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Home My WebLink AboutPermit Building 2004-07-29Building/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: COM2004-00802ISSUED: 0712912004 ,r -- j':' i iOtrJ: Arubil[ilJ recut&&,ll;l00l; . .,,EI(BrySle or&1d39[ill00F Iri,-.r i .'ir .n cerYd,LM&e rutesSr63}fi6frn srrE ADDRESS: 862 S 43RD ST SpedfngdleDgnE0{lwoBffie €ryone ASSESSOR'S PARCEL No.: 18020s2406203 number for the Oregon Utility Notilication C e n E[Fl S USe -agatf.d itio n PROJECT DESCRIPTION: Carport addition to existing M.H. Owner: MASON DONNA R Address: 862 S 43RD ST SPRINGFIELD OR 97477 MIT SHALL EXPIRE IF THE WORK Residential ANY 180 DAY P EBIOD.Llcense ONED FOB Expiration Date PhoneContractor Type General Contractor OWl\ER ; INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: u-1 VN 12.00 nla 384 40.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Vo oILot Coverage: 0.00 Sidewalk Type: Downspouts/Drains: Drywell application shall be filled out and submitted to DEQ. - MS 5.60 REQUIRED PARKING Total: 2 Handicapped: Compact: Drywell - Provide Drywell Engineering Yes Notes: $ Per Sq Ft or multiplier Square Footage or Bid Amount DEVELOPMENT INF( PUBLIC IMPROVEMENTS Description Type of Construction Pase I of3 Value Date Calculated r:r. Valuation Description 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: COM2004-00802ISSUED: 0712912004 APPLIEDT 0710112004 EXPIREST 0112912005VALUE: $ 6,724.40 Bid Amount Carport Use Bid Amount Carport $350.00 $6,374.40 $6,724.40 07n9t2004 07t0u2004 Fee Description Plan Review Residential + l0oh Administrative Fee + 7oh Sttte Surcharge Building Permit Plan Review Minor - Planning SDC Sanitary/Storm Admin Storm Drainage Impervious Area Storm Sewer - lst 50 Feet Total Amount Paid $r.00 350.00 $16.60 384.00 Total Value of Project Date Paid 7nt04 7t29t04 7t29t04 7t29t04 7t29t04 7t29t04 7t29t04 7t29t04 Receipt Number 1200400000000010r6 120040000000000r156 1200400000000001156 1200400000000001156 12004000000000011s6 1200400000000001156 1200400000000001r56 1200400000000001156 Amount Paid $s4.60 $12.90 $9.03 $84.00 $s9.00 $3.29 $65.88 $45.00 $333.70 Fees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 07t02t2004 07t02t2004 07t02t2004 07n6t2004 APP APP LLH TAJ 07t02t2004 07t07t2004 APP MS 07t02t2004 07fi912004 APP DLM Driveway needs to be paved lst 18' if abutts a curb and gutter street 71712004 - DEQ registration forms are included. The applicant shall submit the DEQ registration form to DEQ and a drywell inspection has been added. Note: the drywell design drawings are included as well. - MS See documents for plan review comments. 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. Footing: After trenches are excavated. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. Storm Sewer Line: Prior to filling trench. Reorrired Insneet Paee 2 of 3 ETL 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: COM2004-00802ISSUED: 0712912004APPLIEDz 0710112004 EXPIRESz 0112912005VALUE: $ 6,724.40 By signaturer l 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 OCCUPAIICY 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. ftuLr/\a-YY)o"arl,n --a-7q-cLl Owner or Contractors Signature Date Paee 3 of3 Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us ,- Ju -oaAa .>. 43-* \5r Narncd /v{ -@ x X W Permit #; Address: Issued by:Date:4a Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: 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, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. 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. 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 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. 7-as{u (Signature of perml t applicant)(Date) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc I 2-09-03 x Acting as Your Own General Clontractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CON$TRUCTION RE,SPONSIBILITIES NOIE: Tltis lnformation Notice to Propefty Owners abaut Construction Responsrbflfiies uzas deyeJoped by the Canstruction Contractors Board in accordance wittt ARS 7A1.A55{5J, passed by the 1989 Aregon Legislature. If you are acting as your o\r,n contractor to construct a new lqme or mgke a subslantial improvement to an existing structure, Jiou can preveiiiinanypnoblemsby-befui$+a:ware oiihe foflding responsibtliiibsand concerns. Employ'er Responsibilities You wifl, in most instances, be ruled to k an "employer" and the eonfractors you.cpntract rvith u.ill be'lemployees" if you use cootractors not.licensed with &e Construction Contractors Board to.do labor in constructing or to assist in the construction or improvement ote residentral strqcture. As the employer, you mFst comply with the following: Oregon's Witillotding fax'iaw: As an employer. you nrust rvithhold income'taxes from employee wages ar the time empioyees are paid. You rvill pe llable tbr the tax payments even 1f you don't actually withhold the tax fiom.your employees. For more information, call the Department ofRevenue at 503-378-4988.'' " :;' Unemployment Insurance Tax: As an employer. you are required to pay a tax for u'nemployment insurance prrpos"; on the wages of all emplayees. For more informatian. call the Oregon Employment Department at 5A3-947-1488. :i,i.,,1,. . -.i, -.