❑ Commercial (b)Reinspection(no.of hrs.x fee per hr.): $58.00 $ JOB SITE INFORMATION AND LOCATION .`.. Placement permit can only be obtained by homeowner or Oregon- , Job site address: /5 -7 t licensed manufactured dwelling installer. (2)Recreational-park trailer City: 5pr.vq c,e l< County: LA4 (a) Installation(includes stand and State: 0 A, ZIP: '2 7 9 7 7 lot preparation;support blocking; • anchoring;temporary steps;plumbing, ' $397:00 $ Subdivision: Space/lot no.: / z mechanical,and electrical): Reference:/ 70,335 L// Taxlot: 002c I (b)Reinspection(no.of hrs.x fee per hr.): $58.00 $, �QQ ?:DESCRIPTIONS OF WORK'; (c)Each additional inspection:(1) $58.00 $ T�C NA/ //U /910g-- Electrical service permit to be obtained only by homeowner performing Year Manufactured: /9 g;_ work or signing supervisor of Oregon-licensed electrical contractor performing work # Bedrooms: / Sq. Ftg: (i/(F Value:5/ 70o `: "FEE :SCHEDULE PROPERTY. OWNER Tlej f” i Surchazge, 12%(.12 x total,equal to 1 or 2): $ Name: 15 r-,a-N L. F 7<f c.rev , I n!L (4)State administrative fee for Address: /'j 7 7 Z M/1-0 gt,4 t) manufactured dwelling(item 1) $30.00 I $30.00 only,OAR 918-500-0105(5): City: j(/ e' State:GO_ ZIPC/WI(2,- (5)Technology Fee, 5% $Z/?S Phone: Fax: TOTAL fees and surcharges(3+4+5): $cif/ al E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family,and is exempt from licensing requirements under OAR 918-515-0010. Signature: CONTRACTOR INSTALLATION Business name: QUp1/i/y /990,y, /-/awe .Sprvtcr. Address: 0,2_0 /5-46 /J9o,,,,fika,,v re.,u Dr. City: 13e4 State: /co ZIP: 977o/ Phone:59f-38t 1.2)1 Fax:S41-Lilo- /,49 E-mail: CCB license no.: 399/3 MDI license no.: Print name: G,q_,-y LwtrSc</ Signature: . o r1 �c SZ-witg.0 Cc WA ` t �G 3I 1 S �►Iv i I vii, S'lPK I po JLW NO H u G71 . i • - /5, 7 -i2 it sr -41 / 2 —5le 'T/Y6:/'n-ciD , O77 X797 1`� 7 V