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Home My WebLink AboutPermit Building 2002-02-27SPRINGFIELD Job# 02-00143-01 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Page 1 of4 Job Number: 02-00143-01 Office:726-3759 lnspection Line: 726-3769 Tax Lot #: 03600 Subdivision : Ambleside 225 Fifth Street Springfield, OR97477 Location Of Proposed Site: 2292 00035th St Spr AssessorsMap#: 17021943 Lot: 82 Block: Addition: 1st ctTY oF SPRTNGFTELD, OREGOI' Owner: Guy Gibson Address: 6783 Camellia Court Scope Of Work: Single Family Residence SFR Phone Number: City/State/Zip: New 541-726-8453 Springfield, OR 97478 Value: $211,040 Contractor Type General Contr Electrical Contr Mechanical Contr Contractor Dave Duncan Construction 2646 Hawkins Lane, Eugene, OR 97405 Harding Electric lnc 1019 Brotherton Ave, Eugene, OR 97404 Dean Heating and Air 4301 Main, Springfield, OR 97478 2t2312003 541-767-0626 Registration # 114894 61112003 541-485-9196lr t0 1 32089 1 33733 21112004 541 -688-5006 g t\rl To request an inspection call the 24 hour recording a1726-3769. All inspections 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 working day. NOTICEI Required lnspections rHtc ptrFltvltT SHALL EXPIRE IFTHE WORK Building I AUTHORIZED UNDERTH]S PERMIT IS NOT -To be made after excavation but prior to setti ns foTmSOMMENCED OR lS ABANDONED FOB -After trenches are excavated. qNY 180 DAY PEBIOD. -After forms are erected but prior to concrete placement. -Prior to floor insulation or decking. -Prior to decking. -Prior to cover. -Before covering sheathing with finish materials. -Prior to cover. -Prior to Cover - Prior to taping. -When all required inspections have been approved and the building is complete Electrical Temporary Power -Approval required prior to SUB energizing pole Plumbi Site Footing Foundation Post and Beam Floor lnsulation Ceiling lnsulation Shear Wall Nailing Framing Walllnsulation Drywall Final Building Underfloor Plumbing Underfloor Drain Rough Plumbing Expiration Date Phone -Prior to insulation or decking. - Prior to cover or placement of concrete. - Prior to cover. Job# 02-00143-01 Required lnspections Plumbin -Prior to filling trench. - Prior to filling trench. -Prior to filling trench. -When all plumbing work is complete. Mechanical - Prior to insulation or decking. - Prior to cover. -When all mechanicalwork is complete Pubtic Works -After forms are erected but prior to placement of concrete -After forms are erected but prior to placement of concrete Page 2 ol 4 Water Line Sanitary Sewer Line Storm Sewer Line FinalPlumbing Underfloor Mechanical Rough Mechanical FinalMechanical SW-Curbside CC-Standard Street lmprovement: Curb Cut?l{ San Sewer Depth (Ft): Storm Sewer Available? SpecialReq.: Security Required: Bond Begin DateTime: Special lnstructions: Other Utilities: Project Supervisor: Fully lmproved lmprovement Agr.? 6-4 00/00/0000 00:00 AM Sidewalk Type: Additional ROW? Size Of Line (in): Downspouts/Drains: Enchroachment Permit San Sewer Tee (in): Bond End DateTime: Curbside - 5' 8 To Curb and Gutter b 00/00/0000 00:00 AM Types Of Warning Devices Reqd. Zoning: LDR FloodPlain? [ Wetlands? ! Journal numbers 1: Comments: 2: Planner: Sam Gollah Urban Growth Boundary?