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Home My WebLink AboutPermit Building 2009-11-10 "., ~. Status Issued 225 Fifth Street;'Sprlngfleld, OR ._ 541-726-3753 Phone ' . 541-726-3676 Fax, 541-726-37691nspection Line (:.' CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01475 ISSUED: 11/10/2009 APPLIED: 10/06/2009 EXPIRES: 05/1012010 VALUE: $ 375,145.00 SITE ADDRESS: .;' 6493 DOGWOOD ST ASSESSOR'S PARCEL NO.: 1702344303200 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: . New PROJECT DESCRIPTION: ,Single Family Residence, Lot 98 Mountaingate Residential . .;::" (" Owner: Address: HINKEL RICHARD K &'EMIL Y M 10953 FLORISTON AVE TRUCKEE CA 96161'" .> # of Stories: 2 Lot Size: Height of Structure 29.00 Sq Ft 1st Floor: Type of Heat: Forced Air Gas .fi 1 Ft 2nd Floor: , ._ >>,~!er Type: It lft'isVJO~ 1 Ft Basement: : \.l \ \R~~~e itY~n"ll Ei-I'IR~f:R~~S t.\Q I Ft Garage/Carport . 3 ., J\\S En.er~'\) P~W:O~.R II-1\S Mm fOR Sq Ft Other: '," :\\.lI\~pn'nili~'B~IW'fF:i\3"NOO\'N'lI Occupant Load: , , ._.~"t:["\ ["II) , I DE'VELO'P'ME~II~OkIVI:ATION I ., : : " Contractor Type;' General Electrical Mechanical Plumbing i Contractor OWNER OWNER OWNER OWNER # of Units: Primary Occupiincy,Grbup: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I R-3 U "VB ; .. r. . . Frontyard Setback: . Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: , . 27,11 25,70 11.90 32.00 27.50 Street Improvements: Storm Sewer Available:., Special Instruction: requireS 'Iou .t? .. ._,,,,,,. oregon \a~~^ nreqon Ut~\lty~ p..' \ ~I ....~ e l1dopleu ~ '.:,".1' L\P~ ~Je '0)"''' ,...,1.- ~ ICI!J@NTRI6J;~rINFtfJtMA.11lW'\!f2-OO1 I~G'..J-. I -00' ;-Uu I J.' . o(IH. pules bY p.f\ 952 . copIes ~ In 00 '(ou ma'l obte.\~NotJ...i\lei\!l~~ iration Date 009 '. the center. \ Utility Not' ca\\lng tor the oregon -332-tl44). , 'numbercenter is 1-S00 Phone BUILDING INFORMATION" 17,424 1,552 961 1,140 568 " Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: 2 Handicapped: Compact: Hillside 2 Yes 33.00 I PUBLIC IMPROVEMENTS I Sidewalk Type: DownspoutslDrains: Fully Improved ~ Yes Storm water piped to storm sewer Notes: ':.:. To Storm Sewer Paee I of 4 __ . 11 ~ .~ ..... . . , '-f '~. Status Issued '.l . ~1'~';~, .' 225 Fifth Street"Springfield, OR ,; ~>. 541-726-3753 Phone,i'{"',' ,', ,,' 541-726-3676 Fax" , 541-726-3769 In~pec.tio~ Line Description .~~ . Garal!e/Misc ,I ,SFlDuple~ ,~ -.' ,,\..:.::: : Tvpe~f Construction "~ : ':~"~../ . .,' '~:~ <u VB Utility' ',R-3 VB 1&2 Familv , .. -:v .. y :. 't;: !::.' Fee Description.: I .!~ ":~~: , -, --"', Plan Review R~sidential .. + 12% State Surcharge + 5% Technology Fee . 1st Appliance 3 Baths One & Two Family Addressing Assignment Appliance Vent Building Permit Dryer Vent ,. _ _'__ Exhaust Hoods Fireplace (Listed) Gas Outlets 1-4, Plan Review Major - Planning ~ ,. Plan Review Resideutial . Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer - Improvement Sanitary Sewer 7 Reimbursemeni ;;' SDC MWMC Admlnisiration '. SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Tran Reimbnrs-Residential SDC Trans Improvement-Resident SDC Transportation Admin Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan . .. ,- Willamalane Single Family ~ -t'.. , .;: .\ Total Amount Paid '.. , ," .. " ~ c :') CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009-01475 . ISSUED: 11110/2009 APPLIED: 10106/2009 EXPIRES: 05/1012010 VALUE: $ 375,145.00 I Valuation Descriotion I $ Per Sq Ft or multiplier $37.72 $96.83 ,'J " Amount Paid $897.20 $326.41 $146.55 $79.00 $402.00 $38.00 " $9,00 $1,832.07 $9.00 $13.00 $20.00 $7.00 $211.00 $293.65 $134.00 $125.00 $639.34 $840.80 $10.00 $1,044.54 $101.97 $232.88 $211.21 $931.65 ., $70.59 $2,289.96 $63.00 $27.00 $2,858.00 $13,863.82 u Square Footage or Bid Amount 568.00 3,653.00 Value Date Calculated $21,424.96 $353,719.99 $375,144.95 10/06/2009 10/09/2009 Total Value of Project J;'pp" PiiaJ Date Paid Receipt Number 2200900000000001143 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 2200900000000001274 10/6/09 11110/09 11110/09 11110/09 11110/09 11/10/09 11110/09 11/10/09 11110/09 11/10/09 11/10/09 11110/09 11110/09 11110/09 11110/09 11110/09 11110/09 11110/09 11110/09 11/10/09 11/10/09 11110/09 11110/09 11/10/09 11/10/09 11/10/09 11/10/09 11110/09 11110/09 Pal!e 2 of 4 I" .. " CITY OF SPRINGFIELD' Building/Combination Permit Status , Issue~f . ~~ ''-' 'It ., '" ....~::.. .::.". .' PERMIT NO: COM2009-01475 ISSUED: H/I012009 APPLIED: 10/06/2009 EXPIRES: 05/10/2010 VALUE: $ 375,145.00 225 Fifth Street, Springfield; OR '-:" ';, 541-726-3753 Phone ,," "< 541-726-3676 Fax 541-726-3769 Inspection Line.... ,i-.' ~. ;', ':. ;,{.' .:~ ..',;': Floor In~:nl~t~on':.' Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. ;., ~;l.., ,). t. ., . Framing'Inspection:Prio....t~,cover and after all rough in inspections have been approved. Wall Insulation: Prior to c'o~kr. Ceiling Insulation: Prior to cover. , . . .:;):;::.. (,' Drywall: Prior to tapmg')!'.,f::.'-' , - ,.-.; Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Underslab Plumbing: Prior to filling the trench and including required testing. . " Rough Plumbing:' Prior to cover and including required testing. Shower Pan. Prior to covering and including required testing. Water Line: Prior to filling trench and including required testing. ..J . Sanitary Sewer Line: Prior t? ftIling trench and including required testing. ... ,,'f:. ., >_ Storm Se.wer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. "I I .. Underslab Gas: ~fter Iin~.is installed and required testing and capped if not attached to an appliance. Undert1oorMechanical. Prior to insulation or decking and including required testing. Undertloor Gas: After line is installed and required testing and capped if not attached to an appliance. " Rough Gas: After line is i~s!!,II,ed and required testing and capped if not attached to an appliance. Gas Service: ,,After. line is installed and line has been connected to a minimum of one appliance including required testing, Presure test done at this point ,. . Rougb Mechanical: Prior to Cover . , Final Gas: When all gas wor!' is complete. Final Mech'anical: When all mechanical 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 of any structure without permission of the Community Services Division, Building Safety. I further certify tbat 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 st~hat the permit card is located at the front ofthe property, and the approved set of plans will remain on the site at all C2)"qc/.lhl"c/ Owner or Contractors Signature L / //;0 loc; I Date ',' t.' ,. Paee 4 of 4 CITY OF SPRIN\..-1<lJ'.,LU Building/Combination Permit PERMIT NO: COM2009-0I475 ISSUED: 11110/2009 APPLIED: 10/06/2009 EXPIRES: 05/10/2010 VALUE: $ 375,145,00 , " Initial Review:,. .' Plan Reviews I ':. . .. , ~.: . r' . ," 10/07/2009 1 0/07/2009 APP LLH .' 10/0712009 10/08/2009 WE DDK , Plannin2 Review " ...., .., ""; .'. ~, . j" , ,: .i:". Structural Review j(:;,. 