HomeMy WebLinkAboutPermit Building 2014-08-28SPRINGFIELD --
225 Fifth St
CITY OF SPRINGFIELD
Springfield,OR97477
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Phone: 541-726-3753
'OREGON
Building / Commercial Permit
Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01650
w .spdngfield-ocgov
permitcenler@spdngfield-ocgov
PROJECT STATUS:
Issued ISSUED: 08/28/2014
EXPIRES: 02/23/2015
STATUS DATE:
08/28/2014 APPLIED: 08/01/2014
SITE ADDRESS: 3957 HAYDEN BRIDGE RD, Springfield, OR 97477
SCOPE: Commercial Miscellaneous
ASSESOR'S PARCEL NO:
1702190003300 TYPE OF STRUCTURE: Public
PROJECT DESCRIPTION:
_ North filter building _and _basin improvements_
OWNER: CITY OF EUGENE
Phone Number:
ADDRESS: CITY HALL
EUGENE OR
97401
CONTRACTOR INFORMATION
Contractor Type
Contractor Name Lie Type
Lie No Lie Exp Phone
INSPECTIONS REQUIRED
Inspections
1829 Special Inspection
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.
C-Oner or Contractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification 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).
IPY GF:
11 NS PERMIT SHALL EXPIRE IF THE WORK
til I I10RIZED UNDER THIS PERMIT IS NOT
iiviFNCED OR IS ARANDONED FOR
0 DAY PFRIOD.
Springfield Building Permit 8/28/2014 11:37:11AM Page i of i
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GFIELD CITY OF SP121NGFIF.LD
225 Fifth St
�„ TRANSACTION RECEIPT Spdngfield,OR 97477
OREGON 541-726-3753
811-SPR2014-01650
ww .springfield-or.gov 3957 HAYDEN BRIDGE RD permitoenler@spdngfield-or.gov
RECEIPT NO: 2014001897
RECORD NO: 811-SPR2014-01650
DATE: 08/28/2014
DESCRIPTION
ACCOUNT-CODE/TRANS CODE
AMOUNT'DUE
Building Permit Fee
224-00000-425602
1002
2,969.00
Continuing Education
224-00000-425606
2.50
Special Occupancy Fee
224-00000-425602
1097
29.69
State of Oregon Surcharge (12% of applicable fees)
821-00000-215004
1099
356.28
Structural Plan Review Fee Commercial
224-00000-425602
1060
1,929.85
Technology fee (5% of permit total)
100-00000-425605
2099
148.45
Credit Card water engineering 5,435.77
072019
TOTAL PAID: 5,435.77
Structural Permit Application
225 Fifih Street ♦ Springfield, OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689
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OREGON
DEPARTMENT USE ONLY
Pennit no.:
Date: ,- (/Z /✓e// JlJ
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.
Signature:
Date:
This project has DEQ approval.
Signature:
Date:
Zoning approval verified: ❑ Yes ❑ No
--Propreyis witfiin flood plain:— ❑-Yes _E1 No
CATEGORY OF CONSTRUCTION
❑ Residential
® Government I ❑ Commercial
JOB SITE INFORMATION
AND LOCATION
Job site address: 3957 Hayden Bridge Rd
City: Springfield State: OR ZIP: 974
Subdivision: n/a Lot no.:
Reference: TaxloC 1702 90003300
PROPERTY OWNER
Name: Eugene Water & Electric Board
Address: PO Box 10148
City: Eugene
State: OR ZIP: 97440
Phone: 541-685-7619
Fax:541. 68.5 7619
E-mail: chriotopher.irvin@eweb.org
Building Owner or Owner's agent authorizing this application:
Sign here:
❑ This installation is being made on residential or faun property owned by
me or a member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
CONTRACTOR INSTALLATION
Business name: TBD
Address:
City:
State: ZIP:
Phone: - -
Fax: - -
E-mail:
CCB license no.:
Print name:
Signature:
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SUBCONTRACTOR INFORMATION
Name CCB Liccuse # Phone Number
Electrical
Plumbing
Mechanical
FEE SCHEDULE
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(a)Jobdescription: Utility
Occupancy none Llk
Construction type: IIB
Square feet: n/a
Cost per square foot: n/a
Other information:
Type of Heat:
Energy Path:
❑ new (3alteration ❑ addition
(b) Foundation -only permit? ❑ Yes ®No
Total valuation:
S 600,00
2. Building fees
(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
S
(e) Reinspection ($ per hour):
(number of hours x fee per hour)
S 0
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
S
(e) Subtotal of fees above (2a through 2d);
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3. Plan review fees
(a) Plan review (65% x permit fee [2a]):
(b) Fire and life safety (40% x permit fee [2a]):
(c) Subtotal of fees above (3a and 3b):
,i2 -rel
4. Miscellaneous fees
(a)Seismic fee, l%(.01x permit fee [2a]):
4�34r�'---'
(b) Technology fee, 5% (.05 x permit fee[2a]):
S
TOTAL fees and surcharges (2e+3c+4a+4b):
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