HomeMy WebLinkAboutPermit Building 2009-10-27
CITY OF SPRINGFIELD
Status
Issued
I
Building/Combination Permit
PERMIT NO: COM2009-01576
ISSUED: 10/27/2009
, APPLIED: 10/27/2009
EXPIRES: '06/30/2010
VALUE: $1,500,00
225 Fifth Street, Springfield, OR
541.726.3753 Phone
541.726.3676 Fax
541.726.3769 Inspection Line
SITE ADDRESS: 1422 ANDERSON LN
ASSESSOR'S PARCEL NO.: 1703284002400
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: 6 circuits for heaters, hot tub, and lights in residence, Install beams,
Residential
Owner: DAME CHERYL A
Address: 1422 ANDERSON LN
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Contractor
OWNER
NEW REYNOLDS ELECTRIC INC
License
Expiration Date Phone
184921
01/01/20 II 541.343.7297
.. ~UlLI:>ING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group:. R-3 Height of Structure
Secondary Occupancy Group: Type of Heat: \0
Primary Construction. Type VB ;~gll:~'\\'f
Secondary Construction Type: ~ "'~
# of Bedrooms: ~ Ole~~~wo i!'fA' ali'1..OI)~
~~O '~~e ~rrr~'Vl
"1'- .\1'.9 III . "'l. ,'It" Jm' ."Ill
\o\\?: ~on~ti.l.~,' ',~_, ..J~l~ION I
\,\o\l\fa.9!I'1.~ r~l. "A'l,'Vimo--~' ,
'1\ 0;.> '''OU tIIlll~el.. ~ 01\ ~~, ~)o ,
rP90'~,~ \'" "". ~~st:
~:.._ \0' ~e( "'*~~ Trees Rqd:
(\U(I\>'""-~ Paved Drive Rqd: ..
0/0 of. Lot Coverage~'
Lot Size:
Sq Ft 1St Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
nla
, REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Total:
Handicapped:
Compact:
I PUBLIC I~PROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type"",';:""
. '. ' Down~'W~MlP?\\ ,'.
N01\CE. SI-I/I..\.\. t~l'\ ER\'J\\1 \5 N01."
1\-1\5 I'ER\'J\\6 ut,l\)ER 1\-1\5 I' ONED ~O? :.<'.
/l..Ul\-10R\2\D OR \5 /l..B/l..ND .'>
CO\'J\\'J\\:NCD/I..'i I'ER\OD. ','
/l..N'i '\ 80
Notes: '
Pa2e I of 3 ,
,_'iil!'l!Rl.I!l<i!I"I~\,I;!,;
I:
Status
Issued
225 Fifth Slreet, Springfield, OR
541.726.3753 Phone
541.726.3676 Fax
541.726.3769 Inspection Line
Description
Tvpe of Conslruction
Estimate
Estimate
Fee Descriution
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend dirc Ea Add
+ 12% State Snrcharge
+ 5% Technology Fee
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
+ 12% State Surcharge
+ 12'% State Surcharge
+ 5% Technology Fee
+ 5% Technology Fee
Building Permit
Building Permit
Reversal. + 12% State Surchar
Reversal. + 5% Technology Fee
Reversal. Building Permit
Total Amount Paid
CITY OF SPRINGFIELD
Building/Combination Permit
"
PERMIT NO: COM2009-01576
ISSUED: 10/27/2009
APPLIED: 10/27/2009
EXPIRES: 06/30/2010
VALUE: $,1,500.00
I VaJuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
1,500,00
Value
Date Calculated
Total Value of Project
$1,500,00
$1,500,00
12/3112009
[."1'1,' Plili\J
Amount Paid
Date Paid
Receipt Number
$10,20
$4.25
$55,00
$30,00
$14,76
$6,15
$42,00
$81.00
$6,96
$6,96
$2,90
$2.90
$58,00
$58,00
$.6,96
$.2,90
$.58.00
10/27/09
10/27/09
10/27/09
10/27/09
12129109
12/29/09
12/29109
12/29109
12/31/09
12131109
12/31109
12/31/09'
12/31/09
12131109
12/3] 109
12/31/09
12131109
1200900000000001194
1200900000000001194
1200900000000001194
1200900000000001194
1200900000000001364
1200900000000001364
,1200900000000001364
1209900000000001364
1200900000000001371
120090000000000]367
1200900000000001371
1200900000000001367
1200900000000001371
1200900000000001367
1200900000000001368
1209900000000001368
1200900000000001368
$311.22
I Plan Reviews I
To Request an inspection calI the 24 hour ~ecording at 726-3769. AII inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a,m, willpbe made the following
work day.
