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Home My WebLink AboutPermit Building 1995-2-21 ~~ LOCATION OF PROPOSED WORK: ~\ '22~ ~ '('\'{)~\) ~ ASSESSORS MAP: \f)O~~Q.~~ ~ OWNER: !.,:x.C\. \' ~ ) \< \'("'~Q ~ PHONE: \4:\. 7R:rq . 6c\?1~ -~f\- ~ ~L C'L -; :~~~ES~~~"'i~~~~o~QC9- STATE (\)lQ~~ ZIP 0:14lQ '~ESCRIBE'WORK:~f)\,,\\~)\~ Q~ b ~J'r\: ~_l_l) ~-f)()'(Y"\. NE,W'~ i:~, .. REMODEL~'ADDITION ~ DEMOUS'I"'!, <?!~ER\) () , CON ST. CONTRACTOR /I ~;;. ... ;j RESIDENTIAL PERMIT APPLICATION Inspections: 726-3769 Office: 726-3759 LOT: CONTRACTOR'S NAME GENERAL: PLUMBING: MECHANICAL: ELECTRICAL' 00"<';5<. , (' /I If QUAD AREA~~ /I OF BLDGS: \ OCCY GROUP:~~ , . \ /I OF STORIES' WATER HEATER: .... JOB NUMBER C\~ \()~ SPRINGFIELD BLOCK' ADDRESS -' OFFICE USE - \ l \ \ \ .. \/ AJ LAND USE: /I OF UNITS: CONSTR. TYPE: . . HEAT SOURCE: RANGE: 225 Fifth Street Springfield, Oregon 97477 TAX LOT: o~q.rr) SUBDIVISION: \ / / EXPIRES PHONE FLOOD PLAIN: ~ \~ ZONING CODE: /I OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: To request an Inspection, you must call 726-3769. This Is a 24 hour recording. All Inspections requested before 7:00a,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. D Underslab Plumbing/ Electrical/ Mechanical - Prior to cover. D Footing - After trenches are excavated. D Masonry - Steel locatlon, bond beams, grouting: D Foundation - After forms are erected but prior to concrete placement. D Underground Plumbing - Prior to filling trench. , D Underlloor Plumbing/Mechanical , - Prior to Insulation or decking. D Post and Beam - Prior to floor Insulation or decking. ~or Insulation - Prior to decking. D Sanitary Sewer - Prior to filling trench. D Storm Sewer - Prior to filling trench. o Water Line - Prior to filling trench. . 0 Rough Plumbing - Prior to cover. REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. ~U9h Electrical - Prior to cover. D Electrical Service - Must be . approved to obtain permanent 'electrical power. o Fireplace - Prior to faCing materials and framing Insp. ../ ~. Framing - Prior to cover. .".. . ~ Wall/Ceiling Insulation - Prior to cover. ~YWall - Prior to taping, D Wood Stovo - After Installation. D Insert - After fireplace a'pprovlll and Installation of unit. D Curbcut & Approach - A.fter forms are erected but prior to placement of concrete. \,'~ D Sidewalk & Driveway - After excavation Is complete, forms and sub-base material in place, D Fence - When completed. o Street Trees - When all required trees are planted. D Final Plumbing - When all plumbing worl~ Is complete, ~nal Electrical - When all electrical work is complete. D Final Mechanical - When all mechanical work is complete. ~al Building - When all required Inspections have been approved and building is completed. D Other MOBILE HOME INSPECTIONS o Blocking and Set-Up - When all blocking Is complete. D Plumbing Connections - When , home has been connected to water and sewer. D Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. D Final - After all required inspections are approved and porches,skirtlng, decks, and venting have been Installed, Lot faces Lot sq. ftg. Lot coverage Topography Total height BUILDING PERMIT ITEM SQ. FT. Main Garage Lot TYPl Inter'ior Corner Panhandle Cul.de.sac' , X $ISQ, FT. Carport ~ , C6J)//I;<<fl>} 190" /~.?'1 '~3SSC[~ , ~L5'a 3.$~ ~ ---':L.~-()7 ~.,- SYSTEMS DEVELOPMENT CHARGE (~C) (B) j2?~~ Total Value, Building Permit Fee Slale Surcharge Z. ?- 1 -f- J 31 Total Fee (A) PLUMBING PERMIT ITEM Fixtures Residential I?ath(s)' NO Sanitary Sewer FT. FT. Water Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge I P.L. IN Is 'Iw IE VALUE " sSS'7'.tTO FEE / / / MECHANICAL PERMIT (C) Furnace Exhaust Hood. Vent Fan NO Wood Stove/Insert/Fireplace Unit Dryer Vent Mechanical Permit / Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk ft Curbcut ft Demolition State Surcharge ~iJ .&'cv/@J.E6c A1JJjJ5r; ( Total Miscellaneous Permits (E) .' 3"er.3i_ j 52 ~iJ- TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, an.,!~' Combined) \'::.