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Home My WebLink AboutPermit Building 2009-9-3 -.,!~~,~~,J,~m;_ ..' ~"'" ~ ,;; ~"f';'" CITY'OF SP<<.ml.FIELD Building/Combination Permit , Status Issued PERMIT NO: COM2009-01214 ISSUED: 09/03/2009 APPLIED: 08/20/2009 EXPIRES: 03/0312010 VALUE: $ 62,688.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone . 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 7298 ELDERBERRY ST ASSESSOR'S PARCEL NO.: 1802022100600 . Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition PROJECT DESCRIPTION: Bed/Bath and Garage Addition to Single Family'Residence Residential Owner: WITTMER DANIEL A JR Address: 7298 ELDERBERRY ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION ~ Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER License Expiration Date Phone BUILDING INFORMATION I VB # of Stories: ] H~ight of Structure ]7.00 Type of Heat: aseboard Electric Water Type: Range Type: Energy Path: Sprinkled Building: No Lot Size: Sq Ft ]st Floor: Sq Ft 2nd Floor: Sq Ft Basel)lent: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 15,246 342 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 784 I DEVELOPMENT INFORMATION' REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yes % of Lot Coverage: 23.00 ATTENTION: Oregon law requires you to f"II^.., ....I....... ......J__~_ _, '- " _ ". -,-._- ~J .".... '-',.....:::turl UUJIlY I PUBLIC IMPROVEMENTSlcatlon Center. Those rules are set forth , .... _..R 952.-001-n01f) through OAR 952-001- Street Improvements:.. . . 0090 YOLSldewalli,Type: . . , : .:E: Fullv Improved '. , '''''y uu a.". ~llples of the rules GvrbSlde 5' Storm Sewer A,v~il~~lrRI\iI Yes . callrng IDownspoutslDrain.she tele~,€urbJand Gutter Special Instruction: '. IT SHALL EXPiRE IF THE WORK number for the Oregon Utility Notrlication ,,~;,~9rR~~~~ ~NOER THIS PERMIT IS NOT Center is 1-800-332-2344). Notes: STORM DMINSoTOfC,I'JRIPA, ND'I)G'"t:'f-TERR ANY 180 DAyPERI06:- ...- " u ru 20.00 25.00 6.00 Total: Handicapped: Compact: 2 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 0.00 Paee 1 of 4 $~JUNGF,Im.:.., ,.J. ,., - t"'""H!iI"""""'~ /?iB;:riM1t:""'"'if''' ii{~'-t'~L' ',-'-',~,~:?":~.~lr;Fi ~" .:/f'" Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description . Tvpe of Construction Garal!e/Misc SF/Duplex U VB Utilitv R-3 VB 1&2 Familv Fee Description Plan Review Residential + 12% State Surcharge + 5% Technology Fee 1st Appliance Building Permit Fire SF Fee - Residential Fixture Minimum/Adjustment Plumbing Plan Review Major - Planning Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage Impervious Area Total Amount Paid Initial Review Initial Review 08/20/2009 08/2l/2009 Plan nine: Review 08/2l/2009 Planninl! Review 08/27/2009 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01214 ISSUED: 09/03/2009 APPLIED: 08/2012009 EXPIRES: 03/03/2010 VALUE: $ 62,688.00 I Valuation Description I $ Per Sq Ft or multiplier $37.72 $96.83 Square Footage or Bid Amount 784.00 342.00 Total Value of Project !?pp" P~ilU Amount Paid $343.56 $79.87 $43.83 $79.00 $528.56 $56.30 $57.00 $1.00 $211.00 $176.37 $231.94 $44.62 $484.16 $2,337.21 Date Paid 8/20/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 9/3/09 I Plan Reviews I 08/2l/2009 08/2112009 08/25/2009 08/27/2009 WI NJM APP LLH WE DDK APP DDK Pal!e 2 of 4 Value Date Calculated $29,572.48 . $33,115.86 $62,688.34 08/20/2009 08/20/2009 Receipt Number 2200900000000000938 120090000000000]024 1200900000000001024 1200900000000001024 1200900000000001024 1200900000000001024 1200900000000001024 1200900000000001024 1200900000000001024 1200900000000001024 .1200900000000001024 120090000000000]024 1200900000000001024 Hillside _ Requested revised plot plan sbowing complete site, including walkways, driveway, decks, P3;tios, all structures etc. in order to determine lot coverage. Plans OD'hold until new plot plan received. ' Received revised plot p!an showing all improvements on site. Approved as shown on plans. Removal of 5 or more trees will require a tree felling permit. _&~!!!~~!1':;:~~~'.'" t . . - -'r, . Status Iss u ed CITY VI' ~ndNGFIELD Building/Combination Permit PERMIT NO: COM2009-01214 ISSUED: 09/0312009 APPLIED: 08/2012009 EXPIRES: 03/03/2010 VALUE: $ 62,688.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Public Works Review 08/2112009 08/28/2009 APP BJG STORM WATER TO CURB AND GUTTER. WORK BEING DONE ON FAIRLY FLAT GRADED SOIL. 'NO LDAP REQUIRED. As noted on plans Structural Review 08/21/2009 08/28/2009 APP CJC 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. Rpnll;rptl Iv"np!,:~in!\, I Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Slab: To be made after all ins lab building service equipment, conduit piping and other equipment items are in place but prior to concrete. 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. Special Inspection - Soils/Compaction: To be done during construction by a State Certified Special Inspector with approval from the City of Springfield. Copies of inspection results shall be provided to the City of Springfield. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. U ndertloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. 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 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. Paee 3 of 4 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01214 ISSUED: 09/0312009 APPLIED: 08/2012009 EXPIRES: 03/0312010 VALUE: $ 62,688.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 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. ?--~C) '7 Date Paee 4 of 4 ~ Structural Permit Application ~- 225 Fifth Street. Springfield, OR 97477. PH(541)726,3753. FAX(541)726-3689 Iti[1oE~ARmMEN;f;rusB0'NI1y'k!l' ,;}1J.4'~"..W"~~.I",:::-''''~i;.~'':~~''r'~j.tl'~'\,,~/!!ti Permit no, c.1.-1.J../l.( I Date: 1f/:;-0/01 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days odssuanc-e or j'f work is suspended for 180 days. 1~~~~EllOCj\;~GOVERNMENm~BRQv.m'~~,jjl"ill.ll,1T~:la'!til1\1 it~k _~'.". ....._.'O';___.,_.,(_,~~___..,'~~"...-'-.."d',._,~~!d..~~.<! I This project has final land-use approval. 1~\li&\~-~~EE~sclrE6l11!Ej,''';;;~4il':Jll}'f''''!tt2r~!t1 1:~;~~:ecthasDEQapprOvw ::::: :~~~~~~~~~~~~~;: 1 Zoning approval verified: 0 Yes 0 No I Occupancy:rz- I 1 Property is within flood plain: 0 Yes 0 No I, Construction type: \/ \<., I Ig~~.f1i1'.qQRYdiciFiil!g'QN~[BY:~'fll:1N~m~f~\1i!ll I Square feet: ~ '6':\ I1!IH / ?'-I2. 1>,.,; I 11,~:d:~~"""__",,L~ Go~~m=~_,,_JE~, CO~~~;f~~j I Cost per square foot: 1 ~'P'Jl'~wiJ9E:llliSI;l!;,"IN!i,Q.RIV!~i!'JQNlt~.tlJ)fJ!Qg~'I!9N,~~~ I Other information: I . 1 Job site address: 7 "J.. Cf 8 EfJrr b,.",ra.':;:/- , I Type of Heat: (../~'- /f3(tf~ B 0 I 1 City: StJr'NeC,;lrJ I State: /) ~ 1 ZIP: q:ftrkl I I ~ Energy Path: I Subdivision: X~k,." ;>," U. {/5 'I Lot no,: tJD6tro 1 D new D alteration ~ddition I I Reference: I Taxlot: i gO?D).,;;.\ I 11:.__J1llil'"~"~'c~--',"lv"<'~~'-'i'im!,i;-"l,,m""'N';n-~';1 1 (b) Foundation-only permit? DYes 0 No I ~a'!irJi~]$~RJ~J~RJ~B!E(~;..QV'{~J;_R~i'!fj~~~~'-~i,t'!i~ I Name ))a",,,( WI-H-mr'T ~r I Ifi'i;;~Oill~;;;~<S~~M~~~~~~~~:7I\B I Address: -=l2<if< Ffj"" h<f'I';'1 c,-t I I Me I (a) Permit fee (use valuation table): $ I City: "Pt,"') -('I.d,) 1 S e: d( I ZIP:Cf-1q:j.<;j 1 1 (b) Investigative fee (equal to [2a]): S I I Phnne:9I1 - 27,1 ?, f.({,:f- ' 1 Fax: - 1 (c) Reinspection ($ per hour): I 1 E-mail: kj,+-/rn,.r"J 632. &, 1'14., '- Ll> "" 1 (number of hours x fee per hour) S This installatinn is being made on residential or farm property owned by (d) Enter 12% surcharge (.12 x [2a+2b+2c]): S I me or a member of my immediate family, and is exempt from licensing Jequirement~der O~701.01O.. /- . If,;~~~~~;;;~~;;~~~;~;;~;~~,"1l?'C~~~'i Sign here: I~ ~ _ _._,~-} .._.~~_,._.__~~.~~~~A..J';;i!'";m;r.;t~~~~~"*~Jj?~~ !lli!:=""'i!!1'~~-'---~-~";i;D4",L'''''~~<''<'~~1!i\.''''''<i'''"''''"'''1 1 (a) Plan review (65% x permit fee [2a]): S 31..{ J.3i ~m,!lf,!fJ:,Q.t:lJJFe,Q;T:O ~ !.Ps!'~"'IJ~'I;)QNI~~~l!li~l1ll~~ 1 (b) Fire and life safety (40% x permit fee [2a]): S 1 I Business name: nl I 1 Address 1 ~~~~L;~i.:i~ii~i~;~~;i;~~;ti~;~~~~~~f,t~~~_~~l 1 City: I State: 1 ZIP: 1 1 Phone: Fax: 1 I (a) Seismic fee, 1 % (.01 x permit fee [2a]): I S 1 I E-mail: I I TOTAL fees and surcharges (2e+3c+4a): S I I CeB license no.: I Print n~e: I Signature: r!lk~~S1$,CJ!31c::$1!ill~~cff@!'l3INKQ~~&l;IQ_f.l~~.i4i.~1 I Name CCB License Number Phone Number I I Electrical I I Plumbing I I Mechanical I , Mechanical Permit Application ~~DEr?;A~rMEN:Tr~sF0Nlfv.-i;1";'11 l;h~;}rA,,\;':;h'i~'~i";''''~7!~;d~~'5fif'#v.~~~~~~~.:;;;y;~1~i' I Permit no.: t!.- c;- /2j'( I ID.~ I 225 Fifth Street. Springfield: OR 97477 . PH(541)726-3753 . FAX(541)726-3689 . 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. I~T~i'eAmEG0Ry.r0E;Ji'C:0N-sjfROGmI0N;C"~"'-~_.1 ~~~o<"~",_.Lmv-~0~__""-.-,!r&L"_0~""_.,,,,~__,,,-,-~,~%'ie'1.1,.-1R.~~~~ ,0Residential I. 0 Government J 0 Commercial I _ ~OB1lSImEl!fNF.:oRMATf0N~ANDf;l1!0CMiI0N-!1l?i'l?!~~1 _, ,,,,,"..__..r._.~~~".=.,_._...!i::,.,.,+.,,".,.,,~,_~~.::.b:,m'-='~"'h'._.+,__~~,~l.;k...Jl~'.Y.. - 1 Job site address: 1- ,NHs ?I)~r.bc.('('Sd. C;-l I - I City: -7.or-"V4H,-JJ I State: oev I ZIP: ~7-Jfl~ I Subdivision: AGo/<. e'l2:j~ I-/.f/~ 1 Lot no.: erkllD _ 0J?~!liJ!liil!'.Ji;"iIi;'i]l5ESCRIRci]10Njf0J;llhW0RK~!?i~~~~ fi",~,;y;;~~~l:__,_,_,,,,._,~~"~~~_,.,;.o;'_'..,mJI4iU,"~,-,~...l.:-~M?iE,~~gi}!:',I_o-. 1 1 ~1i:ts--~'-~+1f~iRR0e:ER;jjY~@WNE~~itj(P"lfi!;i~;;"t,,~;!~ .~':~a~""~i'!l'<"":":;;m'^'wT",.~....,.iA,.,,,,,",",..,,-___,^,,,.-:..Jj?fu&b1~i~~:;~Y',"~:""Jm", 1 Name: ))Illl/d U l.f.#nt'r :::rr 1 I Address: n q g Ei)er b.na. 5t- _ I CIty: SDc,-", , hdd 1 State: '0/:2... 1 ZIP: Cf:ftf-1;;J I Phone:!iQ/-2il MIl, '7 I Fax: 1 I E-mail: WI.I.fr>1~rd <<2 6r1'1",d. c.O <1.