10/07/2009 ~ ',I l Plannin2 R~vie~' '" 10/29/2009 . . i,,'h.. n~ ~~t:~. .: -, . .'/ 10/12/2009 APP CJC 10/~912009 , APP DDK " . ..,- .~. .. Public Works Review APP LKW 10/30/2009 11/0412009 Called homeowner. Need the plot plan to show trees on the site indicating which will be removed and which are being preserved. - Received copy of LDAP site plan from Todd Singleton in PW showing location of trees. As noted on plans At 33% lot coverage this site is close to the maximum allowed of 35% for hillside coverage. Place construction fencing to the dripline of trees to he preserved. Follow tree preservation guidelines in the attached Hillside Development Plan handout. Storm water piped to storm sewer 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. " > " l1rnn",rl Tn~"e('tion"'l Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Temporary Electric: Approval required prior to Utility Company energizing pole, . ., Underground Electric: Prior to cover Underslab Electric: Prior to cover Rough Electric: Prior to Cover Electric Service: Approval reqnired prior to utility company energizing service. Final Electric: When all electrical work is complete. Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Foundation: After forms are_erected but prior to concrete placement. .. I. Post and Beam: .Prior to floor insulation or decking. , . ... ' : Pa2e 3 of 4 . DEPARTMENT USE ONLY I ._..~.... .:::i:J --= ~--1111' .Permi;no.:Cc; -/LJ7 5' I Dare:/j(J!I//O 7 I This permit is issued under OAR 918-460-0030. Per.mits expire if work is Dot started within 180 days ofissuance or if work is . suspended for 180 days. Structural Permit Application 225 Fifth Street. Springfield, OR 97477. ?tI(541)726-3753.+ FAX(541)726-3689 Ci I")" OF SPRINGFIE~D. OREGON ~. .~ \ ~ \':7t\\.O \ ' 1-- /.. ~vf> C\cY- \,," <" ' LOCAl. GOVERNMENT Al'PROVAL I This project has ftnalland.use approval. Signature: Date: I This project has DEQ approval. Signature: Date: 1 Zoning approval verified: ' 0 Yes 0 No I Property is within flood plain: 0 Yes 0 No I CATEGORY OF CONSTRUCTION I [i1'Residential I 0 Government 1 0 Commercial I';,,',' '.' JOB' SITE INFORMATION 'AND LOCATION \ Job site address: c''-/9'1, Udi~ -5rreef- ICitY~D~~\-~e(J ~Statel:l)~ IzlP~ : ~:~=:~::n: \~\1rn.~ Lotnu GtW ' I' .... "-PROPE~TYOWNER I N""ame:~ I<...y:: E::m;f.I WI. ~I I Address: I ~ F lo,"IS7(M.,' /fie, 1 City:Tl;!. ,d~p.p I State:(!A 1 ZIP:Cf{;({, II I Phone~C;-<() -({i7C( Fax: - . I I E.mail: PL.,.I<t>J j.~ tna..c ,a."., I This installation is being made on residential or farm Y.....Y.....,1 owned by me or a :EOfmy immediate family, and is exempt from licensing requirem nts der On ~IO. J I L -" /7 Sign ber ~ ~.ji.LL[ '<.. ~ CONTRACTOR INSTALLATION. I Business name: I Address: I City. I Phone. 1 E-mail: [ CCB license no.: Print name: I State: I Fax: 1ZlP: -, Signature: IN" I Nnme I Electrical I Plumbing , Mechanical SUB-cONTRACTOR INFORMATION CCB License Number Pbone Number 0~ rr . . FEE'SCHEDULE I I I I , I 1 I 1 I I I \ $1f.,f{. 'J:;f1- I I I I I , I $ <;q?'~ I \ .1 I I '1. Valuation information (a) Job description: Ne V.J Cr.:.IV\.t;;']}l! vc..ri ..1.\... OccuJl8DCY j2.eSl .k.-)--; J :. Construction type: Woo d Square feet: 1..S: I ~ Cost per square foot: CJ 9 , '1-11' I I I Other information: I Type of Heat: r; c~ S I EoergyPnth: r:-,Ncd fli.e. QO%i4f/.Ic II~\ I g new 0 alteration 0 additioo I (h) Foundatitm-only pertDit? 