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Home My WebLink AboutPermit Building 1994-5-31 _ .<t..... ,,' R~IDENTIAL PERMIT APPLICATION Inspections: 726,3769 Office: 726,3759 LOCA~ION OF PROPOSED WORK: 41'\p) \. ASSESSORS MAP: \'1[)';4" ?~~\ '. ^ m-iNER:'~Q Q 12 ~)_ ~,OO \~~ t h(\'\ (l _ PHONE:~\("j-4:-lr4 \ ADDRF~~' *, ,<PJ Fr~'10 f\ f1<,CT'Q r q_ CITY'S',) J_ N - STATE:" C ~~)A.QI'f~l \ ZIP: ~ ~\~ 1>> ~'f(\~"~~~'{\~~ k \cktN , ADDI~N ~ DEMOLISH OTHER I CON ST. ADDRESS' . CONTRACTOR' LOT' DESCRIBE WORK: NEW REMODEL CONTRAC1'~' R' NAME 'to GENERAL: . -If\R r, ,(/ PLUMBING' U ~ MECHANICAL'!t'. r:;-'\ ELECTRICAL' ~ 1:Jf \ _\J \U QUAD AREA: 4\<." JC( / . OF BLDGS' \ OCCY GROUP: ~~ . OF STORIES: \ WATER HEATER' . .. . Cf1CL~) I BLOC/'" '''j JOB NUMBER 225 Fifth Street ;J;~f) Oregon 97477 "-'t:j tlld\f'f). SUBDIVISION' ;.! - OFFICE USE - \ \ \ \ . OF UNITS' l CONSTR. TYPE: V 1\ / 'LAND USE: HEAT SOURCE: RANr-:~' EXPIRES PHONE .' .. * ..... FLOOD PLAIN' ZONING CODE: JI)~. ~ OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE: .!j('i) 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. will be made the following work day. REQUIRED INSPECTIONS D Temporary Electric o Site Inspection - To be made after excavation, but prior to setting forms. D Underslab Plumbing/Electrical I Mechanical - Prior to cover. ~ Footing - After trenches are ~ excavated. . ~ Rough Mechanical"': Prior to cover. ' t:::7I Rough. Electrical - Prior. to --t::::::::I...cover. ". D Electrical Service - Must be approved to obtain permanent elect~lcar power. D Fireplace - Prior to facing mate~lals and framing lnsp. D Masonry - Steel location, bond , ,beams, grouting. ~ ~ Frs":,lng - Prior to cover. ~ Foundation - After forms are ~rected'but prior to'concrete placement. D Underground Plumbing - Prior to filling trench. 'I';?l' Underlloli!:.Plumbln~echanlcal ~.PrJor to inSUlation or decking. ~ Post and Beam - Prior to floor ~Insulatlon or decking. Fi:7I Floor Insulation - Prior to ~ecking. D Sanitary Sewer - Prior to filling trench. . D Storm Sewer - Prior to filling trench. ' D Water Line - Prior to filling trench. ~ Rough Plumbing - Prior to cover. fa Wall/CeUlng Insulation - Prior to J,.6.l cover.' . t::!4DryWall .,... Prl,or to taping., D Wood Stove - After Installation. D Insert - After fireplace approvlll and Installation of unit. D Curbcut & Approach - After forms are erected but prior to placement of concret.e. D Sidewalk & Driveway - After excavation Is complete, forms alid'sub.base material In place. D Fen~e,,- When completed. OS.reet Trees - When all required trees are planted. '. , ~ Final Plumbing - When all ~ plumbing w9rk Is complet.e. ~ Final Electrical -:- When all )6.l electrical work Is complete. f'\:7I Final Mechanical - When all ~ mechanical work Is -complete. ~Flnal Building - When all ~requ'red Inspections have been approved and building Is completed. D O:ther MOBILE HOME INSPECTIONS D Blocking and Set-Up - When all blocking Is complete. D PlumbIng Connections - When home has been connected to water and sewer. D Electrical Connection - When blocking, set,up, and plumbing Inspections have been approved and the home Is connected to the service panel. D Final - After all required 'nspectlons are approved and porches, skirting, decks, and venting have been Installed. "., :..j,\ ~ :~'..:. "';'li:'~'~~:1 ~~i~.,J~~j~~b:~. ,..:::'L:i\.;'. \,"..: ,'.,': - ,,:'... .:~.~ ;;'~.:l;t:,~",,(' .' Setb-cks.' .. 11 I I I .' 'PL. HSE GAR ACC 'I N Is' Iw IE .! i Lot faces r.' L~/~:pe. ' )( Interior Lot sq. ftg. Lot coverage Corner Topography Total helght( ~\j;+'1 panhandle Cul.de~sac BUILDING PERMIT sa. FT. () on x~~\~~~u= ~LU~ '. -:- r ITEM Main Garage Carport Total Value Building Permit Fee '7/4.+ /1. 'To State Surcharge Total Fee (A) ? '2, 9::> "'" J'j.O.:{- 7..<7P f SYSTEMS DEVELOPMENT CHARGE (SDC) ~ $C1st' ~?,,;t PLUMBING PERMIT ITEM Fixtures Residential Bath(s) N' 3 Sanitary Sewer Water FT. FT. Storm Sewer FT Mobile Home' Plumbing Permit State Surcharge Total Charge .9D -1/.