HomeMy WebLinkAboutPermit Building 2009-11-30
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-0]696
ISSUED: 11130/2009
APPLIED: 11/24/2009
EXPIRES: 05/30/20]0
VALUE: $4,500.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54 ]-726-3769 Inspection Line
SITE ADDRESS: 117 S 14TH ST
ASSESSOR'S PARCEL NO,: 1703363204401
,
-,"
Springfield TYPE OF WORK: Restaurant
Owner:
Address:
TYPE OF USE: Repair:
PROJECT DESCRIPTION:' Car drove into bnildin.&:.., See attached documents for police report. PI~ns are not
required if wall is corl\.lif.fi!tbTtiWNh61re~dIlwPjjqolr/ielYllo,ltinat construction.
{nll,":'A1 r~ll.ae- ~N""~+"""'~: ~"': ~ -':;.;;..~: 'eX::,:,
CROMBIE DOUGLAS G Notification Center, Those rules are set forth
33328 HOWE LN In OAR 952-001-0010 through OAR 952-001-
CRESWELL OR 97426 0090. You may obtain copies of the rules by
c:::illinr:' th~,..ontar {to.ll"'ltoo tho tglgpt:ler.a
nUmt>J'Li"J:!!'F.Q'1'-!Y.'!:' ~_f>lOtificalion
I CONTRA""~---...).
Commercial'
Contractor Type
Electrical
Contractor
C & SELECTRIC
License
3849
Expiration Date
09/01/2010
Phone.
541-741.2236
BUILDING ~NF@.MATlON I
.~~':l",1r"",
VB
# of Stories: Lot Size:
NOTI~ight of Structure Sq Ft 1st Floor:
fm~ of Heat: Sq Ft 2nd Floor:
THIS PWlll'e~T19W\Ll EXPIRE IF THE WORlSq Ft Basement: '
I.\UTHOR'~~Iij;ht:WHR THIS PERMIT IS NOllq Ft Garage/Carport
r;OMMiElifJrg5J {l\lihIS ABANDONED FOR Sq Ft Other:
ANY i E~p"1\'fI'f~OV?g: n/a Occupant Load:
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type;'
Secondary Construction Type:
# of Bedrooms: ' "
A-2
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
. Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation DescriDtion I
Description'
Tvpe of Construction
$ Per SqFt
or muttiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I of3
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01696
ISSUED: 11/30/2009
APPLIED: 11/24/2009
EXPIRES: 05/30/2010
VALUE: $ 4,500.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Estimate
Estimate
$1.00
4,500,00
$4,500,00
$4,500.00
11/30/2009
Total Value of Project
r Fft~' ~nu
,.' .
$20.52
$8:55
$90,00
$81.00
$10.47
$4.36
$87.25
11/24/09
11124/09
11/24/09
11/24/09
11/30/09
11/30/09
11/30/09
Receipt Number
2200900000000001324
2200900000000001324
2200900000000001324
2200900000000001324
1200900000000001286
1200900000000001286
1200900000000001286
Fee Descriotion
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ EaAdd
Perm Serv/Fdr 200 amps or less
+ 12% State Surcharge
+ 5% Technology Fee
Building Permit
Amount Paid
Date Paid
Total Amount Paid
$302.15
I Plan Reviews I
To Request an inspecti6n 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. wiIrbe made the following
work day.
I~fr~
Rough Etectric:' Prior to Cover
,
Final Etectric: When all electricat work is complete.
Framing Inspection: Prior to cover and after all rough in inspections have been approved,
Firewall: Located and constructed according to plans.
Finat Building: After all required inspections have been requested and approved and the building is complete,
Rough Plumbing: Prior to cover and including required testing.
Finat Ptumbing: When all plumbing work is comptete.
1 ~'..../ ~,Pae:e 2 of 3
Status
Issued
225 Fifth Street, Springtield, OR
541-726-3753 Phone
541-726-3676 Fax
54] -726-3769 Inspection Line
I..'
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01696
ISSUED: 11/30/2009
APPLIED: 11/24/2009
EXPIRES: 05/30/20]0
VALUE: $4,500.00
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
informatiou 'hereon is true and correct, aud 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
tbat NO'(),CCUPANCY wilt be made o!'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 wilt 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 tocated at the front of the property, and the approved set of plans wilt remain on the site at all
times during construction.
,-A~J:-~
ownerO;~Si~
Pa!!e 3 of 3
/ /~ . 3'--0' ~ O?
Date
Structural Permit Application
-
225 Fifth St,eet. Springfield, OR 97477. PH(541)726,3753 . FAX(541)726,3689
I" o.~PARrMENf,uSE9Ni..Y
Pe~it no:{~ q - / (.; c; (0
I D,ate: /I / '50 )() )
This permit is issued under OAR 918-460-0030, Permits expire if work is not started within 180 days of is~uance or if work is
suspended for 180 days.
1~~:>,:;:',;~,';',~"~~/*,:'49\~A~::~:QS("~BNM.~Nft;~t.~~JfRGyC~Uj~~i~~~~~
I This project has final land-use approval.
Signature: Date:
I This project has DEQ approval.
