HomeMy WebLinkAboutPermit Building 1993-7-26
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SPRINGFIELD
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RESIDENTIAL
PERMIT' APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK: -
ASSESSORS MAP'
JOB NUMBER
Q3l)0t3 ~
225 Fifth Street
Springfield. Oregon 97477
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~ LJ S ~ (}y./)~,~.
\ J O~ ":) y y~
Cb.
TAX LOT:
O::J9Q(')
LOT'
BLOCK:
SUBDIVISION:
So~ ~vh5l-
~L\S<R ' ~vv~
SpV-" V\j~ p QJ_
fld cL '!tv & of VDO Irv--.
OWNER:
ADDRESS:
CITY:
DESCRIBE WORK:
PHONE:
7 ';It.,-::-- Lf &JS.
r~./ .
STATE:
0(<.
ZIP: QjL/7-;,
NEW
REMODEL
ADDITION
DEMOLISH
OTHER
CONTRACTOR'S NAME
G~NERA:L: 'nlAJ'Y\.~
pLUMBING:
MECHANICAL:
.
ELECTRICAl'
~
CON'ST;
,C'ONTRACTOR if
EXPIRES,
PHONE
ADDRESS
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~?N0 - OFFICE USE -
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QUAD AREA: LAND USE: FLOOD PLAIN:
\ ZONINC? CODE: -LD~
if OF BLDGS: ,~... if'OF UNITS: \
OCCY GROUP:' CONSTR, TYPE: I VAl Ii OF BDRMS-
.1 .
, HEAT SOURCE: ~e,
if OF STORIES: " : l' SECONDARY HEAT:
WATER HEATER: RANGF' SQUARE FOOTAGE: ~SIo
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,
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms,
o
Underslab Plumbing/ Electricall
Mechanical - Prior to cover,
~ooting - After trenches are
~ excavated, , .
D Masonry - Steel location, bond
beams, grouting,
~ Foundation - IAfte; forms are
~erected but prior to.concrete
placement. '
o
Underground Plumbing - Prior
to filling trench,
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover,
o Final Plumbing .- When all
plumbing work is complete.
'K:71' Rough Electrical - Prior to
~ cever.
~ Final Electrical - When all
~Iectrical work is complete,
o Electrical Service - Must be '
approved to obtain permanent
electrica1 power. '
o Final Mechanical - When all
mechanical wory. is complete,
o Fireplace - Prior to facing
materials and framing Insp,
-Ixf Final Building - When all
. required Inspections have been
approved and building is
completed.
,,'t><11 Framing - Prior to covar,
....
I:8J Wall/Ceiling Insulation - Prior to
cover,
o Other
-
J><.l Drywall - Prior to taping,
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MOB!LE HOME INSPECTIONS
o Underfloor Plumbing/Mechanical
_ Prior to insulation or dec~ing~. _ D Wood Stove - After in:>taila.tion,
l'5?1 Post and Beam -,Prior to floor, " , '"
~nsulation or decking, ".' " ,-0 Insert - After fln,;place ;,;,rproval
, ' and installation of unit.
.
""',:XFloor Insulation - pr'jorto . ,.'
~ decking, , 0
o
Sanitary Sewer"":" Prior to filling
trench,
, 0 Storm Sewer - Prior to filling
trench. :'~,: .... ", .
o Water Line - ,erior \0 'IUling',
trench, '
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,0
Rough Plumbing - Prior to
# . ':...,.....:-
cover. " ~
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o Blocking and Set.Up - When all
- blocking is complete,
Curbcut & Approach :..... l\ iter
forms are erected but prior to
placement of concrete,
[] Plumbing Connections - When
home has been connected to
water and sewer,
o
Sidewalk & Driveway - After
excav:1tio[1 is complete. !o(ms
ar.d sub.base materia! in place,
D Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
n Fen,~e - When cumpl:~ied,
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D Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
r--u' Slre'?t Trees - When ci;1 nr~'.Iired
lln.'~:> <Ire pl<lntcd. ,
Lot' faces . Setbacks
Lot Type
Lot sq. ftg, Interior I P.L HSE GAR ACC
IN
Lot coverage Corner
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Topography Panhandle Iw I
Total height 15:' X Cul-de-sac
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( IS'THE PROPOSED WORK IN ~HE._
HISTORICAL DISTRICT, OR ON, ..
T'HE HISTQRICAL REGISTER?
