The URL can be used to link to this page

Home My WebLink AboutPermit Building 2009-6-29 $P-RINGIiilIe:LD -'d,4"""'m,"'''~''''''_'_'- ;',"'I"-,,,,,J; ~.! =11. CITY OF SPRINGFIELD 1~ Building/C6mbination Permit '; Status Issued PERMIT NO: COM2009-00887 ISSUED: 06/29/2009 APPLIED: 06/1812009 EXPIRES: 12/29/2009 VALUE: $:45,162.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2592 MANOR DR ASSESSOR'S PARCEL NO.: 1703233301600 Springfield TYPE OF WORK: Sing)e Family Residence TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Addition of Second Story over Garage, Covered Porch and Conver\lng Garage to Storage. Owner, Address: SIMHI ZIV Y 2592 MANOR DR SPRINGFIELD OR 97477 " Phone Number: 541-914-9046 Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER ._... ~.........,i.......<" \lnll tn A1ICI\lIIVI'l. ......,""::;......" .-_. , . - Ilt'!','ty . '_' 1_.. ~.l,.,.^ """Ol"lnn I joIIC<"ON'fRA:CTOR:INFO~AnON,tlorth NO~AFt952-00i ~-001 0 through Of'R 952-001- . . ,~090. You may obtain copies !;1we!lse,es b~Xplratron Date Phone calling the center- (Note: the tele~hone. number for the Oregon Utility Notification :! Center is 1-800-332-2344). BUILDING INFORMATION 1 R3 2 25.50 Lot Size: 9,148 Sq Ftlst Floor: 163 " Sq Ft 2nd Floor: 355 Sq Ft ~asement: Sq Ft Garage/Carport Sq Ft Other: 123 Occup~nt Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: VB E ~ ater Type: NOne ~~I'-\l:'I;~~: EXPIRE IF THE WORK THIS PEPEnergy Pa . MIT IS NOT AUTHORspJi'nWI~dlB i11tli.s. PER ..IiI r..-,:"~:,~=::::::~ no 1<: ~RA~inONED rul'\ tl~DE,v'EL0PMLN'IllUIFORMA TION 1 Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 10.50 8.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Urban Fringe 1! REQUIRED PARKING " Total: , Handicapped: :' Compact: 30.50 28.00 I PUBLIC IMPROVEMEN,TS 1 Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: il Notes: Stormwater to existing eaves. No new fixtures. Paee I of 3 Status Iss u ed 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 5~1-726-3769 Inspection Line Description TVDe of Construction Garaee/Misc Garaee/Misc SF/DuDlex U VB Utility U VB Utility R-3 VB 1&2 Familv Fee Description Fire SF Fee -. Residential Plan Review Residential + 12% State Surcharge + 5% Technology Fee 1st Appliance Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Copies - Ea Addtl @ 50 Cuts Ea Copy 6th @ 75 cents Fixture Minimum/Adjustment Plumbing Plan Review Minor - Planning Plan Review Residential SDC Sanitary/Storm Admin Storm Drainage Impervious Area Vent Fan Total Amount Paid \ CITX OF SPRINGFIELD Building/C~mbination Permit PERMIT NO: COM2009-00887 ISSUED: 06/29/2009 APPLIED: 06/18/2009 EXPIRES: 12/29/2009 VALUE: $45,162.00 I Valuation Descdntion I $ Per Sq Ft or multiplier $37.72 $37.72 $96.83 Square Footage or Bid Amount 163.00 123.00 355.00 Value Date Calculated Total Value' of Project $6, I ~8.36 $4,639.56 $34,374.65 $45,167.57 06/22/2009 06/22/2009 06/22/2009 ':m P1W Amount Paid Date Paid Receipt Number " $32.05 $207.25 $77.88 $38.40 $79.00 $55.00 $12.00 $435.97 $12.00 $0.75 $19.00 $39.00 $119.00 $76.13 $6.83 $136.63 $9.00 6/18/09 6/18/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 6/29/09 220Q900000000000688 2200900000000000688 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 1200900000000000751 $1,355.89 I Plan Reviews , Initial Review 06/22/2009 06/22/2009 APP LLH Adjusted value of project using minimurh default table. " " Public Works Review 06/22/2009 06/23/2009 APP TSS Stormwa'ter to~ existing eaves. No new fixtures Plaonine: Review 06/22/2009 I' 06/26/2009 APP DDK Approved per Jim Donovan - meets front yard setback and allows for 2 ", off street parking spaces. Structural Review 06/22/2009 06/26/2009 APP CJC II as noted ~n plans Pal!e 2 of 3 , _ ~,~~~\@~~,~~;ig~.,~!!J~~,IlUIU!l~t," 'r:' .' CITy,: OF SPRINGFIELD Building/Combination Permit Status Issued " PERMIT NO: C.OM2009-00887 ISSUED: 06/29/2009 APPLlED: 06/18/2009 EXPIRES: 12/29/2009 VALUE: $:45,162.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested 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. ~~!lUirerl l~soection.s 1 Footing: After. trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to t100r 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. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Undert100r Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing workis complete. Rough Gas: After line is installed and required testing and capped if not attached to an ap~liance. 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 Final Electric: When all electrical work is complete. Final Building: After all required inspections have been requested and approved and the building is complete. By signature, I state and agree, that I have carefully examined the completed application and do h~reby certify that all information hereon is true and correct, and I further certify that any and all work performed shaH be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the w~rk 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 he 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: __~..-----:7 /3/.- ...-..----x-.-.. /.--- ~~ ,--- . v __<._,--~', /. ./' (----- -- 'tTwner or Contrastors.SigniitU;:e ;{/Z 7/09 I . Date 'Paee 3 01'3 225 Fifth Street. Springfield; OR 97477tPH(54I)726-3753tFAX(541)726-3689 1~1~i'i<;'-~~"-ii~:li')!~'iI&;/f;i?',l%,*~".1Z~~.'7~iligl f~1i"DEI?ARTMENTiUSE,ONIl<Y(,' . S:k;,,~f:F,>J;'i'>~'~*:~\';'iji1i-!l.'d'iitlr&Jr"_~&-~~..,,;if_f'h,: lJ Permit n~ . C'a -BB 1 I' IDU~' I Electrical Permit Application ;)1. This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or jfwork is suspended for 180 days. 1~[(:tcAl!~S.rcl.Ml;gNMENif'JSgRgQV;6;Ii;I'~~I.' f~~;~;~~~I~~~j[cl~G~g~l~~C!CillIP~~~~~Ff~ 'I Residential, per unit, service included: 1~~~~~~:;~mrE"IN~.. ~~~~~':~:AND)~~C~~';~~;~V[i~ 11,000 sq ft. or less (4) $134.00 $ ~:te~d;ess: L~-qi "/y;;no;. j}~.~"r>!'1 1 ~~~~:fdditionaI500Sqftorportion $ 25.00 $ 1 City: Jy:;r-''l"ll; (, JfJ 1 Stat<Q Z 1 ZIP: QYlll7-I-1 Limited energy (2) $ 32.00 $ . ~m~~~cl~~~~~5~~~ ! !:~::~:~~::r::s~~:::~:~:nd::ration, re/o:at::~OO $ .11,_. ,~.~ ~jili",",~f""";r'~RclBER:t,Y:,jf0WNER1!f,,,g;J!!':'r(~:t"""''i;:;:~1r~lj ~~~ ::;00:;: ~~; : ::::: : i?~1l:~~~""""^,,,,:g:~~'f ','''"'.__ -_____.w,,,w."'_~_~. _u___,_);~,;},j[~.-_",ffl~,-~,..!".~ I Name: -=-U'v _<;,N,~; 1 1 401 to 600 amps (2) $158.00 $ 1 Address: 251.2 /Y'h/1<< f) t 1 I 601 to 1,000 amps (2) $205.00 $ 1 city:5/J).,'/,(/f";t-/j 1 State:O)( I ZIP: 17t,!91 lOver 1,000 amps or volts (2) $469.00 $ I PhoneW/-q;rj qoC/~ I Fax,')/.{/-i!h? ..J1qg, , I Reconnect only (2) $ 63.00 $ I E '1' . - I Temporary services or feeders: installation, alteration, relocation -mal. " Th" 11.' . b ' d 'd' I < 200'amps or less (2) $ 6300 $ tS msta atlOn IS emg ma e on rest ent," or ,arm property . owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchange, lease, or rent. 0 R 479.540(1) and 479.560(1). 