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Home My WebLink AboutPermit Building 2008-8-22 CITY VI:< ~nuNGFIELD ' Building/Combination Permit PERMIT NO: COM2008-01274 ISSUED 08/22/2008 APPLIED: 08/2212008 EXPIRES 02/2212009 VALUE. $ 2,000.00 Status Issued 225 F,fth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme SITE ADDRESS 275 55TH ST ASSESSOR'S PARCEL NO 1702334201100 Spnngfield TYPE OF WORK Dryrot Overlay DlSt # Street Trees Rqd Paved Dnve Rqd % of Lot Coverage E 'tJOl\~ t.,ni\C~: .. ,~ fl/l" t=f-f~E ~~i:T I!; ~Ol 111\1?J~\~~~fN.i~.,E.\) fOl\ , If"" '161,-,- I 'tl ",IJ ~~M~NCE.\) OR ,,, DJ'''''' ..' Sidewalk Type COw, 00 D"''l pE.RIO . AN\' 10 TYPE OF USE PROJECT DESCRIPTION Dryrot I water damage repair Ownel Address JOHNSON VICKI LYNN 342 S 35TH ST SPRINGFIELD OR 97478 I, CONTRACTOR INFORMATION' Contractor Type Contractor LIcense # of Umts Pnmary Occupancy GlOup Secondary Ollllpancy Group Pnmary ConstructIOn Type Secondary ConstructIon Type # 01 Bedrooms ..^t\\O I, BUlLIIf\W'm~~~~ ~\-H=-\'l\\ON dOf.-ed O'j "1~\eS ale \2-00'< IUles a. ofi;~wn;,s O~\\ 9 \)'1 \o\19f~a.\\On cent I elii1I1f~EAIthll lules l'lo\\\ 9S2-00~- lbPml,ft \elephone In ~@\\ '{ou fl\a.'jel ~I\ltI9~\~~~ l'lo\\\ICa.\\On 00 ca.lllng \~el ~hl}~2.2344). (l1lfl\\:lel 0 (I\eF\W~11t ce Sprmkled Buddmg nl a I DEVELOPMENT INFORMATION' Front yard Setback SIde I Setback. SIde 2 Setback Rearyard Setback Solar Setbacks Street Improvements Storm Sewer A vadable Special InstructIOn Repair ReSidential ExpIration Date Phone Lot Size Sq Ft 1 st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load REQUIRED PARKING Total Handicapped Compact Downspoutsffiralns Notes I ValuatIOn DescrIotIon , DescnptlOn $ Per Sq Ft 01 mulhpher Square Footage or BId Amount Type of ConstructIOn Pa2e I on Value Date Calculated Status Iss u ed 225 Fifth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe Fee DescnptlOn + 10% AdmlDlstrahve Fee + 12% State Surcharge + 5% Technology Fee BUlldlDg Permit Fixture MlmmumlAdJustment PlumblDg ReSIdence Wifing 1000 Sq Ft ResIdence Wifing Ea Addtl 500 Total Amount Paid CITY 01' .sn<.INGFIELD Building/Combination Permit PERMIT NO: COM2008-01274 ISSUED 08122/2008 APPLIED: 0812212008 EXPIRES: 02/2212009 VALUE: $ 2,000.00 Total Value of ProJect "'r,r,.. P'WlJ Amount Paid Date PaId Receipt Number $24 70 $29 64 $12 35 $52 00 $5100 $100 $12100 $22 00 8/22/08 8/22/08 8/22108 8/22/08 8/22/08 8/22/08 8/22108 8122/08 1200800000000000905 1200800000000000905 1200800000000000905 1200800000000000905 1200800000000000905 1200800000000000905 1200800000000000905 1200800000000000905 $313 69 I Plan ReYlews I To Request an inspectIOn call the 24 hour recol dIng at 726-3769. All InspectIOns requested before 7 00 a m wIll be made the same workIng day, Inspections requested after 7:00 a m will be made the folloWIng work day I ~~r'l.rprlln<.n~ctlOns I Shear Wall NaIlmg Before covermg sheathlDg with fimsh matenals Frammg InspectIOn Pnor to cover and after all rough m mspectlOns have been approved Wall InsulatIOn Pnor to love I Filial BUlldIDg After alii eqUlred mspectlOns have been requested and approved and the bUlldlDg IS complete Rough Plumbmg Pnor to cover and