HomeMy WebLinkAboutPermit Building 2016-05-04 (2){30N
www. springfield-or. gov
PROJECT STATUS:
STATUS DATE:
CITY OF SPRINGFIELD
Building / Commercial Permit
PERMIT NO: 811-SPR2016-00952
This Perm or thereof shall remain at the untilfina! i
225 Fifth St
Springfield,OR 97477
Phone: 541 -726-3753
IVR Phone: 1 -888-299-2821
lVlessage Phone: 541 -7 26-3769
permrtcenter@springfield-or. gov
on
lssued
0510412016
ISSUED:
APPLIED:
05to4120'16
04t2212016
EXPIRES:
IVR REF #:
10t31t20'16
81 1030884498
SITE ADDRESS: 693 36TH ST, Springfield, OR 97478
ASSESOR'SPARCELNO:1702311201600
PROJECT DESCRIPTION: Cell Antenna Addition
SGOPE: Cell Tower - Communication Tower
TYPE OF STRUCTURE: Commercial
OWNER:
ADDRESS
STAFEK TERRY L
87820 GEDAR FLAT RD
SPRINGFIELD OR97477
Phone Number:
CONTRACTOR INFORMATION
Contractor Contractor Name Lic Type Lic No Lic Exp Phone
CCB 200980 09119t2017 224-757-0001
INSPECTIONS REQUIRED
IVR Code / lnspection Type
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 Current Development Department, Building Safety. I
further certify that only contractors and employees who are in compliance with ORS Chapter 701 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
it, or copy thereof, shall remain iobsite until final inspection.ql^(.1 3
DateOwner or Contractor Signature
NOTIGE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AI,,THORIZED UNDER THIS PERMIT IS NOT
CO-MMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Springfield Building Permit 51412016 1:04:30PM Page 1 of 1
&effi TRANSACTION RECEIPT
81 1-SPR2016-00952
693 36TH ST
CITY OF SPzuNGFIELD
225 Fifth St
Spnngfield,OR 97477
541-726-3753
permitcenter@springf ield-or. govwww.springfi eld-or. gov
DATE:05/04/2016RECEIPT NO: 201600'1 1 13 RECORD NO: 811-SPR2016-00952
Building Permit Fee
Continuing Education
Fire Code Compliance Fee (15% of applicable fees)
Planning - Minor Review - City
State of Oregon Surcharge (12o/o of applicable fees)
Structural Plan Review Fee Commercial
Technology fee (5% of permit total)
224-00000-425602
224-00000425606
1 00-00000-424006
100-00000425002
82'1-00000-21 5004
224-00000-425602
1 00-00000-425605
1002
2099
1231
1099
1 060
2099
348.90
2.50
52.34
123.00
41.87
226.79
34.94
TOTAL DUE 830.34
Check
3323
Velociel, lnc 830.34
TOTAL PAID:830.34
RHOLMAN AMOUNT PAID
Ctrv op SpRtNcFtELD, oREGoN
Structural Permit Application
225 Fifth Street r Springfie\d, oR 97477 . PH(541)726-37 53 . FAX(541 )726-3689
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days
suspended for 180 days.
or work is
wry
o
Ott hD
R/A,{^s. ^! b eevt t# S lZ-E e
R
Name CCB License #Phone Number
Electrical
DEPARTMENT USE ONLY
ffi-?:Permit no
Date: //ZZ/l t
LOCAL GOVERNMENT
Date:
This project has final land-use approval
Signature:
Date:
This project has DEQ approval
Signature:
Zoning approval verified: ! Yes E No
Property is within flood plain: E Yes f] No
CATEGORY OF CONSTRUCTION
f] Residential E Govemment ! Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: I
State: $ Q zIP:9.,tl?1
Lot no.l\Subdivisionl
Reference:raxtor l'fQl,]l I Z-Ot gO'
PROPERTY OWNER
Name:\rv-e i l-i
Address:3lvp #4oo
City:State:Q$,ZIPgooc {
Fax:rhone:$l O' 4l $ I --StStr
E-mail:
this application:
Sign here:
Building Owner or
,C.i
E rnis instlIail6'n/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.
CONTRACTOR INSTALLATION
I rr.\CBusiness nu-., \ [p ]
ZIP:State:
Address
phonS$ 9Ot-, -..t1d e,Fax:
E-mail: (1 - trll gl.rs 6 Ve.OOr 'gl .Gor,yr
CCB license no.:
b. \rPrint n re.rrS
Signature:
4
Plumbing
Mechanical
FEE SCHEDULE
l. Valuation information
(a) Job description:h
Occupancy >Z
Construction type
Square feet
Cost per square foot:
Other information:
Type of Heat:
Energy Path
! new Ealteration n addition
(b) Foundation-only permit? ! Yes E No
Total valuation:$
,fees
(a) Permit fee (use valuation table):$
(b) Investigative fee (equal to [2a]):$
(c) Reinspection ($ perhour):
(number ofhours x fee per hour)$
(d) Enter l2olo surcharge (.12 xl2a+2b+2cl):$
(e) Subtotal offees above (2a through 2d):$
3. Plan review fees
(a) Plan review (650% x permit fee [2a])$-l
(b) Fire and life safety (40% x permit fee [2a]):$
(c) Subtotal offees above (3a and 3b):S
4. Miscellaneous fees
(a) Seismic fee, l%o (.01 x permit fee [2a]):$
(b) Technology fee,5o/o (.05 x permit fee[2a]):$
TOTAL fees and surcharges (2e+3c+4a+4b):$
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