HomeMy WebLinkAboutPermit Building 2014-6-5 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
° ` OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01229
www.spengfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/05/2014 EXPIRES: 12/01/2014
STATUS DATE: 06/05/2014 APPLIED: 06/05/2014
SITE ADDRESS: 1125 58TH ST,SPC#100,Springfield,OR 97478 SCOPE: Manufactured Home in Park
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ASSESOR'S PARCEL NO: 1702342200100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Place manufactured home in park-No sdc's per KG(same size and#fixtures as old home)
OWNER: ABENA ANTHONY Phone Number:
ADDRESS: 6009 SHANE DR
EDINA MN 55439
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
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 Safely. 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.
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Owner or Con tractor Signature Da e
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility HIS PERMIT SHALL EXPIRE IF THE WORK ..-
Notification Center. Those rules are set forth ,UTHORIZED.UNDER THIS PERMIT IS NOT
In OAR 952-001-0010 through OAR 952-001- ;OMIVIENCED OR IS ABANDONED FOR •
0090. You may obtain copies of the rules by ANY ?80 DAY PERIOD.
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 6/5/2014 10:55:49AM Page 1 of 1
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SPRINGFIELD - - CITY OF SPRINGFIELD
!1 � -Axes— . -,. 225 Fifth St
OREGON TRANSACTION RECEIPT SpringfielchOR 97477
541-726-3753
811-S P R2014-01229
www.springfield-or.gov 1125 58TH ST. SPC 100 permitcenter @springfield-or.gov
RECEIPT NO: 2014001235 RECORD NO: 811-SPR2014-01229 DATE:06/05/2014
(DESCRIPTION = ACCOUNLCODEITRANSCODE • :AMOUNT:DUE
.__i
Continuing Education Fee 224-00000-245606 2.50
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: 543.79
PAYMENT TYPE „ PAYOR _CASHIER:CCARPENTER ' COMMENTS - AMOUNT PAID •
Credit Card RALPH COCHRAN 543.79
055533
TOTAL PAID: 543.79
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CITY OF SPRINGFIELD, OREGON DEPARTMENT USE ONLY
SPRINGFIE
Permit no.: 5p f._�2 a9
225 Fifth Street • Sorinetield.OR 97477 • PHf5411726-3713 • PAXG411726-3689
Manufactured Dwelling/Recreational-Park Trailer Date: o/.57/V
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 (I)Manufactured dwelling
Sanitation approval verified: ❑ Yes ❑No (a)Placement(includes placement.
„ electrical feeder,water/sewer $447.00 $Lip
CATEGORY OF,'CONSTRUCTION', / /
connection):
❑ Residential 0 Government ❑ Commercial (b)Reinspection(no.of hrs.x fee per hr.): $82.00 $
JOB SITE INFORMATION AND LOCATION ' Placement permit can only be obtained by homeowner or Oregon-
Job site address: //2 licensed J ��� licensed manufactured dwelling installer.
City: S f/{ p/A- County: L >q,,de (2)Recreational-park trailer
t��& s-^ � - (a) Installation(includes stand and
State: O�.EG,6i- ZI P:CT 74/7(57 lot preparation:support blocking:
$447.00 $
anchoring;temporary steps;plumbing.
Subdivision: Space/lot no.: mechanical,and electrical):
Reference: Taxlok (b)Reinspection(no.of hrs x fee per hr.): $82.00 $
DESCRIPTION 'OF WORK (c)Each additional inspectiom(I) $82.00 $
Electrical service permit to be obtained only by homeowner performing
Year Manufactured: work or signing supervisor of Oregon-licensed electrical contractor
performing work.
#Bedrooms: Sq. Ftg: Value: .
`SCHDULE
PROPERTY. OWNER . (3)Surcharge, l2^/°(.12 x total,equal to t or 2): $S�YG
Name: A/J-i--{q0/ley 48�jv/ / (4)State administrative fee for
Address: ��11 / manufactured dwelling(item 1) $30.00 I $30.00
g19,QE J 1�p/Y,t only,OAR 918-500-0105(5):
City:t%/fir / State: A ZIP: (5)Technology Fee, 5% $2/ gr
Phone: - - Fax: - -
(6)Continuing Education Fee $2.50 $2.50
E-mail:4 C 9
✓J��Q Q�//J��/1/7 p� TOTAL fees and surcharges (3+4+5): $)-0
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 918-515-0010.
Signature:
CONTRACTOR INSTALLATION
Business name:7 p
Address:
City: State: ZIP:
Phone: - - Fax: - -
E-mail:
CCB license no.: MDI license no.:
Print name:
Signature: