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HomeMy WebLinkAboutPermit Building 1997-10-2 RESIDENTIAL PERMIT APPLICATION .. I." , Inspections: 726-3769 Office: 726.3759 LOCATION OF PROPOSED WORK' ~o a 5 ASSESSORS MAP' V\tl~'rl..'l4", LOT' BLOCK' .. JOB NUMBER q 7 1l(S.! 225 Filth Street Springfield, Oregon 97477 TAX LOl' SUBDIVISION: o~o(X) OWNER: \J,(\~\CA- ~f\-YT~ - __,.I,. PHONE:_9>-nlo .2,..':2()_q ADOR""~" l () 2:l~ ~ rL ~J\2o ~ / \-<rUl ~ CITY- \.\i\C\ \ Y\ , STATE:. \~~ ZIP' C\'l4a~ OESCRIBE WORK: ~f\'('{\ ~i.ct..e, Ox~f _' : ~N \] (~ 'DY\ ,. NEW REMODEL ADDITION ~,' DE~&:ISH: ,qTHER CONTRACTf {l'S NAME GENERAl' .,U..l)N)lL. PLUMBING: ~i)M ~ ? ' MECHANICAl .~l){\{li/ ELECTRICAl' ADDRESS . CON ST. . . .. CONTRACTOR . EXPIRES '," PHONE .. .... ! , -j, - OFFICE USE - QUAD ARE'" LAND USE: FLOOD PLAIN: . OF BLOGS: . OF UNITS' ZONING CODE: OCCY GROUP' CONSTA. TYPE: . OF BORMS' . OF STORIES: HEAT SOURCE: SECONOARY HEAT: WATER HEATER' RANGF' SQUARE FOOTAGE: 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 tha same working day, Inspections roquested alter 7:00 a.m. 'will ba made the following work day. REQUIRED INSPECTIONS O Rough Machanlca~ -: Prior to cover. ~~. ~ o Temporary Electric o Site Inspection - To be made . after excavation, but prior to setting forms. o Underslab Plumbing/Electrical I 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 10 filling trench, o Underlloor Plumbing/Mechanical - Prior to Insulation or decking. o Post and Beam - Prior to floor Insulallon or decking. o Floor Insulation - Prior to deckl ng. o Sanitary Sewer - Prior to filling trench. o Storm Sewer - Prior to filling trench. O Waler Line"':' Prior to filling' trench. . \. , ' O Rough Plumbing -;-.Prlor to \ cover. II o Rough Electrical ...1. 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. ~all/celllng Insulation - Prior to cover. ~wall - Prior to taping, o Wood Stove - After Installation. o Insert - After fireplace approval and Installetlon of unit. o Curbcut & Approach - After forms Bre erected but prior to placement of concrete. o Sidewalk & Driveway - After excavation Is complete. forms and sub.base material In place. , o Fence - \-"hen cOinpleted. o Stroot Trees - When all required . trees are planted. ~nal Plumbing - When all plumbing W9rk Is complet.e. L2t-Rnal Electrical - When all electrical work Is complete. o Final Mechanical - When all mechanical work Is complete. ~al Building - When all required Inspections have been epproved end building Is completed. \ o Other MOBILE HOME INSPECTIONS o Blocking and Set.Up - When all blocking Is complete. o Plumbing Connections - When home has been connected to water and sewer. o Electrical Connection - When blocking, set.up, and plumbing Inspections have been approved and the home Is connected to the service panel. o Flnel - After ell required Inspectlona are approved and porchea, skirting. decks, and venting have been Installod. A:vH~ 0Jc1 I"~/. I~, ~U-'l!l:' ~Ott'?) . ;( I "e. "$0 7;f~ r Lot faces Lot s~. flg: ~t~_ , '- Interior Lot coverage Corner Pa~handle ~' Topography Total height Cul.de-sac BUILDING PERMIT 'I ITEM SO. FT: " 'f X $/SO, FT, = Main Garage Carport Total Value Building Permit Fee +- O,O~.,,, Slate Surcharge Total Fcc (A) ~~. 1.;.\ ,. :. : I P.L ,I N Is ,'~W' IE: VALUE " 1St. ~ SYSTEMS DEVELOPMENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM Fixtures Resldenllal Bath(s) N' Sanitary S~wer Water FT, Storm Sewer FT. FT. Mobile Home Plumbing Permit Stale Surcharge '\- ~/o Total Charge (C) MECHANICAL PERMIT Furnaco Exhausl Hood Vent Fan N' Wood Stovellnsert/Flreplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk fl Curbcul fl Demolition Slate Surcharge Total Miscellaneous Permlls (E) TOTAL AMOUNT DUE (excluding eleclrlcal) (A. B, C. D. and E Combined) ~~ , '1 l'b,uO V'W ~ ;, . : j: ~ ,'.:. \I i. ~'l' '.'. .' 'I : ~ :1~f ~ .;: ':,J;; ,., - ''is :.: . 