HomeMy WebLinkAboutPermit Building 2009-2-6
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00I27
ISSUED: 02/06/2009
APPLIED: 0112712009
EXPIRES: 08/0612009
VALUE: $ 269,905.46
SITE ADDRESS: 6190 Graystone Lp
ASSESSOR'S PARCEL NO.: 1802032206100
Springfield TYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: Single family residence
TYPE OF USE: New
Residential
Owner: BRUCE WIECHERT
Address: 3073 SKYVIEW LN
EUGENE OR 97405
, .
, I CONTRACTOR INFORMATION'
Contractor License
BRUCE WIECHERT CU~~NcfWM~flNCI 101717
L &tEEHtT(';TRi~iN",.C~n, by the Olegol1 Utility 105475
JA YMIE/<i'()MHJJrF.'F'Wil~e1IIL~t:\fflN(J;et forth
S"'Ey)\~~:rOxr.~~~No'thlOUgh op.,R 952~~02.'65065
"......' .-- " ,-- :-........,=~.'lLlln. !:-,J.-- -I
0090., You may (lu~uJwi~Gl{'If1mM'ION I
callmg the cen~. . n Utility Notiticahon
# of Units: number 11)[ the [~g~~-13%l!U2~4).
Primary Occupancy Group: MntellS 1 8l'leight of Structure.
Secondary Occupancy Group: U Type of Heat:
Primary Constrnction Type VB Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: 3 Energy Path:
Sprinkled Building:
Contractor Type
Genera'
Electrical
Mechanical
Plumbing
I
28.00
Gas
Gas
Gas
nla
I DEVELOPMENT INFORMATION'
Hillside Total:
2 Handicapped:
Yes ~act:
31.0~~,~t~ ~t;)\
e'l.~\~~~~\\)~9.
I PUBLIC IMP\l..~~~~iQ\\>.~~~ \~\~~t;)~'i::V . .
\"~ ~'t.t" '\ ~~'i) 'd'e~
Fnlly Improved \~\S ~t;)~\ttl'0 t;)~ ~(\'0. alk Type:
Yes "'\)\ ~t~C ;:{ ~t'mJWnspouts/Drains:
Ct;)~ \CO\) '01"
, ~~i
Storm routed to storm sewer. Impervious area at max for this lot.
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
18.00 '
26.40
5;00
48.00
25.72
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Street Improvements:
Storm Sewer'Available:
Special Instruction:
Notes:
~*
Page I of 4
Phone Number: 541-686-9458
Expiration Date
09/16/2010
03/30/2010
Phone
541-686-9458
541-933-2653
03/12/2010
541-342-3765
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
10,430
2,156
386
631
393
REQUIRED PARKING
2
Curbside 5'
To Storm Sewer'
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Garage/Misc
SF/Duplex
U VB Utility
R-3 VB 1&2 Familv
Fee Description
Plan Review Residential
+ 12% State Snrcharge
+ 5% Technology Fee
1st Appliance
3 Baths One &'Two Family
Addressing Assignment
Appliance Vent
Building Permit
Curbcut Permit
Dryer Vent
Exhaust Hoods
Fire SF Fee - Residential
Fireplace (Listed)
Fixture
Gas Outlets 1-4
Mountaingate Impervious Area
Overwidth Application Fee
Plan Review Major - Planning
Plan Review Residential
PW Disc - 2nd Permit
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC SanitarylStorm Admin
SDC Transpolmprovement
SDC Transpo Reimbursement
SDC Transportation Admin
Sidewalk Permit'
Temp Power 200 amps or less
Vent Fan
Willamalane Single Family
I V~luation Descrintion 1
$ Per Sq Ft
or multiplier
$37.72
$96.83
Square Footage
or Bid Amount
630.00
2,542.00
Total Value of Project
f,~rdS\ pqiH
Amonnt Paid
Date Paid
$725.24
$281.36
$137.33
$79.00
$402.00
$38.00
$9.00
$1,400.65
$88.00
$9.00
$13.00
$153.90
$20.00
$38.00
$7.00
$1,302:48
$45.00
$211,00,
$185.18
$-30.00
$134.00
$125.00
$715.24
$940.62
$10.00
$1,009.17
$97.90
$188.73
$888.98
$201.54
$69.57
$88.00
$63.00
$45.00
$2,858.00
1/27/09
2/6/09
216/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6/09
216/09
2/6/09
2/6/09
2/6/09
2/6109
2/6/09
216/09
2/6109
216/09
2/6/09
2/6109
216/09
2/6/09
2/6/09
2/6109
216/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6/09
2/6109
2/6/09
Page 2 of 4
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-00I27
ISSUED: 02/06/2009
APPLIED: 01/2712009
EXPIRES: 08/0612009
VALUE: $ 269,905.46
Value
Date Calculated
$23,763.60
$246,141.86
$269,905.46
02/05/2009
02/05/2009
Receipt Number
2200900000000000103
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
1200900000000000083
CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-00127
ISSUED: '02/0612009
APPLIED: 01/27/2009
EXPIRES: ' 08/06/2009
VALUE: $ 269,905.46
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541_726-3676 Fax
541-726_3769 Inspection Line
Total Amonnt Paid
$12,549.89
Plan Reviews I
Initial Review
Public Works Review
01/28/2009
01/28/2009
01/28/2009
01/28/2009
OK
APP
NJM
BJG
Impervious area at Max for this lot.
