HomeMy WebLinkAboutPermit Building 1993-3-18
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Olfice: 726.3759
LOCATION OF PROPOSED WORK'
ASSESSORS MAP:
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LOT:
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SPRINGFIELD
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BLOCK'
OWNER:
ADDRESS:
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CITY'
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930354
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
;< / /777
PHONF'
72,,:.. - "7613 /
ZIP:
'7' ?~7 '/
DESCRIBE WORK: /}ec/.eiJ,T .A't$.1'm~ ,4) iu~~ ' -
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NEW REMODEL _~ ADDITION DEMOLISH ,OTHER.JI, ~.,. : //.7
CONTRACTOR'S NAME
CENERA' .
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PLUMBING:
MECHANICAL'
ELECTRICAL'
If)I/./A/~
ADDRESS
CONST.
CONTRACTOR P
EXPiRES
PHONE
- OFFICE USE -
OUAD AFJ.EA: LAND USE: FLOOD PLAIN'
. OF BLDGS:, # OF UNITS: ZONING CODE:_
OCCY GROUP: CONSTR. TYPE: . OF BDRMS:
P OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER' RANGF' SOUARE FOOTAGE:
To raquas) :irl-InSp0Gtj'or;~yt.,:_, rnll:::>l coil 7ZG.:)7G9. '7'11:5- '~;:!'-2-1-!,G~!'--~G~-2.:-r.~P~~rl\.!-! jr.SI')P..Gt~~;;g requeSTAd before 7:00 :3o.m, will be
made the'sarne workil"lg day, inspections requested after 7:00 a.m. wiil be made the foliowing work day. -
D Temporary Electric
D Site Inspection - To be made
after excavation, but pdor to
setting forms.
D
Underslab Plumbing I Electrical1
Mechanical - Prior to cover,
D
Footing - After trenches are
excavated.
D
Masonry - Steel location, 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.
o FIDDr Insulation - Prior to
decking,
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior ~o filling
trench. "
o Rough Plumbing - Prior to
cover. .
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~raming - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
D WODd Stove - After installation.
o Insert - After f:rlJplace approval
and installation of unit.
o Cllrbcut & Appronc.:h -. After
forms Clre cmcleo bt't prior to
pIClCem~f1t of concret'J.
o
Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base materia! in place.
il Fence - Whcn corn.pletca.
D ~~~raet Trees - 'Nilt:n all requirad
..,-;.P.5 are plil/ltlJd.
D Final Plumbing - When all
plumbing work is complete.
D Final Electrical - When all
electrical work is complete.
o Final Mechanical - When all
mechanical work Is complete.
15<1 Final Building - When all
,.. ...squired Inspections. have been
approved and building is
completed.
DOther
MOBILE HOME INSPECTIONS
D BIDcking and Set.Up - When all
blocking is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
r-l Electrical Connection - When
blocl~ing, set.up. and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o
Final - After all required
inspectlons are approved and
porches, skirting, decF<s, and
vef"t!ng have been installed.
Lot faces
Lot Type.
Interior
Lot sq. flg.
Lot coverage
Corner
Topography
Panhandle
Total height
Cul-de-sac
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
Main
Garage
Carport
..~-
-,.
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Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
N
PL. HSE GAR ACC
-----
Sctb lcks
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.. THE PROPOSED WORK IN T~E
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
S
W
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--- ---- ---- - ._-~-
VALLIe
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SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) -HA-
/
/
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
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
fl
Curbcut
It
Demolition
State Surcharge
Total MisccllaneolJs Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
1~.7S
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 Ctleck Fce:
Date Paid:
Receipt Number:
Received By:
N1t
Plans Reviewe~('~
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
_~~ P~J2Iiu/.1:A-L
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By signalure, I sta~c and agree, lhall have carcfulty examined
tho 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 described
herein, and that NO OCCUPANCY will be made of any
structurc_ without permission of the Building Safety Division.
I further certi fy that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
projeci.
I further agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from tile street, that the permit card is located at the front
of the property, and tne approved set of plans will remain
;:g~::US~~ ~ns\r cf n.
Date
VALIDATION:
RECEIPT NUMBER
'7~4{_
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. /5 .7S"
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DATE PAID
AMOUNT RECElv~n
RECEiVED BY
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Permit No:
. '7 30 :5 ~ f
/~f}5 AI :4/ sr;
~~ Date: r~)
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 Hie permit
Fill .in the applicable blanks; and initial boxes 1 and 2, and either box 3A or 3B:
1. ~I. I own, reside in, or will reside in the completed structure.
.....
2. II 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 i~
Contractor registration number
I will instruct my general contractor that ail subcontractors who work on the'struc- .
ture must be r~gistered with the Construction Contracto~s Board.
OR
3. B..,-=-<11 will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If Lchange 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 thisbujlding permit of the name of
. the contractor.
I hereby certify that the above information is correct anI! that I have read and understand
the Information Notice to Property 0 ners about Construction Responsibilities on the
reverse side of this form.
/2,',_L - "/rt~ ~~
S~~' Ap ',cant
].-:../r:'-U
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT;FILE
.PINK COPY TO APPLICANT
INFOR,!.ION NOTICE 'TO PROPERTY OIERS
ABOUT CONSTRUCTION RESPONSIBILITIES
. '~'+--
NOTE::' :. This information Notice to Property Owners About Construction Responsibilities
was cjevelope,d byJhe Co~struction Contractors Board in accordance with ORS 701.055(5),
". ~ ' .
,passelfby the 1989 Oregon Legislature. .
".. .
It'y~u 'ar~ ~cting as your own c6~tractor 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 RESPONSIBILlTIES:~
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, yolJ 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 Withh~ding Tax Law: :As an employer, you must withhold (n'come taxes from employee wages at
the iime employees are paid. You will be liable for the fax 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.
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Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all employees. F9r more information , call the Oregon. Employment Division DHR
at 378-3224. .. .
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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 withhotd fe.deral income tax from employees' wages.
You will be liable for the tax payment even if you didn't.actualiy with'hold the tax. F.or more information, call
the Internal Revenue Service at 221-3960. . '
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:,
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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 arid 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 .have sufficient 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 an.8 finish itaqes, and to notify buildi~o.f(i~~~IS:~t.:~he,'~pr9Rri~t~:~irr~s,si'they can perform
the required inspections. - , J-.... . ~ . ,.,. - ~. '-
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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
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