HomeMy WebLinkAboutPermit Building 2020-02-12OREGON
Web Address: www.springfield-or. gov
Building Permit
Residential Structu ra I
Permit Number: 81 1-18-OO2632-STR
IVR Number: 811017609063
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR97477
54L-726-3753
Email Add ress: permitcenter@springfield-or. gov
SPRINGFIELD
afi
Permit Issued: February L2, 2O2O
TYPE OF WORK
Category of Construction: Single Family Dwelling
Submitted Job Value: $700.00
Description of Work: Freestanding additional storage room
Type of Work: Addition
JOB SITE INFORMATION
Worksite Address
4475 DAISY ST SPC 48
Springfield, OR 97478
Parcel
1702323406500
Owner:
Address:
COUNTRY MANOR LLC
7OO7 SW CARDINAL LN
STE 185
PORTLAND, OR97224
LICENSED PROFESSIONAL II{FORMATION
Business Name
SEE PROPERry OWNER
INFORMATION - Primary
License
Owner (Property)
License Number
OWNER
Phone
PENDING INSPECTIONS
Inspection
1999 Final Building
1260 Framing
1260 Framing
Inspection Group
Struct Res
Struct Res
Struct Res
Inspection Status
Pending
Pending
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: 811017609063
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 18O 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 constructlon 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-OO1-OO1O through OAR 952-OO1-OO9O. You may obtain copies of the rules by calling the Center at (5O3)
232-L987.
All persons or entities performing work under this permit are required to be licensed unless exempted by ORS 701.O10
(StructuraUilechanical), ORS 479.540 (Electrical), and ORS 693.O1O-O20 (Plumbing).
Ptinled oni 2lf2l20 page 1 of 2 C:\myReports/reports//production/01 STANDARD
Permit Number: 81 1-18-0O2632-STR Page 2 of 2
Fee Description
Technology Fee
Structural building permit fee
Structural plan review fee
State of Oregon Surcharge - Bldg (l2o/o of applicable fees)
Printed oni 2/LZ|2O Page 2 of 2
Quantity Fee Amount
$8.17
$99.00
$64.3s
$ 1 1.88
$ 183.40Total Fees:
C: \myReports/reports//production/01 STAN DARD
PERMIT FEES
SPRINGFIELD
b Transaction Receipt
8{ 1 -1 8-002632-STR
IVR Number: 81 1017609063
Receipt Number: 473804
Receipt Date= 2112120
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
54L-726-3753
perm itcenter@spri n gfield -or. govOREGON
www.springfield-or. gov
Worksite address: 4475 DAISY ST, SPC# 48, Springfield, OR 97478
P arc.el: 17 0232 3406500
Transaction Units
date
2l12l21 1.00 Ea
2t12t20 'r.00 Ea
Description
Structural building permit fee
Structural plan review fee
State of Oregon Surcharge - Bldg
(12olo of applicable fees)
224-00000-425602-1 030
224-00000 -425602- 1 030
821 -00000-21 5004-0000
1 00-00000-425605-0000
2t12t20 1.00 Ea
2t12t20 1.00 Automatic Technology Fee
Fees Paid
Account code Fee amount
$99.00
$64.35
$11.88
$8.1 7
Paid amount
$99.00
$64.35
$1 1.88
$8.1 7
Payment Method: Cash Payer: SEE PROPERry
OV1NER INFORMATION
Payment Amount:$183.40
Cashier: Katrina Anderson Receipt Total:$r 83.40
Ptinled: 21 1 2l2o 3:33 pm Page 1 of 1 Fl N_Tra nsaction Receipt_pr
-.
Crrv or SpRnqcFIELD, oREGoN
Structural Permit A pplication
225 Fifth Street o Springfield,OR 97477 . pH(541)726-3753 r FAX(54 1 )7 26_36g9
This permit is issued under OAR 9f g_460_0030. permits expire il
suspended for
Phone:
Print name:
Signature:
work is not started within lg0 davs
180 days.
ffi_{
issuance or if work is
S
4. Miscellaneous fees
fees and surcharges (2e+3c+4a+b)
S
S
S
\ose
morAes\c \"&3 @ SMAi\ '(,ol't
Name
Electrical
Mechanical
Phone Number
DEPARTMENT USE ONLY
Permit no.: l8 -
Date: 1l
LOCAL GOVERNMENT APPROVAL
This project has final land-use approval.
Date:
This project has DEQ approval
Sigrature:Date
Zoning approval verified:!yes ENo
Property is within flood plain:
.-l o
AND LOCATION
BResidential
Job site address: {
Government Commercial
OF CONSTRUCTTON
JOB
!yes f]No
City: SOq \v\at,, 0,\ r\nrhState zD: q1\78
SubdivisiJn: \)Lot no.
