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Home My WebLink AboutPermit Building 2005-9-30 . . CITY OF SPRING~lELD Building/Combination Permit PERMIT NO: COM2005-01342 ISSUED: 09/30/2005 APPLIED: 09/30/2005 EXPIRES: 03/30/2006 VALUE: Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone' , 541-726-3676 Fax .~ 541-726-3769 Inspection Line SITE ADDRESS: 5335 Daisy St 67 ASSESSOR'S PARCEL NO.: 1702330001300 Springfield TYPE OF Manufactured Home in Park TYPE OF USE: New Residential PROJECT DESCRIPTION: MH in park Owner: FRANCIS ROTHAUGE Address: 949 S 6TH ST COTIAGE GROVE OR 97424 Phone Number: 541-746-4279 I CONTRACTOR INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Yrimary Construction Type . Secondary Construction . # of Bedrooms: Contractor License Expiration Date BURRELL BROS ENTERPRISES INC 1364Afiires yOU to 08/20/2009 JERRY OTT ATiENT\ON: Oregon ~a~t~~regon Utilit\09/2612006 OWNER ."lIn\AI ru\es adopte~. y_;;., .Ioc: ~re set 10rth . jI]P1 li.~-- R 952-UU ,- ~18wm"lNU ~\l'J:ONlt QA . UA~t;.- . 'es ot the rules by in obtain COpl 009#JotlstOfMY (Note: the te\ephOr.~t Size: dDiggt~ cen~~'egon Utility NotiticasqrFt 1st Floor: n\!'MP.rortiH"elh~. 1 800-332-2344). Sq Ft 2nd Floor: Water (t'yplGr IS - Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled n/a Occupant Load: Phone 541-747-2724 541-935-2696 Contractor Type Electrical ..~ Manuf Home Inst Plumbing R-3 VN I DEVELOPMENT INFORMATION I " Front yard Setback: Side 1 Setback: Side 2 Setback: ."- Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: IPUBLIC IMPROVEMENTS I Street Storm Sewer Available: Special Instruction: , Sidewalk Type: Downspouts/Drains NOltC!: D.PIRi " lKE WORK lH\SPERM~ :~~~ tM'S PERMft " NOT AUTHOR\1 ED OD lS A8AKDf)~a> FOR CQMMENC n , ANY 180 DAY PtR\OD. Notes: . 1 of 3 "I . . . CITY OF SPRINGFIELD Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Building/Combination Permit PERMIT NO: COM2005-01342 ISSUED: 09/30/2005 APPLIED: 09/30/2005 EXPIRES: 03/30/2006 VALUE: I Valuation Description' Description Type of Construction $ Per Sq Ft or multiplier , Square Footage or Bid Amount Value Date Calculated " Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Placement Manufactured Home Service Amount Paid Date Paid $25.50 $17.85 $30.00 $45.00 $160.00 $50.00 9/30/05 9/30/05 9/30/05 9/30/05 9/30/05 9/30/05 Receipt Number 1200500000000001436 1200500000000001436 1200500000000001436 1200500000000001436 1200500000000001436 1200500000000001436 Total Amount $328.35 I Plan Reviews I .1, , To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. Manuf Home Set Up: When installation of all piers or stands is complete. Final ManufHome Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Manuf Home Plumbing: After home has been connected to water and sewer. MH Service: Approval required prior to utility company energizing service. ., ,. 2 of 3 -;,9..,~~~~r.~~ .,'..c,. l il. . '. CITY OF SPRINGFIELD. Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Building/Combination Permit PERMIT NO: cOM2005-01342 ISSUED: 09/30/2005 APPLIED: 09/30/2005 EXPIRES: 03/30/2006 VALUE: 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 wiD 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 wiD remain on the site at all tiAes during constr __ ( ~.._..: :7-~D - 2> ~ - v"'--- Owner or Contractors Signature Date , 3 of 3 225 Fifth Street Springfield, Oregon 97477 5~il-726-3759 Phone . ""-.ity of Springfield Official Receipt .evelopment Services Department Public Works Department Job/Journal Number COM2005-01342 COM2005-0 1342 COM2005-0 1342 COM2005-0 1342 COM2005-01342 COM2005-0 1342 Payments: Type of Payment Check . , '1 '~' " ~ " ~t . '. , - " " . , , , :/ -.. , ," 'I , - " , I ;$ , 9/30/2005 ~~.f.