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Home My WebLink AboutPermit Building 2006-12-26Status 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: COM2006-01332ISSUED: 1212612006APPLIED: 10/1612006 EXPIRES: 08/0812007VALUE: $ 7,000.00 SITE ADDRESS: 1487 30TH ST ASSESSOR'SPARCELNO.: 1702303401901 Springfield PROJECT DESCRIPTION: Replace existing manufactured home TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New Residential PhoneNumber: 541-744-8147Owner: Address: BOB BOTTOM 1213 PARI(ER ST SPRINGFIELD OR 97477 Contractor Type Electrical Manuf Home Inst Plumbing Contractor BILLS ELECTRIC OWNER OWNER Expiration Date 04t28t2008 Phone 541-501-5650 License 21351 CONTRACTOR INFORMATION TION )RMATION # 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: # of Stories: Height of Structure: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: "h of Lot Coverary{1 to\\ow I Lot Size: Other: Occupant Load: I R-3 VB 3 REQUIRED PARKING 30.00 5.00 31.00 31.00 0.00 ., .,\)i Street Improvements: Storm Sewer Available: Special Instruction: Fully Improved No Notes: Storm H2O to ditch line.JLP Pase I of4 .? Range Energy ED OR Type Water Rtl\1 1H\S iav'l tofl rF Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2006-01332ISSUED: 1212612006APPLIED: 10/1612006 EXPIRES: 08/0812007VALUE: $ 7,000.00 Description Type of Construction Foundation Onlv Use Bid Amount Manuf Home Manufactured Home $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 2,000.00 5,000.00 Value $2,000.00 $5,000.00 $7,000.00 Date Calculated 10n6t2006 10n6t2006 Total Value of Project Date Paid Fee Description Plan Review Residential + l0o/o Administrative Fee + 57o Technology Fee + 87o State Surcharge Temp Power 200 amps or less + l0o/o Administrative Fee + 57o Technology Fee + 8%o State Surcharge Foundation Permit Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Placement Manufactured Home Service Plan Review Minor - Planning Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Storm Sewer Each Addtl 100' + l0o Administrative Fee + 57o Technology Fee + 87o State Surcharge Fixture Total Amount Paid Amount Paid $29.2s $s.00 $2.s0 $4.00 $50.00 $35.90 $23.55 s28.72 $45.00 $30.00 $4s.00 $r60.00 $s0.00 $112.00 $118.74 $156.16 $2s.02 $22s.s3 $4s.00 $14.00 $1.40 $0.70 $1.12 $14.00 $1,222.59 t0tr6t06 t2t18t06 t2n8t06 12fi8,t06 t2n&t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26/06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 t2tz6t06 2t8/07 2t8t07 2t8t07 2t8t07 Receipt Number 1200600000000001531 2200600000000001714 2200600000000001714 220060000000000r714 2200600000000001714 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200700000000000096 3200700000000000096 3200700000000000096 3200700000000000096 Fees Paid Plan Reviews APP LLH Delay in plan review. Plans placed in wrong location. Willamalane SDC, Addressing, and Fire Fees not applicable - Replacement home Initial Review tU02/2006 ty02/2006 Paee 2 of 4 Valuation Description I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 54l-726-37 69 Inspection Line Buildin g/Combination Permit PERMIT NO: COM2006-01332ISSUED: 1212612006 APPLIEDz 1011612006 EXPIRES: 08/0812007VALUE: $ 7,000.00 Planning Review Public Works Review Structural Review 1U0212006 tUtst2006 APP TAJ This is Parcel 3 of Minor Subdivision 173, legally created on lll07166. Two street trees are required unless they are already in. Need to provide 32 sf of permanent enclosed storage. Storm H2O to ditch line.JLP Standard M.H comments sheet used fro plan review comments. ty02t2006 1u02t2006 rut4t2006 tu06t2006 JLP DLM APP APP To Request an inspection call the24 hour recording at 726-3769, AII 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 work day. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Foundation: After forms are erected but prior to concrete placement. Final Building: After all required inspections have been requested and approved and the building is complete. Manuf Home Set Up: When installation of all piers or stands is complete. Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Water Line: Prior to filling trench and including required testing. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. MH Service: Approval required prior to utility company energizing service. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. leouired Insnecfions Paee 3 of4 : Status Issued 225 Fifth Street, Springfieldo OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line CITY Building/C ombination Permit PERMIT NO: COM2006-01332ISSUED: 1212612006APPLIED: 10/1612006EXPIRES: 08/0812007VALUE: $ 7,000.00 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 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 Pase 4 of 4 225 Fifth Street Springlietd, Oregon 97 477 541-726-3759 Phone C'' ' of Springfield Official Receipt L.- elopment Services Department Public Works Department RECEIPT #: 3200700000000000096 Date: 0210812007 9:21:33AM Job/Journal Number coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 Description Fixture + 5% Technology Fee + 8% State Surcharge + l0%o Administrative Fee Amount Due 14.00 0.70 t.t2 1.40 Item Total s17.22 Payments: Type of Payment Paid By Received By Batch Numher Check Number Authorization Number How Received Amount Paid Cash Change BOB BOTTOM BOB BOTTOM djb djb In Person In Person Payment Total: $20.00 ($2.78) $17.22 Job/Journal Number coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 Description Fixture + 5% Technology Fee + 8% State Surcharge + 10Yo Administrative Fee Amount Due 14.00 0.70 t.t2 1.40 Item Total:s17.22 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Cash Change BOB BOTTOM BOB BOTTOM djb djb In Person In Person Payment Total: $20.00 ($2.78) s17.22 cReceintl Page I of 1 21812007 atilraar3.,B Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-36768ax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01332ISSUED: 1212612006APPLIEDz 1011612006 EXPIRESz 0612612007VALUE: $ 2,000.00 SITE ADDRESS: 1487 30TH ST ASSESSOR'S PARCELNO.: 1702303401901 PROJECT DESCRIPTION: Replace existing manufactured home Springfield TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New Residential PhoneNumber: 541-744-8147Owner: Address: Contractor Type Electrical Manuf Home Inst Plumbing BOB BOTTOM 1213 PARIGR ST SPRINGFIELD OR 97477 Contractor License BILLSELECTRIC 2I35I A ACTION MOBILE HOME MOVING & DEN1428O7 OWNER Expiration Date 04t28t2008 05/05/2008 Phone 541-501-5650 541-935-1786 CONTRACTOR INFORMATION BUILDIN( # 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: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: rules b No Notiticatlcn Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 1I R-3 VB 3 30.00 5.00 31.00 31.00 nla ) NOTICE: REQUIRED PARKING Total: 2 Handicapped: Compact: rHts pEfl$4tr sHALL EXpIRE tF THE w ORK'.l.Lir t;C,dl 0.00 r. ThiQ$e r C A fol Street Storm Special low rules Sidewalk Type: Downspouts/Drains: DEVELOPMENT INFORMATION Notes: Storm 344) Paee I of3 OF Building/C ombination Permit PERMIT NO: COM2006-01332ISSUED: 1212612006APPLIED: 10/1612006 EXPIRES: 0612612007VALUE: $ 2,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line Description Tvpe of Construction Foundation Onlv Use Bid Amount Manuf Ilome Manufactured Home $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 2,000.00 5,000.00 Value $2,000.00 $5,000.00 $7,000.00 Receipt Number 1200600000000001531 2200600000000001714 2200600000000001714 2200600000000001714 2200600000000001714 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 3200600000000000640 Date Calculated 10n6t2006 10n6t2006 Amount Paid Total Value of Project Date Paid Fee Description Plan Review Residential + l0o/o Administrative Fee + 57o Technology Fee + 87o State Surcharge Temp Power 200 amps or less + l0oh Administrative Fee + 57o Technology Fee + 87o State Surcharge Foundation Permit Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Placement Manufactured Home Service Plan Review Minor - Planning Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Storm Sewer Each Addtl 100' Total