HomeMy WebLinkAboutPermit Building 2003-11-12
Status
Issued
_' CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: cOM2003-01044
ISSUED: 11/12/2003
APPLIED: 10/14/2003
EXPIRES: 05/12/2004
VALUE: $ 9,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 303 S C St
ASSESSOR'S PARCEL NO.: 1703353400700
Springfield TYPE OF WORK: Foundation
TYPE OF USE:
PROJECT DESCRIPTION: Foundation and breezeway for moved house
New
Residential
Owner: LAURA FOUMAL
Address: 1750 WASHINGTON ST EUGENE OR 97401
Phone Number: 541-345-4751
I. CONTRACTOR INFORMATION.
Contractor Type
General
Plumbing
Contractor
OWNER
OWNER
License. Expiration Date Phone
I BUILDING INFORMATION.
# of Stories: 1 LObSi~,
~ight of Structure ~\~t...~"o.?r:
....~ e of Heat: ' JQSa~t ~ Itt6i:n::
~.... ~ .0 c;.; 0' (;,
VN ~ ter Type: ~ fi ~tJ~6!~eIRente.
~ ~~ ~ ~ge Type: ~ ,0 O'S~'Ft~arage/~a~~rt
&~ ~~ ~~~rgyPath: ,fbo ~0 ~q~otfe~~v1f
..S:~ ~<(j ~ ~<::-..o~ 9,,0<;~liW~~ioq~'~~face Area:
, ,~ f' f-}('). n-."J ~ r ^ . 't, _0 ~ .,.
,')..~ ~ ~ ~~bEVEL0PMENT INFORMjP'~lJ~""()~' vO~~0:-# 11
SETBACKS A.. ~,~<(j ~ ~. /;" ~'" 'lf~, \::)().... ~<::- ~o ~~~QUIREDPARKING
~. ..~, ~ ~'i;; ~<:;) ... ~ 0tJ:J (;0 " ~~. 0 ~
Front yard Setback: ~ ~. fS> . ~ ' Overlay Dist: ^<</ ,~~ \::)() 0 ~0 0CJj ~<::)Total: " , 2
Side 1 Setback: ~~ ~~ # &J<$>3..~ # Street Trees ~oO~ ~o~.,; ~~ v0~30<; "CO Handicapped:
Side 2 Setback: ~"".:~~..~...~ ~.OO . Paved Drive Rq~.~v'lfn..Q) ~ ;.<::-0 ~0",I,'.f.:' Compact:
.... ~.... ~. ~ ~ ~ - ~o "-.:: ~ :o<,e,'
Rearyard Setback: ~ \:::)~ ~ ,Cij % of Lot Coverage<? ,,0 !::), ~<::-O; 0$.~O'
Solar Setbacks: '-> ~ 0.00' ~t:::;)Oj v'lf # C
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
980
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS I
AC Mat
'"-
Sidewalk Type:
Downspouts/Drains:
Storm sewer to drainage ditch.
Notes:
Pal!:e 1 of 3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description Tvpe of Construction
Bid Amount Use Bid Amount
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: cOM2003-01044
ISSUED: 11/12/2003
APPLIED: 10/14/2003
EXPIRES: 05/12/2004
VALUE: $ 9,000.00
I Valuation Descriotion I
$ Per Sq Ft
or multiplier
$1.00
Square Footage,
or Bid Amount
9,000.00
, Value
Date Calculated
Total Value of Project
$9,000.00
$9,000.00
10/14/2003
~
Fee Description Amount Paid Date Paid Receipt Number
Curbcut - Overwidth Appl $35.00 10/14/03 1200200000000002314
Encroachment Permit $120.00 10/14/03 1200200000000002314
Plan Review Residential $64.74 10/14/03 1200200000000002313
+ 10% Adlministrative Fee $29.36 11/12/03 1200200000000002449
+ 7% State Surcharge $20.55 11/12/03 1200200000000002449
Addressing Assignment $8.00 11/12/03 1200200000000002449
Building ]>ermit $99.60 11/12/03 1200200000000002449
Moved Structure Plumbing Conn $45.00 11/12/03 1200200000000002449
Plan Review - Planning $59.00 11/12/03 1200200000000002449
Sanitary Sewer - 1st 50 Feet $45.00 11/12/03 1200200000000002449
Sanitary Sewer - Improvement $223.73 11/12/03 1200200000000002449
Sanitary Sewer - Reimbursement $294.32 11/12/03 1200200000000002449
SDC MWMC Administration $10.00 11/12/03 1200200000000002449
SDC MWMC Improvement $214.23 11/12/03 1200200000000002449