-r I This installation is being made on property. owned by me or a member of my immediate mily, and is ex~pt ITom licensing requirement under ORS 0 010. Signature: ~~!llii#4]ilitt'; . """",._. -:;-,., 'mr..i"'<"'iWIl?fA~"~%~h~~frt:!f;1..'l:i-1a:\6 W:;!l;;IH.g,lll_lIlXL<::Q~i!iM!,';~~.?JF~~If'~ml!;m~Jiz.~'tlll'(!ii1 I Business name: I Address: 1 City: 1 Phone: I E-mail: 1 CCB license no,: I Print name: I Signature; I State: 1 Fax: 1 ZIP: 440-2545-J (ll/08/COM) ~;~\il1~J1'.,\\iliJ;:lm!!l1\'j111~"F.EE~S-eREjjiiii!Elt~?'~f.'~l'+~ ~$?i.~\t?lf~~i-:'L~.,.~.,_.'-,_c,,,.,,,,;_.,,.,__~~~;g~l!!~~ ).:i,l; "'\w<>u;:;:;~!"'H~~~.. B.Y '.. "!!~?i""~'~i'<..~"" '......;w:WG1~ti':i'(tO,-"t" h!ST'~Cl'-:- ~:jResi(j'entiah~~&~;,%7~i: L..; _c~~~W~~~; ~Qt' Ii ~~~., ,~,~s. "," ~,~~_a". !~ '>"_';'<;b;,,,,,,"_~~'''''l!,lli,,-R~E,,";.,"",".I_,.~Z'I!,J1,~ea~I_costll I First Appliance I $79.00 $ I lFurnace/burner including ducts and vents I I Up to lOOk BTU/hr. I I $17.00 I $ I Over lOOk BTU/hr. $20.00 $ I I Heaters/stoves/vents I I Unit heater $17.00 $ I I Wood/pelleVgas stove/flue $38.00 $ I I Repair/alter/add to heating appliance/, I refrigeration unit or cooling system! $58.00 $ absorption system I Evaporated cooler $13.00 $ I I Vent fan with one duct/appliance vent $9.00 I $ I I Hood with exhaust and duct $13.00 I $ I Floor furnace. including vent $58.00 $ I I Gas piping I lOne to four outlets I I $7.00 I $ I I Additional outlets (each) $4.00 $ I I Air-handling units, including ducts I I Up to 10,000 CFM I $11.00 I $ I lOver 10.000 CFM I $20.00 $ I I Compressor/absorption system/heat pump I I Up to 3 hpll OOk BTU $17.00 $ I I Up to 15 hp/SOOk BTU $29.00 $ I I Up to 30 hpll,OOO BTU $43.00 $ I I Up to 50 hpll.7S0 BTU $57.00 $ I lOver SO hp/I.750 BTU $95.00 $ I I Incinerators I . I- Domestic incinerator - I Enter fee based' on valuation of mechanical system, etc. I $ I "0-'0"'''''-\\tl'''''-:'ll!:'&~'''''ft'.'!JIl''~'''.T.''"''V'''~~'''Il<'i'"'t~m.IITT 1""1 ~l\IIiscellan"eous}.fees!!h~;l~,7A't!;trr:~:~ihJi; te:ms' .;~.f's,~4Jj ~h .,1'..-8 e"~~ i1."W:Hi\;,:-"~;&\'1'A>.".-tk)dtf~~.",!'~7,.#~t_~y.)f;~:;;.'1 :'$:'>;:~-" (; t%rea1i~ i _~cost~ Reinspect/on I $58.00 $ I Specially requested inspections (per hr.) $S8.00 $ I 1::;~~;::~2;;~,~i~;~(~d:".,)"._~&~~1~,". """I ,~l!i~"''''0!!1!1ilh~~gFl.I:.I!,';'A.~iJL!tSE__'1''i~''''''l,,"~ (A) Enter subtotal of above fees (or enter set I minimum fee of $ 79.001 $ I (B) Investigative fee (equal to [A]) $ I I (C) Enter 12% surcharge (.12 x [A+B]) - $ I I (D) Seismic fee. 1% (.01 x [A]) $ I (E) Technology Fee (5% of[A]) $ I i TOTAL fees and surcharges (A through E): $ I Enter total valuation ofmechanicaJ system and installatIOn costs $ Plumbing Permit Application ..r If";~DERARTMEMrrUSElONi~W'j1!'1"i1 ~~"'~_""'=f~."...."\""",.,,,,....",_...=...""_.,..,.~,~,,,___"..,;'1:ij:~ "_ -'_~~'''' "'~"_'~"""'''=',...""","O'=''''''''''~r=~r.~~~''.k~_ Permitno/}C}- (;2 /1-( I I Date: I -,. ~- 225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689 This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. :Z~~;~;~~~~~~V~~~~~EBN~~rr~:'~~ROVfj;:~~r.tJ;;{);~:HI Sanitation approval verified? 0 Yes 0 No I ti!!!i);ii},~~lc~",EGORYJ[QI;~l::~0NSjf;RtJClI'ION~'lR~ ~e'.ide~t~al ..,' .1. 