0 Yes I Total valnalion: ''2. <,'<l L. I 2. Buildin2 fees ! (a) Permit fee (use valuation table): I (h) Investigative fee (equal to [23]): I (e) Reinspection ($ per hour): (number of hours x fee per hour) , I (d) Enter 12% surcharge (.12 x [2a+2b+2c]): I (e) Subtotal offees above (2a throngh 2d): 1"3. Plan review fees 1 (a) Plan review (65% ; p';;"it fee [2a]): 1 (h) F;;;';;"d life snfety (40% x pennit fee [23lJ: I (c) Subtotal of fees abov~ <3~'';';d'3b): 14. MisceUaneous fees , I <a) Seismicfee, 1% (.01 x pennit fee [2a]): I $ - I 'TOTAL fees and surcharges (2e+3c+4a): I,s tl(No Is I $ $ $ 1$ $ $ I I I I I ~ ~. /\' '" '. Electrical Permit Application CITY OF SPRINGFIELD. OREGON 12S Fifth Strut.Sprlngfield, OR 97477.PH(54I)7Z6--3753.FAX(541)726--3689 SPA,.onOLD I DEP~RTMENT USE ONLY I WiL:~ I Permit no.: (]7-ILf'l S- I I Date: I This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days ofissuanee or if work is suspended for 180 days. I Total I cost $134.00 $ IJ.CJ.J $ 25.00 $ \ '2. cj ,c.V I I I I I I I I I Reconnect only (2) $ 63.00 $ I I. Temporary services or feeders: ins/al/alion, alteration, relocation I \ I 200 amps or less (2) \ $ 63.00 $ \f.)SIL-V I 201 to 400 amps (2) $ 87.00 $ I , 1;401 to 600 amps (2) $126.00 $ I I Over 600 amps or 1,000 volts, see services or feeders section above I I Brancb circuits: neM1, alteration, extension per panel I I a. Fee for branch circuits with purchase of a service or feeder fee: I I Each branch circuit I 1 $ 6.00 I $ 1 I b. Fee for branch circuits without purchase of a service or feeder fee: I I Fin" branch circuit (2) I I $ 55.00 I $ 1 I Each additional branch circuit $ 6.00 I $ l I Miscellaneous fees: service or feeder. not included [ I Each pump or irrigation circle (2) $ 63.00 $ I I Each sign or outline lighting (2) $ 63.00 $ I I Signal circuit or a limited-energy panel, $ 63.00 $ I I alteration, or, extension (2) I Each additional inspection: (1) . $5.8.00 I $ I I APPLICANT USE J & '^' I (A) Enter suhtOlal of above fees , 0 (MInimum Permit Fee $58.00) 't!.JJt' I (B) Enler 12% surcharge (.12x [AI) ~ ~'-( I (C) Technology Fee (5% of [AI) ... e . . I TOTAL fees and surcharges (A through C): ,,~ ~ LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No ,CATEGORY OF CONSTRUCTION bd Residential l 0 Government I 0 C_.._u.. .:al JOB SITE INFORMATION AND LOCATION I Job site address: (.,LjCj. ~ ~~A::t .s;' IUd- ICi~~lej) rSbte:O~ZIP:97tf7.9 I Refe....;c~!l. '?)~4-:1.,. Taxlot.:()6'2n~ I DESCRIPTION- OF WORK I I I _ PROPERlY OWNER I Narne:\4,Ch,J [-< tf ~trli/~ to t-/-jJ:1/ceA I Address: loCj,'} 3 F(oriSTtf1.,' A-~ I I City:1"72v due..- I State: l:!.A I ZIP:Y. t I b II I Phone:h~ Sw-((,7C:; I Fax: I I E-mail: ~IA ,,,,tle f l.(Ol' mvtc ,e ~ I This installation is being made on residential or farm y.vy.....) owned by me or a member of my immediate family. This property iglntended for sale, exchan e, lease, or rent. OAR 479.540(1 an 479?p~, 7 ( SIgnature.. ,V,~ /1,0(., ' CONTRACTOR INSTALLATION I Business name: I Address: I City: I Phone: I E-mail: CCB license no.: I BCD license no.: I Signing supervisor's license no.: I Print name of signing supervisor: I Signature of signing supervisor: I State: I Fax: I ZIP: 440.2584.1 (9108ICOM) I FEE SCHEDULE I. Number ofinspections per item () IQty.1 ~t I Resldendal, per unit, service Included: I t,OOO sq. fl. or less (4) , I Each additional 500 sq. ft. or portion t:-.. thereof U I Limited energy (2) I Each manufactured home or modular dwelling service or feeder (2) I ~rvices or feeders: installation, alteration, relocation I 200 amps or less (2) $ 81.00 I 20 I to 400 amps (2) $ 95.00 I 401 to 600 amps (2) $158.00 160 1 to 1,000 amps (2) $205.00 Over 1,000 amps or volts (2) $409.00 $ 32.00 $ 63.00 $ $ $ $ $ $ $ Plumbing Permit Application DEPARTMENT USE ONLY [4:~~ -.... ~ Pennitno.: CITY OF SPRINGFIELD, OREGON 225 Fifth Street. Springfield, OR 91477. PH(541)726-3753 . FAX(541)726-3689 Date: This permit is issued under OAR 918-780-0060. Permits are issued only to tbe person or contractor doing tbe work- Permits expire if work is not started witbin 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No Sanitation approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION ts(ResidentiaI J 0 Government I 0 Commercial I I Description I New residential l,bathroomll kitchen (includes: first /00 feet of water/sewer lines, hose bibs, ice maker, underfloor low-point drains and rain-drain packages) I 2 bathrooms/I kitchen $374.00 $ I 3 bathrooms/I kitchen $439.00 I $ I Each additional hathroom (over J) $95.00 I $ I Each additional kitchen (over 1) $95.00 I $ I Residential fire sprinklers (includes olan review) I 0 to 2,000 square feet $58.00 I 2,001 to 3,600 square feet $116.00 3,601 to 7,200 square feet $174.00 7.201 square feet and greater $232.00 Manufactured dwellioe: or pre-fab (circle one) Connections to building sewer and I I $58 00 I $ water supply. . Commercial, industrial, and dwellings other tban one- or two-family Minimum fee FEE SCHEDULE IQIy.1 Cost elL $238.00 I State: I Fax: I I Miscellaneous fees 100' stonn, sewer, water line I $76.00 $ Each fixture, appurtenance, and piping $19.00 $ Stonn water retention/detention facility I I $19.00 $ Irrigation systems I I $19.00 I $ I Piping or private stonndrainage I I $19.00 I $ systems exceeding the fir.::t 100 feet I Specialty fixtures I I $19.00 I $ I Reinspection (no. ofhrs. x fee per hr.) I I $58.00 I $ I Special requested inspections (no. of I I $58.00 I $ hrs. x fee perhT.) I Each additiooal Inspectioa: (I) I I $58.00 I $ I Medical gas piping I Minimom fee I $ I Enter value of installation and equipment $_. I Enter fee based on installation and equipment value. I APPLICANT USE I (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) I (B) Investigative fee (eqoallo [AD I (e) Eoter 12% sun:harge (.12 x [MB]) I (D) Technology Fee (5% of[A]) I TOTAL fees and surcharges (A tbrough D): Each fIxture $58.00 I $ $19.00 $ I ZIP: CCB license no.: Plumbing license no.: Print name: I Signature: I BCD license no.: $ $ $ $ $ 440-2500-1 (I1108lCOM) $ Total cost $ $ $ $ $ I I I I I I 1 I I I I I I j I I Mechanical Permit Application , CITY OF SPRINGFIELD;OREGON 225 Fifth Street. Springfield, OR 97471. PH(54I)726-3753. FAX(541)726-3689 " , DEPARTMENT USE ONLY ,'_ '._ c ~I._ ',,-- ~~ I-permit no.: , Date: Tbis permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or irwork is snspended for, 180 days. , I, CATEGORY OF CONSTRUCTION 'I[~esidential. I 0 Gov......_..~ 1 0 Commercial , " JOB SITE INFORMATION ,AND LOCATION I lob site address: t. 49~fJoqUJ()(Jd Sf-ree-f- 1 City:,<)pr..~~Qt' /;) r Sbte:Cl R I ZIP: 9]'l-7?1 Reference: I Taxlot.: I DESCRIPTION, OF WORK 1 I 1 I 1 I I 1< _ 'PROPE-rUY:OWNER 1 Name: R'f..ll"~ d 1<tJ. Emily I-I',o/./~<I Address: 10'153 FloriS.tin /fOe, City:T12ud~ 1 State:C1 I ZlP:q (,11{ b Phone:,i)30 -55e>" / {.7C; I Fax: I E-mail: eL..1' I~t: ( j,@ /l1l1e ,('VYV\ This installation is being made on property oWned by me or a memb~r _ immediate familY'i[Qand is exempt from licensing requir ents de~I.OIl) /) SIgnature. ;7~.J .t?<.. :.L Y I" ...