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Home My WebLink AboutPermit Building 2007-4-13 . .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01237 ISSUED: 04/13/2007 APPLIED: 09/27/2006 EXPIRES: 10/13/2007 VALUE: $ 239,984.00 Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Iuspeetiou Line SITE ADDRESS: 633 Level Ln ASSESSOR'S PARCEL NO,: 1703341405300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: Single Family Residence Phone Number: 541-480-0421 Owner: DEA VILLA JOEL & SANDRA Address: 1900 NE 3RD SUITE 106 #285 BEND OR 97701 NOTICE: I BUILDING INFORMATION I # of Units: ' THIS PE/1MIT SHAitlLOE~'o~' :'FTH 2 Primary Occupancy Group: AUTHRI3IZEO UND~irA\ of tructu~:WORK 32,00 Secondary Occupancy Group:COMMEWiCEO OR I I!e H e\;RMIT lillitia~ Air Gas Primary Construction Type ANY 1!YQ'/ "MMlYfiWED FOR Gas Secondary Construction Type: DAY PERIOOnge Type: ,Gas # of Bedrooms: 3 Energy Patb: Path I Sprinkled Building: n/a Contractor Type General Meehauieal Plumbing Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: I CONTRACTOR INFORMATION I Contractor OWNER OWNER OWNER License Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Occupant Load: 578 1,533 819 I DEVELOPMENT INFORMATION I C,TTENT1Q,\j.O....1..." 1-. , 'OIIQ.OO.,., :,Overlay:Dis,t~qUlres'" I 1\1,;'..... ns ~\"O""+~-I L.,. ''--. 4 . "' No' 1,.10.00. 1#'Street'Trees Rqd:"n " "/1 1I"~'!on C I " '-'~ . 7:00" en ilpa-red:Drive Rod:. ' In OAR US" 00' '... ' ,,,._~. ure S(;\ r- ;;J c.- f -0(% lof Lot Coverage: ",-" 00900JllfU may obta:n'" ::":' ......:n 952-00 ,."II'n.~ ...._ _, . ' cop'G~ of (h~ rul"" ~ numb'llr f"ri~p,UB4i~. i~1PRQYEMENIfSII~e Cn'l"~rl'" 1 .' '.-....,...,xm '" 'g '" -800.33" ."'l . "\ Sidewalk Type: Fullv Improved .:. '-v"l~,. Yes Downspoutsmrains: Hillside 4 Yes 30,50 REQUIRED PARKING Total: 2 Handicapped: Compact: Curb aud Gutter Notes: Storm H20 to curb & gutter, No sidewalk in this area, Must get Encroachment permit & necessary plumbing permits for sanitary bookup, Lft msg on macbine 11/8/06 @ 2:25pm,JLP Page I of5 Status Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-37691nspeetion Line Descrintion Tvne of Construction Deck V Wood Frame V Wood Frame Garaee Garaee DeeklBaleonv Dwellines Dwellin2s Garaee Garaee Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Snrcharge 3 Baths One & Two Family Addressing Assignment Appliance Vent Building Permit Curbcut Permit Dryer Vent Encroachment Permit Exhaust Hoods Fire SF Fee - Residential Furnace - up to 100,000 htu Gas Fireplace Gas Outlets 1-4 Plan Review Major - Planning Plan Review Residential Plan Review/Residential Hourly Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Storm Drainage Impervious Area Storm Sewer Each Addtl1 00' Temp Power 200 amps or less . I Valuation Descriotion I $ Per Sq Ft or multiplier $18,00 $103.00 $99.00 $26,00 $27,00 Square Footage or Bid Amount 507,00 113,00 1,998.00 696.00 123,00 Total Value of Project Fpp< Pqitl I Amount Paid $612.72 $10,00 $159,54 $93,43 $116,85 $306,00 $31.00 $6,00 $1,020,65 $80,00 $6,00 $130.00 $9,00 $134,70 $12.00 $15,00 $4,00 $198,00 $50,74 $292.50 $573,93 $754,77 $10,00 $961.52 $91.61 $146,19 $68,21 $836,32 $189.58 $870,25 $14.00 $50,00 Date Paid 9/27/06 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 , 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 4/13/07 Paee 2 of5 6:ITYOF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01237 ISSUED: 04/13/2007 APPLIED: 09/27/2006 EXPIRES: 10/13/2007 VALUE: $ 239,984.00 Value Date Calculated $9,126,00 $11,639,00 $197,802,00 $18,096,00 $3,321.00 $239,984,00 10/31/2006 04/04/2007 09/27/2006 09/27/2006 04/04/2007 Receipt Number 1200600000000001453 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 1200700000000000416 , Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Vent Fan Willamalane Single Family Total Amount Paid Initial Review Plannine Review Public Works Review Puhlie Works Review . Public Works Review Structural Review Structural Review . 