The URL can be used to link to this page

Home My WebLink AboutPermit Miscellaneous 2009-7-21 Structural Permit Application _,'.,'."'(l..~.'.DO.II.'., '" .. ... . _. '-'=: I', -, 225 Fifth Street. Springfield, OR 97477. PH(54 1)726-3753 . FAX(541)726-3689 i;:'R~~,~BTNt~NiU~E.iW:J~Y?'1 b:J!1M(!lj307~ c) (oS I Permit no.:' ~ . . I Date: 7" - '2.. ( -6 'l . I This permit is issued under OAR 9]8-460-0030. Permits expire if work is not started within 180 days Of issuance or if work is . . , R suspended for 180 days, ," l~i~/~~;L;'~f3;W~~~~:~~~;'G9_C:~~!~:9QYE,BNM_~~I~,~~F[8,Q.v~_m~!~*'1t~1;~~l.t~~~ I ~~~~;~;eect has final land-use approval Date ~!~gj:~:;!ii;;;j~)~;:;!.~~,1~n~~~1~'~8~QiJ~~I?'~~J;:';r~(~"!\:?\;'~;';;'41 I This project has DEQ approval.. . jJ.'1~;~S{~([~Ji,~:rr1(~~tQfi1j~!~q~Wt~ri~1t~~Jj'i~1~~t1~{i/!&lfi~nfm~~~~~~:;~;~'1 Signarure: Date: I (a) Job description: ~ef.,)re fO,..."'-t..\-Tle....... Zoning approval verified: 0 Yes 0 No I Occupancy Property is within fiood plain: 0 Yes 0 No I Construction type: _~~1~~j~GAt~9PBY~_QJ::.Flg;:Q~:~ff:frQ:Gl~lQfr~lt{~~~~~~~R~1 I Square feet: 1 ~Residential I D Government I D Commercial I ...oJ ' Cost per square foot: 1;~~J~~~i:g~tj^9J3~Jrs)W~1EINJf9J{MAljrc:ir;j[A'Nj~~~9~~:IrQ.JJ~~~~~~ I Other information: 1 Job site address: i 1') h 4- F ~ I I Type of, Heat: 1 Ciry &fL-d I State eR. I ZIPl/7 'l-77 1 . " Energy P~h: 1 Subdivision: I Lot no,: (,., I 0 0 I' 1 Reteren,e,F? 3 ~.5f1J:~Xlot" ..,,:,ri~{~ 'C:: ,.,1 : (~;::dation-o:II~;~;:it? J;:':~ 0 No \ " I ,"'~.. ' ".J'R()~E;~I:,;YWNJ;:0:;'"-'~' ":':",:' 1 Total valuation:"! I $ ~I III ;~" ~~1.i~~"q,!:(.)cJ111 :f :: I :,(~:~' i~~:~~~~>itt,'~t~;~tJtD Phone, c.:.-'f-{ - /, VI //111 Fax, - - , , I " I (c) Remspectlon ($ per hour): $ I E-mail: (numb.er of hours x fee per hour) This installation is being made on residential or farm property owned by 1 (d) Enter 12% surcharge (.12 x [2a+ 2b+2~]): $ I me or' a member of my immediate family, and is exempt from licensing requirements und;t:J7 ~O!~O. . 11,(~~.~,~~:;;::I;;~!,;e,~,~,~::'~~~~~~:~~~~l~0"~'1li:.""""~;llf"""SZoiF' ! '/ r "i3;:p,lan,revleW,;fees'-""''''~\'"~",f.fu't~ii'''.]}''$i!:_ "li'"~l;;':''lt~'''i~''~'''' 71 Sign here: ',., ,'___ ' {- _ ' '~_: _"_'. : _ ",_' .e, ',J:" " j" (~';'~'l~'~~r'~~;~-:'-(-~~~~:~;~:~~;~;;-~;l~~)-~'~~""'-"'--""".~I";~~~S ~ ~-" [:'~~siness~~::c;ONT~z5~~~;tLI\T1()N,",'t5; ::''':'~/''<;;:'';' I (b) Fire ~nd life safety (40% x permit fee [2a]): sl 1 Address. 1~~~M~;~i;;l;~~~sr;~~;I~~;fJ~~i~:~:;;;1\:i;~~\i;~'iiii,:~;!;;:11 I~ 1&- I~ 1 (a) Seismic fee, 1 % (.01 x permit fee:[2a]): $ I I Phone: Fax: cJ!i. , E-mail: I TOTAL fees and sureharges (2e+3c+4a): .~ I"? ;e.j ! CCB license no.: ~ I Print name: I Signature: I i 1:~;~l~i,~~{,f!~f,?~.$lJ~;;~G~NIr{AGltof{;lNj;.PJ~~MAI(Q~~!&t~{fj~j~~~i%~;~j I Name CCB Lice.nse Number Ph~umber I I Electrical ___ --- I I Plumbing ~ I I Mechanical/' I CITY QF SPRINGFIELD it Building/Combination Permit . Status issued PERMIT NO: COM2009-01050 ISSUED: 07/21/2009 APPLIED: 07/21/2009 EXPIRES: 01121/2010 VALUE: $,5;000.00 I' 225 Fifth Street, Springlield,OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1064 F ST ASSESSOR'S PARCEL NO.: 1703:i51106100 . Springfield TYPE OF WORK: Foundation TYPE OF USE: Repair I' Residential PROJECT DESCRIPTION: Replace foundation , Owner: Address: DUSTRUD PETER 2100 MADISON ST EUGENE OR 97405 I CONTRACTOR INFORMATION I ~ Contractor Type General Mechanical Plumhing Contractor OWNER OWNER OWNER License Expiration Date Phone BUILDING INFORM~TION I # of Units: # of Stories: Primary Occupancy Group: R2 Height of Structure , Secondary Occupancy Group: Type of Heat: Primary Construction Type VB, Water Type: Secondary Construction TYlt ON' Oregon law rlR~rigesryp~;}O # of Bedrooms: ATT NT: ' dopted by