HomeMy WebLinkAboutPermit Building 2013-5-23 •
SPRINGFIELD
► 9 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
/ ,i Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01043
www.springfieldar.gov pennitcenter@springfieId-or.gov
PROJECT STATUS: Issued ISSUED: 05/23/2013 EXPIRES: 11/18/2013
STATUS DATE: 05/23/2013 • APPLIED: 05/23/2013
SITE ADDRESS: 123 INTERNATIONAL WAY,Springfield,OR 97477 SCOPE: Hospital
ASSESOR'S PARCEL NO: 1703154001100 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Riverbend Annex Warehouse copy center
OWNER: PEACEHEALTH Phone Number:
ADDRESS: 123 INTERNATIONAL WAY
SPRINGFIELD OR 97477
OWNER: POOLED INCOME FUND NO 1 OF PEACEHEALTH Phone Number:
ADDRESS: 123 INTERNATIONAL WAY
SPRINGFIELD OR 97477
OWNER: SACRED HEART MED CTR CHARITABLE FUND Phone Number
ADDRESS: 123 INTERNATIONAL WAY
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
L. INSPECTIONS REQUIRED
Inspections
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.
/1/444.-- - /3
•
Own or Contractor Si nature Date
ENTIOH: Oregon law requires you to NOTICE:
follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK
Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telepL.-.n:-; ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 5/23/2013 8:47:44AM - Page 1 of 1
•
A
SPRINGFIELD CITY OF SPRINGFIELD
• 225 Fifth St
DL OREGON TRANSACTION RECEIPT 225Pa-ft'
541-726-3753
811-SPR2013-01043
www39666field-or.gov 123 INTERNATIONAL WAY permitcenter @spdngfield-or.gov
RECEIPT NO: 2013001027 RECORD NO:811 SPR2013-01043 DATE:05/23/2013
ACCOUNT CODELTRANSrCODE ,., 3i. .': AMOUNTt'DUEii,'.�
Building Permit Fee 224-00000-425602 1002 80.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
P.AYMENT�TYP,E P.AYOR etr a:acasn e - COMMENTS AMOUNTfP.AID _
Credit Card John Hyland Const. 93.60
023919
TOTAL PAID: 93.60
•
Structural Permit Application SPRINGFIELD ,cDEPARTMENT USEONLY 1.
tr .a
at __„�' .0 cz yrws �.^ 3 1i� �i.s�.>'3'Cq u- 4y:r 5sr
£, .C1TgY OF SPRINGFIELD{OREGON ar,,.-s- y 'A VS1:1 t Permit no.:
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689 _ OREGON
. Date:
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.
P `T' LOCAL;GOVERNMENT APPROVP.L". ,, ,,_,`.:,.- Z 1=gi?"„Il-?iz.'t+nryS-aFEESCHEDULE 0_1._4^ ',74
This project has final land-use approval 11tYaluatron,informahbn?.R, ,l*a ,w: a j��'J i:o-A :'
Signature: _ Date: (a)Job description: P g5 �
This project has DEQ approval. I ) r 1;
Occupancy
Signature: - Date:
Zoning approval verified: ❑Yes ❑No Construction type: (�
Property is within flood plain: ❑Yes ❑No Square feet: 3 S S '
`AM ,,,±r,.,;,tl i,'1CATEGORYx0F.rONSTRUCTIONVI 3f_' to Cost per square foot
❑Residential ❑Government 'RI Commercial Other information:
)viai :%JOB{SITEYINFORMATION?AND LOCATION`" _ =' Type of Heat:
Job site address: 12 3 I i oAJaL W y Energy Path:
City 5P 0/7WAtD I State:Q I ZIP:9?(j-7} ❑new ❑alteration ❑addition
Subdivision: Lot no.: (b)Foundation-only permit? ❑Yes ❑No
Reference: Taxlot: Total valuation: $
„ .. ^aa- 2,
'4Y $ r"` '�`'.,.,PROPERl,Y,01NNER.;,r„';;nx r+ t- t. ,PBuilding.fees x. r `t' ''Nl;f g.f". , .x .c_ _,'` .?-zg';
Name: Pi,,%&L( ACT KitgiRogo AAJtJ1f4( (a)Permit fee(use valuation table): $
Address: 1�2'�3 - toit J4q, J 4/y (b)Investigative fee(equal to[2a]): $
City:5-PRi7ll2hx,.l7 State: oft_ ZIP:97q 77- (a)Reinspection($ per hour): $
(number of hours x fee per hour)
Phone: - Fax: - -
E-mail: (d)Enter 12%surcharge(.12 x[2a+26+21): $
(e)Subtotal of fees above(2a through 2d): $
Building Owner or Owner's agent authorizing this application: 3�[Plan review:fees,k x;„r t r s°Sxy„M:W."' . °-.> r w Y IK
- (a)Plan review(65%x permit fee[2a]): $
Sign here: (b)Fire and life safety(40%x permit fee[2a]): $
❑This installation is being made on residential or farm property owned by (c)Subtotal of fees above(3a and 3b): - S
me or a member of my immediate famil y.and is exempt from licensin g 4r M lscelasaeoufees S_ 4 r y _ i
.
requirements under ORS 701.010. (a)Seismic fee, 1%(.01 x permit fee[2a]): $
0.-- r?=CONTRACTOR INSTALLATION.`;- -441, ,a (b)Technology fee,5%(.05 x permit fee 2a $
O gY ( P fee[2a]):
Business name: --5-4,4,„ W tl(�, Cs'x./� TOTAL fees and surcharges(2e+3c#a+4b): S
Address: /91/G, C n,,,,A,lit 41- -
City: 9p bJiR�J^'"'�l State:DR ZIP:QJt tZ
Phone: 541- ha,
'/;p$( Fax: - -
E-mail: SLA-acif4Jlute TItcatui➢'LDN'l
CCB License no.: Iy(007'/t
Print name: ' LAUf(j/lo/(
Signature
* 7: _ISUB.CONTRACTORIFORMATION� 3 -
Name CCB License N Phone Number
Electrical -
Plumbing -
Mechanical