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Home My WebLink AboutPermit Building 2007-06-11C Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-01493ISSUED: 0611112007 APPLIEDz 1210712004 EXPIREST l2llll?007VALUE: $ 26,650.00 SITE ADDRESS: 454 35TH ST ASSESSOR'S PARCEL NO.: 1702312411401 PROJECT DESCRIPTION: Garage and carport Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential NDER THIS PERMIT IS NOT PhONE NUMbET: 541-912-1865 COMMENCED O R IS ABANDONED FOR Owner: TODD CLIFTON Address: 454 35TH ST SPRINGFIELD OR 97478 AUTHORIZED U Contractor Type General Electrical Contractor OWNER OWNER Expiration Date 12l18l20l0 Phone 541-747-6638 License 8699 # 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: o/o of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/CarPort Sq Ft Other: Occupant Load: U VN 900 288 35.00 26.00 nla 24.30 UTilWOregontorth REQUIRED PARKING Total: 2 Handicapped: Compact: 12.00 s.00 Fullv I Curbside 5' Curb and Gutter Notes: Pase 1 of3 Status Issued 225 Fifth Street, SPringfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01493ISSUED: 0611112007 APPLIEDT 1210712004 EXPIRESz l2ltll2007VALUE: $ 26,650.00 Description Carport Garage Fee Description Plan Review Residential + lDoh Administrative Fee + 77o State Surcharge Garage/Carport Plan Review Minor - Planning SDC SanitarY/Storm Admin Storm Drainage ImPervious Area Storm Sewer - 1st 50 Feet + l0o/o Administrative Fee + 77o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amPs or less + l0o/o Administrative Fee + 57o TechnologY Fee Renew Building Permit Renew Electrical Permit Renew Plumbing Permit Total Amount Paid Initial Review Planning Review Public Works Review Total Value of Project Date Paid Value $4,780.80 $21,870.00 $26,650.80 Date Calculated 01/18/2005 1210712004 Receipt Number 1200400000000001702 22005000000000000s9 2200500000000000059 2200500000000000059 22005000000000000s9 2200500000000000059 22005000000000000s9 22005000000000000s9 1200s00000000000660 1200500000000000660 r 200500000000000660 1200500000000000660 1200700000000000732 l 200700000000000732 I 200700000000000732 1200700000000000732 1200700000000000732 Storm drainage to existing system to curb face 1211412004 CAS See documents for Plan review comments nspections requested before 7:00 :00 a.m. will be made the following Type of Construction Carport Garage $ Per Sq Ft or multiplier $16.60 $24.30 Square Footage or Bid Amount 288.00 900.00 Amount Paid $r53.47 $28.11 $19.68 $236.10 $59.00 $29.14 $s82.80 $45.00 $8.10 $5.67 $18.00 $63.00 $13.50 $6.75 $4s.00 $45.00 $45.00 t2t7l04 yt4l05 1n4105 Ut4l05 ut4l05 ul4l05 ut4l05 yt4l05 5124105 5124105 5t24t05 5124105 6nll07 6nll07 6t1u07 6nu07 6llu07 $1,403.32 12t0812004 t2t0812004 12t08t2004 12t0812004 r2n7t2004 12n412004 APP APP APP SKG TAJ CAS Structural Review 12t0812004 0l/05/2005 APP DLM To Request an inspection call the 24 hour recording at 726'3769. Alli' a.m. will be made the same working day, inspections requested after 7 Plan Reviews work day. Paee 2 of3 F'ees Paid I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01493ISSUED: 0611112007 APPLIED: 1210712004 EXPIRESz l2llll2007VALUE: $ 26,650.00 Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Framing Inspection: Prior to cover and after all rough in inspections have been approved' Drywall: Prior to taPing. Final Building: After all required inspections have been requested and approved and the building is complete' Storm Sewer Line: Prior to filling trench. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete' By signature, I state and agree'that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made 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 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 ofplans will remain on the site at all +l^times du Owner or rs Signature t/)ttne ru7 Date Paee 3 of3 Reouired lnsnections 225 FifJh Street Springfield, Oregon 97 477 541-726-3759 Phone 6':t'y of Springfield Official Receipt relopment Services DePartment Public Works DePartment RECEIPT #: 1200700000000000732 Date: 0611112007 8:51:06AM Job/Journal Number coM2004-01493 coM2004-01493 coM2004-01493 coM2004-01493 coM2004-01493 Description + 5%o Technology Fee + 10Yo Administrative Fee Renew Building Permit Renew Plumbing Permit Renew Electrical Permit Item Total:$r5s.2s Amount Due 6.75 I 3.50 45.00 45.00 45.00 Payments: Type of Payment Paid BY Check Number Batch Number Authorization Number How Received Amount PaidReceived By djb 473419 In Person Payment Total:$155.2s $ 155.2s CreditCard TODD CLIFTON cReceint I Page I of I 6^112007 rxil$ae[mD City of Springfield Development Services Department Community Services Division, Building Safety 541-726-3759 Phone 541-726-3676Fax May 4,2007 TODD CLIFTON 454 35TH ST SPRINGFIELD, OR 97478 Date Permit Issued:Ut4l200s Permit Number:coM2004-01493 Location:454 35TH ST Project Description:Garage and carport Dear Permit Holder: As stated on your permit and/orapproved plans, work authorized under the permit issued will expire if the work is not coflrmenced or is abandoned for any 180 day period. Because you did not contact us to request an inspection or to call us to verify that progress has continued to be made on the project, your permit(s) has expired. This letter is a reminder that the above referenced permit(s) expired on 1211912006. please contact our office at Springfield City Hall, 225 Fifth Street, Springfield, Oregon between 8:00 a.m. and noon or between 1:00 p.m. and 3:00 p.m. Monday through Friday,excluding holidays prior to continuing work on your project. There are additional fees that are due in order to complete your project. incerely, Hopper Building Safety Management Analyst cc Dave Puent, Community Services Manager Code Enforcement City of Springfield 225 Fifth Street, Springfield, Ox^97477 547-726-3759 Phone 541-726-3676 Fax November 22,2006 CLIFTON 454 35TH ST SPRINGFIELD Job Number: Location: oR 97478 coM2004-01493 454 35TH ST TODD Project:Garage and carport 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 454 35TH ST which is set to expire on 1211912006. 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 54I-726-3790. Sincerely, Lisa Hopper Building Safety Management Analyst City of Springfield 225 Fifth Street, Springfield, OR 97477 541-726-3759 Phone 541-726-3676Fax May 04, 2006 CLIFTON 454 35TH ST SPRINGFIELD Job Number: Location: oR 97478 coM2004-01493 454 35TH ST TODD Project:Garage and carport 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 454 35TH ST which is set to expire on 612l12006. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notiff 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 541-726-3790 Sincerely, Lisa Hopper Building Safety Supervisor City of SPringfield 225 Fifth Street, Springfield, OR97477 541-726-3759 Phone 541-726-3676Fax October 20,2005 CLIFTON 454 35TH ST SPRINGFIELD Job Number: Location: oR 97478 coM2004-01493 454 35TH ST TODD Project:Garage and carport 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 454 35TH ST which is set to expire on lLl24l2OO5. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notifu 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 S afety S upervisor A. New Residential $ e.o0 ,% 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726'3689 ELECTRICAL P ERMIT APP LICATION City Job Number c -o Date 5* Z 5 L O CA'rr ON OF rNSryI I-A7' r O NI 3. '/ s'7 N, 3 f sf.egt unit.LEGAL DESCRTPTION i7o2!)tz-ft/40l JOB DESCRIPTION of,,.,l Permits are non-transferable and "' not started within 180 days of issuance Suspended for 180 days. ., e c,rr-.,;E Yqr Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof 601 Amps to 1000 Amps Over 1000 AmpsA/olts Reconnect Only 