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Home My WebLink AboutPermit Building 1992-7-15 ~- i', 2- , RESIDENTIAL PERMIT APPLICATION Inspections: 726,3769 Office: 726.3759 ASSESSORS ~r- LOT: ~ / CONTRACTOR'S NAME <;r;// , GENERAl' PLUMBING' MECHANICAl' ELECTRICAl' QUAD AREA: ~~ Q.R' ./ .' # OF BLDGS: _ . r OCCY GROUPjSJ)'1 JV\ " OF STORIES: d Y'.-/ WATER HEATER: . SPRINGFIELD !B NUMBER 4fJ!B1d 225 Fifth Street Springlield, Oregon 97477 . J:v./-".,.Ce~-ey-,"~~_n , TAX LOT- l/lI eYS T:Cr) SUBDIVISION: Luce.rne NeAdow5 REQUIRED INSPECTIONS ~ Rough Mechanical ~ prIor to ~ cover. , 'f:::7r Ro.ugh Electrical - P;I~r' to ~cover. rv1 Electrical Service - Must be ~pproved to Obtai" permanent electrIcal power. o Fireplace - Prior to facing materials and framing Insp. ~ Framing - Prior to co~cr, fVf Wall/Ceiling Insulation ..:..: Prior to ~ cover, , . ~ ' \ ~ Drywall - Prior to la~j~g: \ o Wood Stove - After Installation, o Insert - After fireplace approval and Installation of unit. -F=;Z1 Curbcut & Approach - After ~orms arc erected but prior...to: . placement of concrete.. :"~_: . , iVf Sidewalk & Oriveway - After ~xcavation Is complete, forms and sub.base material In place, o Fence - When completed, 1@Slreet Trees - When all re~ulred L:::I trees are planted,' .' '-_ PHONE:.7Lb> ' L/37/ ZIP: 9 7-Y' 7A OWNER _-r;-a.C.o/--!_/?01~:T M;'~h7 ADDRESS: 3e.!/.-.IV. ,~2-" d . CITY- ;:!in,.., -""L~/d' STATE: _I?/:/"~ . // / DESCRIBE WORK' '/?e-;"dt!~c...e NEW . t/"" REMODEL ADDITION BLOCK' DEMOLISH' . OTHER '. CONST. CONTRACTOR' PHONE EXPIRES * FLOOD PLAIN: _ ZONING CODE: WIZ.-/ . OF SDRMS: ~ ~ SECONDARY HEAT: SQUARE FOOTAGE: ZqcPz-' -- 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. wlll be made the following work day. ADDRESS _ ~e. A <; A h/\ t/e" \ , , .1~ ,. , - OFFIC: U~E - LAND USE: _I. I \ . OF UNITS: _ ) CONSTR. TYPE: Jl.f; #p HEAT SOURCE: -F .J C?' j./ RANG'" ~ r'\7r Final Plumbing - When all ~ plumbing work is comple.te. f"C7I Final Electrical - When all ~ electrical work is complete. r\:7T Final Mcchanical - When all ~mechanlcal work is complete. t\:7r Fin~i1 Building - When all ~reQuired Inspections have been approved and building is completed. DOthcr MOBILE HOME INSPECTIONS o Blocking and Set-Up - When all blocking Is complete. D Plumbing Connections - When home has been connected to waler and sewer. D 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. ~ Tcmporary Electric D Sltc Inspection - To be made after excavation, but prior to setting (arms, J,.tl.w/.A;A()A,). . o Und~rsl~b . L.:. ".....~I~_'\..;._,. -M-....-"-.;.____ - Prior to cover, 'K7r Footing - After trenches are ~excavated, D Masonry - Steel location, bond beams, grouting, rvT Foundation - After forms are ~ erected but prior to concrete placement. o Undcrground Plumbing - Prior to filling trench. ~ Underfloor Plumbing/Mechanical ~- Prior to Insulation or decking. ~ Post and Beam - Prior to floor ~nsulation or dec~ing,. '"F::7f Floor Insulation - Prior' to' ~ecklng. I'::A"Sanilary Sewer - Prior to filling ~ trench, r9T Storm Scwcr - Prior to filling ~ trench. ,--' - ~ ~'. " . J\71 Water Line - \!t~r,,;2..!i1iln,t,.. ~ trench. .........., ~. ..... . \ " . \ 1....\' '01 Rough Plumbin....g -7 ~-~rtO'r to ;o.s cover. '-:...' I .... ,'~, ,~ , ~ 'q'l[ '700f ) 4'2/1= 2./35 #6.3$ SYSTEMS DEVELOPMENT CHARGE (SDC) f4?> . H. l'f , . (B) wZ,'Z-TZ- Lot faces * Lol sq. Itg. ----- Lot coverage M L:Zfo 23&' ., "_. ~ Topography Total hcight BUILDING PERMIT ITEM SQ. FT. Main '-'2-/~q . r1il 1- Garage Carport Total Value Building Permit Fec State Surcharge Total Fcc Lot TYP. ~rior Corner Panhandle Cul-dc.sac X $/SQ. FT. '-3-,'4 70 -L,J./ () (A) I P.L. HSE GAR ACC I 2()1 I I Iw I /:/1 'LLft.~-.J N S VALUE ~,.., 115 /-Cl!! ;;; ~ PLUMBING PERMIT ITEM FEE Fixtures Acsidcnlial Balh(s) N' ~ _13.2_.5"0 Sanitary.Sewer, FT. Wator FT. -' \ Storm Sewer FT " Mobile Home ~ Plumbing Permit State Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan (C) . Dryer Vent Wood Stove/lnsertl Fireplace Unit . N' ~ Mcctlanical Permit Issuance Slate Surcharge Total Permit Mobile Home MISCELLANEOUS PERMITS (D) State Issuance State Surcharge Sidewalk srJ,t) "3D II It Curbcut Demolition State Surcharge Total Miscellaneous Permits (El qt.?, 2t?2/3 ~.t)o 4. So qo-O --3.0-0 2'2.50 .L.p.ao /./3 ..33.~3 ~"2-0-0 /4.50 ---; r ?-,~ pO TOTAL AMOUNT DUE (excluding electrical) ,~9P.80 (A, B, C, D, and E Combined) 3/7/,50 Selbacks J -,. . IS THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed ~rI' approved by the Historical "- /oordinator prior to permit issuance, APPROVED' BUILDING VALUE, PLAN CHECk AND BUILDING PERMIT This permit is, granted on the express condition lhallhe said construction shall, in all respects, conform to -the Ordinance adopted by the City 01 Springfield, including the Development Code, rcgulaling the' construction and use of buildings, and may be suspended or revoked a~ any time upon violation of any provisions of said ordinanc'es, Plan Check Fee:~'l(), <:06 . ~ _\\01"') Date Paid: ,1 -\ L Rcceipt Numbcr: t, ~ C:> l R~cei~~ ~ Pan Revle-wed fi!y ?