HomeMy WebLinkAboutPermit Miscellaneous 2009-7-9
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Permit nO:eollU:-"O 'i' -o/bo.8-
Date: 7- .,~ O't I
225 Fifth Street . Sorimdield. OR 97477 . PH(541)726-3753 . F A)((S41 )726~3689
Manufactured DwellinglRecreational-Park Trailer
Placement Permit Application
This permit is issued under OARs 918-500-0105 and 918-525-0370. Permits expire if work is not started within 180 days of
issuance or if work is suspended for 180 days.
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I Zoning approval verified: 0 Yes 0 No I
I Property is within flood plain: 0 Yes 0 No I
I Sanitation approval verified: 0 Yes 0 No I
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1 (g,Residential .1 0 Government 1 0 Commercial 1
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I Job site address: <f7r;o F"'I",kl,..., Bv, ~ N -2 ,
1 City: IF \lOieNL County: LVvt I
1 State: 0 R ZIP: Cf7 ...,0 ! I
1 Subdivision: IF,,j.,.....l4.i.,le 1 Space/lot no.: tJ - 2 I
Reference: /l29fO 31 ( 1 Taxlot: D"3 S-O n I
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1 S<f'A'€-. IN- Mob'/ L f"..k. I
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1 Name: Ev'le..>e. M.b.l.. 1I,((A1e. _ll.C I
I Address:L{7~L) F""",k{]oJ 1'3" I'or-F Ie\:''' I
I City: f'Vi o->-e... 1 State: (!) r-z 1 ZIP:'!7'! 0 3 I
. 1 Phone:s'""lI-74i Z Z, '7 I Fax:"'t -7'-/7 Z Z \'7 I
1 E-mail: -., ~AN4e~ to. e--!',v ,OF'<} 1
This instaifation is b~ing ~ad~ on residential ~r fann property owned by
me or a member afmy immediate family, and is exempt from licensing
requirements under OAR 918-515-0010.
Signature:
1~:@N.tilli~~ill~BJ~~I[~IJ!~]rg~I"~1
1 Business name: .A -Ac.--t-tc,,", 1
IAddress:d57/& WJqgr'n<) 1
I City: Ven eJC-l .1 State: Dc 1 ZIP:G7 749 '11
1 Phone:,9-II-Q3"7 II 'i5 fp I Fax: . I
I E-mail: I
I CCB license no.: i 4 2 ~ 0"1 1 MDI license no.: /10 <J 1
1 Printname:( Jnl1hl'\j .-t. 0(tn:J~ 1
I Signature: lJ~1IC4 t JjaJ\ ~ I
(j (
440-2547,) (9/08/COM)
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. Description I Qty.1 Cost each I Total ,
1 (I) Manufactur.ed dwelling I
(a) Placement (includes placement, a 1
electrical feeder, water/sewer. $397_00 $ /;? ~ ~
; connection): . 7.......-
(bi Reinspection (no. ofhrs. x fee per hr.): $58.00 $ -- I
Placement permit can only be obtained by homeowner or Oregon- I
lic~nseq. manufactured dwelling installer.
I (2) Recreational-park trailer I
(a) Installation (includes stand and
lot preparation; support blocking;
anchoring; temporary steps; plumbing,
mechanical, and electrical): .
$397.00
$
(b) Reinspection (no. ofhrs. x fee per hr.):
(c) Each additional inspection: (1)
$58_00 $
$58.00 $
Electrical service permit to be obtainedonly by homeowner performing
work or signing supervisor of Oregon-licensed electrical contractor
performing work
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(3) Surcharge, 12%(.IZxtotal,equalto I orzj: $ 1./7::>
(4) State administrative fee for
manufactured dwelling (item I)
only, OAR 918-500-0105(5):
I (5) Technology Fee, 5% I
1 TOTAL fees and surcharges (3 + 4+5): 1 $
$30.00
$3000 :?U,
,~
$ I ';155"
1
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. I
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;l~~~~~~~~~~~~;~:~:;;~i~ PH:(541)726-3753 . FAX: (541)726-3:8~, ~i~~::~~~}!l-~
City Job Number C~vv1 ?-c>C:>-7- 0 I OO~ Date ~ ~O q
1. . LOCATION OF INSTALrATI()N .
47 r-o ~....\c..f.:"7S1v'.L
LEGAL DESCRIPTION
I <OOSO] ( (
JOB DESCRIPTION
0] SaO
1#/1-
!:Ltx- T<L \.G.A-L
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
S~spended for 180 days.
.. CONrRACTORINSTAJfLIl.nol-li6NLY.
2. .." <.. '.. _... ..__ ..,......
Electrical Contractor
Rn,NW1/cf'i I3krJ-r/(
.
Address ~ II ,..-
(.J --1..wd ~ ~
City ;:::'" t:: ,,--,,_0-
. ;
Phone3(t~.7.:2.77
Supervisor License Number ~ J.L) - 5-
Expir~iion Date /rl / I l..2-o/a
Constr. COntr. Number ) '7 2.5" 2..
Expiration Date
:LI""1 /07
Signature of Supervising Electrician
/J~~:~
~Name .eutl-:S'I c:::>GC-
Address" b 20 i' II 6fV\-1 wo be
city ---r;J c~,v Phone
kl
OWNER INST ALLA TIQN
The installation is being made on property I Dvm which
is nor intended for saie_ lease or rent. ~
Dwners,Signarure: ~~ ~~ '^S~
. ~'l~1
C"(';. ~\'liO\\
;f \ ,\'11:
Inspection Request: 726-3i69
3.
