The URL can be used to link to this page

Home My WebLink AboutPermit Building 2010-8-5 Structural Permit Application 1~4+J~~~ "t";FE'", 225 F;tlh Street. Springfield, OR 97477. PH(541)726-3753. FAX(54 1)726-3689 'DEPARTMENT USE ONLY ',"r"'I~ ";i'~',~_ Penn it no,: (JI ()- /0 c::? This permit is issued uuder OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL This project has final land-use approval. Signature: Date: This project has DEQ approval. Signature: Date: Zoning approval verified: 0 Yes 0 No Property is wilhin flood plain: 0 Yes 0 No CATEGORY OF CONSTRUCTION cf:j....Residential 0 Government 0 Commercial Reference: Name: t 51t1 wN Address: I z..5 G /11\- 0 p" L City:? State: 0 (l Phonc:S / - SO~ Fax: E-mail: L-l~,<J;:t;W" C-~Ca ~.. #~-I- This installation is being made on residential or fann property owned by me or a member afmy immediate family, and is exempt froJ]1licensing requirements under ORS 701.010. Sign here: D.-dJ CONTRACTOR INSTALLATION Business name:<)t,0!Jt::.1L Address: City: Phone: State: Fax: ZIP: E-mail: CCB license no.: Print name: Signature: SUB-CONTRACTOR INFORMATION Name CCB License Number Phone Number Electrical Plumbing Mechanical FEE SCHEDULE 1. Valuation information (a) Job description: ~ t?t::-f>L"''- to-.N-r eNL"'~C Occupancy~ IV\N (lOw Construction lype: VR Square feet: Cost per square foot: Other information: Type of Heat: Energy Path: o new ~ration o addition (b) Foundation-only peomit? DYes DNo Total valuation: $ :;;z,:xX) 2. Building fees (a) Pcomit fee (use valuation lable): $ <;~- (b) Investigative fec (equal to [2a]): $ (c) Rcinspection ($ per hour): $ (number of hours x fee per hour) (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ (q9~ (e) Subtotal offees above (2a through 2d): $ 3. Plan review fees (a) Plan review (65% x peomit fee [2a]): $ (b) Fire and life safety (40% x peomit fee [2a]): $ (c) Subtotal of fees above (3a and 3b): $ 4. Miscellaneous fees r% ~--U-r ? 'T~ (a) Seismic fee, 1% (,01 x peomit fee [2a]): $ TOTAL fees and surcharges (2e+3c+4a): $ iP7 ~ ~~ ~\n~ Qj\Y -" .,,, i;i;~~.>.. "l-~i;~f . ......'" .CO , ~,~:' CITY OF SPRINGFIELD Building/Combination Permit Status Issued , . PERMIT NO: COM20l0-01057 ISSUED: 08/05/2010. APPLIED: 08/05/2010 EXPIRES: 02/05/2011 VALUE: $ 2,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 'j, ',. J i ,,';' ). : SITE ADDRESS: 1236 MODOC ST Springfield TYPE OF WORK: Single Family Residence ASSESSOR'S PARCEL NO:: 1703264417400 'res you to ATTENTION: Oregon la~hre6r~gon Utili{yYPE OF USE: Alteration Residential PROJECT DESCRIPTION: ~~P!ace:door,reillarg'er\f;~dOr~IW)iV.\!Jgf!'I':QJJth . Notitication c~nt;~" l~~:~ ,nh OAR 952-001- In Uf\n ;;'v"- -v....., - ~. . of the rUles uy Owner: IWEN LISA 0090. You may obtain cOf'e~he telephone Address: 1236 MODOC ST callinq the cente!., (~O e, " N 'tilication SPRINGFIELD ORn27~2Zr _tor .the,?~~~~~_~i~~~34~). ........' ..-' ':;~t.t~~;;; pj.' {..~' I CON'Ti~ACTOR INFORMA TION . Contractor Type General Contractor O\yNER . License Expiration Date Phone I BUILDING INFORMATION' ,_ _,e,..", # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: NOTICE: # of Stories: Il'lE \FTHE WORK THIS PERAAf1'~~~~m~~;rPERM\T \S NOT AUTHOR\~l)1>Y~:ABANDONED FOR .' COMMENka~gp;i"~)"e::t'. ',' " . ANY 1 SO "Nri\,\glp~t'fiY'" . Sprinkled' Building: nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %~~{LotCover'age: .