Amount Paid $29.2s $5.00 $2.50 $4.00 $s0.00 $3s.90 $23.55 s28.72 $4s.00 $30.00 $45.00 $160.00 $s0.00 $112.00 $118.74 $1s6.16 $2s.02 $225.53 $45.00 $14.00 t0n6t06 t2n8l06 t2n8t06 t2n8/06 t2n8t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26t06 12t26/06 12t26t06 12t26t06 $1,205.37 ['ees Pa Plan Reviews Initial Review tu02t2006 tt/02t2006 APP LLH APP TAJ Delay in plan review. Plans placed in wrong location. Willamalane SDC, Addressing, and Fire Fees not applicable - Replacement home This is Parcel3 of Minor Subdivision 173, Iegally created on lll07166. Two street trees are required unless they are already in. Need to provide 32 sf of permanent enclosed storage. Planning Review tU02/2006 tt/15/2006 Paee 2 of3 Valuation Descrintion I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line OF Building/C ombination Permit PERMIT NO: COM2006-01332ISSUED: 1212612006APPLIED: 1011612006 EXPIRES: 0612612007VALUE: $ 2,000.00 Public Works Review Structural Review Lu02t2006 1u02t2006 tut4t2006 tu06/2006 APP APP JLP DLM Storm H2O to ditch line.JLP Standard M.H comments sheet used fro 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Foundation: After forms are erected but prior to concrete placement. Final Buitding: After all required inspections have been requested and approved and the building is complete. Manuf Home Set Up: When installation of all piers or stands is complete. Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Water Line: Prior to filling trench and including required testing. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. MH Service: Approval required prior to utility company energizing service. Temporary Electric: Approval required prior to Utility Company energizing pole. 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. / Z- zl -o6 Owner or Contractors Signature Paee 3 of3 Date I(equtreo lnsDeeuollsl r/2.{1f/78- SPFlll*iFlELD D EV ELO P M ENT SER V I C ES D E PARTM ENT MANUFACTURED HOME SET.IP AGREEMENT As the required attached by the City of Springfieid one of tl're following Development Code, I understand and agree that of manufactured homes will be placed at Springfield, Oregon, City Job Number C.>^^ 2A)6 . o,j 3'l-- A multi sectional (doubie wide or wider)unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing,and that has been certified by the manufacturer to have an exterior thermal envelope meetin-q performance standards which reduce heat loss to levels equivalent standards required for single family dwellings at the time of construction.initials Type II Manufactured Home: 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 vvww. ci. s p ri n gf i eld. o r. us A unit of not less than 12 feet in width enclosing a minimum floor area of 500 square feet. that has a nominal roof pitch of 2 feet in height for each tl feet in width, that has no bare metal siding or roofing, and that has been certified by the itanufacturer to have an exterior thermal envelope meetilg performance standards which reduce heailoss to levels equivalent to the performance standards required for single family dwellings at the time of construction. initials { I further state, by my signature below, that I have been provided with the following information: Manufactured Home Blocking, Water Line Connection, Street Tree Standards, Sanitary Sewer Conneqtion, Electrical Co6ection, and Minimum requirements for permanent steps. I also understand that the manufactured home shall be placed on an excavated and backfilled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure, enclosed at the perimeter with stone, brick or other .on"r"t. or masonry materials approved by the Building Official and with no more tban24 inches of the enclosing material exposed above grade. /2-%-,96 Date CITY OF SPrTTNGFIELD SYSTEMS DEVELOPMENT --JRKSHEET JOURNAL OR JOB NLIMBER: COM2006-01332 NAME ORCOMPANY Bob Bottom LOCATION 1487 30rh St. TAX LOTNUMBER: DEVELOPMENT TYPE:SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 1. STORMDRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM COST PER S.F $0.336 BUILDING SIZE (SF] O LOT SZE (SF): IMPERVIOUS S.F. x 672.00 RTINOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F 0.00 NUMBEROFDFU's 6 B.IMPROVEMENT COST: NLIMBER OF DFU's 6 ADTTRIPRATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 SIIBTOTAL $500.43 COST PER S.F $0.336 COST PER DFU $26.03 $19.79 NUMBER OF UMTS 0 NUMBER OF I"INITS 0 ADM. FEE RATE 5Yo C}IARGE $225.s3 DISCOUNTRATE 50% s225.53 DISCOUNT $0.00 x ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER. CIry A REIMBURSEMENTCOST: x x x x x ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A REIMBURSEMENT COST: s274.90 COST PER TRIP $19.8r COST PER TRIP $87.39 $0.00 xx xx NEWTRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 A B. ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANIIARY SEWER-MWMC x COST: x MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMIMSTRATME FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBToTAL (ADD rTEMS 1,2,3, & 4\ 5. ADMIMSTRATI\TEFEE: $0.00 $500.43 CHARGE $25.02 TOTAL SANITARY ADMIMSTRATION FEE: TOTAL ADMIMSTRATION FEE Jeff Prociw tr/13/2006 NLIMBER OF FEU's 0 COST PER FEU $91.61 $118.74 s0.00 $0.00 $0.00 $0.00 00 $525.45 1070 1091 1092 l 093 1094 1054 t 055 I 054 1056 079 a IJ]o U & E]F U) o IJ]& IM NUMBEROF FEU's 0 COST PER FEU $961.52 PREPARED BY DATE TOTAL SDC CHARGES x DRAINAGE FD(TT]RE UNIT CALCULATION TABLE NUMBER, OF NEW FXTIJRES x UNIT EQIJIVALENT = DRAINAGE FXTURE UNTTS CALCULATE ONLY THE NET ADDMONALFOR MISCELIANEOUS DFU TYPE NT]MBER OF EDI.IS TOTAL DRAINAGE FTXTI]RE I.]NTTS *EDU toa NO. OF FDfIIRES DRAINAGE FIxTURE LIMTS 0 I.INIT NEW OLD ALENT lmit ser at I 67 IS LAND ELGIBLE FOR ANNEXATION CREDIT? @nter 1 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) 20 a MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 2 BmoRE 1979 r979 1980 1981 1986 1987 1988 1989 1990 l99l 1992 1993 t994 t995 1996 1997 1998 1999 2 1979 1983 1982 1984 1985 VALUE / 1000 $0.00 CREDITRATE ss.29x CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALI.IE / 1OOO CREDIT RATE $0.00 x $5.29 TOTAL MWMC CREDIT $0.92 $0.72 $0.48 $0.28 $0:09 $0.05 1 3 ?BATHTIJB 2 0 0 1 0DRINKING FOUNTAIN FLOORDRAIN 0 0 3 0 0 3 0INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 0 6 0INTERCEPTORS FOR S,\ND / AUTO WASH / ETC. 0002LAUNDRY TUB 1 3 01CLOTI{ESWASIIER / M()P SINK 0 0 6 0CLOTTIESWASTIER . 3 oR MORE (EA) 12 000MOBTLE HOME PARK']RAP (1 PER TRAILER) 0 0 1 0RECEPTORFORREFNIf / WATER STATION / ETC. 1 0 3RECEPTOR FOR COM. IJINK / DISHWASHER / ETC. 0 0 2 0SHOWER. SINGLE STA]-L c002SHOWER, GANG (NTI.]MBER OF FIEADS) 3 c11SINK: COMMERCIAL/RESIDENTI.AL KITCHEN 0 0 2 cSINK: COMMERCIALBAR 0002SINK: WASH BASIN/DC,UBLE LAVATORY I 022SINK: SINGLE LAVATC'RY/RESIDENTIAL BAR 0 5 CTIRINAL. STALL/WAL].0 0006TOILET. PIIBLIC INST.AILATION 3 022TOILET, PRTVATE INSI'ALLATION 6 CREDIT RATE/$I,OOO ASSESSED VALIIE \GAR ANNEXED 00 0 $0.00 2000 2001 :$5.19 :$5.12 Construction Contractors Board Permit *a't 7' z' -o/3rz 700 Summer St IrlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 lYebAddress:www.ccs1lgj@ Address: Issued by:+il Date: I >- 4'9 b Z 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 the following 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), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3,{ or 3B: l. 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. 3A. My general contractor is (Name)(ccB #) x X F I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 38. I will be my own general contractor. 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 notify the office issuing this building permit of the n:rme 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. I 2 /Z-Z/-06 (Signature of permit applicant) @ate) (White copy to issuing agency peftnitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 ,^, i*f Aetixlg as Your $wxr Gerxena$ Cb$trnetor? INFORM,ATI$N. NCITICg T* $SK#Pff &TY ffiWr*MRS ,&*&uY csN$TRu6?tGrd Rffi $psNs$&tLx?*E$ flIOIS; Tttis lnf*rmafion Ncfie* to Praperty Owners ahaut **nsfr*cfion Respansi&flifies ,!