HomeMy WebLinkAboutPermit Building 1992-4-28
OWNER: ~lf\t\()J\{l. &. t\O ru V - P~E: 'l4l-4-lCf?'
ADDRESS: \ n Cj t '([\tlun ~ ~cr V_t:(\J ~ J -, '
CITY"~ ) . t) STATdi)J'tO ~ ZIP cn4i"7
DESCRIBE WORK l' ~ \l~ 1\ T"; C\Q f\ QD: Q... t I'J C'{\v) ror,---
), ADDITION DEMOLISH 0 ,OTHER
CONTRACT~NA~
GENERAL:~~l~ .
PLUMBING: .S'l... .G..-;___n___~_'---
..~
RESIDENTIAL
PERMIT APPLICATION
LOT:
NEW
MECHANICAL:
ELECTRICAl'
h 'K\\)(\ ~
QUAD AREA:
" OF BLDGS: __- \
OCCY GROUP: R~
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" OF STORIES:
WATER H.EATER:
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q~Dr::i:1-
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SPRINGFIELD
e
JOB NUMBER
~~ 225 Fifth Street
~" Springlielrl, Oregon 97477
,_()~fCli \)J\\~
. TAX LOT: (\.9 aCY;
BLOCK:
SUBDIVISION:
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'" 'ir"1
-.
~~-;::-: i/
(
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ADDRESS
" CONST.
CONTRACTOR"
EXPIRES PHONE
-:- OFFICE USE -
\ '- \ \
\ .' I
CONSTR. TYPE: \J N
HEAT'~~URCE: -G )\+
FLOOD PLAIN:
ZONING CODE:
, ,LAND USE:
- -
W~)
1/ OF UNITS:
" OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
RANGE:
To request,an inspection;,yo~J' 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,
. ,
o Temporary Electric ~, '.
"'.... ". .."~: ''to.'' ~..
o
Site Inspection - To be made
after excavation, but prior to
setting forms,
o
Underslab Plumbing/Electrical/
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 trench,
o Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
'fv7r Post and Beam - Prior to floor
~ insulation or decking,
,
~ Floor Insulation - Prior t6
.I V~ecking:'
o
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., ",
o Final Plumbing - When all
plumbing worl, is complete,
~\
,~ough Electrical _ Prior to
cover.
'IXf Final Electrical - When all
'" ~Iectrical work is complete,
,
o Electrical Service - Must be
approved to obtain permanent
electrical power,
o Final Mechanical - When all
mechanical worl, is complete,
o Fireplace - Prior to facinD
Imiterlals and framing Insp,
l5<r Final Building - When all
/..(equired inspections have been
approved and building is
completed,
~r'aming - Prior to cover.
o Other
~ Wall/Ceiling Insulation - Prior to
~ove~ '
~DrYWall - Prior to taping,
MOBILE HOME INSPECTIONS
o Wood Stove - After installation,
o Insert - After fireplace approval
and installation of unit.
o Blocking and Set.Up - When all
blocking is complete,
o
o Plumbing Connections - When
, home has been connected to
water and sewer.
Curbcut & Approach - After'
forms are erected but prior to
placement of concrete,
o Sidewalk'& Driveway - After
" excavation is complete, forms
and sub.base maler,ial in place,
o Electrical Connection - When
blocking. set,up, and plumbing
inspections have been approvecl
ancl the home is conneclet1 to
tile service panel.
I I Fence - When completed,
o
-":>..' \-::'."
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed,
o Street Trees - Wh~n ~II required
trees are planted, . .~'. '.
I
~
Lot faces ' Lot Type_ Setbacks
Lot sq, fig, Interior I P.L HSE GAR ACC
IN
Lot coverage Corner
Is
Topography Panhandle
Iw
Total height Cul-de-sac
'~
.
_S 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,
,t APPROVED:
ITEM
SQ, FT,
X $/SQ, FT, =
VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
BUILDING PERMIT
Total Fee
(A)
:l'6~ ).a:: ,
J '
.~~ ~$iO
9-
/1 ~
4{J~3~
. .