[ Quantity Of Fill: Supplier: Drainage: Floodway FEMA: X-White 2 3: Additional Requirements: Required Attachments: Source Locn: Material: Flood Plain FEMA:1161 of2975 Land Use: Single Family Dwelling Pave Driveway? Z Overlay District: # of Street Trees Glenwood Area? [ Construction Types(VN) Wood Frame Occupancy Groups: Dwelling # Of Buildings: 1 # Of Bedrooms: 4 Handicap Access? Area (Sq Private Garage/Carp/Stor # Of Stories: 2 Height (feet): 25 Current Units: Proposed Units:1 Census Code: New SF - detached Main:2644 Accessory7O4 Total:3348 H#Job: 02-00143-01 Received: 21712002 Unit: BLDG:Address:2292 35th St Owner: Guy Gibson Fees FEE DETAILS Value/Quantity FLR: Amount Due Amount Paid Mechanical Surcharge Mechanical Surcharge State Surcharge - Mechanical SubTotal 0.00 3.15 3.1s Totalfor Mechanical 0.00 61.75 Permits w/o Srchg Permit without Surcharge or Admin Address Assignment Temporary Occupancy PIan Check Building Plan Check Fees Residential Plan Check SubTotal Totalfor Permits w/o Src 1.00 1.00 0.00 8.00 8.00 8.00 604.27 604.27 21 1,040.00 SubTotal 100.00 100.00 100.00 Totalfor Plan Check 0.00 604.27 Planning Subtotal Planning Fees Planning Plan Review SubTotal 1.00 0.00 50.00 50.00 0.00 50.00 Plumbing Subtotal New 1 or 2 Family Dwelling Three Bathrooms Minimum Permit Fee Minimum Plumbing Permit Fee SubTotal 306.00 Page 3 of 5 1.00 0.00 306.00 Totalfor Planning 3Pnl]lcitEr-D Job: 02-00143-01 Received Unit: 2t7t2002 BLDG:Address:2292 35th St Owner: Guy Gibson Fees FEE DETAILS Value/Quantity FLR: Amount Due Amount Paid Building Building Permit Fees Building Permit SubTotal Building Administrative Fee 8% Building Administrative Fee SubTotal Building Surcharge State Surcharge For Building Permit SubTotal 211,040.00 0.00 0.00 0.00 929.65 929.65 74.37 74.37 Totalfor Buildi DeposiUCopies/Mis Subtoti! : Deposit Deposit 27ea f7# SubTotal Total for DeposiUGopies/Mis Electrical Residential Per Unit Service lncluded Wiring Footage 1,000 Sq Ft or Less Wiring Footage Each Add'l 500 Sq Ft Temporary Service or Feeder Temporary: 200 Amps or Less Minimum Permit Fee Minimum Electrical Permit Fee Minimum Electrical Permit Fee SubTotal 250.00 0.00 1,069.10 0.00 0.00 106.00 57.00 50.00 1.00 3.00 1.00 250.00 250.00 250.00 Page 1 of 5 0.00 213.00 65.08 65.08 Subtotal Job# 02'00143-01 Page 3 of 4 Fee Paid On Receipt# Value/Quantity Fee Amount Plan Check 02t07t2002 7973Residential Plan Check Total Plan Check 211,040 $604.27 $604.27 Building Building Permit State Surcharge For Building Permit 8% Building Administrative Fee Total Building 0212712002 02t27t2002 0212712002 81 66 B1 66 B1 66 211,040 $929.65 $65.08 $74.37 $1,069.10 Minimum Electrical Permit Fee Temporary: 200 Amps or Less State Surcharge - Electrical 8% Admin Fee - Electrical Total Electrical Electrical 0212712002 0212712002 0212712002 02t27t2002 B1 66 81 66 81 66 81 66 1 $.00 $50.00 $3.50 $4.00 $57.50 Plumbing Minimum Plumbing Permit Fee Three Bathrooms State Surcharge - Plumbing B% Administrative Fee - Plumbing Total Plumbing 0212712002 02t2712002 02t27t2002 02t2712002 B1 66 B1 66 81 66 B1 66 1 Mechanical Hood and Exhaust Minimum Mechanical Permit B% Administrative Fee - Mechanical Less than 100,000 BTU Vent Fan to One Duct Dryer Vent Mechanical lssuance State Surcharge - Mechanical Total Mechanical 02t2712002 0212712002 02t27t2002 02t2712002 02t27t2002 0212712002 02t27t2002 02t27t2002 81 66 81 66 B1 66 B1 66 B1 66 B1 66 Bl 66 B1 66 1 $9.00 $.00 $3.60 $12.00 $18.00 $6.00 $10.00 $3.15 $61.75 1 3 1 New Sidewalk New Curbcut Total Public Works Public Works 02t27t2002 0212712002 81 66 B1 66 122 $77.24 $75.00 $152.24 1 System Development Residential - Single Family - Storm Residential lmprovement MWMC MWMC Administrative Fee SDC Administrative Fee Property Annexed 1997 Residential Sanitary MWMC Residential - lmprovement Residential - Reimbursement Sanitary Sewer SDC Reimbursement Sanitary Sewer SDC lmprovement Total System Development 0212712002 02t27t2002 02t2712002 02t27t2002 0212712002 02t2712002 0212712002 02t27t2002 0212712002 0212712002 B1 66 81 66 81 66 81 66 81 66 Bl 66 81 66 B1 66 81 66 8166 $657.11 $34.83 $10.00 $149.81 $-19.4e $332.86 $659.76 $1 55.1 3 $662.47 $503.44 $3,145.92 2 ,407 1 1 31 1 1 1 31 31 S.F. Residence - Willamalane TotalWillamalane SDC Willamalane SDC 1 $1,000.00 $1,000.00 02t27t2002 8166 $.00 $306.00 $21.42 $24.48 $351.90 Job# 02-00143-01 Fee Paid On Receipt# Value/Quantity Fee Amount Planning Plan Review Total Planning 02t27t2002 8166 $50.00 $50.00 Address Assignment Tota! Permits w/o Srchg Permits w/o Srchg 02t27t2002 8166 1 $8.00 $8.00 Grand Total Plan Check Type Checked By Date Gompleted Comment lnitial Review-Res Lisa Hopper 0210812002 Engineering-Res Bob Kettwig 0211412002 Planning-Res Sam Gollah 0211112002 Structural-Res Don Moore 0212512002 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will re n on the site at all times during construction "/$Date $6,500.68 a-/>7 /o> Page 4 ol 4 1 na? ) LE I $)err'Resi 1000 sq.ft. or less Each additional 500 sq. ft orportion thereof Each Manufd Home or Modular Dwelling Multi-Family per drvelling unit. Service Included: Items Cost oal _ed $no$7 J B DES Permits are rion-transferable and expire if work is noflstarted within 180 days of issuance br if work is suspended for ,ro *r, jlii i 2. CONTRACTOR INSTALLATION ONLY _ $106.00 ,i{.',' $ 50.00 B. Servi Sewice or Feeder ces or Feeders Installation, Alterations oi:. Relocation 200 amps or 201 arnos (HnE tFpT IPefiJYli[ Over D. Branch New on or Fxtension Per. oildtth not inclu Illinimum Electric Permit Inspection Fee 4. SUBTOTALOFABOVE 7%o State Surchnrge , S% Adminittrative Fee, TOTAL s50.00 s25.00 $15.00 is S-15.00 * Surchirrges Elect\ical' Address Supenis & o 5-1 .:C CITY OF SPRIN GFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET NAME OR COMPANY: LOCATION: TAXLOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS:1 BUILDING SIZE: 3348 SF LOT SIZE: 7406 SF guy gibson 229235TH SINGLE FAMILY RESIDENCE 17021943 TL: 3600 JOURNAL OR JOB NUMBER: 02-00143-01 COST PER S.F DISCOUNT RATEIMPERVIOUS S.F. 0.00 IMPERVIOUS S.F 2407.32 COST PER S.F $0.273 $6s7.20 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS x x x I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM .20ITEM l TOTAL. STORM DRAINAGE SDC PER DFU .4416.243l NUMBER OF DFU's 31 COST PER DFU $21.37 $662.4',7 B.IMPROVEMENT COST: x x 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: IITEM 2TOTAL. CITY SANITARY SEWER SDC NUMBER OF UNITS COST PER TRIP NEW TRIP FACTORADT TRIP RATE 1.00 '169.s]I $68.94 ADT TRIP RATE 9.57 NUMBER OF UNITS I COST PER TRIP $16.21 NEW TRIP FACTOR 1.00 155.13 B.IMPROVEMENT COST: xxx x xx 3. TRANSPORTATION A. REIMBURSEMENT COST: 14.89ITEM 3 TOTAL. TRANSPORTATION SDC $10.00 NUMBER OF FEU's I COST PER FEU $332.86 $332.86 NUMBER OF FEU's I COST PER FEU $34.83 $34.83 ($19.49) SUBTOTAL OF MWMC REIMBURSEMENT, IMPROVEMENT & CREDIT MWMC ADMINISTRATIVE FEE $348.20 B. IMPROVEMENT COST: x x MWMC CREDIT IF APPLICABLE (SEE REVERSE) 4. SANITARY SEWER. MWMC A. REIMBURSEMENT COST: ITEM 4 TOTAL . MWMC SANITARY SEWER SDC 996.20SUBTOTAL (ADD ITEMS 1,2,3, &4) SUBTOTAL ADM. FEE RATE 996.20 5Vo 149.81 5. ADMINISTRATIVE FEE: x $3,146.01TOTAL SDC CHARGES2t14/2002tfurr,&k 4.tq- SDC COORDINATOR DATE 0r!ooU & 14Fa ()r!