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Home My WebLink AboutPermit Building 2010-9-30 CITY OF SPRINGFIELD . Building I Residential Permit PERMIT NO: 811-SPR2010-00218 IVR Number: 811137953888 www.ci.springfield.or.us 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@ci.springfield.or.us PROJECT STATUS: Issued ISSUED: 9/30/10 APPLIED: 9/3/10 EXPIRES: 3/29/2011 VALUE: $56,300.00 SCOPE: Single Family Residence WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential Addition to Single family Dwelling P8'f sf ~l\ t> SITE ADDRESS: 753 OLD ORCHARD Springfield ASSESOR'S PARCEL NO: 1703234307500 PROJECT DESCRIPTION: Phone Number: OWNER: ADDRESS: I HUNTER MICHAEL l II & KAREN M 753 OLD ORCHARD IN SPRINGFIELD OR 97477 I Contra~tor Type CONTRACTOR INFORMATION I Contractor Name Lie Type Lie No Lie Exp Phone BUilDING INFORMATION I # of Units: # of Stories: 1 I Height of Structure: Type of Heat: Heat Pump Water Type: Range Type: Haz~at: No o # of Bedrooms: Sprinkled Building: No Fire Alarms: No Electrical Specialty Code Edition: Springfield Fire Code Edition: Path 4A Zonal heat with 71M h . I 5 . Ily C d Ed't' ee amca pecI3 0 e I Ion: Municipal I Development Code: Plumbing Specially Code Edition: Residential Specialty Code Edition: Structural Specialty Code Edition: Energy Path: Site Information Engineered Fill: Fill Volume: ;-- Flood Hazard Area: -No land Hazard Area: No Retaining Wall: No Soils Report Requirel!TTENJlON: Oregon law requires you to follow rules adopted by the Oregon Utility NotIfication Center. Those rules are set forth In OAR 952..()O1..()O10 through OAR 952-001. 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number for the Oregon Utility Notification Center 18 1-800-332-2344). No , Springfield Building Permit . 9/30/2010 11:41:19AM Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: 590 200S oJ I ,,- -.... ;;-",b'~:'ll\t;r.~';:.!.;,f';fk~c.;JV,!;l(;, ,,', NOTICE: . .-,.,,'!W".;.4',".... .,'(, THIS PERMlTSHAllEXPlREtF1MlWORK :~~ AUTHORIZED UNDER THIS PERMIT IS NO!:,~:. COMMENCED OR IS ABANDONED fOR :/.1\;;:'::';. ANY 180 DAY PERIOD. ".""".,,:>.;,,::; "'". Page 1 of 5 www.cLspringfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00218 IVR Number: 811137953888 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfield.or.us PROJECT STATUS: Issued ISSUED: 9/30/10 APPLIED: 9/3/10 EXPIRES: 3/29/2011 VALUE: $56,300.00 SITE ADDRESS: 753 OLD ORCHARD Springfield ASSESOR'S PARCEL NO: 1703234307500 SCOPE: Single Family Residence WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Addition to Single family Dwelling 581" sf DEVELOPMENT INFORMATION ~ REQUIRED PARKING Frontyard Setback: Interior Setback: 8 Sideyard Setback: Rearyard Setback: 61 Solar Setback: Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: 22.5 Highest point on structure to north property line: Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description ~ Description Tvpe of Construction Unit Amount Unit Tvpe Unit Cost Value , Springfield Building Permit 9/30/2010 11:41:19AM Page 2 of 5 www.ci.springfield.or.us " CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811cSPR2010-00218 IVR Number: 811137953888 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 S:~=~HG:E.L..