1 401 to 600 amps (2) $126.00 $ ~. ) Signature: /~..-,~ _"'\ lOver 600 amps or 1,000 volts, see seryices or feeders section above IfA~~c'~I\/jI1.:'Gmi:!)~B!INSifr;6;l!~~mli:!)N.~~~j!.~~~ 1 Branch circuits: new, alteration, extension per panel I Business ;ame: rrf/&//I e....- ria. Fee for bran:h circuits with purchase ofa service or feeder fee: 1 Address: 1 Each branch circuit "I 1 $ 6.00 1 $ I City: I State: I ZIP: ~ee forbranch circuits without pu~~hase ofa service or feeder fee: 1 Phone: 1 Fax: I I First branch circuit (2) I I $ 55.00 I $ I E-mail: ! I Each additional brand). circuit . $ 6.0~ $ ! CCB license no.: I BCD license no.: I I Miscellaneous fees: service or feede~ not included I Signing supervisor's license no.: I I Each pump or irrigation circle (2) $ 63.00 1 Print name of signing supervisor: 1 I Each sign or outline lighting (2) $ 63.00 I I Signal circuit or a limited-etlergy jJan'~I, Signature of signing supervisor: alteration, or extension (2) $ 63.00 $ $ $ ~ ~ .~~Q/ ~~ I Each additional inspection: (I) . I $58.00 1 $ ~\I~~~'\WgP,:~UicP;Nft~\!JS"E~~~~ (A) Enter subtotal of above fees I - (Minimum Permit Fee $58,00) .. $ 1 (B) Enter 12% surcharge (.12 x [All 1 $ I (e) Technology Fee (5% of [All 1 $ I TOTAL fees and surcharges (A t~rough C): I $ 440-2584-J (9/08/COM) .,~r~(,turaI Permit Application .1 . - 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689 Ij;q;iDE[ARTMEH-f,'i!isErC:)'f.l'1!oy~1 ;r~F~,~,~;.:,}t0'","b>~~,",.::o..~~~'>'!'1ii'~ pe~it noca ,5)\ I Dat,~" This permit is issned under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. . l~iBI:~0G.~~rq.~~.F~JlJ!lENif'AeB~ I Th. is project has final land-use approval. I 1""'''''l1_'!!\lil'!''''J!!;-.'''''''.''~'"''~'~~_~_''I'' SIgnature:. Date: ~",~~,,~E;5\lt~9J'-E;D.,UJi_E.l!\i~~~ 'I~;:~;eecthas DEQ approval. . Date: :~~;~~~~~:q!tmri~~_1 1 Zoning approval verified: DYes D Nn . 1 Occupancy 1 1_;[#':;~~~jQ~;~E~~J~~Q]r~~~~~~~~' :. ~:::7;:~:n type: I ! itResidential I ,0 Government I,D Commercial I Cost per square foot: I 1__~ll.i~);r:~lill:Ili.i;lI3M~iij~,~.fK~MI@~Ti&?Jl_~~ Other infonnation: 1 I Job site address: 7,S-Gfj /Y /.LJhoyIJ y ~~~ I~~~::€:::"D~~" ON'! I Name: 7; V S ,';.01 ;; " 1 I,ToB~a~~.~~;~,~~.~,,,_~.,,,,,,,,,,,..,..../..,,,,,,,~_,,..~.1 $ u <<'.'11 1 - - . - fi2::; lnldin~g{fees"'i"1!~' '1';~"~h~~\~,~-".ir<'l:~jh,iJi9l1i:f.i'., .'" .' ot!t~,ti Address: ?~9-:1 . /1'2A/7i!Y l) 1--.. I" .....,~..........."'__''''''~r~,...'''...I,..''. ..... ..,......,... . ., ".,,' 1 C'. ~ ~ .., /. /.1 Is' 0 <7 1 ..'>;7 u-, -'1 1 (a) Perrmt fee (use valuation table): $ Ity, -Tc1rl I"-.I.,f tate. R ZIP..r7 r '" 1 .. , 1 Phone:Wf-9/lf- gol.f9' FaxfiI.fIJl{?..qq'l,q' I' (b)InvestIgatlvefee(equalto[2a]):; $ 1 . . . I I (c) RemspectlOn ($ per hour): . E-mail: (number of hours x fee per hour) Ii $ This installation is being made, on residential or farm property owned by 1 (d) Enter 12% surchar e (,12 x [2a+2b+2c]): $ me or a member of my Immediate famIly, and IS exempt from licensmg g~, requirements under ORS 701.010, ------7 1 (e) Subtotal of fees above (2a through 2d): . $ I Sign here: 0/;:X(- ~;../ 1~~1l[@Trl~xJ~1~1'1l\lt~~~"~~1 Ie,!~.... "''''''''''~' ~_.."~. .' ........~.. ~..~'~""'~-~......"'~<~...""~. .~..nlii 'I 1 (a) Plan revIew (65%x pennitfee [2a]): $ 1 '" '.. "''''''',G0NmRAGl'0RJiiINSml>:l!!lY\.mI0N'.. '" .'