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Home My WebLink AboutPermit Building 2004-10-25 CITY OF SPRINGFIELD' Building/Combination Permit Status Issued PERMIT NO: COM2004-01166 ISSUED: 10/25/2004 APPLIED: 09/21/2004 EXPIRES: 04/25/2005 VALUE: $ 32,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5216 FORSYTHIA DR Springfield TYPE OF WORK: Manufactured Home on ASSESSOR'S PARCEL NO.: 1802042102200 Private Lot TYPE OF USE: New Residential PROJECT DESCRIPTION: Replace existing 24x56 double wide MH w/ 28x40 double wide MH. Owner: NIBLER CURT M Address: 2085 RIVERVIEW ST EUGENE OR 97403 I CONTRACTOR INFORMATION I Contractor Type General Contractor DAVID CHARLES NIBLER License 135265 Expiration Date 05/12/2005 Phone 503-355-2557 BUILDING INFORMATION I 3 # of Stories: 1 Lot Size: Height of Structure Sq Ft 1st Floor: l\ntr.:nr.,!\~~e of Heat: \{I~ORt\q Ft 2nd Floor: u\J1\JI Yat\~n1fY3W\LL EXPIRE I c ~<<s NO~q Ft Basement: 1\1\5 ~..'a~~ge r~\~\)ER 1\1\5 PE~i'till r;ihR Sq Ft Garage/Carport AU1\1~Ii\! a,t~~:~~BANOONe~fi\f Sq Ft Other: COMISp-rti 1'Ii' i : n/a Occupant Load: ,',' .'\1"1 nrN p. . Ul\J. l 1 v.... - I DEVELOPMENT INFORMATION I 6,970 1,120 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 VN REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 20.00 5.00 5.00 55.00 5.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: 2 Yes 24.30 Total: Handicapped: Compact: 2 Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IW~QM~~n tavv requireS you. ~o . th Or~gon Utility follow rules adoptea by 'Si~~lrIWre~:forth Notification Center. Th~~~aRWoo.l:' in OAR 952~001 ~~t~?nt copies of the rules by 0090. You may (Note' the telephone calling the centoer. on Utility Notification mber for the reg \ nu \.:~~.... I 'SS~ ~Q?_?~44 . Notes: Description Type of Construction $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 4,000.00 Value Date Calculated Foundation Only Use Bid Amount Total Value of Project Pa2e 1 of3 $4,000.00 $4,000.00 09/21/2004 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description Plan Review Residential + 10% Administrative Fee + 7% State Surcharge Foundation Permit Manuf Home State Issuance Manufactured Home Conn - Plmb Manufactured Home Placement Plan Review Major - Planning Storm Sewer - 1st 50 Feet Temp Power 200 amps or less Total Amount Paid Initial Review Planninl! Review Public Works Review Structural Review CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01166 ISSUED: 10/2512004 APPLIED: 09/21/2004 EXPIRES: 04/25/2005 VALUE: $ 32,000.00 ~ Amount Paid Date Paid Receipt Number 2200400000000001179 1200400000000001511 1200400000000001511 1200400000000001511 1200400000000001511 1200400000000001511 1200400000000001511 1200400000000001511 1200400000000001511 1200400000000001511 $39.39 $36.06 $25.24 $60.60 $30.00 $45.00 $160.00 $103.00 $45.00 $50.00 9/21/04 10/25/04 10/25/04 10/25/04 10/25/04 10/25/04 10/25/04 10/25/04 10/25/04 10/25/04 09/23/2004 09/23/2004 $594.29 I Plan Reviews I 09/22/2004 APP SKG 10/08/2004 APP TAJ Needs survey because of minimum setbacks. 09/29/2004 APP CS New dwelling smaller than existing no SDC fee required 10/05/2004 APP DLM 09/23/2004 09/23/2004 To Request an inspection call the 24 hour recording at 726-3769. All inspection 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. ~eouire~"snectio"s I 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. Manuf Home Set Up: When installation of all piers or stands is complete. Final Building: After all required inspections have been requested and approved and the building is complete. Manuf Home Plumbing: After home has been connected to water and sewer. Storm Sewer Line: Prior to filling trench. Temporary Electric: Approval required prior to Utility Company energizing pole. MH Service: Approval required prior to utility company energizing service. Pal!e 2 of 3 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-01166 ISSUED: 10/25/2004 APPLIED: 09/21/2004 EXPIRES: 04/25/2005 VALUE: $ 32,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front ofthe property, and the approved set of plans will remain on the site at all times during construction. GJ-~4t4- ( tJ - ;< S-~ ?3? r Owner or Contractors Signature Date Paee 3 of 3 , 225 Fifth Street Spr!ngfield, Oregon 97477 541-726-3759 Phone r'ity of Springfield Official