0 Govemmen~ . . . ..~ l 0 ;omm:~~~~ .. , ~1"i~J0e.~SlmE~IN~OBM;tI.i1iION~;tI.NQSll!O&;tI.mION~~~ 1 Job site address: -:; ). q 9 13J't'r !J("/,r:r <;-t . 1 City: XJr,-v";~/....O 1 State: 011 . IrzIP: 7:rqT~ 1 1~~ES:CRIP,;tIQN!l'OF.!WJ~K~;li\~~:J,'i!;gi.?1 I I 1~~'i;m~~l1~~R'ORERT'Y;[Q\i\.'-NER~~~f~~i I Name: J)" ^I...J t..) /....rmt'r-:fr- 1 1 Address: 7-2C(Q Eldi?r_~~tr'u. ~T 1 I City: lnf",^,~?/<J;) I State: f)~ I ZIP: q=1-lflR 1 1 Phone:t;'I I Z."{1 10 {?;; 7- 1 Fax: I 1 E-mail: r.J/+fll1rrd@ brr1t7.,1 ~ CtllVl I This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt from.[icensing rFiJir/r:',,~OAR 918-695-0020. Signature: J) -.l( ~ l~tio<3:'li'!ffi"~'''"''''''G'0NmRACiioDZI.'<Vf;AI!:l!!'MI()N~,;;!m~''''<1\~,~r." 'b'f^:w~:;;.Jtift;l,fu?:!1IP.. " , ..' . . ...' ~ ,1,:\.'1 1.J..-='>IJ" ,"', ,_se:'i~'(~f:s,~c,~."....~:1~" I Business name: I Address: I City: I Phone: I State: 1 Fax: I ZIP: E-mail: CCB license no.: 1 Plumbing license no.: I Print name: I Signature: I BCD license no.: 440-2500-J (11/08/COM) ~i;'ii;:;~ii:'\l:s:&:!i~~riliiIiEEifSCHEDUl!!E!f~~fi1a.~~1 ~D~~rn~~~~.IQr-'~lii~C.Q1!~;I~n(ii!~1 ~""",,,,,,"""'_..,Jl"~~m,, .: ,;,~ ~ea~" iW$_os!.~" I New residential I I bathroomll kitchen (includes: first lOOfeel ofwaterlsewer lines, hose bibs, ice maker, under floor low-point drains and rain-drain packages) I 2 bathroomsll kitchen $374.00 $ I 13 bathrooms/I kitchen $439.00 $ I Each additional bathroom (over 3) $95.00 I $ I I Each additional kitchen (over I) . I $95.00 I $ . I . I Residential fire sprinklers (includes plan review) I 1.0 to 2.000 squardeet I $S8.00 $ I I 2.001 to 3.600 squardeet I $116.00 $ I I 3,601 to 7,200 square feet I $174.00 $ I I 7.201 square feet and greater I $232.00 $ I I. Manufactured dwelling or pre-fab (circle one) I Connections to building sewer and I I $58.00 I $ I water supply Commercial, industrial, and dwellings other than one- or I two-family I Minimum fee I I $58.00 I $ I I Each fixture $19.00 I $ I I Miscellaneons fees I 1 _100' storm, sewer, water line $76.00 $ I j Each fixture, appurtenance, and piping $19.00 $ I I Storm water retention/detention facility $19.00 $ I Irrigation systems $19.00 $ I Piping or private storm drainage I systems exceed in. the first 100 feet $19.00 $ I Specialty fixtures $19.00 I $ I Reinspection (no. ofhrs. x fee per hr.) $58.00 $ I Special requested inspections (no. of $58.00 $ I hrs. x fee per hr.) I Each additional iuspection: (I) $58.00 $ I If::::~~;~~:~::~::=~~~ $ Minimum fee $ [ II",;~::,--...fee b~=~:~.~:~ti?~'m.~:. q.~u~,~en~::':~Jr;'rn<^".. I 'l!t"'~)!!l~~&i~,lt;,;AP,P,llICANiT~USE1:"""''tt'~~.~.n~ I (A) Enter subtotal of above fees $ I (Minimum Permit Fee $58.00) I (B) Investigative fee (equal to [A]) $ I I (C) Enter 12% surcharge (.12 x [A+B]) $ I I (D)Technology Fee (5% of [A]) $ I I TOTAL fees and surcharges (A through D): $ I $238.00 $ '.- , j. , ConstructioifCo.ntractots Board , 700 $ummer StNE Suite 300 PO Box 14140 Salem 'OR 97309-5052" . '. - 'Phone: 503-378-4621 Web Address: www.ccb.st:ite.or.us ,Permit.#: " /..9 -. /2/'1' Address: 72CZ 'f EL.l>E)e..'R'~Je(Z.ll C-~ '.".1 'Isf,ied b~: ..l~ . Date: -y - >"'" " ., .