mcludmg reqUIred testlDg Water LlDe Pnol to filhng t1ench and IDcludlllg reqlllred testmg Samtary Sewer LlDe Pnor to filhng trench and lIIc1udlDg reqUIred testlDg Filial PlumblDg When all plumblDg work IS complete Rough Electnc Pnor to Cover FlDal Electnc When all electncal work IS complete Pa2e 2 ot 3 Status Issued 225 Fifth StI eet, Spnnglield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO ISSUED APPLIED. EXPIRES: VALUE COM2008-01274 08/2212008 08/22/2008 02/22/2009 $ 2,000 00 By signature, I state and agree, that I have carelully examlDed the completed apphcatlOn and do hereby certify that all mformatlOn hereon IS true and correct, and I further certify that any and all work performed shall be done ID accordance With the OrdlDances of the City of Sprmgfield and the Laws of the State of Oregon pertammg to the work descnbed he. elD, and that NO OCCUPANCY WIll be made of any structure Without permISsIOn 01 the Commnmty SerYlces DIvISIOn, BmldlDg Safety I further certify that only contractors and employees who are ID comphance With ORS 701 005 wIll be used on thIS proJect I further agree to ensu.e that all reqUIred IDspectlOns 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 remam on the SIte at all times durmg constructIOn \C'r_ ! CM~V'- Own'er or Contractors sQtu;e- ., . Pa2e 3 00 ~ y ) d.--;), \ C) K Date ( SPR~NCPII!LD ~ ZON t...1)Q., L~-....J [NITIALS~_ ..:1.. ~ .A!... DATE ~7 'lJ'V "JiV' ~ SOURCE ~~{V ELECTRICAL PERMIT APPLICATION P_ 2-Z -ZOO~ CltyJobNumber (OW\~O ~- Q I Z 71..( Date 0 I J;;;-TION :;;';f~LLATION So ~ 3 ~OMPLLm; FEE SCHEDULE ~EL~W - ---- 1\ ~,mw~~~ 225 FIFTH STREET' SPRINGFtFLll, OR 97477 . PlI ('41)726-3753 . MX (541)726-3689 LEGAL DESCRIPTION 1701.334 z.. JOB DESCRIPTION I A I New R~ldent..l- SlDgle or Mulh-F=,-m.!~y per dwel~ng umt 01100 I / Z ( 22. NF=1.N VJ..-.el '- r~t.Jlre- k,Ow\e I Permits are non-transferable and expue If work IS not started wlthm 180 days of Issuance or If work IS Suspended for 180 days ServIce Included 1000 sq ft or less Each additIOnal 500 sq ft or portion thereof Each Manufact'd Home or Modular DwelllDg Service or Feeder $57 00 I I $12100 $ 22 00 2 I CONrI'RACTORINSTALLATIONONLY I B I Services or Feeders - Installation, Alterahon;or Relo~;tJon 200 Amps or less $ 73 00 AA-I ~l!llI1llSl\JOIA~s $ 86 00 ^,~ >:NTION. orego; tNl'h6~~0J1'lJ}Yli. $14300 , (V fL""~ ujopte 1iE\Ii~jtol'tn 1\'~;lliGat'on Center ThClM 1'\Y5l!-6(J'11o' $18600 Phone '-, ^Da;?_001-0010t~9~ Iltitl1lillly $42600 0090 . You may obtain ~~fg~~~ \'€phone $ 57 00 ......(\ callmg the center ( n-Utlhty NotlllcaUon __ --- SupervISor License Number \t:: number tor the OrEl9~o~I2'3~l:'ervlces or Feeders ___ __ J t verner IS 1-1)' () Electrical Contractor Address City EXpIratIOn Date Constr Conlr Number ExpiratIOn Date ____ .:-J InstallatIOn, Alteration or RelocatIOn 200 Amps or less 20 I Amps 10 400 Amps 40 I Amps to 600 Amps Over 600 Amps orlOOO Volts see "B" above . "D , IJrdnlh CirCUits "-~ .... - $ 57 00, $ 79 00 $11400 -------, Signature of SupervIsmg ElectrICian New AlteratIOn or ExtensIOn Per Panel Owners Name V lCJ<. ~ 77-;- s\> F' ~ Address City OWNER INSTALLATION . -- .9.",,~..rcUlt "n; WOt:\\t 50 00 N01IDJ:Add!ll~M',~~<FI~If r "'aT 1:1.. lH\~<fijaMll''iWi6€'R''\'kIS PER~nll IS.. 500 .. ... ~... - I A~IHORIZED-UL_Jl.RANDOMEDFOI\ - ;;J S 5.H... Sore "A^"""Ift~l)eQR ~&.Rlte/(eeder not mcluded) -Each InstallatIOn _ ,V\IVII:"OAY PERIOO; -- - - -- Phone '15 <( ~ 52. s 4.MP'u~~~r lITIgatIOn $ 57 00 SlgnlOuthne LIghtmg $ 57 00 L,mlted Energy/ReSldentlal $ 29 00 Limited Energy/Commerclal $ 52 00 MIDlmum Electnc Permit InspectIOn Fee IS $52 00 + Surcharges 4 ISUBTOTALOFABOVE I I Lf:S 12% State Surcharge 17fh 10% AdmmlStratlve Fee 11/ SO 5% Technology Fee 71r '8/~ The mstallatlOn IS bemg made on property I own which IS not mtended for sale, lease or rent ~{tler~ Signal#: -.J! ,_';..IL f O"'l':^- _ /, . InspectIOn Request 726-3769 TOTAL Shared Dnve(T )/BUlldmg FormsfElectncal Permit ApphcatlOn 7-08 doc - Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone 503-378-4621 Web Address www.cch state or us Penrut # ~ ;;Lo 06 - Ol':l- ?y Address ::L 7 ') ,>,<;r:!J- Issued by ~ <'PRi A.\('-, f"2 Ii Date 'iJ;l2.J(Jf I , Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUires resIdential constructIOn permIt applzcants who are not lzcensed wIth the ConstructIOn Contractors Board to SIgn the followzng statement before a bUIldzng permIt can be Issued ThIs statement IS reqUired for resIdential bUlldzng, electrzcal, mechamcal and plumbzng permIts L;censed archItect and engzneer applIcants, exempt from lzcenszng under ORS 701010(7), need not submIt thIs statement ThIs statement wIll befiled wIth the permIt FIll In the appropnate blanks and IrntIal boxes I and 2, and either box 3A or 3B ~1 -t}2 I own, reside Ill, or Will reside In the completed structure I understand that I must become lIcensed as a constructIon contractor If the structure IS sold or offered for sale before or on completIOn o 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 ;gJ 3B I Will be my own general contractor IfI hIre subcontractors, I WIll hIre only subcontractors lIcensed with the ConstructIon Contractors Board IfI change my mmd and hire a general contractor, I Will contract with a contractor who IS lIcensed with the CCB and Will munedIately notifY the office ISSUIng thIs bUlldmg 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. ~ l ~ Q'ri ~ I d-d- I 0 ~ ~ (s,,"rp'tt~ CO".) (WhIte copy to Issumg agency permIt file, pmk copy to applzcant) Property_owner doc 06-01-04 Acting as Your Own General Contractor? h.'""i. - - INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES \ ~ -... '. . . - I NOTE This InformatIOn Notice to Property Owners about Construction Responsibllttles was developed by the ConstructIOn Contractors Board In accordance wtlh ORS 701 055(5), passed by the 1989 Oregon Legislature If you are acting as your own contractor to construct a new home or make a substantIallmproyement to an eXlstmg structure, you can prevent many problems by bellig aware of the follOWing responslblhtIes 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 labor In construchng or to assIst 111 the constructIOn or Improvement of a reSIdentIal structure As the employer, you must comply with the followmg: .. . . Oregon's Withholding Tax Law: As an employer, you must \vlthhold Income taxes from employee wages at the tIme employees are paid You WIll be liable for the lax payments even If you don't actually WIthhold the tax from your employees For more mfonnatIon; call the Department of Revenue at 503-378-4988 - - , . Unemplo)ment Insurance Tax: As an employer, you are reqUIred to pay a tax for unemployment lDsurance purposes on the wages of all employees For more informatIon, call the Oregon Employment Department at 503-947-1488 - The Oregon BUSiness IdentIficatIOn Number (BIN) IS a combined IJumber. for both Oregon WIthholding and Unemployment Insurance Tllx To file for a BIN call 503-945-8091 or WW\\ dor state or us/fonusnav htmll for the appropnate fonus '_'J , Workers' Compensation Insurance: As an employer, you arc subject to the Oregon Workers' Cu...p~",atIon Law, and must obtain workers' compensatIon Insurance _for your erpployees If you fall to obtain workers' compensatIon msurance, you could bc f>ubJect to penaltIes and be liable for all dalm costs If one OfYOlIT employees IS Injured on the Job For more informatIOn, call the Workers' CompensatIon DIVISIOn at the Department of Consumer and BUSiness ServIces at 503-947-7815 U.S. Internal Revenue Seryice: As an employer, you must Withhold federal mcome tax from employees' wages You \\,11 be hablc for the tax payment even If you dIdn't actually \VIthhold the tax For a Federal EIN number, call the IRS at 1-800-829-4933 or VISIt thClr web sIte at www 11 S f!OV ; .' Other Responsibilities and! Areas of Concerns Code Comphance As the permIt holder for thIS proJect, you are responSIble for: rcsolvmg any faIlure to meet code reqUIrements that !llay be brought to your attentIOn through mspectlOns LiabilIty and Property Damage Insurance: Contact your Illsurance agent to see If you have adequate msurance coverage for accldcnts and omISSIons such as fallIng tools, pamt over spray, water damage from pIpe punctures, fire or work that mu;t be redone - ~ , TIme Make sure you have suffiCIent time to supervISe your employees , , . 1 "'" ExpertIse: Make sure you have the sk1l1s to act as your own general contractor, to coordmate the work of rough-m and fimsh trades, and to notIfy bUlldmg offiCIals as the appropnate tImes so they can perform the reqUIred mspectIons If you have addll10nal questIOns call the Construcl1on Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 " Property_owner doc 06-01-04 225 FIfth Street Sprmgfleld, Oregon 97477 541-726-3759 Phone ~i'i City of SprIngfield OfficIal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-0 1274 COM2008-01274 COM2008-01274 COM2008-01274 COM2008-0 1274 COM2008-0 1274 COM2008-01274 COM2008-0 1274 Payments Type of Payment CredltCard cRecelOtl RECEIPT #. 1200800000000000905 Date 08/22/2008 DeSCription BUlldmg Penml fixture Residence Wifing 1000 Sq Ft Residence Wifing Ea Addtl 500 Mmlmum/AdJustment Plumbmg + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee PaId By VICKI JOHNSON Item Total Check Number AuthoflzatlOn Received By Batch Number Number How Received cJc 040216 In Person Payment Total Page I of I 105926AM Amount Due 5200 5100 12100 2200 100 1235 2964 2470 $313 69 Amount Paid $313 69 $313 69 8/22/2008