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Permit Building 2014-3-7
SPRINGFIELD b x 225 Fifth St rr� CITY OF SPRINGFIELD Springfiield,OR 97477 "'rmK�4-,.a+ Phone:541-726-3753 S OREGON Building / Commercial Permit Inspection Phone:541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02263 www.spnngfield-or.goy permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 03/07/2014 EXPIRES: 09/03/2014 . STATUS DATE: 03/07/2014 APPLIED: 10/09/2013 SITE ADDRESS: 1701 CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Cell Tower-Communication Tower ASSESOR'S PARCEL NO: 1703253404502 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Cell Tower-replace and add antennas on telecom tower OWNER: ORDER OF ELKS LODGE#2145 Phone Number: ADDRESS: 1701 CENTENNIAL BLVD SPRINGFIELD OR 97477 CONTRACTOR INFORMATION - Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor LEGACY WIRELESS SERVICES INC CCB 150432 02/15/2016 503-656-5300 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. .J SSN(1.. Vik wet.r ( -V; 4 y Owner or Contractor Signature Date % ke,,. !.,. td4tar/NJt, • 4A d lew"'Luau to touow ado � a n{'rtp�0 2.001- NO-ilCE: rules Center. Those rule s9524)01.0090. Youmeyobtain THIS PERMIT SHALL EXPIRE IF THE WORK 0010 through OAR bycaning the center(Note:the ;an number for the Oregon Utlllly No ti AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR Center Is 1-800-3 32-23441• ANY .DAY PERIOD. Springfield Building Permit 3/7/2014 11:20:20AM Page 1 of 1 SPRINGFIELD' CITY OF SPRINGFIELD 225 Fifth St `� TRANSACTION RECEIPT Spnngfield,OR97477 OREGON 541-726-3753 811-SPR2013-02263 www.springfieldor.gov 1701 CENTENNIAL BLVD permitcenter @springfield-or.gov RECEIPT NO: 2014000510 RECORD NO:811-SPR2013-02263 DATE:03/07/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE ` AMOUNT',DUE Building Permit Fee 224-00000-425602 1002 245.21 Planning-Minor Review-City 100-00000-425002 1231 119.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 29.43 Technology fee(5%of permit total) 100-00000-425605 2099 12.26 TOTAL DUE: 405.90 1 PAYMENT TYPE PAYOR CASHIER:OBOWLSBY COMMENTS AMOUNT PAID Credit Card LEGACY WIRELESS SERVICES INC 405.90 007539 • TOTAL PAID: 405.90 • SPRINGFIELD++-r CITY OF SPRINGFIELD et. TRANSACTION Fifth St TRANSACTION RECEIPT Spdogfield,OR97477 OREGON 541-726-3753 811-SPR2013-02263 www.springfield-or.gov 1701 CENTENNIAL BLVD permitcenter@springrield-or.gov RECEIPT NO: 2013002246 RECORD NO: 811-SPR2013-02263 DATE:10/09/2013 I'DESCRIPTION • ' • - ACCOUNT CODEITRANSCODE AMOUNT DUE'-'.. Structural Plan Review Fee Commercial 224-00000-425602 1060 159.39 TOTAL DUE: 159.39 L.'PAYMENT TYPE PAYOR CASHIER:DBOWLSBV_;. --. COMMENTS `.` AMOUNT PAID° - Check urban wireless inc 159.39 2327 TOTAL PAID: 159.39 • Structural Permit Application DEPARTMENT USE ONLY ONPINDFIOID t2SPRINGFIGLI0;(i] .Qlr _,. Permit no.:$f3-0 ZZ 63 225 Fifth Street•Springfield,OR 97477*P1-1(54 )726-3753♦FAX(541)726-3689 ' Date: /D///9�j This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days oT is ante 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:replace & add antennas on telecom tower Zoning approval verified: ❑Yes ❑No Occupancy unmanned telecom Property is within flood plain: ❑Yes ❑No Construction type: modular telecom CATEGORY OF CONSTRUCTION square leer: no change ❑Residential ❑Government I lib Commercial Cost per square foot: JOB SITE INFORMATION AND LOCATION Other information: Job site address: 1701 Centennial Blvd 'type of Heat: City: Springfield Stale: OR I ZIP: 97477 — Energy Path: Subdivision: Lot no.: Reference: 11'axlot: 1703253404502 ❑new alteration 0 addition Applicant Pftert yyry_R (b)Foundation-only permit? ❑ Yes ® No Name: Verizon Wireless(VAW) LLC c/o Land Services NW Total valuation: $1$,000.00 Address: ATTN: Ed Fournier PO Box 302 2. Building fees City: Bend State: OR ZIP: 97709 (a)Permit fee(use valuation table): $ '21/12.-1 Phone: - - 541-728-3328 Fax: - 206-350-1223 (b)Investigative fee(equal to[2a]): $ Ed LandServicesNW.com (c)Reinspection(3 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+26+2c $ 4 me or a member of my immediate family,and is exempt from licensing ( �- g a(' [ ])'- - 25 v requirements under ORS 701.010. (e)Subtotal of fees above(2a through 2d): S Sign here: 3.Plan review fees ll-p 7 CONTRACTOR INSTALLATION (a)Plan review(65%x permit fee[2a]): $ �J F Business name: to be determined (b)Fire and life safety(40%x permit fee[2a]): $ (c)Subtotal of fees above(3a and 3b): Address: S 4. Miscellaneous fees Z a State: I ZIP: - - Phone: - - Fax: - - (a)Seismic fee, 1%(.01 x pennit fee[2a]): $* E-mail: TOTAL Ices and surcharges(2e+3c+4a): S 4/(1( Z CCD license no.: Print name: Signature: SUB-CONTRACTOR INFORMATION Name CCfl License Number Phone Number Electrical Plumbing Mechanical •