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Home My WebLink AboutPermit Building 1995-4-3 v RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 ASSESSORS MAP' /4- LOT' .: " ':'l ~ JOB NUMBER 95"??::2c;-r 225 Fifth Street Sprlnglleld. Oregon 97477 .;[ t0e>. (7ft,... P(C<.<-'<- ?1h'1'~fi'~ TAX LOT: .,{':73707 c!:C)711- ~~~~trs-;~ Pcw-h +. ~ BLOCK' OWNER' 0l/lA.on...v r:., i30Sc, JA. ( '{ou. v.a. 1,&[. ADORE!"'" 24 10 CITY:' \:::;:'--"'i e.<-<-e. STAT':' ClL DESCRIBE WORK: NEW ;: REMODEL s~(~ ~"kr v2esC~G.p - I CONTRACTOR'S NAME GENERA" OrAl fA o~_ PLUMBING: MECHANICA' . ELECTRICA' . ~' QUAD AREA: 5~\\ "i1 ') r. OF BLDGS' \ OCCY GROUP: ~~-\ \1\ . OF STORIES: :l T, WATER HEATER: ADDITION DEMOLISH OTHER PHON':' 34-5"-794 X' ZIP: '77 'fO/ ADDRESS CONST. CONTRACTOR' PHONE REQUIRED INSPECTIONS [Xl Rough MechanIcal - Prior to cover. ~. Rough Electrical - Prior to L.# cover. r\11 Electrical Service - Must be ~ approved to obtain permanent electrical power. rw Fireplace - Prior to facing '-N materials a7mln~.,ln.p. [1] Framing - Prior to cover. M Wallle'elllng Insulation - Prior to cover. rn Drywall - Prior to taping. D Wood Stovo - After Inslallallon, D Insert - After fireplace approval and Installation of unit. rvl Curbcut & App,oach - After L..fU forms are erected but prior to placement of concrete. [Xl Sidewalk & Driveway - After excavation Is complete, forms and sub-base material In place. D Fence - When completed. rV1 Street Trees - WhenT~lI. requlre9 ~ trees are planted. EXPIRES FLOOD PLAIN' r ZONING CODE: \~ f) SECONDARY HEAT: F\) SQUARE FOOTAGE:--1~ , , . - OFFICE USE - LAND USE: tIt I. . OF UNITS: I. . I CONST,R. TYPE: V fV HEAT SOURCE: c!:/_cC/ 5. /it7? . OF BDRMS: ( To request an Inspectlon, you must call 726-3769. This Is a 24 hour recording. Alllnspecllons requested before 7:00 a.m. wlll be made the same working day, Inspections requested after 7:00 a.m. will be made the following work day. ~ Temporary Electric D Site Inspoctlon - To be mado after excavation, but prior to setting forms. D Under.lab Plumblng/Electrlca" Mechanical - Prior to cover. rv1 Footing - After trenches are L..AJ excavated. rn Masonry - Steel location, bond .beams, grouting. ~ Foundation - After forms are L..N erected but prior to concrete placement. D Underground Plumbing - Prior to filling trench. rvl Underlloor Plumbing/Mechanical LA.I _ Prior 10 Insulation or decking, [Xl Post and Beam - Prior to floor Insulation or decking. rYl Floor Insulation - Prior to l.A"J deckl ng. [Xl Sanitary Sewer - Prior to ftlUng trench. [SlJ Storm Sewer - Prior to filling trench. /VI Waler Line - Prior to filling l...,bJ trench. , ,- rVl Rough Plumbing - Prior to ~ cover. RANG':' I\7l Final Plumbing - When all Lf.=J plumbing work Is complet.e. rvl Final Electrical - When all Lpd electrical work is complete. fV1 Final Mechanical - When all L....f'J mechanical work Is complete. IVJ Final Building - When all f required Inspections have been approved and building is completed, .l8l Othar ~11,77(V, - ('Ai'( l.N) J; 1'11. MOBILE HOME INSPECTIONS D Blocking and Set-Up - When all blocking Is complete. D Plumbing Connections - When home has been connected to water and sewer, D Electrical Connection - When blocking, set-up, and plumbing Inspections have been ,approved and the home is connected to the service panel. o Final - After all required Inspectlons are approved and porches, skirting, decks, and venting have been Installed. "'" -- ... Lot Type ~ Lol (aces ::::. l'\~Cll) Lot sq. ftg. Interior Lot coverage ~ v' Corner Topography _ .,. r, Total helg~t,. .3D.:: t- ~n4-~) /W\i. \-Itb'l\\:. ' BUILDING PERMIT Panhandle Cul.de.sac ITEM SO, FT. 2')'77 0/1 X $/SO. FT. = Main </~. ... / "I/O Garage Carport UA?f:m. ~Tl1x(" -;II? €L ?7.4t,. Total Value Building Permit Fee Slale Surcharge 'lU.!