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Relocation: /2, b) City Electrical Contractor Address Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Signature Electrician ownersName T.Ji R. C"1,1'*on Address fi-l lJ 3f slreef City 'th 7tL-/A65 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. C. Temporar.v Services or Feeders Installation, Alteration or Relocation $ 63.00 $ 75.00 $ 125.00 $163.00 $375.00 $ s0.00 $ 50.00 $ 69.00 $100.00 s 43.00 $ 3.00 Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit ,P"66Ii'dtional Circuit or with Q:I4." o/reeder Permit t>/8 E. Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is M5.00 * Surcharges Pump or irrigation Sign/Outline Lighting 7%o State Surcharge 10% Administrative Fee TOTAL $ s0.00 $ s0.00 B/Owners Sisnature:-t/t-d4-.-s@ Inspection Request: 726-3769 6ro ?{ ?Z Shared Drive(T:)/Building Forms/Electrical Permit Application I -03.doc COMPLETE 401 Amps to Amps THIS P D. L 4. SWTOTAL OF ABOVE 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: COM2004-01493ISSUED: 0111412005 APPLIEDz 1210712004 EXPIRESz 1112412005VALUE: $ 26,650.00 SITE ADDRESS: 454 35TH ST ASSESSOR'S PARCEL NO.: 1702312411401 PROJECT DESCRIPTION: Garage and carport Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential Owner: Address: Contractor Type General Electrical Contractor OWNER OWNER TODD CLIFTON 454 35TH ST SPRINGFIELD OR 97478 PhoneNumber: 541-912-1865 License Expiration Date Phone CONTRACTOR INFORMATION # 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: # ofStories: Height of Structure Center is 1 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo ofLot Coverage: Lot Size: st Floor: Oregon law requires FIoor: adoPted bY the Orego Center.Those rules are -00 10 through OAR coptPi of th Load: U YN 900 288 35.00 26.00 N -2344\. 24.30 Sidewalk Type: Downspouts/Drains: n REQUIRED PARKING Total: Handicapped: Compact: 2 12.00 5.00 Fully Improved yes Curbside 5' Curb and Gutter it'iJftpi"rP'5H$i*ff,gJs itY\Hi-^! Ptntoo PUBLIC IMPROVEMENTS Notes: Page 1 of3 I,ulLUtNU rNtur(lvrluJ 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: COM2004-01493ISSUED: 0111412005 APPLIEDT 1210712004 EXPIRESz 1112412005VALUE: $ 26,650.00 Description Carport Garage Type of Construction Carport Garage $ Per Sq Ft or multiplier $16.60 $24.30 Square Footage or Bid Amount 288.00 900.00 Value $4,780.80 $21,870.00 $26,650.80 Date Calculated 01/18/2005 12107t2004 Fee Description Plan Review Residential + l0oh Administrative Fee + 77o State Surcharge Garage/Carport Plan Review Minor - Planning SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet + l0Yo Administrative Fee + 7o/o State Surcharge Add, Alter, Extend Circ Ea Add Perm Serv/Fdr 200 amps or less Total Amount Paid Total Value of Project Date PaidAmount Paid $153.47 $28.11 $19.68 $236.10 $s9.00 $29.14 $582.80 $45.00 $8.10 $s.67 $18.00 $63.00 $1,248.07 Receipt Number 1200400000000001702 2200s000000000000s9 2200500000000000059 2200s00000000000059 22005000000000000s9 22005000000000000s9 2200s000000000000s9 2200500000000000059 1200500000000000660 1200500000000000660 1200500000000000660 r200500000000000660 t2t7t04 yt4t0s ur4l05 ut4t0s Ut4t05 ut4l0s 1n4t05 ut4t0s 5t24t05 5t24t0s sl24t05 5t24t05 tr'ees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 12t08t2004 12t08t2004 12t08t2004 12108t2004 1211712004 12^4t2004 APP APP APP SKG TAJ CAS 12t08t2004 01/05/2005 APP DLM Storm drainage to existing system to curb face 1211412004 CLS 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 foltowing work day. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Paee 2 of3 Rennirpd Insnpefinns Valuation Description I Status Issued 225 Fifth Street, SpringIield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01493ISSUED: 0111412005APPLIEDz 1210712004 EXPIREST 1112412005VALUE: $ 26,650.00 Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Storm Sewer Line: Prior to fiIling trench. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made 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 ,t?, -t oQG' )-5*- 24 -D3- Owner or C/ntractors Signature Date Pase 3 of 3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone lity of Springfield Official Receipt - Oevelopment Services Department Public Works Department RECEIPT #: 1200500000000000660 Date: 0512412005 2:47:07PM Job/Journal Number coM2004-01493 coM2004-01493 coM2004-01493 coM2004-0r493 Description Perm ServlFdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7o/o State Surcharge + lUYo Administrative Fee Item Total: Payments: Type ofPayment Paid By Received By Batch Number Number IIow Received Amount Paid CheckNumber Authorization CreditCard PHILLP CLIFTON djb 614274 In Person $94.77 PaymentTotat: -5Ei7 l-t t ,: 512412005 Page I of I Amount Due 63.00 18.00 5.67 8.10 s94.77 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-01493ISSUED: 0111412005 APPLIEDz 1210712004 EXPIRESz 0711412005VALUE: $ 26,650.00 SITE ADDRESS: 454 35TH ST ASSESSOR'SPARCELNO.: 1702312411401 PROJECT DESCRIPTION: Garage and carport Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential Owner: Address: Contractor Type General Contractor OWI\ER TODD CLIFTON 4s4 35TH ST SPRINGFIELD OR 97478 PhoneNumber: 541-912-1865 License Expiration Date Phone CONTRACTOR INFORMATION # 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: # ofStories: Lot Size: Height of Stnictuie -;,-''- le!,rr require$6ffftrt Floor: Type of Heat: ',.1 i)y tire Oregofi(nlilyd Floor: Water Type: i:-ii,li -rncse rules areQ*ffdfrtement: U VN 35.00 26.00 Range Type:gh oAR Energy Path: Spdnkleg Euldu$er. (ti nla of the Load: REQUIRED PARKING Total: 2 Handicapped: Compact: Curbside 5' Curb and Gutter 900 288 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: e tel 24.3012.00 s.00 HI Sidewalk Type: Downspouts/Drains: Fullv Improved Yes Notes: $ Per Sq Ft or multiplier Square Footage or Bid Amount PUBLIC Description Type of Construction Pase I of3 Value Date Calculated l' U r Lr"rlN u rrygx!4qf rlll_l f ht\ Valuation Description 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: COM2004-01493ISSUED: 0111412005 APPLIEDz 1210712004 EXPIRESz 0711412005VALUE: $ 26,650.00 Carport Garage Carport Garage $4,780.80 $21,870.00 $26,650.80 12t07t2004 12t07t2004 $16.60 288.00 $24.30 900.00 Total Value of Project Date Paid Fee Description Plan Review Residential + l0Yo Administrative Fee + 7%o State Surcharge Garage/Carport Plan Review Minor - Planning SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Total Amount Paid Amount Paid $153.47 $28.11 $19.68 $236.10 $s9.00 $29.14 $s82.80 $4s.00 $1,153.30 r2t7t04 yt4l05 ilt4t0s ut4t05 yt4t05 ut4l05 ut4t0s ut4l05 Receipt Number 1200400000000001702 2200500000000000059 22005000000000000s9 2200s00000000000059 2200500000000000059 2200500000000000059 2200500000000000059 22005000000000000s9 ['ees Paid Plan Reviews Initial Review Plannins Review Public Works Review Structural Review 12t08t2004 12t08t2004 12t08t2004 t2108t2004 12n7t2004 12n4t2004 APP APP APP SKG TAJ CAS 12t08t2004 01/05/2005 APP DLM Storm drainage to existing system to curb face 1211412004 CAS 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Storm Sewer Line: Prior to filling trench. Rpnrrirpd Insnpefinns Paee 2 of3 .: Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax S4l-7 26-37 69 Inspection Line PERMIT NO: COM2004-01493ISSUED: 0111412005 APPLTED| 12t07t2004 EXPIRESz 0711412005VALUE: $ 26,650.00 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 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 Page 3 of3 L Construction Contractors Board 700 Summer St IttE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: rysl[lg4q Ad&ess L4 SLl 3 S+^ St- Permit #:-otrl73 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 