HomeMy WebLinkAboutPermit Building 2006-02-27CITY OF SPRINGFIELD
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Frx
S4l:7 26-37 69 Inspe ction Line
Building/Co mbin ation Permit
PERMIT NO: COM2006-00230ISSUED: 0212712006APPLIEDz 0212712006E)?IRES: 09/1312006VALUE: $ 2,000.00
SITE ADDRESS: 625 21ST ST
ASSESSOR'S PARCEL NO.: 1703361300600
PROJECT DESCRIPTION: Replace lire damaged framing
Springfield TYPE OF
TYPEOF USE:
Single Family Residence
Repair Residential
Owner:
Address:
Contractor Tvpe
General
Electrical
CHRIS WALPOLE
24439 WARIIIEN RI)
ELI\iIIRA OR 97437
Contractor
OWNER
OREGON ELECTRIC SERVICE
License
Phone Number: 541-935-2852
Expiration Date Phone
616455-2223
09t28t2006 s41-343-1681
CONTRACTOR INFORMATION
i\
o{th
# of Units:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
Frontyard Setback:
Side l Setback:
Side 2 Setback:
Rearyard Setback:
Sohr Setbacla:
Sfteet
Storm SewerAvailable:
Special Instruction:
R-3
VN
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Overlay Dist:
# Street Trees
Paved Drive Rqd:
oh of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
1\\E
Notes:
1of 3
# ofStories:
Height of
Type
Water
r{L
rC nla
Buildin g/Co mbinatio n Permit
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-726-3676Fax
541:7 26-37 69 Inspe ction Line
PERMIT NO: COM2006-00230ISSUED: 0212712006APPLIEDz 0212712006E)PIRES: 09/1312006VALUE: $ 2,000.00
Description
Estimate
Type of Construction
Estimate
$ Per Sq Ft Square Footage
or multiplier or Bid Amount
$1.00 2,000.00
Total Value of Project
Amount Paid Date Paid
Value
$2,000.00
$2,ooo.o0
Date Calculated
02t27t2006
Fee Description
+ l0o/o Administrative Fee
+ 87o State Surcharge
Building Permit
+ l0o/o Administrative Fee
+ 87o State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Total Amount
$4.s0
$3.60
$45.00
$r0.00
$8.00
$43.00
$57.00
$r71.10
2t27t06
2t27t06
2t27t06
3n3t06
3n3t06
3n3t06
3n3t06
Receipt Number
r20060000000000021 r
1 2006000000000002 l r
12006000000000002r r
120060000000000029s
120060000000000029s
1200600000000000295
1200600000000000295
PIan Reviews
To Request an inspection call the24 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.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Reouired fnsnections
2of3
Valuation Description I
Ilees raro I
CITY F D
Status: Issued
225 Fifth Street, Springfield, OR
541:726-3753 Phone
541-7264676Fax
541:7 26-37 69 I nspection Line
Building/Co mbin ation Permit
PERMIT NO: COM2006-00230ISSUED: 0212712006APPLEDz 0212712006E)PIRES: 09/1312006VALUE: $ 2,000.00
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 certi$ that any and all work performed shall be done in accordance
with the Ordinances of the City of SpringfieH and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCT PANCY will be made of any structure without permission of the Community Services Division,
Building Safety. I further certiff 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
3 of 3
225 Fifth Street
Springfield, Ore gon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
velopment Services Department
Public Works Department
Date: 0311312006 11:45:21AM
Job/Journal Number
coM2006-00230
coM2006-00230
coM2006-00230
coM2006-00230
Description
+ 8% State Surcharge
+ l0oA Administrative Fee
Add, Alter, Extend Circ Ea Add
Add, Alter, Extend Circ
Amount Due
8.00
10.00
57.00
43.00
Item Total:$118.00
Payments:
Type of Payment Paid By
CheckNumber Authorization
Received By Batch Number Number How Received Amount Paid
Creck oREGON ELECTRTC SERVTCE djb 19474 In Person
Payment Total:
$118.00
-5lis-"o-d-
i
t
,i
il
(
3/t312006 lofl
*PRIH(lrrf&$
RECEIPT#: 1200600000000000295
CITY OF RINGFIELD, OREGON
l*t_Nnn
225 FIFTH STREET o SPRINGFIELD, OR 97477 o PH:(541)72G3753 o FAX:
E LE CTRI CAL P ERMIT APPLI CATI ON
City Job Number (Duttzo o L- OoZ3o
LEGAL DES
no336t 3 06b
(541)72c$6$fl"s
Date
-%__**
JOB DESCzuPTION
t h Q--<r--\-r,-L o ,,L/Lra--Lh
Servlce Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion 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 to 1000 Amps
Over 1000 AmpsA/olts
Reconnect Only
One Circuit
Each Additional Circuit or with
Sen ice or Feeder Perrnit
8% State Surcharge
l0% Administrative Fee
TOTAL
$106.00
$ 19.00
$s0.00
$ 63.00
$ 7s.00
$r25.00
$163.00
s375.00
$ 50.00
I $ +g.oo 93 -
fq $ 3.oo 5l*
Permits are non-transferable and expire if work is
not started within 180 days of issuance or lf work is
Suspended for 180 days.
