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Home My WebLink AboutPermit Building 2007-8-9 CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2007-01071 ISSUED: 08/09/2007 APPLIED: 07/18/2007 EXPIRES: 02/09/2008 VALUE: $ 405,198.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2979 Yolanda Ave ASSESSOR'S PARCEL NO.: 1702193300802 Springfield TYPE OF WORK: Single Family Residence PROJECT DESCRIPTION: Single family residence TYPE OF USE: New Residential Sidewalk Type: A .lli>wnsp'outs/Drains: To Storm Sewer I I e:lffiON: Oregon Jaw requfres you to tofl.ow rules adopted by the Oregon UtIlity Notification Center. Those rules are set forth In OAR 952-001.0010 through OAR 952-001- 0090. You may obtain copies of the rules b calling the center. (Note: the telephone Y number for the Oregon Utility Notification Center Is 1-800-332-2344). Owner: JOEL & KOY A CRUTCHFIELD Address: 3582 AMBLESIDE DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type General Electrical Plumbing Contractor HOME STYLES INC EASTSIDE ELECTRIC INC DONALD CLEWIS License 89219 117770 167921 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: 1 R-3 U VB # of Stories: 2 Height of Structure: 34~00 Type of Heat: Forced Air Gas Water Type: Gas Range Type: Gas Energy Path: Path 1 Sprinkled Building: n/a 3 I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 53.00 13.00 12.00 70.00 0.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Urban Fringe 3 I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Partially Improved No Notes: NdMCIf:'ater to stub provided 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 of 4 Phone Number: 541-726-4015 Expiration Date 02/19/2008 10/04/2007 01/16/2008 Phone 541-345-8000 541-915-9828 541-688-1931 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 20,452 2,446 1,316 1,084 476 REQUIRED PARKING Total: Handicapped: Compact: 2 17.20 ~$P"INAJ'I~, 1~1I!lIJ~~1:! " , Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Description I Description $ Per Sq Ft or multiplier $19.00 $103.00 $27.00 Square Footage or Bid Amount 476.00 3,562.00 1,084.00 Tvpe of Construction Deck/Balconv Dwellinl!s Garal!e Deck V Wood Frame Garal!e Total Value of Project ~ CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2007-01071 ISSUED: 08/09/2007 APPLIED: 07/18/2007 EXPIRES: 02/09/2008 VALUE: $ 405,198.00 Value Date Calculated $9,044.00 $366,886.00 $29,268.00 $405,198.00 07/18/2007 07/18/2007 07/18/2007 Fee Description Amount Paid Date Paid Receipt Number Plan Review Residential $1,116.91 7/18/07 1200700000000000934 -Mech Iss 2+ Appliances- $40.00 8/9/07 2200700000000001273 + 10% Administrative Fee $283.84 8/9/07 2200700000000001273 + 5% Technology Fee $142.47 8/9/07 2200700000000001273 + 8% State Surcharge $205.79 8/9/07 2200700000000001273 3 Baths One & Two Family $337.00 8/9/07 2200700000000001273 Addressing Assignment $35.00 8/9/07 2200700000000001273 Building Permit $1,718.32 8/9/07 2200700000000001273 Copies - Ea Addtl @ 50 Cnts Ea $42.50 8/9/07 2200700000000001273 Copy 6th @ 75 cents $0.75 8/9/07 2200700000000001273 Dryer Vent $7.00 8/9/07 2200700000000001273 Exhaust Hoods $10.00 8/9/07 2200700000000001273 Fire SF Fee - Residential $266.10 8/9/07 2200700000000001273 Fireplace (Listed) $17.00 8/9/07 22007000000000D1273 Furnace - up to 100,000 btu $14.00 8/9/07 2200700000000001273 Gas Outlets 1-4 $5.00 8/9/07 2200700000000001273 Residence Wiring 1000 Sq Ft $117.00 8/9/07 2200700000000001273 Residence Wiring Ea Addtl 500 $189.00 8/9/07 2200700000000001273 Sanitary Sewer - 1st 50 Feet $50.00 8/9/07 2200700000000001273 SDC Transpo Admin $58.36 8/9/07 2200700000000001273 Storm Drainage Impervious Area $1,167.13 8/9/07 2200700000000001273 Storm Sewer Each Addtll00' $16.00 8/9/07 2200700000000001273 Temp Power 200 amps or less $55.00 8/9/07 2200700000000001273 UGB Plan Rev Mj/Min - Planning $277.00 8/9/07 2200700000000001273 Vent Fan $21.00 8/9/07 2200700000000001273 Water Line - Each Addtll00' $16.00 8/9/07 2200700000000001273 Total Amount Paid $6,208.17 I Plan Reviews I Pal!e 2 of 4 Building/Combination Permit PERMIT NO: cOM2007-01071 ISSUED: 08/0912007 APPLIED: 07/18/2007 EXPIRES: 02/09/2008 VALUE: $ 405,198.