The URL can be used to link to this page

Home My WebLink AboutPermit Building 1996-9-3 ~"H ESJD ENTIAL PERMIT APPLICATION Inspections: 726-3769 Office: 726-3759 LOT: BLOCK: ;:Joa NUMBER C\, Lo \. \ ~~ '225 Fifth Street Springfield, Oregon 97477 TAX LOT: SUBDIVISION: ()~~o OWNE~~\ ~~a\-\~lli\\ \Qf\O., \~ ~~'\\ PHONE: , ADDR~4\0J~ (\n:~~~ AQ) AI (\':\<\\'Lo.l") CITY ~ {{\\C\: ' ~ d1-J - --~ STATE -0 \0 f)pl\ _ ZiP, l\'\ '\-lPJ DESCRIBE WORU ~ \:.<1--- \j\f}~().t\lJ(\~ c\J\ \.J\(,)cJ) 'l ~ \_hN NEW REMODEL ADDITION DEMOLISH O~~E:-<\ CON ST. CONTRACTOR It ( nc:)~ CONTRA9{'?R'S NA~ . ADDRESS GENERAL~V\(\ \~ll""J\~ PLUMBING: \J -, -- MECHANICAL: ELECTRICAL: ~~scq n,~~~~ - OFFICE USE - QUAD AREA: LAND USE:_, FLOOD PLAIN: It OF BLDGS: It OF UNITS: ZONING CODE: OCCY GROUP: CONSTR. TYPE: /I OF BDRMS: It OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER: RANGE: SQUARE FOOTAGE: To request an Inspection, you must call 726-3769, This Is a 24 hour recording. 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. D Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms, o Underslab Plumblngl Electricall Mechanical - Prior to cover. o FootIng - After trenches' are excavated. o Masonry - Steel location, bond beams, grouting. o Foundation - After forms are erected but prior to. concrete placement. q Underground Plumbing - Prior to' filling trench. D Underlloor Plumblng1 Mechanical - Prior to Insulation or decking, D Post and Beam - Prior to floor Insulation or decking, D Floor Insulation - Prior to decking. , D Sanitary Sewer - Prior to filling trench. D Storm Sewer - Prior to filling trench. D Water LIne trench. 'Prior to filling D Rough Plumbing - Prior to cover. REQUIRED INSPECTIONS D Rough Mechanical - Prior to cover. ~h Electrical - Prior to cover. ' ~ Electrical Service - Must be approved to obtain permanent electrical power. D Fireplace - Prior to facing materials and framing Insp. o Framing - Prior to cover. ~all/Celling Insulation - Prior to cover. ~ ~ Drywall - Prior to taping. o Wood Stove - After Installation. D Insert - After fireplace approv~1 and Installation of unit. o Curbcut & Approach - After forms are erected bllt prior to placement of concreto. o Sidewalk & Driveway - After excavation Is complete, forms and sub.base material In place, o Fence - WtlOn completed. D Street Treos - When all required trees are planted. D Final Plumbing - When all plumbing w9rl< Is complet,e. /" ~ Final Electrical - When all electrical work Is complete. o Final Mechanical - When all mechanical work Is complete. ~al Building - When all required Inspections have been approved and building Is completed. o Othor MOBILE HOME INSPECTIONS o Blocking and Set-Up - When all blocking Is complete. o Plumbing Connections - When home has been connected to water and sewer. o Electrical Connection - When blocking, set-up, and plumbing Inspections have been approved and the home Is connected to the service panel. o Final - After all required Inspections are approved and porches, skirting, decks, and venting have been Installed. Setbacks HSE GAR ACC lot faces lot Type lot sq. Itg. Interior I P.L. IN lot coverage Corner Topography Panhandle S Total height Cul-de-sac W IE BUILDING PERMIT ITEM SO, FT. X $1 SO. FT. Main Garage Carport Total Value Building Permit Fee Slale Surcharge Total Fee (A) VA lU E " _IJOOI'.CV C-X~~~ ~ I. (g ~I .y 0 SYSTEMS DEVELOPMENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM Fixtures Resldenllal Bath(s) NO Sanitary S~wer Water FT. FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan NO Wood Stovellnsert1Flreplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance Stale Surcharge Sidewalk 1\ Curbcul ft Demolition Slate Surchargfl Total Miscellaneous Permlis ~E) ," TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) FEE \~ro. \ \ ~ ( ,_ THE PROPOSED WORK iN THE, HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this appllcallon must be sIgned aild approved by the Historical Coordinator prior to permit Issuance. APPROVED: . I BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condlllon that the said construcllon shall. In all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construe lion and use of buildings, and may be suspended or revoked at any lime upon violation of any provisions of said ordinances. Plan Check Fee: Date Paid: Receipt Number: Received By: Plans Reviewed By