/ss develop*d by t*e Sonsfruclion Sorfracfors ffoard in accordance wft$ CIfrS 7S?"0S5($J, p*ssed *y ffi* ?98$ Oregon Legiisfafure. {f y*x are a*ti:":g es y*l*r *w:tl c*ntva*t*r t* c*ns*ust a r:ew hc:n* *r m*ikr a suhst*nti.al improvernent ts an existing $tfi:e{ur*, y*rx *a3} pr*vent mauy problems by beirg aware of the fo}lowing responsihitritie* and oL}n€erfi$. KNxNgxlmyer x{.*sp*Nxs*&x$&*tiew Y*et will, in n":ost irrcta***so be ruled t* b* ar:r n'effipl$yfitr" and the ccntra*t*rx y*u **xtract with will be *'expSoy**s" if ysu u$s csntract*rs r:o& licensed with ttrre C*nstruction Conkaet*rs S*ard t* e}* labsr in ennsfrxrting ar tc assist in the c*nstruclio* *r irrrpr*vem*nt of,* r*side*ti*l skuctwe. As {hc exnptroy*r, ytlu r$}rst **mply witfu ths filff*wlugl #r*gelxa's 34litkhotr,*{mg Yax Lxwl As xn r:mployer, }rr:u x??rist rvithh*ld incont* tax*s f,r*m *mpl*y** wag*s at th* time **:pl*y*cs xre p*id. V*u :vili i:* liable f,r:r thr tax pavrnrnt! *\'en lf ,"**>r:l {t()n't sf tl}411y withh*id {he txx }r*m y*ur *mpl*y*es. .F*r rncra jnf*mraii*n, *altr &e lleparlment *f K*ver:ue at 5S3-378dSSS" Un*mployment fn:iurance Tax: As ea enrpinyer, you ars required to pay a tax for tmemployrnent insurance purpo$ef on the lrisge$ of all mrpl*yres. For:nq:re inf*rx'!ati*n, call *ee Oreg*n fimpl*yment tscpartri:ent at 5S3-947-1488. T.he Oreg*n B*siress Ider:tifieaticn Num'ber {*S{} is a e*nrbined number for bath Oregor Withholding and LI*employmenlIns:ra***Tax-To&tr*fbraBIN,caltr5*3-s45-8*$x$rforthe appropriate fonxs. Workers' Compersation Insuranee: As an empl*yerr you are subject to the Oreg*n Workers' Ccrapensation L*w, ar:d must cbtain w<,rke?$' cornpsnsafion insrirance for yow employees. If yo* fail to obtai* workers' c*mpensation insurance, yoLl coultr be subject to penalties and be liable for all claim cbsts if one of yor:r ernployees is injured on tJre "job. For rnara infcrmatiein, call the Wcrkers' Compensation Divisios at the Departmmt of Consumer and Business $ernrices at 5*3-947-78 15. Li.$" Xxxtern*-l Ksv*l:xi* $ea"v!ae; As an r:xployer, y*r"l rxuxt :vit:ihsld federal inc*me tax fr*m empln;rees' wa&ss. Y** will hr triai:le f,:r lhe try palment evc$ if y*x didn't *l*tleaily viili"rhr*l*9 th* 9ax" F*r * Fed*rxl fitrili nux:h€r, call the IR$ at X-800-82941r33 *r visit their web sils at xw.L{$.gcg" ffithxr Kcspoxrsihitrities sxld Areas of Conesr$$ Co** Cclr$plixxte*: At ll,* p*rrnit hq:}*i*r {*:r *}:lis 3:r*j*et, }"** ere resp**sibir fr>r res*lvi&g *r:y faiiur* to rx*et *oele requiren:cnts that rnay 1:* br*ugl':t ts yilur xlt**ti** thr**gh i*spe*tir:*r. X.iability xmel Pr*rp*r'ty []x;nage nnsuran*e: C*ntaet y*ur insr:r*ne* *g*n{ to see if -v*u have atleq*at* ir:suramcr c*ver*S* fbr x**icl*tls *trd *n:issi*ns sueh as I;llling t**}s, paixt (11 cr spra-v, u uler durnage fr*r:: pipe p*n*turr$, fir* *r wE:rk th*t r::ust be rt:d*:re. Time: M*kr sure yx.l have suf,fi*ient time t* supervlse yor:r *mpi*ye*s. Sxp*r{isrl Ma}ct: sur* you have the skills to act a$ your oih,n g**erel f$*tr&st*r. t* *r:*r*3in*te t}r* work of r*ugh*in a*d finish trades, a*d t* n*fify buitrctring *fH*i$ls as th* *pprnpr.l*xl* times r* tl:ey **lr perfr:rm the r*quired insp**ti*ns. if y*u have additional questit:ns cal} the C*rTsti"r"i*i'iox C*ntraetcrs Eoard {5{i3-3?S4621i *r rrorite the agency at F{} l}ox 141,lCI, "$alem, tlR. 9?3$9-5052. Property*owner,doc 0$-* I -04 225 FIFTH STREET . SPRINGFIELD,OR97477 . PH:(541)726--1753 o FAX: (541)726-3689 E L E CTRICAL P ERM IT AP P LI CATTON City.Iob Number ZoN {- INITIALS DATE SOURCE Date -o 3.CO]IfPLETE FEE SCHEDALE BELO\I' SPNTIt.GFTELD d 1. LOCATIANOTINS?H,TTATION:zs7 =oz- sT, A. n*elr'Ilesidential - Single or S'Iulti-Iiamii-v per dwelling unit. Service Included 1000 sq. ft. or less Each additional500 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 Amps/Volts Reconnect Only LEGAL DESCRIPTION JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Electrical Conffactor Address / q 8.7.