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review 07/19/2007 07/19/2007 APP LLH Planninl! Review Public Works Review 07120/2007 07/20/2007 08/03/2007 07/26/2007 APP WE TAJ BRC Public Works Review Structural Review 07/30/2007 08/01/2007 07/30/2007 08/08/2007 APP APP BRC LLH Structural Review 07120/2007 08/01/2007 10 LLH CITY OF SPRINGFIELD. Completed at 3:30. Will route to pw 1st thing in a.m. Friday, July 20, 2007. Exempt from Willamalane SDC. Okay to maintain address. See attached documents. Property had an existing home that was demolished and no information was provided for SDC credits. I contacted Joel (owner) and he is in the process off obtaining a site plan that shows sq ft and fixture to receive credit. Waiting for site plan to continue review. BC Stormwater to stub provided. Plans reviewed by Shawn Eaton with the Building Department under contract with the City of Springfield. Forwarded to the Building Department for review 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. ~eouiredJ'nsnections 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. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. 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. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Pal!e 3 of 4 CITY OF SPRINGFIELD. Status Issued Building/Combination Permit PERMIT NO: cOM2007-01071 ISSUED: 08/09/2007 APPLIED: 07/18/2007 EXPIRES: 02/09/2008 VALUE: $ 405,198.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line'is installed and iine has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. 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 aUhe 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 HmJi1;c:~~ Ow~rl~t;s Signature C ~ r q I DJ I Date Pal!e 4 of 4 ZON ltJrv INITIALS ~-- c.- :. DATE 1J.l/' ., L &) SOURCE I ;'^~~, ~ 1 \.C~ K}CLJ/U\ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (54])726-3689 ELECTRICAL PERMIT APPLICATION City Job Number 0 fl. \ m \ Date 1. LOCATION OF INST.ALL4TION: ~J\\q l/n\LtNitl ~e., LEGAL DESCRIPTION: \1())x:\~ ~CJfL. JCm DESCRIPTION: W-- ~ ~n~~;:~~e~p::::-~ not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRA..CTOR INST.ALLATION ONLY Electrical Contractor EA~51f)( G~((rR)c Address 3~) ~ ~ Bose A G-E LANE City Sf~LD Phone -7lf 1- I Lj~q N~JJkr;;r License N\llllhej:.. l. iJ:J 7, - S K TH\S PERMIT SHALL tXt-'I:l[ I. -~~t Woo- . AEk~ BdtJJ N D EJftfl=:l.\~ p-E,biS.lj) NOT CO\;1MENCEO UK I~ Abf\I'JOi:JttfD r6n f~s1ItH!~AYN'J,lli9D. II 77 7 0 I (j.- (<).00 '7 Expiration Date Signature of Supervising Electrician ~~1 )~ . Owners Name 0J\1rl1'1\~~ Address (~~ ~._Q CityW A Phone \ L\.(l~ O~ER Il~ST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. own';;Z~,~e: ~-/) ~/ // // '~.~ / /.p7/ /) /~..'I.~'L~./ -r'c ---'-'..J Inspection Request: 726-3769 3. C01\,fPLETE FEE SCHEDULE BELOlV A. New Residential- Single or Multi-Family per dwelling unH. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder \ ~ U~~ q ~ 1~. $50.00 B. Services or Feeders - Jnstallation, Alterations or Relocation: 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 C. Temporary Services or Feeders :fjc;J Installation, Alteration or Relocation .!:S5PCJ 200 Amps or less ~ 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps _ $100.00 Over 600 Am~~ ~r.}2~~~1od~ fg,~i '~'c\ab:~~O~ti~~'/ D. Brap,tilf~j~.C~~~~\~d:)~;ted b'f~~~~\~~e~e set 10r~ New Mt~~J!~~~I(~ensiJKIr.~6\f9'~~AR 95Z-00b- One ~k"h4i(;;9C:2-001-00i ~ ~ ~c~\es oi the $U.1~~Y E h . ~ld':";\ :,.k-I,....~'Jt()b\at\t~ ' . ~""e teieph6 , ac 1"I~~Ol~<U\ll..UUtLI."Dr :f.l ,'\\e..