+ !~ \- (A) Total Fec Setbacks I P.L. HSE GAR ACC I IN Is lib M Iw I r~ I I lLL-LJ VALUE '. L~~d'?/ I' fbt;.S7 /h4/J 7 \ si..l.{<1S Co~~,SQ CI,Q (Oq~.()l SYSTEMS DEVELOPMENT CHARGE~C) (~~~fO PLUMBING PERMIT ITEM FIxtures ~ Residential Bath(s) N' Sanitary Sewer FT. Water FT. ", Storm Sewer FT. Mobtle Home r Plumbing Permit Stale Surcharge Total Charge ct.~~ "- 3"'6 (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' -4 Wood Stovellnsert/Flreplace Unit Dryer Vent MechanIcal Permit Issuance State Surcharge '6..t) 1.-\ ~<t> Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance Slate Surcharge SIdewalk QRC, L.{~ It ft Curbcut Oemolitlo,g ~A7"7. ~e. r..:.cr !:!qv/I~ ~&if t~~~~"l Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrlca" (A, B, C, D, and' E' Combined) FEE I q~ 'S.Q \~~ IS.'ll ~Dl."'\ I' 'i:!l2 lo. ~.~ \ 'd.. <:2Q. lS,oO ~.~ '-I:O.~ \Q.~ ~.as SS:Z.L 5~.<;{) \k3.0 ",Z S.6a \ L\..h3. ~9; .e,"j I ~ (,J.,..fJ., ,. . ;.,;, ~...;::< , '. THE PROPOSED WORK IN THE. "HISTORICAL DISTRICT, OR ON THE HISlORICAL 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 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 of said ordinances. Plan Check Fee: _1-tJ,s- .7tP '7 - "Z g -:?c:;- Receipt Number: /~ <;/ h"2.. Received By: /'? ~ , K~' '// PI~ns\\~ewed ~y ~J~i Date Paid: Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved, AIll}l.,TIONAL COMMENTS ~/ . J;~~.n'~ ~\~\J,;.. ~ ~ ~.,;)!..~ . .. '\.- ~~~, ~.~ SLV~'lur~- By signature, I stale 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 01 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 further agree to ensure that all re~ulred 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 ~g:::?~~SZ:- Datp +/$/ W- VALIDATION: RECEIPT NUMBER \ \O~~1J DATE PAID 4~ AMOUNT RECl!Yf.D~' !~.Lil6 RECEIVED By'\:;;['j,IJ,:",,-) . . Permit #: C\ S (')~ ~ 4, Address: \ 141_ \10 \ ~ fi1~___ Issued by: ~ l hr\ ) Date: 4 ,.9:, .q<::J Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement 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 appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~ D D Ji1 I. 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. 3A. My general contractor is (Name) Contractor regis. # I will instruct 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 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and 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 do understand the Information Notice to p~~orn Responsibilities on the reverse Sid';./;hr; ~ (S~e 7>f permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) ~\ . . ][U1I~I(lIi'mBl'i:oOIl'i U\lo~ics ~1(lI Pi'I(lI~si'ity OWi1ei's AIbJI(lIM~ iCOU1lS'i:i'MIt::~OI(llU1l ~eslOloU1lsDlbJm'i:DSs Note: This Information Notic~ to Property Owners about Construction Responsibililies was developed by Ihe Conslruction Contractors 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 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 liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregoll 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 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 at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue 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't actually withhold the tax, For more information, call the Internal Revenue Service at 1-800-829- I 040. 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 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, 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 or call the Construction Contractors 'Board (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 j