~, CONTRACTOR INSTALLATION I Business name: Address: City: Phone: E-mail: I CCB Hcens; no.: I Print Dame: . I Signature: I State: I Fax: I ZIP: 440-2545-J,(11/08lCOM) , I 1 ,I I FEE SCHEDULE I I Residential IQiY r Cost Total I ' . S79~O cost I First Appliance $ I lFumacelburner including ducts and vents I 1 Upto lOOk BTUIhr. I I $17.00 I $ I lOver lOOk BTUIhr. $20.00 $ I I Heaters/stoves/vents I. I Unit heater 'I I $17.00 $ I.. I Wood/pellet/gas stove/flue I I $38.00 $ ,I I Repair/alter/add to heating appliance/ I I I refrigeration unit or cooling system! $58.00 $ absorption system I Evaporated cooler I I $13.00 $ I I Vent fan with one duct/appliance vent I I $9.001 $ I I Hood with exhaust and duct I I $13.00 1 $ I I Floor furnace including vent I I $58.00 I $ I Gas pipinl! I I One to four outlets I I $7.001 $ I I Additional outlets (each) $4.00 $ I I Air-handlinl! units, ineludinl! ducts I I Up to 10,000 CFM :1 ., $11.00 I $ I I Over 10,000 CFM 1 $20.00 $ I I Comuressor/absorotion svstemlbeat oumo I I Up to 3 hpllook BTU $17.00 $ I I Up to 15 hp/5ook BTU $29.00 $ I I Up to 30 hpll,Ooo BTU $43.00 $ I 1 Up to 50 hpll,750 BTU I $57.00 1 $ I lOver 50 hp/I,750 BTU $95.00 1 $ I I Incinerators I I. Domestic incinerator $20.00 I $ I f,;Commercial I I Enter total valuation of mechanical syst~ I and installation costs $ _ I' Enter fee based on valuation of mechanical system, etc. $ I I Miscellaneous fees J.emsl Cost Total I ea. cost I Reinspection I I $58.00 I $ I I Specially requested inspections (per hr.) I $58.00-\ $ I I Regulated eqoipment (onclassed) I $13.00 i $ I I Eacb additional inspection: (I) I $58,00 i $ I I APPLICANT USE j I (A) Enter subtotal of above fees (or enter set I minimum fee of $ 79.00) $ I (B) Investigative fee (equal to [A]) $ I I (C) Enter 12% surcharge (.12 x [A+B]) $ I, I (D)Seismicfee, 1%(.01 x [A]) $ 1 1 (E) Technology Fee (5% of [A]) $ I I TOTAL fees and surcharges (A through E): $ 2~ Willamalane t~ Park & Recreation District Job, No. 0.q - \41 C6 SYSTEM DEVELOPMENT CHAR~E WORKSHEET FOR 2009 NAME:-\t~f~~--'t"-&o.J-L:1-t\i~~Y-~-O--;--PH0NE:-~~' ~~D-.\\0"1~ , _ADDRESS: \Dq~3 '\:-\~r Tru~STATE&:Z:IP: Qlo~\,pl LOCATION OF PROPOSED BUILDING SITE: Street Address:104.C\ 'A. ~I~d) Plat Name: WJ. ha.te Tax Lot Number: ~lt)f2:34.4S02>zo:) 1. DEVELOPMENT TYPE (Check appropriate dwelling{s). Dwelling type definitions are on the back.) , A. Sinale-Familv Detached NO. OF UNITS \ X $2,858 per unit = B. Sinale-Familv Attached NO. OF UNITS X $3,100 per unit = C. Multi-Familv ADartment NO. OF UNITS X $2,641 per unit = D. Sinale Room OCCUDanCI( NO. OF UNITS X $1,321 per u'nit= E. Accessorv Dwellina Unit , NO. OF UNITS X $1 ,q50 per unit = WILLAMALANE SDC -,-. 2. SDC ,CREDIT. (1f-applicable)SDCpayer_must.fumishproofoL Willamalane Credit approval.) , 3. TOTAL WILLAMALANE NET SDC ASSESSED (if SDC reduced for Credit) De~e~~t ~~c~~ City of Springfield , $ ry__ <6 ~<6.oJ $ ... .. $ $ $ $ , I)~ p;<(),cD -----@' $ $.J ~~r:p,R ,cV 1/ I /0 I 0 9- Date 5 -. . . . , , . . . .... ...' ". .' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 '. 'Web Address: www.eeb.state.or.us Pennit #: C'?- ILf7~ fY-/73 JJc>;;/./O{)[? Address: Issued by: Date: .' . Statement. Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residentia(c~nstruction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before d 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. ~~ the appropriate blanks and initial boxes I and 2, and ei~er box 3A or 3B:' \~"i\ 1. 