\ 1 . ,. uon Service ~~e~i:\Yt~r~e . ~ Ullill-\I Not\$I03':oo vC':'. -' th Qrecol' 44) \lumber 10r e. 1_800-33Z-Z3 . E. MiscellaIleou~t~iJ;/feeder not included) -Each Installation Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SUBTOT.AL OF ABOVE aJ 8% State Surcharge 10% Administrative Fee 5% Technology Fee TOTAL Shared Drive{T:)/Building Fonns/Electrical Pennit Appiication S-06.dof CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT WORKSHEET JOURNAL OR JOB NUMBER: COM2007-01071 - SDC Credits for previous home that was demolished- NAME OR COMPANY: Joel & Koya Crutchfield LOCATION: 2979 Y olanda Avenue TAX LOT NUMBER: 17-02-19-3300802 DEVELOPMENT TYPE: Single Family Residence NEW DWELLING UNITS 0 BUILDING SIZE (SF: 3373 LOT SIZE (SF): 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM IMPERVIOUS S.F. x I COST PER S.F. I I CHARGE 3373.00 I $0.346 I = $1,167.13 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. x DISCOUNT RATE I I 0.00 I I $0.346 50% I DISCOUNT $0_00 ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANlT ARY SEWER - CITY . A. REIMBURSEMENT COST: I NUMBER OF DFD's x I 18 $1,167.13 COST PER DFU I $26.83 I . B. IMPROVEMENT COST: I NUMBER OF DFD's I x I 18 I I COST PER DFU I $20.40 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = 1 $0.00 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE x I 9.57 B. IMPROVEMENT COST: ADT TRIP RATE x 9.57 I NUMBER OF UNITS x I 0 COST PER TRIP 20.43 x 'NEWTRIPFACTORI 1.00 I I NUMBER OF UNITS x I 0 x INEW TRIP FACTOR I 1.00 COST PER TRIP $90.10 $0.00 , ITEM 3 TOTAL - TRANSPORTATION SDC =1 4. SANlTARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's x I 0 ICOST PER FEU I $91.61 B. IMPROVEMENT COST: INUMBER OF FEU's x COST PER FEU I 0 $961.52 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = 1 $0.00 - ~-~ SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $1,167.13 5. ADMINISTRATIVE FEE: 20452 I $1,167.13 $0.00 I $0.00 r/) ~. Cl o u ~ ~ E-< r/) ...... o ~ $0.00 $0.00 = $0.00 1070 1091 1092 1093 1094 1054 = $0.00 1055 $0.00 11054 $0.00 11056 r I Billy Curtiss TOTAL SDC CHARGES I SUBTOTAL x ADM. FEE RATE 1= I $1,167.13 5% TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINlSTRATION FEE: CHARGE $58.36 PREPARED BY DATE 0.00 I 1079 $58.36 11078 =, $1,22S.49 I DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS IBATHTUB 3 1 3 = 6 DRJNKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 LAUNDRY TUB 2 0 2 = 4 CLOTHESW ASHER / MOP SINK 1 1 3 = 0 ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3 ISHOWER, SINGLE STALL 0 0 2 = 0 I SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 I SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 1 3 = 0 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 3 3 1 = 0 IURINAL, STALL / WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 3 2 3 = 3 MlSCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 18 *EDU (EQuivalent Dwelling Unit) is a discharge eQuivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULA TION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 CREDIT RATE/$I,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 $ 1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 2 IS LAND ELGlBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 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 , r - l'V r 1 .- IU'} J Permit #: v . Address:c9Qf}Q . t/()({]/)oioJ Issued by: I l!sJl, Date: 8-CLcn .. . . . . . . . . "0 ." 00.00 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 Statement: Information Notice to Property Owne~s . About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construct~on permit applicants whoare not licensed -With the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is requiredfor 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 stqtement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: , 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. 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 B. 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.. 1 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 00. the reverse side of this form. //Z U )~~'JC~/1 YBh/D; /"--~hrreOfP~HH~~PPlir I '...J I (Date) ( (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 , .'-. . ' _,;.. 