09/28/2006 09/28/2006 04/05/2007 11/08/2006 12/05/2006 03/12/2007 09/28/2006 $18,00 $1,000.00 $8,872,51 I Plan Reviews I 09/28/2006 11/30/2006 04/05/2007 11108/2006 12/05/2006 04/09/2007 10/30/2006 APP APP APP WE WE APP WE Paee 3 of5 .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01237 ISSUED: 04/13/2007 APPLIED: 09/27/2006 EXPIRES: 10/13/2007 VALUE: $ 239,984.00 4/13/07 4/13/07 1200700000000000416 1200700000000000416 LLH TAJ JLP Revised plot plan OK too, 4/4/07Revd msg from Don, owner submilled plan change ou 3/12107, I borrowed plans from building tile. Made cbanges to SDC fee's & notes in Tidemark, Owner must obtain an Encroachment permit for sewer connection prior to working in Public RW, Added Ene fees & placed application in tile for applicant.JLP 4/5/07 Storm H20 to curb & guller, No sidewalk in tbis area, Must get Encroachment permit & necessary plumbing permits for sanitary bookup, Lft msg on macbine 11/8/06 @ 2:25pm,Sent tile to Tara, she will return & will remain in PW until owner completes an Encroachment Permit ApplicationJLP Tlkd w/owner Joel via telepbone @ 1:50pm 11/5/06, He informed me he is not goiug to proceed w/project until at least Feb 07. PW will list as APP after Encroachment permit is granted, File will be in my hanging tile system until owner proceeds with eneroaebment process, Storm H20 must go to curb & gUller,JLP Received revised building plans 3/12/07dlm See documentation for Plan review comments. meet wi owner 4/9 to resolve remaining bldg, issues,4/5/07dlm Bldg entry iinadequate for stair rise (headroom); beam protection details needed for untreated exterior beams, Met w/ owner 10/31; he will provide revisions. dim JLP JLP DLM DLM . r -.r~~N~~,~~ I. . t. ""I.' ~ ~ "~;.r . .11 }' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01237 ISSUED: 04/13/2007 APPLIED: 09/27/2006 EXPIRES: 10/13/2007 VALUE: $ 239,984.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line 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. ~rprlln.~ Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing andlor foundation inspection, Footing: After trenches are excavated, Foundation: After forms are erected but prior to concrete placement, Post and Beam: Prior to 1100r insulation or decking. Floor Insulation: Prior to decking, Sbear Wall Nailing: Before covering sheathing witb finish materials, Framing Inspection: Prior to cover and after all rough in inspections have been approved, Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping, Hold Downs Installed: Special Inspection performed prior to placement of concrete, Provide report to City Buildiug Inspector, Final Building: After all required inspections have been requested aud approved and tbe building is complete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill, Underl100r Plumbing: Prior to insulation or decking, Underl100r Drain: Prior to cover or placement of concrete, Rougb Plumbing: Prior to cover and including required testing, Shower Pan, Prior to covering and including required testing, Water Line: Prior to filling trencb and including required testing, Sanitary Sewer Line: Prior to filling trencb and includiug required testing, Storm Sewer Line: Prior to filling trench, Final Plumbing: When all plumbing work is complete. Underl100r Mechanical, Prior to insulation or decking and including required testing, Underl100r 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 aud 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 Paee 4 of5 . .ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01237 ISSUED: 04/13/2007 APPLIED: 09/27/2006 EXPIRES: 10/13/2007 VALUE: $ 239,984.