I R,,,..;ro..-l rn<no~Hnn< .
-,]\_.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete,
Electric Service: Approval required prior to utility company energizing service,
Paee 2 01'3
Status
Issued
CITY OF SPRINGFIELD'
Building/O~mbination Permit
PERMIT NO: COM2009-01576
ISSUED: 10/27/2009
APPLIED: 10/27/2009
EXPIRES: 06/30/2010
VALUE: $1,500.00
225 Fifth Street, Springfield, OR
541.726.3753 Phone
541.726.3676 Fax
541.726.3769 Inspection Line
Framing Inspe'ction: Prior to cover and after all rough in inspections have been approved,
Final Building; After all required inspections have been requested and approved and the b~i1ding 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 thatany 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
time,sd~:nstr/ / G/ ~ C(
. ,~~ /2-3(-
Owner or Contractors Signature
Date
Pa2e 3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009.0 1576
COM2009.0 1576
COM2009.0 1576
Payments:
Type of Payment
Cash
Change
Job/Journal Number
COM2009.0 1576
. COM2009.0 1576
COM2009.0 1576
Payments:
Type of Payment
'Cash
Change
cReceil111
RECEIPT #:
Description
Building Permit
.. 5% Technology Fee,
+ 12% State Surcharge
Paid By
KIMBERLY BROWN
KIMBERLY BROWN
Description
Building Permit
-* 5% Technology Fee
-~ 12% State Surcharge
Paid Ily
KIMBERLY BROWN
KIMBERLY BROWN
~.
,",- ,"".".,'
City of Springfield Official Receipt
Development Services Department
Public Works Department
,
1200900000000001371
Date: 12/31/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How ~eccived
OJB
OJB
In Person
In p'erson
Paym~nt Total: ,
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
,J., to
OJB
DJB
In ~:erson
In Person
Paym~nt Total:
\~r~:
,-
,
Page 1 of 1
9:46:3IAM
Amount Due
58,00
2,90
6,96
$67,86
Amount Paid
$70.00
($2,14)
$67,86
Amount Due
58,00
2,90
6,96
$67,86
Amount Paid
$70_00
($2.i4)
$67,86
12/3 1/2009
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COIistructiop €tmtractors JJoard
700 Summer St NE Suite 300
PO B~x 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state:or.us
f.ddress:
Permit #: COIMZ.= c; - C / .$ 7 b
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Date: /2- 3/~ c) '7
IL(ZL
, ~re::
I~sued by:
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Statement: Information Notice to Property Owners,
. 11 . ,L ," _ .. '~
,; AboutConstruction Responsibiliti~s '
,
, . . " .
Note: Oregon Law; ORS 701,055(4) require~ residential construct(onpermitapplicants who are not
licensed with the Construction'Co,ntractors Board to sign the following statd'ment before a b~ildini
permit can be issued This statement is required for resii:Jential buUding, electrical, mechanical and
pl~mbinipermits, Licensed architect'and engi~eer applicants, exempt from licensing under '
ORS 701. 010(7),. need'notsubmit this statement" This statement will be filed with the permit,
, . . ~ .' - " - . ~ . '
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Fill iil the appropnateb1anks and initial boxes 1 and 2, andc;:ithe~ bpx 3A or 3B: '-r
. ", '. .... ....
