HomeMy WebLinkAboutPermit Building 2007-11-6
Status
Issued
CITY OF SPRINGFIELD"
Building/Combination Permit
PERMIT NO: COM2007-01591
ISSUED: 11/06/2007
APPLIED: 10/24/2007
EXPIRES: 05/06/2008
VALUE: $ 20,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 250 68TH ST
ASSESSOR'S PARCEL NO.: 1702344106603
Springfield
TYPE OF WORK: Single Family Residence
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Laundry room remodel/extension, add bath
Owner: MICHAEL VOSS
Address: 250 68TH ST
SPRINGFIELD OR 97478
Phone Number: 541-747-9418
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Mechanical
Plumbing
Contractor
OWNER
BURRELL BROS ENTE~I~Qrt Oregoftl&fi~ 08/20/2009
J COO INC .OW nI'e8 adoptedUVI~H3 Ore 0 ~tfh2/2008
RIGHT WAY PLUMBlrt~::':~~rter. ~h"esJ~A~~~6/2008
I B~Nmwlm'~nOAR952-OO1.
IliCUIUlg Ine center. (Note: ~~t the rules by
~rffA':the Oregon Utilg.Ph'L'lR Size:
Height~dtP~680o-aa2. ft~'t 1st Floor:
Type of Heat: Electn. Sq Ft 2nd Floor:
Water Type: Gas Sq Ft Basement:
Range Type: Gas Sq Ft Garage/Carport
Energy Path: Path 1 Sq Ft Other:
Sprinkled Building: n/a Occupant Load:
License
Expiration Date
Phone
541-747-2724
541-746-7065
541-484-3787
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
60
VB
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontya,"d Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
15.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot CovtNtllflCE:
THIS PERMIT SHAll EXPIRE 'f THE WORK
I PUBLIC IMPROvFM4JNI-f!r_Ltu UNDE:R I HI::> PtHMII I~ NUl
OJlvlfvJ[ CEO OR IS ABANDONED FOR
ANY 180 OAy~O'b.Type:
Downspouts/Drains:
Total:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special I nstruction:
Fully Improved
Yes
Curb and Gutter
Notes:
Pae:e 1 of 3
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-01591
ISSUED: 11/06/2007
APPLIED: 10/24/2007
EXPIRES: 05/06/2008
VALUE: $ 20,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description I
Estimate
Tvpe of Construction
Estimate
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
20,000.00
Value
Date Calculated
Description
Total Value of Project
$20,000.00
$20,000.00
10/24/2007
~
Fee Description Amount Paid Date Paid Receipt Number
-Mech Iss 2+ Appliances- $40.00 11/6/07 1200700000000001371
+ 10% Administrative Fee $42.24 11/6/07 1200700000000001371
+ 5% Technology Fee $21.12 11/6/07 1200700000000001371
+ 8% State Surcharge $33.80 11/6/07 1200700000000001371
Add, Alter, Extend Circ $48.00 11/6/07 1200700000000001371
Add, Alter, Extend Circ Ea Add $8.00 11/6/07 1200700000000001371
Appliance Vent $21.00 11/6/07 1200700000000001371
Building Permit $204.44 11/6/07 1200700000000001371
Dryer Vent $7.00 11/6/07 1200700000000001371
Fixtu re $112.00 11/6/07 1200700000000001371
Gas Outlets 1-4 $5.00 11/6/07 1200700000000001371
Minimum/Adjustment Mechanical $10.00 11/6/07 1200700000000001371
Plan Review Residential $132.89 11/6/07 1200700000000001371
Sanitary Sewer - Improvement $122.42 11/6/07 1200700000000001371
Sanitary Sewer - Reimbursement $161.00 11/6/07 1200700000000001371
SDC Sanitary/Storm Admin $15.21 11/6/07 1200700000000001371
Storm Drainage Impervious Area $20.76 11/6/07 1200700000000001371
Vent Fan $7.00 11/6/07 1200700000000001371
Total Amount Paid $1,011.88
Plan Reviews I
Plannine: Review
Public Works Review
Structural Review
10/24/2007
10/24/2007
10/24/2007
10/24/2007
10/24/2007
10/25/2007
APP T AJ
APP LKW
APP DLM
No Planning issues.
to curb & gutter
See documents for Plan review fees
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.
