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Home My WebLink AboutPermit Building 1992-12-14 ~., " RESIDENTIAL PERMIT APPLICATION . Inspections: 726.3769 Office: 726.3759 LOCATI~N OF PROP07f~WQfl~ l O!J.. ASSESSORS MAP: {, \( J:):~..rr1T :.I_ LOT' BLOCK' A rA ~ . q/d Ifo~1d- JOB NUMBER SUBDIVISION' Q\(\/NER: <- \ _p V"V1 t 1,{ )(1:\ J, , PHONE: IW J-rt)J4..Lt -. ,. h 0 fin - - U. L)A -+r--. -. LCT V STAT~: _(UJJ flWYl) ZIP: L(747 /7 v ADDRE:;JS: CIT'Y"-~ - DE~210RK: UOJIlWy---/ NE REMODEL \ ADDITllN DEMOLISH COtTRACf~,NA~f1 ,f} ') GENERAl' UJ )/lJU(.-/ PLUMBING' MECHANICAl' ELECfRICAI . QUAD AREA:\~~\\.'tL) \ OCCY GROUP' "^' \ . OF BLDGS: . OF STORIES: WATER HEATER' OTHER ADDRESS CON ST. CONTRACfOR . 14r;;a /44 '- OFFICE ~SE - LAND USE: \ \ \ \ . OF UNITS: vrJ EXPIRES FLOOD PLAIN: - ~ ZONING CODE:. ~l< '} . OF BDRMS: \ J^ ../ SECONDARY HEAT: SQUARE FOOTAGE: JaPn 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 the same working day. Inspections requested after 7:00 a.m. will be made the following work day. o Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. o Under,'ab Plumbing/Electrical! MechanIcal - Prior to cover. ~ Footing - Atter trenches are , excavated. D Masonry - Steel location, bond beams, grouting. rlI1 Foundation - After forms are ~ erected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. o Underfloor Plumbing/Mechanical - Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decking. o Floor Insulation - Prior to decking. o Sanitary Sewer - Prior to filling trench. o Storm Sewer - PrIor to filling trench. O Water Line - Prior to filling trench. o Rough Plumbing - Prior to cover. CONSTR. TYPE: HEAT SOURCE: RANG'" REQUIRED INSPECTIONS o Rough MechanIcal - Prior to cover. D Rough ElectrIcal - Prior to cover. \ o Electrical Service - Must be approved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. [l] Framing - Prior to cover. D Wail/Ceiling InsulatIon - Prior to cover. o Drywall - Prior to taping. D Wood Stove - After Installation. o Insert - After fireplace approval and Installation of unit. D Curbcut & Approach - After forms are erected but prior to placement of concrete. o Sidewalk & Driveway - After excavation Is complete. 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 w9rk Is complel.e. D Final Electrical - When all electrical work Is complete. o Final Mechanical - When all mechanical work Is complete. 00 Final Building - When all required Inspections have been approved and building Is completed. DOthor MOBILE HOME INSPECTIONS o Blocking and Set-Up - When all blocking I' 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 Final - After all required Inspections are approved and porches, skirting. decks, and venting have been Installed. Lot faces Lot sq. Itg. Lot coverage Topography Total height \ll:-~ ,. Lot Type. X. Interior Corner Panhandle Cul-de-zac BUILDING PERMIT ITEM SO. FT. X $/SO. FT. Main Garage Carport (,qPf) Total Value Building Permit Fee State Surcharge Total Fee "f~.'.::.. '~_I~..':"t). 'i~tf\.1i I<~":'~ "'.,. ....:t ,',,. i'~ Setbacks ' , .S THE PROPOSED WORK IN THE P.L. HSE GAR ACC I"HISTORICAL DISTRICT, OR ON /.1A ~ ~ THE HISTORICAL REGISTER? If yes, this application must be signed B/:. w: I and approved by the Historical 6;~" I . Coordinator prior to permit issuance. / nt64 I N Is Iw IE VALUE 14. I [) '.18/'145., (A) a.,c/.!;;:::> b.)~ i'LJ.2? , ..... I 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 an~'?Jsi~s of said ordinances. Plan Check Fee: _t! . I ."'-f; JJ ,,~n ' Receipt Number: L1l. . Date Paid: Rec~'7BY: ~~~ /'2-~?'.2, ~~evlewed-~ r Date Systems Development Charge Is due on all undeveloped " properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) -e-tE PLUMBING PERMIT ITEM Fixtures Residential Bath(s) N' Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan Wood Stovellnsert/Flreplace Unit Dryer Vent Mechanical Perml t Issuance State Surcharge Total Permit (B) (C) N' Mobile Home MISCELLANEOUS PERMITS (D) State Issuance State Surcharge Sidewalk It Curbcut It Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) FEE If/. :2:$ ADDITIONAL COMMENTS , .L ~~n~ -'\ ~(h^ n\)\~ , <<)( 0 Q~ \ \l\~Kl;.V\ ~ (J( ,rx\~ UJ OJ (rtC~J\L 00 0<Ql)ido {1 '0 By sIgnature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information hereon Is truo 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 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 ensure that all required Inspectlons 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 on the site at all times during construction. YSlgnature -z.; "hi fhd:;- Date /1. - If Jj'7 VALIDATION: RECEIPT NUMBER '103.5' )2 -/~-7'L /4/,2 ! ,-~ DATE PAIr> AMOUNT RECEIVEr> RECEIVED BY . .