HomeMy WebLinkAboutPermit Building 2010-10-14
Stru~turaI Permit Application
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, . -c' ~./CI'FY OF SPRINGFIEL:D;o'REG(:JN ~';'''''~' . .';
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. DEPARTMENT USE ork y
r~~:~i~ Permit no '>1'0 - ~ d
225 Fifth Street. Springfield, 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 0
suspended for 180 days.
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This project has finalland~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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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:
CONTRACTOR INSTALLATION:
Business name: M~7V 2$ c... J::,,' L,
Address: 155" /B#J
City: ,/,/'r! fJeu> State: 0;:: ZIP: 971'71
Phone: 911- #t- MIS Fax:?41-741.. U 'i9r;.
E-mail: /J7a7ocJf.p..e...IAl.....K: ..v. 1-
CCB license no.: lOCI -330
Print name: ~t!: /v?K2b?-.Y
Signature:
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Name CCB License Number Phone Number
Electrical
Plumbing
Mechanical
/vOTlCE'.
THIS ",'<>..,.'
AUTH6~~~~ SHALL EXPIRE IF THE WORK
COMMENC UNDER THIS PERMIT IS NOT
ANY 180 DAEyD OR IS ABANDONED FOR
PERIOD,
. '. ..... '. . . .. . 'FEE 'SCHEDuLE .......,..
LV:al~;,.ti1i!li~forma'ti.;D.'.:!}<;;;;,X;;;.:::,' ,.
(a) Job description: e:- ~.(
Occupancy
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,,"',
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1<00 '"
5"500
Construction' type:
Square feet:
Cost per square foot:
Other infonnation:
Type of Heat:
Energy Path:
o new 0 alteration
(b) Foundation-only permit?
Total valuation:
o addition
o Yes
ONo
'2;B1ijjiliD.gte'e,~K ;'~;'.;i,:"'.."...
(a) Permit fee (use valuation table):
(b) Investigative fee (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 of fees above (2a through 2d):
$
(a) Plan review (65% x permit fee [2a]):
(b) Fire and life safety (40% x permit fee [2a]):
(c) Subtotal of fees above (3a aod 3b):
'4; M:i~i:eii"it~1i.D.stee'~ic;;::'>;:\. ., .
(a) Seismic fee, 1 % (.01 x permit fee [2a]): $
TOTAL fees and surcharges (2e+3c+4a): S
8't:Z
ATTENTION: Oregon law requires you to
foUow rules adopted by the Oregon Utility
~otlflcatlon Center. Those rules are set forth
In OAR 952-001-0010 through OAR 952-001-
0090,. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
!<;ity of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Planning Division Information Sheet for Building Permits
Com mercia IfInd ustrialf Multi-Family Residential
The Planning Division requires the following information for IDl building permit submittals on
properties zoned Medium Density Residential, 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.
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A ~ Phone: 51/- 744 -244 g
Fax: 511 - 74r-f.f)oC(Cf
Address:
tt7471
ASSESSOR'S MAP NO:
Address: 4404
TAX LOT NO S
MA1n
Description of the proposed work to be completed under this building permit:
1(15- t'oiJehf ,,/' m/J,'M+ f}7op,
Has this development proposal been reviewed by the Planning Division
through an application process (i.e. MDS or Site Plan Review)? 0 Yes 0 No
If yes, Case #:
If no, is this a change in use? 0 Yes 0 No
Prior A roved Use: Pro osed Use:
. . - -
Zonin TOTZ: Overla
The proposed project requires submittal and approval of the following Planning application
prior to building permit approval:
o DWP Overlay District Development 0 Statement Letter Regarding DWP Exemption
o MDS 0 MDS Land Use Compatibility Statement
o Site Plan Review 0 Other:
Reviewed b
Jid$l
Date:
.
TRANSACTION RECEIPT
811-SPR2010-00508
4404 MAl N ST
www.ci.springfield.or.U5
CITY OF SPRINGFIELD
225 Frfth 81
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
DATE: 10/14/2010
RECEIPT NO: 2010000568 RECORD NO: 811-SPR2010-00508
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Building Permit Fee 100-00000-425602
Technology fee (5% of permit total) 100-00000-425605
State of Oregon Surchar~"U~2% of applicable fees) 821-00000-215004
TOTAL DUE:
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Credit Card
014976
MCKENZIE ROOFING INC
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$20425
$1021
$2451
$238,97
--AMOQNJPAID : --,-:;~
$238,97
$238,97