~:~)~:~ '>\~:~':..r:"~' "'l:" Total: Handicapped: Compact: I PUBITCIMPROVEMENTS. Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Draius: Notes: I Valu~tion DescriPtion I .,,' i':' Description Tvpe of Construction $Per '8qFt or m~liiplier '....:: Square Footage or Bid Amount' Value Date Calculated Pa2e I of 2 Issued :.:,." ---;":i.t!J. " { ..""...~'.~;" ~, :yr:~': . ;.~~,; CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2010-01057 ISSUED: 08/05/2010 APPLIED: 08/05/2010 EXPIRES: 02/05/2011 VALUE: $ 2,000.00 Status ,....,. ',,'. .,..};..~ 1....j'. 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid ~ .~. , , Fee Description + 12% State Surcharge + 5% Technology Fee Building Permit Amouut Paid" ,. , '_z. ~";; " D'ate Paid Receipt Number . :'.;"hi $6.96,' , $2.90 $58.00 8/5/10 8/5/10 8/5/10 2201000000000000921 2201000000000000921 2201000000000000921 Total Amouut Paid $67.86 I p,lljn Reviews ~ '.;Y.':~:.~~~;' '.,. .-,'. . ,,'::.,,:i~',.:(: ... _...1:... To Request an inspection call the 24 hour rJ~~rding at 726-3769. Ali 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. I Reauired InsDect~ Framing Inspectiou: Prior to cover and afte~ all rough':in i,nspc.ctious have'been approved. . , Wall Insulation: Prior to cover. ,. ..,. \'.'" . :: l" !,:\ ~ ~ '!. ., .' Final Building: After all required iuspections bave been requested and approved and the building is complete. . ~:. " ,. By signature, I state and agree, that 1 have carefully examiued the completed application and do hereby certify that all iuformation 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 strncture without permission of the Community Services Division, Building Safety. I further certify that ouly coutractors and employees who are iu 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 of.th'e property, and the approved set of plans will remain on the site at all times during construction. 11";(-;~; ,,:~ 'i.~:.-;." ;" r' "',d' .,'., '. '.' '.. ........ ,\, . .&l- ~#~ ,,--/ Owner or Contractors Signature .... .;:~~~' :>: . ....-,.....<" ~-S'-/D Date ':\ P~~;e 2 of 2 . ....-~ ~'" ..". ,'Ud.; ....' 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ~11Ir~"'" G."......... ,&W...... ..... Wil:.. . . . ....liIIiI!l.. "~" ~",""'" .- ~",..,.,.",';",,"-;,''''..'' "~ .., .. City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2201000000000000921 Date: 08/05/2010 9:03:04AM Job/Journal Number COM20]O-OI057 COM2010-0]057 COM2010.0]057 Payments: Type of Payment Cash Change Description Building Penn it + ] 2% State Surcharge + 5% Technology Fee Paid By LISA IWEN Amount Due 58.00 6.96 2.90 $67.86 Item Total: Check Number Authorization Received By Batch Number Number How Received cjc Amount Paid In Person In Person Payment Total: $80.00 ($12.]4) $67.86 Job/Journal Number COM20 I 0-0 1057 COM20]0-0]057 COM2010-0]057 Payments: Type of Payment Cash Change cReceintl Description Building Penn it + ] 2% State Surcharge + 5% Technology Fee Paid By LISA IWEN '~'i .f;'~%*~~ :,~,::~:g",~~ck Number ~e~~ivedJ3y!' {,Ba~ch Number ."- ......1t'.. '._~l1' \ :.~:"~jc" I,"", /! '0' ~,",~~~ ...' '\;"~,,:'{'.. ''';;''1:V ir,!,~\,;"tat't ')W~.h1\i'.~ ji ":":.~" .>. Page] of] Item Total: Authorization . Number How Received Amount Due 58.00 6.96 2.90 $67.86 Amount Paid In Person In Person Payment Total: $80.00 ($12.]4) $67.86 8/5/20 I 0