HomeMy WebLinkAboutPermit Building 1997-10-10
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SPRINGFIELD
Page 1
RESIDENTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
Job Number: 971224
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location of Proposed Work: 4464 GLACIER ST
Assessors Map #: 18020521
Lot: 92 Block:
Tax Lot #: 03000
Subdivision: LUCERNE MEADOW
Owner: TOM/KARl MALONE
Address: 463 SOUTH 3RD STREET
Phone #: 741-3638
City/State/Zip: SPRINGFIELD, OREGON 97477
Describe Work: S.F. RESIDENCE
NEW
Contractor
Const.
Contractor #
Expires
Phone
General:
OWNER
Plumbing: OWNER
NOTICE:
THIS PERMIT SHAll EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANt 180 DAY PERIOD.
Mechanical: OWNER
Electrical: OWNER
QUAD AREA: 3RSC
# OF UNITS: 1
CONSTR. TYPE: VN
WATER HEATER: E
OFFICE USE
LAND USE: 1111
ZONING CODE: LDR
# OF BDRMS: 3
RANGE: E
# OF BLDGS: 1
OCCY GROUP: R3
HEAT SOURCE: WH
INSUL PATH: PI
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,
REQUIRED INSPECTIONS ---
FOOTING - After trenches are excavated.
FOUNDATION - After forms are erected but prior to concrete placement.
UNDERFLOOR PLUMBING - Prior to insulation or decking.
POST AND BEAM - Prior to floor insulation or decking.
INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover
WATER LINE - Prior to filling trench.
SANITARY SEWER LINE - Prior to filling trench.
STORM SEWER LINE - Prior to filling trench.
ROUGH PLUMBING - Prior to cover.
ROUGH MECHANICAL - Prior to cover.
ROUGH ELECTRICAL - Prior to cover.
ELECTRICAL SERVICE - Must be approved to obtain permanent power.
SHEAR WALL NAILING - Before covering sheathing with finish materials.
FRAMING - Prior to cover.
INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover
CURBCUT - After forms are erected but prior to placement of concrete.
SIDEWALK - After excavation is complete, forms and sub-base material
in place.
FINAL PLUMBING - When all plumbing work is complete.
FINAL MECHANICAL - When all mechanical work is complete.
FINAL ELECTRICAL - When all electrical work is complete.
FINAL BUILDING - When all required inspections have been approved and
the building is complete.
SPRINGFIELD
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Job Number: 971224
Lot Faces: S
Topography: 2
Solar Approved: Y
Lot Sq. Ft.: 9500
Total Height: 17
Lot Type: INTERIOR
Setbacks
S W E
29 19 10
19 10
Page 2
Lot Coverage: 16.8 %
Setbk From NPL: 75
N
House
Garage
Item
Main
Garage
Total Value
BUILDING PERMIT
Square Feet x
1210
386
$/Square Feet
64.66
16.27
Building Permit Fee
Surcharge/Admin
TOTAL FEE
(A)
PLUMBING PERMIT ---
Item
Residential Bath(s)
2
Plumbing Permit
Surcharge/Admin
TOTAL CHARGE
(C)
MECHANICAL PERMIT ---
Exhaust Hood
Vent Fan
Dryer Vent
2
Mechanical Permit
Issuance
surcharge/Admin
TOTAL PERMIT
(D)
--- MISCELLANEOUS PERMITS ---
Surcharge/Admin
Sidewalk
Curb Cut
CITY SDC
PLAN REVIEW FEE
WILLAMALANE SDC
ELECTRICAL PERMIT
TOTAL MISCELLANEOUS PERMITS
(E)
(Excluding Electrical)
unless otherwise noted
TOTAL AMOUNT DUE
(A. B, C, D. and E combined)
--- BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT ---
= Value
78,239.00
6,280.00
84,519.00
388.00
31,04
419.04
Fee
160,00
160,00
12.80
172.80
4,50
6,00
3.00
15.00
10,00
1. 20
26.20
0.00
23.50
14,50
2,247,91
60,00
1,000.00
124.20
3,470.11
4,088.15
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 provisions of said ordinances.
SPAINOPIELD
Job Number: 971224
Page 3
Received By:
Plans Reviewed By: DON MOORE Date: 09/17/97
Building Site Reviewed By: LISA HOPPER
- - - ADDITIONAL COMMENTS
PATH 1; GRASS ROOTS PROJECT (OWNER/BUILDER)
DRIVEWAY REQUIRED TO BE PAVED
2 STREET TREES REQUIRED
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 701.055 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 ~,ee) a..I'l-1" O,l'r .H. ~:u, ':: 'ouring construction,
V t\(1,,--(~ flLLMJI' /O/IOIC17
(" signatur~~ Date I I
- -- VALIDATION
Date Paid:
'2.75'f,3
/o/3A?
. ,
4c)~f% jJ
~{p?~
Receipt Number:
Amount Received:
Received By:
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SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME:~~~Ai I ~Q. .
ADDRESS: 4\8 JA'> :\(~ &
LOCATION OF PROPOSED BUILDING SITE: k-...fro
Street Addr s' 44\04 G \~ (1ll.a.aJ
Plat Name: Tax Lot Number: -' ~() ~~ I O@)
PHONE: l ~\ .PJVJo'6 .
STATE:~ZIP: ~l_l
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1. DEVELOPMENT TYPI=, (Check appropriate dwelling(s). SDC calculations and dwelling t
ype definitions are on the back.)