2.
City Phone 3qA -(lo{ I
Supervisor License Number /39"3 d
Expiration Date /o- o/ ^o)
Constr. Contr. Number
Expiration Date Q -at -ob
Signature of Supervising Electrician
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.O. 1:r1,,.
New Alteration or Extenslon Per Panel
B.
Electricalc(tfttg$N%
P0. BCii:2"iAd&ess
c.
I
7k *r1a,yw' Ol8*,
Owners Name
Address
City Elmi Phone I \t-t Qor-l
OWNER INSTALLATION
The installation is being made en properfy I own which
is not intended for sale, lease or rent.
Owners Signature:
Limited Energy/Commercial $ 45.00
Mlnimum Electric Permlt Inspection Fee lg $45.00 + Surcbstges
eO
PERMIT IS N
DONEB+O+
$ 25.00
80a
lo oo
ll*rcInspection Request: 726-3769
4,
Shared Drive(T:)/Building Forms/Electrical Permit Application l-06.doc
l.3.
Cei
rn Utilit
THIS
ANMil8O BtrFr$/fiFf{J&Ttial
CITY OF SPRINGFIELD
Buildin g/Co mbin atio n Permit
PERMIT NO: COM2006-00230ISSUED: 0212712006APPLIED: 0212712006E)GIRESz 0812712006VALUE: $ 2,000.00
Status: Issued
225 Fifth Street, Springfiel{ OR
541:726-3753 Phone
541-7263676Fa.x
541:7 26-37 69 Ins pe ction Lin e
SITE ADDRESS: 625 21ST ST
ASSESSOR'S PARCEL NO.: 1703361300600
PROJECT DESCRIPTION: Replace fire damaged framing
Springfield TYPE OF
TYPE OF USE:
Single Family Residence
Repair Residential
Owner:
Address:
CHRIS WALPOLE
24439 WARTIMNRI)
ELMIRA OR 97437
Phone Number: 541-935-2852 :I
Contractor Tvpe
General
Contractor
OWNER
sY
,$OO
are
ou to
Expiration Date Phone
1-
o1
Lot Size:
Sq Ft lst Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
# of Unia:
Primary Occupancy Group:
Secondary Occupancy
Primary Construction Type
Secondary Construction
# of Bedrooms:
Frontlard Setbaclc
Side l Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacla:
Street
Storm SewerAvailable:
Special Insfruction:
Notes:
R-3
YII
eqon u
-5oo-sg ?:L
1
Range Type:
Energy Path:
Sprinkled
Overlay Dist:
# Street Trees
Sq Ft Garage/Carport
Sq Ft Other:
nh OccupantLoad:
IF THE
REQUIRED PARI(NG
Total:
Handicapped:
w0RRo-p""tt
EXPIRE
P ERMIT IS NOT
ANY 180 DAY Sidewalk Type:
DownspoutVDrains
$ Per Sq Ft
or muftiplier
Square Footage
or Bful Amount
]YELOPMENT INFORMATION
Description Type of Construction
lof2
Value Date Calculated
llln lS.B
Water
Paved Drive Rqd:
THIS
ru\es
Valuation Description I
UIrnI|ILs
Status: Issued
225 Fifth Street, Springfield, OR
541:7264753 Phone
541-726-3676Frx
541:7 26-37 69 I ns pe ction Line
Building/Combination Permit
PERMIT NO: COM2006-00230ISSUED: 0212712006APPLIED: 0212712006E)?IRESz 0812712006VALUE: $ 2,000.00
Estimate Estimate
Fee Description
+ lOYo Administrative Fee
+ 87o State Surcharge
Building Permit
Total Amount
$1.00 2,000.00
Value of Project
Date Paid
2t27t06
2t27t06
2127t06
Receipt Number
1200600000000000211
1200600000000000211
1200600000000000211
$2,000.00
$2,000.00
02t27t2006
Amount Paid
$4.s0
$3.60
$45.00
$s3.10
Plan Reviews
To Request an inspection call the24 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.
Framing Inspection: Prior to cover and after all rough in inspections have been approved.
Final Building: After all required inspections have been requested and approved and the building is complete.
red fnsnecfions
By signaturer l state and agree, that I have carefully examined the completed application and do hereby certify that atl
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance
wift the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein,
and that NO OCCIJPAI\CY will be made of any shucture without permission of the Community Services Division,
Building Safety. I further certiff 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 atl required inspections are requested at the proper time, that each address is readable from I
the street that the permit card b located at the front of the property, and the approved set of plans wil remain on the site
at all times durins construction
9- -27-OG(h*hA
Owner or Contrrc(rs Signature
2ol 2
Date
Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
WebAddress:!Erygb!8!g@
permit *: Coyaz-o<e- O O ZjO
Address:6z; ztsF s
Issued by:\5 Date 2(/o
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), neednot submit this statement. This statementwtll befiledwith thepermit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38:
\
ff t. I own, reside in, or will reside in the completed structure
2. I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion.
tr 3A. My general contractor is
(Name)(ccB #)
v
Y
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Constuction Contractors Board.
OR
38. I will be my own general contactor.
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.
*-R7-M
permit applicant)(Date)
(White copy to issuing agenq) pennitfile, pink copy to applicant.)
Property_owner. doc 06-0 1 -04
Ac*img es *sur *wxr Gcxrerafr Contractor?
Xf{FSK&{ATISN NST'CH T* Pffi*PffiRTY ffiWNMKS
SLStrUT C*r*$?RUCf*Sru ffi m$pffi h*$&ffi lI-ITIX$
ffOI#; trliis lnfurrrafi'on ldoffee to Fr*p*rty Onrrers a&o$f S*nsfr*cfion &esponsiblldi*s was d*v*laped by th*
S*nsfruefior: Co*fracfors fioar# in aceordance witlt $&,S 7&?"S5$f5J, pa.*sed Sy flre ?98$ Oregon leglslafare.
lf y*x are acti*g es yslnr *aq,n **ntraet*r tc) **nstnlct a :rew k*rx* *r make a sub*tantial inxpr*v*l:?ent t* an existing
$&"*etl.;*:e" yr:u *efi ;?r*l"ffit mainy problerors by treing aware of the fiollowing rcspcnsibilities and ssnfferfis"
ffi mrpX*ysr K*spmxx s*b{}tties
You will, in mrst insta*c*s, be rui*d ts be an '"ernplsyer" end the s$rttre$t$rs y<lu contract with:arill be "emplsy*es" if
y*rl u$s cclntractcrs n*t ti*e$se{i with tlie ilonstffi;rti*lt C*niractors S*ard t* dc }abor iu conskucti*g or t* assist in t}re
c*nstnr*li** *r im rovcrnent qrf a resid*xgia! skx*ftire. As the emrp[*y*r, you must comply ryith the fo]I*wlng:
*r*gein's Wi*kh*Id*mg Yax Lxw; As an *mpl*yer, y*u m*st withhold illc*rtr* t;rxes fi'*m emp?*ye* \tragss at thr ti*re
ompl*yers are paicl. Y*r: will be liabte f*r the cax peyn"rfin{s evsrs {f y** d*n't actua}}y withhotd t&e tax .fi*r:r y**r
emptr*y*es" Sor:n*r* i*i*ru:*ti*n, catrl the $eparfinent crf R"evexuo at 5S3-3?S-4988.
U*curployment l*sur*mee Tnx: As ar: exnpl*yer, you are required to pay * tax fbr unemploymerrt insura*cs purps$es\
on tl:re lr/agss of all empi*yees. For n:cre inf,*rmation, call the Sreg*n Hmployrrent llepartment at 5S3-947-i488.
The Oregon Businsss n<ientificaticn N*nrber (*S$ is a eombined nurnber for both Oregon 'Witirholding and
Uneinplo1merrt}nsuranc*Tax.Tofi1efor*BIN,ca1i503.945-8091eirf.orthe
appropriate forms.
Workers' Compe*sation Insxrance: As aa empl*yer, you are subject tc th* *r*gcn $/*rkers' C*mpensaticn l-aw,
and must obtain rvorkers' compens*tion insrxance for y*ur emplayees. If,you fail ts obtain wcrkers'ccmpensation
insurance, you could be subject to penalties and be liable for ali clairn costs if ore of your ernployees is iljured on the
job. Fcr more infarmation, eall th* Workers' Cornpensatio,r: Division at the Departmffit of Cqrnsumer aad Business
Services at 5S3-?47-78 15.
