HomeMy WebLinkAboutPermit Building 2009-10-12
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. 225 Fifth Street;'Spriilgfield;'OR?,,-.t
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541-726-3753 Phone ,,;::. "''.:,1;;>)1,'::
541-726-3676 Fax' ',. . ;;' ': .
541-726-3769 Inspection Line .
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CITY OF SPRIN&l'lJ!,LD
Building/Combination Permit
PERMIT NO: COM2009-01456
ISSUED: 10/12/2009
APPLIED: 09/30/2009
EXPIRES: 04/1212010
VALUE:' $ 10,000.00
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SITE ADDRESs::,;:,,,,499 34th Sti..Y
. ASSESSOR'S ~~~CELNO~: 1702312410702
,: " . . ,.;';;,,, " ". . TYPE OF USE' R d I
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'(PROJEciDES:cRiPTiON:::\".litt~rior Remodel: Modify Bathroom and Add Bedroom in Garage
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Owner:
Address:
Springfield TYPE OF WORK: Single Family Residence
Residential
OSTERHOFF JEFFERY SD & TINA M
499 34TH ST ;:i,<'. ,.',
SPRINGFlELD;'01~:::97478 ' ,:;
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General .' .',. OWNER .;:
Electrical OWNER;.. ".
Mechanical OWNER,
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Plnmbing .' OWNER~,
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Secondary Occupancy Group: ,;I'~ U
Primary Construction Type VB
Secondary Construction Type: ..
# of Bedrooms:
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Frontyard Setback: ':., . '!-
Side I Setback: ..
Side 2 Setback:
Rearyard Setback:
Solar Setbacks: J, :
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: Street Improvements: .;-
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Storm Sewer Available:" ,[.:,,,~..t~ q,.
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Speciallnstrnction: ., "
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I CONTRACTOR INFORMATION I . s "DU \0
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ATTE1"T'''';~: urel"- .\_ ' ~....--' C'Ii=-.'101l Ulit:ty
101'0\" . .~, adoo:L;ice'nse"I' . Expi~litiiii1 Date
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ca"inn \h8 can\8t. ("("I'~"";iY~ Noti1ic"tion'
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BUlLDING'iNFORMATlON .N.j"'''~~ 'I'
Phone
# of Stories: I Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Electric Sq Ft Basemeut:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
Sprinkled\Building: No Occupant Load:
1~\J I \,J.... _.._,nr Ie TUt: WnRK
, DEVELOPME'NT'iN[OWiiON;'IS'PERMIT IS NOT
, ~O~~MEi~CED OR IS ABANDONED FORREQUIRED PARKING
Overlti'~rPi~~O OAY PERIOD, Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: Compact:
% of Lot Coverage:
322
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I PUBLIC IMPROVEMENTS I
Sidewalk Type:
Downspouts/Drains:
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. 225 Fifth Street;;Sjirjn'gfieId;9~~;,:;;'...
541-726-3753 Phone" ,i, "'.~'" );J\~..:
541_726-3676 Fax' '.' .. , ""
541-726-3769 Inspectio~ Line '.;: .:;<
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Estimate EstImate"
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.; Fee Description~~}:.;';;~J~~'~~;> .'--
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Plan Review Residenti~I" . :'''- ~ ,;; "',
+ 12% State Surcharge" "i' .;;
+ 5% Technology'Fee " "'
Ist Appliance ,,)
Add, Alter, Ext.end rir~_ ,; f 1,1.;i>il~H~~_.. .
Add, Alter, Extend CiriiEa'Add''1';;~:, ;
Building Permrt,j;;~!,"t:,' '-~"1('
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Dryer Vent ;' ,': ".
'Fixture :L:"h:iL':::: ,.
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Minimum/Adjustin'ent Plumbing., :..,
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Sanitary Sewer - Improvement d.
Sanitary Sewer - Reimbursement
SDC Sanitary/Storm Admin
Vent Fan
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Total Anioli'nt Paid " "
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Structural Review ' 10/06/2009
1~+
Initial Review
10/?512009."
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,. . 10/06/2009
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Plan nine: Revi~wi~,:~[,:':!:~^,
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. ~ublic Works R,eview .
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10/07/2009
",~..10/1212009
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CITY OF SPRINl.nELD
Building/Combination Permit
PERMIT NO: COM2009-01456
ISSUED: 10/12/2009
APPLIED: 09/30/2009
EXPIRES: 04/12/2010
VALUE: $ 10,000.00
I Va,luation Descrintion ~
$ Per Sq Ft
. . or multiplier
. '> $1.00
Square Footage
or Bid Amount
10,000.00
Value
Date Calculated
$10,000.00
$10,000.00 .
09/30/2009
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Total Value of Project
Fp~~~
Amount Paid
$88.40
$45.12
$18.80
(I $79.00
$55.00
$30.00
$136.00
$9.00
$57.00
$1.00
$66.14
$86.98
(I $7.66'
$9.00
$689.10
Date Paid
Receipt.Number
9/30/09
10/12/09
10/12/09
10112109
10112/09
10/12/09
10/12/09
10/12/09
10112/09
10/12/09
10/12/09
10/12/09
10/12/09
10/12109
1200900000000001109
220090000000000i173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
2200900000000001173
I Plan Reviews ,I
10/0612009
10/07/2009
10/08/2009
10/12/io09
APP LLH
APP
No planning issues. .
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To Request an inspection call the 24 .~our 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
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CITY OF SPRINGFIELD
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Building/Combination Permit
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Status
Issued'
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PERMIT NO: COM2009-01456
ISSUED: 10/1212009
APPLIED: 09/30/2009
EXPIRES: 04/1212010
VALUE: $ 10,000.00
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. 225 Fifth Street; Springfield,'OR':~:1!!<}: ,
~ 541-726-3753 Ph'o~~~j~~.t~~~:"\;~;~~'j\~J~~~-;~~
: 541-726-3676 FaxTl:~;'" " ".
,: 541-726-3769 i';sp~~tioD Line
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Reouired Insuections I
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Post and Beam: Prior to 1100r insulation or decking.
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Floor Insulatioll;~PrioiJo'!Jeckiiig'. '
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Framing:insp'ectiori: Prior to' cover and after all rough in inspections have been approved.
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Ceiling In'sulatfon:.Pi-ior to cover.
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Drywall: Prior to taping.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough ~i.!!~~i~g~"p~Ior t~: c~ver and including required testing.
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Final P!'imbifg: . When all plumbing work is complete,
. Rough'l\:!echa.nical: Prior to Cover
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Final Mechanical: When all mechanical work is complete.
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. Rough Electric: Prior to Cover
Final Electric: When all elec.trical work is complete.
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By signature, I state,and agree, thatI have carefully examined the completed application and do hereby certify that all
information lier~oD is tiue and correct, and I further certify that any and all work performed shall be done in accordance witb
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCYiwilIbe made of any structure without permission of the Community Services Division, Building Safety.
I fu'rther certify that oniy 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. "f~ ~)
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Owner or co\.l.:~Us-\;ignatu~// ------ Date
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Ele,~tr,i~al Permit Appli~ffion
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225 Fifth Street. Springfield, OR 97477+PH(541)726,3753+ FAX(541)726,3689
kc.,..~,6.~g~~TnliENfU~EON.Cy;; ."
I Permit no C 1- 1. 156
I Date 'f -' 3e - act
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 if work is suspended for 180 days,
1;1'.\~;,'.i;!. 'jF;~,I.!'OCA' L)"GOVER N' M'ENT','A' "p' PR'O'VA' ,,!,,~,"i~tt;!1\"1\1
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I Zoning approval verified? DYes D No I
1:(l;!lf;Jj~i,::;,~;!'i;cME Go.RV,#0I7J!.G0NSTRlJGIl'ICl N:;i~';',i"l';i;;' /ii'l
l]:8:.Residential I 0 Government I 0 Commercial I
1!f.~l'$I!J,()BxS(r:E,~INF,QRM;t('l'fQNif.-?:Nt51iiL!OCA;r;J()N~i~J;f,~f~!1
I Job site address:LjQ'1 34tt.. ~-\- I ~~~~:ritional 500 sq ft. or portion
. City Sri'~{:'e1r\. I State: 0(< I ZIP: <j141~ I I Limited energy(2)
Reference: I Taxlot.: I I Each manufactured home or !l1odu1ar
c''.'::i;';','',' :';..i""'.'DEScRlltnoN;..l<:W;'.wClRK',q~",i;L\'ii!ii,R~'fJ,,??}';1 dwelling service or feeder (2)
_ ,.I L, I I Services or feeders: installation, alteration, relocation
~~2~~~ 'I
27.-0 ;rJ ~ I I 200 amps or less (2) $ 81.00 $
j.;PRClI"ER;rY:o.vvNER: .,:,,1 1201 to 400 amps (2) $ 95,00 $
I Name: ~ ~ I I 401 to 600 amps (2) $158,00 $
I Address: l.\.~ 2>4 *- ~ I I 601 to 1,000 amps (2) . $205.00 $
I City: 2oi1N~,M I State: 012. I ZIP: C)'lLnS I lOver 1,000 amps or volts (2) $469.00 $
Phone: SqI'1l/,,~?;gt/ I fax: I I Reconnect only (2) $ 63.00 $
. E-mail: I I Temporary services or feeders: instal1ation, alteration, relocation
1 200 amps or)ess (2) . $ 63.00 $
I 201 to 400 amps (2) $ 87,00 $
I 401 to 600 amps (2) $126.00 $
lOver 600 amps or 1,000 volts, see services or feeders section above
.."1 I Branch circuits: new, alteration, extension per panel
1 a. Fee for branch circuits with purcha?e,of a se.rvice or feeder fee:
I Each branchcir~uit . (I $. 6.00 i $
I b. Fee.for branch circuits without pur.chase of a service or feeder fee:
I First branch circuit (2) \
J J Each additional branch circuit .~ $ 6.00.