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%I':' ',I o~, '~eside in, or will reside in the completed structure, ,~
~,
I undetstandthat I Iilusfbecome licensed as a construction. contractor ifthe structure is sold or
, . "
offered for sale before or, on completion, ' . :1
"
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D
3A. My general contractor is
(Name)
,
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(CCB #)
I . . .
I will instruct my general contractor that all subco~tractoi-s who 'work onthe structUre must be
licensed with the Construction Contractors Board,/I
I
OR,
%JB. I will ge my own general contractor.
i,_,. .
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If I hire subcontractors; I will hire only subcontractors licensed with the,cConstruction Contractors
Board, If I change my mind' and hire a general contractor, I will contract ,with a contractor who is
1icense~ with the CCB and will irirmediate1ynotifythe office issuing tp.is'$ui1ding ~ermit of the i
name ofthe contractor, : c . "
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" ".
I hereby certify that the above information is correct and that Iha~e read and do undhstand tlte Information
. - . - ~
Notice, to Property Owners about Construction Responsibilitie~ on the reverse ~ide of this form.
,.1". "
'!fimlxr Iv! dJrn ~ ~ 8(7) vvvJ " ;:~/ 81/09 '
< ~a of permit applicant) .'" < ' , (Date) ,
:' (White. copy to issuing agency permit file, pink copy to applicant.)
'. .
r.vy,,;j_owner.doc,06.01.04 '
_ ._ . _. _ ,_, " .' _ 'n __', '
Actrn~~ as -Yoll.r''()wil''GeneFal; Contractor.:?
'v,-..j ~l'""~:"';NF6RM';f1bJ;t~OTICE:TO'PROPERTY dWNERS ,:: .',.
_'{ Co '\::::' -~::, \, ., " ;. ,,', .6.B2,W;~ON~TRLJ~;rIQ!" :RESPONSIBILlTIES I"
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NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the
Construction Contractors Board in accordance with ORS 701,055(5), passed by the 1989 Oregon Legislature,
- ~'-l.. ,,~\,,'r~,..r'-; "~" -: .._' . '..... \,' ,'.. . '.. -':;'; ... ':",;-'Ir' '. t- "; . ~ ...' .'j:~, ,,- >,-
If you are acting as your own 90ntractor to construct a '1ew home or make a subsl!1nfial improvement to an existing
structure, you can prevent)ilallY problemS by being 'aWare OfthefolloW,ing:.responsibilitid imdconcel1)s,
Employer Responsibilities
-.,.':1",,::,. ...(\--, '>~';-l..~.-i~::,:~.\-)~,":"- ". ._,'.... ..~........_~;\'".
You will;, jn most instans<;s, be ru1e,~ to, p<; ~I( ~',eP1p10yer" and. tge'c,opJp~tqrs YClH con~act,wit? y<ill b.e,"employees" if
you Ilse c(:m_n;a.ctO[~;p~t hcens~d :v;th,!he CRn~ln;tS~lo_n G?!'tr-\l~"tors Bpardto do lab()~m con~~ctlf)g~rto a;;slst m the
construction or improvement of a residential su:ucture, , As the employ'er, you. must comply wit,h,!he following:
t .... . ~. , ',. . ..: . ".' 4~"''';'''' ,.:,' -,'J.':'. '-:,-' ~ '. ._~"'...
Oregon's Witbholding +aJ[L~i: As'ah ~mpl~y~r, you'b\ust'withhii1d ihc'ohiJkk~j; from emp1~;~e wa~es ~t llie time
employees are paid., You will beJiable for the tax payments even if you ~on't-actually .withho1d the tax from your
employees.. For more' inf6rmation~call'iJ{~ Depiirt!i1ent"of Revenue at 503.3-784988: '; ., ' '.. "{'J,;)' . :.., ,: l, ", "r:" 1:_
UnemplOYOllintlnsurance Tax: As an emp1oyeri6r6u Ifre:requifed to pay a taX, for \kemployment insurance pwi>~
on !he wages of all employees, ~or more information, call the Oregon Employment Department at 503-947-1488, _
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!.~,,'l.::_.". ..... :'-: "~' ,'...,.;..1... :'. w' ..;., ')' "'_ ,. .......'.:~..)...:.. j:.~,. ,."..,.,_!1".1~'...:';'_~" . ~.
