HomeMy WebLinkAboutPermit Building 2009-8-14
Structural Permit Application
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225 Fifth Stceet. Springfield. OR 97477. PH(541)726-3753. FAX(541)726-3689
1,;~-jj'7PARTMENTUs'E'9N~Y I
Permit noC 't ..:-,. .t- t 35""
I Date J- J.-4-~ &4
This permit is issued under OAR 918-460-0030. 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 T~is project has final land-use approval. I
Signature: . Date:
I T~is project has DEQ approval.. I
SIgnature:. Date:
1 Zoning approval verified: DYes D No I
~property is within fiood plain: DYes D No I
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1 Job site address ?lq..Jj~.rieJ, (lJrlrl<o llJaLe' I
1 City . ""prlv\Q \;tct:1\ I St;Tf)t.. I ZIP Cj'tf71l
I Subdivision \ ~~ U t 7-- I Lot no/:3 1-- ~2--- 1
! Reference: I Taxlot: 1
ii:, ..,.' ::, p,ROPE,RT''I':ciwNER'3':;'::''t',Jh,.,,1
1 Name \i : D9U (~ir It \",-,-" 1
1 Address .~ ' ^\.J S 1-. I
ICity?fprdl1"3.,\'-veJ. St,;(e 'l_ IZIpQn771
I Phone;Wt -7111 ~ '17 D Fax: ~ I
I E-mail: 1
This installation 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 70rOIO.
Sign here:
I. . .;<,;'g;ONTRA<::TOR.I~Sl;AL.L.Jl,T1()N11'c'~~';,i.,\::
*,1 Business name: :\: _P!U,M.v>'f c.On~t-.
1 Address: I ~'H-' SlGx\Cb WL
ICily: C; I 1 ,,0 State: (1(
I Phone: (){f -~Sl - '6 <1>-13 Fax:
I E-mail: 'ioW'>re. (l,,\'n~{~ cal ('"",CJ\.sLI'J~J-.
I CCB license no,: 111 R.+9
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.1 (a) Job description (J"rch X!Q.{)(J,1r"
I Occupancy R.c J I
I Construction type: V 13:>
1 Square feet: \ ~ . .
1 Cost per square foot: 1/ s<.
I Other information:
1
I Energy Path:
I D new' ~alteration
(b) Foundation-only-permit?
I Total valuation:
I
I
I
1
I$Z-~
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I_(a) Permit ,fee (use valuation table):
I. (b) Investigative fee (equal to [2a]):
I (c) Reinspection ($ per hour):
. (number of hours x fee. per hour) $
I (d) Enter 12% surcharge (.12 x [2a+2b+2c]): 1 $ I
I }~~".~~~~. ~~.I~~.'~~::~:~~.fi~~.'t. ~~.2. ':~.'.~~~'~~:~.".":\~... ,.;.. h~4.~~. ~i'6..~';:.'i -,."l:. ~!\Ifij!rt.~."; '".'-~I
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I (a) Plan review (65% x permit fee [2a]): $ I
I (b) Fire and life safety (40% x permit fee [2a]): $ I
I (c) Subtotal of fees above (3a and 3b), $ I
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I (a) Seismic fee, f% (.01 x permit fee [2a]): $
I
Type of Heat:
D addition
DYes
DNo
$
$
S2~
I
I
TOTAL fees and surcharges (2e+3c+4a):
$ 6:J--aC.1
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Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
CITY OF :'lYKll'lt..1'lELD
Building/Combination Permit
PERMIT NO: COM2009-01l85
ISSUED: 08/14/2009
APPLIED: 08/14/2009
EXPIRES: 02/14/2010
VALUE: $ 2,000.00
SITE ADDRESS: 819 HA YDEN BRIDGE PL
ASSESSOR'S PARCEL NO.: 1703261201102
Springfield TYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Repair and replace existing patio roof.
