HomeMy WebLinkAboutPermit Miscellaneous 2013-12-2 SPRINGFIELD 225 Fifth St
lit't .f,.. ;4.. CITY OF SPRINGFIELD Springfield,OR 97477
C« • Phone: 541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02559
www.springfield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/02/2013 EXPIRES: 05/31/2014
STATUS DATE: 12/02/2013 APPLIED: 11/21/2013 . •
SITE ADDRESS: 157 12TH ST,SPC#34,Springfield,OR 97477 SCOPE: Manufactured Home in Park
ASSESOR'S PARCEL NO: 1703354100201 - TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Place MFH in park-water/sewer/power is existing
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OWNER: BRIAN L FITTERER INC Phone Number:
ADDRESS: 19772 MACARTHUR BLVD STE 100
. IRVINE CA 92612
CONTRACTOR INFORMATION
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Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Manufactured Home Installer QUALITY MOBILE HOME SET UP&SERVICE LLC CCB 200448 07115/2015 541-410-1144
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.
�— i - L/tiia 2-6 2---/,�
•Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
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foilow rules adopted by the Oregon Utility ^
Notification Center. Those rules are set forth IS PERMIT SHALL EXPIRE IF THE WORK
in OAR 952-001-0010 through OAR 952-001- .
0090. You may obtain copies of the rules by JTHORIZED UNDER THIS PERMIT IS NOT •
calling the center. (Note: the telephone ;OMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit - 12/2/2013 9:45:35AM Page 1 of 1
SPRINGFIELD i GFFy OF SPRINGFIELD
225 Fifth St
c
- e; TRANSACTION RECEIPT Springfield,OR97477
OREGON 541-726-3753
. 811-SPR2013-02559
www.springfield-or.gov 157 12TH ST, SPC 34 permitcenter @springfield-or.gov
RECEIPT NO: 2013002578 RECORD NO: 811-SPR2013-02559 DATE: 12/02/2013•DESCRIPTION -- A CCOUNT CODE/TRANS CODE _AMOUNT DUE_-I
Manufactured Home Placement 224-00000-425602 1017 437.00
Manufactured Home State Issuance 821-00000-215009 1089 30.00
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: 541.29
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LPAYMENT TYPE .- PAYOR CASHIER:CCARPENTER COMMENTS _,_, • - �..�_AMOUNT PAID __ .1
Check Springlane MH villa 541.29
2915
TOTAL PAID: 541.29
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SP&INGFIELD DEPARTMENT USE ONLY
irt.ViQ '01
, PRINC'FIE 2EGt)lY , , _
Permit no.' 7 —2)3-7
225 Fifth Street • Springfield OR 97477 • P11(5411726-3753 • FAN(541)726-3639 l
Manufactured Dwelling/Recreational-Park Trailer OREGON Date: ///2//19
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 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,
CATEGORY OF CONSTRUCTION electrical feeder,water/sewer $437.00 $437
rr--���� connection):
Iyrcesidential 0 Government 0 Commercial (b)Reinspection(no.of hrs.x fee per hr.): $80.00 S
/ JOB SITE INFORMATION AND LOCATION Placement permit can only he obtained by homeowner ar Oregon-
.lob site atk 'ess; �k licensed manufactured dwelling installer.
is. N. 12 tsr. SP�.. .3
(2)Recreational-park trailer
City: Spght16p ELF County: LANE 1
(a) Installation(includes stand and
State: ORE Uli ZIP: q 71i 77 tot preparation;support blocking; $437.00 $
anchoring;temporary steps;plumbing.
Subdivision: Space/lot no.: 3i./.
mechanical,and electrical):
Reference:/7e2 ?3 r-c1/ Taxiot: GO U� (h)Reinspection(no,of hrs.s tee per hr.): $80.00 $
DESCRIPTION OF WORK —
(c)Each additional inspection:(1) $80.00 $
; Aril /A/ 19�'> tC- Electrical service permit to be obtained only by homeowner perfbrining
Year Manufactured: I-LI work or signing supervisor of Oregon-licensed electrical contractor
performing work
4 Bedrooms: I Sq. Fig: 504 Value: FEE SCHEDULE
PROPERTY OWNER (3)Surcharge, 12%(.12 x total,equal to I or 2): $
Name: B21AAi FurCQLQ. (4)State administrative fee kir
Address: manufactured dwelling(item I) $30.00 I $30.00
amide_ BL SU f1E/00 only,OAR 918-500-0105(5):
City: I eta� State: ati ZIP:cw . (5)Technology Fee,5% S ZI _
Phone:gt4q. dN0- 230,0 Fax:cp./7_0o -,-8d0 !
TOTAL fees and surcharges(3+4+5): $ 57/
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 91 5-515-0010.
Signature:
CONTRACTOR INSTALLATION
Business name: GArtq I-Ai2S F t■
Address: 2 01 SU `Mi vitui /)
City: BEdi) State: O2 ZIPgY?0/
Phone: - - Fax: - -
E-mail:
CCB license no.: 260 v(ag-MDt license no.:
Print name:
Signature: