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HomeMy WebLinkAboutPermit Building 2009-6-5 CITY, OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: cOM2009-00781 ISSUED: 06/0512009 APPLIE D: 06/04/2009 EXPIRES: 12/05/2009 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54]-726-3676 Fax 54]-726-3769 Inspection Line SITE ADDRESS: 380 S 58TH ST . ASSESSOR'S PARCEL NO.: 170233440]601 Springfield TYPE OF WORK: Bathroom TYPE OF USE: PROJECT DESCRIPTION: Ownerto remodel bathroom to make it ADA Residential Owner: Address: EHL PROPERTY LLC . laW requires youto 399 E 10TH AVE STE ]01 ATTENTION: Ole~o; by the oregon U~\itih EUGENE OR 97401 toll oW rules adop eThose rules are sezt 00~1_ 'f allon Center. hOAR 95 - EHL PROPERTY LLC ~o~~~ 95Z-001~001 0 thrOu~s of the rules by 399 E 10TH AVE STE 101 In You may obtain Copl. the telephone EUGENE OR 97401 0090\.\. n the center. (Notle)t' 'l'tV Notification r.A. m~ _ r-.~",....\t'\n \ \ number \UI ~""':: -I J~.()()_332-'L6~'"t'J' I.Cl;)Nl'~CTOR INFORMATION I Owner: Address: Contractor Type Contractor License Expiration Date Phone ..BUlLDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Constrnction Type Secondary Construction Type: # of Bedrooms: # of Stories: ~~OTICE: Height of St(:~ffit IF iHE WORK ;THIS PERN!Npe\J"H~a\HIS PERMIi IS NOi VN UiHORlz~retmtPe: ONED FOR ~OMMEN~t'/J~(I;~eI\BAND fl,NY i 80 ~tY;n~~'W,;ilding No Lot Size: Sq Ft 1st Floor: Sq Ft 2~d Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENTINFORMATlON I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: .Compact: I PUBLIC ]MPROVEMENTS I Street Improvements: Storm Sewer Available: Special ]nstruction: Sidewalk Type: Downspouts/Drai~s: Notes: Page] of2 _~!'lINOfl~Q,;. ~ -; .. Status Issued 225 Fifth Street, Springtield, OR 541-726-3753.Phone 54]-726-3676 Fax 54]-726-3769 Inspection Line Description Type of Construction Fee Description + 12% State Surcharge + 12% State Surcharge + 5% Technology Fee Fixtnre Not Covered Plumbing Total Amount Paid Plumbing Plan Review 06/04/2009 I Valuation Descriotion , $ Per Sq Ft or multiplier Square Footage or Bid Amount CITY'OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-00781 ISSUED: 06/05/2009 APPLIED: 06/04/2009 EXPIRES: 12/05/2009 VALUE: RWC Value Date Calculated Total Value of Project Fees Paid I Amount Paid Date Paid Receipt Number ]200900000000000627 ]200900000000000627 1200900000000000627 ]200900000000000627 ]200900000000000627 field verify changes to ADA To Request an inspection call the 24 hour recording at 726-3769. All inspections re!}uested 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. $6.84 $13.80 $2.85 $57.00 $58.00 6/5/09 6/5/09 6/5/09 6/5/09 6/5/09 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 eontractors 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.... -2.\;:.. . - I Owner or Contractors Signature $138.49 I Plan Reviews I 06/03/2009 10 Reouired Insnec~!?,!!.~ , Page 2 of2 lc('5\o~ Date 225 Fifth Street Springfield,Oregon97477 541~726-3759 Phone Job/Journal Number COM2009-0078I I COM2009-00781 COM2009-0078I COM2009-0078I COM2009-0078! COM2009-00782 COM2009-00782 COM2009-00782 COM2009-00782 . Payments: Type of Payment Check cReceintl City of Springfield Official Receipt Development Services Department P4blic Works Department RECEIPT #: 1200900000000000627 . Date: 06/0512009 ]] :02:52AM Description Fixture + 5% TechnologyFee + 12% State Surcharge. Not Covered Plumbing + 12% State Surcharge .Fixture Moved Structure Plumbing Conn + 12% State Surcharge + 5% Technology Fee Amount Due 57.00 2.85 6.84 58.00 13.80 57;00 58.00 13.80 5.75 $273.04 Paid By ELDERHEEALTH AND . LIVING Item Total: Check Number Authorization R~ceived By Batch Number Num,ber How' Received cjc 4179 In Person $273.04 Amount Paid . Payment Total: $273.04 / Page I of I 6/5/2009