I Miscellaneous fees: service or feeder ':lot included
I Each pump or irrigation circle (2) $ 63.00 $
I Eacb sign or outline lighting (2) $ 63.00 $
I Signal circuit Of a limited-energy pane( $' 63.00 $ I
alteration, or extension (2)
I. Ea~h additional inspection:(I) ", ""I " ." $58,00 1,.$ '.' 1
1~~~l!f~I~~f~MgpmCAt:Jt~lJSE~~i~:;~~ffif;il~;\\j;~&0i;,~iE~';~1
I (A) ,Enter subtotal ofabove fees $ D.. t=...cJJ
(Minimum Permit Fee $58,00) r} cJ
I (B) Enter 12% surcharge (.12 x [A]) $ \.0. 'l.l1
I (C) Technology Fee (5% of[A]) . $ Rr... ~'j)
I TOTAL fees and surcharges (A through C): $'-\4 ~
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
I.Slgnat;~re:::;~~~LATI()N"
. Business name:
Address:
I City:
I Phone:
I E,mail:
I CCB license no.: I BCD license no.:
I Signing supervisor's license no.:
I Print name of signing supervisor:
I
State:
1 Fax:
I ZIP:
Signature of signing supervisor:
"3"GPF
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440,2584.J (9/08/COM)
!""""'''.'1?,"P'''''''''i'''''~';F EE~SCH'E 0 ' ''''''''''Y~'''''f''''''''':''~'''''''l
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I,}~t.ri.be~':of~in~~c-:fc'f.t;~;~- ;' ~~',i~~f(:;rr?~t~ !Qi' :;1- ",:-;FqSf~~'i'l. '~:)'o'ta.l..:..~ I
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o' <."n,.,,--, "".,.",< """'_.~.1-.... ....-1 .".. ,-''''_'.,_"~'.r'_'',, or' -""" ,.,., " ~...-".__' ,".(.0'
I Residential, per unit, service included; I .
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1,000 sq. ft. or less (4)
$134.00
$
$ 25.00
$
$ 32.00
$
$ 63.00
$
$ 55.00
$5S
$gn'
Construction Contractors Board
700 Summer St NE Suiie 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
Permit#:_ (\J\-~~',
Address: ~q 2A.;~-g, Y ,
Issued by: ~.h5LlD( ,Date: \D ,\f)~'(5\
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Stat~ment: 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 ain be issued. This statement is required for residential building, electrical. mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt from licensii-,g 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 I and2, and either box 3A or 3B:
~ I. I own, reside in, or will reside in the completed structure. '
,~ 2.
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
o 3B. I will be my own general contractor,
.,
/
If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board, Ifl change my mind and hire a general contractor, I will contract with a contractor who is
licensed with the CCB and will immediately.notifythe office issuing this building permit of the
mupe of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information -
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
C'ECf2' (2M~;/~ ~ .
U(~ure 'or lMuy;;~cant)
(j- 3D- 0<1
(Date) .
(White copy to issuing agency permit file, pink copy to applicant.)
Property _ owner. doc 06-01-04
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A~bng m~- 1['plUllr...-OWn 'General .Contractor?'
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, INFORMATION NOTICE TO PROPERTY OWNERS
ABOllT:CC;>N$T,RUqION:RESPONSIBILlTIES .'. '. '. .
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NOTE: This Information rIotlce Ita Properly Owne~s about ConstruCtion Resp;nsibilities was deveioped by the'
Construction Contractors Board'in accordance with ORS 701.055(5). passed by the 1989 Oregon Legislature.
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If you are acting as your own 'contractor to construct a new' home or make a substantial improvement to an existing
structure, you can preventmimy problems.by being a;are of the following responsibilities~~d concerns,
.. ,,'.' .\.',",', . lEm,ployer Responsi~ilities .,' ."
You.will,in,mos! instances, b~ ruled to be lit) ",employer" and the contractors. you contract with will be "employees" i'
you use co~.trac!ors not Iicens~ 'vithl~h~.CRj1s~~tior: CO[1tr~~tors Bpard t~ d.<i labo~' in coJis~cti~gor,to ass.i~.t in thl
construction ,or impro~~g1eJ?t qf.a,iesid~ntial.~tructljfe. As'the.empIoyer, you must comply 'Yith t,he.following:
, . . .' - '. . ,,' .' ,", ' .