Signature: Date:
I Zoning approval verified: 0 Yes 0 No
I Property is within flood plain: 0 Yes 0 No I
1.~!ii~\Wi~~,,#~~,'!;:cAtE("0RY;~0F,R(CONS;fRUCfrir0'N~i::~:{zW:'i,~'!"ill:..j
~,~~".,..,..~",.".=,...,."...,..._.___ _____.".""<4;.........._ ,l~_..._" n..C.'....... .".""^..~__~",.."~'''"L"''^,....;;I>i1.,,'''
l 0 Residential j D Government. I D Commercial
r~;~t?iJ~g1:.;,;~i!i9~~~~~,~I!t_~rff{~9RMA,{IQ~lfANJ!~'g9J;:~tR:r~1g~~j)jl~
I Job site address: I 1"'"'1 <;;'9 I Lfr;vf C-f'f)M~
I City (;:JflL/I1(c.hr,.-,/O I St~te oa... T ZIP'7 7'~~
7
I Subdivision: I Locoo.: I
I Rere.rence:" . . . ".,1 Tax. lo~.. .' .1
I';~', '. ',' ..... :, P'R9PE~T'(9WNE~ j
I Name '_ 'D~ Ib-A-LA--'f' V I
1 Address: 1
I City: (\ (l1f'Z--..",-..t7 , I State: dL.. I ZIP:
I Phone: Fax: - ,
I E-mail:
This installation is being made on residential or farm property owned by
me or a member afmy immediate family, and is exempt from licensing
requirements under ORS 701.010. .
Ij~:l"t~Y:; W~~.~:;.tr~~):,;.'~%;IK~H~.~.g.,';,'~~ H~pirl~~:':;~f,C,'~J ~~~'~~.'f:Y'~>:~;",;< .-i<~'~i 1
I~I~lM~.t_~~tI9~R{i~JQr!if~!'9:~~11~~~~1~~~t~}~~\11~.~~;;?~{~t{~1fi;~~!i~:t;~~~:}n,il
(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot
Other information:
Type of Heat:
Energy Path:
o new 0 alleration
(b) Foundation-only permit?
Total valuation:
f2.rl? fJ7 IZ
E)v(r7^t..1
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I $ Yft'lO-t
l/lIm--<.
o addition
DYes
ONo
lil7'5;~i.:{~it4Jpgff~~~s11~~fi:~\i?~ff~~1i:~~~ig~~:lhx:i:J;~[f~k:;r\~:i~';~1,i0~~~~~~;:.:i~~:.,;:1
I (a) Permit ree (use valuation table): $'5rl , 25f
I (b) Inv~stigative fee (equal to [2a]): $ I
I (c) Reinspection ($ . per hour): I
(number of hours x fee per hour) $
1 (d)EnterI2%surcharge(.12x[2a+2b+2c]): $ 10 'i.2-1
I (el Subtotal of fees above (2a through 2d): $ I
Sign here:
'.. .(;OI'iTRAC[9~,if:ol$T:At.LAT!ON~,;";;:'..,/..,.:>;,,,::.,,: 1 (a) Plan review (65% x permit fee [2a]) I :
I ~~::::s name~~(G~~ {7~ ~~"1~ ~ ~~~ 111~~:.:..flu.I;;~~:~.~~~i;~~~~;:0:;::j~;::i';';'it\#~.~iT'~. ,0;,:11
[I ~~:ne.:f::~':;;'~D r ~:e~ I ZIP'77 Y?~" II (a) ~ei;:ic;~;,;;:(:;;'I:~;:I:~~';;~)' ..." "$$j;1{)",u~='11
~ .-l-- TOTAL fees and surcharges (2e+3c+4a): I ,~"
E~maJL K. ~ ~\ \L-....~~ L~~r.l~r "'un I ,. -
I CCB license no: /1{'7 ',?,< 0 ' I
I Print name: ..J<Jslf I~I 4tL.., ILl--'? I
I Signature'~~,-- I
-c- ~_?'____
1':.~~.,.!'."J1Jiil,'4'."r,"~:'S'UEi,t0NT, J~'At:'r..OR,1 N FO: 'R'M" A""'I'O"Nrffi,,'iifr;ar;;"'''''''"''''i''ii'fC!'1
".5';"1'!~'""",,,''.c.,,'y,'''_ .__._,_.<>.... ,.,..,,__..;1:.............,._.,___.,... ...._ ..' .,I,:..___~__._1_?^;fl.~'j~!J-'i,J"L~"'fl_.
I Name CCB License Number Phone Number
I Electrical I
I Plumbing I
I Mechanical I
".,'
.."
225 Fifth Street
SpFingfiel.d, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2Q09-Q 1696
COM2QQ9-Q 1696
COM2QQ9-Q 1696
Payments:
Type of Payment
Check
,cReceioll
RECEIPT #:
Description
Building Permit
+ 12% State Surcharge
+ 5% Technotogy Fee
Paid By
PRICE RITE ROOTER &
PLUMBING
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001286
3:10:3QPM
Date: 11/30/2009
" Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
87.25
10.,47
4.36
$10.2.0.8
Amount Paid
cjc
$10.2.0.8
30.0.8
In Person
Payment Total:
$1tI2.Q8
Page 1 of 1
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