HomeMy WebLinkAboutPermit Building 1995-7-20
RESIDENTIAL
PERMIT APPLICATION
Inspections: 72G.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:_,
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ASSESSORS MAP'
LOT'
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BLOCK:
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OWNER:JA:t/IO f Lt>4?l,)H'~ ~
ADDRESS: /77'!;:__U~__~
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CITY:
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7\50S&~~
JOB NUMBER
225 Filth Street
Springfield, Oregon 97477
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SUBDIVISION'
STATE: -6,-",:?
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PHON!:'
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ZIP:-.5' .?~4
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DESCRIBE WORt(:
NEW ""------I'lEMODEL
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OTHER
CONTRACTOR'S NAME
GENERAL: __--.L2f&) A}P~
PLUMBING:
MECHANICA' '
ELECTRICAl'
~WA)~
QUAD AREA, 5~~~
. OF SLDGS: __ \
OCCY GROUP: "^
. OF STORIES:
WATER HEATEn:
:ADDITION DEMOLISH
ADDRESS
CONST,
CONTRACTOR'
PHONE
- OFFICE USE _
\\ Sf)
LAND USE:
. OF UNITS:
CONSTR, TYPE:
HEAT SOURCE:
VtJ
EXPI R ES
FLOOD PLAIN:
ZONING CODE:
L~
RANGE: _
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: _-:52fJ
To request an In~pccllon, you must call 726.3769, Ttlls Is a 24 hour recording. AI/Inspections requested before 7:00 a.m. will be
made the SOnJe working dny, Inspecttons requested after 7:00 a.m. will bo made tho following work day.
o Tomporary Electric
O Slto Inspection - To be mado
after excavation, but prior to
setting for/llS.
o
Underslllb Plumbing I Electricall
Mechanical - Prior 10 cover.
~
;
eoollng - Aller trenches are
excavated,
o Masonry - Steel location, bond
beams, groutIng.
0' Foundation - After forms are
.. erected bu t prior to concrete
placement.
o Underground Plumbing - Prior
to f1lllnQ trench,
o
Underlloor Plumbing/Mechanical
- Prior 10 Insulation or decking,
o Post and Bea~ - Prior to floor
Insulation or deck.lng.
o Floor Insulation - Prior to
decking,
o Sanitary Sewer - PrIor 10 tilling
trench.
o
Storm Sewer - PrIor to fillIng
trench,
o
Water Line
trench,
Prior to flllln'g
. '
o Rough Plumbino - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
~ough Electr~cai - Prior to
~over. '
rs:;J-Electrlcal Service - Must be
r ""pproved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and 'ramlng Insp.
QFram.lng - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover,
o Drywall - Prior to taping.
o Wood Slovo - After InstallaUon.
o Insert - After fireplace approvlll
and Installation of unit. .
,
o Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
o Sidewalk & Driveway - After
excavation Is compictc, forms
and sub,base material In place,
o
Fence -- When completed.
o
Street Trees - When all required
trees are planted.
o Final Plumbing - When all
plumbing work Is complet,e,
~Inal Electrical - When all
~Iectrlcal work Is complete.
o Final Mechanical - When all
mechanical work Is complcte.
~Flnal Building - When all
required Inspections have been
approved and building is
completed,
o Other
-'
-
MOBILE HOME INSPECTIONS
o Blocking and Set. Up - When all
blocking Is complele.
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
Final - Arter all required
Inspections are approved and
porches, sklrtl'ng, decks, and
ventlng have been Installed.
Setbacks
I PL. HSE GAR
IN
I S I
I IN. I ,I I
lL:LL~,1
Lot faces
Lot'Type.
InterIor
Lot sq, fig.
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de.sac :'
\
BUILDING PERMIT
ITEM SO, FT, X $/SO, FT,' ~ VALUE
Main
.,
Garage
5"ze,
><'-/f/O', Zq.~~
Carp.ort
,
, '
Total Value
Building Permit Fee
Stale Surcharge :s :f J 7'- Z ~'"
Total Fee (A)
0~.s;o
,"} . '15'
/~,:n
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
Sanllary Sewer
Water
N'
Storm Sewer
FT,
FT,
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust. Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
Curbcut
fI
Demoiltlon
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B. C, D, and E Combined)
7,~,~r
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ACC I
I
I
_S THE PROPOSED WORK IN THE
'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this applicallon musl be signed
and approved by Ihe Historical
Coordinator prior to permit Issuance.
A'PPROVED: ,
..
'.
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
" This permit is-granted on.tho cxprcSS'c~,;dillon lhallho said
.;;..... ' -
construction shall, In all respects. conform \0 the Ordinance
adopted ,bh the' Cit'y; of 'Springfleld; including the
Development Code, regulating tho,COf)$lruction and use of
buildings, and may be suspended' o'r 'rcv()kCd at any time
upon violation of any provisions of saId ordinances,
Plan Chec'k'Fee" #;53
Dale pald:,__~ZflS- _,
Receipt Number:____/iI'glL
Received By: _,_,~~
~~' -- ~ :. ,,'
Plans Revlewed''s''y'-''---'---
Date
Systems Development Charge Is due on all undeveloped
properties within tllO City lirr,(ts.whiCI1 are being Improved,
ADDITIONAL COMMENTS
By slgnature,l~tate nnd agree. thallllD.ve carefully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and t further certHy
that any and all work performed shall be done In accordance
with the Ordlnancos of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein. and thai NO OCCUPANCY will be mado 01 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 further agree to ensuro that all required Inspoctlons are
requested at the proper time, that oach address Is readable
(rom the street, that the permll card Is located at the fronl
of the property. and the approved sot of plans will remain
on the site a atl times 9 on ructlon,
Xonature <
Date
VALIDATION:
Jg, 3'7/
DATE PAID _ ~~ .r..,
AMOUNT RECEIVED _./? <2l.. .75'
4-PA~
-..;.
RECEIPT NUMBER
.. RECEIVED BY
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.
Address:
.
9 5/1 5Jb~ A
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Date:
Permit #:
Issued by:
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:
g( 1. I own, reside in, or will reside in the completed structure.
tvr 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
P 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
~ 3B. I will be my own general contractor.
If I hire subcontrac'ors, 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 'his 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 Prope Owner b t C truction Responsibilities on the reverse side of this form.
7AiJ/jr
(Signatutf of permit applicant) ((D~te{ -
(White copy to issuing agency permitfile,
pink copy to applicant)
..
.
I. , :
i[nformatiOri 'Notice to Property Owners
~,;,,;'" " , ':i-~~p~t C~n~t~~ction Responsibilities
"\... ....' - :::':"_w,:.~'."'.... ,_ i . .
Note: This Injormqtjo,nfJ..otice toJ>roperty Owners. about Construction Responsibilities' '
was developed by the C;;"struction 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 erilployer, you must withhold income iaxes 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 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'triu~t
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 informati(;n,
call the Workers' Compensation Division at the Department of Consumer and Business Se~ices at 945-7888, '
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 1-800-829-1040.
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 overs pray, 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 qii~stions, write or call the Construction Contractors Board (PQ'Box 14140, S~em"OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. '
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