Oregon's Witbholillng Tax La~: "As an em~lo~ei:,'yb'u'n\Ust "';ithhold'income taxes from emplby~e\~ag~s: at the timt
employees are paid. You will be liable for the tax paxments even if you don't actually withhold the tax from YOul
employees. For more inforniation:-bllthe Depanmeht,<jfRe~~iie at 503\3784988. ' .'.' '~:" ..':" ?' ,':'
'.
. '. _. - - I ." . .~~
Unemployment Insurance Tax: As an employer,'yori are'fequini'd to pay a ta;<'forunemployment insurance purpose'
on the wages of all employees. For more information, call the Oregon Employment Department at 503-947,1488, '
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The Oregon Business Identification Number (BIN) is a com,biqed i number for bo~, Orego!). Withho.1ding am
Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsoav.htmll for tht
app:~pri~t: fo~: . _ . - "
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Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law
and must qbtain workers' compensation insurance for your employees, If you fail to obtain workers' compensatior
insurance, yi~ :c~~i&bf' subj~d to p'ehaltiesana be'l;lible for all' d~im co~ts if ond of your' ~fuployeei i~ 'injured on tht
job. For more information, :call the Workers' Compensation Division' at the bepartment of Constimer'and Busines1
Services at 503-947-7815.
U.S. Internal Revim'ue Service: As an'employer, you mustwiihhold'fedeniljincoriJ.e 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 IC800"829'49'33;oi'visit~thcir'Vireb site at w\vwjrs,l!ov,' :': .. : '; ";.., .'''; ,';:'~"I):', ';;""'.
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i;Other,.ReSp~msibillti~s 3~d A...r.ea.~ 9f-(:oIi~erills' ":~,.,
Code Compliance: As the permit holder for this project, you are responsible for rekolvihg'anY'fail~re to meet code
requirements that may be brought to your attention through jnspections.
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Liability and Property' Damage 'lnsuraric'e:' C6ntac\~yotir insurance agent'to see' if "you 1i~ve( adequafe 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., ' .
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Time: Make sure. you have sufficient time to supervise your employees.'
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Expertise: Make.sure you' hav~tIi'eskilli to ac't as y~ur 'b~ geiienil 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 S503.378-4621) or write the agency at PO
Box 14140, Salem, OR 97309.5052,
),
Properly- owner.doc 06.01.04
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2iS,Fifth ~tree~,\s::":';:f)ii.;",,),,,';,;~2flt::f[ , :
Springfield,'Or~g<!,1l,!97477-J' ; ," 'I::
S41~726-37S9 pIiQne. ,', .
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City of Springfield Official Receipt
Development Services Department
Public Works Department
.'REC'EiIh';#: .y 2200900000000001173
Date: 10/1212009
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Job/Journal Number'~~'~' Description ,.' .' '. ,
C0M2009-01456':\.. ,Slll1itary Sewe.i"ReimbiJrsement .
CQM2009-0 1456, ,-:1i;.;:~~$~i.tary;~.~~ii~~I~Ptii~~ment
<::01\12009-0 1456:~&:\;,!,SDpsd~;iiirY/SiO'rm Admin
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COM2009-0 1456. ,~. '.'" '[Building Permit
~QM~009'O 1~,?,~ i;[~!M:!;f.\Ktwe. ',,' '.; ,
COM200<:i:0 1456'-','~~;:i'1MmiinUri1JA<;Ijustment Plumbing
. . ,,:,,~,,::':,{:':':"{'i' <":~"-;"'~;~',,::~:;i-;':
COM2009-0 1456'''. ;1 stApphan,ce.:':~;: "::.'
C0M2009-01456 ~ '. Vent Fan .:.
COM2009-01456 . ,', ,Dryer Vent / ,:'i".; .',';
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COM2009-0 1456/::",Add,'Alter;:Eiitend Circ'; .
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COM2009-01456:JI.?'i'\AddicA1teriE,{ieiidCirc Ea Add
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COM2009-0 1456 ".::'i.';iJ':J+'5%' Technology F~e
C0M2009-01456\"':' :,+ 12% State Surcharge
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Payments:
Type of Payment
CreditCard
Paid By
JEFFERY OSTERHOOFF
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Item Total:
Check Number Authorization
Received By Batch Number Number How Received
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CJC 05929B In Person
Payment Total:
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Page 1 of I
2:25:52PM
Amount Due
86.98
66.14
7,66
136,00
57.00
1.00
79.00
9.00
9.00
55.00
30.00
18.80
45.12
$600,70
Amount Paid
$600.70
$600,70
10112/2009