The URL can be used to link to this page

Home My WebLink AboutPermit Building 2006-6-6 -e . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00461 ISSUED: 06/06/2006 APPLIED: 04/19/2006 EXPIRES: 12/06/2006 VALUE: $ 29,700.00 Status Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 3621 HAYDEN BRIDGE RD ASSESSOR'S PARCEL NO,: 1702194205300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition' PROJECT DESCRIPTION: Addition to existing single family residence Residential Owner: DOUGLAS WISE Address: 3621 HAYDEN BRIDGE RD SPRINGFIELD OR 97477 Pbone Number: 541-747-5289 Contractor Type General Electrical Mecbanical Plumbing ATTr:t\lTlnf\I' t'lrcnnr"\ 1...101 .......,." .i.......S you to I <WNTRACTORINFORMATION I Ut'I't . _ In II Y Notification Center, Those rules Rre s~' fnr\h . Contractor in OAR 952-001-001 0 thr(~lf,~~~e ,~Xp\~atlOn Date DAVID ZARZYCKI ,GENERAL)CONTRACTId05626 AthR 95"1 UU04/26/2009 vUOJV. IUU I lay tJUldt" L;Ufll~<;; Of e ru es b'f REYNOLDS ELECTRL~lIino the r.p.ntl'!r, 11\1 tV~M, I 0210812007 DAVID ZARZYCKI GEN1 ERALuCONTR IN CO 11105620~te efPhone 04/26/2009 llU IIUtl1 Illlt;Ulet10n It'lr".otllcatlon Roes PLUMBING ' "~IOll,7 01103/2008 ("'ant"",... It:''' Of'\f'\ _ ,_. . ,_....., Phone 541-688-0243 541-343-7297 541-688-0243 541-607-8704 r DUlLUll__.... U"llrvrtrt1ATION I VN # of Stories: 1 Heigbt of Structure 17.00 Type of Heat: Forced Air Gas Water Type: Range Type: Energy Patb: Patb 1 Sprinkled Building: nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Otber: Occupant Load: 300 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.00 0.00 I DEVELOPl\-."-,,. mFORMATION I , RElbU~ED PARKING Overlay ~i~l\C;: ~\1 S\1I>.LL EXPIRE IF i\15:~~~~i # Street Tr~e~R'qd~1\ EO UNDER 1\1\S PERMITt1a~i1iCapped: Paved Dri,:eJR'<jft':R\2 OR IS ABI>.NOONEO 8lmpact: % of Lot ~QY.~iiiie\lCEO 00 ' ANY 180 OI>.Y PERI ' I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Partially Improved Yes Sidewalk Type: DownspoutslDrains: Curb and Gutter Notes: Storm drainage piped into existing to curb face 4/24/2006 CAS Pa2e 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction V Wood Frame Dwellines Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 8% State Surcharge Building Permit Exhaust Hoods Fire Fee - Residential Fixture Gas Outlets 1-4 Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing SDC Sanitary/Storm Admin Storm Draiuage Impervious Area Total Amount Paid . . CITY OF ~rKll'\jld<lJ!,LD Building/Combination Permit PERMIT NO: COM2006-00461 ISSUED: 06/06/2006 APPLIED: 04/19/2006 EXPIRES: 12/06/2006 VALUE: $ 29,700.00 I Valuation Descriotion I $ Per Sq Ft or multiplier $99,00 Square Footage or Bid Amount 300.00 Value Date Calculated $29,700,00 $29,700,00 04/19/2006 Total Value of Project J;'pp<, PIilLI Amount Paid Date Paid Receipt Number 1200600000000000498 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 1200600000000000801 $164.87 $10.00 $35.87 $27.49 $253,65 $9,00 $15,00 $14,00 $4,00 $32,00 $31.00 $4,24 $84,71 4/19/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 6/6/06 $685.83 I Plan Reviews I luitial Review 04/20/2006 04/21/2006 APP LLH Plannine Review 04/21/2006 04/27/2006 APP TAJ No Planning issues. Puhlic Works Review 04/2112006 04/24/2006 APP CAS Storm drainage piped into existing to curh face 4/24/2006 CAS Structural Review 04/21/2006 OS/23/2006 OK RWC 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. UenuirerUnsnections I Footing: After trenches are excavated, Foundation: After forms are erected hut prior to concrete placement, Post and Beam: Prior to 1100r insulation or decking. Floor Insulation: Prior to decking, Paee 2 of3 . . U 11: OF ~nuNGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2006-00461 ISSUED: 06/06/2006 APPLIED: 04/19/2006 EXPIRES: 12/06/2006 VALUE: $ 29,700.