HomeMy WebLinkAboutPermit Building 1992-2-22
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RESIDENTIAL'
PERMIT APPLICATION
Inspeclions: 726.3769
Office: 726.3759
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SPRINGFIELD ",'
LOCATION OF PROPOSED WORK: .v-v'~9, _ /~=c ?-i,
ASSESSORS MAP' /51 "";> .0';;-.2. c,t:
LOT'
OWNER: 3tJ/;:>~n~
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ADDRESS: ~ n ~,/P I//t:">-J
CITy:--=<,o.i?u1/,c;,,;=//~/ ])
BLOCK'
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STAT'"
/92
DESCRIBE WORK: /J7 ,qae.cJFAeTi-/!2BD
NEW)( REMODEL ADDITION
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Q(),/0!rY
JOB NUMBER
225 Fifth Streel
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
?f20</
PHON~'
?~h-q9.;/
ZIP: 97/7 7
#'o/l7 6' - 'P LA-CS' /n P.Aj"/
- OFFICE USE",\:
LAND USE: -1/ 5( ~
# OF UNITS: I
CONSTR. TYPE: .-.JLAJ
HEAT SOURCE: _F"u
rJ
RANGE: _
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wallie-ailing Insulation - Prior to
cover.
o Drywall - Prior to tapIng.
o Wood Stove - After Installation.
o Insert - After fireplace approvQI
and Installation of unit.
o Curbcut & Approach - After
forms arc erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Fence - When completed.
i
D Street Trees - When all required
trees are planted.
CONTRACTOR'S NAME
GENERAL: J<::;"'''''''''' ,+.
:Sk.\l ADDRESS gg~i~ACTOR #
W,q,"i7"ZQ/ A/ $'C/2.~ /JJ/9-.oo/ -<;ct:; ~7 z...
PHONE
72.";" -2/ 7 I
DEMOLISH
OTHER
PLUMBING:
MECHANICA' '
ELECTRICA" ~ j;Jfi ?5'~..L J.. p
/
QUAD AREA:6R~r ./
# OF BLDGS: ",.!)-
OCCY GROUP:~.v\
I
&
. OF STORIES:
WATER HEATER:
EXPIRES
/ /- /Z-'V'
FLOOD PLAIN: _
ZONING CODE: W Id-J
# OF BDRMS' ...... ~
SECONDARY HEAT:
SQUARE FOOTAGE: j/QP{)
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be
made the same worklng'day, Inspections requested after 7:00 a.m. will be made the followIng work day.
o Temporary Electric
O Site Inspection - To be made
after excavation, blll,frior to
seUln ~~mns^ V
WUnde~t?;; lectrica~1
~,. Mechanical - Prior
~FOOtlng - After trenches are
I excavated.
o Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
- Prior to Insulation or deckIng.
D Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking,
rIi Sanitary Sewer - Prior to. filling
ce trench.-\o <iffitr:0
r.:t? Storm Sewer ~-~rlor to flll.ing
LfJ.. trench. .
~Water Line - Prior to flll;~9'~
{ trench.
o Rough Plumbing - Prior to
cover.
D Final Plumbing - When all
plumbing work Is complete.
, ,
D Final Electrical - When all
electrical work is complete.
o Final Mechanical - When all
mechanical work Is complete.
D
Final Building - When all
required Inspections have been
approved and bUilding is
completed.
OOthsr
MOBILE HOME INSPECTIONS
mBIOCklng and Set.Up - When all
I,. blocldng Is complete.
rfPlumblng Connections - When
home has been connected to
water and sewer.
d. Electrical Connection _ When
4-1 blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
rlnal - Aftor all required
Inspections are approved and
porches, skirting, decks,' and
venting have been installed.
I
'..' .,
Lot faces
Lot T;pe.
Interior
Lot sq. ltg,
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac.
BUILDING PERMIT
ITEM SO. FT.
X $/SO. FT.
Main
Garage
vrpo~
\(")~V\
11 Value
Building Permit Fee
State Surcharge
Total Fee
(A)
Setbacks
J ...
i
;:. THE PROPO~ED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
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I P.L. HSE GAR ACC I
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SYSTEMS DEVELOPMENT CHARGE J,Sp..c)
(B) \ 1~b-
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C83~) ~'jJ?fJY
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PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
'FT.
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
A:S .DU
J) S .au
~5,W
f)'S ,au
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APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or .revoked at any time
upon VIolation of any provi51fns of said o~nces.
