HomeMy WebLinkAboutPermit Building 2013-7-8 Structural Permit Application SPRINGFIELD -- rp fgiDEPARTMENTUSEONLY-;‘
CITY OF SPRINGFIELD, OREGON . • ci Permit no.: Si 3 (5 ��
225 Fitch Street•Springfield,OR 97477•PH(541)726-3753•FAX(54l)726-3689 OREGON
Date: `,��jJ�C 7/1//3
This permit is issued under OAR 918-460-0030.Permits expire if work is not started within 180 days of Of or if work is
suspended for 180 days.
' ° t '?'_LOCAff2GOVERNMENT,APP,ROVAL%:--)a ;f„f,"` K , ''; ''- ` *� fiFEE SCHEDUL'E_„x10.fla; 40
This project has final land-use approval. (1s al toli morrifi atirx : 74e. 4 5_ ysM
Signature: Date:
(a)Job description:( ) P e.:1411-Ate-OF Oise -("Joao Oct-TPA/9 7-0
This project has DEQ approval. .
Signature:
Date: Occupancyri s-g /YIE-77°y f��' e-Li/V
Zoning approval verified: ❑Yes ❑No Construction type:
Property is within flood plain: ❑Yes ❑No Square feet:
,'"_.'): °; CATEGOR7,605ONSTRUGTIQN','„01`'k6Z .In Cost per square foot:
❑Residential ❑Goverment ❑Commercial Other information:
`a. ,RJrJOBTSITEvINFORMATION A-115: LOCATION'KO Type of Heat:
Job site address:24)( Cs3vhAr,• ttIeL IAN a Energy Path:
City: CfCtiJEtel 0-0 State: D(L ZIPx11L110 ❑new Deteration ❑addition
Subdivision: Lot no.:l e y f f f 2 (b)Foundation-only permit? ❑Yes ❑No
Reference: I Taxlot e00 ,700 goo 10Q Total valuation: $G 0d .
r:F; ia:0 .. ..?P,ROPERTY OWNER36' CjeltT.`_..., . p2i Buildi gfees'.r',�;,, - x y -r .=' ,s: g ..nce < -.y7'
Name:piwoe4N IN vSC-r J U-C_- (a)Permit fee(use valuation table): $ iv
Address: 90QQ epJfA ..R(,1Ati A%4 (b)Investigative fee(equal to[2a]): $
City:ll Zt tJG. i 2LA) State: v' - ZiPq f (c)Reinspection(S per hour):
•{ 4-.1 - 1 4-4- 40 Q s 4- (number of hours x fee per hour) $
Phone: Fax: - -
E-mail: (d)Enter 12%surcharge(.12 x[2a+2b+2c]): S. 9G O
(e)Subtotal of fees above(2a through 2d): $
Building Owne r wnei's age a i o •' g this application: `3[iPlau'rev w fees d ., a. 7j' `-�c x e til-' rya+. C-w `
(a)Plan review(65%x permit fee[2a]) $
Sign here: (b)Fire and life safety(40%x permit fee[2a]): $
❑This install tion is being made on residentia .r fart property owned by (c)Subtotal of fees above(3a and 3b): S
me or a member of my immediate family,and is exempt from licensing a N "v' `
4:Mrscellaiieousfees�,;,�=_,*� nm ,:K:_�_„,.. ��'� �_±,',;
requirements under ORS 701.010. o
(a)Seismic fee, 1%(.01 x permit fee[2a]): $
5;fiW r;S:1;1 CONTRACTOR INSTALLATION l r` i2,74?,git5-, r U
(b)Technology fee,5%(.05 x permit fee[2a]): $ (f0
Business name: TOTAL fees and surcharges(2e+3c+4a+4b): 5 g3_-
Address:
City: State: ZIP:
Phone: - - • Fax: - - ' —WC()
Vo
E-mail: ,
i
CCB license no.: I L
Print name: .
