HomeMy WebLinkAboutPermit Building 1992-10-12
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RESIDENTIAL
PERMIT APPLICATION
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,
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
LOT:
OWNER:
ADDRESS:
CITY:
DESCRIBE WORK:
NEW
REMODEL
CONTRACTOR'S NAME
O~V
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL:
QUAD AREA:
'2- ~5 <;: .
1
M
I
1/ OF-BLDGS:
OCCY GROUP:
II OF STORIES:
WATER HEATER:
SPRINGFIELD
~-
40~q ~~__~
l,o:>"3)4Y
BLOCK'
ADDITION
DEMOLISH
OTHEF1___
JOB NUMBER ~ ~ ) ~ J~_
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
o /(/7~5
----..-- --
SUBDIVISION:
ZIP: ._._ __9:1-"1:_7 ~
ADDRESS
CONST.
CONTRACTon II
EXPIIlES
PHONE
- OFFICE USE -
LAND USE:_
U_L L __ _, ____n
FLOOD PLAIN:
ZONING CODE: __J-D fL.--.
H OF BDRMS: _
SECONDARY HEAT: _ _________
SQUARE FOOTAGE:__3fi1L_____n
To request an inspection, you must call 726,3769. This Is a 24 hour recorcling_ All inspections requested before 7:00 a_m_ will be
made the same worl<ing day, inspections requested after 7:00 a,fl1, will be 1rI<ldc the followinp worl< clay,
o Temporary Electric
o
Site Inspection - To be made
after excavation, but prior to
setting lorms_
o
Underslab Plumbing/ Electrical!
Mechanical - Prior to cover.
~ Footing - After trenches are
~ excavated,
o
Masonry - Steel location, bond
beams, grouting,
o
Foundation - After forms are
erected but prior to concrete
placement.
D
Underground Plumbing - Prior
to filling trench.
D
Underlloor Plumbing I Mechanical
_ Prior to Insulation or decking.
o
Post and Beam - Prior to floor
insulation or c1ecl<ing,
o Floor Insulation - Prior te
decki ng,
o
Sanitary Sewer - Prior to filling
trench,
o Storm Sewer - Prior to filling
trench,
D Water Line - Prior to filling
trench. "
o Rough Plumbing - Prior to
cover.
# OF UNITS:
CONSTR. TYPE:
V-M.. --00--
HEAT SOUF1CE: ________._ ..
RANGE:
REQUIRED INSPECTIONS
o Rough Meclwnical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtai n perll1anen I
electrical powe~
o
Fireplace - Prior to facing
materials and framing Insp,
~ Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover,
o Drywall - Prior to taping,
D Wood Stove - Aller install;lliol1,
o Insert - Alter liruplilcn approv;i1
and Installation 01 unit.
~ Curbcut & Approach - After
~ forms are erected but prior 10
placement or concrete,
K7I' Sidewalk & Driveway - Aller
~ excavation is complete, forms
and sub,base material in place,
D Fence - When completed_
D Street Trees - Wilen all requirecl
trees are planted. -
I~I
Final Plulllbin~J - Wilen all
plul11IJinn worl< is cUI11plrJte,
1--1 Fil1al Electrical - Wilen all
-- electrical work is cOlllplete,
I~ Final Mechanical - When all
mechanical work is complete_
J5<:[ Final Building - When all
required inspections have been
approved and building is
completed,
D Other
MOBILE HOME INSPECTIONS
CI Blocking ;lI1d Set-Up - When all
- blocldnq is COfllp!.-~I(~_
[~ Plulllbin~J Connections - Wilen
home has been connected to
water and sewc~
[J
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, skirting, decks, and
venting have been installed,
Lot laces
Lot Type
Lot sq, ltg,
Interior
Lot coveragc
I
Corner
Topography
Panhandlc
Total height
Cul-clc'sac
BUILDING PERMIT
ITEM
SQ_ FT.
X $/SO, FT
Main
Garagc
t."...
l 'v-THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
I( yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance_
- t..,.
Sc t1)ac I~s
PL_ HSE GAR ACC
-.--- ---- ---
N
s
W
E
VALUE
Carport
?:}+D
10 . LO_ _3Y~L.fOO
PLUMBING PERMIT
ITEM
Fi xtu res
Residential Battl(s) NO
Sanitary Sewer FT
'Water FT.
'Storm Sewer FT
Mobile Horne
Plumbing Permit
State Surctwrge
Total, Chargc
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hoocl
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
/2 ft
Curbcut J2-_ ft
Demolition
State Surctlarge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combinerl)
FEE
-Lt SO
~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, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
:l5? .C}~
q-It.f--0~
Datc Paid:
Receipt Number:__Ct:2I9.L.J
z>.JB
Received By:
--~~~
Plans, Flevlewecl By
_/LJh/9~
"Detro .
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved,
ADDITIONAL COMMENTS
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 sllall be done in accordance'
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to, the wort< 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
are In compliance with ORS 701.055 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 proper:ty, and the approved set of plans will remain
on the site at all times during construction.
.)!signal"~ )7 /n'~
Date J t:J - I?-- ..9 ~
VALIDATION:
RECEIPT NUMBER b 7"~z.
