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Home My WebLink AboutPermit Building 1992-5-6 OWNeR __~ L. ---G'tX:\b.t-l.Cf~--.\J~~J AODRE% __ _3, ~S-jJ)r-d../~ ):tJ ( II Y_______S fV-I\':~--b.doL SIAl E QQ. 'J)7'-M ;vj g 12 _ ReSIDENTIAL PERMIT APPLICATION Inspecllons 7263769 Office 72& 3759 LOCATION OF PROPOSED WORK ASSESc;OI-lS MAP Lor DESCRIEJE WORK New REMODEL_L CONTRACTOR S NAME GENERAL (0\A1Y\il1; PLUMBING MECHANICAL ELECTRICAL OUADAREA -3.~ " OF nLDGS _"'~ nccy GflOUP ~_ ____~_ "Ot- SIOHIES __~__~ WATen HEATEH SPRINGFIELD ~~ I _I C1_:l CAa{JVr.,",-CL \ ., () :B3..=?::'J. ' BLOCK tl OI"PI"O ;,h,>r\ JOB NUMBER ~Ofd)J 225 Fifth Street SpringfIeld Oregon 97477 ~o lAX LOT o Lf.2cy) ADDiTION DEMOLISH OTHER SUBDIVISION PIIONE -=2':::1J' 3 L:::LCJ_____ ZIP 0;411 ADDRESS CONST CONl RACTOR # 7/1 J'tb PHONE - OFFICE ~SE- LAND USE \ \~\ '. OF UNITS \ I CONSTn rYPE _\l_~__ HEAl SOUnCE __~Wil_ RANGE EXPIRES lo;.bh..2.. I FLOOD PLAIN -- - -0 ""j ZONING CODE -W ~ II OF RDnMS SECONDAllY ilEAl SOUARE FOOTAGE -J~ 10 request an In~pectlOn, you must call 7263769 ThiS Is a 24 hour recording AlllnspcctlOlls rpqucstC(j before 7 00 a In Will be lTIddc the ~arnc VJorklng day lll~pccllons requested after 700 a m Will be rnaeJe the follOWing work day l~ Temporary Electnc D Site InspectIOn - To be made alter eXCdvatlon but prior 10 setting forrn~ o Undersldb Plumblllg/ Electncal/ Mechanical - Prior to cover l':7f Footing - After trenchcs are ~ excdvatc(l o Masonry - Steer locdtlon, bond beams groutIng ~/l FoundatIOn - After rorlll~ [Ire ~ erected IJut pllor to concrete placement D UnderglOund Plumblllg - Prior to lllllng trench K"7f Underllo~Plulllblncp.lVlechdnlcal )6J _ Pilar to lnsulJIIOn or decklno )'V1 Post and Doam - Prior to floor ~In~urdllon or dccl~lng r;(f Floor Insulation - Prior to ~lccklng D Sanitary Sewer - Prior to filling trencll D Storm Sewer - Prior to fllItng trench ., - D Water Line trench Prior 10 ftlllng ~, 't9"'1' Rough Plumbing ~ cover Prior to " , " lV(Electncal SerVice - Must be ~pproved to obtain permanent electrical power~Ea<l<)""G::--r) l5<:f Final BUlldlllg - Wtwn all '" ,.eqUlred Inspections have been approved and burldlng IS completed REQUIRED INSPECTIONS D Rough Mechanical - Prlor~ to cover rv( Rough ~ cover Electrical Prior to D Fireplace - Prlor to faCing materials and framing Insp ~ Framing - Prior to cover K7f Wail/Ceiling Insulation - Prior to ).6.L cover , I. ~ Drywall - Prior 10 taping D Wood Stove - After lnsldllauon D I I Inserl - After fireplace approval and Inslallatlon of unit D Curbcut & Approach - After fonTl~ <-Ire erected but prior to placement of concrete D Sidewalk & Dnveway - After excavation IS complete fOlln::. and ~ub base material In place , ,- D Fence - Wh~n completed D Street Trees - When all requIred trees are pldnled f'V1 FlIlal Plumbing - When drl ~plUlTlblllg work IS complete "J'Vf' Final Elcctm..al - When dll ~elecl(Jcal work I~ complete o FlIlal Meclldnlcal - When all mecllanlcdl work I~ complete I~ Other MOBILE HOME INSPECTIONS D Blocking and Set Up - When all blocking 15 complete D Plumbing Connections - WIlen home Ila~ been connected to water dncJ suwer D Electncal Connection - WIlen blocking, ~ct up d/1(j plumbing Inspccllon~ have been approved and tllC home IS connected to the servIce panel D FlIlal - After all reqUired I nspectlons are approved dnd porches, skIrting, cJecl~s. and venttng have been Installc(l S THE PROPOSED WORK IN HiE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? Lot sq fig Interior I :L Is Setbacks , HSE I GAR I ACC I I Lot fac-os Lot rype Lot coverage Corner Topography Panhandle Total height CuI de sac W E ----- APPROVED BUILDING PERMIT ITEM SO FT X $/SO FT VALUE Main GdlngC Carpor! hd..&.- 1<;'0_ """ TOld! Value ~QQCL _(",9, S~ ::3 4?' -Z Lc:l3 Bull(JmQ PerrTllt Fcc Slate SUI(..harge Total Fcc (A) SYSTEMS DEVELOPMENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM FEE FIxtures _iO -I/YJ.d-O Rcc,lucnllal Bath(s) N' Sanllary Sewer Fl Weltf'l FT 5101 m Sewer FT Mobile 1101110 PIUll1blflq POI mlt ---~--- Slate SUlclnrgc ~-- Tolnl Clli11 qe (C) I05._PO / MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' :z. ...~ .....