The URL can be used to link to this page

Home My WebLink AboutPermit Building 2003-06-23Status 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003EXPIRES: 0411412004VALUE: $ 8,000.00 SITE ADDRESS: 641 19TH ST Springfield TYPE OF WORK: Single Family Residence ASSESSOR'S PARCEL NO.: 1703361212500 TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Interior remodel, rewire and add bath; add window/door headers. Redo all plumbing fixtures, adjust to 12 fixtures total. Owner: CLAy HELT Address: 641 19TH ST SPRINGFIELD OR 97477 PhoneNumber: 541-606-0770 Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER License Expiration Date Phone CONTRACTOR INFORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: 6I c Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o//o R-3 VN 1O \ne 91gtw\q\ \t 6\$e Sidewalk Type: Downspouts/Drains: Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: r$ 3 ARIflNG DEVELOPMENT INFORMATION Notes: Page I of3 "".-l \ Status 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003 EXPIRESz 0411412004YALUE: $ 8,000.00 Description Bid Amount Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $1.00 8,000.00 Total Value of Project Amount Paid Date Paid Value $8,000.00 $8,000.00 Date Calculated 06t05t2003 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 7oh State Surcharge Building Permit Fixture Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing Residence Wiring 1000 Sq Ft Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan + l0o Administrative Fee + 7Yo State Surcharge Fixture + l0oh Administrative Fee + 7oh State Surcharge Residence Wiring 1000 Sq Ft Total Amount Paid Receipt Number 1200200000000001444 1200200000000001610 1200200000000001610 120020000000000r610 1200200000000001610 120020000000000r610 12002000000000016r0 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000002322 1200200000000002322 1200200000000002322 1200200000000002404 1200200000000002404 1200200000000002404 $s9.67 $10.00 $28.78 $20.15 $91.80 $42.00 $39.00 $3.00 $106.00 $117.53 $1s4.63 $13.61 $6.00 $16.80 $11.76 $168.00 $10.60 $7.42 $106.00 6tst03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6123t03 6123t03 6t23t03 6t23t03 6t23t03 6t23t03 t0lt6t03 t0n6t03 r0n6t03 tu3t03 ru3t03 tu3t03 $1,012.75 tr'ees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 06t06t2003 06/06t2003 06/12/2003 06t06t2003 06t06t2003 06fi3t2003 06/16t2003 06t20t2003 APP APP APP APP LLH AJD VRJ DLM Confirmed zoning as LDR. Single-Family homes are an outright permitted use and the existing setbacks for the primary structure conform to the SDC. No public works permit, SDC's calculated for bathroom fixtures. See documents for plan review comments Paee 2 of3 Valuation Descrintion I Status 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003EXPIRES: 0411412004VALUE: $ 8,000.00 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. I Framing Inspection: Prior to cover and after all rough in inspections have been approved. 2 Wall Insulation: Prior to cover. 3 Ceiling Insulation: Prior to cover. 4 Drywall: Prior to taping. 5 Final Building: After all required inspections have been requested and approved and the building is complete. 6 Rough Plumbing: Prior to cover and including required testing. 7 Final Plumbing: When all plumbing work is complete. 8 Rough Mechanical: Prior to Cover 9 Final Mechanical: When all mechanical work is complete. 