SDC MWMC Reimbursement $314.63 11/12/03 1200200000000002449
SDC Sanitary/Storm Admin $54.52 11/12/03 1200200000000002449
SDC Transpo Admin $58.57 11/12/03 1200200000000002449
SDC Transpo Improvement $727.42 11/12/03 1200200000000002449
SDC Transpo Reimbursement $164.89 11/12/03 1200200000000002449
Storm Drainage Impervious Area $312.62 11/12/03 1200200000000002449
Storm Sewer - 1st 50 Feet $45.00 11/12/03 1200200000000002449
Storm Sewer Each Addtll00' $14.00 11/12/03 1200200000000002449
Water Line - 1st 50 Feet $45.00 11/12/03 1200200000000002449
WilIamalane Attached (duplex) $924.00 11/12/03 1200200000000002449
Total Amount Paid $3,929.18
Initial Review
Planninl!: Review
10/14/2003
10/14/2003
I Plan Reviews'
10/14/2003
10/1512003
APP LLH
APP TAJ
This is considered a duplex because
the roofs tie at the rafters and the
foundations tie in.
Pal!:e 2 of3
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: cOM2003-01044
ISSUED: 11/12/2003
APPLIED: 10/14/2003
EXPIRES: 05/12/2004
VALUE: $ 9,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Public Works Review
10/16/2003 10/1612003 APP VRJ 2nd driveway approved as per
submitted plans, encroachment
permit for new sewer tap, street cut
and culvert has been applied for,
storm drainage to ditch.
10/14/2003 10/1512003 APP DLM
Structural Review
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.
I ReQuired InsDections .
1 Site Inspection: To be made after excavation but prior to setting forms.
2 Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
3 Footing: After trenches are excavated.
4 Foundation: After forms are erected but prior to concrete placement.
5 Post and Beam: Prior to floor insulation or decking.
6 Floor Insulation: Prior to decking.
7 Final Building: After all required inspections have been requested and approved and the building is complete.
S Underfloor Drain: Prior to cover or placement of concrete.
9 Water Line: Prior to filling trench and including required testing.
10 Sanitary Sewer Line: Prior to filling trench and including required testing.
11 Storm Sewer Line: Prior to filling trench.
12 Underfloor Plumbing: Prior to insulation or decking.
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
timCSda~nj;n\/{G~
Owner or Contradon signa'T
r nVfl/,L~LIYIW~
Dat~ / /
,
Pal!:e 3 of3
· 'p.~ -WilIamalane
" -:.J, j _ Park &. Recreation District Job. No. ~~O\U{t
~. SYSTEM DEVELOPMENT CHARGE
.) . WORKSHEET
NAME: ~,~ \=&m7(L . .
Ao6RESS: \'15{) \Cft~Y\ ~_J
LOCATION OF PROPOSE~ BUIlD~G SITE:
Street Address:- ,?f)~ btlllli. ~ !i,~
PIal Name: - t\~- Tax Lot Number: 'f\~~'.Y\ fY)1(X)
1 ~ '.DEVELOPMENT TYPE: (Check appropriate dwelling(s). SOC calculations and dwelfing 1
. ~e definitions are on the back}
PHONE: ~.6f\':>\
STATE: m..- ZIP:. ~Art1L
A. Single-Family Detach.ill!
Single Family home
,NO. OF UNITS
Manufactured home not in a park
X $1.000 per unit =$
, X $924 per unit . = .
, '.{fJ
$ (\'t:\..
NO. OF UNITS
X .$692 per unit - $
D. Manufacfumo Home ParK.
NO. OF UNITS
, WILLAMALANE SOC
X $699 per unit :::
$
$
QQA-.OO
(j
Q9~pO
2. SDC CREDIT (if applicable) SOc-payer must furnIsh proof of
Willamalane Credit approval. See sac Credit Worksheet. $
.---......
-" .
