HomeMy WebLinkAboutPermit Building 2014-07-25SPRINGFIELD
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w w.spnngfield-oreov
CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2014-01600
225 Fifth St
Springfield,OR 97477
Phone: 641-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
pe rmitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 07/25/2014 EXPIRES: 01/20/2015
STATUS DATE: 07/25/2014 APPLIED: 07/25/2014
SITE ADDRESS: 3792 OREGON AVE, Springfield, OR 97478 SCOPE: Single Family Residence
ASSESOR'S PARCEL NO: 1702314208202 TYPE OF STRUCTURE: Residential
---- PROJECT DESCRIPTION:-------Roof-repair--res heathed/reroofed-oversupport-
OWNER: GARCIA RALPH & JEAN T
ADDRESS: 3792 OREGON AVE
Phone Number:
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
ccs 000000
INSPECTIONS REQUIRED
Inspections
1620 Roofing Roofing: Prior to installing any roof covering.
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.
wner or C recto Sigrrat a Date
�
I-1HIS'PERMIT SHAD EXPIRE IF THE WORK
AUTHORIZED T is
con MENC DOOR ISRABANDONED I FOR NOT
ANY 180 DAY PERIOD.
r l ; I ;nN: Orei;on law requires you to
vv ruics adopted by the Oregon Utility
i :uti6cniion Center. Those rules are Set forth
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1.800.332.2344).
Springfield Building Permit 7/2512014 8:17:33AM Page 1 of 1
SPRINGFIELD -
CITY OF SPRINGFIELD
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TRANSACTION RECEIPT
225 Fifth St
Spngfield,OR 97477
' eRE(iON
811-SPR2014-01600
541-726-3753
wmv.springfield-or.gov
3792 OREGON AVE
permitcentergspringfield-or.gov
RECEIPT NO: 2014001596 RECORD NO: 811-SPR2014-01600 DATE: 07/25/2014
DESCRIPTION ACCOUNT CODEITRANS CODE AMOUNT DUE
Continuing Education Fee 224-00000-425606 2.50
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 9.84
Structural Building Permit Fee 224-00000-425602 1002 82.00
Technology fee (5% of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
041611
TOTAL PAID: 98.44
Structural Permit Application
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225
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This permit is issued under OAR 918-460-0030. Permits expire if work is not started within
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
This project has final land -use approval.
Signature:
Date;
This project has DEQ approval.
Signature:
Date:
Zoning approval verified: ❑ Yes ❑ No
Property is within flood plain: ❑ Yes ❑ No
CATEGORY OF CONSTRUCTION
Erkesidentiat ❑ Government ❑ Commercial
JOB SITE INFORMATION AND LOCATION
'Job site address: -- //
City: 4 (e . n State: 0Z_ ZIP: Y 7
Subdivision: I Lot no.:
Reference: Taxlot:
PROPERTY OWNER
Name: f} 2C
Address: ' ,-
City:
I State:Q ZI `f%
Phone: r — OO
Fax: - -
E-mail: 96 002-),-
h2-),-Building
BuildingOwnee wrier agent authorizing this application:
Sign here: �
d�C�N c c
❑ This installation i Bing ma on residential or fans property owned by
me or a member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
CONTRACTOR INSTALLATION'
Businessname: t,/C_ Vx---
Address:
City:
State: ZIP:
Phone: -
Fax: - -
E-mail:
CCB license no.:
Print name:
Signature:
$ �j
=SUB -CONTRACTOR INFORMATION
$
Name
CCB License N
Phoue Number
Electrical
(b) Fire and life safety (40%x permit fee [2a]):
Is
Plumbing
S
4. Miscellaneous fees
Mechanical
(a) Seismic fee, 1%(.01 x permit fee [2a]):
$
DEPARTMENT USE ONLY
Permit no.: S'q_/600
Date: Z S `
/
180 days of issuance or if work is
FEE SCHEDULE
1. Valuation information
(a) Job description:
Occupancy X 3
Construction type: OG
Square feet:
Cost per square foot:
Otter information:
Type of heat:
Energy Path:
❑ new alteration ❑ addition
(b) Foundation -only permit? ❑ Yes ❑ No
Total valuation:
S% 2coc7
2. Building fees
(a) Permit fee (use valuation table):
$ Z •—
(b) Investigative fee (equal to [2a]):
$
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
$
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
$ �j
(e) Subtotal of fees above (2a through 2d):
$
3. Plan review fees
(a) Plan review (65%x permit fee [2a]):
$
(b) Fire and life safety (40%x permit fee [2a]):
Is
(c) Subtotal of fees above (3a and 3b):
S
4. Miscellaneous fees
(a) Seismic fee, 1%(.01 x permit fee [2a]):
$
(b) Technology fee, 5% (.05 x permit fee[2a]):
$ �—
(c) Continuing Education Fee $2.5052.50
TOTAL fees and surcharges (2e+3c+4a+4b+4c):
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