10 Rough Electric: Prior to Cover 11 Final Electric: When all electrical work is complete. Reouired Insnections 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 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. Owner or Contractors Signature Date Paee 3 of3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Spfingfield Official Receipt Development Services Department Public Works Department coM2003-00456 coM2003-004s6 coM2003-00456 Residence Wiring 1000 Sq Ft + 7o/o State Surcharge + lUYo Administrative Fee 106.00 7.42 10.60 Item Total:$124.02 P TypeofPayment PaidBy Received By Batch Number Authorization Number How Received Amount Paid Check PACIFICA V/EST djb In Person Payment Total: sr24.02 $124.02 ( City of Springlield 225 Fifth Street, Springfield, OR97417 541-726-3759 Phone 541-726-3676Fax August 23,2004 HELT 641 19TH ST SPRINGFIELD Job Number: Location: oR 97477 coM2003-00456 641 19THST CLAY Project:Interior remodel, rewire and add bath; add windoddoor headers. Redo all plumbing fixtures, adjust to 12 fixtures total. Dear Permit Holder: The Springfield Building Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the permit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at 641 l9TH ST which is set to expire on 911212004. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notify you that your permit(s) will be expiring shortly. If you are ready to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project. If you have any questions, please feel free to phone me at 54L-726-3790 Sincerely, Lisa Hopper Building Safety Supervisor ,PRINGFIELD City of Springfi-_-d Voucherh, Report lD : SPRA103 Voucher lD : Handling Code : 00069389 RE Accounting Date : Vendor Number: lnvoice Date : lnvoice # : Approver: Operator: Gross Amount: Proi/Grant November 13, 2003 0000010430 November 13,2003 coM2003-00456 . Puent,David wtLS5940 124.02 Amount 7.42 106.00 10.60 Pacifica West 32929 Camas Swale Road Creswell, OR 97426 Description Electrical refund Account Fund 91g SubClass BY 215004 426102 426605 Comments: Express check electrical refund ok'd by Lisa Hopper 641 1gth /job number com2003-00456 821 100 100 2004 2004 2004 22s FrFrH srREEr . spRrNGFrELD, oRs7477 o pH:(541)726-37s3 .ffiffjit$"rff"&-ry*pp*'jf[t:iil,t'L:f[",:'" E LECTRI CAL P E RM IT AP P LI CATICIAT CityJobNumber rcnnz{X,3 - t-OY56 out" L->? 0) 1.3. LEGAL DESCRIPTION A. lierv Residential * Single or l\'Iulti-F arnilv per rhrelling unit. t7 03> 6r z lTsoo JOB DESCRIPTION "artl tL€H<,u-^{ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. approval /'o o 3 Zoning Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or pofiion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps ro 1000 Amps Reconnect o\ $ 106.00 $ 19.00 $50.00 t0L , Electrical Contractor Address {. v Expiration Date o Signature of Supervising Electrician B. Sen,ices or Feeelers - Installatian, dlterations or B.elocation: $ 63.00 $ 7s.00 $ 12s.00 $163.00 $37s.00 $ s0.00 Lr^, City Phone 7Jq-llsr Over 1000 SupervisorLicenseNumber jla.fl Expiration Date /n-l -d{ Constr. Contr. Number 9:so6 C. $.o Volts see "B" above. $ 50.00 $ 69.00 s100.00 $ 3.00 or Extension Per Panel _ $ 43.00 6'il '-l( s+ Each Additional Circuit or with Service or Feeder Permit \s '7o/o State Surcharge l0% Administrative Fee TOTAL clu /L//Owners Name Address ?I City SPTA Phone OWNER INSTALLATION The installation is being made on propefiy I own which is not intended for sale, lease or rent. Owners Signature: 606 Qtzc>Pump or Minimum Fee is $45.00 * Surcharges /c6 7qL tO 6a tz'l* $ s0.00 $ 25.00 $ 4s.00 Inspection Request: 726-3769 4. Shared Drive(T:)/Building Fonns/Electrical Pennit Application l -03.doc mffi bqt rlh sr Date BELAW Amps/Volts ttl Only