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Home My WebLink AboutPermit Building 1994-4-22 " . . ..~~.- 0< ',~' RESIDENTIAL PERMIT APPLICATION SPRINGFIELD Inspections: 726.3769 ' .~ Office: 726-3759 ~JJ LOCATION OF PROPOSED WORK: 5]::.{'C) ~.6~ ~/ ASSESSORS MAP: //~2-"33-YY OWNER: ~;6j/t9Ye: #I: tL5-~~ , ,"""- ~, - . ADDRESS: p~:CJ~.x ~Y/ ;c::-~'~ c#'E_ , " LOT: II CITY: BLOCK: ! . i , ."- ... ..-. JOB NUMBER 9 v~ YB .> ~ - ' 225 Fifth Street Springfield, Oregon 97477 TAX LOT' C/'7/'7y , ' '~~P7YI//Y: Yl t!= *"" ' , SUBDIVISION: /b(41lfJL/F~~r ~..>)~c.-. >, '- d/'~-;-, L '9' ,PHONE: TT?'" '" 7. . '. , 6Sf"'S21/"?' . ZIP: ~;:> ~.e::>.:2. STATE: 6J:?/i? .. ~~~J: ~4"~~!d~..:z: "1r~~ ~8' ....~,~~.a/W~.4'R. ~(~~?' > ' ~""....b:=- ~ '<1; '" ~ ':2.. y~ '2..~'~ - '7 , NEW REMO L DDITION ~ DE OLlSH OTHER . ~ ~.- 1 CONST. CONTRACTOR # EXPIRES PHONE ?6~"'. //v.sr-'~ S'3"5'~~~- . , ~\1ie5 (~(~()-~qm) , FA~,-f3?l)'CGl<?i5 CONTRACTOR'S NAME ~..... ~DRESS . J? ~ ,-- S Il9~C~A'~. GENERAL:~~~~- ._~'"y.J ~.~.'='~" PLUMBING: MECHANICAL: ELECTRICAL:.a ~ . .. . ~ QUAD AREA: ~RGC' J # OF BLDGS: 1- YJ-:::l... OCCY GROUP: "" J \ WATER HEATER: y' / # OF STORIES: LAND USE: OF\\~~C5 # OF UNITS: \ '. 1 CONSTR, TYPE: V IV HEAT SOURCE: t='~ RANGE: 7' .../ FLOOD PLAIN: - ZONINGCODE: ~~~} \0 ~ # OF BDRMS: J SECONDARY HEAT: ,e; SQUARE FOOTAGE: l4,q~. 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/Electrical/ Mechanical - Prior to cover. M Footing - After trenches are ~ excavated. ' o Masonry - Steel location, bond beaf!1s, grouti ng. , ~ 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. o Post and Beam - Prior to floor Insula,tion or decking, o Floor Insulation - Prior to deckl ng, D Sanitary Sewer - Prior to filling trench, D Storm Sewer - Prior to filling trench, ' o Water Line - Prior to filling trench. , o Rough Plumbi~g '~ Prior to cover. REQUIRED INSPECTIONS , 0 Rough Mechanical - Prior to cover. ' D 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. o Framing - Prior to cover. D Wall/Ceiling Insulation - Prior to cover. D Drywall - Prior to taping. o Wood Stove - After I~sta"atlon. o 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, .~. . D Fence ~ When completed. .' D Street Trees - When 'all required trees are planted. o Final Plumbing - When all plumbing work Is complete. D Final Electrical -When all electrical work Is complete. D Final Mechanical - When all mechanical work Is complete, o Final Building - When all required Inspections have been approved and building Is completed. D Other MOBILE HOME INSPECTIONS .,' ' ~BIOCking and Set-Up - When all 'blocking Is complete. ' , ~PIUmblng Connections - When home has been connected to water and sewer, ' ' ~ Electrical Connection - When blocking, set-up. and plumbing Inspections have been approved and the home Is connected to the service panel. ~inal - After all required Lprnspectlons, are 'approved and " porches, sklrtln'g, decks, and venting have been,lnstalled: Lot faces . Lot Type , Lot sq. ftg. , Interior Lot coverage Corner Topography Total height Panhandle Cul-de-sac ", - "j, ;....... . . . :"'SOIL'D1NG PERMIT ;-: ITEM sa, FT, x $/SO. FT, = Main ~~~ Garage -, . ' \~~()(\ , " ", J Total Value , Building Permit Fee '1;f~te SlJrcharg~ Total Fee " " (A) I " :-- "J '~ I . {.'HE PROPOSED WORK IN T~E -. HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical " Coordinator prior to permit Issuance. I '> .... , ' Setbacks I P.L. HSE GAR ACC IN Is I W",'-.: ,;.'.." IE VALUE ~S,-,"'P- C5 -;' . , 0f)rj) ~ ... ~-, SYSTEMS DEVELOPMENT CHARGE (SDC) (B) .' ~ . .~CCO \E1 . CD ," ,.05 " '1'5.15 " PLUMBING PERMIT ITEM Fixtures Residential Bath(s) NO Sanitary Sewer FT, Water FT. Storm Sewer FT, Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan NO Wood Stove/lnsert/Fireplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS MOQile Home State Issuance State Surcharge Sidewalk ft Curbcut ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) FEE , " \SCU ~I~ \5.qs \C5~ dJO ,W 0a5 llo\.'l~ . , , 'APPROVED.:" ' BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT " , " ." .... ' , : I I R.ecel.~e ' y: ::. . --...; -1": \....... '....... ., ~ ':",,:,. . .':'. " ,.1 ol... ,r-., ' .... " " ',. .... ;. .,. . . I...... '", ' <, . " '-:' ?fans Reviewed By Date Systems Development Charge Is due on all undeveloped properties within the City limits '{IIhlc?h are being Improved. JfD- )ITI~NA4 C9M EN S 0 ~O~~~~~ __ ~ -: L^W\~'1'Q - 9f\L .~'\Q " Sl"\}nO - &. ~ 9\(~ L _ ~~rY(.t~CJ08 -Lo ~<..tQ / ~_ ,-U't'l~ ~ 'K\tinQ c?\j1\ P(Ji 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, 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 ; ; r , I I j " 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 he site ~Imes during cptruc~". J. " nature j d 2uJ~/). !7.)ff4.N::/ - . . Date " VALIDATION: (A/L{)Q RECEIPT NUMBER II. -r ~:1'I) ,,4.Y/' ,G. ' DATE PAID ,.., t.../ lj\~_- \ ) Permit No: C\L\rA87 Address: ~ ~(;o tt\i ~::1. Issued b: \L)~ Date: .~ v 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 box 3A or 3B: ... / 1. I )(. / "- 2. I I own, reside in, or will reside in the completed structure. , , understand that I must register as a construction contractor it 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 \/ N 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. 3. B.I 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 of this form.. a!#~d ;5:' ~Jh Signature of Permit Applicant J Z-Z- - 91 Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COpy TO APPLICANT INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES , , . NOTE; . This Il'Jformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), . passed by'the 1989,Otegon' 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 responsibilities 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 Withho,lding 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 Revenu~ Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn'~ 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: 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 rough-in and finish trades, and to notify 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 S1. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89