The Oregon Business Identification Number (BIN) is a cOlri1:Jin!ld,l!u.rnber [Qr. botll.Qregon Wit!Qio1ding and
Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www,dor,state,or_us/formsoav,htmll for the
appropriate forms, ." ___ '._ . ...,J\,:"'!: ;-i:'.:' '.<' ""
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Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workcrs' compensation insurance for your employees, If you fail to obtain workers' compensation
insuran~6; y~~J' ~diilirbC'Stb.jeci't~ 'penii1li~~'aAd b~' ji;;ble"f<1t.all claim costs' it' one of your' einp1oyees'i~"i~jured on the
job,For more itiform~ii';n, calf the Workers' Compen'sa'Wfn Division at the'Departmentof e6i:is~met and Business
Services aI503.947.7815.
,
. , ' , . '.,......;
U.S. In'ternal Revenue Service:' As an employer, you must withhold federa]';incOlne:tax; frorri'enip1oyees' wageS:--,..,
You will be liable for the ta.x payment even if you didn't actually withhold the tax, For a Federal EIN number, call the
IRS"t 'I "800cS29-'4933>,or .visit'tl"Iir'web site.at.ww",:ii:s!l!'1-v.:' "~, ,; ,P' ' ,'..', .:.:~ '1'" r " .
'';...,....~~: ..~r: !~":.:l..'i.. ,.~< ~.,~-.!;.'. '. ":,..\. .~'i ,<;~. "'~"'\.' . ':~lt,: ......... ;':'.-.~';' " ~;.1 .~.
';, ;,,', , -_'v,:Other-, ~esponsibUiti~~;~nctAr.~~$"Of C~ni~~rns ',",; " .,',
Code Compliance: As th~ pennit holder for !his project, you are responsible for rellbhiihg'ahy-fai1ure' to \heet code
requirementsthat'may be-brought to y'our !lttention through inspections, ' .
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Liability and Propel-if, 6~in~ge"insMali'h: Cohtact '~o\ir insuianceagent'.to 'see H you 'have' aMquate' insurance .-,
coverage for accidents and omissions such ~S falling tools, p-aint over spray, water damage from pipe punctures, fire or
, r '
work that must be redone, ,'. --.",.\' " '-, '..,
+ _.~ \'~.\.~i: ~ ~'" M~._. H' _ '(~, \\ "' - _l~ '\"{~ ,~)~ ~':: . +,_\~':\.:).~\L~~ '>-/~~"
Time: Make sure ymrhfve sufficient time to supervise your employees!': -I;':~, '., ,.'.' -.' ' ~'
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E)(}lertise: Make sure you have 'theskills"to ad asyoufown genefai contractor, 'to coordinate !he 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 !he Construction Contractors Board (503-378-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052,
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Property_owneLdoc 06.01.04
Oav1s Gabinets' '
.!bhnWilliams
150 E 10th Avenue PO Box 545
'Junction City, OR 97448
541-998-8778._______._____._____ ______[12-23-09L___.___
Room 1
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Str..uctu,ral Permit Application
-
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
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';:Pfj:@~n/IENTU~E'9N~Y; '.
C04NI z:.oO'l- 0 IS7'1
Permit no.: I
1 Date: / Z- 3(-0'1 I
This permit is issued 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,
1\(f:;?;'t\rUj,*~~~~i}[9~g'A~~j~:QY~~BNM~ijT1~~~'R@:V~U~~i!71{~~~~:~~Th
I This project has final land-use approval.
Signature: Date:
I This project has DEQ approval.