U"$" X*{ernnl Rov*mre* Serviee: As a;: *mpl*yer. you must rvitirhcld federal income tax frorn ernployees' $/ages.'--
You rvill b* lia'ble f*r the lax pay:nent *ve$ if y*x didl:'t ;rct*a}}y v,,ithh*ld tl"rc tax. Fr:r a Federal ilIN nur*:ber, clall the
IR"S at I-E00-S?q-4933 *r visit their web site at wlvrv.ir:$.gov-"
$ther Responribilities amd ,&.reas of C*nc*rns
Cod* Coxnpliam**: As the p*rmit h*trd*:r f*r tl*s pr*j*ct, ysu ar* respr*r'rxible fur resr:lving ;*ny failure to m*e{ r:*de
requirern*nto thac ntay }:e bro*ght t* y*lr attention Nlx*ugtr insp**ti**s"
I*i*b*|ity axd Pr*per*y Bx**rag* *assrxrlce: Cuntaet y*ur i*surar:ee agc*t tc see if you h*ve adequat* ins*rance
eover&Se for *c*i<lenli .rnri olmssr*:rrs sr-r*h els falli*g lo*ls, pain{ *ver $Fray} rvater dan:xge fr*m pipe p***ture$, fir* $r
vr*rk th*t must be red*ne"
Timer Make surs you have suf{icieut time tc sup*rvise your empl*yees.
Xxpertis*; A,{ake srr* y*u }rave the ski}ls tl: act as y*ur slvr} ger:eral e o*lr'*l*lsr, 1* ***rctrinatc the ur*rk *f r*ugh-in
aad finish tr*d*s, an<l t* m*tify buildir:g ofiicials xs thc *ppr*pri*t* times s* they ea* p*rf*r:ex ti:e* r*quiren3 inspecli**s.
If y*u have additi*nal questions call the C*r::rstrur:tion Ccnr:rctors 33*ard {5S3-371}4S?li or llrrite the ag*ncy at PCI
Box 1414S, Salen"t,0I{ 97309-5052.
Property_o*"ner.doc 05-* I -**N
225 Fifth Street
Sfiringlield, Ore gon 97 477
541-726-3759 Phone
^ity of Springfield Official Receipt
_-,evelopment Services Departm ent
Public Works Department
RECEIPT#: r200600000000000211 Date: 0212712006 1:23:45PM
Job/Journal Number
coM2006-00230
coM2006-00230
coM2006-00230
Description
Building Permit
+ 8% State Surcharge
+ l0% Administrative Fee
Amount Due
45.00
3.60
4.50
Item Total:$53.10
Payments:
Type of Payment Paid By Received By
Check Number
Batch Number
Authorization
Number How Received Amount Paid
Check CHRIS WALPOLE djb ll0 In Person
Payment Total:
$53.10
-s$id'
I
'(
'I
I
212712006 lofl
SPilXG"IILO
FD-016
TO Building Department
Springfield Fire Department
Structural Damage to Building
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARI)
sr
Date: Z L o
U .ccZLOFROM:
SI]BJECT:
Address or location of building
Name of Owner Ji IL C
Type of Building
Store, Warehouse, etc.)
Estimatedvalueofbuilding $ \\ h, OOr\
Estimated loss to building $OD
Date of fire
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire {)- o tu f ,)J,:tsTJ
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
(Wiring, Outlets, etc
CC
V:\FD_FORMS\FIX)16 FIRE DAMAGE REPORT.doc
Signed
Location of damage to building i . .'r \\ L'e l, , pr- ,, Fi k Le + rlo"o7 e
FD-016
FIRE DAMAGE REPORT
OR
ELECTRICAL IIAZARI)
Building Department
Springfield Fire Department
Structural Damage to Building
Address or location of building bz{ 2/
c+.bL?J)
TO:
FROM:
SIJBJECT:
Name of Owner
Date:3 t7 - oL(
)?-.5+----/
L
Type of Building
@welling, Store, Warehouse, etc.)
Estimated value of building $.2--<-c c9
Estimated loss to building $t*tl
Date of fire
Location of damage to building .-/z-,L--/-n
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire a.,' ' * z--r,+//s
/
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information 2'-.-(,-. *-/.a /-<- .
Electrical Hazard t--1-- Lr,n-
(Wiring, Outlets, etc.)
CC
V:\FD_FORIVIS\FD{16 FIRE DAMAGE REpORT.doc
Signed t-/
I