- " J .' .:. . Statement: Information .Notice ,to Property Owners. o ' . ...,...., .,~_ . .' :. ". _ . ''',oO .. ,', Ai:)out Construction Respcmsibiliti,~s' , . , 'I Note: Oregon Law, ORS 701.055(4) requires residential coilstrnction permit applicants whoare not- ". ", .; . . <' t. licensed with the Constrnction Contractors Board to sign'th~following statement before a bUilding _' . permit can' be issued.' 'This statement is required fo/- residentiill building, e[{xtrical; mechanical and pliimbingpefmits. Licensed archifect and erigineer applicants, exemptfro.m:'licensing under'. QRS 701: 010(7), neednotsubmit this stat.ement. Tlds statement w,ill be jile4 with the permit. ,/ ... , 0 4; . .' . , -' ". ", '. , .." , Fitrin th~~ppropriatebi3nksandjIiitiaI.boxes 1 and 2, arid either box 3A or 3B: ." -~l. ~2. . I own; reside'in, or will reside in the completed structUre. ~.l , , . I understand that I.must becom,dicensed as ~ cCmstructioncontractor ifth,e structure is sold or offered for sale before or on completion. "" . o 31\. My general contractor is . (Name) . (CCB #) . I will instruct my generiil' contractor 'that all su.bcontra~tors who wor,k' on tpe structure mu~.t be licensed with the Coris~ctionContractors Board.' , ' '. ' OR ... ,~ 3B:. I will ~e my own gen~ral contractor. "0- . . .., If! hfresubcqntractors, I will hire only subcontractors licensed with the, Construction Contractors Board.. If! change my mind and hire a general contractor, I ~ill contract with a contractor ~ho is '. licensed with the CCB and will imniediatelynotify the office issuing this.building permit of the . : minie ofthe contractor. . I hereby ~ertify that the above information is correct and that I ha~e read ~nd do un~erstand the Illfo;mation . . ~ o..~ ..,., C,......,. "'P"'lliili.~" 'h. m''''::r :, . ~ ( . gnat .eofpe~itapplicant) . J '~'/<?ate)1 (WlJite copy.io issuin~ agency permit fil~, pink copy to applicant.) ., , 'I~ . I. ., Property oWher.doc 06-01-04 , ~ *' " " " N . . . ... . :i \.> -' '. Acting as" Y9iR(~wI1rGeneral Contractor? . \ ,..... , .'. '" ,,:I..~' ~\ ,.~ \-'. \, . .... ....1.:\-. "";'d \ - l:...,)' -'. INFORMATION-NOTICE TO 'PROPERTY OWNERS" ~'. ,,~.' , .. ABOUT, CONSTRUCTION RESPONSIBILITIES ' : '. . . .-;' '.~ . :":~.- ~. - : ,,""~ ~.' : '; , '." .-. '. , . . NOTE: This Information Notice to Property Owners about Construction Responsibilit!es was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. , . -0, -." .. -'.' '. .. 0' ' If you are :idling as'~our' own 'contracto; to construc~ a new hOl1?e or make a substantial impiovement to an existing structure, you can prevent many problems'by being aware of the following nisponsioilitiesand concerns. Employer Responsibilities .~\~) .~ \\' ;.:\ . ~, . ',- :., ... ", \,~ You wlll,inmostinstances; be ruled to be an "employer"and the contractors,you contract.(vith.will be'''employees'' if .... - 0" . ".. . , _ _'.,_, .. you use contractors not licensed with \h~, Construction Cl1ntractors Board to do labor in c()nstru.cting or to assist in the construction or improvemeqt of a.re,sidential structure., A~ ,the employer ,you must comply w.ith .the followil;lg: . '.' ',. .'.: .