HomeMy WebLinkAboutPermit Building 2004-4-28 (2)
Status
Issued
.
. CITY OF SrKll~uFIELD .
Building/Combination Permit
PERMIT NO: COM2004-00480
ISSUED: 04/28/2004
APPLIED: 04/28/2004
EXPIRES: 10/28/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4795 FRANKLIN BLVD SPACE 3 Eugene
ASSESSOR'S PARCEL NO.: 1803022002900
TYPE OF WORK: Manufactured Home in
Park
TYPE OF USE: Sew Residential
PROJECT DESCRIPTION: MH in park
Owner: TROY KIRK
Address: 4795 FRANKLIN BLVD 31 EUGENE OR 97403
Contractor Type
Manuf Home Inst
Plumbing
PhonE, Number: 541-221-3097
I CONTRACTOR INFORMATION I
Contractor
JERRY OTT
OWNER
License
69455
Expiration Date
09/26/2004
PhDne
541-935-2696
, BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
SETBACKS
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer A vaUable:
Special Instruction:
Notes:
R-3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
VN
,,, ,c:amclt~tlI!~\'''''Jl'h.~~ATlON I
follow..'" . - = LJ- -...
Notlfloatlanc.M -,<r!WI'"
In OAR96NOt"IOIltsii$ti~
G09O. ~...,ClbCllltoo\y~~31'"
caDJnglht_ltll ~m~
flUmbel fDrthe o.~UiliiiJ
e.am..... 1ft AftA Aftft ftft......
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS'
Sidewalk Type:
Downspoutsmrai ns:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Pal!e 1 of3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Tvpe of Construction
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Manuf Home State Issuance
Manufactured Home Connection
Manufactured Home Placement
Total Amount Paid
.
I Valuation Descrintion I
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
. CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2004-00480
ISSUED: 04/28/2004
APPLIED: 04/28/2004
EXPIRES: 10/28/2004
VALUE:
Value
Date Calculated
Total Value of Project
Fpp<. PiilLI
Amount Paid
Date Paid
Recei:pt Number
1200400000000000561
1200400000000000561
1200400000000000561
1200400000000000561
1200400000000000561
To Request an inspectiDn call the 24 hDur 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 fDllowing work
day.
$20.50
$14.35
$30.00
$45.00
$160.00
4/28/04
4/28/04
4/28/04
4/28/04
4/28/04
I Manuf Home Set Up: When installation of all piers or stands is complete.
2 Final ManufHome Set Up: After all required inspections are requested and approved and porches, skirting,
decks, venting, street address numbers, trees, driveway, etc. have been installed.
3 Manuf Home Plumbing: After home has been connected to water and sewer.
$269.85
I Plan Reviews I
IRPn~
Paee 2 of3
.
. CITY (n' I)rKtl'lut<1J!..LJ.J
Building/Combination Permit
PERMIT NO: tCOM2004-00480
ISSUED: 04/28/2004
APPLIED: 04/28/2004
EXPIRES: 10/2812004
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection 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 of the property, and the approved set of plans will remain on the site at all
times d~~uctitdL y I z.;> )D~~ .
Owner or con~ors Signature Date
Paee 3 of3
. .
',.Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ceb.state.or.us
-.
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. .
. .
", "
. .'
Pennit #: COm zo*-o C)L( 8'0
Address: 479J ~~{........ a/vd fi
Issued by: ~ q Date: '-f / 2-r- /(1'1
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit '.lpplicants 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 befiled with the permit.
Fill in the ayy,vy,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B:
~1.
~2.
I own, reside in, or will reside in the completed structure.
~ 3A. My general CDntractor is
I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion.
-:s-~ O+f~1 On-
(Name) J4-<~/U:: /+u....c
6 '7Lj~r:-
(CCB #)
I will instruct my general contractor that all subcontractors who work on the: structure must be
licensed with the Construction Contractors Board.
OR
o 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 of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to pr~~er~onstruction Responsibilities on the reverse ~dj ;~:~~m.
(Signafute of permit applicant) (Date)
(White copy to issuing agency permit file, pink copy to applicant.)
r.~y__;Lowner.doc 03/11103
. ' .
Acting as Your )Own General Contractor?
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
,
..
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 will, 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 all 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' compe~sation insurance for your 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 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 will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal ElN 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, you are responsible for resolving any failure to meet code
requirements that may be brought to your attention through inspections.
Liability aud Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or
work that must be redone.
I r
Time: Make sure you have sufficient time to supervise your employees.
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
.
v~...
~
iiIti3 of Splringfield Official Receipt
_elDpment Services Department
Public Works Department
225 Fifth Street
SRringfleld, Oregon 97477
541':726-3759 Phone
Job/Journal Number
COM2004-00480
COM2004-00480
COM2004-00480
COM2004-00480
COM2004-00480
RECEIPT #:
1200400000000000561
Date: 04/28/2004
Description
Manufactured Home Placement
Manuf Home State Issuance
Manufactured Home Connection
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
CreditCard ROYCE KIRK
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 000368 028432 In Person
Payment Total:
4/28/2004
Page I of 1
2:21:24PM
Amount Due
160.00
30.00
45.00
14.35
20.50
$269.85
Amount PaId
$269.85
$269.85