\I,9.n-,;.~~, , Ii RECEIPT #: 1200500000000001436 Date: 09/30/2005 2:51:53PM Description Manufactured Home Placement Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Service + 7% State Surcharge + 10% Administrative Fee Amount Due 160.00 30.00 45.00 50.00 17.85 25.50 $328.35 Paid By FRANCIS ROTHAUGE Item Total: l.:heck Number Authorization Received By Batch Number ' Number How Received djb 2581 In Person' Payment Total: $328.35 $328.35 Amount Paid 1 of I ~h6~ ,'" - '~.'''''~ 3 I'" . I - 'j. . ~~~ ,~o ~0 ~0 o~ ~~~~~ ~'Q 0 ",'" ~\<" ,0' c'~ <,,0~ ~ 0\0 0' ~<" "'~ ~,~f:b 000 :;'~i'<<!:~;i:','t"l;\'~)":~'~'i:"e" I'nr,," '>:O~'S aN' G' .E"W'L' 'p' I;'~,'OM"G' o' N"'i";i';\:",'",'i -':"::',"1"'\' ,.:: _, . :!. 'r 'l"~; .::...., " ,.' , 'I" _.1 ',I ,t .~ ,,:,It: ',.' ; I;., 'r'!.t.-."j"" ....,111~. "~" I, ',. ,.1,'.. .,"! l':"~"'r'" ~ i: ~ /;:; . ',: ! i~,.~I: :::.:. ' . :;' '.~I. 'I',' 1'1," .:~.i'..f.. .1\..i:~',~ I. .',41.IJi'j .',\ k' 'I ~,I l' ,II h ',I It" ,.":)1,1 ""'11:, " : 11 . '. "";'j "'1':'; " !:,.'l I 22:; FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (541)726-3689 ELECTRJCAL PERMIT APPLICATION Cifv Joo' ~umberLO....t.~oi - 01342 Date !..EG.:.,L DESCRIPTION , 70 Z- ~~e C> 01300 _'OEl DESCRIPTION I'll ,,f S t"'4- v'l (.~ Permits ue non-lransferable and expire if work is nOI Slarred wirhin 180 days of Issuance or if work is Suspended for 180 days. ;'" "';;'\1'1 ,,\"";l;':';)\f.I\1,C";1.t~ ~.' ~~~l ':CONTRA.r;~ I ri. ';'~ ]. :..' :1.::. ': ..,,'_, " ,. " \~} -: ''-,' __ . ,,' ..~.".....J.,:..:.j\l< :-:itClri(',,1 ConlraclOr .;'.dcress Surrell Bros. Electric 401'59 Booth Kelly Road Springfield, Oregon 97478 ~~~-~~'l~ C!rv '):J?~!"\ ;,or License Number ~~J__\' S E,\;:,!r:;llon Dale \\::) \~:""\ ,'.11' ", C)!'w COl1lr Number ~~~"-o 17\";""101' Date ... :-..C" . \0 \~""\_, .. r'''''H' 0 r sop,,,,r,in, [r"rdOO L ( VJlli1u (J'MM.,..) ~~'c,e . b+-'- r O..,'!1crs ,"-'2Ene r-~c..; ~ :'.dort;; C; 'f ~ 5 c![C::>~~- ~.I~Phone . U\\'\ER ji\'ST,-U.LATION Tnc Inmllation is being made on property I own which I, no! Intended for sale, lease or rent. 0..,'!1cr5 Sign2fure: .~ II1SPC-Clion Request: 726-3769 Service Included 1000 sq ft, or less Each additional 500 sq, ft, or portion thereof $106,00 $ 19,00 Each Manufact'd Home or Modular Dwelling Service or Feeder I $50.00 5e-> ....' '~'~'I':mr\o;('(t!!:i'~. I\,"",~ ";,,, :' , ,1'1/ '~:.~I.~';\J; :~:.-:,:' ',,',.,;..: 'I) , , ~ ,: Q;vL~~~~~:],?\,S,~,.t,lpl,l:,,::,:: ~rJi.'~... ..\ ....r.. ...... .' \.; 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75,00 401 Amps to 600 Amps $125,00 601 Amps to 1000 Amps , $1 ~~,OO Over 1000 AmpsNoltS,H'.' \aW tAOuwes ~q~i?~(PO Recom~\ot.1~ Ore'don tne nreaOI1 ~l~~'~en p;., 1, do ted b)' c:>~ are set tor , ",' , ',., C .11 J;\l;i.'~"'.',""',":">"'"" . . ,'e 1 . }J~7:t\{~~!':;:{~~::::i. \:./~, ',. . - \lvp. 952-001-0 .' -ies o~ the nj\(;" ~YJ.._I~ ,'_...,,_h.. ,.. Inst\fllQ{?;n..,~t~I\~~oQ'l\tf.l~er~~ tiol~\e \e\89hor.e 0090. '(0 \er \No\e. . lie 'AMI1 200 Ari1Ba~rr!gs's'oe cel1 . gall lJ\i\iW \'\''''$ s'U.OO 201 AmRM~.M\Got~fuWse.o~~BOO-332-2~j,C'}$ 69,00 - --\ ,(":r.