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Gas: When all gas work is complete, Final Mechanical: When all mechanical work is complete, Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service, Final Electric: When all electrical work is complete, , Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed, Curbeut - Standard: After forms are erected but prior to placement of concrete, By signature, 1 state and agree, that 1 bave carefully examined the completed application and do hereby certify that all information hereon is true and correct, and 1 further certify that any and all work performed sball be done in accordance witb the Ordinances of tbe 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. [ further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I furtber agree to ensure tbat all required iuspeetions are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of tbe property, and the approved set of plans will remain on the site at all timesdur1:;&J)~ Owner or coLors Signature 4,J /3 ~{)7 Date Paee 5 of5 ,. 8PR~ ,~.~ \ J CITY OF SPRINGfIELD, OREGON 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH,(54I)726-3753 . FAX, (541)726-3689 ELECTRICAL PM1':!IT ~J?,I/fATION City Job Number --.w I \ \ ~ J 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps '1Z,~01 Amps to 1000 Amps I,Over 1000 Amps/Volts ''1/ "Lr- 11/ /S,gec,,!,nect Only "'. '.?" (C';;>t "//, (}?J.>i~fnnor ' "I,' '~1~ c.~~ary ServIces or Feeders . r / '. t/tC/'~ (/,1. '4(;. Ci./ 04 InS~lIa~~ >\!~tion or Relocation \ )20.2'~"lp.s or.l~ ~f' ' $ 50,00 201~g'Tt6'-'l42.o5K~';C' ~ $ 69.00 401 Amps to 6ll6'~~)' (C' ~a $100.00 V,A "II ", ' Over 600 Amps or ~y,61~..,.';:'<'9tB.. above. .;}, -,~ '0.. '" ~ ~ I vn ~,"llr e of SupervISing EU,ctrician, ., C "iI'O "",. . 0, Branch Circuils ./ , . O",,~'. ''O"v<O''/l.., ~'",,,:-''t~l.....''' ,~. ""I,' .. ~u, .... " .L. New Alteration or Extension Per PllOel 1,'1).. t'1.~,~ '?}qr. "0" '1h vJ'I.~" o.~ In_ y _ V I n... 'e ....It..<J.ne Circuit l :: ~).,:."~ ,~(}/~. ~~.' !r.,l~,..",!?ac)1. Add,tional CIrcuit or witb -.t... _ '. I . 't: (~ . \; eJ:Vlce or Feeder Permit $ 3.00 -'L 'O( ."1 ~'.. 'J.:.., """1' . ~il" '.." . . _-. \ct9. .~~;~tMiSccllaueous (Service/feeder not included) -Eacb lustallation j , l"~:A't1~i:,~)1: ,<<"Q ".' Pbone~ 0 ~_ ~h-1 "P.um~or irrigation $ 50.00 - 'M 1\ \<~,;; ~.I/,;~~~,O;.~~/Outline Ligbting $ 50.00 OWNER INSTALLATION lI\V\' "~!-imited EnergylResidential $ 25.00 Tbe installation is being made on property I own wbicb ' Limited Energy/Commercial $ 45.00 is n . en ed for sale, lease or rent. Minimum Electric Permit Inspection Fee is 545.00 + Surcharges ... \ 4,1 SUBTOTALOFABOVE L.c-~!P 8% State Surcbarge .. .2\.'. OU 10% Administrative Fee ~ 5% Tecbnology Fee , ~ lo \ .3) Shared Drive(T:)/Building FonnsIElectrical Permit Application 8-06.doc I, I LOCATIONOFINSTAf.!:!1'!(ON: .-J tt~~~ \,fl)PLlQ.l\V ~ LEG\~Q3R~N\ ~ DCfOO? ~\~~T~ Permits are )on-transferable and expire if 0 k is not started within 180 days of issuance or if rk is Suspended for 180 days, 2.\1 CON'J"RACTOR INSTALLATION ONLlJi Ele~al Contractor Addres~ 'City Supervisor License Expiration Date City Inspection Request: 726-3769 ZON INITIALS DATE SOURCE Date 3, I COMPLEI'E FEE SCHEDULE BELOW A, I New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq, ft, or less Eacb additional 500 sq, ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $19.00 $50.00 B.I Services or Feeders -Installation, Alterations or Relocation: $ 63.00 $ 75,00 $125,00 $163.00 $375.00 $ 50,00 $ 43.00 TOTAL . , CITY OF SAGFIELD SYSTEMS DEVELOPMEN&RKSHEET JOURNAL OR JOB NUMBER: COM2006-01237 NAME OR COMPANY: Joel Deavil\a LOCATION: 633 Level Ln TAX LOT NUMBER: 1703341405300 DEVELOPMENT TYPE: SINGLE