HomeMy WebLinkAboutPermit Building 1996-3-13
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Page 1
RESIDENTIAL PERMIT APPLICATION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
Job Number: 960247
225 North Fifth Street
Springfield, OR 97477
Office: 726-3759
Inspection Line: 726-3769
Location of Proposed Work: 5171 FORSYTHIA DR
Assessors Map #: 18020421
Lot: Block:
Tax Lot #: 05800
Subdivision:
owner: W.T. HARKEY, JR.
Address: 5171 FORSYTHIA DRIVE
Phone #: 746-8757
City/State/Zip: SPRINGFIELD, OREGON 97478
Describe Work: HOBBY/BDRM ADDITION
ADDITION
Contractor
Const.
Contractor #
Expires
Phone
General:
OWNER
746-8757
Electrical: OWNER
QUAD AREA: 3RSC
# OF UNITS: 1
CONSTR, TYPE: VN
OFFICE USE --
LAND USE: 1150
ZONING CODE: LDR
HEAT SOURCE: FE
# OF BI.DGS: 1
OCCY GROUP: R3
SQ FOOTAGE: 192
To request an inspection. call the 24 hour recording at 726-3769.
All inspections requested before 7:00 a.m, will be made the same werking day,
inspections requested after 7:00 a,m. will be made the following work day.
REQUIRED INSPECTIONS ---
FOOTING - After trenches are excavated.
FOUNDATION - After forms are erected but prior to concrete placement.
POST AND BEAM - Prior to floor insulation or decking,
INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover
ROUGH ELECTRICAL - Prior to cover.
FRAMING - Prior to cover.
INSULATION - Floor; prior to decking Wall/Ceiling; Prior to cover
DRYWALL - Prior to taping.
FINAL ELECTRICAL - When all electrical work is complete,
FINAL BUILDING - When all required inspections have been approved and
the building is complete.
Total Height: 14
Lot Type: INTERIOR
Setbk From NPL: 26
Solar Approved: Y
N
Setbacks
S W
41
E
5
House
Item
Main
Garage
Total Value
BUILDING PERMIT ---
Square Feet x
204
$/Square Feet
64.66
Value
13,191. 00
0,00
13,191,00
Building Permit Fee
Surcharge/Admin
104,50
8,37
TOTAL FEE
(A)
112.87
SPRINGFIELD .
. .
Job Number: 960247
Page 2
--- SYSTEMS DEVELOPMENT CHARGE (SDC) ---
(B)
45.86
Systems Development Charge is due on all undeveloped properties within the City
limits and the Citys Urban Growth Boundry which are being improved,
(Excluding Electrical)
unless otherwise noted
TOTAL AMOUNT DUE
(A, B, C, D, and E combined)
158.73
--- BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT ---
This permit is granted on the express condition that the said const:ruction
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 any provisions of said ordinances.
Plan Check Fee:
Received By:
Plans Reviewed By: DON
Building Site Reviewed
64,03
Date Paid: 02/23/96
Receipt Number: 20483
MOORE Date: 03/12/96
By: LISA HOPPER
PATH 1;
OREGON 1
--- ADDITIONAL COMMENTS ---
SEPARATE ELECTRICAL PERMIT IS REQUIRED; NEW OPNG IN M.H TO COMPLY WITH
& 2 FAMILY DWELLING CODE REQ'MTS,
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all information hereon
is true 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
Community Services Division, Building Safety. 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 inspections are requested at the
proper time, that each address is readable from the street, that th.=: permit
card is located at the front of the property, and the approved set .of plans
will remain on the ~ite at all times during construction.
j)f-~~~/~q
Signature ~ ~~ ~
-- - VALIDATION
~- I '<; - 9b
Date
Date Paid:
7~?~
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/?B- 7'3
/7~.
'7
Receipt Number:
Amount Received:
Received By:
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CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARI~E
(RESIDENTIAL)
Name or Company: W.T.
Location: 5171
Developement Type: R
Job No.: 960247
HARKEY, JR.