.. . .. I....~~.si~ess :':ne~""~'~~:~~i~?'-"c""",'- ,W ,~,.. ....' "I' 1 (b) Fire and life safety (40% x pennit fee [2a]): $ I. 1 Address I. ~.~J~;;;:;~~~~;~~;;~~;,~;~t~yj~;~'i~~~~~l<)1 ! ;~::~;: I ::e: I ZIP: ! i;(a)";~;S~i~~~~~f~"~::n::::5~~:;::::::J:>>~'h"l r CCRlicense no.: I Print n~e: . ."1 Signature: 1.~!l"'i1I-Sl'JB;-t-0NT,RAcm0'R'IrNJiORMAtii10N~>-"""~~"'}j..'("1 ~;I;'L ~~:;..;:;;;.o~~'h=""._"'_"A..^~'~'''''~''''''~'_~''o~,;J_.t5!Vft'i~,,~,~ Name CCB License Number Phone Number I Eleetrieal I I Plumbing I I Mechanical I ~ \~\LP~ l),,4~ 5\'6 ~\~U f)\\^~.. f\ ~ lo\ " 1~~W1,.' '. ~~~ ~14~ 1 MMrI:~3 ~s~ - '"' Jil-t echanical Permit Application ; Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 ~;;'.if.JfJj,f!5<.w,;;y.,;{..i:P.;.' <id,:....-:>,~Z': .""-t~z?;;]".~~~_t>o; :~"~..~iiOO- "'~..'JI !~~[)EPAR:rMENmUJSE,ON~YI!R,~' ~':'7"";~~'iF(;;.~.;.]t~~mll -,."., '.. . " ~u.J.n~". . . . - . ~- --........ I Date: " .. .. .. ~.. ... .. .. ::. ........ .. .... .. :: .. :: .... .. . .. ...... r...... This permit is,issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. . . 1~@b,-l"eAffiEG~0RW"0F,'ll"C0NSitRUcmi0N~~!jfil!{~;;J f1~'IJ;i;'l!::'!F'11,!:{li!;;;:;"i'jI~Er:~;:CfO~EN'ijt;E".'~~--~~; ~ilo/2AK51tg15iliESiili!L_..."__~.._.-,-_",-~~,,~.J!:lt._,,,-_~.___,_-..,..,~____,__~~" _ in~5Q;Vi}.E'h :J(3&;'''\~f;.l~t .JG.'J?iL~~..di",'~.~J__.~"'i:__._-,~A~~'1~.i!'>t~t.1k;'H:~ /',..,(Resl'dentl'al I 0 Governrne' nt I 0 Commercl'al l"R,.ps".d,ff."""'t'o!;;';".' ~'~l!'l:"". :'il~J' '!;.~'\%C<t"'!:I.''''''''lml''",eoStiJ'.li:l.'I''1:'TiitaEi~Cl ~ '" _ eSI en Idlli'lf.ir...!iii~\.W~."d~i'.~. ~~tY.!~ ' {1 ".-."",Ji€;%Jb~'-."" F,''''-' t;':\!+C\"'''~'".~\>("."-,,m.,,:\12.,';j'':i:C1'L~:~i::'1;> '.;\'~,\1o'\w...?....-:5'~'i :c,;;.o::4'-' 1. ~ea:y.0ii;t. KY~cost;~: ..i: 1~1lJ~~ill.~j[i'r~9RM:e:jfJQ:r~~_t:l.pjiliQ,~~lt@'t,t1![~~ A First Appliance (W, fl' I $79.00 $ '?nJ' . I Job site address: lj~9;;L ;11/-/,-,0..-' #)1-, .. ~urnaee/burnerin'c1uding ducts and vents 1 ~;~~:;t~~~s~::.::~:", 1 : ~~~I: i I Repair/alter/add to heating appliance/ I refrigeration unit or cooling systemf I $58.00 . $ absorption system ' 1 Evaporated cooler 1 1 $13.00 1 $ I 1 Vent fan with one duct/appliance vent 1 I 1 $9.00 $ '7~ 1 .1 Hood with exhaust and duct I I $13.00, $ I 1 Floor furnace including venl $58.00 $ 1 I Gas piping I lOne to four outlets I I $7.00 I $ I 1 Additional outlets (each) $4.001 $ 1 I Air-handlin~ units, includin~ ducts I I Up to 10,000 CFM I I $11.00 I $ I lOver 10,000 CFM $20.00 $ I I Compressor/absorption svstem/heat pump I I Up to 3 hp/100k BTU t I $17.00 I $ I I Up to 15 hp/500k BTU $29.00 1 $ 1 I Up to 30 hpll,OOO BTU $43.00 $ 1 1 Up to 50 hpll,750 BTU $57.00 $ I lOver 50 hpll,750 BTU $95.00 $ 1 I Incinerators I I Domestic incinerator $20.00 I $ ! I Name: 7~'{/ <;.-nA: 1 Address: LS""9d.- /n1-'7~r f)f-~ 1 City: >/h"'J'f..,rl-fJ 1 State: 0 /( 1 ZIP q r'l1-1-1 I Phone:€;l/f'&...q OI.U 1 Fax:fV-'1b)79Y! I E-mail: This installation is being made on pro'perty owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. ~ Signature: n. r-._..-/ _~~ 1__~N~~~~il~g~if;10N];'~.Iif&i&~!. 1 Business name: ()V/l~r 1 1 Address: 1 1 City: I State: .1 ZIP: 1 1 Phone: 1 Fax: 1 I E-mail: I CCB license no.: I Print name: I Signature: 440-2545-J (1l/08/COM) .. .. .. I Enter total valuation of mechanical s'ystem and' installation costs $ _ :: ~~M-~~:::.,el~I:~~::~~:~~f~~:~~~;~~~~;;~~;;;~~;~~ig~II"~Tiital") ~5:':hl~~~1~22~~A~~!7~~!