Planning Review
01/2812009
02/02/2009
APP
DDK
Choose street trees from the list of
"Native Trees in Hillside
Development" on page 4-6 of the
street tree handout. Shade point
height not to exceed 25 feet for solar
protection.
Structural Review
01/28/2009
02/05/2009
APP
KLK
Approved as noted on plans
To Request an inspection call the 24 hour recording 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.
~n~.np.f'tion~J
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Curbcut - Overwidth: After forms are erected but prior to placement of concrete.
Sidewalk - Curbside: After forms are erected but prior to placemeqt of concrete.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with, footing and/or
foundation inspection.
Footing: After trenches are excavated.
, Foundation: After forms are erected but prior to concrete placement.
Post and Beam: Prior to floor insulatio~ or decking.
Floor Insnlation: 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 reqnired inspections have been requested and approved and the building is complete.
'Undertloor Plumbing: Prior to insnlation or decking.
Underfloor Drain: Prior to cover or placement of concrete.
Rough Plnmbing: Prior to cover and including required testing.
Page 3 of 4
CITY OF SPRINGFIELD'
Building/Combination Permit
Status
Issued
PERMIT NO: COM2009-00127
ISSUED: 02/06/2009
APPLIED: 0112712009
EXPIRES: 08/06/2009
VALUE: $ 269,905.46
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Water Line: Prior to filling trench and including required testing.
Sanitary Sewer Line: Prior to filling trench and including required testing.
Storm Sewer Line: Prior to filling trench.
Final Plumbing: When all plnmbing work is complete.
Underlloor Mechanical. Prior to insnlation or decking and including required testing.
Underlloor Gas: After line is installed and'required testing and capped if not attached to an appliance.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Gas Service: After line is installed and line has been connected to a minimnm of one appliance including required
testing. Presure test done at this point.
Rough Mechanical: Prior to Cover
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Temporary Electric: Approval required prior to Utility Company energizing pole.
Electric Service: Approval required prior to utility company energizing service.
Final Electric: When all electrical 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 irue and correct, and I further certify that any and all work performed shall be done in accordance with
,the Ordinances ofthe 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, BuHding Safety.
I fnrther certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensur that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit ~~ ijocated at the front of the property, and the approved set of plans will remain on the site at all
times dnring co~struct oni I () Il, /' 1 / b I 0 ~
Owner or conrys gna'(..re V Date I
Page 4 of 4
~ ?, Willamalane
t Park & Recre,ation Oistrict
Job. N~. (!? ~ (j]/:J.--j
SY~TEM DEVELOPMENT CHARGE WORKSHEET FOR 2009
NAM~Uchl.a:f Ui)!;)m/J/o(WdrPHONE: !t~ ---BJSo
ADDRESS&-?-5 ,S~er.,) CITY ~1LJt.t../ STATEUMIP: t( 7Lj(J5"
LOCATION OF PROPOSED BUILDING SITE:
Street Address: 10 lj 0 (c;rfLU( 6M11b Lp
Plai NamemOi1rr1!1~n {)Ii/0l t6[i:x Lol Number:! (('7).2 03 ,),?- 0& /OV
1; DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the
back.) ,
A. Sinale-Family Delached
NO. OF UNITS
X $2,858 per unil =
B. Sinale"Familv Attached
-
NO. OF UNITS
X $3,100 per unit =
C. Mulli-Familv Aoartment
NO. OF UNITS
X $,?,641 per unit =
n, ~ina!e-Room-Occuoanc"
NO. OF UNITS
X $1,321 per unit =
E. Accessorv Dwellina Unit
NO. OF UNITS'
X $1,550 per unil =
WILLAMALANE,SDC
~. 2. SDC CREDIT (if applicable) SDC payer must fumish proof of
Willamalane Credit approval. )
3. TOTAL WILLAMALANE NET SDC ASSESSED
. (if SDC reduced for Credit)
~11/A /Xd"J,adU 6.)
City Sp ingfield ' , .
, '
21
, ,Date
$ :;{, ff'S2('. {)7)
$
$
$
~.
$
],/tc:;e: r-v
$
$
$'~ / f"S(,
b, C> i
Q"LJ
n
,.
5
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRlCALfERMIT APPLICATION
City Job Number c..;a222()() q _ ('JO Q,--t Date ():2/0&/ () C}
1. . '!fWGAT~QjJ/oF)INErfA1JiJA170N:;~~'fIi;~ 3.
& 19!5~~~&;;;h~'';jf);;;W{$a~
/ LEGAL D~J;RIPTION I '
f?fJ.,r)5;),? OU Ion
JOB DESCRJPTIO~ ~
MfJy/ (AJi~L ~ ~i^-P ~~
. Permits are non-transferable a~d expire i/work is
," not started within 180 days of issuance or if work is
Suspended for 180 days. '
2.
Electrical Contractor
[,I" e; ~77/LIC--
Address p {; . /:7o'~ ,I ( ( 3'9
Phone Sf( -6ff f'ft'b
City (::::U be=Ve.
Supervisor License Number . ~ '5 c; 'i 5 S
1O)6C:;
5' en '113
C:;/66
Expiration Date
Constr. Contr. Number
Expiration Date
I
Signature of Supervising Electrician
{{'.f Ld#r./
() <
Owners Name luB/ClltX/Di flO/Y'l..-,
^'b'if:'! SjcU V1d.0 -
City- J {){j ~hone & 6& ~ 9<-15&:
OWNE NSTALLATlON
The installation is being made on property I own which
:~:::.~:"" '=;~ ~
~
~. ,
Inspection Request: 726-3769
A.
Service Included
1.3"1. <J" 1'5 tI
$l-(lQ.U0 ..,
f5"V
d5. I~;-
$~
1000 sq. ft or less
Each additional 500 sq. ft..or
portion thereof
I
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
$ 63.00
$ 75,00
$125.00
$163.00
$375.00
$ 50.00
c.
Installation, Alteration or Relocation
200 Amps or less (
201 Amps to 400 Amps
40 I Amps to 600 Amps
or 1000
G2
U.Q.QD
$69.00
$100.00
C, .z, <!0!
D.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
Pump or inigation
Sign/Outline Lighting
Limited Energy/Residential
Limited EnergylCommercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
322.cr-v
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Fonns/Electrical Permit Application I-03.doc
A
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET
, JOURNAL OR JOB NUMBER:
NAME OR COMPANY:
LOCATION:
TAX LOT NUMBER:
DEVELOPMENT TYPE:
NEW DWELLING UNITS
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY StORM SYSTEM
I IMPERVIOUS,S,F, x I COST PER S,F, CHARGE
I 3651.00 I $0.357 I = I $1.302.48 .
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS'
, I IMPERVIOUS SF I x I COST PER S,F, I x I DISCOUNT RATE I I
I 0,00 I I $0.357 I I 50% I ~ '
COM2009-00127
Wiechert Homes
6190.Graxstone Lp .
1802032206100
Single Family Residence
,I BUILDING SIZE (SF" 3525
ITEM I TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - r.ITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x
I 34 I
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x
I 34 I
$1,302.48
COST PER DFU
$27.67
COST PER DFUI
$21.04 I
ITEM 2 TOTAL, CITY SANITARY SEWER SDC
= ,
$1,655.86
LOT SIZE (SF):
10430
~
Ir/l
liS
10
u
I~
10:.1
f-<
r/l
-
o
gj
DISCOUNT
$0.00
" '
, , ~ ,
$1,302.48 I 1070
$940.62
$715.24
1091
1,1092
I
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW ~S X UNIT,EQUIVALENT = DRAINAGE FIXTIJREUNITS
(NOTE: FOR REMODELS, CALCULATE ONLY TIIE NET ADDITIONAL FIXTIJRES)
NO.,OF FIXTURES
~I
UNIT
FIXTURE TYPE NEW OLD EQUIVALENT
BATHTUB 2 0 3 =
DRINKING FOUNTAIN 0 0 1 =
FLOOR DRAIN 0 0 3 =
INTERCEPTORS FOR GREASE lOlL I SOLIDS I ETC. 0 0 3 =
INTERCEPTORS FOR SAND I AUTO WASH I ETC. 0 0 6 =
iLAUNDRY TUB 1 0 2 =
I CLOTHESW ASHER I MOP SINK 1 0 3 =
ICLOTHESW ASHER - 3 OR MORE tEA) 0 0 6 =
IMOBILE HOME PARK TRAP (I PERTRAILER) 0 0, 12 =
I RECEPTOR FOR REFRlG I WATER STATION I ETC. 0 0 1 =
I RECEPTOR FOR COM. SINK I DISHWASHER I ETC. 1 0 3 =
ISHOWER SINGLE STALL 2 0 2 =
iSHOWER. GANG (NUMBER OF HEADS) 0 0 2, =
\SINK: COMMERClALiRESIDENTlAL KiTCHEN 1 0 3 =
,ISINK: COMMERCIAL BAR 0 0 2 =
ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 =
ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 =
IURlNAL, STALL I WALL 0 0 5 =
ITOILET. PUBLIC INSTALLATION 0 0 6 =
ITOILET. PRIVATE INSTALLATION 3 0 3 =
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
- 20 =
TOTAL DRAINAGE FIXTURE UNITS
DRAINAGE
FIXTURE
UNITS
6
o
o
o
o
2
3
o
o
o
3
4
o
3
,0
2.
2
o
o
9
:..J
*EDU (EQuivalent Dwelling Unit) is a discharge eQuivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day
,
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
I
I
YEAR
ANNEXED
BEFORE 1979
1979
1980
198]
]982
1983
1984
1985
.1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
IS LAND ELGlBLE FOR ANNEXATION CREDIT?
(Enter I 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)
VALUE I 1000 CREDIT RATE
$0.00 x $0:00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE I 1000 CREDIT RATE
$0.00 x $0.00
I
I
I
I
I
I
I
I
I
I
I
I
I
I
TOTAL MWMC CREDIT
~ ,
=
2--"
I
I
I
I
I
I
2
2004
$0.00
o
$0.00
Job/Journal Number
COM2009-00127
COM2009-00127
COM2009-00127
COM2009-00127
COM2009-00 127
COM2009-00 127
COM2009-00127
COM2009-00 127
COM2009-00 127
COM2009-00 127
COM2009-00 127
COM2009-00 127
COM2009-00 127
COM2009-00 127
COM2009-00127
COM2009-00127
COM2009-00 127
COM2009-00 127
C0M2009-00 127
COM2009-00127
C0M2009-00 127
C0M2009-00 127
COM2009-00127
COM2009~00127
COM2009-00 127
COM2009_00127
COM2009-00127
COM2009-00 127
COM2009-00127
COM2009-00127
COM2009-00127
COM2009-00 127
COM2009-00 127
COM2009~00 127
Payments:
Type of Payment
CreditCard
Check
cReceintl
RECEIPT #:
Description
Willamalane Single Family
Fire SF Fee - Residential
Addressing Assignment
Temp Power 200 amps'or less
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
Overwidth Application Fee
Sidewalk Pennit
Curbcut Pennit
PW Disc - 2nd Penn it
Mountaingate Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Reimbursement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Stonn Admin
SDC Transportation Admin
Plan Review Major - Planning
Plan Review Residential
Building Pennit
3 Baths One & Two Family
Fixture
I st Appliance
Vent Fan
Appliance Vent
Exhaust Hoods
Dryer Vent
Gas,Outlets ]-4
Fireplace (Listed)
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
BWCH
BWCH
1200900000000000083
Date: 02106/2009
Item Total:
l.:heck Number Authorization
Received By Batch Number Number How Received
djb
djb
18239
00576d In Person
In Person
Payment Total:
Page 2 of2
9:08:24AM
Amount Due
2,858.00
153.90
38.00
63.00
134.00
125.00
45.00
88.00
88.00
(30.00)
1,302.48
940.62
715.24
201.54
888.98
97.90
1,009.17
10.00
188.73
69.57
211.00
185.18
],400.65
.402.00
38.00
79.00
45.00
9.00
13.00
9.00
7.00
20.00
137.33
281.36
$11,824.65.
Amount Paid
$9,500.00
$2,324.65
$11,824.65
2/6/2009
Feb ,,01 09 03: 18p
Jan, 30, 2009 3:WM
No, jUl~ r. 1
Community Sl....vicc~ Oiv. Building Stlftt)'
CITY OF SPRINGFIELD. OREGON Mountaingate SuM. Lot # 90
n5 Sd, Street Springfield. OR 97471 Ph. 72C....37W
SPAINGFI~'-~
~ - I '""ri'.~&'illlll~IIt'''<'~~'~T~~~''''''1II-1iii:: fii"II4-
Mountaingate Subdivision
I Site Investigation Que~tionnaire for Consulting Design Professionals
SiTE ADDRESS: 6190 GRAYSTOHE LOOP CITY JOB # LDP2009.00127
Foundation reauirements - new structures on residential lots
Thi, form msy'bc u'sed as a ve':ificaliun to allow eonstrudion 10 continue onlhe job
site onlilthe ':<tamped' AFFlDA vrr For Site I nvoslillation Oue.nonnaire' is
.uhmitted to the City_ This form mud be completed by a liceo!ied design
prores'ional (engineer or architect) or hisfberauthorized representative, and
submitted to the building inspector prior to requesting City inspections or placlng
foundation concrete. It is important that 011 questions be answered eompletely for
the foundation site to be approved for construction.
Owner: Bruce Weichert Custom HDmes. Inc.
Contractor: Bruce Weichert Custom HDmes, Inc.
A. Date(s) oflhe de,ign professional's sitccvalualinn?
1128/09. 1/30/09
8. Has tile design professional reviewed a copy of the geotechnical inlonnation
that was prepared for the subdivision relating to this,ite? Yes!. No_
If nor, please contacT T!lis office for a copy of The report, The de,\'ign professional
must be jamiliar with The geoTechnicallnjOrmaTion before completing Thi'Iorm.
C. In which GeolechnicallDvestigation calegory is Ihissite located?
, Levell -X-
Level n
Note: Level n roouire:; a site-sneL.;t1c 2eotechnicallnvestitd!atinn & Tenort
Were any !rite conditions identified lIla! would change the category? YES_
, NOr
(For ciiferia d~ttrmlnil1t Call!tory. ~el! The specltic G~tt:chllic;'ll Re{'lort for the COff&! pl'''-l;.e ofttle c;uhdTvisiOn)
If"yes", explain (use the reverse side of Ibis sheet or an added sheet if necessary)
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Feb 01 09 03:18p
, velll. JV. .lUVJ J, l"tl~!
Community Services Div, Duilditlg Safety
CITY 0)' SPRlNGFlLW. OREGON
225 51b Slre~l, Sprlngfiefd~ OR 97471 Ph. 726-3759
Mountaingate Sub<!. Lot # 90
Was a geotechnical cngineer involved at the site to verify that conditions are
suitablc for construction of the proposed building($)? Yes! No
Name of geotedmical engineer Michael RembOldl
D. What was the nl\lure of tbe excavation llnd lor fill?
The 1.......i...llI. pl"1'!'l'inee.ed Dad thai a.......d to be const,,,,,led D' a mi. of .iII, ..od. 6J!l"
sandstDw. and Ila..U collble. ft 1& nm ftodor&landinallllllOO ........oinoered buiklina aads in IhiJ
.ubdiVltion ......, orrin I!laIwn oreviousl. a.olO1le..' bv De ci.., TOO 1ID ..., the 'D,lace WB',
.erv den.e and eomoac1ed. The 100 ollbe pad...... c1eB,ed .. aoqroxirnalel'! 110 d.inches 01 toooe
.ravel..d 1_ ara......... Tbeq ...rop.nalelv 210 4-inches .'>I.-Inch rnlnllt ",","'l-.'8ded
CMbed ~1l!.a1e WllS .lacad and Gladed .n the 'lad 10 ar..id. a Dnitom .mlace 10' loolin~
con,'rllClion.
Was cxisting non-structural fill or expansive soil enCllUntered on the lot?
,Yes_ NoL If "yes", what types, depths and locations, and how docs.it affect
the building foundation?
What mcasUICs were taken to remedy the soil condil;(ln (include type of
engineercd fill used to stabilize the soil)?
Is the site as prepared adequate ~ inadequate to maintain constant
moisture content in the sub grade? Note: Verification (jf moisture stabilization in
the sub grade is a requirement.!i,r "ite preparation, and must be affirmed before
construction cun conJinue.
If inadequate, what measures arc to be taken to provide constant moistme cOlltent
in the sub grade?
Is the site, as prepared, adequate ~ in"deqUalO to support the proposed
structure? Anaffirmative answer is requixite iii proceeding with construction,
If inadequate, what additional work is needed to provide adequate
foundation support?
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Feb 01 09 03:18p
, Jln, JO, ZOU~ J:ZHM
~O, JVn .r, ~
Cmnmunil}. Scrvicl's Div, Btiildit~g Saftl)'
CITY OF SPRINGFIELD. OHLGON
125 S\l.SlTCL:l, Springl'iclL1, OR 97477 Ph. 726-3759
MOW1taingate Subd. Lot # 90
E. Did tbe design profcssionalwjtn..~ plaeement and compaction of tbe
engineered fill, or is thcre a special inspedion reporl fortbcoming from a
qualified agency? J wilrressed Placemenl Speciollnsplcompaclion repllr/
The .r..lo",,,, .Iaced upineered fill tbat Ibe bulldl... oad is conslJuolod.. hi. ."'vio..... been
a.om."" 0' bu lbEi cllv. lb. limil..d deolllo1 Ih.. "'CI!nIIV .Iaced cru.hed ....nular fill does nol war..nt.
anv denoitv les.!ilm.
F. . Thc design "rofes.ional intend. to use tbe following method for in~Mlation
of perforated perimeter footing drains:
The design on the attached drawing provided hy the design professional.... 0
The method shown on the original cOD,truC1ion dr..wings................ , X
The typical 'foundation Druin' drawing a!lached 10 pennit ................... 0
Perforated perimeter drajn~ are not required...., .............. .............. 0
Comments:.
G.. Low-point crawl space drains arc required to prevent the build-up of excess
moisture iDside the fouodations during (and after) construcliolL This drain
may be iostaUed after fOUlIdstiol1 placement ,nnh' with the en.)r~-" nermissloD .
of tbe desil'n nrofessional.
a, The design professional ha.< delem.ined the following:
fire crawl space drain is required w/um tm, foundation is inslalled...., 0
The low-point drain (".an be instal/cd after joundalion pic/cement withoul a
significant moisture build-up problem within thefounda/ion... ,......... 0
(The low-point drain may be installed at the stage
of construction) {.It'SJ It: k>tJm,lram/llg, rQQlmiJ,. ~rc
b. Ha.~ the design professiOliaiobse111ed and approved the installation of the
required low painldrain?........,.., ..,... ...... ......,.... fe,', Na_
if ''yes'', where is Ihe low point drain located under lhe building and
where docs illarminale at this lime? (Must be an approved location.. i,e,
slreet gutter, storm sewer, sump pump and di,tcharge line 10 the street..
ele.) A low-oDin! 'l3l1lsnate drain is not necW8rv klllllis toondatinn.