/24~2- ----'-i~ Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS \._~ffi \ "SID1H~~~ tJJLfWht~ ; f!j.!.rd ( J ~ \'" en [uJ.JL; (C8~Cr .. t\ By signature, I slale and agree, that I have carefully examined the completed application and do hereby certify that all information hcreon is true and correct, and I furthcr 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 Orenon pertaining to the work described herein, and t.hat NO OCCUPANCY will be Illoue of any structure without permission of the Building Safety Division, . I furthcr certify that only contractors and employees who , arc in compliance with QRS 701.055 will be used on this project. I further agree to ensure that all required inspections arc requested at the proper time, that each address is readable from the street, that the permit card Is located at thc f~ont of the property, and the approved set of plans will remain on the site at all times during =~ion. ~nalure~ ----, W"^" Dale~7/ I VALIDATION: RECEIPT NUMBER <55'S DATE PAID ?//~2-- AMOUNT REl;:EIVED :;;3 ;L,.$ 0 RECEIVED BY ~ / r Q c- I ~ . . Permit No: CJ2-t9 =5t::,d ,- , Address: ~j.(/J.I /4~/A Issued by' 4 ~ Date: py12 ~OR 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 ConstructiDn 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 under ORS 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 Dr 3B: 1. T -><-L I own, reside in, Dr will reside in the completed structure. 2 .~J_ I understand that I must register as a construction contractor if the structure is sold Dr Dffered for sale before Dr upDn completion. 3. A.I I My general contractor i~ Contractor registration number I will instruct my general cDntractor that all subcontractors who work on the struc- ture must be registered with the Construction CDntractors Board. OR ~ 3. B.I '><'1) will be my own general contractDr. If I hire subcDntractors, I will hire only subcontractors registered with the CDnstruc- tiDn ContractDrs BDard. If I change my mind and dD hire a general cDntractor, I will cDntract with a contractor who is registered with the Construction CDntractors 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. ~w-~ Sfgnaiu~ of Permit Applicant ~/ CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ~: '-:. INFO.ATION NOTICE TO PROPERTY O~ERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE;. This InfDrmation Notice to Property Owners About Construction Responsibilities was devel,Dped by the CDnstructiDn CDntractors Board in accDrdance with ORS 701.055(5), /. . ;pas~ed._by.the\19890regon Legislatwe. .-.. '. " -If you are"acting as your own'cDntractDr to cDnstruct a new hDme or make a substantial improvement to an existing structure, YDU can prevent many problems by being aware of the fOIlDwing responsibilities and areas of CDncern. . EMPLOYER RESPONSIBILITIES: If you hire persDns not registered with the Construction CDntractors Board to dD labor in constructing or assisting in the construction Dr improvement of a residential structure, you will, in most instances, be ruled tD be an "employer" and the peDple you hire will be "employees". As the employer, YDU must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhDld 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 emplDyees. For more infDrmatiDn, call the Oregon Department of Revenue at 378,3390. Unemployment Insu'rance Tax: As an employer, YDU are required tD pay a tax for unemployment insurance purposes on the wages Df all employees. For more infDrmation, call the OregDn Employment Division DHR at 378-3224. ' . ''\'orkers' Compensation Insurance: As an employer, you are subject to the OregDn WDrkers' CDmpensatiDn Law, and must Dbtain workers' cDmpensatiDn insurance for your emplDyees. If you fail to obtain wDrkers' compensation insurance, you may be subject tD penalties and will be liable fDr all claim costs if one of your employees is injured on the job. For mDre information, call the Workers' Compensation Division DIF at 373-7434. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable fDr the tax payment even if YDU didn't actually withhDld the tax. FDr mDre information, call. the Internal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: .' --- vDde Compliance: As the permit holder for this project, YDU are responsible for resolving any failure to meet <:ode requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact YDur insurance agent tD see if you have adequate insurance coverage fDr accidents and omissiDns such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-dDne. Time to Supervise Employees: Make sure YDU have ,sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your Dwn general contractor, tD coordinate the work of rough-in and finish trades, and to nDtify building officials at the appropriate times so they can perform the required inspections.'. . . . If you have additional questions, write to: Construction Contractors Board 700 Summer SI. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89