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HomeMy WebLinkAboutPermit Building 1993-3-18 ,<,", ~ . RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Olfice: 726.3759 LOCATION OF PROPOSED WORK' ASSESSORS MAP: /7/1 < LOT: . SPRINGFIELD [;/: :~ '5 BLOCK' OWNER: ADDRESS: T!vJy j~Sn,_} /,()q'5" ...1./. A ,<; r ~P/7J , CITY' STATF' ~ . 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~~ ' - I ' /~ ~fXJ5jl:.T.sI#J/!- NEW REMODEL _~ ADDITION DEMOLISH ,OTHER.JI, ~.,. : //.7 CONTRACTOR'S NAME CENERA' . ~UJ,,)~ 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 ..~- -,. -\ ~ Total Value Building Permit Fee State Surcharge Total Fee (A) N PL. HSE GAR ACC ----- Sctb lcks -- --- .. 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 ~-'-J--- --- ---- ---- - ._-~- VALLIe ~.!t!!. /S:~O _____]J /5,7f 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 /~LT _~S ~//....~ 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{_ ~ / ;. <:;.,/ q'~ . /5 .7S" -~ DATE PAID AMOUNT RECElv~n RECEiVED BY .;;.-s. ,I .'. . ~;J: ,. ~,,", ., '. -. 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. . ~- - . " 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. .. . .'. 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:, ,. >- -- .' 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-.... . ~ . ,.,. - ~. '- " 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 J ! .