-~~1;;~~;~il~~,:~~ ~ea~ rj1fcost~1 I Reinspection $58,00 $ I .1 Specially requested inspections (per hr.) $58.00 $ I I Regulated equipment (unclassed) $13.00 $ I ~~_~;;;~o~~~ANff~0sE~~~~_~~ I (A) Enter subtotal of above fees (or enter set I I minimum fee of $ 79.00)" $ I (B) Investigative fee (equal to [A]) I $ 1 (C) Enter 12% s,,,charge (.12 x [A+B)) 1 $ 1 1 (D) Seismicfee, 1% (.01 x [A)) $ I 1 (E) Technology Fee (5% of.[A)) $ I I TOTAL fees and surcharges (A through E): $ ,I I Plumbing Permit Application 1't'~~V.J'~''':'$;.'l,1!>:""-",,,,;'~f!;-;\'}'-'';;}_'i''';>_''!i'''2':~i':';'''1'<!*';l'''''l'iJ.~'ttf!\1 ;::C!;:hDEP.ARTMENMJSEIONliY~'?,,; """'''''''''f''''''{,CC' '.C'" '.,.'..' '. "'b' I Permit nol 'Jvt~ Rr;\ I IDU~ I This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits cxpire if work is not started within 180 daysof issuance or if work is suspended for 180 days. II:Jfz'iii:oifnt~I"n:''''giia~p~pll:r:Oo'vCaAl' vLe'.~r;IGfjlOe'dY?ERNI\IIEDNTyi,FeAsPF!R6VAD.' .I?N~\~oj.i!i~;;)1,~~llli~ilQ~l~.~~~l1it!&r:~~~;$FEEriSCHED.Ul!Ei:j,$l;\~iii~il'~l1:~*'\;H~'!1)i1 . 11JD~tgrT'-:fi5~~--:f~~1i1;~~\*\i:rtfl'6~;~?,';';~"fl~\~;IT''tt'.'~ l~t~g9'~~1[;jll}(]))J~.I~!:1 i;'.:i'{~"t!!i;:;!:;1nP4if!;',:,,'~\?:~~t~~1:It:*;tfi;.)~k'F}}t';~1t;'i~h ~X1j,' ?lID,tei;1_.~;;;I:; ~~(~~c.~~!~}~, I Sanitation approval verified? 0 Yes 0 No I I New residential I I CATEG.ORY.'OF:.CONSTRUtJIOIII.,' I J bathroomll kitchen (includes' first 0.,4, I I JOD feet of water/sewer lines, hose if'J r...esidential 0 Government 0 Commercial bibs, ice maker, under floor /ow~point ~~~:;'li?i1':JOBfsfTE",INF'<:)BMA1!tONifANP1ill!ro<::ATIQN~WtJ1\\fijlitl drains and rain~drain packages) . Job site address: 751:2 /YlA/}or Dr. I I 2 bathroomsll kitchen $374.00 .,./ ./. I J I S ".--, r7 I ZIP Q,."..117Q I 3 bathroomsll kitchen $439.00 CIty: ~,h/fJ)(. e;/, tate: '--./1 \ : TLI''tt I Each additional bathroom (over 3) . I $95.00 Refe,.{nce!r:J{'[~3,?l "?-, . ITax~0t.)j.<J.?2~TIGf&J{j:ach additional kitchen (over 1) I $95.00 ii)-'i~5~i}ii';~!~k;0'DEQRII?;rION;\O~~1l"1l[~i;1J!l;1~"i~ii~ : ~;;i~,eo~t~a:q~::~:~;klers (includes plan reVieW)$58.00 1 2,001 to 3,600 square feet $116.00 I 3,601 to 7,200 square feet $174.00 I 7,201 square feet and greater . h I $232.00 I Manufactured dweJJjn~ or pre-fab (circle one) I Connections to building sewer and ~. I I $58:00 I $ water supply ~ I Commercial, industrial, and dwellings other than one- or two-family ,;, I Minimum fee "I I $58.00 I $, I Each fixture $19.00 I $ I Miscellaneous fees 1100' storm, sewer, water line I Each fixt,ure, appurtenance, and piping I Storm water retention/detention faciliJ:y I Irrigation systems I Piping or private storm drainage systems exceedin!! the first 100 feet r Specialty fixtures I Reinspection'(no. of,hrs. x fee per hr:) I Special requested inspections (no. of.,; hrs. x fee per hr.) ;, Each ad~itional inspection: (l) 225 Fifth Street. Springfield, OR 97477 . PH(541)726.3753 . FA.X(541)726.3689 ,:'~RORERif;Y;~.OWNE:R~j'~:d.~~~r!~\J~f~i~f1}~~*:;~~~ Name Zb <:),hJ,/ Address V;...--qZ- /!1/}rwy tJ).... City~;.-,~,(-jr/ IState@f( IZlP:9PI19 PhoJ€'?