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Home My WebLink AboutPermit Building 1994-6-6 ,~ RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 . LOCA;ION OF PROPOSED WORK: .!;i4iUlAlf ASSESSORS MAP: 17 ".5 d:7 '. LOT'. '1.' BLOCK4 . OWNER:_12,pAlr;; r:__ 5/-i./J;;'L ADDREf''''' Ie::; (7 k'~. CITY: ~~,::A, STAT~'O~, DESCRIBE WORK' .:t3pfh.RiM., ~l~ . JOB NUMBER !y11 8.).'1' 225 Fifth Street Springfield, Oreg,?n 97477 ,. . TAX LOT: ~q:) SUBDIVISION' tI ;/l-v /w PHONE: 24-/.- 2<ffj3 ZIP: VJ-7 ~L OTHER R NEW REMODEL ADDITION "'^ DEMOLlSI:I . .'. CONST. CONTRACTOR'S NAME ,ADDRESS". \ ,_' .CONTRACTOR" . GE~~RAL: ~JJ(.~~_:~0l g.. 'S'2f(..5 RtJ8.h.:pJ. &; ~/<;6;:), ~~ PLUMBING' MECHANICAl .-f.~r =.!.... ELECTRICAl' O/1.J/JBf- QUAD AREA: \~~\J , OF BLDGS: ,,\ OCCY GROUP: \\~ , OF STORIES: ~ WATER HEATER' ". - OFFICE USE - \\\\ \f~ LAND USE: , OF UNITS' CONSTR. TYPE: HEAT SOURCE: RANGE: EX'JIRES J P,Hp-'NE 4/95 r.r1oL .;'Cffl.a9 I '. . FLOOD PLAIN: ZONING CODE::lD~ ~ OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE: -.12J 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 ~fter 7:00 a.m. will be made the following work 'day. REQUIRED INSPECTIONS o Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. o Underslab plumbing/Electrical I Mechanical - Prior to c().ve.~ O Footing - After trenches are excavated. o Masonry - Steellcestlen, bond ,beams. groutIng. o Foundation - After forms are . erected but prior to concrete placement. . 0 Underground Plumbing - Prior to filling trench. o Underfloor Plumbing/Mechanical - Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decking. o Floor Insulation - Prior to decking. o Sanitary Sewer - Prior to filling trench. o Storm Sewer - Prior to filling trench. . o Waler Line - Prior to filling trench. [XI Rough Plumbing - Prior to cover. ILl Rough Mech~nlcal ..:: Prior to cover. '. .' C!l Rough'. Electrical - Prior' to cover. o Electrical Service - Must be ." approved to obtain permanent '. _ eleclrlcal power. o Fireplace - Prior to facing materials and framing Insp. [l] Framing - Prior tq cover. [Z] Wall/C'elllng Insulation - Prior to cover. '",'" . [Z] Drywall - prl.or to ta~Ing. o 'Wood Stove - After I~stallatlon. o Insert - After fireplace approval and Inslallallon of unit. o Curbcut & Approach - After forms are erected but prior to placement of concret.e. o Sidewalk & Driveway - After excavation Is complete, forms and's~b.base material In place. o Fen~e. - When completed. o Street Trees -.Wnen all required trees are planted.' L [;1J Final Plumbing - When all plumbing w~"k Is complet.e. ~ Final Electrical - When all electrical work Is complete. 171 Final Mechanical - When all LAJ mechanical work Is complete. fVI Final Building - When all lA.J required Inspections have been approved and building Is completed. D'Olher , MOBILE HOME INSPECTIONS o Blocking and Sel.Up - When all blocking Is complete. o PlumbIng Connections - When home has been connected to water and sewer. o Electrical Connection - When blocking, set.up. and plumbing Inspections have been approved and the home Is connected to Ihe service panel. o Final - After all required Inspections are approved and porches, skirting, decks, and venting have been Installed. Lot faces Lot sq. Itg. Lot coverage Topography Total height \2{ BUILDING PERMIT sa. FT. ~ i'l'/ ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee PLUMBING PERMIT ITEM Fixtures Resldent.lal Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home Plumbing Permit State Surcharge Total Charge L~/~pe . Interior Corner Panhandle Cul.de.sac X $/SO. FT. ('/ 2-D ~ - * (A) (B) "3;<, /0 N' FT. FT. FT. 1'~t? r3~ Furnace MECHANICAL PERMIT (C) 'Exhaust Hood Vent Fan N' I _ "'7/;yt Wood Stove/lnsert/Flreplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit r5~ r;ll7~ (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk Curbcut Demolition State Surcharge It It Tolal Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C. 0, and E Combined) "" ' . .:" "~ . .. J ,,11 ;'. ;' '. .' ,";, -~, ~"l":" ,,.'.j )~..,J.i'.'. i,. ~'t.. ":'!i~~ \....-' :' : ". -' .~.:' \,t~; ;'~~:iJt~~ ..:.' , . ~.~ .._ THEPROPOSED WORK IN THE. "-HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical . Coordinator prior to permit issuance. . - Setbacks . P.L. HSE GAR ACC I N W IE s #t.~;~' I 2~S1:? I \ " FEE ""?a - . ~~ . i ,~'O -~ ~ . $t"~ L~_ ,. /'6'.- >4) . - ':is 7L:: _ 7L!::> +,.g~.~ APPROVED' BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit Is granted on the express condition thai 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: 52. < 3_~ Date Paid: 4::>/~ /~ Receipt Number: c::; Received By: ~~~....e ~,~ I' ~'RevIewed~ 7 ,/ ( ? Y(!