_23.'-tJ DATE PAID I&>"72. 9"2-
____~3-.. AMOUNT RECEIVED /B.!:5' c......
_.___________.~ __.~~CEIVED BY ___~.u-.~:..!...-_--__. __
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'-lOB NO ~ q-zrz..., 9
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
. WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: ~ME.,=, Moof2.E.
LOCATION: Y-o 2- '1 C-A M E:: L L I A ~,..
DEVELOPMENT TYPE: Lve- A-p'p C.tlo.I2-PDJ::.T
110 2. ~ \ y-y - 0 I L:> 3 S
BUILDING SIZE: \""1.t 7.-0
LOT SIZE
SQ. Ft.
1 STORM DRAINAGE ,c.A~PO~"" Ie? ovEIL E:.)(.t<;;>'T. Vll-IvE
. ...., e:.. oN "J:M fE'. ~\I. A ~It- =- Z 'I'- z..z
IMPERVIOUS SQ. FT. LtY , X $0.192 PER SQ. FT.
c;- ~~~)
----- --
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
X $39.78 PER PFU
c;--)
----- --
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X $401. 05
X $401,.05
X $401. 05
G'-)
----- ---
X
X
$
$
r-
SUBTOTAL (ADD ITEMS 1,2, & 3) $ ~.~
4. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
C;-bO~)
----- --
TOTAL-CITY SDC ~~9
5. SANITARY SEWER-MWMC
NO. OF PFU'S x $13.62 PER PFU + $10 MWMCADMIN. FEE $ ---
(Use PFU Total From Item 2 Above)
v.~~
() Kip Burdick
SDC Coordinator
'l /llP/ tt~
, I
$--
TOTAL.MWMC SOC~~
TOTAL SDC $ <64-~
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
.,.. ..
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. Permit No: ?;2/-:Z79
Address: . ~~~~. ~_7r- -
Issued by: a Date: /C>-~:::_
/ ., .
FOR OFFICE USE ONLY
ST A TEM ENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon La~, ORS 701.055(4) j requires residentia,1 construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
meot is required for residential building, electrical, mechanical, and plumbing
permits. Licensed ArctJitect 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 in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: ,
1 .
y
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 cO'mpletion.
3. A.I
I My general contractor is
Contractor registration number
I will instruct illy general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board. '
- - -
OR
3. B.I
I I will be my own general contractor. '
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I 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 understand
the Information Notice to Property Owners about Construction Respon,sibilities on the
reverse side of this form.
,-
, ";2"'>-vt ~ .
ignature of Permif Applicant-
} 0 - I <1- _ - 7~
Date
CONSTRUCTION CONTRACTORS BOARD ,
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
lw,. . , \
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r
INFOh.lflATION NOTICE TO PROPERTY ll1,ifNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
.....
NOTE: This Inform.ation Notice to property Owners About Construction Responsibilities .
was developed by the Construction Contractors Board in accordance with ORS 70t055,(~k .
, " '_, _,'p'~s~e.d py t~e, 1_9?9 9regon Leg;sl,atur,e. '
. " ~
! . If you are acting 'as your own cbntra~torto construct a new home or make a substantial,improv~ment to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
of concern. ,. -, -
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Cont~actors ~oard to do labor in constructing.or assisting
in the construCtion :01" -improveme_nt of a residential strucrure~' you 'will, in most instances, be ruled to be an
I. -. . .. .. . T
"employer" and the:people you hire w,ill be "employees".' As theemployer,'you must comply with the following:
. . '.. "- .
'.' .
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Oregon's,:WitbtibJdirig Tax Law:: Asan e.rrlployer, you ,must withhold income taxes from el11ployee wages at
the time empjoyees are paid. You will be liable. for the tax paym~nts even ,if you don't. aqtually withhold the
tax from your employees. For more information, call'the Oregon Department of ~even'ue at 378-3390.
Unemployment Insurance Tax: As"anemployer, you are required to pay a tax for unemployment insurance
purposes on the wages of all empl,oye~s, For more information, call the Oregon _Employment Division DHR
at 378-3224. .' .'. . .,. . - .' .
) . . .;. .. _ . . . -'
',yorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers'
compensation insurance, you may_be subjecUo penalties and will be liable for all claim costs if one of your
employees is injured on the job. For more information, call the Workers' ~o~pensation 9ivision DIF at 373-7434.
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 eV~r! if you didri.'t aqt~ally withhold the tax.' For more information, call
the Internal Revenue Service at 221-3960. ' -.'.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
-. .
vode Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
code requir.ements thatmClYJ:;le brought tQ your attention through inspections., .
Liability and Property Damage Insurance:. Contact your insurance agent to see if youhave adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done.
, , .. ,
Time to Supervise Employees: Make sure you h_a,ve suffiqient 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 appropriate times so they can perform
the required-inspections. - 1 -, _J. '
If you have additional questions, write to:
Construction Contractors Board
700 Summer S1. NE, Suite 300
Salem; OR 97310~0151 '
Phone 503-378-4621
0244J 10/24/89