HomeMy WebLinkAboutPermit 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
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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
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.
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
,-)
, -),. ,,',
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::.' ",\ .,\ \
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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