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Home My WebLink AboutPermit Building 2005-12-22Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line SPRIN FTELD Building/Combination Permit PERMIT NO: COM2005-01465ISSUED: 1212212005 APPLIED: 10/1812005 EXPIRESz 0612212006VALUE: $ 32,500.00 SITE ADDRESS: 96016TH ST ASSESSOR'S PARCEL NO.: 1703362204603 PROJECT DESCRIPTION: Remodel only. No change-in-use. Springfield TYPE OF WORK: Medical Office TYPE OF USE: Alteration PhoneNumber: 541-686-8080 Expiration Date Owner: Address: Contractor Type Architect General Electrical INTERIIAL MEDICINE ASSOC OF LANE CO 960 N 16TH ST STE #303 SPRINGFIELD OR 97477 07tru2008 06t08t2007 Commercial Phone 541-342-65rr 541-726-8081 54t-747-0811 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: 0verlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: B VA nla REQUIRED PARIflNG Total: Handicapped: Compact: l[$l[fi$Iffitn******"' DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Notes: Page 1 of3 _- Contractor AFFOLTERWEST & JOHN HYLAND coPies L H MORRIS ELECTRIC Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line FIELD Building/Combination Permit PERMIT NO: COM2005-01465ISSUED: 1212212005 APPLIED: 10/1812005 EXPIRESz 0612212006VALUE: $ 32,500.00 Description Estimate Tvpe of Construction Estimate $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 32,500.00 Total Value of Project Amount Paid Date Paid Value $32,500.00 $32,500.00 Date Calculated r0/18/200s Fee Description Plan Review Comm/Ind/Public + l0o/o Administrative Fee + 77o State Surcharge Building Permit + l0o/o Administrative Fee + 7%o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid $176.28 $27.12 $18.98 $271.20 $4.60 $3,22 $43.00 $3.00 $547.40 10/18/05 12l22los t2t22t05 t2t22l0s 12t23t05 t2t23t05 12t23t05 t2t23los Receipt Number 2200500000000001461 1200500000000001852 1200500000000001852 1200500000000001852 2200500000000001738 2200500000000001738 2200s00000000001738 2200s00000000001738 tr'pes Pe Plan Reviews Fire Department Review l0l2ll200s 10t28t2005 OK GRG Initial Review Planning Review Public Works Review Structural Review Structural Review Structural Review SUB Review WE Remodel - Medical Oflice. COM2005-01465. Plans Appear to meet code requirements. Reviewed by MF, signed offby GRG No change ofuse. Interior alterations only. No planning revien required. Remodel only, No cahnge-in-use, No - new fixtures, no nely square footage. No SDCs Received 1012512005. See attached documents for 4 structural comments faxed to Linn West. WI. Received response from Linn West. Faxed energy code forms to Jack Foster. Received final internal review. No energy code issues and no inspections. JMP called and left a message for Linn West with Sharon requesting the energy code forms. 