The design professional mus1 determine whether the approved pennil drawings have
adequate foundation steel. J. any ~dditional foundation steel required that is not
shown on the (ouodatioD drawiDgs for the building?
Yes No ~ '. If "yes ". desaihe tdditional sleel required (or provide drawing).
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Feb 01 09 03:19p
. Jan, JU, lUUY J:WM
NO, jVl~ r,?
CUTnlTll1nity Scrvict:s.Oiv. Building ~I~'ly
.CITY OF SPRfNGFfF.LD. OREGON
~2S 5d& Street. ,S)lringfltdd.OR 97477 Ph. 720-3759
Mountaingate Subd. Lot # 90
The individul/I doing Ihe "bservuti"",~ and pmviding direction/ilr the l':u.:uvalion and "ite
preparation workon the property mu,..t .sign 'heifllll/wing statement..
The undersigned design professional (or autk'lriud empluyee) allesl. thai heAke
observed required moisture stability procedures un lhis ,'ile, and tha/,.~h procedures
were accomplished hefore arry c/runges ucc""",d in l/re mOL.1ure content '?f the sub-
graile under and around the huilding (where expansive .mils were encountered). The
under~'igned further atlests thallhe sub-grail.~, as ptepat~d, L~ (lJ1~q~ale to support th~
building PT(Ip<J,\;ed flit Ihis sile.
Additional commcnts:
(Note): A copy of Ibis report sbaU be kept on site witb tbe approved plans at aU
times.
This report shall be followed by an affidavit, sig)lCd and stamped by ille design
professional under whose auspices this report was completed, affinning the intbrmation
herein, The signed/stamped affidavit together wiill a c<>py (,f ihis report shall be
submitted to this office prior to requesting framing inspectio" li,r the huilding,
Signature ~ - ~~ .
Name Michael Rembold! Tille Princiole Geotechnical Emrineer
Company K & A Enoineerina Inc.
Phone 684-9399
Lic.nsee Michael Rembolllt
License # 19474 eKpire~ 12/31/2010
The ge()technical report for each phase of the Mounlaingate Subdivision makes'
recommendations for placement of building construction On "each site, The report nls<,
recommends that ,ile preparation durillg wel weather conditions be avoided unle"
special mea')un::S are talten to mitigate ~oft soil conditions and moisture collecting in or
around the Ihundation areas during and after the construction proccss. Positivc site
draim>gc must be provided,
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feb 0109 03:19p
.v(:\lI. JV. lUV' J.l)JIfI
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C()1nml1I~it)' Services Div, UUi,lding: Safe I}'
CITY OF SPRlNGl'lliLD, OREGON
.22$ 51" Slret.t.. Spring.fkld. OR 97477 .Ph. 726-3759
Mountaingllte Subd. LOI # 90
hr~'~'"
AFFIDAVIT
Fur Site lnvestigation Questionnaire
Foundation Sub.Grade Approval for
Residential Building Site in Mountaingate Subdivision
The undersigned hereby alTirms that the excavation, struclurallil1 and moisture
stabilization methods I,)r Ihe huilding site at the address shown above weTeobserved by
me or an authorized employee of my finn and that the following is true:
1, The geotechnical int'om)alion I,,, the subdivision.. specific to this sile, was utilized
as part of the determinalion l\1r loandation preparation and drainage requirements,
2. The foundation sub-grade is eapahle of supporting a minimum of I 500 psI', and is
adeqUllte to support the building proposed for this site,
,
3. The moisture content of the cx~~vation was adequately maintained during Ihe site
preparation process and the site is adequately graded and drained for discharge 10
an approved location morder to maintain stable moisture content throughout Ihe
eonslruction process and thereafter.
4. The accnmpanying report titled "jiitc lnvesli~alion Ouestionnaire for Consultim>;
Dcsi~n Professionals" containing field observations and instructions made on ,
(dates) j128mg aOd tl30109 for this building site wa' completed either by me or by
an authorized represc:ntative under'my supervision, To lhe best of my knowledge,
the information contained in that report is complete and accurate.
Sib",ature
c::;:~
Date,....lp1-!--z.;.'1
Name of Licensed ProJes~ional (print) Michael Rembollll. P.E,
ElG'IIlES ly'J1,) ~