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HomeMy WebLinkAboutPermit Building 1994-10-27 RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 LOCATION OF PROPOSED WORK: ~SESSORSMAP: /7C2...P LOT: ,- ~,..' 1.1 /f4 e.Ai7Ei,;~}Jt1~ L I3Lvd. 7.r,-, .4 4. BLOCK: JOB NUMBER 94i.4?12 225 Fifth Street Springfield, Oregon 97477 LL,4a-t) OWNER:~t1A. ~c:q~/L Cl\q~'I~rE:l::!-QNE: 7</t.-73?d> , ADDRES;;:;S;;ID fr~7EJJJJ/~1 1fL1/r/. .~\.()} qq<(?- ~o33 ~J\;tl' CITY: 5pl'/N1//';/d STATE: IJrcgCJiJ ZIP: 'I?<f 77 o , \ DESCRIBE WORK: &.I~I /~ (!?AJ t1t'l/) -jan:t!/.5: NEW / REMODEL ADDITION DEMOLISH, , i dbNTRACTOR'S NAME GENERAL: ~~~~~ PLUMBING: MECHANicAL: ELECTRICAL: ~~~?f OTHER ADDRESS CONST. CONTRACTOR /I PHONE EXPIRES QUAD AREA:~Ql\)R) - OFFICE USE - LAND USF' \ \ \ } FLOOD PLAIN: /I OF BLDGS' d /I OF UNITS: ZONING CODE: LfJe- OCCY GROUP' CONSTR. TYPE: VN /I OF BDRMS: /I OF STORIES: \ HEAT SOURCE: SECONDARY HEAT: WATER HEATER' RANG E: SQUARE FOOTAGE: <i\lo 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 working day, Inspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS ~ Temporary Electric o Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumblng/Electrical/ Mechanical - Prior to cover. rYl Footing - After trenches are ~ excavated.' . o Masonry - Steel location, bond beams, grouting. I'7'l Foundation - After forms are ~ erected'but prIor to concrete , placement. o Underground Plumbing - Prior to filling trench. O Underfloor Plumbing/Mechanical - Prior to Insulation or decking. rV1 Post and Beam - Prior to floor ~ Insulation or decking.. \ . o Floor Insulatlo'n - Prior t? decking. \. o Sanitary Sewer - Prior to filling trench. rvJ Storm Sewer - Prior to filling ~ trench. ' o Water Line - Prior to filling trench. o Rough Plumbing - Prior to cover. ' o Rough Mechanical - Prior to cover. fYl Rough 'Electrical....,. Prior to ~ cover. ' fYl Electrical Service - Must be ~ approved to obtaIn permanent electrical power. o Fireplace - Prior to facing materIals and framing Insp. rn Framing - Prior to cover. o Wail/Ceiling Insulation - Prior to cover. o Drywall - Prior to taping. o Wood Stove - After Installation. ,0 Insert....;. After fireplace approval , and Installation of unit. , O' Curbcut & Approach - After - , . forms are erected but prior to . placement of concrete. o Sidewalk & Driveway - After excavation is complete, forms and sub.base material In place. o Fence - When completed. D Street Trees - When all required trees are planted. o Final Plumbing - When all plumbing W9rk Is complete. m Final Electrical - When all ~ electrical work Is complete. C o Final Mechanical - When all mechanical work Is complete. ~ Final Building - When all L.:(:.I required Inspections have been approved and building is completed. o Other MOBILE HOME INSPECTIONS o Blocking and Set. Up - Whe[l all blocking Is complete. ' o Plumbing Connections - When home has been connected to ' water and sewer. o Electrical Connection - When blocking, set.up, and plurTJbing 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 sq.ftg. Lot coverage Topography Total "eight BUILDING PERMIT ITEM SO. FT. Main Ga!:age Carport '7'/6 Total Value , Building Permit Fee State Surcharge -\- 3D Total Fee ITEM Flx\ures Residential Bath(s) NO Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit Stat~. Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan Lot Type Interior Corner panhandle Cul-de-sac X $/SO. FT. , . .(,~" ~~'. ~ ':~ \;~;1!