HomeMy WebLinkAboutPermit Building 1997-1-8
SPRINGFIELD
Page 1
RESIDENTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
Job Number: 961598
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location of Proposed Work: 4524 GLACIER ST
Assessors Map #: 18020512
Lot: Block:
Tax Lot #: 03800
subdivision:
OWner: PAUL/KIM HARRISON
Address: 102 ALBERTA #5
Phone #: 461-1969
City/State/Zip: EUGENE, OR
Describe Work: S.F. RESIDENCE
NEW
QUAD AREA: 4RSE
INSUL PATH: SGC
OFFICE USE
LAND USE: 1111
HEAT SOURCE: EW
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
SHEAR WALL NAILING - Before covering sheathing with finish materials.
ROUGH PLUMBING - Prior to cover.
ROUGH MECHANICAL - Prior to cover.
ROUGH ELECTRICAL - Prior to cover.
ELECTRICAL SERVICE - Must be approved to obtain permanent power.
FRAMING - Prior to cover.
INSULATION - Floor; prior to decking wall/Ceiling; Prior to cover
DRYWALL - Prior to taping.
WATER LINE - Prior to filling trench.
SANITARY SEWER LINE - Prior to filling trench.
STORM SEWER LINE - Prior to filling trench.
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.
Lot Faces: S
Topography: 2
Solar Approved: Y
Lot Sq. Ft.: 9600
Total Height: 16
Setbacks
Lot Coverage: 16.66\
Setbk From NPL: 56
N
S
W
10
E
House
Garage
18
Item
Main
Garage
BUILDING PERMIT ---
Square Feet x
1205
395
$/Square Feet
64.66
16.27
Value
77,915.00
6,427.00
SPRINGFIELD
/::t,,~
Job Number: 961598
Page 2
Total Value
84,342.00
Building Permit Fee
Surcharge/Admin
388.00
31. 04
TOTAL FEE
(A)
419.04
--- SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) 2,308.17
Systems Development Charge is due on all undeveloped properties within the City
limits and the Citys Urban Growth Boundry which are being improved.
PLUMBING PERMIT ---
Item
Residential Bath(s)
2
Fee
160.00
Plumbing Permit
Surcharge/Admin
160.00
12.80
TOTAL CHARGE
IC)
172.80
MECHANICAL PERMIT - - -
Exhaust Hood
Vent Fan
Dryer Vent
2
4.50
6.00
3.00
Mechanical Permit
Issuance
Surcharge/Admin
15,00
10.00
1.20
TOTAL PERMIT
(D)
26.20
--- MISCELLANEOUS PERMITS ---
Surcharge/Admin
Sidewalk
Curb Cut
WILLAMALANE SDC
ELECTRICAL PERMIT
PLAN REVIEW FEE
0.00
22.00
14.50
1,000.00
167.40
252.20
TOTAL MISCELLANEOUS PERMITS
IE)
1,456.10
(Excluding Electrical)
unless otherwise noted
TOTAL AMOUNT DUE
(A, B, C, D, and E combined)
4,382.31
--- 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 provisions of said ordinances.
SPRINGFIELD
Job Number: 961598
Page 3
Received By:
Plans Reviewed By: DON MOORE Date: 12/18/96
Building Site Reviewed By: HEIDI KNIGHT
- - - ADDITIONAL COMMENTS
PATH 1; SEPARATE ELECTRICAL PERMIT IS 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 remain on the site at all times during construction.