InstallationE. ft'Iiscell*neous (Sen'icelfeeder AF ABAVE SPRIN 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003 EXPIRESz 0411412004VALUE: $ 8,000.00 SITE ADDRESS: 641 19TH ST Springfield TYPE OF WORK: Single Family Residence ASSESSOR'SPARCELNO.: 1703361212500 TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Interior remodel, rewire and add bath; add window/door headers. Redo all plumbing fixtures, adjust to 12 fixtures total. Owner: CLAy HELT Address: 641 19TH ST SPRINGFIELD OR 97477 PhoneNumber: 541-606-0770 Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER License Expiration Date Phone \o # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: 1s0 0h\ R-3 VN 3 REQUIRED PARJ(NG Total: Handicapped: Compact: \r $\E Sidewalk Type: Downspouts/Drains: .t[\ TION Notes: Paee I of3 ffi LTJl\ Floor: Floor: Basement: Ft Garage/Carport Sq Ft Other: Impervious Surface Area:\heto(is1 # 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003 EXPIRESz 0411412004VALUE: $ 8,000.00 Description Bid Amount Fee Description PIan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 77o State Surcharge Building Permit Fixture Minimum/Adj ustment Mechanical Minimum/Adj ustment Plumbing Residence Wiring 1000 Sq Ft Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan + l0o/o Administrative Fee + 77o State Surcharge Fixture Total Amount Paid Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount $r.00 8,000.00 Total Value of Project Amount Paid Date Paid Value $8,ooo.oo $8,000.00 Receipt Number 1200200000000001444 1200200000000001610 120020000000000r610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 r200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000002322 1200200000000002322 1200200000000002322 Date Calculated 06/05/2003 $59.67 $10.00 $28.78 $20.15 $91.80 $42.00 $39.00 $3.00 $106.00 $117.s3 $154.63 $13.61 $6.00 $16.80 $11.76 $r68.00 6t5t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23103 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 10/r6103 10/16/03 10/16/03 $888.73 lTpps Pci.l Plan Reviews Initial Review Planning Review Public Works Review Structural Review 06t06t2003 06t06t2003 06n2t2003 06t06t2003 06t06t2003 06n3t2003 APP APP LLH AJD 06n612003 APP VRJ 06t20t2003 APP DLM Confirmed zoning as LDR. Single-Family homes are an outright permitted use and the existing setbacks for the primary structure conform to the SDC. No public works permit, SDC's calculated for bathroom fixtures. See documents for plan review comments 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. Paee 2 of3 Valuation Description 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: COM2003-00456ISSUED: 0612312003 APPLIED: 06/0512003 EXPIRESz 0411412004VALUE: $ 8,000.00 Reouired Insnect 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. 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. Owner or Contractors Signature Date 1 ) 3 4 5 6 7 8 9 10 11 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 that all required inspections are requested at the proper time, that each address is readable from the street,permit card is located at the front of the property, and the approved set of plans will remain on the site at all times /C -c/ Page 3 of3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone I City of Springlield Official Receipt Development Services Department Public Works Department 1 Date: I coM2003-00456 coM2003-00456 coM2003-00456 Fixture + 7Yo State Surcharge + l0o/o Administrative Fee 168.00 tt.76 16.80 Item Total:1196.s6 Type ofPayment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check