HomeMy WebLinkAboutPermit Building 1994-10-25
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COM M ERCIAL/I N DUSTRIAL
PERMIT APPLICATION
225 Fifth Street, Springfield, Oregon 97477
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JOB NUMBER 9~ ':::l;='1't:;I'
INSPECTION LINE: 726,3769
OFFICE: 726.3759
LOCATION OF PROPOSED WORK' ~.:..-'~ hf;r.~~/~
ASSESSORS MAP: /) ..e?:i?-'3~..:::::>~
OWNER:---v~/TcF ~~<::t
ADDREf:"" CI/?~~ tv' //~ #2
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CITY'
STATE:
DESCRIPTION OF WORK: Jt?4~~~' ;5~ Y/~
'NEW REMODEL ADDITION DEMOLISH
NAME
ARCHITECT'
CONTRACTOR'S NAME
ADDRESS
GENERA' .
PLUMBING:
MECHANICAL'
ELECTRIC" I .
PLUMBING
NO,
FEE
CHARGE
Single Fixture
Relocated Bldg.
(new fix. addlll
_-W~~~ ft.
S5nltary .few:;'''
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ft.
Storm Sewer
ft.
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Backflow Device
TOTAL PERMIT
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ADDRESS
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OUAD AREA:
. OF BLDGS:
- OFFICE USE -
LAND USF'
. OF UNITf"
OCCY GROUP'
. OF SiORIE~'
CONSTR. TYPF'
HEAT SOURCE:
SO. FT.
$/SO. FT.
SO. FTG MAIN
x
X
X
SO. FTG ACCF"''''
SO. FTG OTHER
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- ;
TAX LOT: re 2_/~ /"
PHONF' ---y~ ~"'7~
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.,,0 ,~r=:-~"
VALUE: --:::S-~
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ZIP' ~ V~2
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-.0;
OTHER
PHONE
CONST.
CO NT RACTO R .
EXPIRES
PHONE
*
MECHANICAL
FFF
"I-IA~n:1=
Furnacefburner & vent
<100.000 BTUs
Furnace/burner & vent
> 100.000 BTUs
Floor turnace and vent
Suspended wall or"floor
mounted unit heater
Appliance Vent
separate
Stationary evap.
cooler
Vent Fan/Single
duct
Vent System apart
from AC or htg.
Mechanical exhaust
hood and duct
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Permit Issuance
$10.00
TOTAL PERMIT
HANDICAP ACCESS:
FLOOD PLAIN'
ZONING'
LIGHTING POWER BUDGET:
WATER HEATER'
VALUE
TOTAL VALUE OF PROJECT
PLAN CHECK FEF RCPT' DATF BY
, BUILDING PERMIT ' PLUMBING f'cf? ~ DEMOLITION
5% State 5% State ~- 1.~
Surcharg.e SurcharQe
I MECHANICAL FENCE
VALUE $
15% State SIDEWALK SUBTOTAL
Surcharae FT. PERMITS
I PAVING CURBCUT SYSTEMS
FT. , DEVELOPMENT
TdrAL PERMIT FEES I
EXCLUDING ELECTRICAl
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REQUIRED INSPECTIONS ·
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It Is the responsibility of the permit holder to see that all Inspections are made at the proper time. To request an Inspection, call
726.3769 (recorder), state your City designated job number, Job address, type of Inspection requested and when you will be ready
. for Inspection. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made
.ihe following work day.
SITE INSPECTION: To be
made after excavation, but
prior to setup of forms.
, UNDERSLAB PLUMBING,
, ELECTRICAL &
MECHANICAL: To be made
before any work Is covered.
ROUGH PLUMBING,
ELECTRICAL &
MECHANICAL: No work Is to
be covered until these
Inspections have been made
and approved.
PAVING: After gravel Is In
place but prior to placing
asphalt or concrete.
CONCRETE SLAB: To be
made after all Inslab building
service equipment, conduit,
piping, accessories and other
ancillary equipment Items are
In place but before any
concrete Is placed.
FIREPLACE: Prior to placing
facing materials and before
framing Inspection.
FRAMING: To be made after
the roof, all framing, fire
blocking and bracing are In
place and all pipes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
SPECIAL INSPECTIONS: In accordance
Section 306 of the State Specialty Code
a special Inspector shall be employed
by the Owner I Contractor during
construction of the following work. A
copy of the special testing reports shall
be furnished to the Building Division.
