The URL can be used to link to this page

Home My WebLink AboutPermit Building 1997-8-29 ~ SPRINQFIELD RESIDENTIAL PERMIT APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DIVISION BUILDING SAFETY Job Number: 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 Location of Proposed Work: 5987 KALMIA LN Assessors Map #: 18020323 Lot: 29 Block: 4 Tax Lot #: 02500 Subdivision: GOLDEN TERRACE Owner: MICHAEL HAGEN Address: 5987 KALMIA LANE Phone #: 741-7776 City/State/Zip: SPRINGFIELD, OREGON 97478 Describe Work: NEW -- OFFICE USE -- 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 working day, inspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS --- FOOTING - After trenches are excavated. ELECTRICAL SERVICE - Must be approved to obtain permanent power. ROUGH ELECTRICAL - Prior to cover. SHEAR WALL NAILING - Before covering sheathing with finish materials. FRAMING - Prior to cover. STORM SEWER LINE - Prior to filling trench. FINAL ELECTRICAL - When all electrical work is complete. FINAL BUILDING - When all required inspections have been approved and the building is complete. Item Main Garage Total Value BUILDING PERMIT --- Square Feet x $/Square Feet 286 16.27 Value 0.00 4,653.00 4,653.00 Building Permit Fee Surcharge/Admin 50.50 4.05 TOTAL FEE (~) 54.55 --- MISCELLANEOUS PERMITS Surcharge/Ad~in ELECTRICAL PERMIT 0.00 37.80 TOTAL MISCELLANEOUS PERMITS (E) 37.80 (Excluding Electrical) unless otherwise noted TOTAL AMOUNT DUE (A, B, C, D, and E combined) 92.35 SPRINQFIELD Job Number: 971223 Page 2 --- 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 any provisions of said ordinances. Plan Check Fee: Received By: Plans Reviewed By: DON Building Site Reviewed 32.83 Date Paid: 08/14/97 Receipt Number: 27073 MOORE By: Date: 08/29/97 - -- ADDITIONAL COMMENTS --- 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 DRS 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 the permit card is located at the front of the property, and the approved set of plans y"n~:Tf;[..~ on U~. '""" ooo",""oU" t!>h.~ /97 Si9~\ ( Date VALIDATION Receipt Number: -?7"J ""/ ~ -, -- ~ , Date Paid: o/2..y~ ? '7'2 .'J r fbP~- Amount Received: Received By: . . 225 FIFTH STREET ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 q"''J'' INSPECTION REQUEST: 726-3769 City Job Number /, ~2] OFFICE: 726-3759 1. LOCATION OF INSTALLATION C)'7 S> 7 KAL~t'4 LAJ ' .. ~~) LEGAL DESCRIPTION /9-.02 0 <, 2.. '3 l'l ~ 5"c70 .'. ." JOB DESCRIPTION Y.ec:r J=ty{ v&..J ~~ li:_ Permits are non-transferable and expire if work is not started vi thin l80 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY ="- Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date The installation is being made on property I own which is not intended for sale, lease or rent. -xovnA/lta'r~ ~Fl~ ----------------------~-------------- DATE: ~/:Z5'/ 5'? RECEIPT #: . , '? 7~$: ( RECEIVED BY: '9//?'f".-1-l 3 . COMPLETE FEE SCHEDULE BELOV A. New Residential-Single or Multi-Family per dwelling unit. Service Included: lOOO sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home. or Modular.Dwelling Service or Feeder .B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to. 1000 amps Over 1000 amps/volts Reconnect Only Items Cost Sum $ 85.00 $ l5.00 $ 40.00 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation $ 40.00 $ 55.00 $ 80.00 see ItB" above 200 amps' 'or less 20l amps to 400 amps Signature of Supervising Electrician Over 401 to 600 amps __- _ __ . _H._ - - . --. Over 600 amps or 1000 volts .J j . t I \'-~'Branch Circui t~ . ~wners Name rrLi ~ Haa..ed\ : . . I \.....I Nev, Alteration or Extension Per Panel Address 'SC) Sf Ka LMI A ! f), // \ . () (J ..-/ One Circuit -'.Ci ty-.:3IX'IIAcI -\: \eis.LPhone~..ft- 7TJt;P Each Addi tional '-'" ' U Circui t or wi th Service OVNER INSTALLATION or Feeder Permi t ~ $ 2.00 " L--- $ 35.00 :IS-~ not included) Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% Administrative Fee TOTAL $ $ $ $ ~ 5" :" I. ?,r 'l..~.[ 'j 7.(K) 40.00 40.00 20.00 36.00 - ) .- Permit #: 9 7/2-2 :J - Address: 5,g? YA/~/..7I- Issued by: ~ Date: 0;~7 ~-~ 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: ,. @ ~2. I. 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. 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 ~ 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If! 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 ofthe contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Prope~ fjers about Construction Responsibilities on the reverse side of this form. . --Y /!~~ -ff~9jq7 ... ~i ''(SdAature of permit applicant) (Date'Y' /" (White copy to issuing agency permit file, pink copy to applicant) - L .' . ,. KnformlilJ~iol<i Notice ~o Property Owners AboLl~ Cons~mc~ion Responsibili~ies . ~ .:-~ ~ '. '..... . . ~ Note: This Informatioll Notice to Property Owners abollt Constrllction Responsibilities , " was de~eloped by the Con,tntction 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 structurc, you can prevent many problems by being aware of the following responsibili.ties 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 ofa 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: Asan employer. you must withhold income taxes from employee wages atthetime 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 infornlation. 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 Oreg~n Employment Department at 378.3524. Workers' compensation insurance: Asan employer, you are subject to the Oregon Workers' Compensation Law. and must obtain workers' compensation insurance for your employees, I I' you fail to obtain workers' compensation insurance, you ma)' _ be subjectlo penalties and will be liable for all claim costs if one of your employees is injured on the job, Formore information,. call the Workers' Compensation Division at the Department of Consumer and Business Services at 945.7888, U.S. Internal Revenue Sen-ice: As an employer, you must withhold federal income lax from employees' wages. You will be liable forthe tax payment even if you didn't actually withhold the tax. For more information, call the Intel11al Revenue Service at 1.800.829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: Asthe permit holder for this project, you are responsible for resolving any failureto 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 coveragefor accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures. tire. 01' work that must be re-done. Time to supen-ise 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. . I I' you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309-5052, 503/378-4621). ''fhe Bi;iiu-o is'located at 700 Summer St NE Suite 300, in Salem.' .- .; . \. .. . . prop-own.pm4 1/94