HomeMy WebLinkAboutPermit Plumbing 1992-5-19
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Oltice: 72G<3759
SPRINGFIELD
LOCATION Ol~ PROPOSED wOnK: _W~
OWNER:__.._~~ ~&d.dCVld
ADDrlESS: __ -,lo,J-,(P~.---", ~tv ,C?l__:.,
._ ~\ Y'\~~r~dd. STATE:
~~) C~0l('J1.~
ASSEssons MAP:
LOT:
CITY:
DESCRIBE WORK:
NEW
F1EMODI::L
COf'JTF1ACTOITS NAME
GENERAL: .__
PLUMBINC:_ ._()~_.
MECHANIC/Ii.: '
ELECTRICAL:
QUAD AREA: ,,,
l-I ~S<2-
" OF BLDGS: ,..,____
OCCY GROIH':
II OF ~'~Tor{II::;:
WAlEf1 HEATI::R: ___.
BLOCK:
(J~
ADDITION
DEMOLISH
OTHER
JOB NUMBEI-l
q:207 3Y-~
ADDRESS
CONST.
CONTRACTOR #
225 Fifth Street
Sprlngrleld, Oregon 97477
TAX LOT:
()O~/::J.
- OFFICE USE -
LAND USE: _'_'mill)
It 'OF UNITS:__
CONSTR: TYF'E:
HEAT SOUFlCE: ,
FlANGE: ____ .0'_______
SUBDIVISION:
PHONE:
/L.fJ-S<S:lj
ZIP: _qiYL'is:__
EXPIF1ES
PHOf\JE
FLOOD PLAIl'-J:
ZONING CODE:
II OF BDRMS: _
SECONDAHY 1,1 EAT: .
SQUAF1E FOOTAGE: ___
To request an inspection, you must call 72G,3769. Tills Is a 24 hour recording, All inspections requested IJefore 7:00 ;1.111, will I)e
made the ~;i1/11e worl;in(l day, inspections requested after 7:00 a,m, will be made' the following worl< day,
[_] Ternpo'i1'Y Electric
o
Site Inspection - To be made
after ex(;avation, but prior to
setting (arms,
o
Underslab Plurnbing/Electricall
Mechanical,- Prior to cover.
o
Footing - After trenches are
excava led, '
o
Masonry - Steel location, bond
beams, S)routing,
o
Foundation - Afler forms are
erectorl tJut prior to concrete
placement.
o
Underground Plumbing - Prior
to fillin(j trencl1-
o
Underlloor Plumbing/ Mechanical
..:.. Prior to insul8tion or decking,
CI
Post and Bealll - Prior to floor
insulcuion or clecl(ing.
o
Floor Insulation - Prior to
deckinu,
o
Sanitary Sewer - Prior to filling
IrenclL
o
Storm Sewer - Prior to fillir.g
trench,
o
Water Line - Prior to, filling
trencll,
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
, I~ Rough Mechanical - Prior to
cover.
[~
Rough Electrical - Prior to
cover.
1:==1 Electrical Service - Must be
approved to ot)tain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
,[:==I Wall/Ceiling Insulation - Prior to
cover.
I~
Drywall - Prior to taping.
o Wood Stove - After installation,
I~ Insert - After fireplacc'approval
and installation of unit.
1:==1
Curbcut & Approach - After
forms are erected but prior to
placemcnt of concrete.
o Sidewalk & Driveway - After
excavation is complete, forms
ancl sub-base material in place.
o Fence - W~len completed.
o Street Trees - When all required
trees arc planted.
.
I~Final'Plumbing - Wilen ali
~ plumbing wOII; is cOIIll-'lele,
o Final Electrical - When all
electrical worl( is cOlllpl'~te,
o
Final Mechanical - Wilen all
mechanical work is complete,
o
Final Building - When all
required inspections have been
approved and builcling i~,
completed.
