HomeMy WebLinkAboutPermit Building 2010-7-15
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225 Fifth Street. Sorin!!field. OR 97477 . PH(541\726.3753 . FAX(541\726-3689
Manufactured DwellinglRecreational-Park Trailer
Placement Permit Application
SPRINGAELD
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;.~'QE(:J~RtME.NtJj$E()NLY(
Permitno.:LJO- '7l(0
~/r 10
This permit is issued under OARs 918-500-0105 and 918-525-0370. Permits expire if work is not started within 180 days of
issuance or if work is suspended for 180 days.
"LOCAL"GOVj:RNMENT,,6;fi.F>RO,YA4s',
Zoning approval verified: DYes DNa
Property is within flood plain: DYes DNa
Sanitation approval verified: DYes' DNa
.....CATEGQRY O'FCONSTR(JctioN
esidential
D Government
D Commercial
J.OBSITEINF.ORI\IIA'nO.NAND 'LocAnO~
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City:
State:
Reference:
Spacellot no.:
Taxlot:
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 OAR 918-515-0010.
Signature:
CONTRACTOR INSTAL: TION
Business name:
'/: ~.'
:,:.,',': :i;','.:,; i.e,'>';" 'FEE' SCI-iEDULE";/""; ,', " ".:"';~>'.~~]:":;,! ':<,
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Description Qty. Cost each Total
(I) Manufactured dwelling
(a) Placement (includes placernen~ ( $J97
electrical feeder, water/~ewer $397.00 ""
connection):
(b) Remspection (nn. ofhrs. x fee per hr.): $58.00 $
Placement permit can only be oQtained by homeowp.er or Oregon- .
licensed manufactured dwelling installer. '
(2) Recreational-pa~k 'trailer .
(a) Installation (includes stand and
lot preparation; support blocking; $397.00 $
anchoring; temporary steps; plumbing, .,.
mechanical, and electrical):
(b) Reinspection (no. ofhrs. x fee per hr.): $58.00 $
(c) Each additional inspection: (1) $58.00 $
Electrical service Rermit to be obtained only lJy homeowner performing
work or signing supervisor of Oregon-licensed electrical contractor
performing work
\':':'\.:' .'y. ."FEE '.SCHEDULE; ,,-, : .. " '..
. , " . , " . - - - , ..... .
(3) Surcharge, 12% (.12 x total, equal tn I or 2): $ '/7&!:j
(4) State administrative fee for
manufactured dwelling (item 1) $30.00 I $30.00
only, OAR 918-500-0105(5):
(5) Technology Fee, 5% $ {<(is
TOTAL fees and surcharges (3 + 4+5): ~9'if" ei
.ft.. .
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00946
ISSUED: 07/15/2010
APPLIED: 07/15/2010
EXPIRES: 01/15/2011
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 225 41ST ST SPACE 39
ASSESSOR'S PARCEL NO.: 1702323200800
Springfield TYPE OF WORK: Manufactured Home in Park
PROJECT DESCRIPTION: Site mannfactured dwelling in park
TYPE OF USE: Move
Residential
.1,
Owner: M & M LAND AND CATTLE CO LLC,. '"
Address: 225 41ST ST SPACE 42 ":~'
SPRINGFIELD OR 97478
Contractor Type
I CONTRACl;OIU!llf9~AIf~N .
ATTENTlv... - - d b the Orego Ul' ,
ContractoinlloW rUlescad~~rt\hO~e rules are LEi\:tmm
Notif~~\i~~ en. O'iothrough OAR 952.btln-
,,,e,,.. ~~ ~ ~mi_Y
0090. YeluBLI ; f. ~. e
calling l" v' .~ . Utility 0 111 ." on
number for \):/'(,~i~g!m;332.2344).
R-3 CentWelght of StJ"Ucture
Type of Heat:
. Water Type:
. . Rimge Type:
Energy Path:
Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Gronp:
Primary Constrnction Type
Secondary Construction Type:
# of Bedrooms:
.. ,',.....-
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFORMATION I
NOTICE: .. 01 E IF THE WORK
THIS PERMIT ~~j,jI.~JstB '. MIT IS NOT
IITHORIZED.ttlISJ\fe\?t ~r~~~. FOR
'1MMENCED tq"~(bI;l!:lve~Rlfd,~ED
oj{ ,SO DAy.~Yfl!J~. Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
~ ,,1 !
I V al~lition~esCriPtion ,
Description
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Pa2e I of 2
'. N:(i
'.tJi'~1 Ed 'n ;(' "J I
Expiration Date Phone
n/a
Lot Size:
.. Sq Ft 1st Floor:
Sq Ft 2nd Floor:
, Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk Type:
Downspoutsmrains:
Value
Date Calculated
i!,;,
l' ':~" ( ,
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20]0-00946
ISSUED: 07/]5/20]0
APPLIED: 07/]5/20]0
EXPIRES: 01/]5120] I
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
'~,' :\(~i,:. >.
Total Value of Project
\;:'..Fees}P-aWj,~ ".
'\;Cl.h 1;n;~ ~~j .
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Manuf Home State Issuance
Manufactured Home Placement
Amount PaJdX}.\ ) ,~:'j ~
'-.:::..- '....
$47.64"
$19.85
$30.00
$397.00
Date Paid
Receipt Number
7/15/10
7/15/10
7/15/10
7/15/10
2201000000000000835
2201000000000000835
2201000000000000835
2201000000000000835
Total Amount Paid
$494.49
J>lan Revie",s I.
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To Request an inspection call the 24 hour recording at 7~769. 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.
LRelluired InsDections ~
".
Manuf Home Set Up: When installation ofcaiIT~\ers;o'rki~nds is complete.
".:.H.~Dl ~r~.~ ..~ ""l ".
Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting,
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decks, venting, street address numbers, tre'e~,;driveway, etc. have been installed.
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.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
] further agree to ensure that all required inspections are requ~sted at;the proper time, that each address is readable from the
street, that the permit card is located at the front ofthe property, and the approved set of plans will remain on the site at all
times during construction. ,', ,''''~ ..' ~
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Owner or Contractors Signature
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;7- 1c;1 - /0
.
Date
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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 #:
2201000000000000835
Date: 07/15/2010
1:31:03PM
Job/Journal Number
COM2010-00946
COM20 I 0-00946
COM2010-00946
COM20 I 0-00946
Payments:
Type of Payment
Cash
Change
Description
Manufactured Home Placement
Manuf Home State Issuance
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
TELLEZ
Check Number
. ~~~~jYed' By':' ~ Bat~h/~umber
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; ";"'"
Item Total:
Authorization
Number How Received
Amount Due
397.00
30.00
47.64
19.85
$494.49
Amount Paid
In Person
In Person
Payment Total:
$500.00
($5.51)
$494.49
Job/Journal Number
COM20 I 0-00946
COM2010-00946
COM2010-00946
COM20 I 0-00946
Payments:
Type of Payment
Cash
Change
cReceintl
Description
Manufactured Home Placement
Manuf Home State Issuance
+ 12% 'State Surcharge
+ 5% Technology Fee'
Paid By
TELLEZ
"
,
"
Check Number
Received By' _~Batch ~umber
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Page I of I
Item Total:
Authorization
Number How Received
Amount Due
397.00
30.00
47.64
19.85
$494.49
Amount Paid
In Person
In Person
Payment Total:
$500.00
($5.51)
$494.49
7/15/2010