This permit is granted on the express condition thaI the said
construction shall, in all respects, confonn 10 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 P{ said ordinances,
Plan Clleck Fee: ,~~ ,OJ
4, r'J ,q~
4~CS~_
Re'~ .~~
Plans Reviewed By (
Date Paid:
Main
Garage
Carport
.
y-
'! 'J
, '.
"
,
,"
Total Value
Building Permit Fee
State Surcharge
4:;k
SYSTEMS DEVELOPMENT CHARGE (SDC);
If/A'
(B)
Systems Development Charge isdue on all undeveloped
properties within the City limits which are being improved,
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
PATI-I "#.z
Residential Bath(s)
NO
Total Charge
(C)
EL - '",",,/ - '
_ __ b::.;71tL'-ffL.._-,I2t)(~/-iC,jS-- A"'6Q1>-.,-
~.' .'
1'10 at= ~("" ~Ma'-AT 2-
&,/ '."7Z( ~/A.r_) -~ ~~
,fJ!/ /t'~~J, 7HE ~~W ~
~E7Z5 A- ~ MfJ 77Iz5
/1,u~~] tiC A- ~A ,~,
~~
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
MECHANICAL PERMIT
Furnace
Vent Fan
NO
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certi fy 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 worl< described
herein, and iha't NO OCCUPANCY will be made of any
structure witho~t permission of the Building Safety Division,
I further certify thaI only contractors and employees who
are In complianc,e with ORS 701,055 will be used on this
project.
Exhaust Hood
Wood Slove/lnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
Slale Surcl1arge
Total Permit
(D)
I further agree lo'ensure Il1al 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, an Jroved set of PI_al~7ain
,on the site at times d ing con:t~ _
V'gnature /2~ /O.._:,/~
/Si - -- " '-/
Date4~b{/ ~ 9c::l.. '
MISCELLANEOUS PERMITS
Mobile Horne
State Issuance
Stale Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
~IV2 r1). Si:/l/(~
VALIDATION:
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
#~....Y"5
~ ..
.
RECEIPT NUMBER t./C/ ~c;'
.
t/....~~~
AMOUNT RECEIVED r~ , '2".7
~ '7.~- ,
v/,
DATE PAID
Total Miscellaneous Permits (E)
RECEIVED BY
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Permit No: 92P$"'L/:)
, - ..
Address: . '""Z ~OV ~~7t~~'":? .
Issued bY:~ ~--'" ...---Date: ~~~:::>
rr _1iZ'_ ,
FOR OFFICE USE ONLY
ST A TEM ENT:
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 the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box3A or 3B:
1. y
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.
3. A.I
I My general contractor is
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
I 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 information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side o,f....th'is rm.
~~~-r/ ;?61~
Signatitfe ofP'Efrmit Applicant I c::/
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D9te
.;26 92.
oJ
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFOR.TION NOTICE TO PROPERTY O.ERS
ABOUT CONSTRUCTION RESPONSIBiliTIES
",....
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NOTE: ,.This:lnforrnation Notice to Property Owners About Construction Responsibilities
was developed"by the Construction Contractors Board in accordance with ORS 701.055(5),
pass~.d.'~y. th,e 198~ Qr~g9~ Legislat.ure.
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<'If you ar~~acting as your~oWn'.contiactor 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. ' ' !
I
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 hi!e will be "employees,". As the e~ployer, 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'liable 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 pay 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 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 withhold federal income ta~ 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 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 and 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: M~ke 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-if! and finish trades, and to notify building officials aphe appropriate times so they can perform
the required' inspections; ). ;', >: " " " "'" '". . ','
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If you have additional questions, write to:
'.
Construction Contractors Board
700 Summer St. NE, Suite 390
Salem, 'OR 97310-0151
Phone 503-378-4621
0244J 10/24/89
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