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Home My WebLink AboutPermit Building 2005-07-22Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00267ISSUED: 0712212005APPLIED: 03/0812005 EXPIRESz 0112212006VALUE: $ 75,000.00 SITE ADDRESS: 845 4TH ST ASSESSOR'S PARCEL NO.: 1703352108600 PROJECTDESCRIPTION: Studio Springfield TYPE OF WORK: Single Family Residence ,'. : t"li ib,f rgff i n o nnlty66g u i res yo u trsidentialr,- ,r., i-r,r:r r:tc,:_.r€,J by the oregon Utility i ,:.i,;,i';:.,ii-v, Center. Those rules are set forth Owner: Address: Contractor Type General Electrical Plumbing JANET SMITH PO BOX 70673 EUGENE OR 97401 Contractor License RENAISSANCE FINE ARCHITECTURAL WC108195 RICIIARD GROSHONG 119785 DOUGLAS LEE JONES 104606 0090. You may o calling the center. (Note:the telephone number for the utit Expiration Date 08fi7t2006 0il22t2006 02n7t2007 Phone 541-935-3451 541-485-7311 541-747-1254 TION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 YN 828 nla REQUIRED PARKING Total: Handicapped: Compact: 5.60 9.60 13.00 0.00 Fully Improved Yes 30.s0 Sidewalk Type: Downspouts/Drains: Curbside 5' Curb and Gutter Notes: Storm drainage connect to existing to curb face 3/10/2005 CAS DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Paee 1 of4 I 3.1{ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fa,x 541 -7 26-37 69 Inspection Line Building/Combination Fermit PERMIT NO: COM2005-00267ISSUED: 0712212005APPLIED: 03/08/2005 EXPIRESz 0112212006VALUE: $ 75,000.00 Description Bid Amount Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 75,000.00 Total Value of Project Amount Paid Date Paid Value $75,000.00 $75,000.00 Date Calculated 03/08/2005 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7o/o State Surcharge Appliance Not Listed Building Permit Fixture Furnace - up to 100,000 btu Heat Pump Plan Review Minor - Planning Sanitary Sewer - lst 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan Plan Review/Residential Hourly + l0o/o Administrative Fee * 7o/o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid Receipt Number r200500000000000306 1200500000000000371 1200500000000000371 r200500000000000371 1200500000000000371 1200500000000000371 r200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 r200s0000000000037r 1200500000000000371 1200500000000000371 1200s00000000000620 2200s00000000000968 2200s00000000000968 2200500000000000968 2200s00000000000968 $304.30 $10.00 $61.72 $43.20 $12.00 $468.1s $s6.00 $12.00 $12.00 $s9.00 $45.00 $109.68 $144.24 $26.83 $282.72 $12.00 $4s.00 $7.20 $s.04 $9.00 $63.00 3/8/05 3t2st05 3t2stos 3t25t05 3t25t05 3t25t05 3t25t05 3t2stos 3t2sl05 3l2st0s 3125t05 3t2sl0s 3t25t05 3t25t05 3t2st05 3t2st0s 5/13/05 7t22t0s 7t22t05 7t22t05 7t22t0s $1,788.08 Plan Reviews Initial Review Planning Review Public Works Review Revised Plan Review - Str Structural Review Structural Review 03/10/2005 03/10/2005 03/10/200s 05n2t2005 03/10/2005 03/11/2005 03/10/2005 03n6t2005 03/10/2005 APP APP APP SKG TAJ CAS 0sn2t2005 APP DJB 03/11/200s IO LLH APP JB Storm drainage into existing to curb face 3/10/2005 CAS Addendum to revise foundation construction details. Plans forwarded to Jason Bush for review 03n412005 Pase? of 4 C] Valuation Descrintion Buitding/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0712212005APPLIED: 03/081200s EXPIRES: 0112212006VALUE: $ 75,000.00 f,l pnrrired Insnpcfinns To Request an inspection call the24 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with 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. Final Building: After all required inspections have been requested and approved and the building is complete. Underslab Plumbing: Prior to filling the trench and including required testing. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Sanitary Sewer Line: Prior to filling trench and including required testing. Electric Service: Approval required prior to utility company energizing service. Pase 3 of4 Status Issued 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00267ISSUED: 0712212005APPLIED: 03/0812005EXPIRESz 0112212006VALUE: $ 75,000.00 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 701.005 will be used on this project. I further agree to inspections are requested at the proper time, that each address is readable from the street,that the card is at the front of the property, and the approved set of plans will remain on the site at all times /-.7-27-r< Owner or Date Pase 4 of4 225 Fifth Street S?ringfield, Oregon 97 47 7 541-726-3759 Phone City of Springfield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 2200500000000000968 Date: 0712212005 11:02:01AM Job/Journal Number coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7o/o State Surcharge + l0o/o Administrative Fee Amount Due 63.00 9.00 s.04 7.20 Item Total:$84.24 Payments: Type of Payment Paid By eheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard NICKRUSSO njm 312230 In Person $84.24 P aym e nt Total : -$ 84-, u-- tlI '| 7t22/2005 Page I of I InfTo'l3.D /\ Zoning 225 FIFTH STREET o SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 E LE CTr/iI CAL P E RM IT AP P LI CATI O N natur€t'n4-Cffi*S City Job Number (D5 - oo)b 7 I. LOCAT'ION OF INSTALI.ATION 2lo C)O LEGAL DESCRIPTION o /stz<a "u JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ) 3. CO]ITPLET'E h-EE SCHEDULE BELAI4I New Residential - Single or l\lulti-Farnily per duelling unit. Service Included Date 7-tg-os COATruLA CT O R I N S TAL IAION O N L''B. 1000 sq. ft oiibiriDr'l: ores;on la\4#lsF.s[ffi/ -@Each additional 500' sd d.c&te cJ byllit-Oregp portion thereoEr rn O".iei Thole rutes are^${^$S - iir:2-001 -0010 throuQ-h-UAR952-001'- iffl'"Y":flifl:ii*flffiv,i$ii,i:Sffi #i#*Feeder c;tllrrrg the C nun.iiri, for the Oregon Utilityl{otilication s"roiceslr r"@anxorotlag00oA9a*Se&ns or Relocation: Electrical Contractor Address Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date --1-----1 Signature of Supervising Electrician Owners Name Address +k sil-. C. Temporary Services or Feeders Installation, Alteratiqll or. Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit -(-. $. Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only Each Additional Circuit or with Service or Feeder Permit Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Phone $ 63.00 $ 75.00 $ 125.00 s 163.00 $37s.00 $ 50.00 $ 50.00 $ 69.00 $ 100.00 67,oo 3 ]Jrw o (, orlzz/noa 43,00 E. Miscellaneous (Service/feeder not inclutled) -Each Installation $ 3.00 $ s0.00 $ 25.00 $ 50.00 OWNER INSTALI,ATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOTALOFABOVE 7)dD '|Yo State Surcharge l0% Administrative Fee TOTAL sa g1< L+5, .c.. Inspection Request: 726-3769 Shared Drive(T:)/Building Fonns/Eler,trical Permit Application I -03.doc o city C{+rrtslFa.rZ rnone ?4€.,- tlc-:o Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0312512005 APPLIED: 03/08/2005 EXPIRESz llll2l2005VALUE: $ 75,000.00 SITEADDRESS: 8454THST ASSESSOR'S PARCEL NO.: 1703352108600 PROJECT DESCRIPTION: Studio Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PhoneNumber: 541-741-0779Owner: Address: JANET SMITH PO BOX 70673 EUGENE OR 97401 Contractor Type General Contractor License RENAISSANCE FINE ARCHITECTURAL WC108195 Expiration Date 0811712006 Phone 541-935-3451 CONTRACTOR INFORMATION BUILDING INFORMI # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: REQUIRED PARI(NG Total: Handicapped: Compact: 828 Curbside 5' Curb and Gutter R-3 # of Stories: Lot Size: Height of Structure Sq Ft lst Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: nla Occupant Load: VN s.60 9.60 13.00 0.00 30.50 Oregon lawrequhcs Yo of Lot street Improvements: Fu[v rmproved Storm Sewer Available: Yes Special Instruction: Notes: Storm drainage connect to existing to curb face $ Per Sq Ft or multiplier Square Footage or Bid AmountDescription Type of Construction Pase I of3 Value Date Calculated Valuation Description