Signature: Date:
I Zoning approval verified: DYes D No I
1_;~:~:~.:.::i"..,~00d..P!:~~;,;.9,Y~".,., ,.[].~o". ,..,'~."'.."l<r" "II
~~~~I,\;'v:'t;:,AI~.9.9BYtJ.QE%?<::,o~!l;TRU.c:.[IQ~i;1i'i.~5!.~},N'f;'!b.i
I ,0'Residential .1 0 Government I 0 Commercial I
l~j~;:~~~f1i:tit~P"~:i~JtS)jfEl--fN1fq~}~'A,I)Q~'~A~.R~~o~~fj'9.'~t}1~,~~~~Y;;JI
I Job site address: \4 z..<... ","",~u-u;..,-~ L..... _ I I
I City: ST>~~FI "-'-~ I State: c::.'L I ZIP: I I
I Subdivision:_ , I Lot no,: I I
I Reference: I /03 Z. gC( (:) I Taxlot: L 400 I
h~:,; ,}. <: . :" R~Oi'ERTy'.6v1Jt'.fE~/",:;t. ,~\^;~, ..," J
I Name: \-<. 'L.--.J~ ~;::> I
I Address: \41Jw A""'b'b~ t .",", I
I City: <S\,,'2...\~E:.~\ u...b I State: 61L, I ZIP: I
I Phone: Sl::>"S'--oc,,4A- Fax: - - I
I E-mail: I
This installation is being made on residential or farm property owned by
me or'a member of my imhlediate family, and is exempt from licensing
requirements u~der ORS 701.01R. . .'
Sign here: lVmWI'-{ /.Jo..me - B rouJ ()
I, - )::ONTRAi:!)IQR)i~ST:AtLA'n6N~:,;",;.:".'.,;., :,,:j
I Business name: 1
I Address: I
I City:
I Phone: ' _ (({'....
I E-mail: ..1'"
CeB license no.() - 0,
I Print name:
I Signature:
I State: _
I Fax:
I ZIP:
i:~:~::::::':SV$-f~€~~~~~~~TAr~~:~:~~~~"tj
I Plumbing I..... fA I I
i Mechauieat I u IA. I I
1~~J;::;l~1~t%~~t~:;:\:~:;~~i1~:'i~"0:j.~'~~{$?A'~ptr~~Jt/1f;;~~~P:tY})i~.'U.,:~:~f:t?'F~'!:.:;{'[':: I
J1!l~M~.tlf~II9A:fiQf~[,~]t~~t(OJ1~~~~~~~{~l~f~~1*?{~~~~~~;~?~.~}:1\(I;,t~t~~i~:~;;~:;~,~:1
(a) Job description: "5"&/K-l
Occupancy YL ~
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I $1.5O"D I
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I (a) Penn it fee (use valuation table): $ '$'8 I
I (b) Investigative fee (equal to [2a]): $ '\ II
I (c) Reinspection ($ per hour):
(number of hours x fee per hour) $
I (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $
I (e) Suhtotal of fees above (2a through 2d): $ \ I
i~r~:j~::\~~::~~!~;:;~~~!~:~:~:~~~i~~~i
~(c) Subtotal of fees above (3a and 3b): $ / I
*.-t'O; M-'-'- :-'~"':';I'I"':".'{"'3;,~~,t;.:(io'-L""'1-;'~jfi"~'!~~'~.':'~:j'\"'t'{~\i:"'j';;ff;:- -'*I~.:_;~I:';'1',~,<iJ.;'\'i'qi ,~" . -,,~.;; .-,. 'I
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I. (a) Seismic fee. 1% (.OI.x permit fee,[2a]): I $ !
1 TOTAL fees aud surcharges (2e+3c+4a): 1 $ L:7 ~
.=-.
Construction type:
Square feet:
. Cost per square foot:
Other infonnation;
Type of Heat:
Energy Path:
D new ,.....B1nTeration
I (b) Foundation-only permit?
Total valuation:
o addition
DYes
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