'T IS THE PROPOSED WORK IN THE. . '"HISlORICAL OISTRICT, OR ON THE HISlORICAL REGISTER? If yes, this application musl be signed and approved by the Historical . Coordinator prior to permit Issuance. Setbacks HSE GAR ACC I I I II I BUILDING V~Ll'jE, PLAN CHECK AND BUILDING PERMIT APPROVED: . This permit Is gran led on the express condlllon that ,the aald construcllon shall, In all respects, conform 10 the Ordinance adopted by tho City of Springfield, Including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked al any time upon violation of any provisions of said ordinances. Plan Check Fee: Date Paid: Receipt Number' Received By: . Plans Reviewed By Oate Systems Development Charge Is due on all undeveloped properlles within the City limits which are being Improved, ADDITIONAL COMMENTS \ , ~ \l~\\\ (~~_ , . (\ ~,- - \~ J ~ II~~ ..-4 '\fll~~/ J/~ ./ 41 By signature. I state and agree, that I have carefully examined lhe completed application and do hereby certify that all Information hereon Is true and correct. and I further certify that any and all work performed ahall be done In accordance with the Ordinances of the City of Springfield, and the Laws of the State of Oregon perlalnlng to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of Ihe Building Safety Division, I furl her certify that only contractors and employees who are In compliance with ORS 701.055 will be used on this prolecl. 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 permll card Is located at the fronl of the property. and the approved set of plans will remain on the site at all tlm~ during constructlo1l Signature 'vJ~c. " ,-- ) i"~ %- Irl ' - - . Date ::L &...- + '1: / VALIDATION: RECEIPT NUMBER d.... 75 l { DATE PAin ID -,..}- '1 7 AMOUNT RECEIVED # ,..:;}(JS, ,1r;;;: RECEIVED BY _ ~ Permit #: Address: ~~~ \\itJ\\ ')\~ Issued by: Date: 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: cg< I own, reside in, or will reside in the completed structure. o 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, D 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 ~ 38. 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 Property Owners about .construct~on ~esponsibilities on the reverse side of this form. 'yV)^~~ ~ ~~ - ~ (9,cf C( 7 1- (Signature ~permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) [nformation Notice to Propeiiy Owners , AboutConsfn.!Cij6n Responsibilities . - ~ " I .' . \ , _ 4. Note: This Information Notice to Property Owners aboul Construction Responsibililies was developed by the Construction Co11lractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a ncw home or make a substantial improvement to an existing structurc. you can prevent many problems by being aware of the following responsibilities and areas of concern, EMPLOYJ;:R RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement ofa residential structure. you will. in most instances, be ruled to be illl employer and the people you hire will be employees, As the employer, you must comply with the follo~ving: Oregon'swithbolding tax law: Asan employer. you must withhold income taxes from employee wages at thetimeemployees 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 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 Department at 378-3524, Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law. and m~st . . , obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may besubjectto penalties and will be liable for all claim costs ifoneofyouremployees is injured on thejob, Formore information, call the Workers' Compensation Division at the Department OfCOIisilmer and Business S<;rvices at 945-7888, U,S.lnternal Revenue Sen'ice: As an employer, you must withhold federal income tax from employees' wages. You will be liable forthe tax payment even if you didn't actually withhold the tax, Formore information, call the Internal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the pemlit holder forthis 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 toqls"paint overspray, water damage fr\lm pipe punctures. tire, 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 theexpertisctoact as your own general contractor, to coord inate thc work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the rcquired inspcctions, If you have additional questions. write or call the Construction Contrabors Board (PO Box 14140, Salem. OR 97309-5052, 503/378-4621), The Board is. located at 700 Summcr St. NE Suite;300. in Sllle[ll. . .- ... j prop-own.pm4 1/94