~ ~"''''W''' :}i ~ '';'~~OREGON permi1center@ci.springfield.or.us PROJECT STATUS: Issued ISSUED: 9/30/10 APPLIED: 9/3/10 EXPIRES: 3/29/2011 VALUE: $56,300.00 SITE ADDRESS: 753 OLD ORCHARD Springfield ASSESOR'S PARCEL NO: 1703234307500 SCOPE: Single Family Residence WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Addition to Single family Dwelling 581 sf t:rg: ~.~.. ._:-..'~~"~/:~C!'*0~:~ L::~~;:;;:'~' ~~.~~:T~~?,~~0~:2'~:~?~Jf~~~JRAj'p~:"" ~t;:>;~1i~'Y?'J;t7~'~:Zi,'x,'~"S~~,::':-'::i;;,~'::?;f1,:-~'?;':" : ,::V>d:T'.,.~~t*-~:1___.2 Description SDC: Reimbursement Cost - Storm Drainage SDC: Total Sewer Administration Fee SDC: Improvement Cost - Local Wastewater SDC: Improvement Cost - Storm Drainage SDC: Reimbursement Cost - Local Wastewater Sink/basin/lavatory Residential Fire (,05 Per Sq Foot) Planning - Minor Review Structural Building Permit Fee Water closet Admin fee (10% of applicable fees) Bathtub Balance of Minimum Plumbing Permit Fees Single-duct exhaust (ba~hrooms, toilet compartments, utili First Appliance Fee Branch circuits without service or feeder - 1 st circuit Branch circuits without service or feeder - each additional State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) Structural Plan Review Fee Residential Tota(Amount Paid Amount Paid $103.89 $61.20 $304.22 $250,61 $565.18 $19.00 $35,80 $119.00 $499.34 $19,00 $3.58 $19,00 $1.00 $9.00 $79.00 $55.00 $24.00 $86,92 $36.22 $324.57 $2,615,53 Date Paid 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/30/2010 09/03/2010 Receipt # 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 374440 299420 rf;:'c':":...~, -:'J~~~r'-{,ifiitK~"';~'~{iE~~LJ;;;1';J;:~',~<;,7f~:t~e,~~!!tR;~~~~;~1~~~~-:", ;;:r:~:~3~:';:;!7S0,:~~~' ';:',;~.' ;_~'~"41r':o,:~f,r;y~,~~~f2t;?!::;j DeDartment Received Due Date Complete Result Reviewer Structural Review 09/29/2010 09/14/2010 09/14/2010 Approved Chris Carpenter Application Acceptance 09/14/2010 09/03/2010 09/03/2010 Application Accepted David Bowlsby Initial Review 09/14/2010 09/14/2010 09/14/2010 Approved David Bowlsby Public Works Review 09/24/2010 09/14/2010 09/14/2010 Approved Ben Gibson Permit Issuance 09/30/2010 09/29/2010 09/29/2010 Issued David Bowlsby Planning Review 09/20/2010 09/14/2010 09/14/2010 Approved Deyette Kelly Comments Received on 9-20-20101 Stor Springfield Building Permit 9/30f2010 11:41:19AM Page 3 of 5 .. .' www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00218 IVR Number: 811137953888 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@ci.springfieJd.or.us PROJECT STATUS: .Issued ISSUED: 9/30/10 APPLIED: 9/3/10 EXPIRES: 3/29/2011 VALUE: $56,300.00 SITE ADDRESS: 753 OLD ORCHARD Springfield ASSES OR'S PARCEL NO: 1703234307500 SCOPE: Single Family Residence WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Addition to Single family Dwelling 581 sf INSPECTIONS REQUIRED I Inspections 1110 Footing 1120 Foundation 1160 UFER Ground 1220 Underfloor framing 1260 Framing 1410 Underfloor insulation 1420 Insulation Vapor Barrier 1430 Insulation Wall 1440 Insulation Ceiling 1530 Exterior Shearwall 1540 Gypsum Board/LathlDrywall 1999 Final Building 2210 Underlloor Gas 2300 Rough Mechanical 2310 Rough Gas 2995 Final Gas 2999 Final Mechanical 3130 Footing/Foundation