buildtng, electrical, mechanical and plumbing permits. Ltcensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. ry 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 #) 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. iz4- r@6 Issued by: ofpermit applicant) (White copy to issuing agency permitfile, pink copy to applicant.) Properfy_owner. doc 06-0 I -04 7 Fill in the appropriate blanks and initial boxes I and 2, md either box 3A or 3B: ff f . I own, reside in, or will reside in the completed structure. I will instnrct my general contractor that all subcontractors who work on the stnrcture must be licensed with the Construction Contractors Board. .-/oR -[l. fg. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Constuction 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. Acting'as'Y our €}wn General Con*ractor? INFORMATION NOTIGE TO PRGPERTY OWNERS ABOUT CONSTRUGTION RESPONSIBILITIES If you are acting as your own contactor to construct a new home or make a substantiai improvement to an existing stnrcture, you can prevent many problems by bems aware of the following rrisponsibilitiis igd.concerns. Employer Responsibilities You will,.in most instances, be nrled to be an o'employer" and &e contractors you contact with will be "employees" if you.use conhactors not licensed with the ConsEuction Contractors Bpard to do labor in constructing or to assist in the construction or. improvement of a residential structure. As the employer, you must comply with the followiqg: Oregon's Witlholding Tax Law: As an employer, you must withhold income taxes &om employee wages at the time employees are paid. You will be liablE for the tax payments even if you don't actuaily withhold the tax from your employees. For more informafion, call the Deprtment of Revenue at 503-3784988. Unemployment Ins*rance Tax: As an employer; you are required topay a tax forunemploynxert insurance purposq{: on the wages of ali employees. For more information, call the Oregon Employrnent Department at 543-947-1488. ,\ The Oregon Business Identification Number Gnq is a combined number for both Oregon Withholdrng and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or x,'*,rv.dor.state.or.us/formspay.htmll for the appropriate forms lYorkers' Compensafion Insurance: As an employer, you are subject to the Oregon Workers' Compn'rsation Law, and must"o-btain workers' compensation insurance for your employees. If you fail to obtain workers'compensation insurance, you couid be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Departinent of Consumer and Business Services at 503-947-781 5. U.S. Internal R"evenue Service: As an employer, you must withhold federal incorna tax from enipioyees',*"g.* You will be liable lbr the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRSat1-800-829-4933orvisittheirwebsihatwrvrv.iis.gov . ., :' Other Responsibilities and Areas of Concerns Code Compliance: As the pennit holder for this project, you are responsible for resolving any failure to meet code requiremcnts that may bc brought to your attention qhr::Fh inspections. i: Liabitity antl Froperg; Ilamag* Insarance: Contac? yottr insurance agent to see if you tiave adequate insiJranc#l coverage feir accidents and omissions such as faliing tools, paint over spray, water damage frr:m pipe puncrure$, fire or wark that rnust be red*nc. Time: Make #ffirncie,t time to .r.,p"..ri.. yo* "*plosrym f,xpertise: Make sure you havi: thd skills'io ict as yoir'owir'genii& contractor, to coordiiiat" the work of rough-in and finish frades, and to notiff building officials as the appropriate times so they can perform the required inspections. If you have addirional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 973$9-5052. !.,-. r, : .,,: Property_owner.doc 06-0 1 -04 E NATE: This lnformation Notice to Property Owners abaut