PACIFICA WEST CORP djb In Person Payment Total: $196.56 $196.s6 ( 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: COM2003-00456ISSUED: 0612312003 APPLIED: 06/0512003 EXPIREST 1212312003VALUE: $ 8,000.00 SITE ADDRESS: 641 tgTH sT Springfield TYPE oF woRK: Single Family Residence ASSESSOR'S PARCELNO.: 1703361212500 TYPE OF USE: Alteration Residential PROJECT DESCRJPTION: Interior remodel, rewire and add bath; add window/door headers. Owner: CLAy HELT Address: 641 19TH ST SPRINGFIELD OR 97477 PhoneNumber: 541-606-0770 Contractor Type General Electrical Mechanical Owner Plumbing Contractor OWNER OWNER OWNER CLAY HELT OWNER License Expiration Date Phone 541-606-0770 # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction TyPe: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: I R-3 VN # of Stories: I Lot Size: Height of Structure Sq Ft lst Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range rvil{OTlCE: sq Ft Garage/Carport Energy r"$1ls pERMtT SHALL EXPIflI{Fq$E WoRK AUTHO RIZED U ND ER THISPEfiTfigP$1q$fC ATEA: 3 D.REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: PUBLIC IMPROVEMENTS Notes: Pase I of3 Downspouts/Drains: rT.l rggon law lEqutrE n ries of the rutes r e: the telophone r+iri+., trlntif iCftiOf ina ihn nantaf r /1raf GFIELD 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003EXPIRES: 1212312003VALUE: $ 8,000.00 Description Bid Amount Type of Construction Use Bid Amount $ Per Sq Ft $1.00 Square Footage 8,000.00 Value $8,ooo.oo $8,000.00 Date Calculated 06t0st2003 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 7o/o State Surcharge Building Permit Fixture Minimum/Adj ustment Mechanical Minimum/Adjustment Plumbing Residence Wiring 1000 Sq Ft Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Paid Total Value of Project Date PaidAmount Paid $59.67 $10.00 $28.78 $20.15 $91.80 $42.00 $39.00 $3.00 $106.00 $117.53 $154.63 $13.61 $6.00 s692.17 Receipt Number 120020000000000r444 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 1200200000000001610 120020000000000r610 1200200000000001610 1200200000000001610 1200200000000001610 120020000000000r610 6t5t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 6t23t03 tr'ees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 06t06t2003 06t06t2003 06n2t2003 06t06t2003 06t06t2003 06n3t2003 06n6t2003 06t20t2003 LLH AJD VRJ DLM APP APP APP APP Confirmed zoning as LDR. Single-Family homes are an outright permitted use and the existing setbacks for the primary structure conform to the SDC. No public works permit, SDC's calculated for bathroom lixtures. See documents for plan review comments 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. I Framing Inspection: Prior to cover and after all rough in inspections have been approved. 2 Wall Insulation: Prior to cover. Rennired Insnpefinns Page 2 of3 Valuation Description I FIELD 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: COM2003-00456ISSUED: 0612312003APPLIED: 06/0512003 EXPIRESz 1212312003VALUE: $ 8,000.00 3 Ceiling Insulation: Prior to cover. 4 Drywall: Prior to taping. 5 Final Building: After all required inspections have been requested and approved and the building is complete. 6 Rough Plumbing: Prior to cover and including required testing. 7 Final Plumbing: When all plumbing work is complete. 8 Rough Mechanical: Prior to Cover 9 Final Mechanical: When all mechanical work is complete. 