10t2u2005 tut7t2005 APP sB t0t2u2005 t0t26t2005 WE JMP tu29t2005 tu29t2005 IO JMP r0t2u2005 1012U2005 ru30l200s tu30t2005 10t2u2005 11/01/2005 11/30/200s 11/30/2005 SKG EMM APP APP APP APP JMP JF JF Paee 2 of 3 SUB Review 10t25t2005 10t28t2005 Valuation Descriotion I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-01465ISSUED: 1212212005APPLIED: 10/1812005 EXPIRESz 0612212006VALUE: $ 32,500.00 To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. wilt be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work 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 of 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. Owner or Contractors Signature Date Reouired Insnect Pase 3 of3 --t 225 Fifth Street Springlietd, Oregon 97 477 541:726-3759 Phone ^ity of Springlield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 2200500000000001738 Date: 1212312005 8:42:35AM Job/Journal Number coM2005-0146s coM200s-0146s coM200s-0146s coM2005-01465 Description + 7%o State Surcharge + l0o/o Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Due 3.22 4.60 43.00 3.00 Item Total:$s3.82 Payments: Type of Payment CheckNumber Authorization Paid By Received By Batch Number Number How Received Amount Paid CreditCard DAWN HELGEN djb 027609 In Person S53.82 Payment Total: -Sffi / .; t2t23/2005 Page I of I sl.xelrlD \ 86123/2AA5 07t44 7253675 CITY OF SPRI gf,pr: 225 FIFTE STREET r SPRINGFIELD, OR 97477 t pE:(541)726-3753 r FAX: E LE CTRI CAL P E RM IT AP PLI CATI bN City Job Number -o Date I -zz-6d s. :j;cottii,tffi riEis:ixi;iqli,ia/Ofi'i', ..,,,1, ,,,,,, ,,, , , , . ,,, a. . li ",,*'ni;il* Ui -'sr'igi[,6:rr,ri1tr-r#,lv pli g *"irin g :u nit. Servite Included 1000 sq. fi. or less Each additional 500 sq. ff. or portion thereof Eqch Manufact'd Homc or Modular Dwelling Scrvice or Fecdcr s106.00 s 19.00 Authorized S ,. LEGAL DESCRIPTION I "o3,3622 o'l6oS, JOB DESCRIPTION b\ Permits arc non-transfcrsble nnd expire lfwork is not stsrted wlthin 180 days of is.susnce or if work is Suspended for I60 days. i":,"''"''-'i':i-'.....'';..., i:.,coN'TRecron ntsr/u,i,n it6i oi,rw,'."'. ,,,. ".;jr.'. .r ... l- .,:i Lr, ;:.t,.. .. .i\!...;,,.ii.r. . ,i. ,:.i:. . :fr_. .i Electrical Contractor L;frS Addre.ss City Phone Supcrvisor Liconse Numbcr 7 OO A S c. Expiration Date I D-f-6-1 Constr. Contr. Number s6s Zpo{rforu orqaular:r.A.rroN . il .,."76o lL*n sf -& qv{*he Instelletlon, Alteretion or Relocsff on 200 Amps or less S 50.00 201 Amps to 400 Amps -- S 69,00 401 Amp.s to 500 Amps $t00.00 ? s50.00 B. t Expiration Datc Signature of Supervising Elcctrician Owners Nsme Address o tu, City S PF\Phone l" OYITNER INSTALLATION T'hc installarion is being made on properly I own which is not intended for sale. lease or rent. Owners Signature: olTf99 ATel gl.lggo Votts-seelfB" above, o. i,eralih ,Cit+rili:1,.l, r; rr..;,,i t, l r'l'i i:,., i,,i,, ,:'ifl; .i!i Ncw Alteration or Extension per panel , OneCircuit / $43.00 Each Additional Circuit or with Service or Feeder Permit / $ 3.00 o3 u.', rorir,9;1r""..i;s is;*"Jr1;i;i i . ::11, . :. ri :1.1 :-,,: v3 -9oto Pump or irrigation Sign/Outline Lighting $ 45.00 Fee is S45.00 + Surcharges ClL 32" -- U60.t s 3,82 Strarcd Drivcf:)/Buikling Forms/Elccricat pcmit Ap.Flicarion I _03.doc l0% Administrative Fee TOTALInspection Request: 726-3769 06/23/05 THU 08:45 ITX/RX N0 56161 '[hose $375.00 s 50.00 -4. 