Drains 3170 Underlloor Plumbing 3500 Rough Plumbing 3999 Final Plumbing 4500 Rough Electrical 4999 Final Electrical Springfield Building Permit 9f30f2010 11:41:19AM Page 4 of 5 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2010-00218 IVR Number: 811137953888 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 pe rmilce nler@ci.springfield.or.us PROJECT STATUS: Issued ISSUED: 9/30/10 APPLIED: 9/3/10 EXPIRES: 3/29/2011 VALUE: $56.300,00 SITE ADDRESS: 753 OLD ORCHARD Springfield ASSESOR'S PARCEL NO: 1703234307500 SCOPE: Single Family Residence WORK INVOLVED: Addition TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Addition to Single family Dwelling 581 sf 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 or 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;- 30 -10 Owner or Contractor Signature Date Springfield Building Permit 9/30/2010 11:41:19AM Page 5 of 5 Electrical Permit Application BP~ l<mm'f@]p~~~ I ~ 225 Fifth Street+Springfield. OR 97477+ PH(54I)726-J753 t FAX(S41)726-3689 -- DEPARTMENT USE ONLY Pennitno.: SID- .2'6 Date: '1 J I D 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!or 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION Qg Residential I 0 Government I 0 Commercial JOB SITE INFORMATION AND LOCATION Job site address: 75) old OrAu1 L._r: City: ~h.'~ I: ( / j State: /)1( r ZIP: '17 n 7 Reference: I. II A,1':I I Taxlot.D1Eil? DESCRIPT!tlN OF WORK l2/t.1,;<.{ .p., n{v .Jj:f.~" PROPERTY OWNER Name: M:,,/.s?1 fLier Address: 75; O/) Ord...,d L "n~ City: S/r.~ f,-, /j State:,,~ I ZIP: 97~77 Phone:S'f1 -7'17- 6 f';} I Fax: - - E-mail: t r It 33 @. a.o/, L'", This installation is being made on residential or fann property owned by me or a memherofmy immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). , .......... Signature: '/rJ. /J ~ 7!Jf:- AI- CONTRACTOR INSTALLATION . Business name: Address: City: Phone: E-mail: CCB license no.: I BCD license no.: Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: State: I Fax: I ZIP: ~.,Q ~~ ~~ 440-2584-1 (9108/COM) FEE SCHEDULE Cost Total . Number of inspections per item () Qty. ea. cost Residential, per uo;4 5enrice iIKluded: 1.000 sq. ft. or less (4) I $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: instal/ation. alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconoect only (2) $ 63.00 $ Temporary senrlce5 or feeders: installation, alteration, relocation 200 amps or less (2) S 63.00 $ 201 to 400 amps (2) $ 87.00 $ 40J to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new. alteration, extension per panel a Fee for branch circuits with purchase ofa service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First braoch circuit (2) , $ 55.00 $ y. . Each edditiooal branch circuit A- $ 6.00 rJ}_ A... , Miscellaneous fees: service or feeder not included Each pump or inigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited--energy panel. $ 63.00 $ alteration; or extension (2) Eaeh additional inspection: (1) $58.00 $ APPLICANT USE (A) Eoter subtotal of above fees $lq, a: (Minimum Permit Fee $58.00) ... (B) Enter J2% surcharge (,)2 x [All $ V\.:. ) (C) Technology Fee (5%0f[AIl $:--') H :) TOTAL fees and surcbarges (A through C): n.... A'L ~\L. . ':..J rP O::J Mechanical Permit Application I <Omw@ff~~ 225 Fifth Street + Springfield, OR 97477 + PH(541)726-3753 + FAX(541)726-3689 DEPARTMENT USE ONLY I~ Date: This permit is issued under OAR 918-440-0050. Permits expire if work is not stnrted within 180 days of issuance or if work is suspended for 180 days. CATEGORY OF CONSTRUCTION .EI Residential 0 Government 0 Commercial JOB SITE INFORMATION AND LOCATION 7!ij U Drol-,,/ L-a....