~ . . Permit No: c?2 /~?, 2- . Address: _,5"~2- (""7.,...,/./J/'J/AL Issued bY:~ Date: /2.-14-72 FOR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state. ment is required for residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt from registration underORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: 1. ,.:; ~~ I own, reside in, or will reside in the completed structure. 2. r - '-i.., I understand that I must register as a construction contractor if the structure is sold -- or offered for sale before or 'upon completion. 3. A.I I My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 3. B" r:::-c.:ILwill be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. If I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I 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 understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~?l1~ SfgnaU:1re of Perm if Ap'plicant /2- - JI/-7 2- Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPUCANT .' '. .~ INFORM!ION NOTICE TO PROPERTY OIERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Infqrmatian Notice ta Property Owners Abaut Canstructian Responsibilities was develaped by the Canstructian Cantractars Baard in accardance with ORS 701.055(5), passed by. the .1989 Oregon Legislature. " yau are acting as yaur awn cOntractar ta canstruct a new hame .or make a substantial improvement ta an existing structure, yau can preyent many problems by being aware .of the fallawing respansibilities and areas .of cancern. EMPLOYER RESPONSIBILITIES: If yau hire persans nat registered with the Canstructian Cantractars Baard ta da labar in canstructing .or assisting in the canstructian .or improvement .of a residential structure, yau will, in mast instances, be ruled ta be an "emplayer" and the peaple yau hire will be "emplayees". As the employer, yau must camply with the fallawing: . .1', Oregan's Withhalding Tax Law: As an emplayer, yau must withhald incame taxes fram emplayee wages at the time emplayees are paid. Yau will be liable far the tax payments even if yau dan't actually withhald the tax fram yaur emplayees. Far mare infarmatian, call the Oregan Department .of Revenue at 378-3390. Unemplayment Insurance Tax: As an emplayer, yau are required ta pay a tax far unemplayment insurance purpases an the wages .of all emplayees. Far mare infarmatian, call the Oregan.Emplayment Divisian DHR at 378-3224. Warkers' Campensatian Insurance: As an emplayer, yau are subject ta the Oregan Warkers' Campensatian Law, and must .obtain warkers' campensatian insurance far yaur emplayees. If yau fail ta .obtain warkers' campensatian insurance, yau may be subject ta penalties and will be liable far all claim casts if .one .of yaur emplayees is injured an the jab. For mare informatian, call the Wa~kers' Campensatian Divisian DIF at 373-7434. U.S. Internal Revenue Service: As an employer, you must withhald federal incame tax from emplayees' wages. Yau will be liable for the tax payment' even if yau didfl't actually withhold the tax. For more information, call the Internal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN:, Cade Campliance: As the permit halder far this project, yau are respansible far resalving any failure ta meet cade requirements that may be brought to your attentian through inspectians. Liability and Praperty Damage Insurance: Cantact yaur insurance agent ta see if yau have adequate insurance caverage far accidents and amissians such as falling taals, paint averspray, water damage fram pipe punc- tures, fire, .or work that must be re-dane. Time, ta Supervise Emplayees: Make sure yau have sufficient time ta supervise yaur emplayees. Expertise: Make sure yau have the expertise ta act as yaur awn general cantractar, ta caardinate the wark .of raugh-in and finish trades, and ta natify building .officials at the apprapriate times sa they can perfarm the required inspectians. If yau have additianal questians, write ta: Canstructian Cantractars Baard 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phane 503-378-4621 0244J 10/24/89 ~