7o/o ' ".':' '!i:, i, r. :.:. .. ,,....':...1.i... rf,$r-rilILD Status: Issued 225 Fifth Street, Springfield, OR 54l:726-3753 Phone 541-726-3676Fax 541:7 2637 69 Irspection Line GFIELD Building/Co mbination Permit PERMIT NO: COM2005-01465ISSUED: 1212212005 APPLIED: 10/1812005 E)PIRESz 0612212006VALUE: $ 32,500.00 SITE ADDRESS: 96016TH ST ASSESSOR'S PARCEL NO.: 1703362204603 PROJECT DESCRIPTION: Remodel only. No change-in-use. Owner: INTERNAL MEDICINE ASSOC OF LANE CO Address: 960N 16TH ST STE#303 SPRINGFIELD OR 97477 Contractor Tvpe Architect General Electrical Springfield TYPE OF' TYPEOF USE: Medical Office Alteration PhoneNumber: 541-686-8080 Commercial Phone 541-342-6511 54r-726-8081 54t-747-081t ESY ou to # of Units: Primary Occupancy Group: Secondary Occupancy Primary Construction Type Secondary Construction # of Bedrooms: Frontyrrd Setbaclc Side l Setback: Side 2 Setback: Rearyard Setback: Solar Setbacls: Street Storm Sewer Available: Special Instruction: # ofStories: Height of Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Overlay Dist: # Street Trees Paved Drive Rqd: o/o of Lot Coverage: CE: ANY 1 so oN ate Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: B VA nla UNDER REQUIRED PARKING Total: Handicapped: Compact: r lHE WORK r0R )PMENT INFORMATION iltr--l.|Sffi Notes: 1of 3 are set torth -001- Contractor AFFOLTERWEST &OAR mayJOHN HYLAND L H MORRIS ELECTRIC ca\\\n9 PEII4I'II&D Status: Issued 225 Fifth Street, Springfield' OR 541:726-3753 Phone 541-726-3676Fax 541:7 26-37 69 Inspe ction Line GFIELD Buildin g/Combination Permit: PERMIT NO: COM2005-01465ISSUED: 1212212005APPLIED: 10/1812005E)PIRESz 0612212006VALUE: $ 32,500.00 Description Estimate Type of Construction Estimate $ PerSq Ft Square Footage or muhiplier or Bid Amount $1.00 32,500.00 Total Value of Project Amount Paid Date Paid Value $32,500.00 $32,500.00 Date Calculated 10/18/2005 r Fee Description Plan Review Comm/Ind/Public + l0Yo Administrative Fee + 7o/o State Surcharge Building Permit Total Amount $176.28 $27.12 $18.98 $271.20 $493.s8 10/18/05 12t22105 12t22t05 t2t22l0s Receipt Number 2200500000000001461 1200500000000001852 1200s000000000018s2 1200500000000001852 ees Paid Fire Department Review 1012112005 1012812005 OK GRG 10t2u2005 tut7t2005 APP SB t0t2u200s 10t2612005 wE JMP 1u29t2005 1u29t2005 Io JMP Remodel - Medical Office. COM2005-01465. Plans Appear to meet code requirements. Reviewed by MF, signed off by GRG - No change ofuse. Interior alterations only. No planning revieu required. Remodel only, No cahnge-in-use, No new fixtures, no new square footage. No SDCs Received 1012512005. See attached documents for 4 structural comments faxed to Linn West. WI. Received response from Linn West. Faxed energy code forms to Jack Foster. Received final internal