& 1070 l09l 1092 1093 1094 1055 1056 1073 IJT'U NUMBER OFNEW FXTURES x UNIT EQUTVALENT = DRAINAGE FXTURE UNMS (NOTE: FOR REMODEI^S, CALCUL-ATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE FIXTURE UNITSFIXTURE TYPE (#NEW - #OLD ). UNIT EOUIVALENT BATHTUB ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( J 0 )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x )x 5 9 DRINKING FOUNTAIN 0 0 I 0 FLOOR DRAIN 0 0 J 0 INTERCEPTORS FOR GREASE I OIL ISOLIDS / ETC 0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LAUNDRY TUB 0 0 2 0 CLOTHESWASHER / MOP SINK I 0 .,J CLoTHESWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 t2 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. RECEPTOR FOR COM 0 0 I 0 0 0 0 SHOWER, SINGLE STALL I 0 2 SHOWER, GANG (NUMBER OF HEADS )0 0 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN I 0 J 3 SINK: COMMERCIAL BAR 0 0 2 0 SINK: DOMESTIC BAR 0 0 I 0 WASH BASIN 0 0 2 0 LAVATORY 5 0 I 5 URINAL, STALL/WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 6 0 TOILET PRIVATE INSTALLATION J 0 J 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'sX (o-o)*.20_= TOTAL DRAINAGE FIXTURE UNITS = 0 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day 31 DRAINAGE FIXTURE UNIT CALCULATION TABLE MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE $19.49 .00 19.49 IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE, CALCULATE CREDIT SEPARATELY CREDIT FOR LAND (IF APPLICABLE) CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) YEAR ANNEXED CREDIT RATE PER $I,OOO ASSESSED VALUE YEAR ANNEXED CREDIT RATE PER $1,OOO ASSESSED VALUE 1979 OR BEFORE $4.92 1990 $2.06 t980 $4.83 l99l $1.64 198 I $4.'.|7 1992 $1.4s 1982 $4.64 1993 $1.31 l 983 $4.47 $ l.l3 1984 $4.30 I 995 $0.97 I 985 $4.09 1996 $0.82 1986 $3.78 199'7 $0.63 1987 $3.4r l 998 $0.41 1 988 $2.98 t999 $0.22 I 989 $2.s2 2000 $0.04 TOTAL MWMC CREDIT = 0.000 x $0.63 VALUE/ IOOO CREDITRATE 30.943 x $0.63 = 3 2 2 1994 )CITY OF OREGON SP. GFIELI) f':t!'/"i:"'13y,rn 225 FIFTE STREET ,":.Ei. SPRINGFIELD, OREGON 97 477 INSPECTION REQTESTz 726-3769 OFFICE: 726-3759 INSTALLATI5r^ CAI PERI{IT APPLICATION Job Nunbe, 0Z-OA/43-Ol 3. COHPI,ETB FEE SCMDULE BELOII $rgrraiure 1 OF 3 ONJ I,EGAL DESCRIPTION67 lAq\o)La <) A. Nev Residential-Single or HuIti-Family per dvelling unit. service rncruded t ,,",ns cost lOoO sq.ft. or less I $-sf.O0 Each additional 500 sq. f t or portion -? thereof J g 15d0 Each J,tanuf , d .llqEre..or ;ffiss you to {s0ur,+cgxe"Bigoy rre oregon qtilitx ^^*Sfrttuaiffi g6nr$?.ef,fes ;ules are s& ttllttPu Sumt7 JOB DE x)cnt SCRIPTION('ttn1lf uclict n Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. COI{TRACf,OR INSTALI,ATTON ONLY Electrical Contractor ltardinq Llec)ri c- Address l0t 9 Brolhclc:n U Ci ty er1 Phone O f Supervis o License Number i9lots Expiration Date lo Constr Contr. Number Expiration Date /0'o t -o?