HomeMy WebLinkAboutPermit Building 1997-10-2
RESIDENTIAL
PERMIT APPLICATION
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Inspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK' ~o a 5
ASSESSORS MAP' V\tl~'rl..'l4",
LOT'
BLOCK'
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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
.. ....
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- 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.
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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)
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'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
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II
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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
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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
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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, "
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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 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.
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