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Home My WebLink AboutPermit Building 2007-7-23 \ A.O ~"l-- N -r^ '),,0'1 ~/;~ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2075 SCOTT RD ASSESSOR'S PARCEL NO.: 1703254300800 Springfield PROJECT DESCRIPTION: Garage conversion Owner: KUZELA MILADA M Address: 1026 5TH ST SPRINGFIELD OR 97477 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00996 ISSUED: 07/09/2007 APPLIED: 07/06/2007 EXPIRES: 01/23/2008 VALUE: $ 52,440.00 TYPE OF WORK: Garage Conversion TYPE OF USE: Alteration Residential Phone Number: 541-747-3541 I CONTRACTOR INFORMATION I Contractor Type General Electrical Mechanical Plumbing Contractor OWNER ARC ELECTRIC OWNER OWNER BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: VB License Expiration Date Phone 115113 07/29/2008 541-741-0494 1 Lot Size: Sq Ft 1st Floor: Wall Heat Sq Ft ~nd Floor: Electric Sq Ft Basement: Sq Ft Garage/Carport Path 1 Sq Ft Other: n/a Occupant Load: 690 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: . % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: I Yoult\?.UBLIC IMPROVEMENTS I mtm0N. Oregon law requ res. . . Stre~li"oWrU~em~~~pted by the Oregon UtilIty NOTlceeSidewalk Type: Sto:'~ft~~~8il\fte: Those rules are se~ ~~;~ es THIS PE_rSlWtll~J~E IF THE WORK SPt\flO~fi2tOO.1-001 ~ t~~ui~~ ~~~e9;UI~S by AUTHORIZED UNDER THIS PERMIT IS NOT 0090.. You may o~ta\r(NO~: the telephone COMMENCED OR IS ABANDONED FOR Note~:~~~r %~ f~~ ~~~gon Utility Notification ANY 180 DAY PERIOD. Center is 100800-332-2344). Pa2e 1 of 3 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00996 ISSUED: 07/09/2007 APPLIED: 07/06/2007 EXPIRES: 01123/2008 VALUE: $ 52,440.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-367b Fax 541-726-3769 Inspection Line I Valuation Description I Gara2e Conver. Gara2e $ Per Sq Ft or multiplier $76.00 Square Footage or Bid Amount 690.00 Value Date Calculated Description Tvpe of Construction Total Value of Project $52,440.00 $52,440.00 07/06/2007 ~ Fee Description Amount Paid Date Paid Receipt Number -Mechanical Issuance Fee- $20.00 7/9/07 2200700000000001101 + 10% Administrative Fee $51.42 7/9/07 2200700000000001101 + 5% Technology Fee $25.71 7/9/07 2200700000000001101 + 8% State Surcharge $41.14 7/9/07 2200700000000001101 Building Permit $421.21 7/9/07 2200700000000001101 Fixture $48.00 7/9/07 2200700000000001101 Minimum/Adjustment Mechanical $38.00 7/9/07 2200700000000001101 Sanitary Sewer - Improvement $138.53 7/9/07 2200700000000001101 Sanitary Sewer - Reimbursement $182.19 7/9/07 2200700000000001101 SDC Sanitary/Storm Admin $16.04 7/9/07 2200700000000001101 Vent Fan $7.00 7/9/07 2200700000000001101 + 10% Administrative Fee $5.00 7/23/07 2200700000000001179 + 5% Technology Fee $2.50 7/23/07 2200700000000001179 + 8% State Surcharge $4.00 7/23/07 2200700000000001179 Add, Alter, Extend Circ $48.00 7/23/07 2200700000000001179 Minimum/Adjustment Electrical $2.00 7/23/07 2200700000000001179 Total Amount Paid $1,050.74 I . Plan Reviews I PlanniDl! Review 07/06/2007 07/06/2007 DON TAJ Public Works Review 07/06/2007 07/06/2007 APP MS Structural Review 07/06/2007 07/06/2007 DON DJB 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. ~eouiredJnSDections I Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. Pa2e 2 of 3 CITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: COM2007-00996 ISSUED: 07/09/2007 APPLIED: 07/06/2007 EXPIRES: 01123/2008 VALUE: $ 52,440.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical 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 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. Owner or Contractors Signature Date Pa2e 3 of 3 City of Springfield Electrical Authorization To Begin Work E-mailedTo:arce.ecor@aol.com Receipt # EC514367 7/23/20078:26:13 AM Check on status of permit By Phone: (541)726-3753 or Email: permitcenter@ci.springfield.or.us D New construction Iil Addition/alteration/replacement [K] I or 2 family dwelling D Multi-family D Commercial/Industrial JOB srTE INFdR~~!I()N AND LOCATioN," I Job no.: I Job address: 2075 SCOTT RD I City/State/ZIP: SPRINGFIELD, OR 97477-7814 I Suite/bJdg./apt.no.: I Project name: Cross street/directions to job site: 21 st street to Scott Rd. I