/ Signa ture of Su sing Elec trician Ovners Name Address j Ci ty 5 Phone 724 - >153 OVNER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: 200 amfffigr19!5$)0-332'2341)' $ 50.00 201 amps to 400 amps I S 60.00 - over 1b00 amps/voIts - $300.00 Temporarv Services or Feeders rnStfflf&ion, Alteration or Relocation @ _a I oAR952-001- rules by Utility Notificatlon B. C\ 'il WQdlloo sl$oToo SHALLEXPIHE IFTHEless 400 amps FIMiT 0vep D. Branch Circuits SUBTOTAL OF ABOVE 7% State Surcharge 3Z Administrative Fee TOTAI, 0.00rrgrr "ffi!!- Nev, Alteration or Extension Per Pane1 One Circuit Each Additional Circuit or vith Service or Feeder Permi t $ 3s.00 E. MisceLlaneous (Service/feeder not included) -Each installation Pump or irrigation - Sign/OutIine Lighting- Limited Energy/Res - Limited Energy/Comm $ 2.00 s 40.00 s 40.00 $ 20.00 $ 36.00 /43 DATE: RECEIVED 5 o tf anc eluct Zoning Rgg!:rrar * DI: OF 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: COM2003-00414ISSUED: 0512812003APPLIED: 05/2812003 EXPIREST 1112812003 VALUE: SITE ADDRESS: 2292 35TH ST ASSESSOR'S PARCEL NO.: 1702194303600 PROJECT DESCRIPTION: Owner: 6IBSON GUy & LISA R Address: 2292 35TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORIft TYPE OF USE: License 135242 Contractor Type General Owner Contractor ACTIVE CONCRETE GIBSON G[ry & LISA R Expiration Date 0s/l1/200s Phone (s4t)736-1293 CONTRACTOR INFORMATION # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: 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: Impervious Surface Area: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: Handicapped: Compact: Square Footage DEVELOPMENT INFORMATION PUBLIC IMPROYEMENTS Description Type of Construction $ Per Sq Ft Page 1 of2 Value Date Calculated LT l,UILI-rt1\(, 11\ r (rl(lYrA r rtrL\ | Valuation Description I Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00414ISSUED: 0512812003APPLIED: 05/2812003 EXPIRESz 1112812003 VALUE: Total Value of Project Fee Description Curbcut Permit Amount Paid $75.00 $7s.00 Date Paid 5t28t03 Receipt Number 2200200000000000942 Total Amount Paid Plan Reviews 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. 1 Curbcut - Standard: After forms are erected but prior to placement of concrete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springlield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. ({/2-sfis Owner or Contractors Signature Date Reouired Insnect Pase2 of} r{ ees ralo I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfietd Development Services Department Public Works Department Oflicial Receipt Receipt #: 22002000000000 009 42 Date: 0512812003 coM2003-00414 Curbcut Permit 75.00 Item Total:$75.00 Payment Total:$75.00 5t28/2003 2:53:03PM Page I of I cReceipt.rpt Check ACTIVE CONCRETE 75.00 ---85 /28/2093 13:21 503591-1428 ED CLARK TNS PAGE A1. ED CTARK INSURANCE, INC. 780 Commercial Street SE, Suite 201 Salem, Oregon 97301 (s03) s81 436A Fa:r (503) 581 -3428 FAX COVERLETTER TO, virginia FROM: CissyFouts DATE.May 28,2003 REGARDING.Active Concrete Service 2 pages including cover sheet Any questions please call 5035813360- Thank you! -1 - A5/28/2883 t3:2L 5A3591.428 License Number: License Status: License Category: License EntltY: Name/Address: Work Phone Number: Partner Partner First Licensed: Expiration Date: Employer Status: Bond CompanY Name: Amount: Bond Effective To; lnsurance ComPanY Name: Amount: lnsurance Effective To: Other License Numbers: ED CLARK INS Construction Contrectors Board PO Box 14140 Salem OR 973096052 503-378"d62'l ert 4900 28-MAY-o3 135242 Active PAGE A2 Page I ofl Special$ Conlractor/All PartnershiP ACTIVE CONCRETE SERVICE 487 PINEDALE AVE SPRINGFIELD OR 97477 541-73ts-1293 NATHAN WAYNE DUERRE PAULA JUNE MATHESON 05/11/1999 a1l'1112005 EXEMPT GUMBERLAND CASUALTY & SUREW COMPA $10,000 05/11/2005 ASSURANCE CO oF AMERICA (NY) $1,0oo,ooo 05t11t2004 SE}REFgSFIELS City of Springfi-,d Voucherffi, Report lD : SPRA103 Voucher lD : Handling Code : 00053283 RE Accounting Date : Vendor Number : lnvoice Date : lnvoice # : Approver: Operator: Gross Amount : BY Proi/Grant 2003 September 19,2002 0000008673 September 19,2002 10251 Puent,David wlLS5940 250.00 Amount 250.00 Gibson,Guy 2292 35th St. Springfield, OR 97477 Descriotion Account Fund Return of street tree dePosit 215500 821 Comments: Express Check Refund of tree deposit, Ok'd by Bob Barnhart job number 02-00143-01 7zq7 sfr @ SubClass Conrrrrurriti,Scrviecs Drv, Br rg Saicty Job CI'f Y OF SPTTINGFIELII OREGON 225 5'r' Strcct. Splingljclcl. OR 97411 Ph.126-3159 City Job #L S P:ll N C, 'a i i: i- r-- AMBLESIDE MEADOWS SUBDIVISION-1ST ADDITIoN un requlremen ts - new structures on res This form may be used as a temporary verification to allow construction to continue on the job site until the consultant's stamped affidavit bn the site soil compaction and stabilization is submitted to the City. This form must be completed by a licensed design professional (engineer or architect) or his/her authorized employee, and submitted to the building inspector prior to requesting City inspections or placing foundation concrete. It is important that all questions be answered completely for the foundation site to be approved for construction. Owner and./or Contractor Dav e D ur N (,0 M Co *t7r. t\c-Tr o r-) l. Date of the design professional's site evaluation?z/ 1f oz- ots T----l 2. Has the design professional reviewed a copy of the geotechnical information for the subdivision that was provided with the building permit? Yes/No- IJ'not, please contact this ffice for a copy of the report. The design professional ntust be .forniliar with the geotechnical information before completing this form. 3. What was the size and depth of the excavation and /or fill? Site Investigation Questionnaire for Consulting Design Professionals /+ee. Was existing non-structural fill or expansive soil encountered on the lot? Yes$ No- If "yes", what types, depths and locations? F* "f- What measures were taken to remedy the soil condition (include type of engineered fill used to stabilize the soil)?firLf 7) A< H /t=t/F I e r lr',.tc#A l-trv€ L U l L/.D/iul:r 2-2- ,4u- /rn: t; ( onrrrrunit,r' Scrr ices Div, Br rg Sale ty J (]I'I Y OI. SI-,[{INCF IELT{ OITEGON ll5 5'l' Stree t. Spr inglle ltl. OR 97177 Ph. 126-3159 o5466r.rs ??{ /r'7-o City Job# e --, D -l $i .