C6I Other~. O'16w__
MOBILE HOME INSPECTIONS
D' Blocking alld Set-Up - When all
blocking is completc.
o Plumbing Connections - Wilen
Ilorne has l)cen connected to
water and sewer.
o Electrical Connection - Wllc:n
blocking, set-up, ancl plumbin(J
inspections have been approvecl
and the home is connected to
the service panel.
o
Final - After all requirecj
inspections are approvecJ ancl
porches, skirting, decl(s, ancl
venting have been instClllecL
Lot faces
Lot Type
Lot sq. ftg,
Interior
Lot coverage
Corner
Topography
Panllandle
Total'lleigllt
Cul-de.sac
BUILDING PERMIT
ITEM
SQ. FT.
X $/SQ. FT
Main
Garage
Carport'
Tolal Value
Building Permit Fee
Slate Surcharge
Total Fee
(A)
Setbacks
I I I .1
P.L 'HSE GAR ACe
IN
Is
Iw
~,----==~-
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
VALUE
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Batll(s)
NO
S;:lI1itary Sewer
FT.
Water
FT. .
Storm Sewer
FT.
Mobile Home
~ j.QA")vJ
Plumbing Permit
State Surcharge
Total Char~le
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mecllanical Permit
Issuance
State Surcllarge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
Stale Issuance
t;llfllf~ ~UrQI1Bi'ga
Sidewalk
It
Cu rbcut
ft
Demol i lion
Slale Surcharge
Total MiscellCjneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, 'and E Combined) .
FEE
\~.o6
1<\
JS./<:)
,c;./~
~J l
:; THE PROPOSED WORK IN THE
I~ISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, tllis application mu~;1 be signed
and approved by the Historical
Coordin;]tor prior to permit issuance,
APPROVED: ~__
This perrnit is granted on tile ex pres,s con(lilionlhalllle said
construction shall, in all respects, conform to 1110 Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use oi '
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Clleck Fee:
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
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, thatlllave carefully examined
the completed application and do Ilereby certify that all
information hereon is true and correct, and I further certify
Illat any and all work performed shall be done in accordance,
with the Ordinances of the City of Sprinufield, ;1I1t1 the Laws
of the State of Ore~Jon pertaining to the worl< t1cscribed
herein, and Ihal NO OCCUPANCY will be l11il(le of ;my
structure wilhout permission of the Builtling S;J!"~ly Divi,,;ion,
I further cerlify thal'only contractors and employees wllo
are In compliance with ORS 701.055 will be used on tllis
projec t.
I further agree to ensure that all required inspections are
requested at tile proper time"that each address is readable
from the street, thai tile permit card is located' at the front
of the property, and the approved set 01 plans will remain
on the site n.' rme, du,ing con'l'"ctlon.
::,:a'u'"it;~~~~
VALIDATION:
FlECEIPT NUM81~R ',_' '-/ (pcn,-t::>
DATE PAID S - 10 b,';)
AMOUNT F1ECEIVED _._ $ I S. 7~
RECEIVED BY _
6J8
Permit No:
OJ 'J..O 7 ~ L/
(A / &Lf ~flLoc-C!-
Og Date:S/ IC; It;~
Address:
" Issued by:
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 .
x"" I
,
"
""" I
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. .
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.I _~II 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
refierse Si. of this form.
.. /J: ' /J '
~ <-i0 rCj "")
~nature of petJt Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE'
PINK COPY TO APPLICANT
.'
INFORI...~TION NOTICE TO PROPERTY 0\. .~ERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction Responsiqilities.
was aeveloped by tne Construction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Oreg. on Legisla.ture.
~ . ++ -
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. ..
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction or" improvement of a residential structure, you will,' in most instances, be ruled to be an
"employer" and the people you hire will be "employees". As the employer, you must comply with the following:
Oregon's Withholding Tax Law: As an employer, you must withhold il)come.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 Department of Revenue at 378-3390.
- .
Unemployment Insurance Tax: 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 DHR
at 378-3224. .
. . . .
. - - . .
Workers' 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 subject to 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' Compensation Division 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 even if you didn''t-actually withhold the tax. For more information, call
the Internal Revenue' Service at 221-3960: .
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible ~or resolving any failure to meet
code requirements that may be brought to your attention through inspections.
Liability and Property Damage Insurance: Contact your insurance agent to see if you have 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.ave sufficient ti.me 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.
If you have additional questions, write to:
Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89