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Permit Building 2014-4-18
SPRINGFIELD 225 Fifth St 4 i CITY OF SPRINGFIELD Springrield,OR 97477 Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2012-02404 www.springfield-or.gov permitcentergspringfield-or.gov PROJECT STATUS: Issued ISSUED: 04/18/2014 EXPIRES: 10/15/2014 STATUS DATE: 04/18/2014 APPLIED: 12/05/2012 SITE ADDRESS: 3100 E 17TH AVE,Eugene,OR 97403 SCOPE: Cell Tower-Communication Tower ASSESOR'S PARCEL NO: 1703334400300 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Wireless facility-Install new transmission tower OWNER: LANE COUNTY OWNED LANDS DEPT Phone Number: ADDRESS: 125 E 8TH AVE EUGENE OR 97401 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone General Contractor JON C SOUTHERN CCB 135582 04/12/2015 503-789-9690 INSPECTIONS REQUIRED Inspections 1996 Final Inspection—Planning 1020 Zoning/setbacks 1120 Foundation Foundation: After forms are erected but prior to concrete placement. 1260 Framing Framing Inspection: Prior to cover and after all rough in inspections have been approved. 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 wh• -re in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all require. . spections are r-• ested at the proper time,that each address is readable from the street, that the permit card is locate• = the front of the • •perty, 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 THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility AUTHORIZED UNDER THIS PERMIT IS NOT Notification . Those rul fth COMMENCED OR IS ABANDONED FOR in OAR 952-001-0010 Center through cos AR are 952 set-001or - 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 Springfield Building Permit 4/18/2014 10:23:22AM Center is 1.800-332-2344). Page 1 of 1 SPRINGFIELD - CITY OF SPRINGFIELD 225 Fifth St t0 EGON TRANSACTION RECEIPT Springfield,OR 97477 541-726-3753 811-S PR2012-02404 www.springfieid-or.gov 3100 E 17TH AVE permitcenter @springfieid-or.gov RECEIPT NO: 2014000856 RECORD NO:811-SPR2012-02404 DATE:04/18/2014 !DESCRIPTIO■ __• _ A C C O U N T CODE/TRANS CODE_ __AMOUNT DUE_n Building Permit Fee 224-00000-425602 1002 912.25 Planning-Major Review-City 100-00000-425002 1231 211.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 109.47 Technology fee(5%of permit total) 100-00000-425605 2099 45.61 TOTAL DUE: 1,278.33 `AMOUNT PAID }_ PAYMENT TYPE_ _,PAYOR_.__cnsRiEg;CCARPENTER_i _.,COMMENTS,____ _ :... .. _AMOUNT-_- . .. _ ._t_ Credit Card Scott Sontag 1,278.33 084601 TOTAL PAID: 1,278.33 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St kelt TRANSACTION RECEIPT Spnngfield,OR 97477 Om" OREGON 541-726-3753 811-SPR2012-02404 www springfield-or goy 3100 E 17TH AVE perrnitcenter©spnngfield-or gov RECEIPT NO: 2012002374 RECORD NO: 811-SPR2012-02404 DATE: 12/05/2012 FEJEsdiurriO4 1 • • ACe-OUNTobbetRAWs Aivibtkabik 1 Structural Plan Review Fee Commercial 224-00000-425602 1060 592 96 TOTAL DUE: 592.96 PAYMENT ',PAYOR CASHIER:DeowLsev ' COMMENTS, „.::AMOUNT PAID Check velocitei Inc portlarTeirTeTM7eCCOuW1---------------- 592.96 5276 TOTAL PAID: 592.96 Structural Permit Application • • • • ` • . DEPARTMENT USE ONLY • R,wa I.Lo CITY OF SPRINGFIELD,OREGON Permit no.: S/z-02 L/OL/ 225 Fifth Street•Springfield,OR 97477•P11(541)726-3753•FAX(541)726-3689 44n Date: / Z.13-/Z- 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 This project has final land-use approval. Date: FEE SCHEDULE Signature: This project has DEQ approval. - 1.Valuation information Signature: Date: (a)Job description: Wireless Facility Zoning approval verified: ❑Yes - 0 No Occupancy NA Property is within flood plain: ❑Yes 0 No Construction type: CATEGORY OF CONSTRUCTION Square feet: ❑Residential I 0 Government I Commercial Cost per square foot: JOB SITE INFORMATION AND LOCATION Other information: Job site address:310 0 E. 17th Ave Type of Beat: City: Eugene ' State: OR I ZIP: 97403 Energy Path: Subdivision: I Lot no.: yyy��,---,,,��� 17-03-33-44 I 00300 ignew ❑alteration ❑addition Reference: Taxlot: PROPERTY OWNER 94.1 1.1126 `� (b)Foundation-only permit? ❑Yes ❑No Name: Lane County, attn at��, Total valuation: I $150, 000 Address: 3100 E 17th Av 2.Building fees City: Eugene State:OR I ZIP:9 74 0 3 (a)Permit fee(use valuation table): Phone:541-6.82-4120 Fax: - - (b)Investigative fee(equal to[20: S Patti .Hansen@co. lane .or.us (c)(number of 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]): s me or a member of my immediate family,and is exempt from licensing requirements under ORS 701.010. (e)Subtotal of fees above(2n through 2d): S Sign here: 3.Plan review fees CONTRACTOR INSTALLATION (a)Plan review(65%x permit fee[2a]): S ��fZ -- Velocitel Wireless-Jon Southern (b)Fire and life safety(40%x permit fee 12a]): $ Business name: - - Address:4004 Kruse Way Pl, Ste 220 (c)Subtotal of fees above(32 and 3b): S Lake Oswego OR I 97035 4.Miscellaneous fees 2 City: g State: ZIP: -� I 503-Z89-9690 - - (a)Seismic fee, l%(.01x permit fee 120): 5/� S Phonc: Fax: E-mail: ] . southern @velocitel . com TOTAL fees and surcharges(2e+3c+4a): S CCB license no.: 13 582 Print name: Jo u hern Signature: • SU -CONTRACTOR INFORMATION . Name CCB License Number Phone Number Electrical. Plumbing Mechanical • II