review. No energy code issues and no inspections. JMP called and left a message for Linn West with Sharon requesting the energy code forms. Initial Review Planning Review Public Works Review Structural Review Structural Review Structural Review SUB Review 10t2u2005 10t2u2005 11/30/2005 ru30t200s 10t2y2005 Lu0U2005 11/30/2005 11/30/2005 SKG EMM APP APP APP APP JMP JF JF10t28t2005 wESUB Review 10t25t2005 2oI 3 ]ItLl Valuation Description I rtt*'ilttIl..D CITY F PRIN Buildin g/Co mbinatio n Permit Status: Issued 225 Fifth Street, Springfield, OR 541:7263753 Phone 541-726-3676Fax 541:726-37 69 Inspection Line PERMIT NO: COM2005-01465ISSUED: 1212212005 APPLIED: 10/1812005 E)GIRESz 0612212006VALUE: $ 32,500.00 To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Fire Department. After all requirements of the Fire Department have been met. Final Building: After all required inspections have been requested and approved and the building is complete. By signaturer l state and agree, that I have carefully examlned the completed application and do hereby certify that all information hereon is true and correct, and I further certi$ that any and all work performed shall be done in accordance wi& the Ordinances of the City of Springfield and the Laws of the State of 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 froiect. I further agree to Gnsure that all required inspections are requested at the proper time, that each address is readable from the street, that the located at the front of the property, and the approved set of plans will remain on the site at all uz,zz-=6- DateSigpature \tb1 5 I 3 of 3 u l(eoured I nsDecuons I $ta.lt: ATTACHMENTA CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CIIARGE WORKSHEET JOURNAL OR JOB NUMBER COM2OO5-0I465 Oregon Cardiology 960 16th St NAMEORCOMPANY: I,OCATION: MAP & TAX LOT NIIMBER: DEVEI,OPMENT TYPE: t7 033622 04603 $0.00 $0.00 $$0.00 $0.00 00$ ($ 1,6 I $0.00 $0.00 $0.00 $0.00 $0.00 #DIV/O! #Drv/0! | 1190 NONE NEW DEVELOPED AREA (S.F.): E)ilSTING DEVELOPED AREA (S.F.): TOTAL IMPERVIOUS SI,]RFACE (S.F.): 1. STORMDRAINAGE IMPERVIOUS SQ. FT. 2. SANITARY SEWER.CIry A REIMBI,JRSEMENT COST: NUMBEROF DFU's B. IMPROVEMENTCOST: NUMBER OF DFLIS (SEE REVERSE SIDE) 5. ADMIMSTRATIVE FEES: BASE CHARGE (SUBTOTAL ABOVE) Remodel Doctor's Offices 1,634.00 ITE:720 ITE:720 r.oT SZE (S.F.): TOTAL STORM DRAINAGE SDC: 1,634.00 PREVIOUSLY PAID ON COM2OO4-OIsO9 x $ 0.323 PER SF PR"EVIOUSLY PAID ON COM2OO+01509 X $ 25.07 PERDFU0 0 x $ 19.07 PER DFU $ M.14 TOTAL LOCAL WASTEWATER SDC: 3. TRANSPORTATION PRf,VIOUSLY PAID ON COM2OO4-01509 BLDGAREATGSF XTRIP RATE X COST PERADTXNEWTRIP FACTOR NEW A REIMBIJRSEMENTCOST: 1.63 x 36.13 x $ 19.09 PERTRIP x EffiRovslmlJ-r cosTl- 1.63 x 36.13 x $ 84.19 PERTRIP x E)(ffi A. REIMBURSEMENTCOST: -1.63 x 36.13 x $ 19.09 PERTRIP x B. IMPROVEMENT COST: -1.63 x 36.13 $ 103.28 4. SANITARY SEWER - MWMC NEW: A REIMBURSEMENT COST: NLIMBER OF FEU's B. IMPROVEMENTCOST: NUMBEROFFELTS 1.63 