I t_rl1YtlL(rr[ll,i\ t ri\lltJnuvlAl l(Jl\ | Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0312512005APPLIED: 03/08/2005EXPIRES: llll2l2005VALUE: $ 75,000.00 Bid Amount Use Bid Amount Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0%o Administrative Fee + 7o/o State Surcharge Appliance Not Listed Building Permit Fixture Furnace - up to 100,000 btu Heat Pump Plan Review Minor - Planning Sanitary Sewer - lst 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan Plan Review/Residential Hourly Total Amount Paid $1.00 75,000.00 Total Value of Project Date Paid Receipt Number r200500000000000306 1200s00000000000371 r200s00000000000371 1200500000000000371 1200s00000000000371 1200s00000000000371 r200s00000000000371 1200s00000000000371 1200500000000000371 1200500000000000371 1200s00000000000371 1200s00000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200500000000000620 $75,000.00 $75,000.00 03/08/200s Amount Paid $304.30 $10.00 s61.72 $43.20 $12.00 $468.15 $56.00 $12.00 $12.00 $59.00 $4s.00 $109.68 $144.24 $26.83 $282.72 $r2.00 $4s.00 3/8/05 3tzsl05 3t25105 3t25t05 3lzsl05 3l2slos 3l2slos 3lzslos 3t2st05 3tzst0s 3tzsl05 3t25t05 3t25t0s 3t25t05 3t25t05 3lzslos 5/r3/0s $1,703.84 Rops Paid Plan Initial Review Planning Review Public Works Review 03/10/2005 03/10/2005 03/10/2005 03/10/2005 03n6t2005 03/10/2005 APP APP APP SKG TAJ CAS Revised Plan Review - Str 0511212005 0511212005 APP DJB Structural Review 03/r0/200s 0311u2005 Io LLH Structural Review 03/1r/2005 03tr4t2005 APP JB Storm drainage into existing to curb face3ll0l2005 CAS Addendum to revise foundation construction details. Plans forwarded to Jason Bush for review To Request an inspection call the24 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. leouired Insnections Page 2 of 3 Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0312512005APPLIED: 03/0812005 EXPIRESz llll2l2005VALUE: $ 75,000.00 Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with 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. Final Building: After all required inspections have been requested and approved and the building is complete. Underslab Plumbing: Prior to filling the trench and including required testing. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Sanitary Sewer Line: Prior to lilling trench and including required testing. By signaturer l 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 Springlield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAI\CY 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 701.005 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. 5'- t3 - o{ Owner Signature Date Pase 3 of3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone 9ity ot Springfield Official Receipt rvelopment Services Department Public Works Department RECEIPT #: 1200500000000000620 Date:05/13/2005 e:26:01AM Job/Journal Number coM2005-00267 Description Plan ReviewlResidential Hourly Amount Due 45.00 Item Total:Frs.-0lr Peyments: Type ofPayment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard JANET SMITH djb 133638 In Person $45.00 Payment total: ----$Eidd- 51t312005 Page I of I Building/Combination Permit Status Issued 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0312512005APPLIED: 03/08/2005 EXPIRESz 0912512005VALUE: $ 75,000.00 SITE ADDRESS: 845 4TH ST ASSESSORTS PARCEL NO.: 1703352108600 PROJECTDESCRIPTION: Studio Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition Residential PhoneNumber: 541-741-0779Owner: Address: Contractor Type General JAI\IET SMITH PO BOX 70673 EUGENE OR 97407 Contractor License RENAISSANCE FINE ARCHITECTURAL WCIO8195 Expiration Date 08n712006 Phone 541-93s-345r v # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: rU Height Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: cDyPe R-3 VN s.60 9.60 13.00 0.00 Floor: FIoor: Other: Load: REQUIRED PARJ(NG Total: Handicapped: Compact: Curbside 5' Curb and Gutter 828 30.50 Fully Improved yes NOTICE: THIS PERM1T Notes: Storm drainage connect to existing to curb face 3/10/2005 cAS Sidewalk Type: Downspouts/Drains: $ Per Sq Ft or multiplier Square Footage or Bid Amount Description Type of Construction Page I of3 Value Date Calculated Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0312512005APPLIED: 03/0812005 EXPIRES:. 