HomeMy WebLinkAboutPermit Building 2019-12-30SPRINGFIELD-
-OREGON
PRINGFIELD--OREGON
Web Address: www.springfield-or.gov
Building Permit
Residential Structural
Permit Number: 811-19-002876-STR
IVR Number: 811082486035
Permit Issued: December 30, 2019
TYPE OF WORK
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
541-726-3753
Email Address: permitcenter@springfield-or.gov
Category of Construction: Single Family Dwelling Type of Work: Alteration
Submitted Job Value: $3,000.00
Description of Work: Rec room into a bedroom
JOB SITE INFORMATION
Worksite Address Parcel Owner: MORRIS ARTHUR W &
1427 Menlo LOOP
Springfield OR 97477
1703273302900
CECILY R
Address: 1427 MENLO LOOP
SPRINGFIELD, OR 97477
LICENSED PROFESSIONAL INFORMATION
Business Name License License Number Phone
OWNER - Primary CCB 000000
PENDING INSPECTIONS
Inspection Inspection Group Inspection Status
1999 Final Building
1260 Framing
Struct Res Pending
Struct Res Pending
SCHEDULING INSPECTIONS
Various inspections are minimally required on each project and often dependent on the scope of work. Contact
the issuing jurisdiction indicated on the permit to determine required inspections for this project.
Schedule or track inspections at www.buildingpermits.oregon.gov
Call or text the word "schedule". to 1-888-299-2821 use IVR number: 811082486035
Schedule using the Oregon ePermitting Inspection App, search "epermitting" in the app store
Permits expire if work is not started within 180 Days of issuance or if work is suspended for 180 Days or longer depending on
the issuing agency's policy.
All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not.
Granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copies of the rules by calling the Center at (503)
232-1987.
All persons or entities performing work under this permit are required to be licensed unless exempted by ORS 701.010
(Structural/ Mechanical), ORS 479.540 (Electrical), and ORS 693.010-020 (Plumbing).
Printed on: 12/30/19 Page 1 of 2 C:\myReports/reports//production/01 STANDARD
Permit Number: 811-19-002876-STR
PERMIT FEES
Fee Description
Technology Fee
Structural building permit fee
State of Oregon Surcharge - Bldg (12% of applicable fees)
Page 2 of 2
Quantity Fee Amount
$5.76
$115.10
$13.81
Total Fees: $134.67
Printed on: 12/30/19 Page 2 of 2 C:\myReports/reports//production/01 STANDARD
SPRINGFIELD City of Springfield
Development and Public Works
Transaction Receipt 225 Fifth Street
811-19-002876-STR Springfield, OR 97477
541-726-3753
OREGON
IVR Number: 811082486035 permitcenter@springfield-or.gov
Receipt Number: 473398
Receipt Date: 12/30/19
www.spdngfield-or.gov
Worksite address: 1427 Menlo LOOP, Springfield, OR 97477
Parcel: 170327 3302900
Payment Method: Credit card Payer: MORRIS ARTHUR W Payment Amount: $134.67
authorization: 03631d & CECILY R
Cashier: Katrina Anderson
Receipt Total:
$134.67
Printed: 12/30/19 10:56 am Page 1 of 1 FIN TransactionReceipt_pr
Fees Paid
Transaction
Units
Description
Account code
Fee amount
Paid amount
date
12/30/19
1.00 Ea
Structural building permit fee
224-00000-425602-1030
$115.10
$115.10
12/30/19
1.00 Ea
State of Oregon Surcharge - Bldg
821-00000-215004-0000
$13.81
$13.81
(12% of applicable fees)
12/30/19
1.00 Automatic
Technology Fee
204-00000-425605-0000
$5.76
$5.76
Payment Method: Credit card Payer: MORRIS ARTHUR W Payment Amount: $134.67
authorization: 03631d & CECILY R
Cashier: Katrina Anderson
Receipt Total:
$134.67
Printed: 12/30/19 10:56 am Page 1 of 1 FIN TransactionReceipt_pr
Structural Permit Application
225 Fifth Street ♦ Springfield, OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689
i
RINGFIELD
OREGON
DEPARTMENT USE ONLY
Permit no
Date:
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
This project has final land -use approval.
Signature: I Date:
This project has DEQ approval.
Signature: I Date:
Zoning approval verified: ❑ Yes ❑ No
Property is within flood plain: ❑ Yes ❑ No
CATEGORY OF CONSTRUCTION
Residential I ❑ Government ❑ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: / q (, a L p0
City: ,S' N /% ! State: O ZII''-? 7117
Subdivision: p Lot no.: L3 CPe
Reference: I Taxlot:
PROPERTY OWNER
Name:
Address: /It 2 " L D Z 7�f'
City: Ara State ZIP:11 7y -j
Phone: 6 _111 Fax: - -
E-mail: Q
Building Owner or Owner's agent authorizing this application:
Sign here:
This installation is being made on residential or farm property owned by
me or a member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
CONTRACTOR INSTALLATION
Business name:
Address:
City: A State: I ZIP:
Phone: - Fax:
E-mail:
CCB license no.:
Print name:
Signature:
SUB -CONTRACTOR INFORMATION
Name I CCB License # 1 Phone Number
Electrical
1 Plumbing
Mechanical
Last edited 5-5-2017 BJones
or if work is
FEE SCHEDULE
1. Valuation information
(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot:
Other information:
Type of Heat:
Energy Path:
❑ new ❑alteration ❑ addition
(b) Foundation -only permit? ❑ Yes ❑ No
Total valuation:.
2. Building fees
(a) Permit fee (use valuation table):
$
(b) Investigative fee (equal to [2a]):
$
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
$
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
$
(e) Subtotal of fees above (2a through 2d):
$
3. Plan review fees
(a) Plan review (65% x permit fee [2a]):
$
(b) Fire and life safety (65% x permit fee [2a]):
$
(c) Subtotal of fees above (3a and 3b):
S
4. Miscellaneous fees
(a) Seismic fee, 1% (.01 x permit fee [2a]):
$
(b) Tech fee, 5% (.05 x permit fee[2a]+PR fee [3c])
$
TOTAL fees and surcharges (2e+3c+4a+b):
$ , CP71
,Gal- Tv 150 ut-
et 9 -3
0Y1611 -C"%E G10XCA$ / Twp
_ _L 5
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law 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. (ORS 701.325 (2))
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.
Please check the appropriate box:
D' I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
r—�
j� I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
1 will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. 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 select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and 1 hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applicant
is
Signature of Permit Applicant Date
Permit* 0 Q
Address: L t
Issued by: Date: AeA Jic>
This Copy for Permit Offices
Information Notice to Owners About
F= Construction Responsibilities
(ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
■ Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
= Oregon's Withholding Tax Law: Employers 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: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
9 Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
■ Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their 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 workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
■ Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
■ Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
■ Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough -in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone: 503-378-4621 — Fax: 503-373-2007
Website Address: www.orecion.gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit
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