10 Rough Electric: Prior to Cover 11 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 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 70f .005 will be used on this project. I further ensure that all required inspections are requested at the proper time, that each address is readable from the street,permit card is located at the front of the property, and the approved set of plans will remain on the site at all times Owner or Contractors Signature Date Paee 3 of3 q trLl a/z< lr; r 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works I)ePartment 610 ate: coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-00456 coM2003-004s6 coM2003-004s6 Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture Minimum/Adj ustment Plumbing Vent Fan Minimum/Adj ustrnent Mechanical -Mechanical Issuance Fee- Residence Wiring 1000 Sq Ft + lYo State Surcharge + l0Yo Adminishative Fee 154.63 117.53 13.61 91.80 42.00 3.00 6.00 39.00 10.00 106.00 20.15 28.78 Item Total:$632.s0 Payments: Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check Number Check PACIFICA WEST CORP djb In Person Payment Total: $632.50 $632.s0 as submitted has the lollowing require specilic land use 225 FIFTH STREET o SPRINGFIELD, OF.97477 o PH:(541)726-3753 o F E LE CTRI CAL P E RMIT AP P LI CATON City Job Number (d,n Zoo*^ e<)rl i6 Dare oF rNsT',antarroN / ?+; sl-3.COMPLET'E FEE SCIIEDLILE BELOVT DateGo ro' Signature l. -{r LOCATION bv/ LEGAL DESCRIPTION lzo336tZ /ZSc-O A. r-or llesidelrtial - Single or ]Irrlti-Fanrill pcr duclling urrit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or (ortion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder 'oj'ut$ltlon.[a,Keo irq v14 Permits are non-transferable and .^p,, c if rvorx is not started within 180 days of issuance or if work is Suspended for 180 days. Electrical Contractor Address Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name Address Phone 6clC - 07 70 40 I Amps to 600 Amps Reconnect Onlv S -50.00 $ 106.00 $ 19.00 )o6.dt) $s0.00 Z. CONTRACIOR INS?UIIAIIOItrONLy B. Services or Feeders * Installation, Allerations or Relocation: Cify 200 Amps or less 201 Amps to 400 Amps ,'-t-ffid $ 7s.00 $ 125.00 $ 43.00 $ 3.00 C. D'rY PLHIOrl." tilfr;;;.Ib*rnices or Feetters New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Perrrit E. l'Iiscellaneous (Sen'ice/feeder ttot included) -[ach lttstallatiott City Pump or irrigation Sign/Outline Lighting Limited EnergyiResidential Limited Energy/Commercial $ $ $ $ 50.00 50.00 25.00 45.00 6 TION .4"' The installation is being made on property I own which is not for sale, lease or rent.Minimum Electric Permit Inspection Fee is $45.00 * Surcharges t06 7o/o State Surcharge l0% Administrative Fee TOTAL 7./L /o6o Inspection Request: 726-3769 Shared Drive(T:)/Building Fonns/Elec(rical Pennit Application l -03.doc CITY OF GTIELD,OREGON j.i':iS PtRddtTeS,tiAt&rbUORFpF THE WORK $163.00Phone AUiH0Hi0&&[J0m8ft,il]]t6BERMlT lS NE- s37s.00 Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits 4. S(IBTOTAL AF ABOVD / ^ y',oz Construction Contracfors Board Permit 4, COrnzS.--j ^- oA q S6 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us 6ql l?+'' slAddress Issued by:b(Date: 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, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, 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 I and2, and either box 3A or 38: &1. I own, reside in, or will reside in the completed strucfure. El' z.I understand that I must become licensed as a construction conkactor if the structure is sold or offered for sale before or on completion. n 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR -R' 38. I will be my own general contractor. If I hire subconkactors, 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 notift 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 Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) (l(hite copy to tssutng agency peftnitfile, pink copy to applicant.) Property_owner.doc 03/l I /03 (o ' //'c/^ T @ate) _-/ Actimg as Your Own Generatr Contractor? lrurffiffiM&T$sN r-c*TtsH Ts pffi*pffiffiTy *wr{Efts AffiCIUT CShiSTRU*TION ffi*Spft ru$I&}L*YIffi$ AiS?