~eouiredJnSDections I
Footing: After trenches are excavated.
Foundation: After forms are erected but prior to concrete placement.
Pae:e 2 of3
CITY OF SPRINGFIELD'
Building/Combination Permit
Status
Issued
PERMIT NO: COM2007-01591
ISSUED: 11/06/2007
APPLIED: 10/24/2007
EXPIRES: 05/06/2008
VALUE: $ 20,000.00
225 Fifth Street, Springfield, OR
541- 726-3 753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Post and Beam: Prior to tloor insulation or decking.
Floor Insulation: Prior to decking.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Wall Insulation: Prior to cover.
Ceiling Insulation: Prior to cover.
Final Building: After all required inspections have been requested and approved and the building is complete.
Undertloor Plumbing: Prior to insulation or decking.
Undertloor Drain: Prior to cover or placement of concrete.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Undertloor Mechanical. Prior to insulation or decking and including required testing.
Undertloor Gas: After line is installed and required testing and capped if not attached to an appliance.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
Rough Mechanical: Prior to Cover
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work 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 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. 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 the property, and the approved set of plans will remain on the site at all
times during construction.
.fiv1sL/! Z tI~
I r 06- C/
Owner or Contractors Signature
Date
Pae:e 3 of 3
SPRINGFIELD l"""'.''''C~'';''; ZON t ro.--
-A~'G~1~~ INITIALS \ ~
--~~ ~~~CE {~~~
t."J1:': ~_..~~~".J..,~.;...:r,A"*I.l1~~'" ")M~ ~+"';.j' ,,,,^t...,,'l"~',' -<< .~'... ".r'~"- "~ '\";>""-b~':" ~~...... ~f '
;}~~(.'rrr>\CII.Yr Og SPRINGFIELD' ;.ORECION>.' ~:.f;" ';~,:
f,'~j:-:",*f.' U':-~?,"~:')3-!J.","~~ ..;",/;'I\.~..<;.'" ~ .'~' t<:~-";';,"" l,', . . .,' . ."~ _, ~~I .~ '.'~~' ~~.>
225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number C.oIf1l\ u:>O 7 - 0 I ~ 9 I
. . : .'. .,;-:,~:' "~'!l"U"", .;to __ .. ,";,:i .. :i,',,'/
1. .' LQCATIO!'l OF JN8,TALLATI()N:';: .
'ZS=O .-" 'b g~c:. - .'- .~ f" ._'~
LEGAL DESCRIPTION:
/702- sCft.{1
JOB DESCRIPTION:
Ob60S
AJJ "3
c. (/"" C\A: t-~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Supervisor License Number
Constr. Contr. Number
Expiration Date
OWNER INST ALLA nON
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
,
~
Inspection Requos.: 726-3769~ foff)r!J\
Date
3.
COMPLErEPEE SmEDuLEBELOW
- .,:'_:\
'~:r :--~" ~,,-^ '. ~~ .u -....,. .' -
A. New Residlmtia~~ ,S!~gl~,oi'_~~_lti~ Fa mUy per dlVelIing u~it..
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder. .
$117.00
$ 21.00
$55.00
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 55.00
$ 76.00
$110.00
8% State Surcharge .
