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Home My WebLink AboutPermit Mechanical 1994-7-28 OWNER cC1\-n,>> ,~ (\ n 11 \ J) ,Q.\ \.1 1'1 ADDR~S _ ~\ or::z,o... (,\ ~O yf) rOO.- ue.- - :f, \ ^ CITY ~ \1\ J (\('t-0 I> 0 c1 STATE \ ~1)M DESCRIBE~OR~ dArt ~titJf\ i n ~o NdOf\(\~ ADDITION ~ DEMOLISH RESIDENTIAL PERMIT APPLICATION Inspections 7263769 Office 7263759 ASSESSORS MAP LOT NEW REMODEL CONTRACT~' NAME GENERAL __ l JfV}e / PLUMBING \ __ t)\\Qj?) MECHANICA~ [)~ Q)(\() ~ ELECTRICAL {C:~ \ ,\\Q~ SPRINGFIELD BLOCK OTHER ~ .r ~4tQ~1- JOB NUMBER 225 Flflh Slreet Springfield, Oregon 97477 Dn\ J~ TAX LOT natrrn SUBDIVISION PHONE ~SS~ w qc::ft t)Pr3t U'\4'15<" ZIP ~ ADDRESS CONST CONTRACTOR # PHONE EXPIRES - OFFICE USE - QUAD AREA ...~'f{\ ~ LANO USE 1\\ \ FLOOD PLAIN # OF BLDGS 'R~ # OF UNITS 0~ ZONING CODE ID~ OCCY GROUP CONSTR TYPE # OF BDRMS # OF STORIES A- HEAT SOURCE .f='c SECONDARY HEAT I-IP WATER HEATER RANGE SQUARE FOOTAGE \ 0 \l 0 To request an Inspection, you must call 7263769 This is a 24 hour recording AlIlnspecUons requested before 700 a m wilt be made the same working day, Inspections requested after 700 a m will be made the (ollowlng work day o Temporary Electric o Site Inspection - To be made after excavatlon, but prior to setting forms o Underslab Plumblng/Electrlcal/ Mechanical - Prior to cover o Footing - After trenches are excavated o Masonry - Steel location, bond beams, grouting o Foundation - After forms are erected but prior to concrete placement o Underground Plumbing - Prior to filling Irench IV"1 Underfloor Plumbing/Mechanical l..,C::j - Prior to Insulation or decking U~~\J' E~\!;,-\'~"'<t "'-""1>t:E !'Vi Post and Beam - pnor to floor ~ Insulatlon or decking rYl Floor Insulation - Prior to L+>J deckl ng o Sanitary Sewer - Prior to filling trench o Storm Sewer - Prior to fttllng trench o Water Line - Prior to filling trench rY1 Rough Plumbing~ ~ Prior to ~ cover REQUIRED INSPECTIONS rYl Rough Mechanical - PrIor to L.f-J cover IY1 Rough Electrical - Prior to ~ cover o Electrical Service - Must be approved to obtain permanent electrical power o Fireplace - Prior to facing materials and framing Insp l1J Framing - Prior to cover f\Tl Wail/Ceiling Insulation - Prior 10 T cover [1J Drywall - Prior to taping . o Wood Stove - After Installation o Insert - After fireplace approvlll and Installation of unit o Curbcut & Approach - After forms are erpcted but prior to placement of concrete o Sidewalk & Driveway - After excavation Is complete. forms and sub base material In place o Fence - When completed o Street Trees - When all required trees are planted , rvl FlOal Plumbing - When all L..f-J plumbing work Is complete rYl Final Electrical - When all I electrical work IS complete CfJ GJ Final Mechanical - When all mechanical work Is complete Final Building - When all required Inspections have been approved and buildIng Is completed o Other MOBILE HOME INSPECTIONS o Blocking and Set Up - When all blocking Is complete o Piumblng Connectlons - When home has been connected to water and sewer o Eiectrlcal Connection - When blocking, set up, and plumbIng Inspections have becn approved and the home Is connected to the service panel D Final - After all required Inspections are approved and porches, skIrting, decks, and venting have been Installed ....- " Lot faces Lot Type )( Interior Lot sq fig Lot coverage Corner Topography Total height hl~ ~{))~ .l-o ~lQo }- Panhandle Cui de sac BUILDING PERMIT l:'~ i=T ~ 0\ Lo , , , '~.)... '1 . It.~ l ~1 ~, Setbacks HSE GAR'ACCI I I I I , I 'PL IN Is Iw IE X, 9/~Q ill ~ ~~r~\q ITEM MaIn Garage Carport Total Val ue Building Permit Fee State Surcharge S "b \M.~ (A) Total Fee ~1..\.6l<i 'J...\S ~ 1'6 \.(') --:: c;,-U 1)~~.1S. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM Fixtures Resldenllal Bath(s) N' Sanitary Sewer FT Water FT Storm Sewer FT 3 Mobile Home PlumbIng Permit State Surcharge s'to Il\c\..t.u. (C) Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove/Insert/Fireplace Unit Dryer Vent MechanIcal Permit motJ. Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk fI fI Curbcut DemolitIon State Surcharge FEE 'Sa .OQ 3CJ c:,Q \~ .~ '2 '"' 'm. ---~ <.cu.::l I 5: 6-0 L \O.QQ .-eo.7 r .~.iS ~ ~")/A~ ,0 Total Miscellaneous Permits (E) \~ TOTAL AMOUNT DUE (excluding electrical) "'~-;-S,')&... (A, B. C, 0, and E Combined) 21./ ,JS .,. 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, conform to the Ordinance adopted by the C,ty of Springfield, Including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any tlme upon vlolatlon of a1' j^Si~f said ordinances Plan Check Fee l'\\ )..