-f: Ij:is lnf*sirafion Sl*fice fo Property Owners a&*ul Oonsfrucficn Responsr*/rfres !v*s developod by ftt* Construc#an Caritracfsrs Soar$ in ac*ordancs wittt SRS 7Sr-055($J, passed fiy the ?989 Oregon legrslafure. If yau ar* a*ting as :cr.]i-xr *wn contractor tr: consffuct a new home or make a substanilal improvemr*t tc a:l existi::g struclure" y*1-1 c,'an prcv*lrl man,v pr*blen:s b-v being arvare of the follorving resp*n,eibilttie:; and eoncerns. H mployer Respsnsibilities You rvril. in rnost instances. be ruled to be an "employer" and the corrtraotsrs ycu *ontra*t v,rith will he "*mpi*y**s" if ycu Lrse s$Rlrastors nnt ircen*ed with lhe Cernstructicn Contr*ctors B*ard to do labor in $onstruetirg or to assist in the c*rstructi*n *r imprt:v*rtrefit clf a residen{ial $k-ui}ture" As the ernplo-v*r, you mrst **mply rvith the following: *reg*nos Wi*hh*lditeg Y*x Law: As an ernptroyer, yfiu ffiust lvithh*ld inc*rns taxes *"qlffi einpk:yee l*"eges *t the time empl*y**s *r* p*id. Y*u will i:e lial:rle f*r the tax p*yment* el,en if y*u rlc:n't actrrally rviti"ih*}d the tax fr*m y*ur empl*yees. Sor a State Tlusiness ltr] number. eall the Busincss Inf,orrr:ati*n Center al 5*3-S$6-2?*S. Llnernpl*yment Insurxnee Trx: As *n empioyer, yoll are required to pay a tax fi:r unemplolment insurance purposes *n the wages of all employees. For more information, eall the Oregon Empl*yment Department at 5t)3-94?-i488. Workers' Comp**sati*n Insurance: As an ernployer, ysu are subject to the Oregein Workers' Compensalion Law, and must otrtain workers' cornpensation insurance for your emplayees. If you fail to nbtain wsrkers' compensation insuranc€, you could be rubject to penaities and be liabie for al1 claim costs if one of y*ur employees is injured on the job. For more information, cali the Wrrkers' Compensation Sivision at the Separtment af Consumer and Business Services at 503-947-7815" U.$. Internal Revenue Iiervice: As an employer, you must withhold federal income tax frorn employees' wages. You will be liable for the tax payffient eyen if you didn't aetually withhotd the ttx. For a Federal EIN nurnber, call &e IRS at 866-816-2*65 or fax them at 801-620-?115. #tfuer S&e*p*nsibilities and Aren$ sff C*meerxnx Cod* Co*rplian*e; As th* permit kolder f*r this proje*t. ysu fire resp*nsible far res*lving any failme tr: rneet c*de rcquiremenls that naay b* br*ught to y*ur attentior through inspecti*ns" Li*hili{-f a*d Fraper$y X}amxge {msurame*: C*ntact ycur insuran*c ag*nt t* s*e i* y*u hal"e *riequate insurance coyerage for *ccidects and omissions such as faliing t*ois, palnt $ver spray, water damage from pipe punctures, fire or rvork that must bc redone. Time: Make swe you have sufficient time to supervise yow employees" Expertise: Make sure you have &e skills to ast a$ yo$r own generai conkactor, to coordinate the work of rough-in and {inish kades, and to ngtiff buildingcfficials as thb appropriate tjmes so they can pe,rfi:rm the required inspections' If you have additional questions call the Constructi*n Contractors Board (503-3784521) or qrrite the agency at PO Box 