HomeMy WebLinkAboutPermit Miscellaneous 2013-12-4 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
11111L Phone. 541-726-3753
OREGON Building I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00782
www.spnngfield-or gov permitcenter@springfield-or goy
PROJECT STATUS: Issued ISSUED: 12/04/2013 EXPIRES: 06/02/2014
STATUS DATE: 12/04/2013 APPLIED: 04/18/2013
SITE ADDRESS: 5310 FRANKLIN BLVD, Eugene,OR 97403 SCOPE: Cell Tower-Communication Tower
ASSESOR'S PARCEL NO: 1803034000300 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Antenna co-locate on existing tower
OWNER: MACAULEY EDWARD L Phone Number;
ADDRESS: 76563 MARTIN CREEK RD
COTTAGE GROVE OR 97424
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor M&A CONTRACTING INC CCB 177866 08/14/2015 503-581-6125
LINSPECTIONS 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. /4///?
Owner or Contracto :ture Date
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Springfield Budding Permit 12/4/2013 11:45:55AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spnngfield,OR97477
I.rt 1#12,A
OREGON 541-726-3753
811-SPR2013-00782
www Springfield-or gay 5310 FRANKLIN BLVD permitcenter[✓a'spnngfield-or gay
RECEIPT NO: 2013002606 RECORD NO:811-SPR2013-00782 DATE: 12/04/2013
Building Permit Fee 224-00000-425602 1002 141.96
Planning-Minor Review-UGB 100-00000-425002 1231 286.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 1704
Technology fee(5%of permit total) 100-00000-425605 2099 7 10
TOTAL DUE: 452.10
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Check MA contractors 359.83
5814
Credit Card URBAN WIRELESS 92.27
00147z
TOTAL PAID: 452-10
SPRINGFIELD CITY OF SPRINGFIELD
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TRANSACTION RECEIPT Springfield10R97477
OREGON 541-726-3753
811-SPR2013-00782
www spnngfield .gov 5310 FRANKLIN BLVD permitcenter @spnngfield-or.gov
RECEIPT NO: 2013000772 RECORD NO:811-SPR2013-00782 DATE:04/18/2013
DESCRIPTION ACCOUNT CODEITRANS CODE AMOUNT DUE
Structural Plan Review Fee Commercial 224-00000-425602 1360 92.27
TOTAL DUE: 92.27
PAYMENT TYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID
Check URBAN WIRELESS 92.27
2061
TOTAL PAID: 92,27
Structural Permit Application DEPARTMENT USE ONLY
C1TY OF SPRINGFIFI.D,OREf;ON 6-tisLefisiN
Permitno.: /?-- rig
225 Fifth Street•Springfield,OR 974771 P1(541)726-3753•FAX(541)726-3689 �r
Date: tiL i g/1 3
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of i uanECJe or if work is
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
This project has final land-use approval.
Signature: Date: FEE SCHEDULE
This project has DEQ approval. 1.Valuation information
Signature: Date: (a)Job description:add 3 antennas to existing 12 antennas
Zoning approval verified: ❑Yes ❑No Occupancy unmanned telecom
Property is within flood plain: ❑Yes ❑No Construction type: modular telecom
CATEGORY OF CONSTRUCTION Square feel. no change
❑Residential I ❑Government I ®Commercial Cost per square foot:
JOB SITE INFORMATION AND LOCATION Other information:
Job site address: 5310 Franklin Blvd Type of Heat:
City: Springfield I State: OR I ZIP: 97477
Energy Path:
Subdivision: Lot no.:
Reference: I Taxlot: 18030340-300 ❑new ®alteration 0 addition
Applicant �Le y (b)Foundation-only permit? ❑ Yes L] No 44
Name: Verizon Wireless(VAW) LLC c/o Land Services NW Total valuation: I s 8000.00
Address: ATTN: Ed Fournier PO Box 302 /
2.Building fees
(a)Permit fee(use valuation table): $ `7�c
city: Bend State: OR J ZIP: 97709 / —
Phone: - . 541-728-3328 Fax: - 206-350-1223 (b)Investigative fee(equal to[2a]): S
Ed@LandServicesNW.com (c)Reinspection($ per hour):
E-mail: (number of hours x fee per hour)
This installation is being made on residential or farm property owned by (d)Enter 12%surcharge(.12 x[2a+2b+2c]): $ f 7 6(-1
me or a member of my immediate family,and is exempt from licensing
requirements under ORS 701.010. (e)Subtotal of fees above(2a through 2d): S
Sign here: 3.Plan review fees
CONTRACTOR INSTALLATION (a)Plan review(65%x permit fee[2a1): $
Business name: to be determined (b)Fire and life safety(40%x permit fee[2a1): 3
(c)Subtotal of fees above(3a and 3b): S
Address: - -
4.Miscellaneous fees 7 K
City: State: ZIP:
(a)Seismic fee, 1%(.01 x permit fee[2a)): S
Phone: - - Fax: - -
E-mail: TOTAL fees and surcharges(2e+3c+4a): s
CCD license no.:
Print name:
Signature:
SUB-CONTRACTOR INFORMATION
Name CUB License Number Phone Number
Electrical _
Numbing
Mechanical