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Home My WebLink AboutPermit Building 2011-11-15Crrv or SpRnqcrIELD; oREcoN\ Structural Permit APPlicatio-DEPARTMENT USE ONLY gU- sfa?bLL - Permit no.2s-61 Da@:ll" l;- tt This project has final land-use approval. S ignature:Date This project has DEQ aPProval' Signature Zoning approval verifi ed nYes ENo Property is within flood Plain:Eves ENo . 1.;.:. ::.,:l :,t1, CATEG( SResidential f] Government D Commercial AN.D Job site address: ciry: EUlaEttV State:1ztP Subdivision:Lot no.: f'?-q3- 31-tt3 R.f."*r/"0 33LlL{ 3 Taxlot 6Jfu PROPERTY OWNER Name: Address:e tg cit.] L,.l)Au4(E'i State AP Phone Fax: E-mail 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 ORS 701.010. Sign here: CONTRACTOR INSTALLATION Business nu*., C{tl Address City:State:ZP.. Phone:Fax: E-mail CCB license no. Print name: Signature: :..:r "--t " j ;li,,r: - :: '-- ,':ri,", €6'' :' 125 Fifth Street r Springfi eld, OR 97 477 o PH(54 I )726-375 3 r FAX(54 1 )'l 26-3689 FEE SCHEDULE 1.V (a) Iob description Occupancy .4.I Construction tYpe::-l/ 1 Square feet: Cost per square foot: Other information: Type of Heat: Energy Path E new I alteration fi addition (b) Foundation-only permit?! Yes .€{to Total valuation: a (a) Permit fee (use valuation table) (b) lnvestigative fee (equal to [2a]):$ (c) Reinspection ($ per hour): (number of hours x fee per hour)$ (d) Enter 1 2oZ surcharge (. I 2 x [2a+2b+2c]):sna (e) Subtotal of fees above (2a (a) Plan review (55% x permit fee [2a]): (b) Fire and life safety (40% x permit fee [2a])$ (c) Subtotal of fees above (3a and 3b)s (a) Seismic fee, 1o/o (.01 x permit fee [2a]):s TOTAL fees and surcharges (2ef3c+4a):s2Of ?3 n+(t{t!. Au l'Lt/ Crn ) Icr t Phone NumberCCB License NumberName Plumbing Mechanical 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. lTAPPROVAL., : ,,, Date: .o ,, JoB slrE a-- .tl€ 2 $ I lr.gaa 5 ,.757f, $ -i:::- ,----::i: .:-:- j1 , i:lr-a: :-ii, :i ' S Electrical Recitals Acknowled gement of Septic System Responsibi I ity And Hold Harmless Agreement Parties /7-c3-3 -45 rL s:"oo 1 The appticant is the owner of residential property located ^t :i'?O3 ( /e 'A 5( 3, .y"t Yd ) and desires building permit approval to construct a 900 square foot accessory 'Cr/(structure on said property as shown on City Building Permit 9{/-s/ftZOt/-20"L I 2. The applicant acknowledges the subject site is not currently served with a City sanitary sewer pipe system and is served by an existing sanitary septic system as shown on BuildingPermitW. 3. The applicant acknowledges that in the event the existing septic system fails to function in accordance with state and local standards the applicant will be required to provide an alternative system (ex: sand filter), or a standard replacement system with future system replacement area as required by OAR 340-71-220 to continue occupancy of the existing residence. 4. The applicant acknowledges that the location of the proposed accessory structure may impact or limit the applicant's options and abilities to replace the existing sanitary system in the event of failure. Hold Harmless Agreement ln the event the existing septic system fails and requires repair or replacement, the applicant agrees to hold the City harmless for costs incurred by the owner/applicant for replacement or repair of the existing system, including alternative systems and/or the removal of the proposed accessory structure for replacement systems or back up replacement areas as required by the Lane County Sanitarian and applicable setback standards. 8: k zcrt City of Springfield (City) 225 Fifth Street Springfield, OR97477 Mr. Andrew Frost (Owner/Applicant) 3903 E. 16th Street Eugene, OR 97403 And rew Frost, Owner/Applicant Date L..L. Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2ll This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: A^t'*-",A.=t E M Name ccB#Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. lf I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. lf I change my mind and hire a generalcontractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the lnformation Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print Name of PermitApplicant Signature of Permit Applicant Date Permit #:splLzotl- 6 2 I Address:3?os E.tLlL 4! gilrerrtg o"tL ?7cl)3 lssued by:Date. This Copy for Permit Offices 5PRt'..iGFIELD www.springfield-or.gov TRANSACTION RECEIPT 811-SPR2011-02561 3903 E 15TH AVE CITY OF SPRINGFIELD 22s Fifth st Springfield,OR 97477 541-726-3753 permitcenter@springfield-or.gov DATE: 0112612012RECEIPT NO: 2012000146 RECORD NO: 81 1 -SPR2O'11-02561 Planning - Minor Review - UGB Residential Fire (.05 Per Sq Foot) SDC: lmprovement Cost - Storm Drainage SDC: Reimbursement Cost - Storm Drainage SDC: Total Sewer Administration Fee State of Oregon Surcharge (12o/o of applicable fees) Structural Building Permit Fee Technology fee (5% of permit total) 1 00-00000425002 I 00-00000-424005 440-00000448028 441 -00000-448029 71 9-00000426604 821 -00000-21 5004 224-00000425602 1 00-00000-425605 1231 9111 1176 1177 1175 1099 1002 2099 286.00 39.00 134.75 92.63 11.37 17.49 145.75 7.29 TOTAL DUE:734.28 Credit Card 391 21 6 ANDREW FROST TOTAL PAID:734.28 734.28 DUE PAYOR PAIDPAYMENT ww. springfield-or. gov RECEIPT NO: 2011002979 TRANSACTION RECEIPT 811-SPR2011-02561 3903 E 16TH AVE RECORD NO: 811-SPR2011 -02561 CITY OF SPRINGFIELD 22s Fifth sr Springfield,OR 97477 541-726-3753 permitcenter@springf ield-or. gov DATE: 1111512011 Structural Plan Review Fee Residential 224-00000-425602 1061 94.74 TOTAL DUE: 94.74 Credit Card 564539 Elements Open Studio 94.74 TOTAL PAID:94.74 ACCOUNTCODE/TRANSCODE AMOUNTDUE