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved, Wall Insulatinn: Prior to cover. Ceiling Insulatinn: Prinr tn cover, Roofing: Prior to installing any roof covering: Final Building: After all required inspections have been requested and approved and the building is complete. Underlloor Plumbing: Prior to insulation or decking. Underlloor Drain: Prior to cover or placement of concrete. Ro.ugh Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing, Sanitary Sewer Line: Prior to filling trench and including required testing, 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 and 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 poiut, Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete, Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete, 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 ofany 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 will remain on the site at all times during construction. ~~ tl ~D v Owner or Contractors Signature ~UJ..1 (P '/..tOh Date Paee 3 00 CITY OF _INGFIELD SYSTEMS DEVELOPME&ORKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS COM2006-00461 Ooue,las Wise 3621 Hayden Brid~e Rd 1702184205300 SINGLE FAMILY RESIDENCE o BUILDING SIZE (SF: 290 LOT SIZE (SF): o '" ~ o o u ~ ~ i- 16 ~ 1, STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S,F, x I COST PER S,F, CHARGE 262,25 I $0.323 1 = 1 $84,71 1 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS 1 IMPERVIOUS S,F, I x I COST PER S,F. 1 x 1 DISCOUNT RATE 1 1 1 0,00 1 $0.323 1 1 50% 1 = I ITEM I TOTAL - STORM DRAINAGE SDC $84.71 DISCOUNT $0,00 $84.71 11070 2, SANITARY SEWER - CITY A. REIMBURSEMENT COST: 1 NUMBER OF DFU's I x COST PER DFU 1 0 $25,07 SO.OO 1091 B. IMPROVEMENT COST: 1 NUMBER OF DFU's I x 1 0 $19.D7 SO.OO 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I SO.OO - 3, TRANSPORTATION A REIMBURSEMENT COST: 1 ADT TRIP RATE I x 1 NUMBER OF UNITS I x I COST PER TRIP x INEWTRlPFACTORI 1 9,57 1 0 I I $19,09 1.00 SO.OO 11093 B. IMPROVEMENT COST: I ADT TRIP RATE 1 x 1 NUMBER OF UNITS I x 1 COST PER TRIP x INEW TRIP FACTORI 9.57 I 0 I I $84.19 I 1.00 $0.00 1094 ITEM 3 TOTAL - TRANSPORTATION SDC =, SO.OO - 4, SANITARY SEWER - MWMC A REIMBURSEMENT COST: INUMBER OF FEU's 1 x ICOST PER FEU I 0 I $82,03 = SO.OO I 1054 B. IMPROVEMENT COST: I INUMBER OF FEU's I x ICOST PER FEU I 0 I I $865.31 = SO.OO 11055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) SO.OO 1 1054 MWMC ADMINISTRATIVE FEE SO.OO 11056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = , SO.OO I SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $84.71 I 5, ADMINISTRA.TIVIJ FEE: I SUBTOTAL x ADM, FEE RATE 1= I CHARGE I $84.71 5% $4,24 TOTAL SANITARY ADMINISTRATION FEE: 4,24 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $0,00 11078 Cheryl Slaymaker 4/24/2006 TOTAL SDC CHARGES =, $88.95 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTIJRE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY TIffi NET ADDmONAL FIXTURES) NO, OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB -0 0 3 = 0 I DRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTHESWASHER / MOP SINK 0 0 3 = 0 ICLOTHESWASHER - 3 OR MORE (EA) 0 0 6 ' - 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER ST AnON / ETC, 0 0 1 = 0 IRECEPTOR FOR COM, SINK / DISHWASHER / ETC. 0 0 3 = 0 I SHOWER. SINGLE STALL 0 0 2 = 0' I SHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCiAURESIDENTIAL KITCHEN 0 0 3 = 0 I SINK: COMMERCIAL BAR 0 0 2 = 0 WNK: WASH BASIN/DOUBLE LAVATORY , 0 0 2 = 0 SINK: SINGLE LA V A TORY /RESIDENTIAL BAR 0 0 1 = 0 IURINAL. STALL/WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 0 0 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 1 i . . I I I J ,:,EDU (Equivalent