( .' I State: of- ZIP: q7~77 Taxlo DES. RIPTION OF WORK Jj.'I:", ~"v(.. ~,'> i.n Name: Address: City: Phone:5~{ -7~7- {, > E-mail: tr n e ....ol.<.~ This installation is being made on property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010. /7"- Signature: ~~ { 7~...!i CONTRACTOR INSTALLATION Business name: Address: City: Phone: E-mail: CCB license no,: Print name: ZIP: Signature: 440-2545.1 (ll108/COM) FEE SCHEDULE ResIdential Qly. Cost Total eo. cosl First A;;;;jiance I $79.00 $ urnace/burner including ducts and vents Up to lOOk BTUIhr, $17.00 $ Over lOOk BTUIhr. $20.00 $ Heaters/stoves/vents Unit heater $17.00 $ WoodIpellellgas stove/flue r $38,00 $ Repair/alter/add to heating appliancel refrigeration unit or cooling system! $58.00 $ absorption system Evaporated cooler $13,00 $ Vent fan with one duct/appliance vent \ $9.00 $ Hood with exhaust and duct $13.00 $ Floor furnace including vent $58.00 $ Gas pioinl! One to four outlets I I $7.00 I $ Additional outlets (each) I I $4.00 $ Air-handling units, including ducts Up to 10,000 CFM I I $11.00 $ Over 10,000 CFM I I $20.00 $ Comnressor/absorntion svstem/heat DumD Up to 3 hp/100k BTU I $17.00 $ Up to 15 hp/500k BTU $29.00 $ Up to 30 hp/I,OOO BTU $43.00 $ Up to 50 hp/l,750 BTU $57.00 $ Over 50 hp/I,750 BTU $95.00 $ Incinerators .' Domestic incinerator I I $20.00 $ Commercial Enter total valuation of mechanical system and installation costs S Enter fee based on valuation of mechanical system, etc. $ Miscellaneous fees Items Cost Total eo. cost Reinspection $58.00 $ Specially requested inspections (per hr,) $58.00 $ Regulated equipment (unclassed) $13,00 $ Each additioDal inspection: (1) $58.00 $ APPLICANT USE (A) Enter subtotal of above fees (or enter set minimum fee of $ I!.Ql!) $ (B) Investigative fee (equal to (A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ (D) Seismicfee, 1% (,01 x (A]) $ (E) Technology Fee (5% of(A]) $ TOTAL fees and surcharges (A lhrough E): $ It-P Structural Permit Application I <<:lJiJ\'f~~~ 225 Fifth Street +SpringfieJd, OR 97477. PH(541)726-3753. FAX(54I)726-3689 DEPARTMENT USE ONLY I ~ Permit no.: 5/0 -:21 S- Date: i 3 10 This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days ofissnance or if work is snspended for 180 days. LOCAL GOVERNMENT APPROVAL This project has final land-use approval. Signature: Date: This project has DEQ approval. Signature: Date: Zoning approval verified: Dyes DNo Property is within flood plain: Dyes DNo CATEGORY OF CONSTRUCTION S,Residential I 0 Government I 0 Commercial JOB SITE INFORMATION AND LOCATION Job site address: 753 old Oo./..rJ /..-"^t. City: 5 No'" i'dJ I State: 01(' I ZIP: '(7'(77 Subdivision: I Lotno.: Reference: 17C3 Z1'411 Taxlot: 07 SOO PROPERTY OWNER . Name: M:, h.,1 J.L"+'r Address: 7 5 3> o/) Or. I.. J Lt:t.-.. c City: >/r.