HomeMy WebLinkAboutPermit Building 1993-9-9
REsmENTIAL
"PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOT:
PLUMBING: .
MECHANICAL:
ELECTRICAl'
QUAD AREA: S'9S0J
\
OCCY GROUP: ~\
1/ OF STORIES: \
1/ OF BLDGS:
WATER HEATER:
SPRINGFIELD
BLOCK:
JOB NUMBER
q3\ \ CCz =)
225 Fifth Street
Springfield, Oregon 97477
TAX LOT: -cf4-rX') I
SUBDIVISION:
'7 4 (, -) /I ~
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PHONE: ~ V? .~).... J..."""""')~
- ~~(~J\ \ ~D.J ~4q Wla. 8,\..0
(\ ;1 i . . I IV
v,)- U) ZIP: ..... ( )
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REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cove~ .
D Rough Electrical - prior to
cove~ .
D Electrical Service - Must be
approved to obtain permanent
electrical power. .
D Fireplace ~ Prior to facing
materials and framing. Insp.
~'Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
o Wood Stove - After installation.
D Insert - After fireplace approval
and installation of unit.
D
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
OWNE~' ~ ~ ro d.lJy ~F)R .., . .
-'-"7\TY ~ N~r\n ...-
ADDRE~~0 \ fi \~ \I \/ t~' ) (\
CITY ~ ~.;VU -fl' 0' - a . ~ --;:TE JW
DESCRIBE ~ORK O~-0 ctiL ~
NEW lf1- REMODEL \~ '~QDI~N DEMOLISH
v ~ .
CONTRACT~S NI;:'~E ". -' _ ')
GENERAL: (Y-tDrl.0.~
OTHER
ADDRESS
.CONST.
CONTRACTOR 1/
EXPIRES
PHONE.
- OFFICE USE-
LAND USE: \ \\ \
1/ OF UNITS:
,CO.NSTR. TYPE:
HEAT SOURCE:
( )
\./A,
FLOOD PLAIN: - r"\ ')
ZONING CODM .1)\L/
1/ OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
4Pn
RANGE:
To request an inspection, you mlJst 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. ';Nill be made the following workday.
o Temporary Electric
D 'Site .Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing/ Electrical/
Mechanical - Prior to cover.
,
~ Footing - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting.
I'V"'l 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.
o
Post and Beam - Prior to floor
insulation or decking.
o
Flo'or Insulation.
decking.
Prior to
o
Sanitary Sewer - Prior to fillJng ','
trench.
(
o Storm Sewer - Prior t'6(!'illing
trench.
o
Water Line
trench.
Prior to filling
o
Rough Plumbing -. Prior to
cover.
.'", .
o
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.
o
Final Plumbing - When all
plumbing work is complete.
o Final Electrical - When all
electrical work is complete.
D Final Mechanical"":" When all
mechanical work is complete.
.~. .
Final 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.
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.
Lot faces
Lot Type
Lot sq. fig.
Interior
Lot. coverage
Corner
Topography
Total height
Panhandle
. ; .,
Cul-de-sac
_.l :-
BUll;.~ING-I?EHM)T--
IT,E~SQJ' ~~
j - I "
Main ' ,
X $/SQ. FT.
Garage
4PD
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
':}- ,J:t~:.---~ ~;;n 'r~f>.-~:'\
"t ,: ;~~f k~
.,
Setbacks
HSE GAR ACC I
I
I
\ .:) THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, ORON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
'.Coordinator prior to permit issuance.
I"....' '"
'PL:
IN
Is
\W
IE
VALUE
La;J 109:>
~?_:s-o
3,1'3
fc5.~
I APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express co'ndition that the said
construction shall, in all respects, conform'to the Ordinance
adopted by the, City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and rnay bE:) suspended or revoked at any time
upOriiliQlation !bf any provisions of said ordinances.
Plan Che-:k Fe~: ~~\!'~.~
Date Paid:' B--:~) q,-~
Receipt Number: 1\ C{SO II
Received y:. ~.lDQ),
P
~/7/7 3
I ;1:>ate'
SYSTEMS DEVELOPMENT CHAR.~E (SDC) ~
(B) :fP \ ~?o~
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT.
Water
FT.
FT. .e( /SO "
. Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent. Fan
NO
Wood Stove/!nsertlFlreplace U,;,it,
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge'
Total Miscellaneous P,ermits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, andE Combined)
FEE
40.60
2~.o
4':L~O
-:240. (Dl
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COM\VIENTS
- ~.,.
\JJ[ \ D'\l 1\,0 \.f'N) ~ (\ ,,-411 Xl clvL
).J '~*fye) I^_'-/ . -'\ \ ~ .
