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HomeMy WebLinkAboutPermit Building 2010-3-5 ~ ~^Sffuctural Permit Application DEPARTMENT USE ONLY f. _. : 'f:. 'G'f.Y.:d~SBflINbFi E\~~6\:ii~~(jf-JYi~1,J.,,,,:.m,.~.<?~;~:~ -. r _ ",_~""" _ _.. 'I::... _ ""' "." y..!L::.,.,. .... "," ~..~ . Penn it no:(!/() , d <r:s Date: 3- S - I 0 225 Fifth Street. Spdngfield, OR 97477. PH(541)726.3753. FAX(541)726-3689 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. "" ' ,_. _ -~:.-,,- -'-.' .- ': '.. .',,,~,,n" ," ... '.' -,' ,'. "".-"}J' ,-.., ",'. ""'''"...>, " ',,"_" :". '''''_ " -:....F "". , , ';';,' ;.';, I;QCAt:. ~bYE~!\H\'1!'!'-IT,,'I,'~P~Q,YJ,>,I!t~{::U~:I,'1%i1 This project has fin~1 land~use approval. Signature: Date: This project has DEQ approval.. Signature: Date: ' Zoning approval verified. 0 Yes 0 No Property is within flood plain: 0 Yes 0 No 't1i\~~~.~';~~{9.-A t~~J~)~X~+dF.j(.G,o-~~f~Uc-;fi.0'~rq;:}fi~~~~@~~}~~; o Residential 0 Govemme~t ~ Commercial 11"!il,:)i~t.~!'::,\:;ili9Birs.l~t.~1:fN~pr{M'-AtiQN:~AN Q~~Q~A'ff9N~~~~S/~~t;~~A;I: Job site address. \ 0 1\ \,-iA-(LU (.0.) Il-t> r City: ...A,;, ~1f-vD State: 0 e... Subdivision: Reference: Name: Address: City: Phone: :, P,ROPERTYOWNER' .' PAUhC (.b,J(j...,~ &A-!JK (..... State: O~: Fax: ZIP: E~mail: 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 701.010. Sign here: ",t".. Business name: City: Phone: E-mail: CCB license no.: Print name: Signature: Ii:f,',~~i:f'i,1l';~:~SOB-cbN;l'I:t6,C:rOR,INI".oRI\lt"''I'IQIII~Y;1;f~tlIi)\~fi{: Name CCB License Number Phone Number Electrical Plumbing Mechanical > ,; <r;y,.' c": '),;","FEE .- 0'." ..c.... _",)- '. .:..:.It..-f;.... SCHEDULE';"". ;i.':?y~'i_~~:(i.~1W(~f6[rna:t'9R;1~~t~\'i~f.;~';~~~t;~~'~;1:.;:;i;i:.,:::~tii;.j<,t,-'~_t:..,:.~::;~.~.<.: (a) Job description: Occupancy Construction type: Square feet: Cost per square foot: Other information: Type of Heat: Energy Path: 0 new 0 alteration 0 addition (b) Foundation-only permit? 0 Yes 0 No Total valuation: $ ;1~:;~B.~U#'!~{gJ~.~~11~NiiL;~~~~\~;~~;<~;~k;~~\~~~F':,~;,;;:\; _ >j\r.~:: '1!';';:f,. ,~~.;~,~:'., (a) Permit fee (use valuation table): $ (b) Investigative fee (equal to [2a]): $ (e) Reinspection ($ per hour): . (number of hours x fee per hour) $ (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ (e) Subtotal of fees above (2a through 2d): $ ~~f'p.rl!'"~2::.",..~t.N:~t~:"~'tli,.t--#;:;~~f,!-;':i'~<r~,"" --~i{"<; F"'~e~ tJ. :'; .' .a.nir:ev)~~' t:~S~;~il:~i~+":~~a'~;t+:_~~'!'L.t:~~~~ ff~"':':of:Sf,';,~~l:; (a) Plan review (65% x permit fee [2a]): $ (b) Fire and life safety (40% x permit fee [2a]): $ (e) Subtotal of fees above (3a and 3b): $ ~'~1H~ti~f~Ii.a:'~~9.~slf~e~.-~~~:(':1fr2ffJ*~~~~'13:(i:~~~;t,~,}.,~..' ;,.,'1.~,:{,;,:;.:! 'i~,~.<~.,,~<~;;~'~_ (a) Seismic fee, 1%(.01 x permit fee [2a]): $ TOTAL fees and surcharges (2e+3c+4a): $ '. ~ /L7Uel ) i/ .~. ,~ "':"f. !City of Springfield Development Services Department 225 Fifth Street Springfield, OR 97477 Planning Division Information Sheet for Building Permits Com mercial/lnd ustrial / Multi-Fa mi Iy Residentia I The Planning Division requires the following information for.Q.)! building permit submittals on' properties zoned Medium Density Residentiaf, High Density Residential, Commercial, or Industrial, including new construction, expansions; and changes of use. New construction, expansions, and changes of use to any building, parking, or development area in' these zoning districts requires either Minimum Development Standards-MDS review (SDC 5.15-100) or Site Plan Review (SDC 5.17-100) by the Planning Division. Overlay District Development review (SDC 3.3-100) may also be required, depending on the site. NOTE: It is prudent to make sure your use is permitted in the applicable zoning district. Building Permit, Police or other permit approvals or inspections are not Planning approval. Requi~~d_~Fijieci:-{nfOim~tfon' .:.:. - ~_ "'7~--,-~-- c..