- Wood Stove/lnscrtlFneplace Unit Dryer Vent Mechanical Pennl t /1411(/. / &Z, "0 /0'0 .7S" -25 7~ IssuanLC State Sun...tlargc Tolal PermIt (D) MISCELLANEOUS PERMITS Mohlle Ilorne Stale Issuance State Surcharge Sidewalk It Curbcul It DemolitIon Slate Surcharge Totar Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) _~ ,iPil- ~ If yes thIS application must be Signed and approved by the Historical Coordinator prior to permit Issuance BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT ThIS perrnltls grAnted on the ex pless condrtlon thai the said construction shall In all respects, conform to the Ordinance adopted by the City of Spnngfleld Including the Development Code rf'qul,llng tile cow,tructlon .1Ilt! W'C of bUlldll1q~, and may bc suspended or revoked <It any trme upon vlol<lllOn of any prOVIsions of s;lId ordln<ln<..cs Plan Check Fee __4-1,'53 Dale Paid --1/2. ~// 2- ReceIpt Number ~'1t3 / Rece#~ ~ _ Pc 22:2~_ PlaMIRevlewed By ---5/1 /q 2 16~e Systems Development Charqe IS due on all undeveloped properties within the CIty limits which are bell1g unproved ADDITIONAL COMMENTS PATl--I -# -; By signature, I state ami agree that I have carefully examined the completed application and do hereby certify that all Informallon hereon IS lrue and correct, and I further certify that any and all work performed shall be done In accordance with the Ordinances of the City of Spnngheld and the Laws of the State of Oregon pertaining to the wOlk descnbed herein, and thatl NO OCCUPANCY will be mdde of any structure without pelllll::'SlOn of the Bulldrng Saft.ly DIVISIon I further certl fy Itldt only contmctors ami employees WI10 are rn complla'"nce with QRS 701055 Will be used on thiS prolect I further agree to ensure that all required inspectIOns are rcqueJtcd althe proper lunc that each adcjrc ,,> IS reaclablp from the street, ttlal ttlC permit card IS located ;1t ttle front of the properly .11lt1 III(.. ilpproved set of pl.m, WIll relThlln on the slle AtlrTles urlng con&trucllo<#.._ Xnatu . ]V I" Date VALIDATION 45"57 ~/92- AMOUNT RECEIVED - -/9. c: /3 RECEIVED BY .#~ , RECEIPT NUMBER DATE PAIr> .... . to Permit No q :"oGc.J 2- /7'2 CI?'Hw'/77~"I ~/-r1---7 Date / A ) S~A2-- , I 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 hied With the permit Fill m the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B 1 >< L I own, reside In, or will reside In the completed structure ~ 2-1~1 -- ---- I understand that I must register as a construclion contractor It-the structure IS sold or offered for sale before or upon completion , I 3 A I I My general contractor I" 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 ><1 I 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 mformation is correct and that I have read and understand the Information Notice to Property Owners about Construction Responslblhfles on the reverse Side of thiS form O~/~P) Signature of Permit AppllcanC v t- ;e~~~ ~ ~ CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 ;'D/; Date' il~ ?:? (/ WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ~ . INFOh...ATION NOTICE TO PROPERTY 0..NERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE This Information Notice to Property Owners About Construction Responslblhtles was developed by the Construction Contractors Board In accordance With ORS 701 055(5), passed by the 1989 Oregon Legislature 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 responslblhtles 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 Income taxes from employee wages at the time employees are paid You will be hable 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 ~ay 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 fall to obtain workers' compensation Insurance, you may be subject to penalties and will be hable 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 '. US Internal Revenue Service As an employer, you must Withhold federal Income tax from employees' wages You will be hable for the tax payment even If you didn't actually Withhold the tax For more Informalion, call the Internal Revenue Service at 221-3960 OTHER RESPONSIBILITIES AND AREAS OF CONCERN Code Comphance 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 Inspeclions Llablhty and Property Damage Insurance Contact your Insurance agent to see If you have adequate Insurance coverage for accidents and omissions such as failing 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 roug~-In and finish trades, and to nolify 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