<. ' . '.. ". -. . - ~. . , Oregon's Witl1hol'ding T~x La..;v: As'ari employer, you lllusi'~thhoid 'income taxes'from bmpioy~e ';ages atthe time employees are paid. You will be liable for the tax payments even if you ~on't actually Withhold the tax from your employees, For more information,'cail-the'D"pa",,;eiit of Revenue at 503.378~988!' " .' .., ' . r Unemployment Insurance Tax: As an employer; you are required to pay.a tax for unemploYment insurance purpos;~~, on the wages of all employees. For more information, call the Oreg~n Employment Dep~ent at 503-947-1488. , -- /....... r'O:': ~.'~!., ~ U. {,f -.'-~ \'lrf. The Oregon Business Identification Number (BIN) is a combined, nuplb~t f\lr b9~,:Oregon Withholding and Unemployment Insurance Tax. To fi1e'for a BIN, call 503-945-8091 or www.doLstate.or.us/formsnav.htmll for the a"", v,,, ;ate forms. ~ 1.'j~,,~, -. ',, , " . j Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' C~mpensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurimc~', :y~~'c;;uid be'subject'.topen~lties and be Hable for all claifn costs if one of yoin' ~niployees is injured on the job. Formore information, call the Workers' Compensation Division at the De'jiartment 'of Consumer arid Business Services at 503-947-7815, ~ I U.S. Internal Revenue Service: As an employer, you must withhold federal'income.tax'.frotiCetTiployees' .wage!:....: 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"829-4933-0r.visinheir.web site at\v:.vw.irs,l!ov..;,., - 'll '. .' ~ _ ",'., ii .. ' . ~'. ' .',' ,t .' I , ;.,. " Oth~r.Responsibmtie~a~d Are.~s of Concern!i J. I: _ Code Compliance: As the permit holder for this project, you are responsible for resoivihg'any faihire fo'\neet code requirements that may be .brought tQ your attention through inspections. ,j .... ' ~'r.'.'!.:,'-"-':''', O.~. ,,".,.'; '':''~:~.''., J. .I+'.~. .. Liability aUd Pro~~riy' Damag; Insurance: . Contact yoUr insunince agent t6' 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. \ '. . . ' . .,; .. . ,....... . ~ 1- -' _ .~_ \ ..\..~.~.~+1'-,['7'_ "'.. .__0.__..0 _ '1,~_,J .~/'~. Time: Make sure you 'have'~fficierit time to supervise your empl~yees. . ,.' - ' !. '.. " , . ..... - ~. . - ~o . . 'j . . Expertise: Make sure you have the skills to ac'Cas your oWn gblerafcontractor; to' coor~inate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. ., ~f"o . ~.. If you have additional questions cal1the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. ,-- ~. ,OJ Properly _ owner.doc 06.01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2009-01214 COM2009-01214 COM2009-01214 COM2009-01214 COM2009-01214 COM2009-01214 COM2009-0 1214 COM2009-01214 COM2009-01214 COM2009-01214 COM2009-0t214 COM2009-01214 Payments: Type of Payment Check cReceint 1 . City of Springfield Official Receipt Developm~nt Services Department " Public Works Department RECEIPT #: 1200900000000001024 Date: 09/03/2009 , Description Fire SF Fee - Residential Plan Review Major - Planning Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture Minimwn/AdjuSlment Plumbing 1st Appliance + 5% Technology Fee + 12% State Surcharge Paid By DANIEL A. WITTMER Received By njm Page 1 of I Item Total: t:heck Number Authorization Batch Number Number How~Received 101 . In Person Paym~nt Total: 12:23:20PM Amount Due 56.30 211.00 484.16 231.94 176.37 44.62 528.56 57.00 1.00 79.00 43.83 79,87 $1,993.65 Amount Paid $1,993.65 $],993.65 9/3/2009