10% Administrative Fee
5% Technology Fee
~r~f
Shared Drive(T:)/Building Fonns/Electrical Penn it Application 7,07.doc
TOTAL
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
JOURNAL OR JOB NUMBER: Com2007-0I 59IIBathroom Addition
NAME OR COMPANY: Michael Voss
LOCATION: 250 68th Street
TAX LOT NUMBER: 1702344106603
DEVELOPMENT TYPE: Single Family Residence
NEW DWELLING UNITS 0 BUILDING SIZE (SF: 60, LOT SIZE (SF):
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS S.F. x 1 COST PER S.F. CHARGE
60.00 I $0.346 = $20.76 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
IMPERVIOUS S.F. I x 1 COST PER S.F. x 1 DISCOUNT RATE I
0.00 I. $0.346 I 50% = 1
ITEM 1 TOTAL - STORM DRAINAGE SDC '$20.76
DISCOUNT
$0.00
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's x
I 6
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 6 I
COST PER DFU
$26.83
COST PER DFU
$20.40
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
=,
$283.42
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE x
I 9.57
I NUMBER OF UNITS I x
I 0
COST PER TRIP
20.43
x I NEW TRIP FACTOR
I 1.00
B. IMPROVEMENT COST:
I ADT TRIP RATE x I NUMBER OF UNITS I x COST PER TRIP
I 9.57 I 0 I I $90.10
ITEM 3 TOTAL - TRANSPORTATION SDC : = , $0.00
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x COST PER FEU
I 0 I $95.35
B. IMPROVEMENT COST:
INUMBER OF FEU's x
I 0
x NEW TRIP FACTOR
1.00
ICOST PER FEU
I $990.39'
I '
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = ,
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = ,
5. ADMINISTRATIVE FEE:
I SUBTOTAL x I. ADM. FEE RATE
I $304.18 1 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
$0.00
$304.]8
CZl
~
Q
0
u
~
25700 ~
E-<
CZl
......
0
gz
,I
$20.76 11070
$161.00
$]22.42
$0.00
$0.00
=
$0.00
1091
1092
1093
1094
1054
1055
1054
1056
CHARGE
$15.21
-_.~~ -. .
'''.'- -
Kaye Wilson
10/24/2007
TOTAL SDC CHARGES
PREPARED BY
DATE.
=
$0.00
$0.00
$0.00
,
I
15.21 . 1079
$0.00 11078
i
$319.39 '
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY TIlE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIVALENT UNITS
BATHTUB 0 0 3 = 0
DRINKING FOUNTAIN 0 0 1 = 0
I FLOOR DRAIN 0 0 3 = 0
INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0
LAUNDRY TUB 0 0 2 = 0
CLOTHESW ASHER / MOP SINK 0 0 3 = 0
CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0
/RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0
SHOWER, SINGLE STALL 1 0 2 = 2
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 = 0
SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0
ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1
IURINAL, STALL / WALL 0 0 5 = 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INSTALLATION 1 0 3 = 3
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 6
*EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at ] 67 gallons per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BEFORE] 979
]979
]980
]981
]982
]983
]984
]985
]986
]987
]988
]989
]990
199]
1992
1993
1994
1995
]996
1997
1998
1999
2000
2001
CREDIT RATE/$I,OOO
ASSESSED VALUE
$5.29
$5.29
$5.19
$5.12
$4.98
$4.80
$4.63
$4.40
$4.07
$3.67
$3.22
$2.73
$2.25
$1.80
$1.59
$1.45
$1.25
$1.09
$0.92
$0.72
$0.48
$0.28
$0.09
$0.05
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter 1 for Yes, 2 for No)
BASE YEAR
CREDIT FOR LAND (IF APPLICABLE)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
= I
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE / 1000 CREDIT RATE
$0.00 x $5.29
TOTAL MWMC CREDIT
=
2
2
1979
$0.00
o
$0.00
Construction Contractors Board'
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
Permit #: C/JYW2QEJ 7.....0/59/
Address: 2$0 ~eb72t ~r;
/)f?
Date:
-
II /b~ 7
/ I
Issued by: .
.'
Statement:.lnfo.mation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055 (4) requires residential construction permit applicants who are not
licensed with the Construction Contractors Board to sign the following statement before a building
permit can be issued. This statement is required/or residential building, electrical, mechanical and-
plumbing permits. Licensed architect and engineer applicants, exempt from licensing under
ORS 701.010(7), need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
~.
)8' 2.
1.. I own, reside in, or will reside in the completed structure.
I understand that I must become licensed as a construction contractor ifthe structure is sold or
offered for sale before or on completion.