Subdivision: I Lot no.: I Tax map/parcel no.: 1703254300800 Add smoke detectors I Name: Lester Stoner 1 Phone: (541) 914-0317 Ex!: I Email: IFax: Ex!: I EI. lie. no.: 20-403C I CCB lie. no.: 115113 I Business Name: ARC ELECTRIC INC I Contact: Virgil I Address: PO BOX 1723 I City/State/ZIP: SPRINGFIELD OR 97477 1 Phone: (541 )741 0494 I Fax: (541 )7411685 I Email: arcelecor@aol.com I Metro lie. no.: I City lie. no.: I Supervising electrician's lie. no.: 4368S I Supervising electrician's name: STEPHEN M SEBASTIAN Upon review and approval by your local jurisdiction, your permit will be e-mailed or faxed within one business day, with instructions on how to schedule your inspection. NOTE: This Authorization To Begin Work expires within 180 days if a permit is not obtained. The local building department may determine that an Authorization To Begin Work is null and void if it does not meet applicable land use laws and local ordinances. I Description Qty. Ea. Total 1,000 sq. ft. or less I Ea. addl 500 sq. ft or portion I-Limited energy, residential (wIth above sq. ft.) I-Limited energy, multifamily residential fwith above sq ft) . I S.ervicesORfeede~in~'~i!~~10llf alteration, ANOioR rel~cation 1 200 amps or less 1201 amps to 400 amps 140 I amps to 599 amps 200 amps or less 1201 amps to 400 amps 140 I amps to 599 amps IBnlllc~,dr~~it(:. NEW, l\Jte,rNi,?nr!>R extellsio.~; per panel A. Fee for branch circuits with above service or feeder fee, each branch circuit. B. Fee for branch circuits without service or feeder fee, first branch circuit; each add I branch circuit $48.00 $48.00 I 1 1 I I I I Service reconnect only Each manufactured or modular dwell ing, service and/or feeder Pump or irrigation circle 1 Sign or outline lighting Signal circuit(s) or limited- energy panel, alteration, or extension. I I I 11........"..."..'.>'. .. 11 I , :",:-,-,_",>:_,':,.-,.-,_,n,',_' ,__-,--,__,_-,-__'__; __:_ _ _ ", '/"'1>1:1.'..'< -, .,--,--,.-:" .. '.,EL:ECTRIGAL PERMITt:=Ei:S", Subtotal $48.00 I Minimum fee used instead of Subtotal $50.00 I State Surcharge (8% of penn it fee) $4.00 I City Of Springfield fees · $7.50 I TOTAL PERMIT FEE $61.50 I 10% Local Admin Fee; 5% Local Technology Fee I I · City Of Springfield This Authorization To Begin Work must be posted at the job site until replaced by a Permit. 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 Payments: Type of Payment - ONLINE CHGS cReceint I RECEIPT #: 2200700000000001179 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee City of Springfield Official Receipt Development Services Department Public Works Department Date: 07/23/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received Paid By ONLINE PERMIT CHGS ddk Page 1 of 1 ONLINE Arc Electric Online Inc. Payment Total: 8:39:48AM Amount Due 48.00 2.00 2.50 4.00 5.00 $61.50 Amount Paid $61.50 $61.50 7/23/2007 " Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00996 ISSUED: 07/09/2007 APPLIED: 07/06/2007 EXPIRES: 01/09/2008 VALUE: $ 52,440.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2075 SCOTT RD ASSESSOR'S PARCEL NO.: 1703254300800 Springfield TYPE OF WORK: Garage Conversion TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Garage conversion Owner: KUZELA MILADA M Address: 1026 5TH ST SPRINGFIELD OR 97477 Phone Number: 541-747-3541 I CONTRACTOR INFORMATION I Contractor Type General Mechanical Plumbing Contractor OWNER OWNER OWNER License Expiration Date Phone BUILDING INFORMATION I VB # of Stories: Height of Structure: Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: 1 Lot Size: Sq Ft 1st Floor: Wall Heat Sq Ft 2nd Floor: Electric Sq Ft Basement: Sq Ft Garage/Carport Path 1 Sq Ft Other: n/a Occupant Load: 690 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive R~ Compact: % of Lot Cov~,ag~NTfON: Oregon law rAft I follow rules adopt d b "''''IU res you to Notifi,..~ti,.,... "';r:I. ef, Y the Oreaon Ut~ity I PUBLIC IMPRO~~~~~~~:t~~~~~6tRe=~ calling the cenfJr. ~9f the rule. by number for the Ok/f/Uft't:IitWWflt!..8j)hone Center Is 1-800-332.2344)~ Street Inmrovements: I~OTlCJ:' Storm S~illr~jl.'tIl\ble: Yes Special IA f\lctis~MIT SHAll EXPIRE IF THE WORK THORIZED UNDER THIS PER Notes: COMMENCED OR IS ABANDON MIT IS NOT i~NY 180 DAY PERIOD. EO FOR Paee 1 of 3 , . Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00996 ISSUED: 07/09/2007 APPLIED: 07/06/2007 EXPIRES: 01/09/2008 VALUE: $ 52,440.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Garafe Conver. Garafe $ Per Sq Ft or multiplier $76.00 Square Footage or Bid Amount 690.00 Value Date Calculated Description Tvpe of Construction Total Value of Project $52,440.00 $52,440.00 07/06/2007 ~ Fee Description Amount Paid Date Paid Receipt Number -Mechanical Issuance Fee- $20.00 7/9/07 2200700000000001101 + 10% Administrative Fee $51.42 7/9/07 2200700000000001101 + 5% Technology Fee $25.71 7/9/07 2200700000000001101 + 8% State Surcharge $41.14 7/9/07 2200700000000001101 Building Permit $421.21 7/9/07 2200700000000001101 Fixture $48.00 7/9/07 2200700000000001101 Minimum/Adjustment Mechanical $38.00 7/9/07 2200700000000001101 Sanitary Sewer - Improvement $138.53 7/9/07 2200700000000001101 Sanitary Sewer - Reimbursement $182.19 7/9/07 2200700000000001101 SDC Sanitary/Storm Admin $16.04 7/9/07 2200700000000001101 Vent Fan $7.00 7/9/07 2200700000000001101 Total Amount Paid $989.24 I Plan Reviews I Planninf Review 07/06/2007 07/0612007 DON TAJ Public Works Review 07/06/2007 07/06/2007 APP MS Structural Review 07/06/2007 07/06/2007 DON DJB 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. Wan Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Final Building: After an required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When an plumbing work is complete. Rough Mechanical: Prior to Cover Pafe 2 of 3 ~ Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-00996 ISSUED: 07/09/2007 APPLIED: 07/06/2007 EXPIRES: 01/09/2008 VALUE: $ 52,440.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Mechanical: 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 mad of ny structure without permission of the Community Services Division, Building Safety. I further ce?ify that only contracto s ano employees who are in compliance with ORS 701.005 wiH be used on this project. I further ag,fee to ensure that all requ'red1inspeu<ions are requested at the proper time, that each address is readable from the street, tha/the per~t card is located tithe fd It ofthe property, and the approved set of plans will remain on the site at all tim7n~c~'\:~ ~,t~~^, 1 ~ 9 -co 7 own~ '{~",Q1natnre V Date Paee 3 of 3 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET - - JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER:" DEVELOPMENT TYPE: NEW DWELLING UNITS ]. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I 0.00 ., $0.336 = $0.00 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. x COST PER S.F. x DISCOUNT RATE I I 0.00 $0.336 50% " = I C0M2007-00996 Milada KuzeIa 2075 Scott Road' ] 7032543 TL 00800 Addition to SFR o BUILDING SIZE (SF: o LOT SIZE (SF): o r/) W Cl o U ~ W E-< r/) ...... o ~ " DISCOUNT $0.00 ITEM 1 TOTAL ~ STORM DRAINAGE SDC 2, SANITARY SEWER - CITY A. REIMBURSEMENT COST: NUMBER OF DFU's 'I x 7 I $0.00 $0.00 11070 COST PER DFU $26.03 $182.19 1091 B. IMPROVEMENT COST: I NUMBER OF DFU's x I 7 I $]9.79 $138.53 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , $320.72 3. TRANSPORTATION A. REIMBURSEMENT COST: ADT TRIP RATE I x NUMBER OF UNITS x I COST PER TRIP x INEW TRIP FACTOR 9.57 I 0 I $]9.8] I LOO $0.00 1093 B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x COST PER ,TRJ]> x I NEW TRIP FACTORI I 9.57 I I 0 I $87.39 I 1.00 I $0.00 1094 ITEM 3 TOTAL - TRANSPORTATION SDC =, $0.00 4. SANITARY SEWER - MWMC I A. REIMBURSEMENT COST: INUMBER OF FEU's x COST PER FEU I 0 $91.61 = $0.00 1054 B. IMPROVEMENT COST: NUMBER OF FEU's I x ICOST PER FEU 0 , ,. $961.52 = , $0.00 1055 MWMC CREDIT IF APPLICABLE (SEE REV,ERSE) , $0.00 1054 MWMC ADMINISTRATIVE FEE f $0.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, $0.00 SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $320.72 "-. ""- ---- - 5. ADMINISTRATIVE FEE: I SUBTOTAL x ADM. FEE RATE , $320.72 5% . TOTAL $ANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: CHARGE $]6.04 ]6.04 $0.00 1079 I 11078 Matt Stouder 7/612007 TOTAL SDC CHARGES =' , $336.76 PREPARED BY DATE _.~....-. . - --_.