Signature: .
o 1411Wellg$E1BgtORTRADTORIINE_ORMATIOKISMIUMal
Name CCB License# Phone Number
Electrical
Plumbing
Mechanical
'City of Springfield
•
•
SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477
Planning Division Information Sheet for Building Permits
Commercial/Industrial/Multi-Family Residential
The Planning Division requires the following information for all building permit submittals on
properties zoned Medium Density Residential, High Density Residential, Commercial, or Industrial,
including new construction, expansions, and changes of use.
New construction, expansions, and changes of use to any building, parking, or development area in
these zoning districts requires either Minimum Development Standards-MDS review (SDC 5.15-100)
or Site Plan Review (SDC 5.17-100) by the Planning Division. Overlay District Development review
(SDC 3.3-100) may also be required, depending on the site.
NOTE: It is prudent to make sure your use is permitted in the applicable zoning district. Building
Permit, Police or other permit approvals or inspections are not Planning approval.
Required_erotect-information T -.,(Applicant complete this section) .;
Applicant Name: DPEjJ AiJ I �k pt■'j Phone:64--J-615.318e
Company: AL-ptN& Vt -nA -S � bt,e, Fax:
Address: 30 np C)M(M` Rtc4'(-
ASSESSOR'S MAP NO: 1102-3 ( ly TAX LOT NO(S): 6007-10 i goo 400
Property Address: 3000 (gyp &AMt(Z-c-{ c Pete l
Description of the proposed work to be completed under this building permit:
Mkjemi6-tC- DF ace W ( Mr36I S it 0 A
kit' rec1/4{,64,1Ne tu-(vl ,
Has this development proposal been reviewed by the Planning Division ��
through an application process (i.e. MDS or Site Plan Review)? ls ❑ No
If yes, Case #:---fkInLIU.J • Oopd &
If no, is this a change in use? )LYes ❑ No
Prior Approved Use:LiAsi3et peisoolip.ibt Proposed Use:Monk, Gt/i,JGI
Does the use necessitate the use of any chemicals or substances that are hazardous or
re. uire Material Safet and Data Sheets MSDS to be ke.t on site? (!1 Yes ❑ No
Required Property Information (City Intake'Staff Complete this section);
Zoning: TOTZ: Overlay's):
The proposed project requires submittal and approval of the following Planning application
prior to building permit approval:
❑ DWP Overlay District Development ❑ Statement Letter Regarding DWP Exemption
❑ MDS ❑ MDS Land Use Compatibility Statement
❑ Site Plan Review ❑ Other:
Reviewed by: Date:
SYSTEMS DEVELOPMENT CHARGES
The City requires Systems Development Charges (SDCs)on new development and
redevelopment to accumulate funds to construct new streets, wastewater facilities and storm
drainage facilities to accommodate the needs of development. Because SDCs are based on the
intensity of the impact on City systems that a use of the property will have,these charges are
sometimes large for commercial developments and can apply even if little or no change is
required to the physical structure of a property.
We are always concerned that someone starting a business in Springfield not be surprised in
needing to pay a significant charge. For that reason,we ask everyone who applies for a
commercial building permit, or inquires about using a vacant or occupied property for
commercial or residential purposes(other than one and two family dwelling units),to give us
some basic information so that we can discuss the potential impact of SDCs. While we can't
provide a precise estimate until we have much'more detail,we can point out approximate costs
you may wish to consider.
Please provide the information below, and we can have someone from the City's Public Works
Department contact you to discuss how your development proposal could include the need to pay
SDCs.
Address or location of the proposed business:
?(pop (40,4A-617x, A47 Av6.
Describe the business activities you are proposing at that location and how much area they will
use.
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kev,c4 3 A' Of n 'l 'I Ar-4E S t r t
Will the general public use or come to your location for the proposed business
activity? t
Do you anticipate needing additional plumbing fixtures and/or needing water or ' f
wastewater facilities?
Do you anticipate adding or removing any impervious surfaces or buildings? t`Lp
What's the best way and time to contact you?
Email:
Phone Numbe?s:
541 q25 3184 _ Ay TAAiC
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Name Date I