1 own, reside in, or will reside in the completed structure. iI4Pr 2. ,I understand that I must become licensed as a construction contractor if the structure is sold or ~\J offered fot sale before 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 Con~truction ContractorS Board: OR ~B. I will be my ~~ general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change iny 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 G2;Q~~'~: :....;; '~p.M;bm"~.. <b. '''''~ "d.:~m::: <] , (Signature of permit applicant). (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner .doc 06-0 1-04 -.. - - - - ~ ~..-....., , Acting as',Your Own Qeneral Contr~ctor.?-; . :::\~c'INFORMATIONN6TICE TO PROPERTY OWNERig:',.'., '. .. ABOUT CONSTRUCT:!ON;RESPONSIBILlTIES.: ' . ",., , i. ... ~ t.": _ .' '.~ ". ." <. ~ . . ~ " . .'~-' ~ NOTE: Thislhformation Notice to Properly Owners about Construction ResponS"ibiliiies was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by th.e 1989 Oregon Legislature. If you ate ac;i~g as yoUr o~ conti?li~r to co~struct a new ho~eo; ~ak.e a su6s~~~1 impr6v:me~t';ii~n~~isting structure, you can preven(many problems.by.beingaware of the -followirig responsibIlities and concerns, Employer Responsibilities ,.-. -', . J. ,.~-.J ':,\ (;~~'.. "'_ .." ~,<....'(:. .... .. j;<')" . . You \yin,il1t!T!9~!.,ins!an~es,.1J~ f!11ed ,to., be an '.'emp1oyer;',and,lhe ~ontractors you cqntrac\with-w!lLbe":employees" if you)lsS f.ont;ra!;tor,s.not)ic~~s<;d .w,it9.th<; .C?nstru.c~ion c;ol1!-!:!,lf~~[s_BoardJo do labor. in cOQstru.ct.in~~rto ~sist in the construction.or- improvement of a residential structure.rAs'the",employer, you must comply with the following: '-._. -,''',' "',\.'1'. ., ,: .'_. -; \....~ ~.',~~'. ...6';. .'..~.., ',' . _. .;. '.'. '" . -.' . Oregon's Withhillai;:~ T~ L~w:ks ,~ erhpi~yei-', yo:;; must ~ithh(jj'diric6irle tiies from ~ri1pid;eewages at'the time ,employees are paid. You will be li!lble for the tax payment,s e"en if you don't llctually withhold the tax from your , .'.- '. ',~ J'_ '. ' '.' '. ,!. ...... - '.' -- . -' . ,. .,. " employees.For more information;'calltlie'Departrrient of ReVenue at 503-378-4988.' - :' '-, ,. , I, " .~ <(. - , Un~mployme~t Insurance Tax: As an employer, 'yoii'arerequifed to pay-a tax,forunempl6yment insurance purp6j~ei' on the wages of all employees. For more information, call the OJ;egon E,mployment Department at 503-947-1488. . ',:" ;...:tj:(',),~,'Y~ "(l~'l,="-,;." "'.J ""f'.,... ::.:.r,,:,..;:~t.t ':~"_' it1i):' ~-;',:!:.h"'-''-'~ -I'~., The Oregon ,Business Identification Number (BIN) is a cOI;1biri.ed )lumber; for both" Oregol1~ Withholding an'd'c \ Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsuav.htmll for the appropriate forms: ' . ..--..--..- - .- -- -~ < ... ' . .....- .--" ',,- " /~ , ,t..,., . . . '.., , . Workers' Compimsation Insurance: As an employer; you are subject to the Oregon Workers' Compensation Law, l\nd must;o,btain workers' compensation i!lsurance for your employees. If you fail to obtain workers' cOmpensation "insuran26: yoi,;'could be'subject to jJ~nalties' 'and be iirtb1e for ~ll claim c6sts if one 'of yoUr et9P1oyee~ 'isinjui-ed on the job. For more' information, calI the Workers' Compensatio'ri biB-sioh' ai the Departlnent of Consumer arid Business Services at503-947-7815. " , ".>,'.,' U.S, Internal Revenue'Service:' As an employer, you must withholil "feileral'income:tax'fron1" employees' wages','~" You will be liable for the tax paymcnt even if you didn't actually withhold the tax. For a Federal EINnumber, call the IRS at,!