) - 'i? ' 97
Signature
'-
Date
Date Paid:
~~()ALIDATION
\''1'~~
()(bW- .fb\
~~~\ '
Receipt Number:
Amount Received:
Received By:
SPRINGFIELD
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
(RESIDENTIAL)
Name or Company: PAUL/KIM HARRISON
Location: 4524 GLACIER ST
Developement Type: R Building Size:
Job No.: 961598
Lot Size:
1. STORM DRAINAGE
Impervious Sq Ft 2354 X 0.216 Per Sq Ft =
2. SANITARY SEWER - CITY
Number Of PFUs 20 X 44.75 Per PFU
(see Page 2)
3. TRANSPORTATION
Number Of Units
1 X
X Trip Rate
1. 010 X
X
Cost Per Trip
451.26
$455.77
Transportation Total
4. SANITARY SEWER - MWMC
Number Of PFUs
20
Per PFU +
20.690 +
MWMC Admin Fee
10.00
X
X
MWMC CREDIT If Applicable (see Page 2)
TOTAL - MWMC SDC
SUBTOTAL - (Add Items 1, 2, 3 & 4)
5. ADMINISTRATIVE FEES
Base Charge (Subtotal Above) X
0.50
TOTAL SDC
Reviewed By: DENNIS ERNST
Date: 12/03/96
Page 1
"-,
Sq Ft
$508.46
$895.00
$455.77
$423.80
$84.77
$339.03
$2,198.26
$109.91
$2,308.18
SPRINOFIELD
Job Number: 961598
Page 2
FIXTURE UNIT CALCULATION TABLE
Fixture Type
Bathtub
Drinking Fountain
Floor Drain
Interceptors For Grease/Oil/Solids/Etc
Inteceptors For Sand/Auto Wash/Etc
Laundry Tub/Clotheswasher
Clotheswasher - 3 Or More
Receptor For Refrigerator/water Station/Etc
Receptor for Commercial SinkjDishwasherjEtc
Shower, Single Stall
Shower, Gang
Sink, Bar, Commercial, Residential Kitchen
Urinal, Stall/Wall
Wash Basin/Lavatory, Single
Water Closet, Public Installation
Water Closet, Private
Miscellaneous
TOTAL FIXTURE UNITS
Number of
New Fixture
Unit
Equivalent
Fixture
Units
2
o
o
o
o
2
o
o
o
o
o
1
o
2
o
2
o
2
1
2
3
6
2
6
1
3
2
4
o
o
o
o
4
o
o
o
o
o
2
o
2
o
8
o
2
2
1
6
4
20
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occured
after annexation date, credits are calculated separately.
(calculations are by $1000)
Year Annexed: 1979
Credit For Parcel Or Land Only If Applicable:
Improvement (if after annexation date) :
24,430
X
3.47 =
84.77
o
X
3.47
0.00
CREDIT TOTAL =
$84.77
(If land value is multiplied by 1 then the parcel/land credit is not accurate.)
.
Permit #:
.
Cfti?/ '5 9PJ
Address: de, 24-- 6LA6/~
Issued by: ~IJY). ./ Date: ! J. Cf1
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: 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 pennit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
~
N
I, 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
N 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.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice I~erty Owners about Construction Responsibilities on the reverse side of this form.
~G.....~^=J'., , );l-lq-q(o
(S'i'gnature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
][nf()rh,~~idn '~~iice io I?roperiy Owners
" ,'., ~~ou~iC~msi~uciion Responsibiliiies
/"-: , _,f "., '. ,.' \ _.',. ...... _''\;"'
Note: This Information Notice to Propert)' 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 stmcture,
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 Depl. of Revenue at 945-8091 .
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 mil&t
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance. you. m~y
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job: For more informail~
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 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 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 bave 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 additi6nal questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop~own.pm4
1/94
....
.
Job. No. C; b \ S. ~B
)
.'
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
~ . .\
NAME: \~~~.~\.a.~
ADDRESS: I{')~ ~\k"\i."
PHONE: i{b\"'\C{l-,<1
STATE: ~ ZIP:
LOCATION OF PROPOSED BUILDING SITE:
Street Address:' 4h.~Lt ~~~~D. ~ ~
Plat Name: \ ~ C'\ ~t~ \ ~
Tax Lot Number: ():3 ~
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations and dwelling t
ype definitions are on the back:) ..
. A. SinolA-F8milv DAt8rhAd
. NO. OF UNITS \
Manufactured home not in a park
OQ
$ \. Cft '" --
X $1,000 per unit = ^-A..J
X Single Family home
B. Sinole-Fmnilv Att8chec;!
NO. OF UNITS
X $924 per unit = $'
C. Multi-Familv ADartment
NO. OF UNITS
X $692 per unit = . $
D.,Manufactured HomA P;:Jrk
NO. OF UNITS
X $699 pe(unit . =$
WILlAMALANE SDC $
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credit approval. See SDC Credit Worksheet. $
. 3.' TOTAL WllLAMAlANE NET, SDC ASSESSED
. (if SDC reduced for Credit) '.$ ., [n ~'\ ~
'R~~..~~
. Development Services Department
,City of Springfield
I I fJ
lilate
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