<tI- 9K; '1 0 L(9 I Fax~V((- Lf6-A1S9 . E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from licensing requirements under OAR ~020. Signature: .r:J--7/'~::::--::+-- ~- '." "~,CO)l'l'RAa.tOFLJNSlJ1!l;('[AT;ION.:j,, ",,;'C:{'';;':h..i Business n.fu.,: OW t1if I I I Address: I City I Phone, I E-mail: I CCB license no.: I Plumbing license no.: I Print name: I Signature: State: I Fax: I ZIP: I BCD license no.: 440.2500.) (11/08/COM) I I I I I I I Enter fee based on installation and eq'\lipment value. I $ I 1~~.w~~~~~Fijfl!iG'~N'fi{\[jS~~~~~~"i I (A) Enter subtotal of above fees $ (Minimum Permit Fee $58.00) I (B) Investigative fee (equal to [AD (C) Enter 12% surcharge (.12 x [A+BD (D) Technology Fee (5% of [AD II TOTAL fees and surcharges (A through 0): $238.00 $76.00 $19.00 $19.00 $19.00 $19.00 $19.00 $58.00 $58.00 $58.00 $ $ c'."" "':""~~9" ":ni :'fJ!~ .1"'>-Q'::~IJt,,~'<,,!i:" ~1;-.l"V'1)''1tJ''""; %~eqi~~I}gas~piping:ft.l}li~~~~jll:citi7;&:~J;;ffl~ Minimum fee I Enter value of installation and equipment $ _. $ $ $ $ $ $ $ $ $ $ . $ $ $ $ $ $ $ $ $ $ $ -. . . . . . . . . " ," . . Construction Contractors Board 700 Summer St NE Suite 300 POBox 14140 Salem OR 97309-5052' Pbone: 503-378-4621 Web Address: www.cch.state.or.us I-\CI/~'I ' Permit#: V l/V. I; , . . Address: !FcfJ..~ N\(L\\D\L \J ( Issued by: Date: '. Statement: I~formation Notice to Property Owners About Construction Responsibilities " ~ Note: Oregon Law, ORS 701.055 (4) requires resiqential construction permit applicants who pre not . licensed with the Construction Contractors Board to sign the following stater:zent 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 subm{t 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 38:. ?no ~ ~ 1. _ ~ 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 b~fore or on completion. ' '. " D 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 -. 'ij 313. I will bemy own gen(;lral contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors . Board, If! 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 imd that I have read and do nnderstand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. /0~...:.~ / <7 ~~ (SigiJhture 'Of p;;;;'...it applicant) '.... ----- (White copy/o issuing agency permit file, pink copy to applicant.) J /10109 o;a~) .' '. !i Property_owner.doc 06-01-04 - . . ... ,~ ........-~" - I ~ -. _ . \r.... /..: ..... I ,; .' . '\ IAc.tJQg,asl-Y~lIt 'Qwo'Gel!lleral Contractor? ; LI ',I ..;: I INFOtRMATioNrJOTICE TO :PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ". . .: ,. ,'. , '. t_ ,....,;11. NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. '", ~ \'i" '. ;:'.'; . ".' . . (-, ,: """.:' , -', . . ~" . . If you are acting as your own Contractor to construct a new home or make a substantial impr~lVement to an existing structure, you can prevent many problems.by being aware of the folloWing responsibilities and concerns. .-. Employer Responsibilities You will,. ip m!>st in~.\lmces,: b.e ruled. to be an "employer" !l"d the c~mtractors you c(mtr~'?t ~ith..w}l11:>e "employees" if younse contractors not licensed wiih the Construction Contractors Board to. do .labor in constructing or to assist in the construction.or impro~~'\llent of,a 'resid.ential struc~~. A~.t!Ie' employer, you'rous! comply ~ith !he foll.,!wing: ..i'" . . .~. ~ ,.' . ..' . .,-. .: _' ,,' ..'. ".' , l~;.,' ,~... ., . ~., ' t. '" \ 'C', : ., . " " ,""- " " . " -". r i-':' . _, l \ \ '\": _, .. . Oregon's Withholding Tax Law: As an 'empIoyer, you must withhold income taxes froin employee wages at the time employees are paid. You will be liable for the tax payment~ even if you dO'1'tacfUlllly withhold the tax from Y9ur . employees. For more information:," call the Dei>artrTIe,nt of Reve~ue at 503"3'78':4988: ,~. . .',. r, - ..' 