* t2 lbundation supp0rt? FO ?6 C)(,t C. .?t?0L< tV i,2 fvr r,*4c r Is the site as prepared adequatu P inadequate E to maintain constant moisture content in the sub grade? Note: Verification of moisture stabilization in the sub grade is a requirement of the geotechnical report, and must be ffirmed before c o tt.s t r uc t ictn c an c ont inue. lf inadequate, what measures are needed to provide constant moisture content in the sub grade? fte 4. Did the design prof'essional witness placement and compaction of the engineered fill, or is there a special inspection report forthcoming from a qualified agency? I witnessed Placement flSpecial Insp/compaction report I 5. The design professional intends to use the following method for installation of perforated perimeter footing drains: The design on the attached drawing provided by the design professional ...... D The method shorvn on the original construction drawings ......... El The typical 'Foundation Drain' drawing attached to permit tr Perforated perimeter drains are not required I Comments c LU CzN-f 7-rt l,t T Note: City inspectors will inspect installed drains prior to cover upon request, Cull: 726-3769 to schedule inspection. 1f-f.€(T T? frf€ ,vtrtfli a 7 S//.vcr OF (nc F,l?') 2 Is the site as prepared adequate fi inadequate I to support the proposed structure? An affirmative answer is requisite to proceeding with constructiort. If inadequate, what additional work is needed to provide adequate AtVn A, a- / kt.t1 t?trr<c fr /) atp D,J,.tD-<.f .f TJ (',,rrrrtrrrttitv Se rviue s l)rr', |---.ling Salcty Job CI'IY OF' SPRINGFIELD, OREGON ll5 5'r' Strcct. Springllclcl. OR L)1411 Pl't'126-f159 Low-point crawl space drains are required to prevent the build'up of excess moisiure inside the foundations during (and after) construction' This drain may be installed after foundation placement onlv with the express permission of the desisn Professional. a. The design professional has determined the following; Tlte crawl space drain is requiredwhen the foundation is irtstalled ". D The low-point drain can be installed after foundation placement without a significant moisture build-up problem within the foundatiort.... tr (The low-point drain may be installed at the = , = , = StaS€ oJ' construction) prtst & beun' Jraming' ntofittg' etc' b. Has the design professional observed and upproved the instctllatiort of the require4 toi point drain?. Yes' -No -tf "yes",whe're is the low point drain located under the building and where cloes it terminate ai this time? (ntust be an approved locatiort, i'e' street guiler, storm sewer, sump pump and discharge line to tlrc street, etc. ) The design professional must determine whether the approved permit drawings have adequatJfolndation steel. Is any additional foundation steel required that is not shown on the foundation drawings for the building?";;'X_ ;; -] - ii ,,yrr", deicribe additional steel required (or provide drawing)' Tlte,f'ctllctwirtg statentent tttust be signed by the individual doing tlte observations and prr-tvidirtg tliiection for llle excavaion and site preparation work on the properry' J .., ., 1 ?, City job #@ :o@l /a4<^-nl ('orttnturtilv Serviccs I)rr', Bu,-,g Salcty (ll'l'Y OF SPI{INGFIELD, OREGON City Job # ll: 5'r' Strue t. SprinSlicld. OR 97177 Ph. 1?6-3159 1s6 666r.tt 774 'Z 7H<( O 1f -o The undersigned design professional (or authorized employee) attests that he/she observed required moisture stability procedures on this site, and that suclt procedures were accomplished before any changes occurred in the moisture content of tlrc sub- grade under and around the building (where expansive soils were encountered). The understgned further attests that the sub-grade, as prepared, is adequate to support the building proposed for this site. Additional comments: (Ngte): A copy of this report shall be kept on site with the approved plans at all times. 