HomeMy WebLinkAboutPermit Miscellaneous 2014-1-14 •
SPRINGFIELD-- 225 Fifth St
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CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
"'this, OR Ecor+
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Building / Residential Permit. Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00094
www.springfieldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 01/14/2014 • EXPIRES: 07/13/2014
STATUS DATE: 01/14/2014 APPLIED: 01/14/2014
SITE ADDRESS: 5240 MAIN ST,Springfield,OR 97478 SCOPE: Interior
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ASSESOR'S PARCEL NO: 1702333104402 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Compliance verification permit-restore unpermitted duplex to single-family dwelling
OWNER: WILLIAMS MARILYN A&SCOT Phone Number:
ADDRESS: 5117 INNSBROOK WAY
EUGENE OR 97402
CONTRACTOR INFORMATION
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Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
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Inspections .
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1999 Final Building Final Building: After all required inspections have been requested and approved and
the building is complete.
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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 oft - . or Oregon pertaining to the work described herein, and that NO --
OCCUPANCY will be made of any structure •ut •> fission of the Community Services Division, Bu. •••g-Safety tfurther
certify that only contractors and em. • -es who.: e in compliance with ORS 701.005 • e. on this project. I further agree
to ensure that all required ins.- ions are-rested at the proper time •- --c address is readable from the street, that the
permit card is located - e front of-the property, and the as- ••-• set of plans will remain on the site at all times during
construction.
Owiie actor Signature Date
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NOTICE: ATTENTION: Oregon law requires you to . •
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THIS PERMIT SHALL EXPIRE IF THE WORK foilow rules adopted by the Oregon Utility
AUTHORIZED UNDER THIS PERMIT IS NOT in OAR Son Center. Those rules are set 001-
in OAR 952-G01-0010 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).
Springfield Building Permit 1/14/2014 10:08:38AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
;, " TRANSACTION RECEIPT Spnngfield,OR 97477
c 541-726-3753
OREGON. 811-SPR2014-00094
www.springfield-cr.gov 5240 MAIN ST permitcenter @spnngfeld-or.gov
RECEIPT NO: 2014000082 RECORD NO: 811-SPR2014-00094 DATE:01/14/2014
:41 t.i "y`„ ..:AGCOUNDCODE/iRANSCODE £- 11�1o1olyd nl'1
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
"_P . T. ,?5:::. COMMENTS°5. 1'i' �, ` _.=•`,._e <3..<AMOUNT `S.-
.AYMENTrTYPE �f��.. PAYOR � .'
Credit Card WILLIAMS MARILYN A&SCOT 93.60
214181
TOTAL PAID: 93.60
Sttuetural Permit Application SPRINGFIELD DEPARTMENT USE ONLY
CITY OF SPRINGFIELD, OREGON E,`c R Permit no 5 j 1-( -'GOO)-`Y/
225 Filth Street•Springfield,OR 97477•PI3(54I)726 3753•FAX(541)726 3689 OREGON
Date: /7/ v/11-7 .
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.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
This project has final land-use approval. I. Valuation information .
Signature: Date 7ICS%7)K6 i tg 4‘,66—A. 70(a) Job description:
This project has DEQ approval. ?P
Occupancy
Signature: Date: �� P
Zoning approval verified: ❑ Yes ❑No Construction type: 'Vt7
Property is within flood plain: ❑ Yes ❑No Square feet:
CATEGORY OF CONSTRUCTION Cost per square foot:
esi/de ntial ❑Government ['Commercial Other inlbrmation:
JOB SITE INFORMATION AND LOCATION Type of Heat:
Job site address: <2 HO R' cats,cats, N TI Energy Path:
City: *Cr C V.(1 State: OR ZAP: ❑ new aulteration ❑ addition
Subdivision: I Lot no, (b) Foundation-only permit? ❑ Yes ❑No
Reference: /702-' r (1 'Faxlot: /i7 l{O7/ 'Total valuation: $G-,2000
PROPERTY OWNER 2. Building fees
Name: Sr KA.) A \\ \ci,„NAT1( (a) Permit fee(use valuation table): $ ropa ,
Address: 5117 --i---,....) ,..3 \.,....).3-a--\ ' (b) Investigative fee(equal to 12a1): $
City: EL) Stater ZIP: (c) Reinspection($ per hour): $
et � q"� (number of hours x fee per hour)
Phone: Pax: - -
13-mail: '1/4.1,,,,,M \(,� C QQ (d)Enter 12%surcharge(.12 x 12a{2b+2e1): $ CO°iv\ �- (e) Subtotal of fees above(2a through 2d): S •
13uilding Owner or ( iner's tent authorizing t 's application: 3. Plan review fees
(a) Plan review(65%x permit fee 12a1): $
Sign here: (h)Fire and lift safety(40%x permit fee 12a1): $
❑This• stallation is being made on residential,or faun 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 4. Miscellaneous fees
requirements under ORS 701.010. u
(a) Seismic fee, 1%(.01 x permit fee I2aJ): $
CONTRACTOR INSTALLATION
(b)Technology fee.5%(.05 x permit feel2a1): $ V
Business name: gt-LCV e,
- TOTAL fees and surcharges(2e+3c+4a+4b): S @3G__—
Address:
City: State: ZIP:
Phone: - - Fax: - -
E-mail:
CCB license no.:
Print name:
Signature:
. SUB-CONTRACTOR INFORMATION -
Name CCB License if Phone Number
Electrical
Plumbing
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