0912512005VALUE: $ 75,000.00 Bid Amount Use Bid Amount Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 77o State Surcharge Appliance Not Listed Building Permit Fixture Furnace - up to 100,000 btu Heat Pump Plan Review Minor - Planning Sanitary Sewer - lst 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan Total Amount Paid $1.00 75,000.00 Total Value of Project Date Paid $75,000.00 $75,000.00 03/08/200s Amount Paid Receipt Number 1200500000000000306 1200s0000000000037r 1200500000000000371 1200s00000000000371 1200s00000000000371 1200s00000000000371 1200s00000000000371 r200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200500000000000371 1200s00000000000371 1200500000000000371 1200500000000000371 1200s00000000000371 $304.30 $10.00 $61.72 $43.20 $r2.00 $468.15 $56.00 $12.00 $12.00 $s9.00 $45.00 $109.68 $t44.24 $26.83 s282.72 $12.00 $1,658.84 3/8/05 3125t05 3125105 3l25t0s 3125t05 3125t05 3125t05 3t25t0s 3tzst0s 3tzsl05 3t25105 3tzst05 3125t05 3t25t0s 3t2sl05 3t25t05 tr'ees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review Structural Review 03/10/2005 03/10/200s 03/10/200s 03/10/200s 03n6t2005 03/10/2005 APP APP APP SKG TAJ CAS 03/10/2005 03/11/200s ro LLH 03nu2005 03n4t200s APP JB Storm drainage into existing to curb Iace3ll0l2005 CAS Plans forwarded to Jason Bush for review To Request an inspection call the 24 hour recording at 726-3769. AII 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Reorrired fnsneef Paee 2 of3 Building/Combination Permit Status Issued 225 Fifth Street, Springlield, OR 541-726-3753 Phone 541-726-3676Rax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00267ISSUED: 0312512005APPLIED: 03/0812005 EXPIRESz 0912512005VALUE: $ 75,000.00 Shear Wall Nailing: Before covering sheathing with 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. Final Building: After all required inspections have been requested and approved and the building is complete. Underslab Plumbing: Prior to filling the trench and including required testing. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Sanitary Sewer Line: Prior to filling trench and including required testing. 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 Springlield 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 701.005 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. '1* zS -o{ Owner or Signature Date Paee 3 of3 Construction Contractors Board 700 Summer St I\tE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress: www.ccbs!4t@ Permit *: (prt-t?p . -- OO Z6-7 €q 5. L{+q s,IAddress: Issued by:b B Date: 3 @ate) applicant.) t kr. ff, Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrtcal, mechanical and plumbing permits. Licensed architect and engtneer appltcants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes t and2, and either box 3A or 38: I own, reside in, or will reside in the completed stnrcture. I understand that I must become licensed as a constnrction contactor if the structure is sold or offered for sale before or on completion. q-ro. My general contractor is t(t.e ?.,uss o l7J- (Name)(ccB #) I will instnrct my general contractor that all subconhactors who work on the stnrcture must be licensed with the Construction Contractors Board. OR n 38. I will be my own general contractor. If I 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 notiff 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. 