'fhis report shall be followed by an affidavit, signed and stamped by the design prol'esslonal under whose auspices this report was completed, affirming the information-herein. The signed/stamped affidavit together with a copy of this report shall be subrnitted ro rhis office prior to requesting framing inspection for the building. Signa Name Title Company N6-r t<JF€t2 ',<)<, Phone l-icensee / c*&€L rvt Licen se#exprres 1'he geotechnical report for the Ambleside Meadows - 1" Addition Subdivision recommends immediate moisture stabilization of exposed expansive sub-grades, and that expansive soils be over-excavated and replaced with at least 12 inches of fill compacted ro ar least 95Vo of ASTM D698 for foundation preparation. The repofi also recommends that measures be taken to prevent water from collecting in or around the foundation areas cluring aniJ after the construction process, and that positive site drainage be provided to reduce the infiltration of surface water into the expansive soils. 'f he geotechnical report further emphasizes that the finish grade of Iandscape soil adjaJent to the foun-dation should be at least 24" above the expansive bearing soils, firmly co[p4e_!g_d to re6uce the infiltration of water at the surface. The adequacy of fill soil nraterial around the building must be v erified to the satisfaction of the design 4 prof-essional ('orrrnrunitv Scrviccs Div, Br, _ ,rg Sirllty Job (]I'IY OF SPITINGFIELD, OREGON 225 5'r' Stree t. Sprinullclcl, OR 91411 Ph.126-3759 2z4a 7l+ CityJob# aL -oo /4?-ol Affidavit For Site lnvestigation Questionnaire Foundation Sub-Grade Approval for Residential Building Site in Ambleside Meadows - 1" Addition Subdivision The undersigned hereby affirms that the excavation, structural fill and moisture stabilization methods for the building site at the address shown above was observed by rne or an authorized employee of my firm and that the following is true: L The foundation sub-grade is capable of supporting a minimum of 1500 psf, and is adequate to support the building proposed for this site. 2. The moisture content of the excavation was adequately maintained during the site preparation process and was adequately covered to stabilized moisture content prior to any significant change in moisture content of the sub-grade. 3. The site is adequately graded and drained to prevent the collection of water in the excavated area during construction. 4. The accompanying report titled "Site lnvestigation Questionnaire for Consulting Design Professionals" containing field observations and instructions made on (date) for the building site was completed either by myself or by an employee of my firm under my supervision. To the best of my knowledge, the information contained in that report is complete and accurate. Name of Licensed Professional (print)L 4zttp Sign Siri:it{i;i: .ir.'I"i, ,:.tlr;': D(PTRES: a oetrts N o a /t794 Vr o-2- Date 7 lsiPRI"GFIELD Ciq'of Springfield / Development Service.s Building Safeqv 225 Fifth Street Job Number Z^3-d Job Address ?-1 %, 9 -q'*c' 2--Date To uaii rur t'ctrrsPcchuIl lnspector *****************rr*** ** * Call fOf inSpeCtiOn * * ** * QUeStiOnS 726-37 59* ** ** * ** * * ********* * ** *