Plan Check Fee:~J ~
Date Paid:
Receipt Number'
R7
. Plans Reviewed By Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
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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 perrormed 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-Building Safety Division.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 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-
~o the site at all times ~uring :onstru~on, ~
SI natura6?'. -/ ~ ~
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Dale/2-.:2.2- '7.2
VALIDATION: t\
RECEIPT NUMBER [. fJ II )~ ' . "
DATE PAID 1:<) t!1f-J___~
AMOUNT REC~~ ~ ~~" "')
RECEIVED Bf '1)/.i:::C' ./ -
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Permit No: !! [JJ!]J{l
Address: , ~\~ '
Issued b~1 M ) Date:
i!)&Jq 2..
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701,055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued, This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits, Licensed Architect and Engineer applicants, exempt from registration
under ORS 701,010(7), need not submit this statement. This statement will be
filed with the permit.
FiI,in re)apPlicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. r I own, reside in, or will reside in the 'completed structure,
2. I I I understand that I must register as a construction contractor if the structure is sold
~ ' or offered for sale before or~o~nommiPleti n, I ,,\ _ .
3, A, ~ My general contractor i<:: ( og ~ _ \A 1 W l Q1'J\ )
r. Contractor registration num:r ,04-~~\, .
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board, '
OR
3, B,I
I I will be my own general contractor,
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above .informatlon is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
c:::!?% ~ ff~
Sig,~~u,e of Permit Applicant
/2 -.22 - 7.2
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
1
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,., .....
INFORrI'ION NOTICE TO PROPERTY OIERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Infqrmiltion 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.
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 areas
of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an
"employer" and the people you hire will'be "employees", As the employer, you must comply with the following:
Oregon's Withholding Tax Law:, 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 Oregon Departm(;jnt of Revenue at 378.3390.
Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all employees, For more information, call the Oregon Employment Division DHR
at 378-3224,
Workers' Compensation Insurance: 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 may be subject to penalties and will be liable for all claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434.
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 more information, call
the Internal Revenue Service at 221-3960, ' '
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: 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,
Liability and Properly Damage Insurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done,
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work
of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform
the required inspections,
If you have additional questions, write to:
Construction Contractors Board
700 Summer SI. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89
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SPRIFIELD
DEVELOPMENT SERVICES
PUBLIC WORKS
METROPOLITAN WASTEWATER MANAGEMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726-3753
MANUFACTURED HOME SET-UP AGREEMENT
As required by the City of Springfield Development Code. I understand and agree
that wi th the approval of the attached J>:N~';.r;. ~~ ~~he fol:~6t'ing 1\
manufactured homes will be placed at ~\_i _ -VI, ~1L.f:-, \<(("'CI.C\!
Springfield. Oregon. City Job Number Y. \1", \ \. - -
~ Type I Manufactured Home. A multi-sectional (double wide or wider)
/ unit with an enclosed tloor area of not less than 1,000 square feet,
that has a nominal roof pitch of 3 feet in height for each 12 feet in
width, that has no bare metal siding or roofing, and that has been
certified by the manufacturer to have an exterior thermal envelope
meeting performance standards which reduce heat loss to levels
equivalent to the performance standards required of single family
dwellings constructed under the State Specialty Codes.
Type II Manufactured Home, A unit of not less than 12 feet in width
with an enclosed tloor area of not less than 500 square feet. that has
a nominal roof pitch of 2 feet in height for each 12 feet in width and
that has no bare metal siding or roofing.
I further state, by my signature below. that I have been provided with the
following information:
- Manufactured Home blocking
- Water line connection
- Street tree standards
- Sanitary sewer connection
- Electrical connection
- Minimum requirements for permanent steps
I also understand that if I am installing a Type I Manufactured Home, the home
shall be enclosed at the perimeter with stone. brick or other masonry materials,
and with no more than 12 inches of the enclosing material exposed above grade,
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\gnat~
bate
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IMPROVEMENT AGREEMENT
.
IN CONSIDERATION of the covenants herein recited, the City of Springfield, hereinafter
referred to as City, and Barrv and Patti Burnette .' hereinafter
referred to as Applicant, do covenant and agree as follows:
WHEREAS Applicant desires Development Approval from City; and
WHEREAS, any future development within City or within City's Urban Growth Boundary located
in Lane County will cause both an immediate and long-term demand on the various publ ic
facilities of City and Lane County;
NOW THEREFORE, Appl icant and City agree to the following schedule of publ ic facil ity
improvements and respective cost assumption policy:
STREET IMPROVEMENTS along the frontage of Jasoer Road
to include: (xl surface paving; (xl storm sewers; (xl sanitary sewers; (xl curbs;
(xl gutters; (xl planter strips; (xl street trees; (x) street lights; (xl sidewalks.