3. TOTAL W1LLAMALANE NET SDC ASSESSED
~f SOC reduced for Credit)
\ ,1\ (\ - )
~ _ _ J:;>(\n (_
Development se~\:~epartment
City of Springfield "
$
It
Date
I l'2... I o~
CITY OF S~NGFIELD SYSTE;,MS DEVELOPMEN1tQORKSHEET
JOURNAL OR JOB NUMBER: Com2003-01044
NAME OR COMPANY: Laura Foumal
LOCATION: 303 S 'C' Street
TAX LOT NUMBER: 17033534 t1700
DEVELOPMENT TYPE: One duplex unit added
NEW DWELLING UNITS I BUILDING SIZE (SF:
o
r/.l
I:.Ll
Q
o
U
p:::
r.I.l
IE-<
(/)
......
c.:;
~
LOT SIZE (SF):
o
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
IMPERVIOUS S.F. x I COST PER S.F. CHARGE I
1078.00 I $0.290 = $312.62
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. x I COST PER S.F. I x DISCOUNT RATE I DISCOUNT'
I 0.00 I $0.290 50% = I $0.00
ITEM 1 TOTAL - STORM DRAINAGE SDC
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:'
NUMBER OF DFU's x I COST PER DFU
13 I $22,64
B. IMPROVEMENT COST:
NUMBER OF DFU's x
13
COST PER DFU
$17.21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC
3, TRANSPORTATION
A. REIMBURSEMENT COST:
ADT TRIP RATE x NUMBER OF UNITS x
9.57 1
B. IMPROVEMENT COST:
ADT TRIP RATE
9.57
x I NUMBER OF UNITs
, I 1
ITEM 3 TOTAL - TRANSPORTATION SDC
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x COST PER FEU
I 1 I $314.63
B. IMPROVEMENT COST:
NUMBER OF FEU's x COST PER FEU
I $214.23
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER SD( = I
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = I
5. ADMINISTRATIVE FEE:
I SUBTOTAL x ADM. FEE RATE
I $2,261.84 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Virginia Jurasevich
PREPARED BY
10/16/2003
DATE
$312.62
$312.62
1070
$294.32
1091
$223.73
11092
= ,
$518.05
COST PER TRIP I x NEW TRIP FACTOR
$17.23 I 1.00
$164.89
1093
x I
I
= I
COST PER TRIP
$76,01
$892.31
x NEW TRIP FACTOR
1.00
$727.42
1094
= $314.63 1054
= , $214.23 11055
, $0.00 1054
, $10.00 'i 1056
$538.86 f
---
$2,261.84 I
CHARGE
$113.09
54.52 11079
$58.57
1078
TOTAL SDC CHARGES = , $2,374.93
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE .
,~
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW . OLD EQUIVALENT UNITS
IBATHTUB 1 0 3 I = 3
IDRINKING FOUNTAIN 0 0 1 = 0
I I FLOOR DRAIN 0 0 3 = 0
IINTERCEPTORS FOR GREASE / OIL 1 SOLIDS 1 ETC. 0 0 3 = 0
IINTERCEPTORS FOR SAND 1 AUTO WASH 1 ETC. 0 0 6 = 0
I LAUNDRY TUB 0 0 2 = 0
ICLOTHESWASHER/MOP SINK 1 0 3 = 3
ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (1 PER TRAILER) 0 0 12 = 0
IRECEPTOR FOR REFRIG 1 WATER STATIbN 1 ETC. 0 0 1 = 0
IRECEPTOR FOR COM. SINK 1 DISHWASHER 1 ETC. 0 0 3 = 0
ISHOWER, SINGLE STALL 0 0 2 = 0
SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3
SINK: COMMERCIAL BAR 0 0 2 = 0
SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 = 0
SINK: SINGLE LA V A TORY IRESIDENTIAL BAR 1 0 1 = 1
IURINAL, STALL/WALL 0 0 5 - 0
ITOILET, PUBLIC INSTALLATION 0 0 6 = 0
ITOILET, PRIVATE INST ALLA TION 1 0 3 = 3
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 13 i
.EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day ,
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR CREDIT RA TE/$I ,000
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 0
BEFORE 1979 $4.92 (Enter 1 for Yes, 2 for No)
1979 $4.92 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 0
1980 $4,83 (Enter 1 for Yes, 2 for No)
1981 $4.77 BASE YEAR 1979
1982 $4,64
1983 $4.47 CREDIT FOR LAND (IF APPLICABLE)
1984 $4,30 VALUE 1 1000 CREDIT RATE
1985 $4.09 $0.00 x $4.92 == ! $0.00
1986 $3,78
,I 1987 $3.41 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
I 1988 $2.98 VALUE 11000 CREDIT RATE
I 1989 $2,52 $0.00 x $4.92 ==! 0
I 1990 $2.06
1991 $1.64
1992 $1.45 TOTAL MWMC CREDIT = J $0.00
1993 $1.31
1994 $1.13
1995 $0.97
- 1996 $0.82
1997 $0.63
1998 $0.41
1999 $0,22
2000 $0.04
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01044
COM2003-0 1044
COM2003-0 1 044
COM2003-0 1 044
COM2003-0 1 044
COM2003-0 1 044
COM2003-01044
COM2003-01044
COM2003-01044
COM2003-0 1044
COM2003-0 1044
COM2003-0 1 044
COM2003-01044
COM2003-01044
COM2003-0 1044