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f3J$; /CA~
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By sigriature, I state and agree, that I have carefully examined
the completed application a~d 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 Ilie Laws
ofthe 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
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 property, and the approved set of plans will rernain
on the site at all times during construction.
.)Glgnature J9:n1 ~
( Date;r~A <. (/
VALIDATION:
RECEIPT NUMBER
DATE 'PAID
AMOUNT RECEIVED
/6) 2cro
, /9/9 .3
/ ( .c.)
'? 1"0 . ~'"
~~'
RI;CEIVED.B;-t
.
.
Permit No: 93//SJ
Address: 1/2/ ~&a;,A-
Issued by: ~~. Date: ~~j'
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential 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-
ment 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 in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1.~
2. 1~1
~ ~
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.I
I My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B .L,::...:><J.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 Responsibilities on the
reverse side of this form.
~~
Signature-of permff Applicant
~66
DcUe I
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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,.:)NFORMATION'NOTICE TO PROPERTY 6W~ERS ,
, ;-.. __ _" '-no _ _ _ _" _. .: - '~-l:,; ~,!f.I~~l!j>~C;>_~~T~Y:~!.lpN RES~ONSIBI.LITIES. '-;:' ,
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. NOTE~~ _ ,>!!1i~, !':lfQIrfia~LoD Nqt,ic~!tQ'Rrope'1Y qwners Abo,ut Constn:.ictiQ.n Respons_ibiliti~sc:"
'_ - "-~~~.d~velgp.eqbYJh~, COQ.struction-C9ntractQrs i39~rd ;iri accord~nce witbORS 701.0~5(5);.::", . .
3--\'passe(j>bY:tb_e"_;1:a6~}Or~g'9~. Legislature. - : ' ,-- - : --. ", .' ',... ' '-, ,f!-~_:\:,~,~~ ',' . :~,.-
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If.' you -,a(e"actirigaisy09r-'(jwn'_'.c;-o.ntt:actcjr~tq cbhstrl,Jct anew hom~ or /11ake. 'a substanti,al imprpyerilEmt-'.to an
: existing structl!r.~, ~9l!, can pre~~nt many problems bytbelng awan{ oethe. folldwing responslbiliiie~vand are-as
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,~ If you hire'persons not registered with ttw Qonstn,iction Co(ltraG~(;>r:sa.o~rt.t to do labor iricQristnJPting'or assisting
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i~, the,. c;onst~(upt~~~:;,;~r ~~:ptoy~:m~'n;tPJ. '-?_: f~~r(teotial;,rrr\i.~t~r~,., Y?;~r. '1'it!:' N: ;mo~t_W\~!~~~~~': :?r- .r.pled' to b~ ~n
"employ.er"andtt:lE~:'P!30pJe you hire will be :'emplqyees": Astheemp,IQyer, you~ml!st.:cQmpt~wl~h"the followmg:
, . ",~;.~:~;;<"-:i.'l,~~:~..)~~~-;r~.~<,., :~'''1(c::\:., ,:: '~~..;",:;;:,;;;tr; ~.-:\:'~.' -,.':,:: \~''':,;-.;l)''f:i::,l,.:.,.f,;:',. . -' . .
Ore~on S' 'N.Jthq9;1~,I~g,Tqx ~aw.: .;f\5. ,~n"r,n;le,IRY;Y,r,. ~gv -~u,st~w,lth;holdu:,cqm~~~?F~~' from _.~mp'l~ye~:_\'V~ges at
, the time emp?IQy~e~~~r-~4),~I,<!: " "YQY wll).:..b~!I~b.!~.for.t~~i~~X;J>.qYrr~n~s. ev.e'lll:Y9t? ,~~fl:t?-G.!~~lI.y wIthhold .th~.
.'. tax.from your e~PIOyees. For mor~ inf~rmation, 'call th~ Orergon Dep~ttmEtnt 'o~-:~~~eQu~C\l378~3390.- .
. , . '.'~:.- k : 1 .t.,~; ,>~-"'__" ':'/\~."~":_:.' ~""_ _..r\....'~....: '~._}:',~. ~ ~~."' ", ;~...,.{:._ -:,,~--~":" ':. {~_f.:: ,'." ';." . .;
UnemploymeJltlnsurance Tax: As an employer, you are requir~dto pay a tax-for unemployment insurance
purposes onJl1e wages of a1temployees. F:.9~':!p'p[,e;in~oqnat.iq'1, caH.,t~~ Q!egpn..S"1pI9YmenkDiyi~,onDHR
at 378-3224... " . , ' - '. - '- ' ,
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- 'Workers' Co-mpehsation'lnsurance:__AS an'employer,'V0,u aresubject~to~the'Oi:egol1 WorREiis: Compensation
Law, and_ must :obtain workers' compensation insurance' for your employees. -If _you fail 'to :obtain workers' '
compe'nsf:ltion: ins.urance"you may..be.s!J~ject to 'penalties ana 'will~be;Iii:iQIEfforall ct'a'im costs- ifona of your
employees is injured.on the job._F6r more information, call the Workers' ,C()mpensat_ion Qivision DIF at 373-7434:
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U.S. Int~mal"Rey"~nue Seryice: ,~~:.,en '~r:rl pl.oye,r, . y,qu rn ust-,wit~~pld, f~E,~fa.l. i~cor:r}~,t~~. frprri empl9yees: 'wages.
