HomeMy WebLinkAboutPermit Building 2014-3-11 SPRINGFIELD 225 Fifth St •
CITY OF SPRINGFIELD Springfield,OR 97477
s - Phone: 541-726-3753•
OREGON Building I Commercial Permit - Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02632 •
www.springfield-or.gov permitcenter @springfield-ar.gov
PROJECT STATUS: Issued • ISSUED: 03/11/2014 EXPIRES: 09/07/2014
STATUS DATE: 03/11/2014 APPLIED: 12/06/2013
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SITE ADDRESS: 3365 GAME FARM RD,Springfield,OR 97477 SCOPE: Cell Tower-Communication Tower
ASSESOR'S PARCEL NO: 1703220000904 TYPE OF STRUCTURE: Commercial
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PROJECT DESCRIPTION: Cell antennas •
OWNER: CITY OF SPRINGFIELD Phone Number:
ADDRESS: 225 N 5TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
General Contractor T3 CONSTRUCTION LLC COB 176816 06/15/2015 541580-1055
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. (•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.
` — // — 26/c/
Owner or Contractor Signature - Date
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€NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
Tres you to AUTHORIZED UNDER THIS PERMIT IS NOT
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ATTENTION: Oregon by the Oregon Utility • COMMENCED
follow rules adopted by ANY 1a DAY OR IS ABANDONED FOR
Notification Center. Those rules are set forth AY PERIOD.
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies-of the rules by
calling the center. (Note:
on Utility Notification on
•
number for the Oregon
is 1-800-332-2344).
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Springfield Building Permit 3/11/2014 12:45:57PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
`OREGON TRANSACTION RECEIPT ' Spnngfteld`OR 97477
541-726-3753
811-SPR2013-02632
www.springfield-or gav 3365 GAME FARM RD pennitcenter @spnngfield-or.gov
RECEIPT NO: 2014000532 RECORD NO:811-SPR2013-02632 DATE:03/11/2014.
[ol .'tW:�l• o7.Rt,' °..;,tii",'., �F`a, .''s,.€`i�e 9T ACCOUNT CODEFFRANS'CODE w132.1.4.7 3AMOUNT-DUE :(
Building Permit Fee 224-00000-425602 1002 265.87
Planning-Minor Review-City 100-00000-425002 1231 119.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 31.90
Technology fee(5%of permit total) 100-00000-425605 2099 13.29
TOTAL DUE: 430.06
. 1111—�..._,..p.�:-... .a.. AMOUNTPxAID_ ,r
PAYAAENTeTYP.E�PAYOR casHiER:.luRSOR - -.COMMENTS �rb.� � ..IL � . ,.>~ :r^.�
Credit Card T3 Construction • 430.06 •.
411155
TOTAL PAID: 430.06
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SPRINGFIELD CITY OF SPRINGFIELD
f ;r `, TRANSACTION RECEIPT SpringfeldtOR97477
t ' OREGON 541-72 6-3753
811-SPR2013-02632
www.springfield-or.gov 3365 GAME FARM RD permitcenter @springfield-or.gov
RECEIPT NO: 2013002622 RECORD NO: 811-SPR2013-02632 DATE: 12/06/2013
(DESCRIPTION ACCOUNT CODE/TRANS CODE . AMOUNT DUE.
Structural Plan Review Fee Commercial 224-00000-425602 1060 172.82
TOTAL DUE: 172.82
I 'PAYMENT TYPE PAYOR LL CASHIER:ccARPENTER ' COMMENTS ' - AMOUNT PAID- . I
Check Adapt Inc. 172.82
11230 •
TOTAL PAID: 172.82
Structural Permit Application SPRINGFIELD ti4 DEPARTMENT USEieNLY
2-
CITY C?I SPRl1yGF[E'L DC)REFQN ' C Permit no.: 3 2(
225 Fifth Street♦Springfield,OR 97477•P11(541)726-3753•FAX(541)726-3689 'OREGON
Date: 2/(�/>
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.
;i "'r LOCAkroOYERNMEMSr''APPRpVALe ' Plumbing
This project has final land-use approval.
Signature: Date:
Mechanical
This project has DEQ approval.
Signature: Date:
Zoning approval verified: ❑Yes ❑No
Property is within flood plain: ❑Yes ❑No ;1'.Vatuatlotttinforination {-1.,.. aii -,, .n -a
-. CATEGORY OFCONSTRUCTION (a) ption:
-iE'ri_�.�'+.�. _. . ..`� {a` - a Job descri
❑Residential ❑Government OCommercial Occupancy 14
z' r:..JOB SITEGRdFORMATIO N_AND:EOGATIONa,ill= Construction type: 1/13
Job site address: 35
c-Fk1MP-F-lrM \ Cn c. Square feet:
City: r;roNce,)A State: Q7 Cost per square foo:
Subdivision: K- Lot no.: Other information:
Relerenc/70 7 22cci Taxlot: L 7Ot/ Type of Ileac:
;" nr ` '_,�:_. _. ffPROPERTYtOWNER ,(_„-' :_, <', Energy Path:
Name: VartL-crx \Arc ESS ,,,,{{
❑new alteration ❑addition
Address: 11:50 IJ= \ZZt na �-
Ci State: 02 ZIP:a"{-� (b)Foundation only permit? ❑Yes ❑No
ty. Pork
Total valuation:' $^�'
C)00
Phon3.1133-t57 -2 Buddin' fees �s 5 r
°
E-mail: thj.b3PM1M\ales/tonne brin-0 r (a)Permit fee(use valuatio n CC:-
table): $l�
Building Owner or 0 •- s a_ent .uthorizing this application: (b)Investigative fee(equal to[2a]): $
(c) Reinspection($ per hour):
(number of hours x fee per hour)
Sign here: q
(d)Enter 12%surcharge(.12 x[2a+2b+2c]): $ 1 d/�
ear his Installation is being :2- a n residential or fa :o.ertyowned by
(e)Subtotal of fees above(2a through 2d):
me or a member of my immediate family,and is exempt from licensing ..
requirements under ORS 701.010.
...; i "' , (a)Plan review(65/o x permit fee[2a]): $ /12
w CONTRACTOR INSTALLATION';; _ ° permit
3333 .: _. -
Business name: (b)Fire and life safety(40%x permit fee[2a]): $
Address: (c)Subtotal of fees above(3a and 3b): $
.;
a L.
City: State: ZIP: '4 Mrscellaneous fees - " r?' ' ..x -.
Phone: - - Fax: - - (a)Seismic fee, 1%(.01 x permit fee[2a]): $
E-mail: (b)Technology fee,5%(.05 x permit fee[2a]): $ /3'9
CCB license no.: TOTAL fees and surcharges(2e+3c+4a+4b): $ qy3€t
Print name:
Signature:
2,11881.40.0'4.0.01C041100;14F:94MATION11,611n4
Name CCB License# Phone Number
Electrical