-,?ar q Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name Address / I 8'7 /-h City Phone '7 q44lq'7 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. / sso.oo fr@ $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 C.Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 s 106.00 $ 19.00 ^ COAI?TTACTORI}{S?XI{,4ruO}/ O,^[I,}' B. Sen'ices or Feeders - Installation, Alteratious nr Relocation:t- City Over 600 Amps or D. Branch Circuits 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. &{iscellaneous (Service/feeder not included) -Each Installation Pump or irrigation Sign/Outline Lighting Limited Energy,/Residential Limited Energy/Commercial Minimum Electric Permit Inspection Fee is $45.00 + Surcharges $ s0.00 $ 50.00 $ 2s.00 $ 45.00 8% State Surcharge l0% Administrative Fee 5% Technology Fee oo b/,uoInspection Request: 726-3769 4. TOTAL Sharul Drive(T:)/Building Forms/Electrical Pennit Application 8-06.doc f , i'^ { - fl,':'l^ ptone'7q48/47 Dob Fo-' -" 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone C;^' of Springfield Official Receipt L - elopment Services DePartment Public Works DePartment RECEIPT #: 3200600000000000640 Date: 1212612006 2:33:26PNt Job/Journal Number coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 Description Foundation Permit Manufactured Home Placement Manuf Home State Issuance Manufactured Home Conn - Plmb Storm Sewer - lst 50 Feet Storm Sewer Each Addtl 100' Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Plan Review Minor - Planning Manufactured Home Service + 5%o Technology Fee + 8% State Surcharge + 10% Administrative Fee Amount Due 45.00 160.00 30.00 45.00 45.00 14.00 225.53 1 56.1 6 118.74 25.02 l 12.00 s0.00 23.55 28.72 35.90 Item Total: Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check AIC/BOB BOTTOMS lkw 038462 In Person Payment Total: $1,114.62 -Eilz:6t cReceintl Page I of I 1212612006 rilnml.affiJ* ffi rfPrlr, SLp E:=]i.$$*e=4n .$..*.!... *==ry,Lsffi.ffiffi *fr,' zoN Lr,L INITIALS oern I 22sFIFIHSTREET o SPRINGFIELD,OR9T4TT o PH:(541)726-3?53 'FAX:(541)726'3689 ELECTRT'CAL PERMIT APPLICATIAN City JobNumber C-Ovtt Zrro;-O135 Z Date lZ- l8 -c 6 1.LOCATION OF lLt E1 INSTALI,ATION: 3o+L I l- 3. COXLPLETE FEE SCT{EI}ULE BELOW A. Nerv Residential - Single or Multi-Fanrily per dwelling unit. LEGAL DESCRIPTION t? oz 3o7 Ll ol ?o( JOB DESCRIPTION: fgv"f Di.-ct Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. coNTRACTaI rNs:rALr.A?rgNojvrv Sen ice Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only One Circuit l0% Administrative Fee 5% Technology Fee \ $50.00 Electrical Contractor Address Phone Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of Supervising Electrician Feeder B. Services or Feeders - lnstatrlaticn. Alterations or Relocation: $ 63.00 $ 75.00 $ 125.00 $163.00 $37s.00 $ 50.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less / $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" above. D. Branch Cirtuits New Alteration or Extension Per Panel City 5-o 41"a5-$ 43.00 Owners Name Address Phone OWNER INSTALLATION The installation is being made on property is not intended for sale, lease or rent. t"rl 5----ZF-6rE-Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Fonns/Electrical Application 8-06.doc ffii##,,SN $106.00 $ 19.00 City Insfallation Lighting $ 50.00 $ 2s.00 $ 4s.00 Permit Inspection Fee is $45.00 * Surcharges OF ABOVE b' Lti dto 5o L' Status OK to Issue 225 Fifth Street, Springfield' OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-01332 ISSUED:APPLIED: l0/1612006 EXPIRES: 06/1812007VALUE: $ 2,000.00 SITE ADDRESS: 1487 30TH ST ASSESSOR'S PARCEL NO.: r702303401901 PROJECT DESCRIPTION: Replace existing manufactured home Springfield TYPE OF WORK: Manufactured Home on Private Lot TYPE OF USE: New Residential PhoneNumber: 541-744-8147Owner: Address: BOB BOTTOM 1213 PARKER ST SPRINGFIELD OR 97477 Contractor BILLS ELECTRIC :fdk;License 21351 Expiration Date 0412812008 05/05/2008 Phone 541-501-5650 s4l-935-1786 Contractor Type Electrical Manuf Home Inst Plumbing A ACTION MOBILE