- .. .';:, ,:;, 1 ,'00 IS THE PROPOSED WORK tN THE. HISTORICAL DISTRICT. OR ON. THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior to permit Issuance. Setbacks HSE GAR Accl I I I I APPROVED:, BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, I'ncludlng the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at :~y ~":~ upon violation of a1-\ provirof said ordlnancj\\P-'"" Plan Check Fee: rlS ' . ~/i Dale Paid . . \.9/) % J:7?:/~ Recelp' N"mbcl ~ ~o \3}- . r~: ~~ Re~elved .: 0^.J:::::1r' ~ f - - -:::2/l? 4J~ r Plans eviewed By r ba~ Systems Development Charge Is due on all undeveloped. properties within the City limits which are being Improved. ADDITIONAL COMMENTS '/'Jf/v. C~~T p;t/"?7/' S~~~ rLl:q;btLA-L ,#~//- ~ Al~d<PB?), '". By signature, I stale 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 descrll:led ,', herein, and that NO OCCUPANCY will. be 'mad~ of any". structure without permission of the Bulldlilg Safety Division. . I further certify that only contractors and employees who are In compliance with ORS 701.055 wlll'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 Sl~e at all t'mes duri. co structlon. , 1_.. , Signature /L- Date/- ? 7 ~6 \ ~~ VALIDATION: \ -7Cf ~ RECEIPT NUMi\ER ,V;~ DATE PAID 0, ~\l\S~\ ' AMOUNT RECEI'(E.:cn 9/ \9(P RECEIVED BY 'f1\~f'rJ...-J Permit #: C(~ \ 19 ./ '- Address: L\\~~ 01\~ ~ Issued by: ~_l:j:L) DaleA,~\~ 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. Fil in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. \ 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. u 3A. My g~neral contractor is i j i i J,n OR ( I fl-;B. 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 contractor. (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. \.. 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 for~. ~ ~:4~~/~- ' OL~-~ / (SignahI;e tp~t applicant) '(Date) (White copy to issuing agency permit file, pink copy to applicant) .. ~'. -'-~- " ~ ~ t,. . . ..\:- ' ~ .. l ~ ']nfor~ati~n "Not~ce'to'Property Owners , /i;~bouJ Cori~tr,4ctioo .~e~ponsibmties "_I .. . _ ." " "'-;. _ "'" . ~_:_". _ . ... ;.~ . '~'f... . I I ' / / "-'" .'. ~_. -....... ., I " -.. ' " " . PlQte.>'This.Jnjormation Ndti~'e to Property Owners about Construction Responsibilitie; .' I J. _ ..:- ,..,', l;-.,. ~ was developed by tke ConstruCtion Co;ttractors 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 prev~nt many:pr~!:>lems by being aware of the.followiJ}g responsibilities and areas of concern. " ' :' 'EMPLOYER RESPONSIBILITIES: ';!- ; If you hire persons not registered wit].1 the Cotlstructi~n, Con!ractors, Board, ~o do labor in, constructing :or assisting in the construction or ifQpio.vemen(of a residential structure, you will, in most instances, be ruled to be an employer and the people . ~ .. l' ,- . . ~ . . .. you hire will b~ employees. As the employer, you must comply with the following: " . " ' .. . ,~ . .. . ~ ' ' . } . .. '., "." \ 'to'~ _. '.' . Oregon's withhoh~in~ b.x I~w: As an e~ployer, you mu~t withhold inc6fue't~es from employeewaie~ at the time employees are paid. Y ou ~illbe liable for the'tax payments even if you don't actualiy'withhold the tax froril'your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. . Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes qn the wages of all employees. For more information, call the.oregon Employment Division at the Department of Human Resources at 378-3524, Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obt;;lin workers' compe~sation insl,lrance for your employees. If YOl,l. fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injureq ()n thejop. For more information, call the Workers' Compensation Division at the Department of Consumer and Busiriess Services af 945-7888. U.s. Internal Revenue Service: As an employer, you must withhold federal incometax from'e'mployees' wages. You will be liable for the taX payment even if you didn't actually withhold 'the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. ' . . .' OTHER RESPONSIBILITIES AND AREAS OF CONCERN: -~ 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 insurance: Contact YOUl;insurance agent to see 'if y~u have adequate inst;J.rance covemr;e for accidents and omissions such as falling tools, paint overspray;.waterdamage from pipe punctures, fire, or wo~k that must be re-done. '. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make 'sure you have the e~perti~e to ~ct as your own gen~ral contractor, to coordin~te ~he wQrk of rough-in and fmish trades, and to notify building" officials' at the appropriate times so they can' perform the required inspections. ' If you have additional questions, write or call. the Construction Contractors Board (pO Box ,14140,-Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1/94 .' :1