\< -r:r jj State: ote I ZIP: q 7 'in Phone:,~f.7V7. {, ;-33 Fax: - - E-mail: Tf''l.. H €2 a...~i ~ (.O}'o'l This installation is being made on residential or fann property owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 701.010, Sign here: ~J t: 7~ l' CONTRACTOR INSTALLATION Business name: t":>W ~€I/L Address: City: Stale: I ZIP: Phone: - - Fax: - - E-mail: eeB license no.: Print name: Signature: SUB-CONTRACTOR INFORMATION Name CCB License Number Phone Number Electrical - T 8 0 Plumbing - r~ D Mechanical - T ~D FEE SCHEDULE 1. Valuation information (a) Job description: .A ~~ Il"/ ON Occupancy ~:a Construction type: ~R Square feet: F;81 Cost per square foot: Other infonnation: TypeufHcat: I-\-c:;.~ 7tA~( (M..v-rc.-G:>5 ) Euergy Patb: LJ.p.. ~ Dnew D alteration IKI addition (b) Foundation-only pennit? Dyes DNo Total valuation: I $ 'X.,. 'SOu 2. Bnilding fees . (a) Pennit fee (use valuation table): $ (b) Investigative fee (equal to [20]): $ (c) Reinspection ($ per hour): $ (number of hours x fee per bour) (d) Enter 12% surcharge (.12 x [2a+21>i-2c]): $ (e) Snhtotal offees ahnve (2a through 2d): $ 3. Plan review fees (a) Plan review (65% x pennit fee [20]): $ ""7.?4 >>; (b) Fire and life safety (40% x pennit fee [2a]): $ (e) Subtotal nffees ahove (3a and 3b): $ 4. Miscellaoeons fees (a) Seismic fee, 1% (.01 x pennit fee [2a]): $ TOTAL fees and su~barges (2e+3c+4a): S Plumbing Permit Application I <CUw@JP~~~ I~ 225Fifth Street + Springfield, OR 97477. PH(54I)726-3753 . FAX(54t)726-3689 DEPARTMENT USE ONLY Permit no.: 6/0 -;1-1 f Date: q 3 ID 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 snspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes DNo Sanitation approval verified? Dyes DNo CATEGORY OF CONSTRUCTION O!l Residential I 0 Government I 0 Commercial JOB SITE INFORMATION AND LOCATION Job site address: 753 o/J o rvku) La", t City: SAr.'"I.; I I State: M. t ZIP: 97'177..... Reference: H~ ,~^"- I Taxlot.U I" T } DESCRIPTION OF WORK 61v~ h ;,Q .(:,c ~.thro.~ I\~ .jJ;t:NI ~ PROPERTY OWNER Name: M;",..."I J.lvl\+.r Address: 753 old O.Lj L,,~< City: ~r.' . -f:, // I State:OK I ZIP: '17'177 Phone: 5"1{ - 7fl- , n , I Fax: - - E-mail: Tr t. 33 e ct. "I. c.o",- This installation is being made on residential or farm property owned by me or a member of my immediate family, and is exempt frOl~equirements under ~I8-695-0020. Signature: V C 7~ CONTRACTOR INSTALLATION Business name: Address: City: . I State: I ZIP: Phone: - - I Fax: - - E-mail: CCB license no.: I BCD license no.: Plumbing license no.: Print name: Signature: 44O-2500-J (11/08/COM) FEE SCHEDULE Description Qty. Cost Total ea. cost New residential I bathroom/l kitchen (includes: first J 00 feet of water/sewer lines, hose I $238.00 $ bibs, ice maker, underj/oor low-point drains and rain-drain packages) . 