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HomeMy WebLinkAboutPermit Building 1993-8-4 ., :r- -.. RESIDENTIAL PERMIT ApPLICATION Inspections: 726,3769 Office: 726.3759 LOCATION OF PROPOSED WORK:. I~~ ASSESSORS MAP: ,,?Z- LOT' DESCRIBE WORK: NEW REMODEL CONTRACTOR'S NAME GENERA' . PLUMBING. 61.u.v~ .-., MECHANICAL: ELECTRICA' . OuJAJM. 4~~ QUAD AREA: # OF BLDGS: __I '1{-2:, OCCY GROUP: # OF STORI ES: -.-:._\ WATER HEATER: . SPRINGFIELD , 1110. I ..' . 6'" 'f7? ,:>P'f<f / JOB NUMBER 9St3597 225 Fifth Slreel Springfield, Oregon 97477 ,<;efld, cr 97478 I . TAX LOT: ? ~C9-cJ SUBDIVISION: -6Olri p f\ ~. PHONE: :J!:)"y~ J IS REQUIRED INSPECTIONS 'C7T Rough Mechanical - Prior to ~ cover. "=7f 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. ~ Framing - Prior to cover. f"C1'" Wail/Ceiling Insulation - Prior to ~ovc~ . \ m. Dlywall - PrIor to tc:.pi!)g. o Wood Stove - After Ins~al!a~ion. Dins-Nt - Af:er fircplar.c appmval n''''l,j lnstaltdtion of unIt. .. o Cllrbcut & Approuch '-'. After fOrlllS am erected- but ;)r:or to placernent of cor.crcll:?,. OWNER J'Y'\ I c.hJ~ J d S:l.nOrt:l N}r [t'JIJ'fh hh~ ADDRESS SCl'Sl Ko..\rY11u L~ - CITY: <-rrIYll'tf, pld . Ad'"i',-\-; Or. ADDITION ~ DEMOLISH STATE: Ji (L OTHER ZIP:_E347~ ADDRESS CONST. CONTRACTOR # EXPIRES PHONE " - OFFICE USE - LAtJD USE: II~n I ~1- ~ 'I FLOOD PLAIN: ZONING CODEJ ~np --- # OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE: <::::;4..0 To request an inspection, you must call 726.3769. This is a 24 hour reccrd!ng. All Inspections requested before 7:00 a.m. will be made nle same working day, Inspections requested alter 7:00 a.m. will bl~~.-nade the fonowing work day. o Temporary Electric D Site Inspection - To be made after excavation, but prior to . setting forms. o .Underslab Plumbing/Electrical I Mechanical - Prior to cover. ~ Fooling - After trenches are ~ excavated. o Masonry - Steel location, bond . bearns, grouting. I"C7f" Foundation - AftN forms art..~ ~ ~rectea but prior to concrete placement. o Underground Plumbing - Prior 10 filling trench. D Underlloor Plumbing/Mechanical _ Prior 10 insulation or decking. 1i<"r pdst and Beam -'- Prior to floor .~ insulation or decking. . . ..... . ~ ' ~FI~O~ lnsulatio~ ',- priO~, to J.?S..L~jcckl ng. o Sanitary Sewer - Prior to filling trench. o Storm Sewer - Plior to filling trench, o Water Line - Prior to filling trench. ,. .. o Rough Plun)piny - Prior 10 ~0V(H. ~~., . .~:~ "'-' . # OF UNITS: CONSTR. TYPE: _V /1/ HEAT SOURCE: RANGE. r I SidelfJ<1lk & Dd'lcw.1v '..- A:~er Cxc3vc'1tion is compl(:t,~. to,m~ ar,d suh.basc materia! in pla(',e. o Ft:.nce - Whorl {:omplc!e~. 11 Stroot Trees -- '.'Y.:'It;;ll,.~~n (~qllir~d tr'.~'.3-~ arc plantod. ~ o Final Plumbing - When all plumbina vJork is complet.e. ~ Final Electrical - When all ~electrjcal work \.5 complete. ~ Final Mechanical - When all ~ mechanical work is complete. ~ Final Building - When all ~ required Inspections have been approved and building is completed. DOther .. MOBILE HOME INSPECTIONS D Blocking and Set. Up - When all -..I biocking is complele. r-J Plumbing Connections - When L- home has been connected to .......ater and sewer. II Electrical Connection - When blocking, set-up. .and plumbing i nspeclions have been approved and the home is connected to the servIce panel. ~ Final - After all required l inspections are approved Cind porches. skirting, decks, and venting have been installed. Lot faces . Lot Type Lot sq. ltg. Interior Lot coverage Corner Topography Panhandle Total height Cul.de.sac BUILDING PERMIT ITEM SQ. FT. X $/SQ. FT. Main Garage Carport AfJ1Jl71/}1f) c::- 40'" Total Valuo Building Permit Fee State Surcharge Total Fee (A) PLUMBING PERMIT ITEM Fixtures Residential Bath(s) N' Sanitary Sewer FT. FT. Water Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove/lnsertl Fireplace Unit / Dryer Vent &x-rev) ~~ Mechanical Permit Issuance State Surcha:-ge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It Curbcut It Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (exc~uding electrical) (A, B, C, D. and E Combined) / / / ,. .... Selbacks P.L. HSE GAR ACe i . IS THE PROPOSED WORK.IN THE . HISTORICALDISTRICT. OR ON THE HISTORICAL REGISTER? -- N S iw IE VALUE .'Z.n~~ FEE /~~" ,h tHJ. /,../ .