~-- - DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONI.. Y TIlE NET ADDmONAL FIXTIJRES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATIITUB 1 0 3 = 3 IDRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 IINTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 0 0 3 = 0 CLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 MOBILE HOME PARK TRAP (l PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 0 0 3 = 0 SHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 = 0 SINK: COMMERCIAL BAR 0 0 2 = 0 I SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 1 0 1 = 1 IURINAL, STALL/WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 1 0 3 = 3 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 7 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 . 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$l,OOO ASSESSED VALUE $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4;07 $3.67 $3.22 $2.73 $2.25 .. $1.80 $1.59 $1045 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 IS LAND ELGlBLE FOR ANNEXATION CREDIT? (Enter 1 for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 = , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE/1000 CREDIT RATE $0.00 x $5.29 o = $0.00 TOTAL MWMC CREDIT '. 1 Permit J. _ nm )/iD1 - (ffiti tr Address' D/Q "- % PJ If Q;f) S'ate~ent: Information Notice to Property Owners About Construction Responsibilities ", 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 Note.~ Oregon Law, ORS 701.055(4) requires residential constrnction permit applicants who are not licensed with the Constrnction Contractors Board to sign the following statement before a 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. , ' . . Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. D. 2, . I own, reside In, or will reside in the completed structure. 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 ~ho work on the structure must be licensed with the Constructio~ Contractors Board. OR ~B. I will be my own gener:al contractor. 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 contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name 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. ~~ 'Ott. ~~ ,'1;;- /h~' 07 (SigIiatureofpermit ~lic~t) . . .. Il 7 (Date)/ , (White copy to issuing agency permit file, pink c/p/to applicant.) Property_owner. doc 06-0J-04 : 1.. .. . . ", " '- ~BpUT -:.._-~-_._'" - NOTE: This Information Notice to Properly Construction Contractors Board in about Construction Responsibilities was developed by the with ORS by the 1989 Oregon Legislature. own contractor to construct a new problems by being aware ~ ~ubstan'tial improvement to an ' concerns. be ruled to ~1;i "employer" with the . of a residential structure. you contract with will be HempI,:,>yees" if or to assist in the the fQUowing: You will, you u~e contractors not construction or income taxes from employee wages at the time withhold the from your employees ~re employees. more 'I : -~ on As an For more unemploynient insurance purP~se} . at 503-947-1488. t<...... t_'.I- ." !.';. ~ .~- ~'_. . . .... '.""1 ..: .-, {or,; both. Oregon Withh91ding .us/formsnav,htmll for the Insurance: As an :' ; Workers' Compensation Law, Jai..Jt. 0 .o.btain workers' c<?mpensation. of your employees is injured on the' Consm:net and Business . As an the tax payment even or Visit their web income tax tax. For a . -', Y wages:, EIN number, can the .'L" . ~ '. failure to meet code 'to seeifyc')U have adequate insurance water pipe punctures, fire or such as \. -- " to your to coordinate can inspections. or the at PO , 225 Fifth Street Springfield, 'Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00996 CO M2007 -00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 COM2007-00996 Payments: Type of Payment Check cReceintl City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2200700000000001101 Date: 07/09/2007 Description Fixture Vent Fan Minimum/Adjustment Mechanical -Mechanical Jssuance Fee- Building Permit + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Paid By MILADA M. KUZELA Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 2310 In Person Payment Total: Page 1 of 1 2:45:35PM Amount Due 48.00 7.00 38.00 20.00 421.21 25.71 41.14 51.42 182.19 138.53 16.04 $989.24 Amount Paid $989.24 $989.24 7/9/2007