NZ-
COIvIPLETE FEESCFIf.prJLE BELQW
A. New Residcn~ar- ~'i,ri.g~~.:'?'~'_:~:i~ul~~'F~~~}y '~er 'd~~;:~!:~~~g:.'~ni:i:~:"
Service Included
1000 sq. ft. or less
. . Each additional 500 sq_ ft_ or
portion ther~of
Each Manufac!' d Horne or.
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
I roo
B. Scn-i~~s,'o~ F~~:~~i~;2!:rii'~f~!J#4~:4~'~4i';~f~:ti~,~s;'?~::~~~*.~~~fB\2;~~~::
200 Amps or less.
20J Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
. $375.00
$ 50.00
. -':-i:'.,....,.,....
C. Temporary S.eryic~s~;o_r:."t~ed~r:s:.
Insrnlla[ion. Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 i Amps to 600 Amps
S 50.00
S 69.00
$100_00
Over 600 Arnpsor 1000 Volts .'e: "B" above_
D. Branch. Circuits . . . . .
New Alteration or Extension Per Panel
One Circuit. $ 43.00
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
(J:)((.Q~us (Se;;'i'ceif~edc~ not'included) -Ea'ch"Jnstul1arion
Pumpar irrigation $ 50.00
Sign/Outline LJghting $ 50.00
Limited Energy/Residential S 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is S45.00 -i- Surcharges
~. SUBTOrlL OF _WOVE
3% State Surcharge
i O%..":"dministrative Fee
TOTAL
Shared Drive(T:VBuildinl5 formSlEl~crricd Permit Appiic:::nion : -06.co
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01008
ISSUED: 07/09/2009
APPLIED: 07/09/2009
EXPIRES: 01109/2010
VALUE:
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4750 FRANKLIN BLVD SPACE N2
ASSESSOR'S PARCEL NO.: 1803031103500
Springfield TYPE OF WORK: Manufactured Home in Park
PROJECT DESCRIPTION: Manufactured home in park
TYPE OF USE: New
Rcsidential
Owner: OGG ERNEST
Address:. 6208 N CAMINO DE COROZAL
TUCSON AZ 85704
Contractor Type
Electrical
Manuf Home Inst
I CONTRACTOR INFORMATION I
Contractor License
NEW REYNOLDS ELECTRIC INC 184921
A ACTION MOBILE HOME MOVING & DElY142807
I BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
. # of Stories: uires yOU to
R-3 ENTION. <!:leiglif'Jt'-St,rSgur.~on Utility
A;T rules ~cl:YiPe'~f.He\''1tl~~ ~are set torth .
tVB~W hon ceM\a1,,;rlJ9R~,tgh OAR 952-00'-
~o~~~ 952-00Rli'IIj~TY}~ies ot the rules by
In090. '{ou me:~iif~In:'x.a~~.i: the telephOne
o aIling the (SPri1fkl~~I~\Y!lI.t'lg:lotltlCatlO~/a
c J:_..4-hpOreQ ~_ .....",11"\
nUI1D'i~Eoo'PM~.!{iNFORMA TION ,
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
IPUBLIC IMPROV~MENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Expiration Date
01/01/2011
05/05/2010
Phone
541-343-7297
541-935-1786
Lot Size:
Sq Ftlst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
. Compact:
Sidewalk Type:
Downspouts/Drains:
NOTICE: PIRE IF lHE WORK
lHIS PERMli SHf\LL ~\SPERMli IS NOl
AU1HORIZED UND\~ ABANDONED FOR
COMMENCED OR
ANY 180 DAY PERIOD.
Notes:
Page I of 3
"
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01008
ISSUED: 07/0912009
APPLIED: 07/0912009
EXPIRES: 01/09/2010
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone .
541-726-3676 Fax
541-726-3769 Inspection Line
I Y~luation Descrintion I
Descriotion
Tvne of Construction
$ Per Sq Ft
or mnltiplier
Sqnare Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
Fppli', P<::aiA ~
l-i!JIliIIoI
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Manuf Home State Issuance
Manufactured Home Placement
. Amount Paid
Date Paid
Receipt Number
$47.64
$19.85
$30.00
$397.00
719/09
7/9/U9
7/9/09
7/9/09
1200900000000000791
1200900000UUUOOU791
1200900000000000791
1200900000000000791
Total Amount Paid
$494.49
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
~lIirpdln~wtion~ ,
Manuf Home Set Up: When installation of all piers or stands is complete.
Manuf Home PluJ.1lbing: After home has been connected to water and sewer.
MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to
the panel.
Final Manuf Home Set Up: After all required inspections are requested .and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc. have been installed.
Paee 2 of 3
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.,\1
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01008
ISSUED: 07/09/2009
APPLIED: 07/0912009.
EXPIRES: 0110912010
VALUE:
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 Springtield 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
Paee 3 of 3
71th?
Date
, OWNER NAME:
PHONE #
ADDRESS:
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SITE PLAN SUBMITTAL FORM
Map and Taxlot #:
Scale:
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c-} f? (. -:;
III ::~ I
APPLICANT NAME:
PHONE #
ADDRESS:
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225 Fifth Street
Springfield, Oregon 97477
541-726-'3759 Phone
Job/Journal Number
COM2009-0 I 008
COM2009-0 I 008
COM2009-0 I 008
COM2009-0 I 008
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
a..'1"'NQFIELD~._"" ..
:-J^ T ., ..
tIIi:., .
City of Springficld Official Receipt
Developmcnt Services Department
Public Works Department
1200900000000000791
Date: 07/09/2009
Description
Manufactured Home Placement
Manuf Home State Issuance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
EUGENE MOBILE VILLAGE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
2286
In Person
Payment Total:
Page I of I
10:39:27AM
Amount Due
397.00
30.00
19.85
47.64
$494.49
Amount Paid
$494.49
$494.49
7/9/2009