>nter \s I 40] Amps to 60u-'~mps'$100,00 New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 4 lOO $ 3,00 11,' . ' E' ." . . . . TOTAL ::>-c:::::> '"J ro 5"0- .0 .s~ ,~D - . Shared Drive(T:)lBuilding FormslElectrical Permit Application I-O),ooc . 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 #: UJU1zA - 0 I 54. Z Address: S3"3.s- ""PA-LSy , D~ Date: .:tI=- b 7 7fr4Ar I / Issued by: Statement: Information 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 for 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. ~mlfuO :::~:::::: ::1 ::0 b~X: :::;~t::::OX 3A or 3B: ~~2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors 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 I 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. J -- ~ ?-~D,D0 (Signatufe of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 \ ' \ '"\ - .) '-,' ., '\' A 1:;ttiiIID ~1ai:3 -I\UtIl'" OWIlll Gte IID te IT'1dlll C! ttIT' 1dl1:;1[(lJl IT'? ,; , , . \~~IFO~MA1~O~- ~Ol~C!E 110 I?~O[pJIE~lV OW~IE~~ Al8jiOlUJ~l CO~~l~lUJ(clr~iO~ ~1E~IP'ON5)~I8j~Ul~lE~ ~ . . . ,- NOTE:- This InfOrm.ti~~ N~ff~'operty ~;;ners .;;;;;; ;on~tm~tion Responsibilities --".~developed by the j Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. - - - __ - _.__.,_..___...__. _______n______.__m..__._..____.__.___n _ _ ___._._ 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. IE mjp) n ({])y tell" lR(te~ jp) ((]) lID ~iifi)) filill ~n te~ You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with ~e Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. A!l ~~e emjpllloyeJr~ Y01lll m1lllS~ lCOmjplny wli~~ ~~e jfollllowlinng: OJregonn~s WH~~olldlinng T2ll;{ 1L2lw: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable 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 503-378-4988. UnnemJPlnoymenn~ TIITn!l1lllJr!llITnce T!lll;{: As an employer, you are required to pay a tax -for unemployment insurance purp~ses ' , on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Bu~iness Identification Number (BIN) is, a combined number for both Oregon Withholding and'" Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fot1nsnav.htmll for the appropriate forms. , WOJrlkeJrs' CompennsattnOllll JInns1lllJr2lnnce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs 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. JInn~eJrnnllllllRevellHlle SenlJice: 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 www.its.gov. (])~lhlteIl" JP(te~n>>({])lID~fifi))finn~nte~. 2lTIl<<:ll All"te2~ ({])1f C({])rrnlCell"lID~ . Codle ComJPlni.2lnnce: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. 1Lll2lbftll]tty anndl Property Damage TIllllSllnnITnCe: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as faIling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. " Tnme: Make sure you have sufficient time to supervise your employees; JExJPlertnse: Make sure you have the skills to' act as your own' general contra~tor: to coordi~ate the work 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. Property_owner. doc 06-01-04 ,"l : .~. .. . . ,\ i ~ 40' . en Electric, y Water & A Sewer Service .} , ~ T, ~ ~ 20' . 13' ~ Rear Porch 3' X4' I I Front Porch 4' X8' io lCl co I LO SOUTH >< 0 N Q) E 0 ::I: ~ .- .0 (:) 0 I'- ~ NOTE: Scale is Aooroximate 1/8 = l' . ~ y . in y + Street o ~ >< o , T"" >- m 3: Q) >., .E~ O~ Granada Estates 5335 Daisy St. Space #67