Reference:Taxlot:
\otsName 6rt\O+ MOvrr e,q (rncr-r.a
Addrels:'tqlb OE\q,L^5k a("U j;\ t{t
City: SO5irnaQ.o;r.LJ Srare: orft zrP:qJ{-I8
Phone: fi,q\ y'-?O Grrqq Far:
E-mail
Building Owner or Owner's agent authorizing this application
Signhere: ,J. Sorlo> {ilo*.r\"> G.
fl This installation is being made on residential or farm propen.n.- owned b1'
me or a member of m1, immediate famill , and is exempt fiom licensing
requirements under ORS 701.010.
CONTRACTOR INSTALLATION
Business name: c2.q u g-^-
Acidress
State ZPCir."":
Fax:
E-mail:
CCB iicense no.
FEE SCHEDULE
(a) Job description:
Occupancl
Constmction troe
Square feet:
Cost per square
Other information
Type of Heat:
Energl'Path:
fl additionI ne*' fialteration
nNo(b) Foundation-only permit? f] yes
Total valuation:$ 700
2. Building fees
(a) Permit fee (use valuation table):$
fee (equal ro [2a]'):(b)S
(c) Reinspection ($ per hour):
(number ofhours x fee per hour)S
(d) Enter 1 2% surcharge (.12 x [2a*2b+2c]):S
(e) Subtotal offees above (2a through 2d):S
3. Plan review fees
(a) Pian review (65% x permit fee [2a]):
(b) Fire and life safetl, (65% x permit fee [3a].t:S
s(c) Subtotal of fees above and 3b):
(a) Seismic fee. l% (.01 x fee [2a])
(b) Tech fee, 5Vo (.05 x permn fee[2a]*PR fee [3c])
Plumbing
Last edited 5-5-201 7 BJones
SUB€ONTRACTOR TNFORMATION
TEGORYCA
SITE INFORMATION
PROPERW OWNER
1. Valuation information
CCB License #
I have read and understand the lnformation Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the inJormation on this homeowner statement is true and accurate.
'\ore \on\c.a Mor,rle6 (at-rr,, a
Print Name of PermitAppiicant
Property Own er Statement
Regarding Gonstruction 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))
l. S.- ).t ,t/or)., G.\0-e? - \8
Signature of Permit Aoplicant Date
lb- On^ tob^Permii #:
Address:T5 *'18
S
This statement is required for residential building, electrical. mechanical, and piumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this staternent. This staternent will be filed with the permit.
I own, reside in, or will reside in the cornpleted structure anci my general contractor is
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
ot'
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. lf I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. lf 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 narne of the coritractor to the office
issuing this Building Permit.
Please check the approoriate box:
cc8#
lltl
Name Expiration Date
lssued Date \>
This Copy for Permit Offces
F
lnformation Notice to Owners Abcrut
Gonstruetion Responsibi lities
(oRS 701,325 (3).)
Homeowners acting as their own general contractors to construct a new home
or make a substantial impro.rement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
s Homeowners who use iabor prorrrdeo by workers not licensed by the Construction Contractors
Board, may be considered an empioyer, and the workers who provide the labor may be considered
emoloyees, As an employer. you must comply with the following:
o Oregon's Withholding Tax Law: Employers must withhold income taxes frorn empioyee wages
at the lime emplolTees are paid. You will be liabie for the tax payments even if you don't actually
withhold the tax frorn your ernployees. For more information, call the Department of Revenue at
503-378-4988.
e Unemployment lnsurance Tax: Employers are required to pay a tax for unernployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
e Oregon's Business ldentification Number (BlN): is a cornbined number for both Oregon
Withholding and Unemplovment lnsurance Tax. To file for a BlN, call 503-945-8091 or go to
http://www.oregon.qoyD-OR/BUS/docs/211-055.odf for the appropriate forms.
o Workers Compensation lnsurance: Employers are subject to the Oregon Workers Compensation
Law, and rnust obtain Workers Compensation lnsurance for their ernployees. If you fail to obtain
Workers Compensalion lnsurance, you could be subject to penalties and be iiable for all ciaim 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 503-947-7815.
e Tax Wlthholdingr Employers must withhold Social Security Tax and Federal lncome Tax from
employee wages. You may be liable for the tax payrnent, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.oov.
Other Responsibilities of Homeowners:
o Code Gompliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate tirnes, 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 inspecticns.
e Property Damage and Liability lnsurance: 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 darnage irom pipe punctures, fire, or work that must be
redone. Liability insurance must be sufficient tc cover injuries to persons on the iob site who are noi
othenadse covered as employees by Workers Comoensation lnsurance.
o Expertise: i'lomeowners 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
700 Summe: St NE, Suite 300, PO Box 1414C, Salem, OR 97309-5052
Telephone; 503-37H62i - Fax 50$3732007
Website Address: \ww.oreoon.qov/ccb
f/propefi_ovrner adopted 9- 23-08 Thi-< Copy for Permii Apolicant
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