HomeMy WebLinkAboutPermit Miscellaneous 2013-12-4 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
. v Phone: 541-726-3753
OREGON ' Building / Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02612
www.springfieldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/04/2013 EXPIRES: 06/02/2014
STATUS DATE: 12/04/2013 APPLIED: 12/04/2013
SITE ADDRESS: 4145 JASPER RD,Springfield,OR 97478 SCOPE: Bedroom •-
ASSESOR'S PARCEL NO: 1802052300403 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Divide bedroom into two bedrooms, Post construction
OWNER:. HOWARD LOREE L&MICHAEL W Phone Number: 844-9336
ADDRESS: 4145 JASPER RD
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor OWNER GCB 000000 08/01/2025 '
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.
Owner or Contractor Signature Date
NOTICE: ATTENTION: Oregon law requires you to
follow THIS PERMIT SHALL EXPIRE IF THE WORK Notlf cat le Ceatert ThosehulOr age s t folrth
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001-
COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
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Springfield Building Permit 12/4/2013 11:33:37AM Page 1 of 1
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SPRINGFIELD - CITY OF SPRINGFIELD
225 Fifth St
14:\ TRANSACTION RECEIPT Spnngfield,OR 97477
-OR N 541-726-3753
OREGON 811-SPR2013-02612
www.springfield-or.gov 4145 JASPER RD permitcenter®spnngfield-or.gov
RECEIPT NO: 2013002604 RECORD NO:811-SPR2013-02612 DATE: 12/04/2013
)el Xto �` r _'.�;-- £-!-E2i 1ge Zif t'Ma V � _: ACCOUNT-CODElTRANS CODE. sk. P3bl::=-AMOUNT4DUE ''i
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
yy�� "'3 -""°'F T'° a'i .r_x - :AMOUNTPAID
IfI�IPAYMENT�TYP,.E P.AY,OR CASHIER:,CCARa.ENTER _ COMMENTS - . .Cash HOWARD LOREE L&MICHAEL W 93.60
TOTAL PAID: 93.60
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Structural Permit Application SPRINGFIELD `DEPARTMENT USE ONLY,
s —CITY OREGON ' Permit no.: 5't? Z
225 Fifth Street•Springfield,OR 97477•PH(541 p26-3753•FAX(541)726-3689
OREGON
V( 7/^��
Date:/2/y //
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of tssua ce or if work is
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
This project has final land-use approval. I.Valuation information
Signature:Si Date: (a)
g (a)Job description: DI v/i)Z
This project has DEQ approval. 7• Occupancy 2
Signature: Date: _
Zoning approval verified: ❑ Yes ❑No Construction type: t--/D
Property is within flood plain: ❑Yes ❑No Square feet:
CATEGORY OF CONSTRUCTION Cost per square foot:
wsidential ❑Government ❑Commercial Other information:
JOB SITE INFORMATION AND pLO�CATION Type of I leaf:
Job site address: �jt///S J 2p4 £ L, Energy Path:
City:CA4 ritiq Gp (C-9 rState: OQ ZIP:g7 ( ❑ new ',alteration ❑addition
Subdiv ton: Lot no.: (b)Foundation-only permit? ❑ Yes ❑No
Reference: 0,22‘95-2 Taxlot: -/,9 Z Total valuation: $'2.c 0
PROPERTY OWNER - V 2. Building fees
Name: 111'chat ! t/a um-tzp� )ree_ /law/)/M (a) Permit fee(use valuation table): $
Address: /1t 4SG .33 ( 9E . A (h)Investigative fee(equal to Pap:
City: 6 ri N ft,,, 1 _ State: OR ZIP:q74175 (c) Reinspection(S per hour):
Phone: �33�0 I-axx: - - (number of hours x Ice per hour)
E-mail: Lela cc- j-j-0 ,0412) a yedioo ,cor (d)linter 12 surcharge(.12 x 12a+2b+2c)): $
(e) Subtotal of fees above(2a through 2d): $
Building Owner or Owner's agent authorizing this application: 3. Plan review fees,
(a) Plan review(65%x permit fee(2aj): $
SSiig,.here: fl� -� (b)Fire and life safety(40%x permit fee pap: $
@-This installation 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 4.Miscellaneous fees -requirements under ORS 701.010.
(a)Seismic Ice, I%(.01 x permit fee[Zap: $
CONTRACTOR INSTALLATION
(b)Technology fee.5%(.05 x permit feel2a1): $
Business name:
'IOTA ,fees and surcharges(2e+3c+da+db): S 41_G0
Address:
City: State: • ZIP:
Phone: - - Fax: - -
E-mail:
CCB license no.: _
Print name:
Signature:
. SUBCONTRACTOR INFORMATION -
Name CCB License d Phone Number
Electrical
Plumbing
flee hanical