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If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance,
APPROVED:
BUILDING PERMIT
ITEM SQ. FT. X $/SQ, FT, = VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT '
Main
asl-"
C:;t-,. :t ) y ~ )T),
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted' by 'the City of Springfield, including the
Development Code, regulating the con~truction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances,
Garage
Carport -
State Surcharge
//O,$'D
5.5'3
/ I (p. (1;"1;>
SYSTEMS DEVELOPMENT CHARGE (SDC)'
N/A
Receipt i-.Jumber'
J I . <23
foj;)q I cr~
0d.7 q
LO~
7ft:l/l ;,
/ Da~
Plan Check Fee:
Date Paid:
Total Value
Building Permit Fee
Total Fee
(A)
(B)
Systems Development Charge is due' o'n all undeveloped
properties within the Cit'y Iii;nits which are being improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
p~ #:z
Residential Bath(s) NO
Sanitary Sewer
FT.
/
/
/
/
-SbJ~c.- ~?U~L
I
~P&em /,T I C\ ~~U!'"~)
Water
FT,
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
,
/
/
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 tt)e City of Spril')gfield, and the Laws
of the 'State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure wilho'ut permission of the Building Safety Division,
I further certify that only corftractors and employees who
are in compliance with ORS 701,055 will be used on this
project. ' .
Exhaust Hood
Vent Fan
NO
Wood Stove/Insert/Fireplace Uni~ >,
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
I furth~r agree to ensure that all required inspectio.n~ are'
requested at the proper time, that each address is readable'
from the st et, that the permit card is located at the front
of the prop r y,~ appr \ed'set of plans will remain
on the site t all ti~.;, durin construction,
Xgnatui-e I .;,
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Date 7 r 7--6 "15
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
VALIDATION:
RECEIPT'NUMBER
RECEIVED BY
qhV~
7 ~?~. "7~
/5$( B8:
d-~.-
r,,/-
Total Miscellaneous Permits (E)
DATE PAID
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
//(P.()~
AMOUNT RECEIVED
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Permit No: ~ -;$r:::>?3~
Address:, -2 ~~~,~ ~~~#c ~r-- ~
Issued bY~~. . Date: 7~~~
FOR OFFICE USE ONLY
ST A TEM ENT:
, ;' .'.'I.NFORMATIONNOTICE'TO PROPERTY 'OWNERS
'ABOUT' CONSTRUCTION RESPONSIBI L1TIES
Note: Oregon Law, ORS 70t055(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 box'3A or 3B:
. 1. I rv, I lawn, reside in, or will reside in the completed, structure, '
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, 2; I, :1 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
.1 will instruct my general ,contractor that all subcontractors who work on the struc-
ture must be registered with the Constructio,:, Contractors Board.
OR
3. B. I ~~ I I will be my own general contractor.' "
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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 whois'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 un'derstand '
the I rmation 0 'ce to Property Owners about Construction Responsibilities on the
rever e s f his rm.
it Applicant
7-Lb ,-q;
Date
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CONSTRUCTION CONTRACtORS BOARD'
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT .
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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NOTE:',:~Ttuslnformailon Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contra~tors Board in accordance with ORS 701.055(5),
, pasS~d'QY th'e 1989~Oregon Legislature. .
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ti ~~~"'~~~ 'a"cting as you;',.~~~ .c6ntractor 'to constr~.ct a new home or make a substantial improvement to an
existing structure, you canprevei1t many problems by being aware of the following responsibilities and areas
of concern. " .....-..-
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EMPLOYER RESPONSIBIUTIES:
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:
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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 liab,le for t~e tax payments even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of ReVE:nue at 378-3390.
Unemployment Insurance Tax: As an employer, you are required t6 pay a tax'for unemployment insurance
purposes on the.wages of all employe~s. 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 theWo~kers' Compensation Division D!F at 373-7434,
U.S. Internal Revenue Service: As an employer, you mustwithhold 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 Service at 221-3960, '
Ol1n-OlE~ ~IESfPONS~~OUlrO~S ~U\!I~ A~lEAS O~ COU\DCIE~U\!I:
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Code Compliance: As the permit holder for this project, you are responsib1e for resolving any failure to meet
code requirements that may be brought to your attention through inspections.,
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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 overs pray, water damage from pipe punc-
tures, fire, or work that must be re-done.
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Time to SuperVise Employees: Make sure ybu have sufficient time to supervis~ your, employees.
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Expertise: Make s~re YO!J have the expertise to act as your own general cqntractor, to coor,dinate the work
of rough-in and finish tra.des, ~ind to notify building officials at the appropiiat~ tiNi.~S so tli.~y can perform
the required inspections. 'i " '.
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If you have additional questions, write to:
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Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
:. 0244J 10/24/89
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