Constructbn ResponsiSiliiie,s was developed by the Construction Contractors Board in accordance with ARS 701.055(5), passed by the 1989 aregon Legislatura. JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLTNG TINITS I. STORM DRAINAGE DIRECT RTINOFF TO CITY STORM SYSTEM CITY OF SPRINGFIELD SYSTEMS DEVELOPMEN1 CRKSHEET coM2004-01493 Clifton 454 35th St 1702312411401 0 BUILDING SIZE LOT SZE (SF):0 RUNOFF ROUTED TO DRYWELL DESIGNED AND IMPERVIOUS S.F 0.00 I rMPERVrous s-F.l-I r sro.oo ADT TRIP RATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 SUBTOTAL $s82.80 COST PER S.F $0.310 NTIMBER OF UNITS 0 NT.]MBER OF LTNITS 0 ADM. FEE RATE 5o/o CHARGE $582.80 TO CITY STANDARDS DISCOI.]NT RATE 5l%o DISCOUNT $0.00 x x x x x x x x ITEM 1 TOTAL - STORM DRATNAGE SDC $s82.80 2. SANITARY SEWER - CITY A COST: COST PER DFU s24.04 COST: x $18.28 ITEM 2 TOTAL - CITY SANITARY SEWER SDC $0.00 A. REIMBURSEMENT COST: x B xx xx COST PER TRIP $r 8.30 COST PER TRIP $80.72 $0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENTCOST: NUMBEROF FEU's 0 B. IMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATTVE FEE ITEM 4 TOTAL - MVYMC SANITARY SEWER SDC SIIBTOTAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE: $0.00 $582.80 CTIARGE s29.14 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRA Cheryl Slaymaker 1211412004 COST PER S.F $0.3 l0 NUMBER OF DFU's 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 29.14 $611.94 I 070 r 091 1092 I 093 I 094 I 055 1054 l0s6 079 078 U) rrloo(-) & E]Fa or!d NUMBER OF DFU's 0 COST PER FEU $82.03 COST PER FEU $865.31 PREPARED BY DATE TOTAL SDC CHARGES DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OFNEW FD(TURES x UNTT EQUTVALENT = DRAINAGE FXTURE UMTS FOR CALCULATE ONLY THE NET ADDMONAL NO. OF FIXTURES UNIT FIXTURE TYPE NEW OLD ALENT MISCELLANEOUS DFU TYPE NT]MBER OF EDU'S TOTAL DRAINAGE FD(TURE UNITS isa toa unit set at I 67 MWMC CREDIT CALCULATION TABLE: BASED ON COTJNTY ASSESSED VALUE DRAINAGE FIXTURE UNITS 0 2 2 1979 +EDU BEFORE 1979 1979 I 980 t98t 1982 1983 I 984 I 985 I 986 1987 1988 1989 1990 l99l 't992 1993 t994 I 995 1996 1997 I 998 1999 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.0e $0.05 $5.29 $5.1 9 $5.12 $4.98 $4.80 $4.63 $+.+o $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 IS LAND ELGIBLE FORANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) VALUE/ IOOO $0.00 CREDIT RATE $5.29x CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $5.29 TOTAL MWMC CREDIT BATHTUB 0 0 3 0 DRINKING FOTINTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 b 0 LAUNDRY TUB 0 0 2 0 CLOTHESWASMR/MOP SINK 0 0 3 0 CLoTHESWAST{ER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASTIER / ETC.0 0 3 0 SHOWE& SINGLE STALL 0 0 2 0 sHowER, GANG (NUMBER OF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTTAL KITCHEN 0 0 3 0 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 1 0 T]RINAL, STALL / WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 6 0 TOILET, PRIVATE INSTALLATION 0 0 3 0 0 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 2000 200t 20 225 Fifth Street Springffeld, Oregon 97 477 541-726-3759 Phone rity of Springfield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 2200500000000000059 Date: 0111412005 1:18:00PM Job/Journal Number coM2004-01493 coM2004-01493 coM2004-01493 coM2004-01493 coM2004-01493 coM2004-01493 coM2004-01493 Description Storm Drainage Impervious Area SDC Sanitary/Storm Admin Plan Review Minor - Planning Garage/Carport Storm Sewer - lst 50 Feet + 7o/o State Surcharge + l0% Administrative Fee Amount Due s82.80 29.14 s9.00 236.10 45.00 19.68 28.11 Item Total $999.83 Payments: Type of Payment Paid By Checl(Number Authorization Received By Batch Number Number How Received Amount Paid CreditCard PHILLIP CLIFTON djb 014407 In Person $999.83 Payment Total : -5999.-67 ut4l200s Page I of I '5mrfD