1. -J \ ' ~A~tiJl1~ ~~.Y.o~\r'qWil'General ~~nt~act.or? , ..! \. \ 'iNFORMATION NOTICE TO PROPERTY OWNERS '. " ABOUT 'CONStRUCTION RESPONSIBILITIES "". ,.' NOTE: This information Notice to Properly Owners about constru~t~~'Responsibiliti~S-:~~~~V~/~;~ by th~e-- Construction Contractors Board in accordance with ORS 701,055(5), passed by the 1989 Oregon Legislature. Iilo _........ - .--------.-..-.~- 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 inst~ces; be ruled to be <Jll :~empioyer" and the contractors yq~contract with will be "employees" if you use contractors not licensed with the ~onstplction .Contract<;>rs Board tp do.labor in con~tr:ucting or to as~ist in the construction qr improvement ?f a residential s?u~~e: As the employer, you' must c~mply .with the ~ollowilllg: Oregon's Withholding Tax Law: As an ~ployer, you Imist withhold income taxes from employee wages at'the time employees are paid. You will be liable for th~ tax payments even if you don't actually withhold the tax from your employees. For more information, call the DepartmtmtOfReveritie at 503-378-4988.' .' Unemployment Insurance Tax: As an employer, you' are required to'jJay,a taxfor'unernploymentinsurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. "-t"i. . . The Oregon Business Identification Number (BIN) is a comb~ne~ number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or w'Ww.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to th~ Oregon Workers' Compensation Law, and must obtain workers' cViul'ensation insurance for your employees. If you fail to obtain workers' compensation insuran~e, 'you' couid'be subject to pdnalties ~d.be: liable fO~'aIYc1aim'cO$ts' if one ofyouf empt'oyees is injured on the job. For more information, call the Workers' Compensation Divi.sion at-the Department 'of Consumer antfBusiness Services at 503-947-7815. u.s. IntemaB lRevenue Service: As an employer, you must withhold' federal income tax. from employees' w~ges. . 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 visittheirweb site:at:\....'\<rwjrs.l2oy: ' , ' . Other Re-SII))OIDlsibiUti~$ and:A~eas 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 and Property Damage J1.nsuraIllCe:' 'Contact your insurance agent to see' if you 'have adequate insurance coverage for accidents ~nd omissions such as falling tools, paint. over spray, water damage from pipe punc;t_ures, fire or work that must be redo.ne. ' . . , . \. ;,' Time: Make sure you have sufficient time to supervise your employees. '\" '. " . . - '., '., ... ," . ":<<..:' .' ...". . " . . ' . Expertise: Make sure you have the skills to act as your own gClieral contnictor, 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 wTite the agency at PO Bqx 14140, Salem, OR 97309-5052. Property _ ovmer.doc 06-01-04 225 F,if.th' Street " Springfiel(j~ OFegon 97477 541-726:'3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-0 1 071 COM2007-01071 COM2007 -01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 COM2007-01071 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001273 Date: 08/09/2007 Description Copy 6th @ 75 cents Copies - Ea Addtl @ 50 Cnts Ea Addressing Assignment Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Temp Power 200 amps or less Fire SF Fee - Residential Storm Drainage Impervious Area SDC Transpo Admin UGB Plan Rev Mj/Min - Planning Building Permit 3 Baths One & Two Family Sanitary Sewer - 1st 50 Feet Water Line - Each Addtl 100' Storm Sewer Each Addtl 100' Furnace - up to 100,000 btu Vent Fan Exhaust Hoods Dryer Vent Gas Outlets 1-4 -Mech Iss 2+ Appliances- Fireplace (Listed) + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By KOY A CRUTCHFIELD Item Total: Check Number Authorization Received By Batch Number Number How Received Ilh 2039 In Person Payment Total: Page 1 of 1 1l:45:56AM Amount Due 0.75 42.50 35.00 117.00 189.00 55.00 266.10 1,167.13 58.36 277.00 1,718.32 337.00 50.00 16.00 16.00 14.00 21.00 10.00 7.00 5.00 40.00 17.00 142.47 205.79 283.84 $5,091.26 Amount Paid $5,091.26 $5,091.26 8/9/2007