TRAFFIC SIGNALS at the intersection of nfa
OTHER IMPROVEMENTS nfa
LEGAL DESCRIPTION: (Place here or see Attachment Al
see Attachment "A"
ADDITIONAL INFORMATION: 4449 Jasoer Road
Property Address
18 02 05 24 08204
Tax Lot No.
IT IS UNDERSTOOD that this agreement is enforceable by the State of Oregon, Lane County or
City.
IT IS FURTHER UNDERSTOOD that Applicant agrees to sign any and all waivers. petitions.
consents and all other documents necessary to obtain the above listed improvements under any
improvement act or proceeding of the State of Oregon, Lane County. or City as may be proposed
or adopted by the State of Oregon, Lane County or City and to waive all right to remonstrate
against such improvements, but not the right to protest the amount or manner of spreading the
assessment thereof, if the same shall appear to Applicant to bear inequitably or unfairly
upon said property of Applicant;
NOW THEREFORE, City agrees that Applicant's execution and performance of the terms of this
Agreement will be deemed to be in compliance with City's policy pertaining to improvement
requirements, and if Applicant complies in every respect with all other applicable laws of
the State of Oregon, Lane County and City, the said Appl icant shall be entitled to
Development Approval; and
IN ADDITION. it is the intenti,on of the parties hereto that the covenants herein contained
shall run with the land herein described, and shall be binding upon the heirs, executors,
assigns, administrators, and successors of the parties hereto, and shall be construed to be
a benefit and a burden upon the property herein described. This Agreement shall be recorded
in the Lane County Deed Records.
"..1
WHEREFORE,. the parties have set their hand and seal thisZZ day of f)e.oer,..,j,p,.- , 199'2..
Director of Public Works
B~ / c??;. ~
A~
By ~~ ~.J/4/c:zfY'
'1\ppl icant ~
By
STATE OF OREGON )
lSS
COUNTY OF LANE 1
On this r;Z""day of O'~~.-n/-'P./
signed the above ~nt.
r- ---~ _~a~
NOTARY PUBLICu - .
My Commission Expires Ab 1.::5 /91'C
'; 197~ there personally appeared before me and
.. OFFICIAL SEAL
~" . lEASA II,;E WILKENS
. ' NOTARY PJULlG - OHEGOIl
, COMMISSION NO. 01SW4
. MY COMMISSION [XPlRES tIDV. 15, 1!J!lj
CITY OF SPRINGFIELD - PUBLIC WORKS DEPT. - 225 FIFTH STREET - SPRINGFIELD, OREGON 97477
.
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ATTACHMENT "A"
18 02 05 24 08204
Beginning at a point that is North 5.00 feet and South 89'13'46" East 80.00
feet from the initial point of MT. VERNON ESTATES, FIRST ADDITION, as platted and
recorded in Book 57, Page 17, Lane County Oregon Plat Records, in Lane County,
Oregon, said point also being 35.00 feet Southerly of the centerline of Jasper
Road; run thence parallel with said centerline and 35.00 feet Southerly therefrom
South 89'13'46" East 80.00 feet; thence leaving said Southerly right-of-way and
run South 331.74 feet; thence South 89'59'52" West 80.00 feet to a point that is
North 89'59' 52" East 80.00 feet from the Easterly boundary 1 ine of said MT.
VERNON ESTATES, FIRST ADDITION; thence North 332.82 feet to the True Point of
Beginning, in Lane County, Oregon.
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OF\iGIi'JAL
BBFORE 'l'HB BOARD OF COUNTY COMMISSIONBRS OF LANE ~v'v.'u, OREGON
IN 'l'HB MA'l"l'BR OF ACCBPTING A DBBD OF LAND
TO BB USBD AS A PUBLIC ROAD BAS............... AND
~vv...J, ROAD FOR JASPBR ROAD (18-02-05)
ORDBR NO.
THIS MA'l"l'BR now coming before the Board of County Commissioners of Lane
County and Barry P. Burnette and patricia L, Burnette owning land within Lane
County which is not within the limits of an incorporated city or town, having on
the day of , 1993, presented to the Board of County
Commissioners of Lane County a good and sufficient deed. said deed being
properly executed and forever dedicating a portion of such land to the use of
the public for road purposes and granting a public road easement and the Board
of County Commissioners of Lane County deeming it proper, as a convenience for
property owners in the area and as a benefit to the general public, to accept
said deed for a public road easement;
NOW, THBREFORE, IT IS IIIlRBBY u=....BD that the said deed shall be and is
hereby accepted by the Board of County Commissioners of Lane County as a public
road easement; and
IT IS ~U~~nDA ORDERED that the described right-af-way is expressly accepted
as a County Road, by this Order; and
IT IS ~u^~h6A ORDERED that the above Order shall be entered in the records
of the Board of County Commissioners' Journal of Administration and in the road
records for County Road No. 49 and the regular numbered road files in the County
Surveyor's Office; and
IT IS ~uA~h6K uKUnKRD that the deed be recorded in the Deed Records of the
County and the Reel Number and Reception Number be noted on this Order,
DATBD this _ day of
, 1993.