~ Date Paid _tq 304t Receipt N\lmber~~n[\\\ Received By \ffi) AX'~ . - 7~~) PlanrRevlewed By ! 2.?.te 5'1 Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved ADDITIONAL COMMENTS ~ ,M\m \ 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 Ordinances of the City of Springfield, and the Laws of the State of Oregon pertainIng to the work described herein, and thai 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 701055 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 on the site at all times durIng construction X //'./ Slgnaturp .~./ --r;:.'~ V ./ (...- 7-'J..<i('-9?i Date VALIDATION RECEIPT NUMBER /d/// DATE PAIr> 7(7 ~I?/ ~.. J;, AMOUNT RECEIVED -c ~ ~ ~:. --'1.f tr ~ ~ RECEIVED BY _ ~ (!':i !- S3 ) - )(Perrmt # 9.:/& /?~ , 1~S-~ ~ ~ MQate r~hf >(Address )(Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701055(4), requIres residentIal constructIOn penmt applz- cants who are not regIstered wIth the ConstructIOn Contractors Board to sIgn the followmg statement before a buddmg permit can be Issued ThIs statement IS requIred for resldentlal bUlldmg, electrlcal, mechamcal, and plumbmg permits LIcensed architect and engmeer applzcants, exempt from regIstratIOn under ORS 701 010(7), need not submIt thIS statement ThIS statement WIll be filed with the permIt Fill 10 the appropnate blanks and InitIal boxes I and 2, and eIther box 3A or 3B ~ ~ D I I own, reSIde 10, or will reSIde 10 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 mstruct 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 lure subcontractors, I WIll lure only subcontractors regIstered With the ConstructIOn Contractors Board If I change my mmd and hue a general contractor, I will contract WIth a contractor who IS regIstered WIth the CCB and wIlf nnmedIately noufy the office ISSUIng this buIldmg pernut 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 Property Owners about Construction ResponsibIlIties on the reverse side of this form. , ~~/ ?-'J-Fr-'lc/ --Z ~s~atUre of pernut applicant) (Date) (White copy to Issumg agency permit file, pmk copy to applzcant) ~- - " -. - - ....-..?... " \,." " i Information NotIce to Property Owners About Construction Responsibilities -, , - -, . }Vote - This InformatIOn NottGe to l?roperty Owners about ConstructIOn ResponSibilIties " - wa,'deve/oped by the Comtruc/ion 'C~ntracto" Board In accordance with ORS 701 055(5)- 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 responSIbIlIties and areas of concern EMPLOYER RESPONSIBILITIES: If you hIre persons not registered WIth the Construction Contractors Board to do labor m constructmg or assIsting In the constructIOn or Improvement of a resIdentIal stmcture, you WIll, In most In~tances, be mled to be an employer and the people you hIre WIll be em~loyees As the employer, you must comply wIth the follOWing Oregon's Wlthholdmg tax law: As an employer, you must wIthhold Income taxes from employee wages at the tIme employees are paId You WIll be !table 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 msurance. As an employer, you are subject to the Oregon Workers' Compensation Law, and must. obtain workers' compensatIOn Insurance for your employees If you fml to obtmn workers' compensation Insurance, you-may " be subject to penaltIes and WIll be lIable for all c1mm 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 Busmess ServIces at 945-7888 U.s. Internal Revenue ServIce: As an employer, you must Withhold federal mcome 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 Service at f-800-829-1040 OTHER RESPONSIBILITIES AND AREAS OF CONCERN. Code complIance: As the permIt holder for th" project, you are respon~lble for resolvmg any fmlure to meet code reqUIrements , I that may be brought to your attentIon through mspectlons " LIabIlIty and property damage Insurance: Contact your msurance agent to see If you have~dequate Insurance coverage for accidents and omiSSIOns such as failing tool;, paint over,pray, water damage from pIpe punctures, 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, tocoordmate the work of rough-In and fimsh trades, and to notify bUIlding offiCIals at the appropriate tImes ~o they can perform th~ reqUIred inspectIOns , If you have addItIOnal que~tlOns, write or call the ConstructIOn Contractor~ Boar<l (pO Box 14140, Salem, OR 97309-5052, 503/378-4621) The Board IS located at 700 Summer St NE SUIte 300, In Salem , prop-own pm4 1/94