-9~ Date ~_?o ~.t:> :I' ''''-4 8d, , 95" SYSTEMS DEVELOPMENT CHARGE (SDC) ~ Y~9'.:z.9 , Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS By slgnalure, 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 stru~ture 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 agr~e to ensure that all required Inspections are requested at the proper time; thai each address Is readable from the slreel, that the permit card Is located at the front of the property, and the appr ved set of plans will remain on the Slt~a I. t es duri structlon. Signature --../ ........, Date ~t, /1'f VALIDATION: J3~' _f '\ RECEIPT NUMljlif. __lCt.J DATE PAID . " ' AMOUNT REt~VGo - ~9 y. Se> RECEIVED BeA~ fJ\ _ J .L, . . Permit #: Cl4{)~~ Address: ~AfJ Ko4~ Issued by: ~~ Date: '\.l<?::..q 4 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: d I. I own, reside in, or will reside in the completed structure. m 2. ~ 3A I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. My general contractor is ~\Jer \h.\A~ .B1.6.5. 1.. (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 D 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 info a ion is correct and that I have read and do understand the Information Notice to Prope~ers abo ~ ruction Responsibilities on the reverse side of this form. 'f'\ ~ 7//;/'14- '~ (Sign~ of permit applicant) (bat~) , l\ \ (White copy to issuing agency permit file, pink copy to applicant) . . ,;~ lin1ormation Notice to Property Owners , About Construction Responsibilities Note: This Information Notice to Property Owners about Construction Responsibilities was developed by ihe Construction 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 structure, you can prevent many problems. by being aware of the following responsibilities and areas of concern. .EMPLOYER RESPONSIBILITIES: If you hire perso~s 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 follo,:"ing: Oregon's withholding tax law: As ari employer, you must withhoid 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 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 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. If you have additional questions, write or call the Construction Contractors Board (pO Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.prn4 1/94 I j Cj 10 'i?S~ CITY OF.RINGFIELO SYSTEMS DEvELol:rn CIlMlGE WORKSHEET (COMMERCIAL ~ RESIDENTIAL) NM1E OR COHPANY: LOCATIOII: 1<:;"/7- DEVELOPHENT TYPE: 15~ c:; ~ k"ff... J~ BUILDING SIZE: .LOT SiZE 1. STORIi ORA I NAGE If1PERVIOUS SQ. FT. ~~~ X 50.203 PER SQ. FT. I . SQ, Ft. : ~Ad) y --" 2, SANITARY SEWER-CITY NO. OF PFU'S (See R.everse) "f X S42.08 PER PFU ~'1~~ ~ 3. TRANSPORTATION NO OF UIIITS X TRIP RATE X COST PER TRIP X ~4.31 ~ X 5424,31 ~X ((~) sr X 5424.31 s 4. SANITARY SEWER-I1WHC NO. OF PFU'S X S15.125 PER PFU + SID MWMC ADM FEE S (Use PFU Total From Item 2 Above) ~ Mlmc CREDIT IF APPLICABLE (SEE REVERSE) S TOTAL-MWMC SDC ~ -y ./ SUBTOTAL (ADD ITEMS 1,2,3 & 4) S z., 1l>.s-t:. S. ADllINISTRATIVE FEE~ U~X'05 u, t-tcl: V ordinator G-~r~ TOTAL SDC S 3~ ?'.2? r ~ '-'^'VII~-I... -..-- For ICl11odcl~. ,.1lcul:,IC only Ihe ~d"i:i'''l;\lli''ll''l':') FIXTUGE TWE Oalhtul>.................................... .......................... Drinking Founlain......................... ........................... Floor Drain.................. ....... ..... .,..... ..... ... ............... .... Inlcrceplors For Grcase/Oil/Solids/E:c................. Interceplors For Sandjl,ulo Wash/Elc.................. La undry T ul> /Oolheswa sh er. ......... ...... ................... C1olheswa~her . 30r More..................................... Mobnc Home Park Trap (1 Per Trailer).................. Recep!or F9r Refrigerator/Waler Station/Elc........ Receptor For Commercial Sink/Dishwasher /Elc.. Shower, Sing! e. Stall. ...... ......... ........ ........... .............. Shower, GaDg............~....... .................. ...... ........:..... S!Dk, Bar, COmmercial.........~................................... . Urinal, Slall/WaIL..................................................... Wash Basin/La\'atory, Single.........................:......... Waler Closet, Public Installation............................. Waler Ooset, Prr..ale.....................................,......... MiscellaDeous: . '. I~L':.~[-(n L~F . l':":lf FIXTURE . I: OL'i\'i,IDH U::lfS :':E\".' H\lL'liE / .. z .: 3 G 2 G G 1 3 2 I/Hcad 2 2 .... / 1 6 1 ~ 4- ~ . TOT.~.L FIXTURE UNITS = :r 7 CREDIT CALCUU,TION TABLE: Based on assessed valuq. If improvements occurred after annexation dale in lable, I"'''' ""', ~~~-~-"~;:~,~i~~ ~ ;::;." ~:;:;':'S~= I, 1979 or before 1930 1931 lGa2 1983 1934 '1985 $3.21 3.13 3.08 2.95 2.82 2.68 2.51 193-5 1937 1933 19&3 199:) 1~1 1~2 S 2.24 1.93 1.57 1.18 0.79 0.44 0.28 i .. Cred~ for Parcel or Land Only If Applicable Improvement (If after annexation date) x s = (Rale X Assessed Value) X S = (Rate X Assessed Value) CREDIT TOTAL = s '. RUNOFF COEFFICIENTS FOR STO.RM DRAINAGE R esid ential..... .................. ................... .............. 0.4 CommerciaL................................................... 0.9 I nd ust riaL....... ........ ................... ........ .............. 0.45 GovernmentaL................................................ 0.5 IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT