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Home My WebLink AboutPermit Building 2005-5-3 (2) _QJ.I~~~I!~gJ. , . \- ~. ~-- r * ,~ -. 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: COM2005-00437 ISSUED: 05/03/2005 APPLIED: 04/18/2005 EXPIRES: 11/03/2005 VALUE: $ 31,880.00 SITE ADDRESS: 2377 CORRAL DR ASSESSOR'S PARCEL NO.: 1703244305800 TYPE OF USE: . Add~ti9.n\, Addition to existing single family residence C-009-~ SI J~ ,',",;;., .(vvC~-Z~f,' .."R!::Iln aU\.lO~J9q\1.lml ;, UO!l~!lHUN I\t~I::' ) 'JalU~'9nD~GliIP' . euoL\da\al aL\l .atN unnqo Aew ~A'~OO:. Aq Sa\OJ aL\110 S~! ~~l6 ~OO- ~Oo-~S6 \:NO U1 , ~€I::-1r~~,",() L\ na1:iU4J. .;.:\~...~ ..nn~l1noN ~ C'L\GC Q re salnJ dopl! S8\N tAOUOI CONTRAc'l~OR', l'Sil \ al ...,,,..a.~' '':I , . . baJ Me BaJO ~LU""'" Ol no^ saJln "'," . License Expiratioi1:'Date PROJECT DESCRIPTION: Owner: Address: ROBERT KOPCZENSKI 2377 CORRAL DR SPRINGFIELD OR 97477 Contractor Type General Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction, Type: # of Bedrooms: R-3 VN Frontyard Setback: Side 1 Setback: Side 2, Setback: Rearyard Setback: Solar Setbacks: 19.60 8.00 0.00 Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description , ' Type of Construction Springfield TYPE OF WORK: Single Family Residence \ Residential 541-747-7930 Phone I BUILDING INFORMATION I , 4~ ." "'l'l'"-'. . .... . . ."'~. ...... # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: -. I DEVELOPMENT INFORMATION. L EXPIRE \r -, . ;}Ct1,r\ :, "<,,,;, \ v"AL PF REQYIm:~ PARKING .. ,'~iltr:' IJNDF.1)1HIS ,.,' ~ OverlayDlst... ',_, .urtianF~I~~ANLJvl.J9tal.R # Street Trees Rqd:\;;:.\~GED UK \ 00 ,Handicapped: Paved Drive ~!I~F J\ 80 DAY PERI. Compact: % of Lot Coverage: I PUBLIC IMPROVEMENTS. Sidewalk Type: Downspouts/Drains: I Valuation Description' $ Per Sq Ft Square Footage or multiplier or Bid Amount Value Date Calculated Paee 1 of 3 . ~ ~, t I f ! , , . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00437 ISSUED: 05/03/2005 APPLIED: 04/18/2005 EXPIRES: 11/03/2005 VALUE: $ 31,880.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-72()-3676 Fax 541-726-3769 Inspection Line Total Value of Project ~ Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Building Permit Dryer Vent Fixture Minimum/Adjustment Mechanical 'Minimum/Adjustment Plumbing Plan Review Minor - Planning Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan Amount Paid Date Paid $172.48 $10.00 $35.53 $24.87 $265.35 $6.00 $42.00 $27.00 , $3.00 $59.00 $36.56 $48.08 $12.29 $161.20 $12.00 4/18/05 5/3/05 5/3/05 5/3/05 5/3/05 5/3/05 ' 5/3/05 5/3/05 5/3/05 5/3/05 5/3/05 5/3/05 5/3/05 5/3/05 5/3/05 Receipt Number 1200500000000000462 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 2200500000000000529 Total Amount Paid $915.36 I Plan Reviews ~ Initial Review 04/19/2005 04/19/2005 OK RJB Plannine Review 04/19/2005 04/28/2005 APP TAJ Public Works Review 04/19/2005 04/20/2005 APP CAS storm drainage piped to existing curb weep hole 4/20/2005 CAS Structural Review 04/19/2005 05/02/2005 OK RJB 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. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Paee 2 of3 '_~'~J.~e~J,!!~j . , , '-' ,...... 1 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00437 ISSUED: 05/03/2005 APPLIED: 04/18/2005 EXPIRES: 11/03/2005 VALUE: $ 31,880.00 Status Issued 225 Fifth Street, Springfield, ,OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. Undertloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover 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 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 ofany 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. Sk~ \~~~ Me Owner or Contr~ors Signature l,J ~- ~-OV; Date Paee 3 of 3 . . CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2005-00437 NAME OR COMPANY: Robert Kopezenski LOCATION: 2377 Corral Dr TAX LOT NUMBER: 1703244305800 DEVELOPMENT TYPE: SINGLE F AMIL Y RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF) 520 .~ " . LOT SIZE (SF): o f/'.J ~ 10 o U ~ ~ Eo-< f/'.J o ~ . ~.-...~..- --...""," , 1. STORM DRAlNAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S.F. x I, COST PER S.F. CHARGE 520.00 I $0.310 , = $161.20 , RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. x COST PER S.F. I x DISCOUNT RATE 0.00 $0.310 50% ' - DISCOUNT $0.00 ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANlT ARY SEWER - CITY I $161.20 I , $161.20 11070 . ".,..---,..- --,......" ,." , A. REIMBURSEMENT COST: NUMBER OF DFU's x 2 B. IMPROVEMENT COST: NUMBER OF DFU's x 2 COST PER DFU $24.04 = , $48.08 1091 $18.28 = , $36.56 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $84.64 I . ~. .........- ---..--..." . 3: TRANSPORTATION A. REIMBURSEMENT COST: ADT TRIP RATE x NUMBER OF UNITS x COST PER TRIP x NEW TRIP FACTOR 9.57 '0 $18.30 1.00 - , $0.00 1093 B. IMPROVEMENT COST: ADT TRIP RATE x NUMBEROOF UNITS l x I COST PER TRIP x NEW TRIP F ACTORl 9.57 I $80.72 1.00 = I $0.00 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = , $0.00 I . ........ ,.".".............--... ..._------"-,.",,,,. '" 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: lNUMBER OF FEU's x COST PER FEU , 0 $82.03 = , $0.00 j 1054 B. IMPROVEMENT COST: NUMBER OF FEU's ' ,x COST PER FEU 0 $865.31 = , $0.00 lOSS MWMC CREDIT IF APPLICABLE (SEE REVERSE) = I $0.00 1054 MWMC ADMINISTRATIVE FEE = I $0.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = , $0.00 I "' .. ., -,.- .". "' -", .-..-... ..- -'-'- " SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) = I $245.84 I , 5. ADMINISTRATIVE FEE: SUBTOTAL x ADM. FEE RATE - CHARGE $245.84 5% $12.29 TOTAL SANITARY ADMINISTRATION FEE: I 12.29 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: I $0.00 1078 ......-_.......~~-~::, Cheryl Slaymaker 4/20/2005 TOTAL SDC CHARGES =, ' $258.13 . Constrl;lction 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 " 4~ . ' permitWIYl2fos-- 004L3 7 Address:d377 C.e:Jr7/ai [X:J' Issued by: Ai . {fJaefa d ODate: O:?/ ():!);;; era ~) Statement: Information Notice to Property Owners About Construction Responsibilities, Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for 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 be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ 1. o 2. I own, reside in, 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 ~ 3B. I will be my own general contractor. IfI 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 ofthe contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Own~rs about Construction Responsibilities on the reverse side of this form. ~clG- \.\!JD~/1-O n -l\_--r') ~- ~-()V) , (@pature of'permi&pplicant) (Date) '-' (White copy to issuing agency permit file, pink copy to applicant.) Property- owner. doc 06-01-04 ,. ," . ,.,. -;,. Ace~ilIill~ ~~ 1:? @llilIr '(QJWIID CG~Iill~Ir~ll C@Iill~Ir~~lt@r? , . ~NfO~M~l~(QlN N(QJ1~(c1E 10 I?IROIF>>IE~'iIlf OWNIEIRS ~~OlUl C(QJNS1~lUl<C1.~ON /R(E~fPJONS~B~1LJ1~IES ' , . . ~. ~ [, NO Tc: This Inlormatk,~7v;,uce -;0- Property Owners a;';;;-;'-;;c60n ~~;;m;jb;;;;;;' -was de~e;"ed-bY the i Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. ; _._-_..... -'-~--~~~--~-'-----'-----'---'----"-.- _._-_"__--... _.~._- ----~----~-------~---...- -.. - ._.~_..- --- ---- _.---~...----_.__._---_.=II' If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and' concerns. IE mrnp n ((DY~Ir ~~~p((D ll1l~n]b)finfi~ e~ 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 constructing or to assist in the construction or improvement of a residential structure. As tlln.e eItlIllJIllloyeIl', ymn rounst complly wntlln. tlln.e foDJIowbng: OngoJlll's Wi~lln.lh1oll<<llnnng T~x JL~w: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. lUnnemjpllloymennt J[JIllsun1l"lllJlllce T~x: As an employer, you are required to pay a tax for unemployment insurance 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 number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. WOlrIkeJJ"s' ComlPeJlllsa~noJlll ][lllsunlJ"~IlM:e: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cvu.yensation insurance for your employees. If you fail to obtain workers' cVUlpensation 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 503-947-7815. lU.S. ][JIll~eIJ"mllJIlReVeJlllune SClJ"Vnce: 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 1-800-829-4933 or visit their web site at www.irs:l!ov. ' <CD1tlln~Ir IR<.~~n:>>(Qlrrn~Ji1bnnn1tn~~ ~rrn<dl AIr~~~ (Qlf[ <<:;(Qlll1ltl;~Irrrn~ Codlc CompJIuannce: 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. , , [J~\bIfilliay ~ID1<<ll 1P'rolP'er~y ][)~m2ge J[JIllsunJJ"21Jlllce: 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 punctures, fire or work that must be redone. ' . . ~ . , , '. I : ' ., Time: Make sure you have sufficient time to supervise your employees. JEXjplClJ"ttnse: 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 notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner.doc 06-01-04 225 Fifth Street , 'Spi'ingfleld, Oregon 97477 >5211-726-3759 Phone . . ....ity of Springfield Official Receipt Wevelopment Services Department Public Works Department " RECEIPT #: 2200500000000000529 Date: 05/03/2005 2:05:20PM Job/Journal Number Description Amount Due COM2005-00437 Stonn Drainage Impervious Area 161.20 COM2005-00437 Sanitary' Sewer - Reimbursement 48.08 , COM2005-00437 Sanitary Sewer - Improvement 36.56 COM2005-00437 SDC Sanitary/Stonn Admin i 12.29 COM2005-00437 Plan Review Minor - Planning 59.00 COM2005-00437 Building Pennit 265.35 , COM2005-00437 Fixture 42.00 COM2005-00437 Minimum! Adjustment Plumbing 3.00 COM2005-00437 Vent Fan 12.00 , COM2005-00437 Dryer Vent 6.00 , COM2005-00437 Minimum! Adjustment Mechanical 27.00 ,;COM2005-00437 -Mechanical Issuance Fee- 10.00 , 24:87 COM2005-00437 + 7% State Surcharge COM2005-00437 + 10% Administrative Fee 35.53 Item Total: $742.88 Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received ' Amount Paid Check ROBERT H. KOPCZENSKI nJm 5178 In Person $742.88 Payment Total: $742.88 :. " , , .'-. .,.,' :". , , , t' , "" ' " ' r ,\ 5/3/2005 Page I of I ,.' .