7 -zs -o (s of permit Property_owner. doc 06-0 I -04 copy to issuing agenq) permitfile, pink copy to CITY OF STnINGFIELD SYSTEMS DEVELOPMEN ORKSHEET JOI,IRNAL OR JOB NUMBER: COM2005-00267 NAME OR COMPANY:Janet Smith LOCATION 845 4th St TAX LOT NUMBER:I 7033521 08600 DEVELOPMENT TYPE:SINCLE FAMILY RESIDENCE NEW DWELLING UNITS 0 I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM COST PER S.F $0.3 r 0 IMPERVIOUS S.F x 912.00 RTJNOFF ROUTED TO DRYWELL DESIGNED AND BUTLDTNG SrZE (SFl 828 LOT SZE (SF): CHARGE $282.72 TO STANDARDS DISCOTINT $0.00 s282.72 s2s3.92 6924 ITEM 1 TOTAL- STOR]I{ DRAINAGE SDC 2. SANITARY SEWER- CIry A. REIMBURSEMENTCOST: IMPERVIOUS S.F 0.00 NUMBER OF DFU's 6 B. IMPROVEMENT COST: NUMBER OF DFU's 6 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 SUBTOTAL $536.64 COST PER S.F $0.3 r 0 COST PER DFU $24.04 $ 18.28 NUMBER OF LINITS 0 NLIMBEROF UNITS 0 ADM. FEE RATE 5Yo x x x x x x x x ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT xx xx COST PER TRIP $r 8.30 COST PER TRIP $80.72 $0.00 NEW TRIP FACTOR r.00 NEW TRIP FACTOR 1.00 ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER. MWMC A. REIMBURSEMENTCOST: NUMBER OF FEU's 0 B. IMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL. MWMC SAIIITARY SEWER SDC SUBTOTAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE: $0.00 $536.64 CHARGE $26.83 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRAN SPORTATION ADMINISTRATION FEE: CherylSlaymaker 3/1012005 DISCOLINT RATE 50o/o ADT TRIP RATE 9.57 s282.72 s144.24 $0.00 $0.00 $0.00 $0.00 26.83 $563.47 I 070 l09t 1092 I 093 1094 l 055 r 056 1079 I 078 aI! oU & rrlF0 rr.l& COST PER FEU $82.03 COST PER FEU $865.31 PREPARED BY DATE TOTAL SDC CHARGES x FIXTIIRE TYPE DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OFNEW FD(TURES x UNIT EQUIVALENT:DRAINAGE FXTURE UN]TS FOR CALCULATE ONLY TLIE NET ADDITIONAL NO. OF FIXTI]RES TINIT OLD MISCELLANEOUS DFU TYPE NTIMBER OF EDU'S TOTAL DRAINAGE FD(TURE UNITS rsa toa mi1 set at 167 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE NEW IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIP (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) 20 DRA]NAGE FD(ruRE 0 2 2 1979 +EDI] BEFORE 1979 1979 I 980 l98l 1982 I 983 I 984 I 985 1986 1987 I 988 1989 r 990 t 99l 1992 1993 1994 I 995 t996 1997 I 998 1999 $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 VALLTE / 1000 $0.00 CREDIT RATE $s.29x CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE/ 1OOO CREDITRATE $0.00 x $5.29 TOTAL MWMC CREDIT$1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 BATI]TUB 0 0 3 0 0 1 0DRINKING FOL]NTAIN 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 0INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 6 0 LAUNDRY TUB 0 0 2 0 CLOTHESWASFIER / MOP SINK 0 0 3 0 CLOTHESWASHER- 3 ORMORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWER" SINGLE STALL 1 0 2 2 SHOWE& GANG (NUMBER OF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 0 SINK:COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 1 URINAL, STALL / WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 b 0 TOILET. PRIVATE INSTALLATION 1 0 3 3 6 YEAR ANNEXEI) CREDIT RATE/$I,OOO ASSESSED VALUE 0 $0.00 2000 200r 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone e,tty of Springfield Official Receipt ,velopment Services Department Public Works Department RECEIPT #: 1200500000000000371 Date: 0312512005 2:50:5epM Job/Journal Number coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM2005-00267 coM200s-00267 coM2005-00267 coM2005-00267 coM2005-00267 Description Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixtwe Furnace - up to 100,000 btu Vent Fan Heat Pump Appliance Not Listed -Mechanical Issuance Fee- Sanitary Sewer - lst 50 Feet + 7%o State Surcharge + l0%o Administrative Fee Plan Review Minor - Planning Amount Due 282.72 144.24 109.68 26.83 468. l5 56.00 12.00 12.00 12.00 12.00 10.00 45.00 43.20 61.72 s9.00 Item Total:$1,354.54 Payments: Type of Payment Paid By Check Number Received By Batch Number Auihorizalion Number How Received Amount Paid Check STERLING EDITIONS djb 2061 In Person Payment Total: $1,354.54 -i"l-s4-5i- I 3/25/2005 Page I of I