HomeMy WebLinkAboutPermit Plumbing 1995-8-15
SPRINGFIELD
JOB NUMBER qSl~)
RESIDENTIAL
PERMIT APPLICATION
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Inspections: 726.3769
Office: 726-3759
LOCATION OF PROPOSED WORK: \4l.C{
ASSESSORS MAP: \1 02A~~~ .
225 Fi fth Street
Springfield, Oregon 97477
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TAX LOT:
BLOCK:
SUBDIVISION:
LOT:
-
OWNm ~'0rcfu~1r Df(\. I_~- ~I
ADDR~~ \~\C\ .C,WOlf\J(\~ro(1 [\1
CITY: '~J\tf\C\~O STATE:. tl\~Dp1'
DESCRIBE WORK\I \~ ~(1\lIU2) 2- (~.~~ I \0 (\)
NEW REMODEL - ADDITION ,\) D~M~L1;H-
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PHONE:
C.flLtll
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ZIP:
OTHER
CONST.
CONTRACTOR /I
CONTRACTOR'S NAME
ADDRESS
EXPIRES. PHONE
GENERAl' -
PLUMBING: D(\).U\ ~ru.,elZ-~
to .~\,qs ~'2R .~lBI-
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MECHANICAL:
ELECTRICAL:
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN'
/I OF BLDGS: IIOF UNITS: ZONING CODE:
OCCY GROUP: CONSTR- TYPE' /I OF BDRMS:
/I OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANG E: SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be
made the same worklng.day, Inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
D Rough Mechanical ~ Prior to
cover,
~al Plumbing - When all
plumbing w9rl~ Is complete.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Rough Electrical - Prior to
cover.
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete.
D Underslab Plumbing/Electrical!
Mechanical - Prior to cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
o Footing - After trenches are
excavated.
D Flnar Building - When all
required Inspections have been
approved and building is
completed.
D Fireplace - Prior to facing
materials and framing Insp.
o Masonry - Steel location, bond
beams, grouting.
o Framing - Prior to cover.
D Other
D Foundation - After forms are
.erected but- prior to concrete
pi acement.
o Wall/Ceiling Insulation - Prior to
, cover.
o Underground Plumbing - Prior
to filling trench.
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Wood Stovo - After Installation.
o Blocking and Set.Up - When all
blocking Is complete.
,0 Post and Beam - Prior to floor
Insulation or decking.
D Insert - After fireplace approval
and Installation of unit.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Floor Insulation - Prior to
decking.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sanitary Sewer - Prior to filling
trench. .
o Electrical Connection - When
blocking, set-up. and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Storm Sewer - Prior to filling
trench.
o Fence - When completed.
o W~ter Line - Prior to filling
trench.
o Final - Alter all required
inspections are approved and
porches, skirting, decks, and
venting have been Installed.
, -
ill Rough Plumbing - Prior to
cover.
D Street Trees - When all required
trees are planted.
Lot faces
Lot Ty
Lot sq. ftg.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
'BUILDING PERMIT
ITEM
SO. FT.
X $/ SO. FT.
Main
Garage
Carport
~
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM i
.p
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT,
Storm Sewer FT.
Mobile Home
Plumbing Permit + '30~
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
ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
'. TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
. .
..
; ':,:; ~
.i,.
Setbacks
I P.L. HSE GAR ACC
IN
Is
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VALUE
'f
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(-" -(pO
aJ leD
., / IS THE PROPOSED WORK IN THE.
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
. APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, c,onform 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:
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, 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 shall be done in accordance
with the Ordinanctls 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
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 agdress Is readable
from the street, that the permit card is located at the front
of the property, and the approved set of plans will remain
:~g:::~;?=; c~z;
Date /
VALIDATION: t<1.....
RECEIPT NUM~ _.~ tl u _' ..J
DATE PAID O'l S .L{~. :-..
AMOUNT REC I ED....~, \\QU
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RECEIVED BY
'"
Address:
C\'S\~ )
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7NJD_J Date: 8"\~qs
Permit #:
Issued by:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with ~he Construction Contractors Board to sign the
. . .
following statement before a building permit can be issued. This statement 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
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1. 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
bef~e or upon completion. r-
3A. My ~n';}*r is Drrr II"- ~f\VeP ~ J..Jl2.~ ~ g-
. (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
~ 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If! change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and 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 do understand the Information
Notice to ProI>>erty Owners about Construction Responsibilities on the reverse side of this form.
VX~- ~ . . .
/ \ I[Signature ofpenfut applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
,w
Information Notice'to~ Property Owners
About CO,nstruction ~esponsibilities
Note.; This Information Notice to Property Owne,rs about Construction Responsibilities,.."
was develop~d by the Construction Contractors Board in accordance with ORS 701.055(5):
~.~ I
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 PJany proble.Q.1s bybeingflware of the following respQnsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons notregi~tered with the Construction Contracto~s Board .to do labor in constructing or assisting in the
construction or irpprovement ofa residential structure, YQl! 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 thf? following:' ,_' '
Oregon '$ withholding tax law: As an employer, you mustwithhold income 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 Dept. of Revenue at 945-8091. .
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; can the Oregon Employment Diy.ision at the pepartment o(Hurnan Resour~es
at 378-3524.
......
Workers' compensatiouinsurance: As an employer, you are subject to the Oregon Workers' Compe~sation Law, and must
obtain work~rs' cOIJ1pe!}s(ltion insurance .fpr your employees, If you fail to obtain workers' compens::j.tion insurance,. you, may
be su'bject to penaities and will be liable f~r all claim costs if one 'of your employees i~ injured on th~ job: For ~ore infoimati,on,
call the Workers' Compensation Division at the Department of Consumer and Business Service's at 945-7888. .
" .
. .. -
U~S. InternaIRevenue.:Service: As an employer, you intist withhold federal income tax from employed wages.Y ou willbe
liable for the tax i>ayment even if you didn't actually withhold'the.tax. for more information, call the Intern~l RevenueSeniice
at 1-800-829-1040'- :
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 and property damage insurance: Contact yo.ur insurance age,Qt to see if you have a<;lequate)nsu~an9.e coverage for
acciqents and oJ1!iss~ons: such as falling tools, .paint overspray, .w,ater damage from pipe punctures, fire, or w.ork that must be
re-done.
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, ..
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Mak~ sure you have the' expertise to act as your own general contraCtor, to coordinate the 'work of rough-lll and fini~h
trades, and tei notify building officials at the appropriate times s(h~ey can perfonn the required inspections. -
If you have additional questions, write or call the Construction Contractors Board (POBox 1.4140\ Salem,OR'9i7309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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