Date Systems Development Charge Is due on all undeveloped properties within tile City limits which are being Improved. ADDITIONAL COMMENTS By slgnature, I stale and agree, thai I have carofully examined the completed appllcallon 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 Building Safety Division. I further certify that only contractors and employees who aro In compliance with ORS 701.055 will be used on this project. I further agree 10 ensure that all required Inspections are requested at the proper lime, that each address Is readable from lhe street, that the permit card Is located at the front of the property, and the approved sel of plans will remain on the~~" t;t7 dUrI5c~t10L , Slgnatu~1/~.-d- /~ -- Date /1-{~-CZ~ . 7 I - - ~ VALIDATION: I\~_ RECEIPT NUMAER oJ.. ~ DATE PAID l1. ~ G\ \...0 ~ AMOUNT REf~ED ' \ \~ .0-:) RECEIVED s;-:-r\ ~.J..)(\. ) , .. - L\~.O\\~S Address: ~<6 D (\~ N\o ~ ) Issued by: ~~fiD Date: q.~.q (0 Permit #: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered 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 registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill ~propriate blanks and initial boxes 1 and 2, and either box 3A or 3B: tLI 1. I own, reside in, or will reside in the completed structure. ~nderstand that I must register as a construction contractor if the structure is sold or offered for sale , before or upon completion. ~ 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR ~ I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the c.ontractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Pr~ Own, aA!;ons~Sponsibilities on the reverse side of this form. V~ ~I ~ !rJ!~~" F 9~ 3 -9h / ~'(7 (SIgnature of permit app~ (Date) (White copy to issuing agency permit file, pink copy to applicant) ...,;,'~ .~ -. 'i~ '" ___ J .--r'" " . , - .. ': . / I., :! ~ JIl11l~{())lJm~~o<<jfl1J N{())~u~~ ~(()) lPl1'{())lP~rt1f OWl11l~IJ$ , ,- ~\b)~!UJ~ C@ll'iJ~~~Ul~~u{())rru rR\~~[P)@U'il$u[b)u~o~O~$ <: ..' . . I ., , / ! . '\ , . 'i _., '. "-No'te: \ This Injormation;Nt?tice to Property Owners about Construction Responsibilities "wa:~ developed by the Construciikm Contractors Board in accordance with ORS 701.055(5). '\ 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 areas of concern. lEMl?lO VlElRllRllES[?OINlS~ lB3~Ul~ lE~: If you hire persons not registered with the Construction Contractors Board to do labor ~n constructing or assisting in the construction or improve~ent of a residential structure, you will, in most instances, be ruled to ~e an employer and the people you hire will be employees. As the employer, you mOst comp~y with the following: ' Oregon's withholding mx Raw: 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 more information, call the Oregon Depr. of Revenue at 945-8091. 1[]nempDoyment JinslUlJrance mx: 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 Division at the. Department of Human Resources at 378-'3524. ' " WOIr!keIrS' compensatnon JiH1lSUllIrOOce: As an employer, you are subject to the Oregon Workers' Compensation Law, and muS! obtain workers' ~ompensation insurance ~or your employees. If you fail to obtai!,! workers' compensation ~nsurance, you may be subject to pemilties and will be liable for all claim costs if one of your employees is injured on the job. For more informatiqn, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. u.s. KnteIrnaD lRevenUlJ(i~ Senice: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax paymerit even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTlHllElRllRllES[?OINl~~I8l~UT~lES AlNllOJ AlRllEAS O!F <C(QlINI<ClEfRllNI: "- Code compllllooce: As tl:1e permit holder for this project, you are responsible for resolving any failure to meet code requ~ments that may be brought to your attention through inspections. ---,_ , . '" LJiabiHity and pIroperty d~mageinsUJlJral1lce: Contact your insurance agent to see if you have ad~quate insurance coverage for accident, and omissions su~h as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to s1Upemse employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropr:iate times so they can perforf!1 the required inspections. \ \ \.. - ~ ..... If you have additional questions, write or call the Construction Contractors Board (PO Box 14.140, Saleril, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. -. ' ...'" '\ prop-own.pm4 1/94