FAMlL Y RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF: 1597 LOT SIZE (SF): 7405 r-- Igj 10 10 I~ I~ II ~ 1. STORM I)RAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I I 2593.00 '$0.336 = $870.25 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F, I x I DISCOUNT RATE I I 0,00 1 $0.336 50% = I ITEM I TOTAL - STORM DRAINAGE SDC '$870,25 2 SANITARY SEWER - CITY DISCOUNT $0.00 $870,25 11070 A. REIMBURSEMENT COST: I NUMBER OF DFU's I x COST PER DFU 1 29 $26,03 $754,77 1091 B. IMPROVEMENT COST: , NUMBER OF DFU's I x I 29 $19,79 $573,93 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =1 $1,328.70 J, TRANSPORTATION A. REIMBURSEMENT COST: I , ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI i 9.57 I 1 I I $19.81 I 1.00 $189,58 I 1093 B. IMPROVEMENT COST: I I ADT TRIP RATE I x , NUMBER OF UNITS I x I COST PER TRIP x INEWTRlPFACTORI 9.57 I I I I $87.39 I 1.00 = 5836.32 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = 1 $1,025,90 4 SANITARY SEWER - MWM<:; A. REIMBURSEMENT COST: INUMBER OF FEU's I x ICOST PER FEU , I I I $91.61 = $91.61 1054 B. IMPROVEMENT COST: INUMBER OF FEU's I x tCOSTPER FEU I I I $961.52 = $961.52 11055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0,00 11054 MWMC ADMINISTRATIVE FEE $10.00 11056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = , $1,063,13 I SUBTOTAL (ADD ITEMS I, 2, 3, & 4) = , $4,287.98 5, ADMINISTRATIVE FEE: 'SUBTOTAL x I ADM, FEE RATE I~ CHARGE I $4.287,98 , 5% $214.40 TOTAL SANITARY ADMINISTRATION FEE: 146.19 1079 TOTAL TRANSPORTATION AD/;I[II/ISTRATlON FEE: $68.21 J 1078 Jeff Prociw 4/512007 TOTAL SDC CHARGES = $4,502.38 PREPARED BY DATE . . \ . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES , UNIT EQUIVALENT - DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY l1IE NET ADDmONAL FIXTURES) NO, OF FIXTIJRES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 1 0 3 = 3 WRINKING FOUNTAIN Q 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE I OIL I SOLIDS I ETC 0 0 3 = 0 I INTERCEPTORS FOR SAND I AUTO WASH I ETC 0 0 6 = 0 \LAUNDRYTUB 1 0 2 = 2 CLOTHESW ASHER I MOP SINK 1 0 3 = 3 I CLOTHESWASHER - 3 OR MORE (EAl 0 0 6 = 0 I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRlG I WATER ST A nON I ETC 0 0 1 = 0 I RECEPTOR FOR COM, SINK I DISHWASHER I ETC 1 0 3 = 3 1 SHOWER. SINGLE STALL 1 0 2 = 2 I ISHOWE~ GANG ~BER OF HEADS\. 0 0 2 = 0 I SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 2 0 1 = 2 I URINAL, STALL I WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 29 .EDU (Equivalent Dwellin~ Unit) is a discharne equivalent to a sinldc family dweJlinp: unit (20 DFU's) set at 167 ~lons DCf day -, L I' MWMC CREDIT CALCULA TION TABLE: BASED ON COUNTY ASSESSED VALUE ~ I I I - n_ I] YEAR CREDIT RATEJ$I,OOO ANNEXED ASSESSED VALUE BEFORE 1979 $5.29 1979 $5.29 1980 $5.19 1981 $5.12 1982 $4.98 1983 $4.80 '984 $4,63 1985 $4.40 '986 $4.07 1987 $3,67 1988 $3.22 1989 $2,73 '990 $2.25 '991 $1.80 1992 $1.59 '993 $1.45 '994 $1.25 1995 $1.09 '99" $0,92 '997 $0.72 1998 $0,48 1999 $0.28 2000 $0.09 200t $0,05 IS LAND ELGlBLE FOR ANNEXATION CREDIT'! (Enler I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT'! (Enler I for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE I 1000 CREDIT RATE $0.00 x S5.29 ~ , sO.oo CREDIT FOR IMPROVEMENT (IF AFTER ANNEXA nON) VALUE I 1000 CREDIT RATE $0.00 x $5.29 ~ , 0 TOTAL MWMC CREDIT SO.OO = t)' . , . . . . , , " " " " " " ...','.. . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Weh Address: www.ccb.state.or.us Pennit#: ~~ -012-37 Address: ~3."-3 LEVeL uvJ ~ 1 Issued by: J)~ Date: .~/~ If 7 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare 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 ouilding. 