COM2003-0 1044
COM2003-0 1 044
COM2003-0 1 044
COM2003-0 1 044
COM2003-0 1 044
COM2003-01044
Payments:
Type of Payment
Check
Paid By
Receipt #: 1200200000000002449
Description
Addressing Assignment
Willamalane Attached (duplex)
Building Permit
Sanitary Sewer - 1st 50 Feet
Water Line - 1st 50 Feet
Storm Sewer - 1 st 50 Feet
Moved Structure Plumbing Conn
Storm Sewer Each Addtl 100'
+ 7% State Surcharge
+ 10% Administrative Fee
Plan Review - Planning
Storm Drainage Impervious Area
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Transpo Reimbursement
SDC Transpo Improvement
SDC MWMC Improvement
SDC MWMC Administration
SDC Sanitary/Storm Admin
SDC Transpo Admin
SDC MWMC Reimbursement
Received By
Check Number
Batch Number Authorization Number
NATIONAL PROPERTY SERVICE Jmp
2895
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 11/12/2003
9:21:53AM
Amount Paid
Item Total:
8.00
924,00
99.60
45.00
45.00
45.00
45.00
14.00
20.55
29.36
59.00
312.62
294.32
223.73
164.89
727.42
214.23
10.00
54.52
58.57
314.63
$3,709.44
How Received
In Person
Payment Total:
Amount Paid
$3,709.44
$3,709.44
.
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
Permit#:Comz.oc..~ -6104c{ ~
Address:_~J'~ ~~~~
Issued by: cJ M P Date: l t - l-z.....O~
Statement: Information Notice to Property Owners
About Construction 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 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 I and 2, and either box 3A or 3B:
~1.
~ 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.
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
A 3B. I will be my own general 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 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 on the reverse side of this form.
~6bJ.~
(Signature of permit applicant)
[0/14(03
((Date)
(White copy to issuing agency permit file, pink copy to applicant.)
PropertLowner.doc 03/11/03
. '
. .'
Ac~~lng as Your Own General Contractor?
~~O~~~') . :.\ IN~~~~~~S~~~g~I~~ :~~;~~;TB~L~7::s
.
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.
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing
structure, you can prevent many problems by being aware of the following responsibilities and concerns.
Employer Responsibilities
You w11l, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if
you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the
construction or improvement of a residential structure. As the employer, you must comply with the following:
Oregon's Withholding Tax Law: As an employer, you must 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 a State Business ID number, call the Business Information Center at 503-986-2200.
Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes.
on the wages of an employees. For more information, call the Oregon Employment Department at 503-947-1488.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' compensatiol]. insurance for your employees. If you faH to obtain workers' compensation.
insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the
job. For more information, 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 employees' wages.
You wiII be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the
IRS at 866-816-2065 or fax them at 801-620-7115. .
Other Responsibilities and Areas of Concerns
Code Compliance: As the permit holder for this project, yo~ are responsible for resolving any failure to meet code
requirements that may be brought to your attention through inspections:
Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance
. coverage for accidents and omissionssuch as falling tools, paint over spray, water damage from pipe punctures, fire or
. work that must be redone.
Time: Make. sure you have sufficient time to supervise yo.ur el1!ployee~:
Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the 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 the Construction Contractors Board (503-378-4621) or write the agency at PO
Box 14140, Salem, OR 97309-5052.
Property _ owner. doc 03/11/03