HomeMy WebLinkAboutMiscellaneous Building 2010-9-7 (2)
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City of Springfield
Community Services Division
225 fifth Slreet, Springfield, OR 9N17
Telephone: j41.726-37j3 fax: S41.726.3676
Deferred Submittal - Agreement
Oregon Structural Specialty Code Section 106.3 allows a permit applicant 10 defer certain
submittals If approved by the BuildIng Official. This form is a deferred submittal
agreement for the following project:
Dnle: "'1-,:/.10 ProjectNamo:J:I'f~". ~-t"",", _ It-l\lr3z.llB.lo ~
Project Addressl ~... \tI~ Il'. ~ 'fW11. Permit Number:Ct:H:!clo~ ClDn
Phase: " B,cayallen & {]radlng 0 fonndallon Only 0 Cnmpleffon
o Slle UllIllles 0 Shcll )fjenMtlmproycment
Design Professlnonlln Responsible Charge: ~ ~.I(. 1-1"",
License number: UJ,~ Broall: 1~12\;>e~o..h_a>tn
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I. ADDrOyal: Eaeb deferred submlltRlshall bear fhe Rpproval oflhe deolgn prof..slnnRI In responsible
charge. NOlation shall be Included Ihat Ihe deferred .ubmlttal documents have becn reviewed and have
been found 10 be In general conformance to thed..lgn oflh. building.
2. '!d1!: Pege 2 of tbls fomlls B IIsl of defened submittals. The deo/gn professional In responsible charge
musl.eheck wbleh .ubmltlels e", requested tn be deC.ned and IndlcRlo an anlleipaled snbmltlal dole.
3. fls.!: Mloimum $100.00 (2 hour) for each deterred submlonl.
4. Tlmclln.., Eyery ettempt will be made 10 proylde IImely reylaws of S-IO bllslness day! per dafened
submlllol.
j. Work ",lIboul "Permll, Work Ihal Js conslrucled 1Yllb0ul baying be.. ,eylewed and appmyed by
b01h the design professlonal/n responsible charse and Ihe City of Springfield BulldolS Official Is
eonsldered lIS 1Y0lk perfonned wllboula permit. Any pusou or Jlrm porfnlllllng work prior 10
approyalshnll be subjecIlo Ihe penollles ofSecllon 108.2.1 of tho Stele ofOregou Struclural Speolally
Code.
Acknowledgaments:
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OlYner Name (Priolcd)
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Oeneral Conlraelor Firm Name (prulted)
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Design Professional I. Responsible Charge(Prinled)
~ . I . 'MI DA\m:> Pue:k1r
BuUding OIDelal NlIIlIe (Prlnt.d)
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City of Springfield
Deferred Submittal Agreement
Date: .q ;J'll)
Project Address: :;,~
Project Name:
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Permit Number: Clll1ZD1O-OIOZZ>
Phase:
o Excavation and Grading
o Site Utilities
Design Professional In Responsible Charge:
Ilems which may be deferred indude. but are not limited to the following:
Deten-ed Item Date
0 1. Acouslfcal ceiling suspensron
slislem
0 2. Auxiliary power systems
0 3. Awnings
0 4. Bleachers
0 5. Carports
0 6. Curtain walt systems
0 7. Electrtcal call system
0 8. Emergency call system
0 9. Exillllumlnalion
'" 10. Fire alarm system
~ 11. Fire sprinkler
>( 12. Fire slopping
0 13. Glass guardrails
0 14. GlazIng systems
0 15. HVAC system
0 16. Intercom system
0 17. Irrigation system
0 18. Metal guardrails and handrails
o Foundalion only
o Completion
>(Tenantlmprovement
oShell
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Deferred Item Date'
0 19, Plumbing system
0 20. Post-tensioned concrete structural
members or panels
0 21. Pre-cast concrete slruclural
members Or nanels
0 22, Prefatlrfcaled slair units (0 include
steel. aluminum, or nre-cast concrete
0 23. Prefabricated wall panel
0 24. Ore-stressed concrete structural
members or panels
0 25. Raised floor systems
0 26. Shelving systems and steel
storace raCks
0 n Signs
a 28, Skyllghls
0 29. Smoke and heal vents
0 30. Specialty retaining walls
0 31. Stone veneer
0 32 Terra cotta veneer
0 33, Wooden. sleel. or composfl
floor or roof lrusses
0 34. Works of art
II( 35.~~~ {1p
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0 36.
FeGs: Minimum $100.00 (2 hr) each for 'he above listed Deferred SubmiUals
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 #:
3201000000000000493
Date: 07/30/2010
9:45:06AM
Job/Journal Number Descripti.on
COM2010-01022 Plan Review ConunJlnd/Public
Payments:
Type of Payment
Check
Paid By
PEACEHEALTH
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
1,254.34
$1,254.34
Amount Paid
KLK 00382294 KLK In Person
Payment Total:
$1,254.34
$] ,254.34
cReceintl
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7/30/2010