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 befiled with the permit, Fill in the apl"VI',;ate blanks and initial boxes I and 2, and either box 3A or 3B: ]&l. )(2. I own, reside in, or will reside in the completed structure. /PUI/>f61N4 I understand that I must become licensed as a'construction contractor if the structure is sold or offered for sale before or on completion, o 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 P/J.{JIt.6INC: ; ~ 3B. I will be my own,(eneral contractor. IfI 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. '/ (l,.,(J no 0 U ~/G('j ).~ 2001 /signanire of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) :"~"_"J:"oWDer.doc 06-01-04 Artriffi\g"~g~'6IDir~&wnn Glennlelrall ctnntJra(Ct@r? ,'v:'.~ ,-'ii~t;?tM\-ft6k~OTICE TO PROPERTY OWNERS AeOUT CONSTRUCTION RESPONSIBILITIES " ....... " 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. 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. JEmjpllloyelt' Resjplol!D.silbnllitnes 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 the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. 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 Department of Revenue at 503-378-4988, Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpos~" on the wages of all employees. For more\il1fQ~fl#\l&:.~IJ.the Oregon 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, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmll for the applVpJ.~ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cu....."..sation 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. , ... -\,6.\.!.I........,..- 'W ..~ J...~.~'i :.....,..\., 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 w\Vw.irs:l!Ov. (()1l:llnell' Re!>fi)OIlll!>nlbm1l:nes lllll1ldl Arellls olf COI!11<l:erll1lS Code Compliance: As the pennit 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 Property Damage Insnrance: Contact your insurance 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 genenil contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the a.....up.:ate 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 06-01-04 225 FIrili"Street Springfielllj'Oregon 97477 541-726-3759 Phone Job/Journal Number COM2006-0 123 7 COM2006-01237 COM2006-01237 COM2006-0 123 7 COM2006-0 123 7 COM2006-01237 COM2006-0 123 7 COM2006-0 123 7 COM2006-0 123 7 COM2006-01237 COM2006-01237 COM2006-01237 C:OM2006-01237 C:OM2006-0 1237 COM2006-0 1237 COM2006-0 1237 COM2006-0 1237 COM2006-0 1237 C:OM2006-0 1237 COM2006-0 1237 COM2006-01237 COM2006-0 1237 COM2006-0 123 7 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 COM2006-01237 Payments: Type of Payment Cbec~ cReceintl . ~~;.. lilt, c~r Springfield Official Receipt "'opment Services Department Public Works Department RECEIPT #: 1200700000000000416 Date: 04/13/2007 Description Addressing Assignment Willamalane Single Family Temp Power 200 amps or less 3 Batbs One & Two Family Storm Sewer Eacb Addtl 100' Furnace - up to 100,000 btu Vent Fan Appliauce Veut Exbaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace -Mechanical Issuance Fee- Curbcut Permit Plan Review Major - Planning Plan Review/Residential Hourly Plan Review Residential Building Permit Fire SF Fee - Residential Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sauitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admiu Encroacbment Permit + 5% Tecbnology Fee + 8% State Surebarge + 10% Admiuistrative Fee Paid By JOEL DEA VILLA Item Total: <":heck Number Authorization Received By Batch Number Number How Received djb 1003 In Person Payment Total: Page I ofl 2:41:13PM Amount Due 31.00 1,000.00 50.00 306.00 14.00 12,00 18.00 6,00 9.00 6.00 4,00 15.00 10,00 80.00 198.00 292.50 50.74 1,020.65 134.70 870.25 754.77 573.93 189.58 836.32 91.61 961.52 10.00 146,19 68,21 130,00 93.43 116.85 159.54 $8,259.79 Amount Paid $8,259.79 $8,259,79 4/13/2007