--- .7f" Q.S, '7S" ~.. '. - 34/7, fi9 " If ye~, t~is application must be signed and approved by the Historical Coordinator prior to permil issuance. f\PPROVED' BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This perrnit is granted on the express condilion that the said construction shall, in all respects, conform to the Ordinance adopl9d by tho City of Springfield, including the Development Code, renulating the construction and use of buildings, and may be suspended or revoked at any timo upon violation of any provision5 of said ordinances, /;2B.3B _ Dale Paid: ?~'5'~3 Receipt Number:_~#S ReCCi~~_~J/f?~ _ _. ~..,nJU s Reviewed By Plan Check Fee: ..$/2../7.I ( Dlile /97Fo , '7. $'S ~7-3f, SYSTEMS DEVELOPMENT CHARGE (SDC) 1# (B) '111/4 ~ Systems Development Charge is due' on all undeveloped properties within ttle City limits whictl are being im'proved. ADDITIONAL COMMENTS By signature, I.state and agree, that I have carefully examined the compleled application and do ,herebY certify that all information hereon Is true and correct, and I further certify that any a~d all work performed shall be done in accordance with the Ordinanct:s or the City of Springfield, and t~c Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY wili be made of any structure without permission of the Building Safety Division. I further certify thilt only comradors and employees who are in, compliance with GRS 701.055 will be used on thIs project. I furlher agree to ensure that all required inspoclio.ns arc requested at the proper time, that each addrCS5 is readable from the street, that ttle permit card is located at the front of the property, and the approved set of plans will remain x':"~:::;;;~;~;y~tJl.. Date VALIDATION: RECEIPT NUMBER 9777 :!J/4/7'3 '3~! >f~ DATE PAID AMOUNT RECEIVED RECEIVED BY ~ . . e- .' Permit No: q3tJ~?' 7 5~~/A 4. Date: ~J Address: Issued by: 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.'Ucensed 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 or 3B: 1.~1 2.l~l ,,- I own, reside in, or will reside in the completed structure. 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.I~ (I will 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. 8/'l}'13 Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ,. . t,," . . . . ... INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: , This Information Notice to Property Owners About Construction Responsibilities was developed by th.e Construction Contractors Board in accordance with ORS 701.055(5), : passed by'the 198!! Oregon legislature. If you ~re ~i::tingas your own contrlictor 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 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 Department of Revenue at 378-3390. 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 EmploY"lent Division DHR at 378-3224. . 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 penalties and will be liable for all claim costs if one of your employees is injured on the job. For more 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 for the tax Payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 221-3960. . 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 faliing tools, paint overspray, water damage from pipe punc- tures, 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 t.rades, .and to notify building of,ficials at the appropriate times so they can perform the required inspections.' . '. ..;. '. .. . . . . If you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151' . Phone 503-378-4621 0244J 10/24/89 ".- . -'" . .B NO. "730"1'11 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: (Y)fu-lltlEL LOCATION: 5"l5' I4tLlV1fA ~ :;RIJPAA !v1C.LA-U6HLfN LANE 1<60 J... ~ 3 '2 ? - 7---800 DEVELOPMENT TYPE: LPI!:. - A P P I TJ 0 1-.1 BUILDING SIZE: LOT STH SQ. Ft. 1. STORM DRAINAGE IMPERVIOUS SQ. FT. ?'?I X $0.203 PER SQ. FT. C/O'J9 2. SANITARY SEWER-CITY NO. OF PFU'S X $42.08 PER PFU <C - ) (See Reverse) ...--/ 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X $424.31 ~- ) '- ...-/ X X $424.31 $ ~ X X $424.31 $ - 4. SANITARY SEWER-MWMC NO. OF PFU'S x $15.125 PER PFU + $10 MWMC ADM FEE $ (Use PFU Total From Item 2 Above) - MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ IOTAL-MWMC SDC ~ SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ /Oq ~ 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X .05 )~ ~L"..k 1 /'2-1./1'1/ ~ Kip Burdick / I SDC Coordinator (5~ TOTAL SDC $ /14- '-jr..