-=-;::iiipplica~t:c:ol1Jiile~e. this se~tionJ , - Com an : licant Name: \2-A:1-J.DY LOn (n:; , St-tUvl2-'S ~-rcw C.-CLOv- \.,...)C ID<gS ~O"'-IL~<;-r "$'-r€::-- C Phone: 0'+( 'G~Cf ('p1,7 Fax: '5'-f-( G"6'1. 3955 f:AJG-L-f::. 0 12-- QI4:0L A Address: ASSESSOR'S MAP NO: TAX LOT NO S Address: W II \..( A-Q..t.0u...J f--.O, SpFtJ) M- ,97L{-77 Description of the proposed work to be completed under this building permit: vJb.,.-n~-fL O~A;-&,~ ~AtC2- --co liV Svc...A.~o-----> S'vLC-....f:..Tlto0k. t Has this development proposal been reviewed by the Planning Division through an application process (i.e; MDS or Site Plan Review)? if yes, Case #: If no, is this a change in use? p Yes 0No Prior A roved Use: 0 ~ ~ Pro osed Use: DYes 8No . -. -. . ..- , - - Zonin TOTZ: Overla s: The proposed project requires submittal and approval of the following Planning application prior to building permit approval: D DWP Overlay District Development D Statement Letter Regarding ,DWP Exemption o MDS D MDS Land Use Compatibility Statement o Site Plan Review D Other: Reviewed b : Date: n ~ >- ," n ~ . !C.~ t.: ~ .~ ~ I ~. ~" I !U -~ i~ 4: ... oc rl -~ ...... .u p. . -. >- f' . -' c' In CU ~ c >c !~~ , . . ~ ~ ~ , .' l ------ 0414842344 COllMERC IAL INV PROP . .. .. .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . ... .. .. .. . . . . . . . . . . . . . . . . . . . . . .. ... ... . . . . .. . . . . .. . . . ? ElF . ... . . . . .' . . . . . . . J' T~ . '. ... . . L,,-''v .. .. .. . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . ...... .,...Tf !:' - n" PATE RECEIVED :ZONE UNIT 5 :STORIES .~.\D Jo No Dc Oc .UPANCY LOAD . Tv E: CONSTRUCTION ,OVJNER 'THE CONTEN.TS HERE ON H/NE B EN REVIE'.NED, WITH j\UER/.TIONS iND':::~TED CN COLC :D PENCIL. CHANGES O~ ALTER.l..TI~ . . ROVED DRAWINGS OR I'ROJECT hFH THE DATE BELOW SHALL BE APPROV THE BUILDING FFICIAL. ' CITY '.~ ;",pROVF.:0 B WO~K v :n '" . "NT; N: Oregon law requir.. you to fonew liOS ado ted by the Oregon UUIIty Nollf1cation Lenter. ose rules afll set filM In OAR 952-001 0010 thr gh OAR. 9~o,\l1'OOIlO. You may obtai copies of he rules by ~ Ill. center (Note: the telephon \iwn~' ~ Utility Notifk;atio Center is ..llhlr:' ,--coo:: . II i~ ill, ~.. ~g ~'" ..- r:: . . o 141 005 ~ ~ iJ ~ ~ \l , ;. . ,d...LO.l , ~. ~. ~ . ~B.d ~-t14S42J44 COMMERCIAL INV PROP . .. .. .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . ... .. .. .. . . . . . . . . . . . . . . . . . . . . . .. ... ... . . . . .. . . . . .. . . . . ... . . . . . . . . . . . . . ' . ... . . . . .. . . ... . . . . :$&:.:.. . . . . . . . VI . . ... . . . . ~ 1 ~ . V) ..., 'I:"'l. It.... 4( o ~ ~ J lQ I"') I4J 008 ~ ~ ~- ~ .~ (j :] D ~ \) () c::y ~ ,~ '. Sll~~ 1~1~3dS gJd g:'9t gaez-6t-&I1:l SS;::;:: 1>86 t \>S 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone aJt'~LO~.: Ilk. . City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 3201000000000000078 Date: 03/05/2010 2:16:47PM Job/Journal Number COM20] 0-00283 COM20] 0-00283 COM20 I 0-00283 Payments: Type of Payment Check .:Rccciotl Description Building Pennit + 12% State Surcharge + 5% Technology Fee Paid By EHLERS CONSTRUCTION Item Total; Check Number Authorization Received By Batch Number Number How Received Amount Due 233.50 28.02 11.68 $273.20 Amount Paid njm 6879 $273.20 $273.20 In Person Payment Total: Page I of I 3/5/20 I 0