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HomeMy WebLinkAboutPermit Building 1995-7-20 RESIDENTIAL PERMIT APPLICATION Inspections: 72G.3769 Office: 726.3759 LOCATION OF PROPOSED WORK:_, /@,~ 2- ASSESSORS MAP' LOT' '2- . )/J B>O ~c;- BLOCK: '3 OWNER:JA:t/IO f Lt>4?l,)H'~ ~ ADDRESS: /77'!;:__U~__~ ~?" CITY: . 7\50S&~~ JOB NUMBER 225 Filth Street Springfield, Oregon 97477 ?c./A-vt / - TAX LOT: ~//<::JD tfi. lIen/.:" rEs;'. SUBDIVISION' STATE: -6,-",:? -------.- PHON!:' A/rz... ) ZIP:-.5' .?~4 . DESCRIBE WORt(: NEW ""------I'lEMODEL , . ~~ fh<" ~/I. 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 $/SO, FT,' ~ VALUE Main ., Garage 5"ze, ><'-/f/O', Zq.~~ Carp.ort , , ' Total Value Building Permit Fee Stale Surcharge :s :f J 7'- Z ~'" Total Fee (A) 0~.s;o ,"} . '15' /~,:n SYSTEMS DEVELOPMENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) Sanllary Sewer Water N' Storm Sewer FT, FT, FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnaco Exhaust. Hood Vent Fan N' Wood Stovellnsert/Flreplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk fI Curbcut fI Demoiltlon State Surcharge Tolal Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B. C, D, and E Combined) 7,~,~r ':.' ACC I I I _S THE PROPOSED WORK IN THE 'HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? II yes, this applicallon musl be signed and approved by Ihe Historical Coordinator prior to permit Issuance. A'PPROVED: , .. '. BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT " This permit is-granted on.tho cxprcSS'c~,;dillon lhallho said .;;..... ' - construction shall, In all respects. conform \0 the Ordinance adopted ,bh the' Cit'y; of 'Springfleld; including the Development Code, regulating tho,COf)$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 c . Address: . 9 5/1 5Jb~ A /O~Z> &/~ /~ /' !~)7 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. ' prop-own.pm4 1/94