~L'... . . APPLICANT'S COpy Lane~"""tJli'" Count ;\" ' " ' , O~ /'~~Il~~ Public. Works SANITATION AUTHORIZATION NO'IICE FOR SP057095 Permit Sub-Type: REFERRAL Application Date: 03/28/2005 Proposed activity: REFERRAL IN UGB FOR BONUS ROOM Job Address: 2377 CORRAL DR SPR Applicant: KOPCZENSKI ROBERT H KOPCZENSKI ROBERT H & SHANDY J 2377 CORRAL DR SPRINGFIELD OR 97477 Owner: ' , 2377 CORRAL DR SPRINGFIELD OR 97477 Parcel #: 17-03-24-43-05800 Discussion: 1324-61. c.s.c 09-12-61 Setbacks met per site plan No increase in flow. Authorized?: Y Y = Yes N=No Inspection Date: 'Date: ' ,r? ' ZCZ:s --> h f.~n~ _"_,_"" Dunty, ~,. if" '.: - \\0' ~ 1'=-10' I - . ~-' " I _BIt; -8' ~" r .,;.:.~ """'...IIlIIL........." ...;..........._-_:....,.. . ' . . ,,__.L_ 801 I o'~t'-\ GAf< O~N s Hen .....J ([)'-\ ~ T \ tJ6) , ----- - - I ----- - - - -' - - - -, - - /'0\- \~t'\"v 1.1\ , I '1' ~...v G- ll,' ' ( - - - -- - - I \ 01 N\'l\l. ," .- .. -- - --- - I ffoPo~EQ ~oorr~N- , I , , L . --- ---'""'---. ---'-'- -' _. - - ,.. - _.~- ..-..... .. - :':"<...;,r- , , '----"-. ","e'.., L_ _. ,--. , . ...... '..-.-- ,,- ',. ..... . "- ." I r G (A'-fit, ry --.- EASEMENT 'E)<.lSTI N~ LO p(<.MN r It: - - - '- - - - I ;p I , I t - -----=-----,-- '-, ...........-....:--- I t...~\ Si ( tv b, lfou.St ". . . - t , .) ., " ,t ,,', , I ' ' '" , I p~DP")(f.> A~\) 'TloN "L_ _ " - - - - -- - --} , , I,r-=~"c""......-",~"_..o"'''~=.._' __"",_ ,___=_ I ~l SilN6 () o~c.tt I I - , :L , ~\tJ ~ E~l~ n)JG, ~ ~& ,'p d>~ ,0 (.I)- - <w 1(:E.?~o\. € i , , , , , ) ------,J 1." ~o p(1.~E~ I~ b f , ."',''''''''''.:: L.~No~ NEW bf.\ r~Dp~ 'TV L,/Vr is 16' FRoM (.L4R.8 , \ ,~ ~ - - ~'-".. ,~"~ ~~ ."::-a~;-...':i",Z:-;',~~,-, . ~ -: ~ ;-. _ -, ~: ,.~,";~......:;~1i:;;','C( ~,;:;.:a,.~;);!;1'.r'~-='~-~'ll(~ ~~1m:-&'-']"P;~~T.ir.:'T., , ( . ~,........,.~~ - - " , .," / r " ~, ';,' . " - , -- ---~. -.."LJ.. -- EK~n N <.:J s('Pn (. r-ft-NK' I ' "" ,- , , 7- ...... '-."""'....-"......'j"...'--- ,..., ,I . ~: .... '.. . ,;' "I',' , 'l " " 'I ~~: ( .' " /' o. ~~,.... . . . . Owner's Responsibility Form Date 1-f8 Property Owner Robu1 ~{Jc. '- e.k.~t J SITE ADDRESS ?..'?:>t7 Col^~l /Jr. ~o~~~L; 61< OJ?lf// Twnshp .I 1 , Range 1/3 , Section 2 f- , ~ Section 'f.3 , Tax Lot 5~ I certify that I have personally investigated the existing sewage disposal system on the above referenced property and have identified the exact location of all parts of the septic system, including the: o Septic tank o Distribution box or drop boxes ' o Drainfield lines associated treatment units ( e.g. sand filter, and future septic system replacement area) The attached plot plan is an accurate representation of the location of the septic system, existing structure(s) and proposed structure(s) on the property; and, I have verified that the proposed development meets all minimum setback requirements from the existing septic system and the future system replacement area (OAR 340-71-220 Table I), including, but limited to: ~ 10-foot separation distance from foundation lines to drainfield ~ 5-feet separation from foundation lines to septic tank. I further certify that I have, to the best of my abilities, thoroughly inspected the septic system and foundno evidence of any failure. The system appears to be functi<:ming in a satisfactory manner at this time. SIGNATURE ;4, it____ (Property owner or authorized agent) ~ 1tl 1~~Oc.LeVl.JL) Name (please print): Address: 2. S 7? (r::u're..,. ( {)r. !3pr l~rAdcP. t>((, q? <f/7 Lane County Land Management Division . On-Site Sewage Program 125 East 8th Avenue Eugene OR 97401 I:\FOIms\Owners Responsibility fonn.doc