. 0 3A. My general contractor is
(Name)
(CCB #)
I will instruct my general contractor that all subcontract()Ts who work on the structure must be
licensed with the Construction Contractors Board.
OR
~ 3B. I will be my own general contractor.
If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If! change my mind and hire a general contractor, I will contract with a contractor who is
licensed with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
X /lM,d;-JJ t! ~ ..
~, (Signature of permit applicant)
/ I_~ '0]
(Date)
(White copy to issuing agency permit file, pink copy to applicant.)
Property _ owner. doc 06-01-04
Acting as Your.Own General Contractor?
. '
INFORMATION NOTICE TO PROPERTY OWNERS
ABOl[r CONSTRUCTION RESPONSIBILITIES
0::-_, t,. . ~. . .....
"
NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the
Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
,.-.I
If you are acting as your own contractor to construct a new home or make a'substantial improvement to an existing
structure, you can prevent many problems by being aware of the following responsibilities and concerns'.
Employer Responsibilities
, ,
You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if
'0; . '. . .
you use contractors not licensed with the Construction Contractors Board to do labor in copstructing or to ,l!,ssist in the
construction or improvement of a residential structure. As the employer, you must comply with tbe following:
. . . '.'
. . _ l . ".' . .
Oregon's Withholding Tax Law: As an einpi~yer, yo~must withhoid income taxes from employee wages at the time
employees are paid. You will be l\able for the tax payments even if you don't actually withhold the tax from your
employees. For more information; call the Department of Revenue at 503-378-49'88.
Unemployment Insurance Tax: As an employer, you are required to paya tax for unemployment insurance purposes
on the wages of a~\ employee~. For more information, ~alJ the Ore~on Employment Department at 503-947-1488.
The Oregon Business Identification Number (BIN)' is a combined~ number for both Oregon Withholding and
Unemployment Insurance Tax. To file for a BIN, 0011 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the
appropriate forms.
~ ..- .; -
Workers' Compensation Insurance: As an employer, you are subj.ect to the Oregon Workers' Compensation Law,
and must obtain workers' c~mpensation insurance for your employees. If you fail to obtain workers' compensation
insurance, you could be subject to penalties and be liable for all claim cos~s if one 'of your employees is injured on the
job. For more information, call the Workers' Compensation Division' at the Department of Consumer' and Business
Services at 503-947-7815.
U.S. Internal Revenue Service: As an employer, you must withhold"federal income tax from employees' wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the
IRS at 1-800-829-4933 or visit their web site at wVv'Woirs.gov. .
Other Responsibilities and ,Areas of CQncer~s
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code
requirements that may be brought t9 your attention through inspec~ions.
, .
Liability and Property Damage Insurim'ce: Contact your"lnsuiance agent to see if you have adequate insUrance:
coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or
work that must be redone. ;
Time: Make sure you have sufficient time to supervise your employees. "
Expertise: Make sure you have.' the skills to act as your own' genedl contractbr, tocobrdin~te the ~ork of rough-in
and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections.
If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052.
t' .
Property _ owner.doc 06-01-04
225 ~if~h Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-01591
COM2007-0 1591
COM2007-01591
COM2007-01591
COM2007-01591
Payments:
Type of Payment
Check
cReceint I
RECEIPT #:
1200700000000001371
Date: 11/06/2007
Description
Plan Review Residential
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Sanitary/Storm Admin
Building Permit
Fixture
Vent Fan
Appliance Vent
Dryer Vent
Gas Outlets 1-4
~Mech Iss 2+ Appliances-
M inimum/ Adjustment Mechanical
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
JULIE VOSS
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
3666
In Person
Payment Total:
Page 1 of I
9:23:05AM
Amount Due
132.89
20.76
161.00
122.42
15.2 I
204.44
112.00
7.00
21.00
7.00
5.00
40.00
10.00
48.00
8.00
21.12
33.80
42.24
$1,011.88
Amount Paid
$1,011.88
$1,011.88
1 1/6/2007