~\~~~. . . IS THE PROPOSED WORK tNTHE - 'HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical , Coordinator prior to permit issuance. . Setbacks " P.L. HSE' GAR' ACc'1 N' Is W E VALUE /~/t:? ., 5'~ ~ (C) Dryer Vent Wood Stove/lnsert/Flreplace Unit NO -S~~5.~ t;6.@ u s:l ' -,. I (A) 'Co \ .<t>3. ~'1 ' ' , SYSTEM/S~EVEtOP1VlENT CHARGE (SDC) /// (B) f/ /0, ~a piUMBING PERMIT Mechanical Permit Issuance State'Surcharge Total Permit Mobile Home MISCELLANEOUS PERMITS (D) State Issuance State Surcharge Sidewalk It Curbcut It Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) FEE ~ rf o II \. 63 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 Check Fee: 7b.?~ ~/2-r4 1c:f7~~ /t/~ . ~\. ~~~ Date Paid: Receipt Number: Received By: Pla}1~wed By Systems Development Charge is due on all undeveloped properties within the City limits whi<?h are being Improved. ADDITIONAL COMMENTS By signature, , 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 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 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 remain Xhe site " time~ duriponstru1J/f. Signature /P.J~~ , {7 J/ DatellJ - cJ / - 9y- VALIDATION: I RECEIPT NUMBER l52{; I DATE PAID ~O .?j} Cl4- AMOUNT REClflvJp ~ l~. \'-.J RECEIVED BY (J tL~-/ q4\~2;- Address: \ tf 0 ~QJ1n1(1 Q PJi It Issued by: 'r, ~) Date: ,D .?/~ .Qi Permit #: I' Statement: Information Notice to Proper:ty Owners About Construction Responsibilities , Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Bbard to sign the following statement before a building permit can be issued. This stateh'lent is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under QRS l()J.010(7), need not submit this statement. This statement will be filed with thei:permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 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 before or upon completion. ~ 3A. My general contractor is (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 I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I 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 tlJis building permit of the 'I name of the contractor. , - I hereby certify that the above information is correct and that I have read and do understand the Information Notice 0 p~ert,y Owners about Construction Responsibilities on the revers~ side of this form. jrP1 Il ~flf IJtJ-cT7-qf \. G (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . f;_ Information Notice to Property Owners About ConstructiQ~~~sponsibmties .-.~_~. _ __--" ......,1.... - ,~ ;::: Note: ThisJnformation Notice to Property Owner.,s qbout Construction Responsibilities, - " ~ wascieve[oped by the ConstruCtion COl'!tractors B~ard in accordance with ORS 701.055(~J~ 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 proQI~ms by ,being aware of the following responsibilities and areas of concern;. " "..:; -. ,f ').,,' ..:: " ..., ,,_/ - ", , '. ~ .... ~. '';' "'" ,EMPLOYER RESPtjNSIBILlTIES: If you hire pers~:ms not registered with the Construction Contractors Board .t9 d@ labor in. CO,llstructing or assisting in the . , _' ~,. ,....' "... ~ _", 4, . _ - z. . - _ _'. .' ....... > ' construction or improvement of a residential s~fUcture, you will, in JIlClSt instances" be iuled to be an employer and the people you hire will be employe~s. As the, ~mP.1.oyer, you mu~t comply with the following: ' Oregon's withli'olding tax)aw:' As an employer, you must wi~hhold in'come taxes from'etilployee wage~ 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, call the, Oregon Employment Division at the Department of Human Resources at 378-3524. , . 