thEflilej:gjlPattl:lt~ lollow ru eSc~nter. Those (lSpBiiiKle(f3fJtmM~ng: ~I"liflcatlon ,. ....._h nM'< Cl'i2-00 . in OAR ~;~~~~ -~bt;l;~iDY~~OPM'ENTI~;()R~A TION I 0090. t r \I'IUl~, '''~ ,--- ,- , calling the cen e ' Utility Notification number for the O~~~~~_33!:?,y'e.rJ,a~ .Dist: , Center IS # Street Trees Rqd: Paved Drive Rqd: ,% of Lot Coverage: Lot Siz~: Sq Ft ]st Floor: Sq Ft 2~d Floor: 1. Ii . Sq Ft Basement: Sq Ft C:a"ige/Carport Sq Ft Other: Occupant Load: , " nla Frontyard Sethack: Side] Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: REQUIRED PARKING Total: H~ndicapped: C~,mpact: I PUBLIC IM~ROV~MENTS' Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: ' c:. NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORk ~gTHOR/ZED UNDER THIS PERMIT IS NOT MMENCED OR IS ABANDONED FOR .. ANY j 80 DAY PERIOD. " Notes: Pa2e ] of 3 .__$Je:JilJ,~'~I~qJ',.I1111l!\i!~~,j;~ldl,l ~'i..~...;",.,.".A'; . ,;,- .. ";';'/>+f''''i''' ~,; . Status Issued CITY OF SPRINGFIELD' Building/Cqmpination Permit PERMIT NO: COM2009-0I050 ISSUED: 0:7121/2009 APPLIED: 0:mi/2009 EXPIRES: 01/21/2010 VALUE: $15,000.00 , 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54] -726-3676 Fax 54]-726-3769 Inspection Line I Valuation Descri'?til~n t Description Tvoe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value, Date Calculated Total Value of Project F'pp~, P'l irlJ Fee Description + 12% State Surcharge + 5% Techuology Fee Fouudation Permit Minimum/Adjustment Mechanical Minimum/Adjustmeut Plumbing PIau Review Residential Amount Paid Date Paid Receipt Number " $26.9] $]1.21 $87.25 $79.00 $58,00 $56,71 7/21/09 7/21/09 7/21/09 7/21/09 7/21109 7/21109 1200900000000000818 ]2009000000000008]8 12009000000000008]8 12009000000000008]8 ]200900000000000818 1200900r00000000818 Total Amount Paid $3] 9.08 I Plan Reviews I Structural Review 07/21/2009 07/21/2009 APP DJB To Request an inspection call the 24 hour recording a:t 726-3769. All inspections requ~sted before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. willi,be 'made the following work day. . ' ;! ~rptl '\"(lectioll1.l Footing: After trenches are e~cavated. Foundation: After forms are erected but prior to concrete placement. Underlloor Plumbing: Prior to insulation or decking. Underlloor Mechanical. Prior to insulation or decking and including required testing. Final Building: After all required inspections have been requested and approved and the building is complete, " :r . Paee 2 of 3 _~f!_AI,~,,9.'\i;I"\I.~' ;it ll> Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD I~ Building/Combimition Permit ,i ,. \l PERMIT NO: COM2009-01050 ISSUED: 07/21/2009 APPLIED: 07/21/2009 EXPIRES: 01/2'1/2010 VALUE: $ 5,000.00 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 Springlield 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 . l' . I further agree to eusure 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 reinain on the site at all times during cOCiction, , , , !j/Z~!)t/J!~{ Owner or Contractors Signature Pa!!e 301'3 7/6.-( (6 ~ l I;! Da~ ' 225 Fifth Street , . Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-0 I 050 COM2009-0 I 050 COM2009-0 I 050 COM2009-0 I 050 COM2009-0 1050 COM2009-0 I 050 Payments: Type of Payment Check cReceintl Item Total: Check Number Authorization Batch Number Number How Received RECEIPT#: 1200900000000000818' Description Plan Review Residential Foundation Pennit Minimum/Adjustment Plumbing Minimum/Adjustment Mechanical + 5% Technology Fee + 12% State Surcharge Paid By PETER DUSTRUD Received By djb Page I of I City of Springfield Official Receipt Development Services Department Public'iWorks Department Date: 07/21/2009 I :32:40PM Amount Due 56,71 87,25 58,00 79,00 11.21 26,91 $3]9.08 Amount Paid 265 In Person " Payme,nt Total: $319,08 $3]9.08 7/21/2009