FORSYTHIA DR
Building Size:
Lot Size:
1. STORM DRAINAGE
Impervious Sq Ft 208 X 0,210 Per Sq Ft
2. SANITARY SEWER - CITY
Number Of PFUs 0 X 43.43 Per PFU =
(see Page 2)
3. TRANSPORTATION
Number Of Units
Trip Rate
X
Cost Per Trip
X
Transportation Total
4. SANITARY SEWER - MWMC
Number Of PFUs
o
Per PFU + MWMC Admin Fee
18.750
X
X
=
MWMC CREDIT If Applicable (see Page 2)
TOTAL - MWMC SDC
SUBTOTAL - (Add Items I, 2, 3 & 4)
5. ADMINISTRATIVE FEES
Base Charge (Subtotal Above) X
0.50
TOTAL SDC
Reviewed By: TROY MCALLISTER
Date: 02/28/96
Page 1
Sq Ft
)
$43,68
$0,00
$0.00
$0,00
$0,00
$0,00
$43.68
$2,18
$45.86
.
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Job Number: 960247
FIXTURE UNIT CALCULATION TABLE
Fixture Type
Bathtub
Drinking Fountain
Floor Drain
Interceptors For Grease/Oil/Solids/Etc
Inteceptors For Sand/Auto Wash/Etc
Laundry Tub/Clotheswasher
Clotheswasher - 3 Or More
Receptor For Refrigerator/water Station/Etc
Receptor for Commercial Sink/Dishwasher/Etc
Shower, Single Stall
Shower, Gang
Sink, Bar, Commercial, Residential Kitchen
Urinal, Stall/Wall
Wash Basin/Lavatory, Single
Water Closet, Public Installation
Water Closet, Private
Miscellaneous
Number of
New Fixture
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
.
Page 2
Unit
Equivalent
2
1
2
3
6
2
6
1
3
2
2
2
1
6
4
Fixture
Units
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
TOTAL FIXTURE UNITS 0
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occured
after annexation date, credits are calculated separately.
(calculations are by $1000)
Year Annexed:
Credit For Parcel Or Land Only If Applicable:
Improvement (if after annexation date) :
o
X
0.00
o
X
0,00
0.00
0,00
$0.00
(If land value is multiplied by 1 then the parcel/land credit is not accurate.)
CREDIT TOTAL =
.
.
Permit #: ~2 0/"/
Address: 5"/ 7/ ~57"7A"./..;,d
Issued by: ~~ - Date: ?-~~
,/#-1
Statement: Information Notice to Propert~, Owners
About Construction ResponsibilitiE~s
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:
[Xl
D
I. I own, reside in, or will reside in the completed structure,
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
[lI 3B, 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 Construction Responsibilities on the reverse side of this form.
_:J1::J.cj/;?4.t,..:,_C7. ~:-/3 -9?:
~ignat~ermit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
,
JInformaiion Notice to Propeiiy Owners
~OUi ~on~t.r.uction Responsibilities
.;-
,Note: This Infonnation Notice to Property Owners about Construction Responsibilities
. .. - -.
,vas developed by the COIislruction CO,ntractors 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 stmcture,
you can prevent many problems by being aware of the following responsibilities and areas of c~ncern,
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the, Construction Contractors Board to do labor in constmcting or assisting in the
constmction or irnprovemfmt of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be 'elnployees, As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes 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 Dep!. 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 must
obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation insurance, you may
be subject to pemllties and will be liable for all claim costs if ~ne of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888,
U.S. Internal Revenue Service: As an employer, you must withhold 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
accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that rnust 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 coordimite the work of rough-in and tin ish
trades. and to notify building officials at the appropriate times so they can perform the required inspections.
. \. \.
If you-hJ!ve adClitiOl1al questions, write or call the Construction ContractorsJ!oJ\rd (P.O'Bm, 14J~O, Salem, DR 9.7309-5052,
. . "
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem", '. .
prop-own.pm4
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