-800'S29-4933'or vi sii'thtiir' web site at-w",-,\':ii"s.\!(JV.:' ,,,,. , " ". ';,;' . '. .., "!.., . -:"t: J .. ~ ~ '.0 ". .~ . I ~ . ~ '. .' , <yt '''; ,'. .'. ".''': ;i", ' ." ,:,r, "'",;,: ,i. ,Other.Respo.lIlsibilities andAr~a.!i .QfCQncerl!1s', ,j ,-. . ; ~'.~, , ..' ~JIL. Code Compliance: As the penllith~lder for this project, you a,r~ responsiblc for res61virigany'failure-tomeet code requirements that may be brought io, your attention through inspections. ' > -..:.~.--:..~..._ '.".,"" '.~. " '. I ,. '-''::." of ," ., ;'.' Liability and P~ope'riY D~mage"lnsiirance:' . Contact' your in~:r,r~rtce'ltgetit t6 see'i!' you have ade'i:p.iife lnstirante coverage for acddents and omissions such as falling tools, paint over ,!;JJ..T,lly, water dam~ge fr?m pipe punctures'~.fire or workthatmustb?,'~~~O~S'..f,~:\ . """,,~.~t_;"".-~~~' ,..~>.~. ", ~_~ 'l'~/" . -- \" -- -. --' .- --. ' - - - . -. . , .., ..' " -- ~ ., . Time: Makesurey6uh~"Yesufficienttimetosuperviseyouremployees.",;.; " .. ,., . ,-..,." . , . Expertise: Make sureyol;ha~~'the skills \0 ac'f~s your own ge;~ral'c6ritr~ctot;'to'b~rd;~~te' the work ofrough-i~ and finish tnides, and to notifY building officials as the appropriate times so they can perform the required u1spections. If you have additional questions call the C~nstruction Contractors Bo~rd (503-378-4621) or Write the agency at PO Box 14140, Salem, OR 9730.9-5052. , '~;,~ ': .?,'~ :.::~.'"'.- . l-~' ')I ,~\ Properly_owner:doc 06-01-04 ,- ,'-""l"''''--......_~~ .'- "-".~.-~'";,,,"'.:r'"!'- . ~:< ".:~ 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone ,r.: Bl~~'.~''',' ., -' ~ ."! .' .~ _. .'0'..' -"~- City of Springfield Official Receipt Development Services Department Public Works Department " . ; , : RECEIPT #: 2200900000000001274 Date: 11/10/2009 10:44:35AM Job/Journal Number'~.' Description COM2009-0 1475";":';' ,:"Addressing Assignment COM2009-01475 ' Willamaian;Sifigie Family COM2009-0I475 Residence Wiring 1000 Sq Ft COM2009-0I475 Residence Wiring Ea A~?tl 500 COM2009-01475 Temp Power 200 amps or less COM2009-0I475, ',Pla~ Revie;''R~sidential COM2009-0I475 >B~ilding Permi{ C0M2009-01475 3 Baths One & Two Family COM2009-0I475 ...'::'lst;App!ia~c~, ,\, COM2009-01475 'VentFan'::'<," COM2009-01475 Appliance Vent' COM2009-0I475 Exhaust Hoods COM2009-0I475 Dryer Vent COM2009-0I475 Gas Outlets 1-4 , COM2009-01475 . Fireplace (Listed) COM2009-0I475 Plan Review Major - Planning COM2009-01475 ..' ,Storm Drainage Impervious Area COM2009-0 1475 Sanitary Sewer -,Reimbursement COM2009-0I475 Sanitary Sewer -Improvement COM2009-01475 SDC Tran Reimburs-Residential COM2009-0I475 SDC Trans Improvement-Resident COM2009-0I475 SDC MWMC Reimbursement COM2009-0I475 SDC MWMC Improvement COM2009-0I475 SDC MWMC Administration COM2009-0I475 SDC Sanitary/Storm Admin COM2009-01475 SDC Transportation Admin COM2009-01475 + 5% Technology Fee COM2009-01475 + 12% State Surcharge Payments: Type of Payment Paid By II " Check RlCHARD HINKLE' , Item Total: Check Number Authorization Received By Batch Number Number How Received cjc I 14 In Person Payment Total: Amount Due 38.00 2,858,00 134.00 125,00 63.00 293.65 1,832,07 402,00 79.00 27.00 9,00 13.00 9.00 7,00 20.00 211.00 2,289.96 840.80 639.34 211.21 931.65 101.97 1,044.54 10,00 232.88 70.59 146.55 326.41 $12,966.62 Amount Paid $12,966,62 $12,966.62 \~ ) I, , d..1J.. ';1,-. .' i , ", {} ..,; d " . .:; ;';' , -- " cReceintl Page I of I I III 0/2009