DEPARTMENT OF PUBLIC WORKS
LAND MANAGEMENT DIVISION
BOARD OF COUNTY COMMISSIONERS
LANE COUNTY, OREGON
App(oved ;Z~ pe~ ,1992.
BY~\ ..\ \~A
For Roy Burns\
Chair
^ -----
~,
Deed recorded on Reel -R, Recorder's Reception Number
County. Oregon Deed Records.
, Lane
ORDER ACCEPTING DEED FOR COUNTY ROAD NO. 49 (JASPER ROAD)
.
.
ORIGINAL
DIIDICATION OF A PUBLIC ROAD KAS<ouw...
BARRY P. BURNETTE AND PATRICIA L. BURNETTE.
GRANTORS, grant and dedicate to LANE CVU&.~~, a political subdivision of the
State of Oregon (GRANTEE) a public road easement on and over the following
described property:
A parcel of land lying in the Northwest One-quarter (NW 1/4) of Section 5,
Township 18 South, Range 2 West, of the willamette Meridian and being a portion
of the tract of land conveyed to Barry P. Burnette and Patricia L. Burnette by
that certain deed, Recorded on Reel 1812-R, Recorder's Reception Number
92717a3. Lane County Oregon Deed Records, said parcel being described as
follows:
The northerly 5.00 feet of the following described property:
Beginning at a point that is North 5.00 feet and South 890
13' 4611 East 80.00 feet from the Initial Point of Mount
Vernon Estates, First Addition, as platted and recorded in
Book 57, Page 17, Lane County Oregon Plat Records, said point
being also 35.00 feet southerly of the centerline of Jasper
Road and the True Point bf Beginning; RUN thence parallel
with said centerline and 35,00 feet southerly ~herefrom South
890 13' 46" East 80.00 feet; thence leaving said southerly
right of way and run South 331.74 feet; thence South 890 59'
52" West 80.00 feet to a point that is North 890 59' 52" East
80.00 feet from the easterly boundary line of said Mount
Vernon Estates. First Addition; thence North 332.82 feet to
. the True Point of Beginning and there ending, all in Lane
County, 'Oregon.
It being the intent herein to widen County Road Number 49 (Jasper Road) to 40
feet from centerline as said road abuts the GRANTORS' property.
There is no consideration for this dedication.
Said parcel being forever dedicated to the use of the public for road purposes
and granting a public road easement.
County Road 49 (Jasper, Road)
After recording return to: Lane County Surveyor, PSB, Eugene, OR 97401
SJ/oo>l; Page 1 of 2
I.. I (>
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rOn;G!NA~
,
Dated this .2 J..
day of
Pee e;n);er
~~j;: &/7?.
~ry P. Bu~~tt~
1//
1992.
/l
iJ~//~zf{
Patricia L. Burnette ~
STATE OF OREGON )
CVUU.Lt OF LANE )88.
On
[) Pe-.J...n
,.J
;L~ . 1992. personally appeared the above-named
"'. ,",':':
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B".6J-...y P BVNV~/T!' "",pI ,;j/",-Tr.'c"/r ).. B"v!-lV...rT-c. .
,who ackndwledged the foregoing instrument to be a ~ary act bef~re m~: . ~
.~--------------------------J ~~ ~ ~
. . OFFICIAL SEAL: ~,
: ',.." ARREN N. CONRAO I Notary Pubhc for Oregon
, \... ..,/ NOTARY PUBLIC - OREGON :
" COMMISSION NO.006832 ,
L_ _~':.:~~~:~~~:~~~E:!~~:.~:..~:5_ ~
DEPARTMENT OF' PUBLIC WORKS
":'LAND MANAGEMENT DIVISION
The Board of Commissioners hereby accepts
this dedication as described herein.
Approved , .2 ~ pt!.C . 1992
By ~\ ,. (\..~(~
For: Roy Burns> Director
LANE Cuu.u. BOARD OF COMMISSIONERS
By
Chair
AT!': Map
County Road 49 (Jasper Road)
SEJ:~>1 Page 2 of 2
, ,f'
S.~1/4 N.W. 1/4 Secti~ 05
T.IS S. R. 2 W. W. tv1.
LANE COUNTY
(" = 100'
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rv-"
u.,"
/,~ rr
.rAn-
//1./1'
lL.
VICINITY MAP
r
7600
00
100
~.. \O~
~~~