Owner: VIOLET JUNE BRICKLEY REVOCABLE LIV
Address: 822 V ST '
SPRINGFIELD OR 97477
Contractor Type
General
Contractor
J ALLARD
# of Units:
Primary Occupancy Group: R3
Secondary Occupancy Group:
Primary Construction Type ' VB
'Secondary Construction Type:
# of Bedrooms:
I CONTRACTOR INFORMATION ~
NOTICE: lRE'ILTL1r: WOPI( . '. D
THIS PERMIT SHALL EXP Iu~n'll- t1X'PlratlOn ate
., 'T' ,nnl7cn IIMnFR THIS PERMIT IS NOT
'C'~.;BUiluflJNG lNFQRMA~iliNl" U run
. "/I "
ANY 180 DAY Ptt"lIUU.
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
TYPE OF USE:
No
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
ATTENTIOttl: ~fli~tolirl'J'~/~1~ires you to
follow rules ~1!X~91PJll:;y ~MOregon Utility
Notification c."&;!!~~o~IK.'!.,,-eri!g~J are set forth
in OAR 952-001-0010through OAR 952-001-
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Residential
Phone
541-517-8243
9.00
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
120
REQUIRED PARKING
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
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.callil-I'II.JBt.tGtIMI?R0.MEMENIfS'llhone
number Tor me ureYUl1 UlIlIlY l'\IulIticatiQf.ld 'Ik T .
Center is 1-800-332-2344). Si, ewa ype.
Downspoutsmrains:
Notes:
Description
Type of Construction
I Valuation Descrlotion ~
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Page 1 of2
Value
Date Calculated
Status
Issued
CITY VI' ~rKll~GFIELD
Building/Combination Permit
PERMIT NO: COM2009-01185
ISSUED: 08/14/2009
APPLIED: 08/14/2009
EXPIRES: 02/1412010
VALUE: $ 2,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Estimate
Estimate
$1.00
2,000.00
$2,000.00
$2,000;00
08/14/2009
Total Value of Project
Fees Pair! I
II I I
Fee Description
Amount Paid
Date Paid
Receipt Number
Total Amount Paid
$0.00
I Plan Reviews I
Structural Review
08/14/2009
To Request an inspection call the 24 hour re'cording at 726-3769. All inspedions 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. ,
I Reouirer!ln~rections I
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Roof Sheathing
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 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.
1 furtber 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 iuspections 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
tim~:;~'S) ~ CJ~
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Owner or cO\Jors Signature
Date.
Pa!!e 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1185
COM2009-0l185
COM2009-0l185
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Building Permit
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JAMIE ALLARD
City of Springfield Official Receipt
Development Services Department
Public Works Department
3200900000000000585
Date: 08/14/2009
It.m Total:
Check Number Authorization
Received By Batch Number Number How Received
701
In Person
Payment Total:
Page I of I
12:20:4lPM
Amount Due
58,00
2,90
6,96
$67.86
Amount Paid
$67.86
$67.86
8/14/2009
1
i-
REVIEWED FOR
CODE COMPLIANCE
N
~
NOTICE:
THI~ PERMIT SHALL EXPIRE IF THE WORK
AUTHORllED UNDER THIS PERMIT IS NOT
CnM~"Nr.m Qrllll p!;'!',rHJOJ'JED ro:-:
ANY 180 DAY PERIOD.
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I ;;ONE I 1'~OCC"PANCY G~I~5"
UNIT'S' OCCUPANCY LOJr ~
STORIFL' _. TVP,n CONST~U'l..~E ..
LEGAL DESCRIPTION 1.-'10"3 U t-?-bL-l.-e;r
Aon""ss~t.q \b,A1p~" 8~~,.e pr.ACli--'":
I OW,""'R ~ fJ~'f
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THE CONTENTS HERE ON HAVE BEEN REVIEWED, WITH
ALTERATIONS INDICATED ON COLOREO PENCIL. CHANGES
OR ALTERATIONS MADE TO THE APPROVED DRAWINGS OR
PROJECT AFTER THE DATE BELOW SHALL BE APPROVED BYi
THE BUILDING OFfiCIAL.
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
~I~U:.-~tion Center. Those rules are set forth
ir OAR 952-001-0010 through OAR 952-001-
OC''''). Yeu me,! obtain copies of the rule by
ceiling the ceolter. (Note: the tele[JtlOne
number 10 thp Ore (Ion Utility Notification
Center is 1-800-332-2344).
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CITY OF SPRIN",,..u:.o..D, OREGO~
ARPROVED BY ~~ DATE 8'JA--~
...--