HomeMy WebLinkAboutPermit Building 2010-4-5
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
Iss u ed
PERMIT NO: COM2010-00420
ISSUED: 04/05/2010
APPLIED: 04/05/2010
EXPIRES: 10/05/2010
VALUE: $ 2,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3377 RIVERBEND DR
ASSESSOR'S PARCEL NO.: 1703220004102
SPRINGFIETYPE OF WORK: Office
TYPE OF USE: Remodel Commercial
PROJECT DESCRIPTION: Remove wall and door in existing office area - demo I plumbing fixture, plumbing
contractor to pull permit
Owner:
Address:
PEACEHEALTH
PO BOX 1479 0 SI J81U,8Cl
EUGENE OR 9744Q?; :::2,:-f)G_~.' '81.\1:)0\ laqU)rlJ
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alJo\.\d8181 ~~~ldO:> lJ!~I~~~~ INFORMATION ~
"q salOl a\.\~o \.\5'OOl\.\1 0 >,~I\Il:>!I\ION
Contractor Type -100 . tlll!l1AAl1l asoL\l la~ II salOl MOIIOI License
General L\)J, ~~llR1Ife\i1 NIBU'If 63579
0\' no" salIn I BUILDING INFORMATION I
Expiration Date
12/09/2011
Phone
541-683-3607
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
'-'-Height of Structure
Type of Heat:
Vl;ater Typp: , . .'
.., Jhnge Type:,
Energy Path:
Sprinkled.Biiildi
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
DEV I
~\O\\C~~\J\\i S\\t>: 't.? i\\\S \' ",,,\t:~ f,O?', .
\\'I\S \,0. D Ij~D B~~'Illf1rist: - ,
~\.l\\'IO?\lt () O? \s ~ ~''street Trees Rqd:
O\'oJ\\'oJ\t.~C,t: " ?'t.?\O'i)'P,aved Drive Rqd:
Cr>-~'i ,\?l() D ~l.O{~fLot Coverage:
Yes
REQUIRED PARKING
Total:
Handicapped:
Compact:
~".~., f-
I PUBLIC IMPROVEMENTS ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Descr.iption I
'"
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of 2
CITY OF SPRINGFIELD
Status
Issued
f'
Building/Combination Permit
PERMIT NO: COM2010-00420
ISSUED: 04/05/2010
APPLIED: 04/05/2010
EXPIRES: 10/05/2010
VALUE: $ 2,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
"
Total Valne of Project
Fees Paid .
Fee Description
+ 12% State Surcharge
+ 5% Technology Fcc
Building Permit
Amount Paid.
Date Paid
Receipt Number
$6.96
$2.90
$58.00
4/5/10
4/5/10
4/5/10
3201000000000000120
3201000000000000120
3201000000000000120
Total Amount Paid
$67.86
Plan Reviews ~
'." ".
To Request an inspection 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. will be made the following
work day.
L Reauired InsDections I
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Final Plumbing: When all plumbing work is complete.
Rough Plumbing: Prior to cover and including required testing.
Final Building: After all required inspectio'ris have been ~'equested 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 Ordinauces 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.
I further 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 inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front oOhe prop~rty, and the approved set of plans will remain on the site at all
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Owner or Contra tors Signatu e
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q - s-- / (-;I
Date
Pa2e 2 of 2
Structural Permit Application
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DEPARTMENT.USE ONLY
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
Permit no.: ~\O . 'VW
Date: <\:-~-\O
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 final land-use approval.
Signature: Date:
This project has DEQ approvaL
Signature: Date:
Zoning approval verified: 0 Yes D No
Property is within flood plain: DYes D No
~ill1~~1:~J~,4~_~~~QAT.1;9~QR~&,<:?F1.G~oN$J~"(jGlr:lQ_~fi~if~~ig.~~t:~G?A~
D Residential D Government 0 Commercial
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Job site address: r:\\ .
City'
Subdivisi n:
Reference:
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:
c:ONTRACTOR..I~STAlLA'n9N'.
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City:
Pho
E-mail:
CCB license no.:
Print name:
Signature:
::;%):;J~t~~:tJ:~r~-~~_S_ltB;:_GO~ji:~~GJ:.o_F'{:;lNf_9BMA;r;IQNrc:~t~r~:Wi~*~~tt~T
""lIlt CCB License Number Phone
Electrical ""-
Plumbing ---
Mechanic~
- - \, ~'<~~:,i:~-7:~':';:'~}::'1~~;~'~;t\F~E .j"g'e H'~QiJC~:;')':J":lru -:~~'
,
(a) Job description:
Occupancy p
Construction tyRe: ~
Square feet:
Cost per square foot:
Other infonnation:
Type of Heat:
Energy Path:
o new alteration
(b) Foundation-only permit?
otal valuation:
D addition
DYes
DNo
$
<!7~;';~Q,ijj.i_~}ng-:i~~t..~~r~t~\~l~~w-~~5(iUl~jf!.Lt~i~Y;~:;~:;~~':~~~,:f:::~L:.~
(aJ Permit ree (use valuation table):
(b) Investigative ree (equal to [2a]):
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
(e) Subtotal or rees above (2a througb 2d):
$
$
$
6
(aJ Plan review (65% x permit fee [2a]): $
(b) Fire and life safety (40% x permit fee [2a]): $
(c) Subtotal or rees above (3a and 3b): $
:~4}}M_i~~~~H:~:n~~~trsjfi~~lt~~M;~f;:_~4~~um 1YlJft./")-~A;{~~FL/,a.-~..
(a) Seismic fee, 1% (.01 x permit fee [2a]): $
TOTAL rees .nd surch.rges (2e+3c+4.): $ a,7!J!-
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 #:
3201000000000000120
Date: 04/05/2010
11:42: I2AI\1
Job/Journal Number
COM20 I 0-00420
COM20 I 0-00420
COM20 I 0-00420
Payments:
Type of Payment
CreditCard
cReccintl
Description
+ 12% State Surcharge
+ 5% Technology Fee
Building Permit
Paid By
STEVEN NORRIS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due.
6.96
2.90
58.00
$67.86
Amount Paid
CJC
467890 In Person
Payment Total:
$67.86
$67.86
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Page I of r
4/5/20 I 0