14140, Salem, SR 973CI9-5052" Property,_owner.dec 031 tr I 103 CITY OF SPRINGFIELD SYSTEMS DEVELOPMEITT WORKSHEET JOURNAL ORJOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: com2003 -0045 6 Helt 641 l9th Street 17033612 tl 12500 DEVELOPMENT TYPE: SINGLE FAMILY NEW DWELLING UNITS 0 BUILDING SIZE LOT SIZE (SF): DIRECT RLINOFF TO CITY STORM SYSTEM I rMPERVroLrs s,F.f-dd-x COST PER S.F s0.282 CHARGE $o.oo RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F 0.00 x COST PER S.F $0.282 x DISCOTINT RATE 50% DISCOUNT $o.oo ITEM I TOTAL - STORM DRAINAGE SDC $0.00 $0.00 airl t-.,1 U &t!Fa tr.1d t070 1091 i 092 l 093 I 094 1054 1055 1054 I 056 I 079 I 078 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: NUMBER OF DFU's 7 x COST PER DFU s22.09 : l-Sis4"63 B. IMPROVEMENT COST: NUMBER OF DFU'S 7 x COST PER DFU sr 6.79 ITEM 2 TOTAL - CITY SANITARY SEWER SDC $272.16 3. TRANSPORTATION A. REIMBURSEMENT COST: ADT TRIP RATE 9.57 x NUMBER OF UNITS 0 x COST PER TRIP s16.8r x NEW TRIP FACTOR 1.00 : I $o.oo B. IMPROVEMENT COST: ADT TRIP RATE 9.57 x NUMBER OF UNITS 0 x COST PER TRIP $74.17 x NEW TRIP FACTOR r.00 = I $o.oo ITEM 3 TOTAL - TRANSPORTATION SDC $0.00 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's 0 x = [ $0.00 B. IMPROVEMENT COST: NUMBER OF FEU's 0 x MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL. MWMC SANITARY SEWER SD( : : t $ooo : I so.oo $0.00 COST PER FEU s332.86 COST PER FEU $34.83 SUBTOTAL (ADD ITEMS 1,2,3, & 4)s272.16 5. ADMINISTRATIVE FEE: SUBTOTAL $272.16 x ADM. FEE RATE 5% CHARGE $ 13.61 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: | 13.61 I so.oo Virginia Jurasevich 6n6t2003 PREPARED BY DATE TOTAL SDC CHARGES DRAINAGE FIXTURE UNIT CALCULATION TABLEDIU DRAINAGE FIXTURE LTNITSFIXTURE TYPE UNIT NEW OLD AqDrTroNAr FXTURES)(NOTE: FOR REMODELS,CAICULATE ONLY THE NET NUMBER OF NEW FIXTURES x UNIT EQUIVALENT: DRAINAGE FXTURE UNITS NO. OF FIXTURES BATHTUB I 0 3 J DRINKING FOUNTAIN 0 0 1 0 DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LAUNDRY TUB 0 0 2 0 CLOTHESWASHER / MOP SINK 0 0 3 0 CLoTHESWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (1 PER TRATLER)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 0 0 2 0 sHowER, 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 IWALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 6 0 TOILET, PRIVATE INSTALLATION 1 0 3 3 7 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 0 TOTAL DRAINAGE FIXTURE UNITS *EDU ts a toa unit set at 167 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED CREDIT RATE/$ I,OOO ASSESSED VALUE BEFORE I979 $4.92 1979 s4.92 1980 $4.83 l98l $4.77 t982 s4.64 1983 $4.47 1984 $4.30 l98s $4.09 I 986 $3.78 1987 $3.41 1988 $2.98 1989 $2.s2 1990 s2.06 l99l $1.64 1992 $r.45 1993 $ l.3l t994 s l.l3 1995 $0.97 1996 $0.82 t997 $0.63 1998 $0.41 1999 $0.22 2000 $0.04 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR IMPROVEMENT (IF AI'TER ANNEXATION) CREDIT FOR LAND (IF APPLICABLE) TOTAL MWMC CREDIT 0 0 x VALUE / IOOO $0.00 CREDIT RATE s4.92 VALUE/ IOOO CREDITRATE $0.00 x $4.92 IU 20 1979 HOPPER Lisa From: Sent: To: Subject: PUENT David Thursday, April 28, 2005 8:15 AM HOPPER Lisa FW: Updates to the Meth Lab listing FYI From: KLEWS Janel M lmailto:ianel.m.klews@ci.eugene.or.usl Sent: Wednesday, April27,2005 6:02 PM To: WILLIAMS Judy M; CHASTAIN Adra; SIEGENTHALER Ann; Brett Sherry; DELF Carolyn L; REYGERS Cindi S; PUENT David; BROOKS Debbie E; NOWAKOWSKI Donna L; DORAN Jebediah A; HALLETf Jackie C; BURGESS Jane; MCDONALD Janis K; HENRY Jim R; WICKS Joseph; CUTTER Leland C; WILSON Loretta; DENBERG Matt H; MCKERROW Mike J; OLSHANSKI Pam K; KOUBELE Sandi L Subject: Updates to the Meth Lab listing Hello, All! Today's update reflects the following changes. 