HO 42807 v'cOWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Secondary Construction # of Bedrooms: Fronfyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # ofStories: Height of Structure Type of Heat: ater Type: Type: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:nla 30.00 5.00 31.00 31.00 0.00 ) REQUIRED PARKING Total: 2 Handicapped: Compact: Fully Improved No 18.40 Sidewalk Type: Downspouts/Drains: Street Improvements: Storm Sewer Available: Special Instruction: PUBLIC IMPROVEMENTS Notes: Storm H2O to ditch line.JLP Pase I of3 /( 4 OF Buildin g/C ombination Permit PERMIT NO: COM2006-01332 ISSUED:APPLIED: 10/1612006 EXPIRES: 06/1812007VALUE: $ 2,000.00 Status OK to Issue 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Description Tvpe of Construction Foundation Onlv Use Bid Amount Manuf Home Manufactured Home $ Per Sq Ft or multiplier $r.00 $1.00 Square Footage or Bid Amount 2,000.00 5,000.00 t0n6t06 t2t18t06 t2n8t06 t2n8t06 t2n8t06 Value $2,000.00 $5,000.00 $7,000.00 Date Calculated 10n612006 t0n612006 Total Value of Project Date Paid Fee Description Plan Review Residential + l0o Administrative Fee + 5olo Technology Fee + 87o State Surcharge Temp Power 200 amps or less Total Amount Paid Amount Paid $29.25 $5.00 $2.s0 $4.00 $s0.00 $90.75 Receipt Number 1200600000000001531 2200600000000001714 2200600000000001714 2200600000000001714 22006000000000017r4 Fees Paid Plan Reviews Initial Review Plannins Review Public Works Review Structural Review tu02t2006 1u02t2006 APP LLH lu02t2006 tut512006 APP TAJ Delay in plan review. Plans Placed in wrong location. Willamalane SDC, Addressing, and Fire Fees not applicable - Replacement home This is Parcel 3 of Minor Subdivision 173, legally created on lll07166. Two street trees are required unless they are already in. Need to provide 32 sf of permanent enclosed storage. Storm H2O to ditch line.JLP Standard M.H comments sheet used fro plan review comments. lu02t2006 Lu02t2006 tut4t2006 lu06t2006 JLP DLM APP APP To Request an inspection call the 24 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. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Foundation: After forms are erected but prior to concrete placement. Reorrired Insnections Pase 2 of3 Valuation Descrintion I OF Building/Combination Permit PERMIT NO: COM2006-01332 ISSUED: APPLIED: 10/1612006EXPIRES: 06/1812007VALUE: $ 2,000.00 Status OK to Issue 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Final Building: After all required inspections have been requested and approved and the building is complete. Manuf Home Set Up: When installation of all piers or stands is complete. Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting' decks, venting, street address numbers, trees, driveway, etc. have been installed. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to Iilling trench. Water Line: Prior to filling trench and including required testing. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. MH Service: Approval required prior to utility company energizing service. Temporary Electric: Approval required prior to Utility Company energizing pole. 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. /z*/e*a6 Owner or Contractors Signature Date Page 3 of3 FZ*f4v{ Construction Contractors Board Permit 700 Summer St hlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: !trIE"Ebs!4!9@g Address: 4. Couwtzc-- > G.- O / 33 Z L.tg1 3O*t^ s c/e h- Issued by:Date: Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constructton permit applicants who are not licensed with the Constntction 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), need not submtt this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: €k- f . I owru reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction conffactor if the structure is sold or offered for sale before or on completion. 3,A.. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the stnrcture must be licensed with the Construction Contactors Board. OR 38. I will be my own general contractor. 