ATTIC DRAFT STOPS &
CURTAIN WALLS
FOOTINGS & FOI1NDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel In place, but
prior to placing concrete.
STRUCTURAL CONCRETE: In
excess of 2500 P.S.1. (306 a.1)
STRUCTURAL WELDS:
Performed on the job. (2722 f)
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UNDERGROUND: Plumbing,
electrical, gas, s~nltary sewer,
storm sew~ale!:,..iMld
drainage lines. 10 be made
prior to covering or filling
trenches.
INSULATION & VAPOR
BARRIER: To be made after all
Insulation and required vapor
barriers are In place but
before any lath or gypsum
board Interior wall covering Is
applied.
HIGH STRENGTH BOLTING:
During all bolt Installation and
tightening operations. (306
a.6)
SPRAYED ON
FIREPROOFING: U.B.G.
Standards 43,8.
UNDERFLOOR: Plumbing,
electrical. mechanical. To be
made prior to Installation of
floor Insulation, decking or
floor sheathing.
FIRE & SEPARATION WALL:
Located and constructed
according to plans. .
SPECIAL GRADING, "
EXCAVATION AND FILLING:
During earthwork. (306 a.11 &
Chapter 29)
POST & BEAM: To be made
prior to Installation of floor
Insulation, decking or floor
sheathing.
LATH AND/OR GYPSUM
BOARD: To be made after all
lathing and gypsum board,
Interior and exterior, Is In
place but before any
plastering Is applied or before
gypsum board Joints and
fasteners are taped and
finished.
GLU.LAM BEAMS: Inspection
Certificate by an approved
agency, furnished to the City's
Building Division before
beams are placed. (2501 U.B.c.
STDS. 25.10,11).
STRUCTURAL MASONRY: (306
a.7)
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior to Installation of
decking or floor sheathing.
MASONRY: Steel location,
bond beams grouting or
verticals In accordance with
UBC 2415.
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base material In
place.
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof covering.
CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
'In addition to the Inspec.
tions specified, the Building
Official may make or require
other Inspections of any
construction work to 'ensure
compliance with the Building,
City or Development Code.
FINAL PLUMBING
FINAL ELECTRICAL
SITE PLAN REVIEW BOARD: Must be requested 2 days In advance
of the date you wish Inspection. All project conditions such as
landscaping, parking lot striping, etc. must be completed before
requesting this Inspection.
FINAL BUILDING: Requested after the final plumbing, electrical,
mechanical and Fire Department Inspections are made and .
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been Issued by the Building Division
and posted on the premises.
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
ADDITIONAL COMMENT""
PLANS REVIEWED BY
DATI:
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information
herein 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 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 Inspections are requested at the proper time, that project address Is readable from the
street, that the permit card Is located al the front of the property, and the approved set of plans will remain on the site at all
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AMOUNT RECEIVED: C(.~, :2'0
/5'?fO
RECEIPT ..
Date /~h01'
DATE PAID: /p.<?C::;-. '7.:=-/,
RECEIVED BY..........-:2--~ .
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VALIDATION:
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Permit#: ~O?~r
Address: ..,. ~ 2~ ff'~-'-'~;-:...F-
, V vl/ c .r....., /" ~_4_....
Issuedby:_ ~~___Date: ./",?~"'!?S-.
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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:
[;1]
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1. ~side 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
14' 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.
CldL- {)oA~_ _ pO ~,C~5'L'
/ (Signature of permit applicant) '&;a;;)/ I
(White copy to issuing agency permit file,
pink copy to applicant)
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lIniorrriationNoticeto Property Owners
,~P..bout Construction Responsibilities
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Note: This Information Notice to Property Owners about Construction Responsibilities .
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was developed by the Construction'Co.ntractors Board in accordance with ORS 701.055(5),
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If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent ,many problems by being awa~ 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
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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 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 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 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 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 requiremenL~
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 falling tools, paint overspray, water damage from pipe punctures, 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
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
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If you have a:d>litiimal qu~stions, write or call the Construction Contractors Board '(PO Box'14140, Sarem, OR 97309-5052,
503/378-4621): The Bdard is located at 700 Summer St. NE Suite 300, in Salem. '
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