Receipt ;velopment Services Department Public Works Department Job/Journal Number COM2004-01166 COM2004-01166 COM2004-01166 COM2004-01166 COM2004-01166 COM2004-01166 COM2004-01166 COM2004-01166 COM2004-01166 Payments: Type of Payment Check 10/2512004 RECEIPT #: 1200400000000001511 Date: 10/25/2004 Description Temp Power 200 amps or less Foundation Permit Manufactured Home Placement Manuf Home State Issuance Storm Sewer - 1st 50 Feet Manufactured Home Conn - Plmb Plan Review Major - Planning + 7% State Surcharge + 10% Administrative Fee Paid By NIBS INVESTMENTS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 3004 In Person Payment Total: Page 1 of 1 2:30:16PM Amount Due 50.00 60.60 160.00 30.00 45,00 45.00 103.00 25.24 36.06 $554.90 Amount Paid $554.90 $554.90 "fl.' !", I ,.F';;~~'':''_'-' DEVELOPMENT SERVICES DEPARTMENT 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 MANUFACTURED HOME LAND USE AGREEMENT As required by the City of Springfield Development Code, I agree that with the approval of the attached permits, one of the following manufactured homes will be placed at '52~SyTJfJ.A 1: ~ Springfield, Oregon, City Job Number t!JJM~4--0/J~{, ~ Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thermal envelope meeting performance standards which reduce heat loss to levels equivalent to the performance standards required of single family dwellings constructed under the State Specialty Codes. Type II Manufactured Home, A unit of not less than 12 feet in width with an enclosed floor area of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width and that has no bare metal siding or roofing. The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of the enclosing material exposed above grade. I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60 days of the date oErssuance of the manufactured home set up permit. These requirements may include, but are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on your approved set up plans and/or permit and your partition approval if applicable: . Street Trees . Paving Driveway . Minimum 32 square foot storage structure . Completion of partition approval . Removal of any existing structures as noted on your partition approval . Signing and recording of any required partition, easement, improvement agreements, etc. . Final lot grading . City Sidewalk and curbcut installation . Any outside agency approval as required i.e" Division of State Land approval. By my signature below, I agree to complete the above mentioned land use requirements. x (' JA. /d4.. JIJ -.;z)'- /~ Owner Signature Date If\. X Contractor Signature Date f. '. Construction Contractors' Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: wWw.ccb.state.or.us" '. Addiess: Permit #: COW\. -z.o(.. ,- 0 I J bb . I S"Z( to ~otl-~ y+t/A , ~~. Date: 10 -z. S-' -O~ Issued by: Statement: Information Notice to Property Owners 'AboutConstruction Responsibilities Note: Oregon Law, ORS-701.055(4) 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 issu~d. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensedarchitect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this state'!"ent. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3Aor 3B: _ Kl. &J 2. I own, reside in, or will reside in the completed _s~cture. I understand that I must become licensed,as a construction contractor if the structure is sold or offered for 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 Construction Contractors Board. OR ~ 3B. I will be my own g~neralcontractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! change my 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 ofthe . name ofthe 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 o,n the reverse side of this form. ~/l~-' (Signature of permit applicant) I tJ ~- rJ.... '7,-tf' f (Date) (White coP,y to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 " I - Actin.'g as-~ ~'ui:- Own General Contractor?- ~ f ~\.~ . ", ,__' ,_ _ . - >, '-,' INFORMATION NOTICE TO ,PROPERTY OWNERS J ABOUT CONSTRUCTION RESPONSIBILITIES .: L. . (;"... .- - , NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the : Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contr~etor to cons'truet a new home or make a substantial iUlplovement to an existing structure, you ean prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled tobe an "employer" and the contractors you contract with will be "employees" if you use contractors not lifensed with the Construction ContracJors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comp~y with the followiug: Oregon's Withholding Tax,Law: As an employer, Y01.i"inust withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes', ~ on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. .' The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or w\vw.dor.state.or.us/foTInsnav.htmll for the appropriate fOTIns. "r ;. '.... Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain wor~ers' compensation insurance for yoW employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is inj1JIed on the job. For more infonnation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from cUlployees' 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 1-800-829-4933 or visit their web site at www.ii:s.!!ov. ' Other Responsibilities.and, Areas of Concerns . . ' .- Code Compliance: As the permit holder for this project, you are responsible for re~olving 'any failure to: meet code requirements that may be brought to your attention through inspections. . - , - Liability and Property Damage Insurance: Cont~ctyour insurance agent to see if you have adequate insurance' coverage for accidents and omissions such as falling tools, paint over water damage, from pipe punctures, fire or work that must be redone. ' Time: Make sure you have sufficient time to supervise your Expertise: Make sure you have the skills to act as your oWn and finish trades, and to notifY building officials as contractor, to coordinate the work of rough-in so they can perform the required inspections. If you have Box 14140, Salem, questions call the Construction 97309-5052. (503-378-4621) or write the agency at PO .' Property _ o\'vner.doc 06-01-04 ). ~\" ""'~. '.~ - 'J," . ~~. . ~\. -, .I" ,~ . . ~ . ! \ . . , . CITY O'P S~Rl;NqPIE~D'~"OREOOt;J. 'I. \~--'}. _ ' . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION n 1 /0' City Job Number ~ Date -3.j'2:5/!2j ,. r'" .', , .... " '.' ,. .' ,... "~'r'" ..... r,. ....',., 1. lii6f]ATi6&i?i.;flys'[.fiLI4T.I0'N:;,:....<},... ..ri 3. ;'CQM~Yf!.Jf.~~(Jl:rl}.I!,[l.p~,'!~~fo.W:.."i; """"'",,.-,"';,~,,,"-:";'''' ..~"c"'~~w.,....",'<w'-<.;;"''',,,,';,,<''''-',,.,.,.,,.;'-'.;&.,,.,,"v"":''"''=''''';''''''>''.-;;;~",.;~~;:;;;::,h...';;...iO:';;'''''\;;.A-i-e'..,,):,,;.,C, '''''_d<>''''''i"",""",:<~-.'--_.;.;,.,.."".!,,,,,;~,,,,,y.:I),~~~,,,,"~":",.,."^~.^"".;"~:;"":,,_,,,,,,.,.".'" .. -.--, .,-'.' "~';'''''''''''':'_h .---ql/ i7 .. Jl f\. "'o~ ~' .> L4 Ia rD r , ~o.. UL.. too:;> ~.., ",9 I . $~~bN;Or,'.X: Dr "Tfl~l1f~~14;~~~t EXPI fie AUTHORIZED UNDER THIS ~V~~'~l~ ~e~J COMMENCED UK I::' ABAI~D2o'~~~~H~ 400 Amps ANY 180 DAY PERIOD. 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only LEGAL DESCRIPTION -----1f50 2- D!d 2.1 0 2J -00 JOB DESCRIPTION J.Ao."u~,J, Ido~.- l/tl~~~1- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Contractor Address City 11 Phone Expiration Date ~~' oj Supervisor License Number Constr. Contr. Number Expiration Date Signature of Supervising Electrician Owners Name Gur}- f./ I hJt:.,1'"' Address 2013S- fLJIIu' r/Ja) 5.t!:. City ~ Phonif'f.0J If'l-I &0' OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: & CuJ4~ Inspection Request: 726-3769 A. Service r~u CI 1000 sq. ft. o~ss Each additional"~ sq. portion thereof (Si $10.6.0.0 $ 63.00. $ 75.00 $125.0.0 $163.00 $375.00 $ 50.00 C. Installation, Alteration or Relocation 200 Amps or less I 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 .._s-O $ 69.00 $100,00 . Over 600. Amps or 1000 Volts see "B" above. ~~-i .":<.: '; ";~'.:c ~,\/'J,':, D. ',' "e.~j,[ ~}teration or Extension Per Panel . fa~8&1i:~rl~.N: Or~ga. $ 43,00 . Not~aCh !iHlfh:tl~/it&@t!l1 lf~~I~eqLJires in 0 '8Jtb'ef'dllGisWRSf. p V the arc You to$ 3.0.0 H 91:: _ . has ~on Utili OO~? call n e C~nt~ Pies of th -- u~t9F ifll~~6n (Note: the t e rUles byS 50.00 Sigij]@NEgpe t!fJMl~gl Utility Nelephone $ 50..0.0 IS r,:Bnl'l'.2.~nr,.; otlTlcat' Limited EnergY/R:e'Si'a"'~344) IOn $ 25.0.0 Limited Energy/Commercial. $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. 50 -:5 -;-0 e;;OQ ~8 s;:- 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application (.03.doc