975 Carolyn - COF zo69 Brittany- COF 1637 Ferry St #r - Added to List The City has switched to Word so I will not be sending out this information in WordPer{ect any longer. Sorry for any inconvenience! Janel KIe*,s - !T[U/SIU/$f,RT 6&z-g;-69ffim Methlab Tracking Report.doc (5... 1537 Ferry St #1.doc (32 KB) 1 Ileodore n,Kubngorki Govenor April 10,2003 Mr. & Mrs. David Hudson 687 Asnen Street Sprinefield, 0R 91411 RE: CERTIFLCATE OF FITNESS, OHD CASE #03-003 6-41^N. TfF Street, SPringfield . Dear Mr. & Mrs. Hudson: SincerelY, of 800 NE Oregon Street Portland, OR 97232-21 62 (503) 7314030 - Emergency (503) nt-Aotz (503) 731-4077 - FAX (503) 731-4031 - TTY-Nonvoice E"#ffiHthy,%Tt,lBi:'slil TM:io cc:Bh..D.,Department of Human Services Lane Environmental Health b Become IndePendent,HealthY and Safe" B VlS1ON ssisting PeoPle T If you need this information in liver ato11Irmgardcaase1epformat,a 2t-401l)035 Enclosure ,A An Equal OPPortunrity EmPloYer Hssszsz(ot/o:) s final were Affordable ect at propertY 15 now use. informa this letter will to the B site at www on You PaY quesfions at (503) 872-6770 if Youhave anY the to CE,RTIFICATE, OF FITNE,S S ) Certificate #03-003 The properry locate dat64rN. 19th street, Springfierd; Torvnship 17 south, Range 03 west of the willamette Meridian, sect ion 36112, Tai l-oi tzso0, Lane county, oregon has undergone a chemical drug lab assessment and chemical decontamination under the supervisigl-of l licensed Illegal Drug Laboratory Decontamination Contractor in accordance rvith oRS 453.855-453'gl},and is hereby certified as fit for use to the extent that can be determined using current techniques and methodologies' Any act of fraud .o*-itt.d in obtaining this certificate rendirs said certificate null and void' a I {L I Department of Human S AuthoritY Date [oHs\ oqqgondeputment 0l rumanselwes L regon Department of Consumer and Business Services Building Codes Division 1535 Edgewater Street NW POBox74470 Salem, OR 97309-0404 (503) 378-4133 FAX (503) 378-2322 TTY (503) 373-7358 http ://www ore gonbcd. org Theodore R. Kulongoski, Governor APRIL 24,2003 DAVID PUENT BUILDING OFFICIAL 225 FIFTH ST SPRINGFIELD OR 97477 RE: REMOVAL FROM DRUG LAB LIST The following property has been removed from the "unfrt for use" list of properties suspected of involvement or involved in the manufacture of drugs. Address: 641 N. 19th Street Springfield OR LOUANN RAHMIG Administrative Specialist County: Owner: County Assessor Stacy Warner, OSFM Lane Co Environ Health David Hudson Lane Mr. & Mrs. David Hudson 687 Aspen Street Springfield OR97477 c: -? 3 00rTb tu-6u*-lw regon Department of Consumer and Business Services Building Codes Division 1535 Edgewater Street NW PO Box 14470 Salem, OR 97309-0404 (s03) 378-4133 FAX (503) 378-2322 TTY (s03) 373-7358 John A. Kitzhaber, M.D., Governor JANUARY I3,2OO3 h DAVID PUENT BUILDING OFFICIAL 225 FIFTH ST SPRINGFIELD OR 97477 RE: DRUG LAB REGISTRATION We have received notification from the Health Division that the following property was declared "unfrt for use" because of illegal methamphetamine manufacturing and./or use as a storage site: Address:641 19th Street Springfield OR County:Lane Property owner:Mr. & Mrs. David Hudson 687 Aspen Street Springfield OR97477 {r;tUJ.Atv LOUANN RAHMIG Administrative Specialist County Assessor Stacy Warner, OSFM Lane Co Environ Health C Eit