A. SinQle-Familv OAt;l&h.eli
\ Single Family home
. NO. OF UNITS
(
Manufactured home not in a park
X $1,000 per unit = $ -Lf){Y).cp
B. ~ing.le~Familv Attached
NO. OF UNITS
X $924 per unit = $
C. Multi-Familv Aoartment
NO. OF UNITS
X $692 per unit = $
D. M;lnllf;lcfllrAci HomA Pm1<,
NO. OF UNITS
X $699 per unit =
$
I DrY) ,co
(Y
/
$ IOm9D
WILLAMALANE SDC
$
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credit approval. See SDC Credit Worksheet.
$
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
1ID-Jl_
Development Se
City of Springfield
s epartment
/CJ I
Date
:l I ??
.JOB No.3..? 122.4-
. ATTACHMENT A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME OR COMPANY:
-r:..,.,. ~ KAR.l MALONE
LOCATION
44~t C-. LAC' ItEll....
DEVELOPMENT TYPE:
SF~
BUILDING SIZE:.
lOT SIZE
SQ, Ft,
1. STORM DRATNP-r,t;,
IMPERVIOUS SQ. FT.
2384
X $0.226 PER SQ. FT. $ S3B.76
2. SANfTARY SFwFR-rTTY
NO, OF PFU'S ~C)
(See Reverse Side)
X $46.86 PER PFU
$ 'B7.20
3. TRANSPORTATiON
'NO OF UNITS X TRIP RATE X COST PER TRIP
X I . 0 I X $472.49
$ 477. 2. (
x
X $472.49
$
X
X $472.49
$
4. SANTTARY SFWFR-MWMr
Ou -DU
NO.OF-FaJ'S X 2.77.7bPER F-W+ $10 MWMC/ADM FEE $ 2..87,7"
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
$ - '00,0",
TOTAl -MWMr SDr $ I ~7. ,"P,
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
$ L/'4-o.R7
5. ADMfNfSTRATIVE FFF'i,
BASE CHARGE (SUBTOTAL ABOVE) X .05
../9[-
$ /07, o<f-
Date: 8-18-17
SDC Coordinator
TOTAL SDr $2.24-7.'1/
. riA I unJ: UIIlII ~I-\l.~'-a' IIUIIl II-\Dl.J:; Number 01 New F*es X Unit Equivalent = Fixtur\l. Units.
(NOTE: For remodels. calculate o"'the NET additional fixturesl. .
, NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub....................................,................................ .
Drinking. Fountain..................,..,...., ......... .............,...
Floor Drain......:.................................,...................,...
Interceptors For Grease/OiI/SolidsIEtc.................
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub/Clotheswasher .......... .............. ,..........
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Traiierl..................
Receptor For Refrigerator/Water Station/Etc........
Receptor For Commerciai Sink/Dishwasher/Etc..
Shower. Single Stall.....................,.,................,........
Shower. Gang....,..................,....... .......... .................
Sink: Bar. CommerCial. Residential Kitchen........................
Urinal. Stall/Wall....................,......................,......,....
Wash Basin/Lavatory. Single..,...............................
Toilet. Public Installation.....................................,..
Toilet. Private..............,.......,.,..............................
Miscellaneous:
z...
'2-
2-
2-
TOTAL FIXTURE UNITS
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
=
4-
4-
2..
'2-
p.
2.0
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table.
calculate credits separates.
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
1979 or before
1980
1981
1982
1983.
1984
1985
1986
$3.97
3.89
3.83
3.70
3.55
3.39
3.20
2.91
1987
1988
1989
1990
1991
1992
1993.
1994
1995
1996
Credit for Parcel or Land Only If Applicable
3. '17 X $ 2.'>.2.10
(Rate X Assessed Value)
X $
. (Rate X Assessed Value)
Improvement (if after annexation date)
=
=
Rate per $1 ,000
Assessed Value
$2.56
2.17 "
1.73
1.31
0.92
0.74
0.61
0.45
0.31
0.17
/00 o'\-"
CREDIT TOTAL = $ /00,08
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
(For Estimating Purposes Only)
Residential..,:......................, OA
Commerical......................... 0.9
Industrial............................ 05
Governmental...................... 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
Address:
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Permit #:
Issued by:
Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Nole: Oregon Law, ORS 701,055(4), requires residential construction permit appli-
cants who are not registered 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 registration 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 I and 2, and either box 3A or 3B:
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1. I own, reside in, or will reside in the completed structure.
2, I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
D
3A, My general contractor is
(Name) Contractor regis, #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
'0' 3B. I will be my own general contractor.
If I hire subcontractors. I will hire only subcontractors registered with the Construction Contractors
Board, If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
A
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I hereby certify that the above information is correct and that I have read and do understand the Information
;;re "Pl"~:n~CoiV:.~":..~"": re"'~'Id~;,7~;~;
~) (Signature of permit applicant) (Date)
(White copy to issuing agency permitfile,;'
pink copy to applicant)
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liniormation Noiice to IPropeiiy Owners
About. .Co"s~ructioi1 Responsibliliiies
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
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.
EMPLOVER 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 Dept. of Revenue at 945-809 J .
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 at the Department of Human Resources
at 378-3524,
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 at the Department of Consumer and Business Services at 945-7888.
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 1-800-829-1040,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder forthis project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections. '.. .
Liabilit:' and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, 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.1?9rform the required-inspections. .
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If you have':additidnai ~ueitions, write or call the ConstruciibnC~~trnctors 'Bdard(PO ~ox 14140, Salem, QR 97309-5052,
503/378-4621), The Board is located at 700 Summer St. NE Suite 300, in Salem.
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