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. (Signature of applicant)(Date) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 Y h, /z^/8-OA Ar;ting as t-our Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT GONSTRUCTION RE$PONSIBILITIES m NOTE: This lnformation Notice to Propeily awners abaut Construction Responsibilities lvas developed by the Canstructian Contractors Board in accordance with ORS 7A1.055(5J, passed by the 1989 aregan Legislature. If you are acting as your own contqactor to conskuct a new home or make a substantial improvement to arL existing structure, you can prevent tnany pri*lems by bing ar{#e of the followitg responsibilities and concerns. E mployer Responsibilities You will, in most i;rstances, be ruled to be an u'employer" and ths conffactors you conkact with wiii be "employees" if you use contractor, not licensed wi& the Construction Contactors Board to do labor in constructing or to assist in the construcdon or imJ,rovement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are pai<i. You will be liable for the tax payments even if you don't actually withhold &e tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Iasurance Tax; As an employer, you are required to pay a tax for unernploymentinsurance purposft on the wages of all enrployees. For more infornration, call the Oregon Employment Department at 5A3-947-1488. ,: andThe Oregon Busi:ress ldentification Number (BINI) is a combined. number fof both Oregon Wilhholding UnemployrrrentInsuranceTax.TofileforaBIN,ca11503.945.809Iorforthe appropriateforms. ,:: - ;.., :..: ..,: : , W'orkers' Compettsation I*suranee: As an employer, you are subject to the Oregon Workers' Compensafion Law, and must obtain w,)rkers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you cou d be subject to penalties and be liable for all clairn costs if one of your employeeS is irrjured on the job. For more infirmation, call the Workers' Compensation Division at the Departmant of Consumer and Business Services at 503-941'-78 I 5. LI.S. Internal Revenue Service: As an ernpioyer, ycu must withhold federal income tax from employees' *ug"N You will be liatrle jbr the tax payme*t even if you didn't actually withhold the tax. For a Federal EIN nurnber, call the \ IRS at 1-800-829-4933 or visit tlreirweb site at 1116ryj$.ggy. : Other Responsibilities end Are*s of Concerrs Code Cornpliance ; As lhe permit holder for this project, you art: responsible for resolving any failure to meet code requirgments that cmy be hrought to your attenlion through insp*etions. Liability and Propenty Damhge fnsurance: Contact your insurance agent to see if you have adequtrte insurance e{:}veragc ft:r accldrnts ancl omissior:* such as {'alhng tools, paint sver spr;}y} water damage from pipe punr:ture$, fire or work that nnust be redone Time: Ivlake sure I'ou have suflicient time to supervise your employees- Expertise; I{ake r;ure yor', iruue the skills to act as yo,r, o*rr'genetal c6iihactbr,'to coordiiiate the work of rough-in and finish trades, arid to nofiflr building officiais as the appropriate times so they ca:r perforrn the required inspections. Ifyou have additiorral questions cail the Construction Contractors Board $A3-3784621) or write the agency at PO Box 14140, Salern, OR 97309-5052. ::.1rg;.: ,r Property_owner.doc t )6-0 1 -04 I 225 Fifth Street Springfield,.Oregon 97 477 541-726-3759 Phone Cits' of Springfield Official Receipt L, ;lopment Services DePartment Public Works Department RECEIPT #: 2200600000000001714 Date: 1211812006 e:ll:35AM Job/Journal Number coM2006-01332 coM2006-01332 coM2006-01332 coM2006-01332 Description + 5%o Technology Fee + 10Yo Administrative Fee Temp Power 200 amps or less + 8% State Surcharge Amount Due 2.50 5.00 50.00 4.00 Item Total $61.s0 Payments: Type of Payment Paid By Received By Batch Number Check Number Authorization Number How Received Amount Paid CreditCard ROBERT BOTTOM djb 330841 In Person $61.50 PaymentTotat: ffi cReceint I Page I of I 12118/2006