Dwelliml: Unit) i~ dischame eouivalent to a single familv dwelli~ unit (20 DFU's) set at 1671t8.11ons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE L YEAR ANNEXED I I I .I BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/SI,OOn ASSESSED VALUE I $5,29 $5,29 S5,19 $5,12 $4,98 $4,80 $4,63 $4.40 $4,07 $3,67 $3,22 $2,73 $2,25 $1,80 $1.59 $1.45 $1.25 $1,09 $0,92 $0,72 $0,48 $0,28 $0,09 $0,05 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT? (Enter I fnr Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE SO,OO x S5,29 ~, SO,OO CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0,00 x $5,29 o TOTAL MWMC CREDIT $0,00 = -,1 \. ../ "'. ", . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Weh Address: www.cch.state.or.us Pennit #: c:.:.OWlz...G- 6 (:) l{ b { Address: :s b z... ( l-h+y~ f::''''" '6 (l..( b G-<f' ~d Date: bJ6 h.~b , 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, Fill in the app.up.:ate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion, ~ 3A. My general contractor is ~v It:> ~'7 elc ( (Name) /o-s-6z{; (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board, OR D 3B. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board, Ifl 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. (VA '1'11:hs:. a~-----U (Signature 07p?rmit applicant) J\ fLU &; . ,J..oo{.> . J (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner,doc 06-01-04 ,-) , -),. ,,', \ ::.' ",\ .,\ \ ..- . A(cfcillnig tal~'.iTI ([j)uillf' ((J)wnn GenneJrtalll C({J)nntIr'tal~tmr? ',", )'j: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT..bONSTRUCTION'RESPONSIBILlTlES , " " 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, JEmjplloyeJ!" ResjpolIlsibillities 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 Wlemployment insurance purposes.:. ' on the wages of all employees, For more information, call the Oregon Employment Department at 503-947-1488, ---.., The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and' Unemploymenqns~ce Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the _\, te',fi'J ',\ ' ' appropna urms. " , . -" '., ,- , ' , -- Workers' Compensation Insurance: As an employe;, you are subject to the Oregon Workers' Compensation Law, and must obtain wOl:kers' 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. 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 www.irS,l!OV, Other lResjpollllsJibftHitJies ~md Areas of COlIlcerns 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 accidents and omissions such as falling tools, paint over spray, water damage from pipe pWlctures, 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 general contracior, to coordinate the work ofrough-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 _ o,",ner,doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541J726-3759 Phone . -~.''''~'' 1Itr' " , . - - -~ 1 - -. .~ ~ ._'. .- ~ of Springfield Official Receipt _elopment Services Department Public Works Department Job/Journal Number COM2006-00461 COM2006-0046I COM2006-00461 COM2006-0046I COM2006-0046I COM2006-0046I COM2006-0046I COM2006-0046I COM2006-0046I COM2006-0046I COM2006-0046I COM2006-0046I Payments: Type of Payment Check cReceintl RECEIPT #: 1200600000000000801 Date: 06/06/2006 Description Fire Fee - Residential Storm Drainage Impervious Area SDC Sanitary/Storm Admin Building Permit Fixture Minimum/Adjustment Plumbing Exhaust Hoods Gas Outlets 1-4 Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 8% State Surcharge + 10% Administrative Fee Paid By DOUG OR CINDY WISE Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2118 In Person Payment Total: Page I ofl ~ 11 :03:48AM Amount Due 15,00 84.71 4,24 253,65 14,00 31.00 9,00 4,00 32,00 10,00 27.49 35,87 $520.96 Amount Paid $520,96 $520,96 6/6/2006