0 ,'.' Unemployment Insurance Tax: As an employer, you are required'tdpay;a taiC for unemployment insurance purpose~' ,; on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. , -,.~ '"1.. -:.')"''-:~~~' .)' .: ~;".' :i;....., . "i"+" .~... ...." .';~ .... 'y The Oregon Business Identification. Number (BIN) is a com..binednumber for both_ Or"gon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.lls/formslJav.htmll .forthe appropriate forms. .' " , . ~ .. .' r.", . , ,~. ~ Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Cvu.p,-usation Law, and must ,obtain .wo~kers' compensation insurance for your employees. If you fail to obtain workers: ~ompensation i ... _' " '_' '.,.... -. " .' , -,' ,- 0--,', ',', '. "_~' ".." . t. . insurance:' you 'cOuid be'subjeCt to'penalties and be liable for_all claim'costs i(()ne ofyo!ir'emp10yees'is injured on the job. For more information, call the Workers' Compensati'on Division'at the Bepartn1ent oft:onsumer and Business Services at 503-947-7815. . U.S. Internal Revenue ,Service: As an employer, you must withhold fedei'alincome tax' fi'omemployees' '~ages. ~ 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.]-800-829.:4933.or'visit their\veb site.avw\vw.irs.l!Ov. '.: ", ',. .' ,'w '. l. ...._ !-f ',{ -: :r-,.. .", ~"'J:~:'...,.. ;,';. J "'_ .:.. "" --"~l' ,:.. :.-1 ~-';':~_:'1( ".'_ . .". .0 Other ~espon~ibilitiesand -1-.reas of Concerns :: '. '):\--. . Code Compliance: As the permit holder for this project, you ~re responsible for teso]vinkimyf~iit,tre:to theet code requirements th~t may be brought to your attention t.hrough inspections. . ~".~ ,. _.... ';.~. - ". ;"l:'! .....c ~,- .-' . . -!. ! ,/~. "l _, '. ~ '-, .,' -:0' '1:. '.... _: " "' "_ <,... .. . "', ", Liability and Property Damage Ins'urance: Contact your insurance agent to see If you have 'adequate Insurance' coverage for accidents and.omissions such as falling tools, paint over spniy, water damage from pipe punctures, fire or work that must be r"done.. C .-~- .....---~ ~,-".-.. Time: Make sure you have sufficient time to supervise your empioyees. :;,. -. .'",' ,. . .- "::-':"-\~l"" " ~ ",:.. f\\, _~~:'~ " ,~. ' '-,~," 't , . " Expertise: Make sure you have the skills.to act as'your'oWn gen"enil contractor, to coordinate the work ofrough-m 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. , . " i"' Property_owner.doc 06-01-04 11 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 COM2009-00887 Steve-5jmbj . 2592 Manor . - I I~ 10 o U ~ W I- VJ 6 ~ Single. Family Residence o BUILDING SIZE (SF: LOT SIZE (SF): o o DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE I 383.00 ' I $0.357 = $136.63 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. 