1.63 x E)flSTING: A REIMBURSEMENTCOST: NUMBEROF FEU's -1.63 B. IMPROVEMENT COST: NLMBER OF FELIs -1.63 MWMC CREDIT IF APPLICABLE (SEE REVERSE) 0.85 NTF $9s7.80 0.85 NTF $4,224.78 0.8 5 NTF NTFx TOTAL TRANSPORTATION REIMBURSEMENT SDC TOTAL TRANSPORTATION IMPROVEMENT SDC TOTAL TRANSPORTATION SDC: PREVIOUSLY PAID ON COM2OO4-01509 x $93.7s PERFEU PERFEU $ 153.19 $988.92 $ 1,615.90 $93.75 PERFEU ($153.19) ($9s7.80) x $ 84.19 PER TRIP 0.8s x Steven W. Beaudry Barnes SDC COORDINATOR $988.92 PERFEU TOTAL MWMC REIMBURSEMENT FEE TOTAL N{WMC IMPROVEMENT FEE MWMC ADMINISTRATTVE FEE TOTALMWMC SDC: suBTorAL (ADD ITEMS r, 2, 3, & 4) x 5% TOTAL TRANSPORTATION ADMINISTRATION FEE: TOTAL SEWER ADMINISTRATION FEE: 1!17/200s x $ $4,224.78) COM2005{1465, Oregon Cardiology, 960 1 6th.xls DATE TOTAL SDC CHARGES 1 JULY 2OO4 DRAINAGE FTXTURE L]NIT (DFU) CALCULATION TABLE NUMBEROFNEWFXTITRES x LINIT EQUwALENT: DRAINAGE FIXTURE LTNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) Oregon Cardiology RATE PER $I,OOO DRAJNAGE FXTURE UNITS $0.00 FXTURES NEW OLD UNIT VALTIE FXTURE TYPE BAT}ITUB DRINKINGFOUNTAIN FLOORDRAIN INTERCEPTORS FOR GREASUOIUSOLIDSIETC. INTERCEPTORS FOR SAND/AIIIO WASTYETC. LALINDRY TIIB CLOTHES WASHER/MOP SINK CLOTFIES WASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (1 PER TRAILER) RECEPTOR FOR REFRIGERATOR/WATER STATIONiETC. RECEPTOR FOR COMMERCIAL SINK/ DISTTWASHER/ETC. SHOWE& SINGLE STALL SHOWE& GANG (NUMBER OF HEADS) SINK: COMMERCIAL, RESIDENTIAL K]TCHEN SINK: COMMERCIAL BAR SINK: WASH BASIN/DOUBLE LAVATORY SINK: SINGLE TAVATORY/RESIDENTIAL BAR LJRINAL, STALI-rWAIL TOILET, PUBLIC INSTALT-ATION TOILET, PRTVATE INSTALLATION MSCELI,ANEOUS: NUMBER OF EDU'S* TOTAL DRAINAGE FXTURE LINITS: *EDU (Eouivalent Dwelline Unit) is a discharge equivalent to a single family dwelling (20 DFU) set at 167 gallons per day IF IMPROVEMENTS OCCURRED AITER ANNEXATION DATE IN TABLE, CALCULATE CREDITS SEPARATELY 0 0 0 0 0 0 3 I 3 3 6, 3 6 12 I 3 2 2 J ) 2 I 5 6 J 0 0 0 0 0 0 0 n 0 0 0 0 0 0 0 0 YF-AR ANNE>G,D CREDIT FOR PARCEL OR LAND ONLY IF APPLICABLE IMPROVEMENT (IF AT'TER ANNEXATION DATE) $0.00 x x 0 RATE PER $I,OOO ASSESSED VALUE YEAR ANNE)(ED 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 t979 1980 198 I 1982 1983 1984 1985 1986 1987 1988 1989 1990 t99l or before $5.29 $5 19 $5. 12 $4.98 $4.80 $4.63 $4.40 s4.07 $3.67 $3.22 s2.73 $2.2s $1.80 $0.00 $0.00 COM2005{1465, Oregon Cardiology, 960'l5th.xls CREDITTOTAL 1 JULY 2OO4 2 2 0 2 I i Street Sg .rng^rt ld, Oregs:r 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT#: 1200500000000001852 Date: 1212212005 10:26:46AM Jcb/Jurrnal Number coM2005-01465 coM2005-0146s coM200s-01465 Description Building Permit + 7o/o State Surcharge + l0% Administrative Fee Amount Due 271.20 18.98 27.t2 Item Total:$317.30 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid CreditCard AFFOLTERWEST AND JONES djb 078842 In Person Payment Total: s317.30 -$3-i?30' t) tfl .,t IJ 't" 121221200s lofl atxexo I