\ The Oregon Business Identification Number (BiN) is a combinbd nurnber for both Oregon Withholding and- Unemployment Insurance Tax. To file for a BIN. call 503-945-8091 or ry..dg.st?lg.gtuglbp1Epe):htn:ll for the appropriate forms. . ., , ii* Workers' Compensation Insurance: As an ernpioyer, you are subject to the Oregon Workers' Compensation Law. and mgst o,b-pin workers'-compensation insurance for your empioyees. If ygu,fail to obtain rvorkers'compensation insurance. 1,'ou could be subject to penalties and bc liable for all claim costs if one of your employees is injured on the job. For more information. call the lVorkers' Compensation Division at the f)epartment of Consurrer ancl Business Services at 503-947 -7 815. Li.S. Internat Revenue Service: As an emplo,ver, you must withhold federal income'tax from employees'wages.. You will be liable for the tax payment ev'en if you didn't actually rvithhold the tax. For a Federal EIN number. call the IRS at 866-816-2055 or fax them at 8CI1-620-71 15. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage fnsurande:' Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling toois, paint over spray, rvater damage from pipe punctures, tire or work that muft be redone. ) I - r Time: Make sure'you have sufficient time to supervise your employees. :: I Expertise: Make sure you have the skills to act as your o\\,n general contractor, to coordinate the work ot'rough-in and finish trades, and to noti$/ building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Constmction Contractors Board (503-378{621) or write the agency at pO Box 14140, Salem, OR 97309-5052. Property_o*ner.doc I 2-09-03 CITY OF SPKNGFIELD SYSTEMS DEVELOPMENT JRKSHEET JOURNAL OR JOB NUMBER: COM2004-00802 NAME OR COMPANY:Donna Mason LOCATION:862 S 43rd Street TAX LOTNUMBER:18020524 Tax Lot 06203 DEVEI-OPMENT TYPE: NEW DWELLING LINITS 0 I. STORM DRAINAGE DIRECT RTNOFF TO CITY STORM SYSTEM COST PER S.F. $0.310 BUTLDTNG SIZE (SFl 0 LOT SIZE (SF): CHARGE $0.00 8712 l- IMPERVTous s-F. x I o.oo RLTNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CIry STANDARDS IMPERVIOUS S.F 425.00 ITEM 1 TOTAL - STOR]VI DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBI]RSEMENT COST: x x x x x x x COST PER S.F $0.310 COST PER DFU $24.04 $r 8.28 NUMBER OF UNITS 0 NUMBER OF LTNITS 0 ADM. FEE RATE 5o/o DISCOT]NT RATE 5OYo $6s.88 DISCOT]NT $65.88 x ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: $0.00 COST PER TRIP $r 8.30 COST PER TRIP $80.72 $0.00 NLIMBER OF DFU's 0 B. IMPROVEMENT COST: NUMBER OF DFU's 0 ADT TRIP RATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.s7 SUBTOTAI. $65.88 xx NEW TRIP FACTOR r.00 NEW TRIP FACTOR 1.00 xx ITEM 3 TOTAL- TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NL]MBER OF FEU'S 0 B. IMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC 5. ADMINISTRATIVE FEE: $0.00 $65.88 CHARGE $3.29 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRAN SPORTATION ADMINI STRA FEE: Matt Stouder 717/2004 COST PER FEU $3 r 4.63 s0.00 $0.00 $0.00 $0.00 $0.00 3.29 00 $69.17 1070 l09l 1092 1 093 1094 I 054 1055 I 056 l 078 ar!o U rrlFa o F]& 1 COST PER FEU $214.23 PREPARED BY DATE TOTAL SDC CHARGES x SUBTOTAL (ADD ITEMS 1,2,3, & 4) DRAINAGE FIXTURE UNIT CALCULATION TABLE NI.]MBER OFNEW FXTURES x UMT EQUIVALENT: DRAINAGE FXTURE UMTS FOR CALCULATE ONLY T}IE NET ADDITIONAL NO. OF FIXTURES LNIT FIXTI.,IRE ryPE NEW OLD NUMBEROF EDU'S TOTAL DRAINAGE FIXTURE UNITS rsa toa unit set at I 67 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 20 DRAINAGE FIXruRE UNITS 0 0 0 t979 *EDU BEFORE 1979 1979 I 980 1982 1983 1984 1985 I 986 1987 '1988 1989 I 990 1992 I 993 1994 1995 1996 1997 1998 1999 $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 l98t IS LAND ELGIBLE FORANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDITFOR LAND (IFAPPLICABLE) VALUE / IOOO $0.00 CREDITRATE $5.29 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE/ IOOO CREDITRATE $0.00 x $5.29 TOTAL MWMC CRf,DIT l99l $1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 BATHTUB 0 0 3 0 DRINKING FOLINTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 b 0 LAUNDRYTUB 0 0 2 0 CLOTI{ESWASHER / MOP STNK 0 0 3 0 CLOTHESWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTORFOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWE& SINGLE STALL 0 0 2 0 sHowER, GANG (NLA,IBER OF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 0 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOI.]BLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 ,|0 URINAL, STALL/WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 b 0 TOILET, PRIVATE INSTALLATION 0 0 3 0 0 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 2000 2001 MISCELLANEOUS DFU ryPE 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone cty of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT#: 1200400000000001156 Date: 0712912004 ttz45:24twl Job/Journal Number coM2004-00802 coM2004-00802 coM2004-00802 coM2004-00802 coM2004-00802 coM2004-00802 coM2004-00802 Description Storm Drainage Impervious Area SDC Sanitary/Storm Admin Plan Review Minor - Planning Building Permit Storm Sewer - lst 50 Feet + 7o/o State Surcharge + lOoh Administrative Fee Amount Due 65.88 3.29 59.00 84.00 45.00 9.03 12.90 Item Total:$279.10 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check DONNA R. MASON njm In Person Payment Total: $279.10 -$mir' 4341 7129t2004 Page I of I 'Duaru