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HomeMy WebLinkAboutPermit Building 1992-10-12 ~~ VVU9to/\Q- PHONE: l::l~ - _LSLfCj l-IO~q r~PL..a...-__~__.____.___ ._- .4pV'1 V"\j J(..p..fL STATE: oR ;'1 'i- :Jr) ~V"t 1 \.u~LCikvV Cu,c6_C-...4-,L-k30' :. . .r" RESIDENTIAL PERMIT APPLICATION " , 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-.~:..!...-_--__. __ .'. '-lOB NO ~ q-zrz..., 9 ~,..~ ,- ''. 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) .,.. .. ,f l .:;,'" . 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,. . , \ --, , 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: . . '.. "- . '.' . '., .. - ,'-, 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