2 balbroomsll kitchen $374.00 $ 3 balbroomsll kitchen $439.00 $ Each additional bathroom (over 3) $95.00 $ Each additional kitchen (over 1) $95.00 $ Residential fire snrinklers (includes nlaD review) o to 2,000 square feet $58.00 $ 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 dwelling or pre-Cab (circle one) Connections to building sewer and $58.00 $ water supply Comme~ial, industrial, and dwellings other thaD one- or two-rami Minimum fee T I $58.00 I $ Each fixture I I $19.00 $ Miscellaneolls fees 100' stonn. sewer, water line $76.00 $ Each fixture, appurtenance, and piping $19.00 $ Stonn water retention/detention facility $19.00 $ Inigation systems $19.00 $ PIping or private stonn drainage $19.00 $ SYStems exceedin. Ibe first 100 feet Specialty fiXlw'es $19.00 $ Reinspection (no. ofhrs. x fee per hr.) $58.00 $ Special requested inspections (no. of $58.00 $ hrs. x fee per hr.) Eacb additional inspection: (1) $58.00 $ Medical'gas piping . Minimum fee $ Enter value of installation and equipment S- Enter fee based on installation and equipment value. $ APPLICANT USE (A) Enter subtotal of above fees $ (Minimum Pennit Fee $58,00) (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ (D) Technology Fee (5% of [A]) $ TOTAL rees and surcharges (A through D): $ I Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: D I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date D I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ~ I will be performing work on properly I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. MiL.t,~,,1 fLd<./ Print Name of Permit Applicant ~~.f Signature of Permit Applicant 9- 2- 7 -2D/D Date Permit #: SlD- 2-1~ 'IS3 6L.D a~~1hLD VFU> b(l .,"/ yl):') L.N Address: Issued by: Date: This Copy for Permit Offices WVffl. ci. springfield. or. U 5 TRANSACTION RECEIPT 811-SPR20 1 0-00218 753 OLD ORCHARD LN CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2010000432 RECORD NO: 81 I-SPR2010-00218 DATE: 09/30/2010 LOESCRip'nON'c,',' ;,' ,'cc:;,\ C'-&~::, ')"~,;c;' n ,: f"''''';'-rA>f'''''''4tf- ~ll"7';A--;-';r.-O"U-N''i';-';O'O'E'-l' -,' ".' -;'A'M' 'o"u' NT:O'U E' ,- "lfEe -'" -';'~___,_"'-:;;;':1>>:.1l.~.-,~,~.~.:.:-~~~~-":tl-bl;7ii.~1!,,tt7;~:;L .y.~~....,"" "\tv.,,.. . ,""'-. d..P'''' .'1" "'_.'m.m~._J::'.._",_,' ,.,"'. ", ,v.:i;~1 SDC: Reimbursement Cost - Storm Drainage _,__,,_' 441-00000-448029 ___ $10389 SDC: Total Sewer Administration Fee 719-00000-426604 $61.20 SDC: Improvement Cost - Local Wastewater 443-00000-448025 $304.22 SDC: Improvement Cost - Storm Drainage 440-00000-448028 $250,61 SDC: Reimbursement Cost - Local Wastewater 442-00000-448024 $565,18 Sink/basin/lavatory 224-00000-425603 $19,00 Residentia~Fire (.O~,Per Sq Foot) , 1 00-00000-424005 $35,80 !:~~ning - Minor Review, 100-00000-425002 $119,00 Structural Building Permit Fee 224-00000-425602 $499.34 Water closet 224-00000-425603 $19,00 Admir:!~J10% of applicablefee~) 224-00000:426605 $3,58 Bathtub 224-00000-425603 $19,00 _._-~,-,-_.,-'.~. ---~~---'-".- Balance of Minimum Plumbing Permit Fees 224-00000-425603 $1,00 Single-duct exhaust (bathrooms, toilet compartments, utility r~oms) 224-00000-425604 $9,00 First Appliance Fee 224-00000-425604 $79,00 Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55,00 Branch circuits without service or feeder - each additional 224-00000-426102 $24,00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $86,92 Technol09Y,~e (5%,Elpermit to~) 100-00000-425605 $36.22 TOl1AL OUE: $2,290,96 ~eAt1'!1~NT;jW-,~,~i);RAYQB'~:#;CAS.t1!ER15.82~~I~tf,tCQMi\iigN[i'Sli:'J'-l~ll<<~;;, i,:~i:1J~Tl;:;:AMOUt:!'Ii ;PAI,O;;:':':" " ,;:~-;,.j Credit Card 09264c HUNTER MICHAEL L II & KAREN M $2,290.96 $2,290.96