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 at the Department of Consumer and B~siness SerVices at 945-7888. U.S. Internal RevenueService: 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 Servic~ 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 your insurance agent to see ifyo~ have adequate insurance coverage for accidents and ~m~ssions such as falling,tools,.pain~ove.rspray, water 9aI1!agt:: frOm pipe pun.ctures, 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 yo~ havelh~ e~pertise to act a'~ yq.tir o'wn general cOQtractor, to coordinate the work of rough- in and finish trades, and to notify building officiaisat the appropriate times so they can Rerf.orm the requ~red in~pections.,: ' \"" ,'-' ,- _ >.\ \'\>', \ i \ ': '-\ \.i.., \ ,,~~>. If you have additionmquestions; write or call the Construction Contractors J3oahl(pllitBd-~14140: Sale~,.oR-97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite'300"in Salem. -. '- prop-own. pm4 1/94 <'- .""') ihe following project as submitte as t e 01 zoning, and does not require specific land us approval. ,/ 225 FIFTH STREET Zonina "7""l De ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 ' 1 n4\AA n INSPECTION REQUEST: 726-37Ut9_ /()- 21.-Q'-( Ci ty Job Number........8 fTIl...-7 OFFICE: 726-3759 /J.,;'l,. . ' - AuthQrized Signature / ,- :; . COMr~u~. l' 1'01'0 ~\...HEDULE BELOV 1. ~~~ OF~~~~lf). 0 ff~E~N \mJ JOHl\J\B~ Permits ~e non=:::~ferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address Ci ty Phone Supervisor License Number Expiration Date, Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Na~~, {\.\.__~~u~.QC)r~ Address 'AA\o\.'\i1\\i~~\ , City ~Cl Phone~.l5\~ OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ers Signature: tef:l ~i~~ -j\c-tTL-------- DATE: ~ \O.rtV)~rr ' RECEIPT #: \ . c:.::J RECEIVED BY: t \\fiLJ \,-,'!Jdf .. i' A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Cost Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular 'Dwelli'ng Service or Feeder $ 85.00 $ 15.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less ~ 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 ~O.,-C> ----- C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps 201 amps Over 401 Over 600 or less to 400 amps to 600 amps amps or 1000 $ 40.00 $ 55.00 $ 80.00 volts see "B" above D. Branch Circuits New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permi t ~ $ 35.00 $ 2.00 h. .. '-'~ E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE _ S;~. ~ 5% State Surcharge ~.~ 3% Administrative Fee l.ba TOTAL ~t'). ~~ JOB NO. 9~/#~2 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) .. · .'" ATTACHMENtSl ,1 NAME OR COMPANY: ;f~ /~ LOCATION: /24~ ~ ~ DEVELOPMENT TYPE: ~ 74 fi BUILDING SIZE: /f)(;2.r- ('i~) LOT SIZE SQ. Ft. 1. STORM ORA T NAGE IMPERVIOUS SQ. FT. So.yr 2. SANITARY SFWFR-r.TTY NO. OF PFU' S . (See Reverse) 3. TRANSPORT~.TTQH X $0.209 PER SQ. FT. ~S.3~ '- _L X $43.26 PER PFU $ /t~ / NO OF UNITS X TRlP RATE X COST PER TRIP X X X X $436.19 X $436.19 X $436.19 $ ~ / $ $ SUBTOTAL (ADD ITEMS 1. 2. & 3) $ /o,5'.3f! 4. ~TTARY SfWFR-MWMC NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADMIN.FEE (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) TOTAl-MWMC SOC SUBTOTAL (ADD ITEMS 1. 2 . 3 & 4) $ & /' $ $ $ /o~. 3~ ,5. ADMTNTSIATTVF FFF~ B~E ~GE. ( .S. )U~T7, ;N::fir ~ AOVE) X .05 ~~ ~~ Date: /Mary:H rnig. P.E'\-/' SDC ordinator ' $0:2-,? ) - 9 - 3cj-r'r' TOTALSllG $ I/O, ~o B2 . SDC .