HomeMy WebLinkAboutPermit Building 2010-3-5
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~^Sffuctural Permit Application
DEPARTMENT USE ONLY
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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.
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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
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o Residential 0 Govemme~t ~ Commercial
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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' .'
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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:
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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: $
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(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): $
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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): $
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(a) Seismic fee, 1%(.01 x permit fee [2a]): $
TOTAL fees and surcharges (2e+3c+4a): $
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!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
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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:
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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:
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0414842344 COllMERC IAL INV PROP
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PATE RECEIVED
:ZONE
UNIT 5
:STORIES
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Oc .UPANCY LOAD
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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
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"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:'
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~-t14S42J44
COMMERCIAL INV PROP
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SS;::;:: 1>86 t \>S
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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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
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