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 DISCOUNT $0.00' ITEM I TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: I NUMBER OF DFU'sl x I 0 I B. IMPROVEMENT COST: I NUMBER OF DFU's , x I 0 I $136.63 $136.63 1070 COST PER DFU $27.67 $0.00 1091 COST PER DFU $21.04 I I = , $0.00 I $0.00 1092 3. TRANSPORTATION ITEM 2 TOTAL ~ CITY SANITARY SEWER SDC A. REIMBURSEMENT COST: I ADT TRIP RATE I x I 9.57 I" B. IMPROVEMENT COST: I ADTTRIP RATE I x I 9.57 I I NUMBER OF UNITS I I 0 I x I COST PER TRIP x INEW TRIP FACTOR I 21.06 I 1.00 ." I x I COST PER TRIP x INEW TRIP FACTORI $92.89 I 1.00 I ~ , =1 $0.00 I $0.00 ,I ] D94 , I $0.00 I 1054 I $0.00 I lOSS $0.00 1093 I NUMBER OF UNITS I I, O' I ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY !mWER'- MWMJ:; A. REIMBURSEMENT COST: INUMBER OF FEU's I x I 0 I B. IMPROVEMENT COST: INUMBER OF FEU's I x 101 ICOST PER FEU I $97.90 = ICOST PER FEU I . $1,009.17' = Todd Singll!ton 6/23/2009 $0.00 I 1054 $0.00 1 1056 = I $0.00, I ~ I $136.63 .J' CHARGE I' $6.83 6.83 1'1079 $0.00 J 1078 ., TOTAL SDC CHARGES ~, $143.46 --- MWMC CREDIT IF APPLlCABI;E (SEE REVERSE) MWMC ADMTI~ISTI0TIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL(ADD ITEMS I, 2, 3, & 4) ~. ADMINISTRATIVE FEE: !SUBTOTAL x '1 ADM. FEE RATE I~ I $136.63 I 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE -- ._--, 'NUMBER OF NEW FIXTURES x UNIT EQUrv ALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULAlE ONLY THE NET ADOmONAL FIXTURES) NO. OF FIXTURES DRAINAGE I UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB 0 0 3 = 0 -I IDR1NKING FOUNTAIN 0 0 1 = 0 I I FLOOR DRAIN 0 0 3 = 0 I IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 .3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 LAUNDRY TIJB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 0 0 3 = 0 CLOTHESW ASHER - 3 OR MORE (EA). 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRlG / WATER STATION i ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0 I SHOWER. SINGLE STALL 0 0 2 = 0 I SHOWER. GANG (N1!MBER OF HEADS)_ 0 O' 2 = 0 I SINK: COMMERClAURESIDENTIAL KITCHEN 0 0 3 = 0 I SINK: COMMERCIAL BAR 0 0 2 = I 0 I SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = I 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 1 = I 0 URINAL, STALL / WALL 0 0 5 = I 0 TOILET, PUBLIC INSTALLATION 0 0 6 = I 0 TOILET. PRIVATE INSTALLATION 0 0 3 = I 0 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 .-EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelli~~ ~t (20 D!l!.'S) set at 167 .gallons per day MWMC CREDIT CALCULA TION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 ]986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,OOO III ASSESSED V AL~ I II I I I I I I I I I I I I I I I I IS LAND ELGffiLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 -'1 I I 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE /1000 CREDIT RATE $0.00 x $5.29 ~ , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT $0.00 = 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Recejpt Development Services Department Public Works Department Job/Journal Number COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 COM2009-00887 Payments: Type of Payment Cred itCard cReceintl RECEIPT #: Date: 06/29/2009 1200900000000000751 Description Copy 6th @ 75 cents Copies - Ea Addtl @ 50 Cnts Ea Plan Review Residential Stann Drainage Impervious Area SDC Sanitary/Storm Admin Plan Review Minor - Planning Building Permit Fixture Minimum! Adjustment Plumbing I st Appliance Vent Fan . Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 12% State Surcharge , Paid By ZIV SIMHI Item Total: Check Number Authorization Received By Batch Number Number How Received CJC 03597a In Person Payment Total: Page 1 of I II :40:24AM Amount Due 0,75 12,00 76,13 136.63 6.83 119,00 435,97 19.00 39.00 79.00 9.00 55.00 12.00 38.40 77.88 $1,116.59 Amount Paid $1,116.59 $1,116.59 6/29/2009