You will'b's'[jaoIEffor th:eJaxpl:l,y.meot even if ydu- .aidn'(~ttu;illy' wit!jhold Hie t~x':,:Foti1lore informationicall
th~ Inte{nalRevenue ~SerJic~' af'2~h:396d.; , " " ::>.l t.t",'~, .<'~:: :-- !',,',-.:',~~\. !t' '~. . " -,-,_ ' .
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- OTHIE.R RESP6.N~IBILiT'ES AND ~REAS OF.'-CO~.~gfil~:_- -:' ,:~-'~~;.~;-n'!\i(' '::';' - :;- ~,"',_.:5s:; ~~:.., ::,' ,:
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Code GompHanoe:Asthe-perri}iLhelde( ,fo.r;~,th_is p.~ojec;t,;wou"arel~~PQ~:sjbJeJor ,reisOlving ~ny fail~re to me-ef-
code 'requirements :tH~t. may be brou-,g;hUd,yburc,attention,.through.jtispectioh'~.{':i::::<:' :':" ' "
. ~;!~~. _.;:" ,..'~..~:_) :-~"~' ",~f';-:' .';,~::~ -.' . '.. .....~~. ,:~;..;' ;';":...;~...~r1....';w~.i,'L..,/",,\"f~~i~'~;'~-;'.f\-." _ :~
Liab.ilitY'~hQ;Pr0~erty Dama~e:lnsUrarice: - ~Cotltact'Yohr .insur'ance:iig~n~to's'eeWyot.i:jtiaveadequate insurance
'coverage .for'accidents and omissions such as falling tqols; ' paintoverspray/'waterdamage from pipe puric-
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tures, fi~~,_or yvork- tha(niUst.be ~e-done., -
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Time- to: Supervi~f3.--Em ployees:'., Mak~:sure:",yoU'have;,s:ufficie'nt. .tirr)~'; to supervise' y_our"e~ployees:
, " _>_ _ ,-__ _:. . _ "_'.' __ _,_ _.;. ". ,:dJ;~ - ,;'('tdi.; _s'.!:.: ~';c,,:;j , ,
-:--:Expertise: . Make sure you have thEf expertise toacl as your- OWn- gell~r~J contractor,_ to coordinate the work
of rou.gh-in' and'finis'g -t~~~e~(.and to notify buil9ing officials.at th~ ap.pl\J~; i~t~ t1!1'~s,S_~,!~,ey cal1 perfO[m:'
:the- required-insp~ctions'~~,~'"::~~~ ~ '- .',' ~,~::q, ~'::;':~~-:::-(~;i:\::{;,-i~\-i:'?'~7-\f?';~l~,~~'::\ ..' . '
If -yo.u' have ad~itional questions, write to: : :>~Cohstruction Contractors Board-
'.', ,.700 Swmm,er St."NEt $.uil~__T3QO..". " -_ ."_
-Salerl:\:- bR-973t6~01'5r rh~,~~'__ '; ';"" '
" ,'''Phone- 503-378-4621_ ' .
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JOB NO. -'1'? l \?~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: DON ~A.\.,..~y ::,~.
LOCATION: 4\ 2.\ CA1V\eL..-L-IA \1 o-Z'2:7"2--~~ --O~ 00 I
DEVELOPMENT TYPE: L-P~ - (..,Pr2.A-~E:.-
BUILDING SIZE: LAo ~ -z;.y..
1. STORM DRAINAGE
LOT SIZE
SQ. Ft.
IMPERVIOUS SQ. FT.
Coz.&.{
X $0.203 PER SQ. FT.
~2.lo lo2)
'--- --'
2; SANITARY SEWER-CITY
NO. OF PFU/S
. (See Reverse)
X $42.08 PER PFU
c-~
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X X $424.31 C ~
J
--'
X X $424.31 $ -
X X $424.31 $ -
4. SANITARY SEWER-MWMC
NO. OF PFU/S --- x $15.125 PER PFU + $10 MWMC ADM FEE $'
(Use PFU Total From Ite~ 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE) ,$ -
TOTAl-MWMC SOC C- )
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ I '2-Co ~
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
~~L~ ~~S'1~
I . -~ - Kip Burdick '
SDC Coordinator
c ~~~
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l ~"'2- 0__0
TOTAL SDC $ -,/-:/