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Home My WebLink AboutPermit Building 2004-06-21Status 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: COM2004-00598ISSUED: 0612112004 APPLIEDz 0512012004EXPIRES: 1212112004VALUE: $ 17,001.00 PROJECT DESCRIPTION: Rebuild laundry room Owner: HALEy LAWRENCE R Address: 1962 N 18TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair Residential Phone Number: 541-747-0869 License Expiration Date PhoneContractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER TION PUBLIC INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Primary Secondary # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: \S REQUIRED PARIflNG Total: Handicapped: Compact: 1 R-3 17.00 0.00 14.00 Path I nla 184 E \S Notes: Pase I of3 0R SITE ADDRESS: 1962 18TH ST ASSESSOR'S PARCEL NO.: 1703252404400 l, U r Llrlr\ (J rN rll2dn4,u!!2Nl 180 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: COM2004-00598ISSUED: 0612112004APPLIED: 0512012004 EXPIRESz 1212112004VALUE: $ 17,001.00 Valu ation I)escrintion Description Dwellings Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0o/o Administrative Fee + 7o/o State Surcharge Building Permit Dryer Vent Fixture Minimum/Adj ustment Mechanical Minimum/Adj ustment Plumbin g Plan Review - Planning + l0o Administrative Fee + 7o/o State Surcharge Add, Alter, Extend Circ Ea Add Perm Servffdr 200 amps or Iess Total Amount Paid Tvpe of Construction Y Wood Frame $ Per Sq Ft Square Footage or multiplier or Bid Amount $92.40 184.00 Total Value of Project Amount Paid Date Paid Value $17,001.60 $17,001.60 Receipt Number 1200400000000000768 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 1200400000000001032 1200400000000001032 1200400000000001032 1200400000000001032 Date Calculated 0st20t2004 $110.37 $10.00 $2s.98 $18.19 $169.80 $6.00 $r4.00 $39.00 $31.00 $71.00 $7.20 $5.04 $9.00 $63.00 5t20104 6t2u04 6t2y04 6t2u04 6t2u04 6t2u04 6t2U04 6t2u04 6t2y04 6t2u04 7t2t04 712104 7t2104 712104 $s79.s8 tr'ees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 05t2u2004 05t2112004 05t2y2004 05t2U2004 05t2u2004 06n5t2004 06t07t2004 06t07t2004 LLH TAJ VRJ TCM APP APP APP OK replace with existing. To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. wilt 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. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Paee 2 of3 Reanired Insneefions Status Issued 225 Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-00598ISSUED: 0612112004APPLIEDz 0512012004 EXPIRESz 1212112004VALUE: $ 17,001.00 Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical 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. Owner or Contractors Signature Date Pase 3 of3 225 FIFTH STREET . SPRINGFIELD, OF.97477 o PH:(541)726-3753 o FAX: E LE CTRI CAL P ERMIT AP P LI CATI ON City Job Number Lo^4 Date 1.3. LEGAL DESCRIPTIONt-o3zsz\ C)Ytloo JOB DESCRIPTION Cc{ZLt*'/= Permits are non-transferable expire if work is i not started within 180 days of issuance or if work is Suspended for 180 daYs. 7 Electrical Contractor Address 01 Supervisor License t\s tn {sl 616{ Expiration to(gt Constr,Number Date of Supervising Electrician Owners Name Address ll 6> /1/, I B*^ City phone 776-Llq7 1 \\\ h$1 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 z0l Amps to 400 Amps to 600 Amps to 1000 Amps AmpsA/olts Only Alteration or Relocation LC- 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $106.00 $ 19.00 $s0.00 $ 63.00 $ 7s.00 $12s.00 $163.00 $37s.00 $ 50.00 $ 50.00 $ 69.00 $100.00 $ 43.00 $ 3.00 $ s0.00 $ s0.00 $ 2s.00 B. D. G0 r9 City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 4L Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges AL Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit 1Ht 7%o State Surcharge l0% Administrative Fee TOTAL ? 4. a20 r7 ZLI Inspection Request: 726-3769 Shared Drive(T:)/Building Forms/Electrical Permit Application l -03.doc A. New Residential - Single or Allerations or Reloc:rtion : rt€a(c Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:rybs,lg[e.or.us permit *: ( OuaLd6q -O O S " tr Address: n6Z t 8,! Si Issued by:b<Date 7 o 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 building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure ,E- A 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 #) 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 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. ,fa,,Juqnnt N 0.,"17 7 2_O (White copy to issuing agency permitfile, pink copy to applicant.) (Date) Property_owner.doc 1 2-09-03 -& L_l A*ting as'Your Own General Contractor? INFORMATION NSTICE TO PROPERTY OWNERS. ABOUT CONSTRUCTION RESPOiI$IBILITIES If you are acting as -vour ow.n conffactor to construct"a new home or make a subskntial improvement to an existing strucalrs, you can prevent many probietns by h+:ffiEiaware.oflthe foHo#ng responsibiiities and concerns. Employer Responsibilities ' I , ;''.! You'will, in most instances, be ruled to be an "ernpl,oyer" aad the coatractors you aonfrast rvith will be "employees" if you use contractors not iicensed w"ith the Conskuctiou Qontractors Board to do labor in constructing 9r to assist in the construction or impravement of a residential structure. As the employeL you must coEplyr with the following: Orcgon's Withholtling Tax Law: As an ernployer, you'must withhold iniome taxes from employee wages at the time ernployees are paid. You rvill be,liable f'or the tax payments even if you don't actually withhold the tax from ypuS employees. For rn*re informaticrr; "'itt tt . Deparrmerrt of R..'*u" atlsir3:3t8qgg8.' -' ' ' , Llnempl*yment lnsur*nce Tax: As an employer, ydu arerequired to pay a tax forrunemployment insurdnce prrpoL}- on the *'ages of all emplo-vees. For more information, call the Oregan Employment Deparlment at 503-947-1488. 'I'he {}rcg*n I4"*sines; Id*nti{icatron Number (BiN} is a eornbined number for bath Oregan Withhalding and l-in*r::lr1*yrr:r:nt inEuraner Tax. To file tbr a tsI^hi. cali 503-945-8091 or::-Euder.qlafc.CILlig-{btglpe:}lit:1] for the appr*priale J'ilrxi:;" Workers' Compe*sation Insurance: As an employer, )iou are subject to the Oregon Workers' Compensation Law, and must obtain lvork€rs' compexsalian insurance for yoqr employ'ees. If you fail to oblairl rvcrkers'.gempensation insurance. ycri could be subject to pinalties'and be liable for all'claim costs if one of your employees is iqured on the job. IIor more informatran. cail the lYorkers' Compelsation Division at the Departrnent of Consuiner and Busiress Serr,iccs at 503 -947-75 I 5. ti-S. lnternal Itevenue Service: As an employer, you must withhold federal income tax from employees'-*";b\- Ycu rvill be iiable for the tax pay:rnert e1€n if you didn't actually rvithhold the tax. For a Federal E{\l number, call the , Other Responsibilities and Areas of Concerns Cadc Ccmpliance: As the pennit holder for this pro3ect. you are responsible for resolving any failure to meel code requirements that rnay be brought to your attention thqgit inspections Liabillty *nrl Property flamage Insurance: Contact your insurance agent to see if you have adequate insurance cov*rage fcr accidents ancl omissi*ns such as falling tools, paint over spray, rvater damage friim pipe punctures, {ire or work rhat rnust be re<lone. Tirne: Make snre you have sufficient time to supen"ise 1'our employees. Expertise: Make sure you harc the skills to act as your own general contractor, to coordinate the work of rough-in and fitish trades, and t* notify building officials as the appropriate times so they can perform the reqirired inspections. If you have additional questions call &e Constructicn Contractors Board (503-3784521) or write the agency at P0 Box 14140, Salem. OR 97309-5052. : Property_ou'ner.doc I 2-09-03 fuCIf$j This lnfarmatian Notice to Prapefiy Owners a&oul Constructian Responsrb#{ies was developed by the **nstructi*n Crsntractors Board in accordance with ARS 7U.A55(5j, passed by the ?989 Oregon Legislature. 225 Fifth Street Spritgfield, Oregon 97 477 541-726-3759 Phone ^ity of Springfield Official Receipt .--- evelopment Services Department Public Works Department RECEIPT #: 1200400000000001032 Date: 0710212004 1:55:21PM Job/Journal Number coM2004-00598 coM2004-00598 coM2004-00598 coM2004-00598 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + loh State Surcharge + l0% Administrative Fee Amount Due 63.00 9.00 5.04 7.20 Item Total:$84.24 Payments: Type ofPayment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Cash Change LAWRENCE HALEY LAWRENCE HALEY djb djb In Person In Person Payment Total: $100.00 ($1s.76) $84.24 Job/Journal Number coM2004-00598 coM2004-00598 coM2004-00598 coM2004-00598 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 7o/o State Surcharge + l0% Administrative Fee Amount Due 63.00 9.00 5.04 7,20 Item Total:$84.24 Payments: Type ofPayment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Cash Change LAWRENCE HALEY LAWRENCE HALEY djb djb In Person In Person Payment Total: $100.00 ($15.76) $84.24 712t2004 Page I of I rt*x3l|3,,,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: COM2004-00598ISSUED: 0612112004 APPLIEDz 0512012004 EXPIRESz 1212112004VALUE: $ 17,001.00 SITE ADDRESS: 1962 18TH ST ASSESSOR'S PARCEL NO.: 1703252404400 PROJECT DESCRIPTION: Rebuild laundry room Owner: HALEy LAWRENCE R Address: 1962 N 18TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORI(: Single Family Residence TYPE OF USE: Repair Residential Phone Number: 541-747-0869 License Expiration Date PhoneContractor Type General Electrical Mechanical Contractor OWNER owttER owNER OWI\ER # of Units: Primary Occupancy Group: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled 10 Sidewalk Type: Downspouts/Drains: Floor: Floor: Load REQUIRED PARJ<ING Total: Handicapped: Compact: 184 $'o r7.00 0.00 PUBLIC IMPROVEMENTS Notes: Page 1 of3 % ll\r(rta.utAlr(rN I Secondary Occupancy Primary Construction Secondary # of Bedrooms: # Street Paved Drive Yo of Lot ITY 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: COM2004-00598ISSUED: 0612112004APPLIED: 05/2012004 EXPIRESz 1212112004VALUE: $ 17,001.00 Description Dwellinss Type of Construction V Wood Frame $ Per Sq Ft Square Footage or multiplier or Bid Amount $92.40 184.00 Total Value of Project Amount Paid Date Paid Value $17,001.60 $17,001.60 Receipt Number 1200400000000000768 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 2200400000000000820 Date Calculated 0512012004 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 77o State Surcharge Building Permit Dryer Vent Fixture Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing Plan Review - Planning Total Amount Paid $r10.37 $r0.00 $25.98 $18.19 $169.80 $6.00 $14.00 $39.00 $31.00 $71.00 $495.34 5t20t04 6t2u04 6t2u04 6t2y04 6t2u04 6t2u04 6t2u04 6t2u04 6t2U04 6t2u04 Rpps Peid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 0512u2004 0st2u2004 05t2u2004 05t2u2004 0st21t2004 06n5t2004 06t07t2004 06t07t2004 LLH TAJ VRJ TCM APP APP APP OK replace with existing. 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. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Pase 2 of3 Reorrirpd fnsnpelions Valuation Descriotion I 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: COM2004-00598ISSUED: 0612112004 APPLIEDz 0512012004 EXPIRESz 1212112004VALUE: $ 17,001.00 Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical 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 or Contractors Signature Date Page 3 of3 225 Fifth Street Springlield, Oregon 97 477 541-726-3759 Phone rrty of Springfield Official Receipt _ velopment Services Department Public Works Department RECEIPT #: 2200400000000000820 Date: 0612112004 1:13:3lPM Job/Journal Number coM2004-00598 coM2004-00s98 coM2004-00598 coM2004-00598 coM2004-00598 coM2004-00598 coM2004-00598 coM2004-00598 coM2004-00598 Description Building Permit Fixture MinimumiAdjustment Plumbing Dryer Vent Minimum/Adj ustment Mechanical -Mechanical Issuance Fee.- + 7o Sral.e Surcharge + l0% Administrative Fee Plan Review - Planning Amount Due 169.80 14.00 31.00 6.00 39.00 10.00 18. t9 25.98 71.00 Item Total:$384.97 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check STEVEN R JOHNSTON jmp 1687 In Person Payment Total: $384.97 -S58-A3rr 6t2t/2004 Page I of I lBtnlnlaar.o Construction Contractors Board Permit t''(. F -co Address: tg6"- tt 9{ Issued by:Jt-^t o^t",Ob- Z( - oq- 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:rybg1lglq Statement: lnformation Notice to Property Owners About Gonstruction Responsibil ities 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 building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and.2, and either box 3,A. or 38 Ef 1. 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. tr 3A. My general contractor is (Name)(ccB #) 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 nirme 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. ' ') ,. ,.'- , ,' . r )i'l \ , {'- , ''... '- ,' i i I i iru (White copy to issuing agency pennitfile, pink copy to applicant.) Property_owner. doc 03/ I I /03 I will instruct my general contractor that all subcontractors who work on the strucfure must be licensed with the Constnrction Confractors Board. OR EI 38. I will be my own general contractor. Aeting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OTN'NERS ABOUT CON$TRUCTION RESPONSIBILIYIES NOIE: Tttis lnformatian Notice to Propefiy Owners about Canstructron Respo nsibilities was developed by the Cons{rucffon Cantractors Board in accardance rvrth OfrS 701.A55$), passod by the 1g8g Oregan Legislature. If you are acting as your own contractor to construct a new home or nnake a substarrtial improvement to an existing skucture, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do iabor rn constnrcting or to assist in the construction or improvement of a residential $tructure. As the employer, you must comply with the fotlowing: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You n ill be liable for the tax payments even if you don't actually withhold the tar from your empioyees. For a State Business ID number, call the Business Information Center at 503-986-2200. IJnemployment Insurance Tax: As *n emplcyer, you are required to pay a tax for unemplo3ment insurance purpose$ onthewagesofallemployees. Formoreinformation,calltheOregonEmploymentDepartmentatS(t3-947-1488. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your empioyees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-78 i 5. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any faikne to meeit code requirements that may be brought to your attention through inspections. Liability and Property Damage fnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe.prmctures, fire or work that must be redone. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notifu building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 03ll l/03