$"0 (C)' MECHANICAL ~ERMIT Furnace Exhaust Hood ., Vent Fan N' / Wood Stove(lnserllFlreplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit . .1S"-r.7S (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk ft Curbcut ft Demolition .," State Surcharge FEE -:<,D ~ 2:(0 . S2..-I/O h?/~ 1,5. /H) ...I-.LJ . t!J 4l 1.')..0 'Z':;:;.2.<l Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) $Z'2..7~ (A, B, C. D, and E Combined) .,., THEPROPOSED WORK tN THE _ . , "'HISTORICAL DISTRICT, OR ON ~ ~ THE HISTORICAL REGISTE~ If yes, this application must be signed and approved by the Historical Coordinator prior to permit Issuance. APPROVED: ' 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 ProVlSionS,wa1d ordinances. Plan Check Fee: \M ,.Il - 'Jt Date Paid: , ' e:-" ~ - l. Receipt Number:~n ~ 3 Recel" :. ~~ } ~ 4);:' - c: .-6/A4 ,Reviewed By'" .. f'if,ri-e I . Systems Development Charge Is due on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS 1~2 5~AfC d_a..r, AC'~/T /J . -f~PP~, 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 tne 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 comllllance with ORS 701.055 will be used on this project. ' I further agre'e to ensure that a,1 required Inspections are requested at the proper time; that each address Is readable . --- from the street, that the rml.oara Is located at the front /' , of the property. and e"a ved set of ns will remain on the site at Ut ng const tlon. X;:gn~ "7 ~/. ,... ~ Date (~d//~ / VALIDATION: \3\ r\d RECEIPT NUMBER VC DATEPAIP ,C':).?, ,.Gft " AMOUNT REf~, V9 " "" _' '., f"'Yd'do. I D RECEIVED B~\ _) . . .=- ., Permit No: /p~D(o~-) Address: ~Y)<6~O[~1 Issued bY~un. ~ Date: ;S.?l t- 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. 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~' the plicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: 1 . I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold I ./1\ { offered for sale before or upon completion.' . \)J~ ~y 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 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 .~~e Property Owners about Construction RBsponsibilities on the reverse_side Of~/ -7 ;sbk~ "hi"""" of ,,,mr Dot' CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT . . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES r', .... NOTE: This Information Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. 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 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 iime 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 informat\on, call the Oregon Employment 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 OfF 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 falling 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 trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write to: Construction Contractors Board 700 Summe~ SI. NE, Suite 300 Salem, OR 97310:.0151 Phone 503-378-4621 - 0244J 10/24/89 . JOB NO, . 7-foC:.'3? CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE"'C.~ WORKSHEET (COMMERCIAL & RESIDENTIAL) .. " NA~lE OR COI1PANY: >/5J/E ,.c;.,<;;~ RuRf>, lOC'ATION: "'17ii' LAe"I'JN,sH 2A,,~ . DEVElOP/'lENT TYPE:1ES' A-P,I)/T7,M/ {FAil?, )('#1" Il,D.R;n. 8AT//) , . BUILDING SIZE: - lOT SiZE SQ. Ft, 1. STORH DRA I NAG E IHPERVIOUS SQ. FT, tf;2. 'if' X $0_203 PER SQ. FT, ~/'?'if',~F) .......... --- .2. SANITARY SEWER-CITY .' NO, OF PFU'S . (See Reverse) 3, TRANSPORTATION 'f X $42,03 PER PFU (" L'I-1- s-(:.) ~ ...-/ NO OF UNITS X TRIP RA~OST PER TRIP . X./ X 5424,31 A' /' X X 5424,31 ~&) '- . .-- S S -- X 5424,31 4. SANITARY SEWER-MWMC NO, OF PFU'S '1- x 515,125 PER PFU + 510 MWMC ADl" FEE S -I:/"i,r"? (Use PFU Total From Item 2 Above) SUBTOTAL 5 --- TOTAL-MWMC SDC c;;.S'--;-fi'? ~ ~ (ADD ITEMS 1,2,3 & 4) S S''T}l.;z.C, _ Mlmc CRED IT IF APPLICABLE (SEE REVERSE) }lor ~/kCA161e 5. ADHINISTRATIVE FEES . B~SE ~~E (~,u"OT~E) X ,05 ~~"A/~ 5"-//,-9?- / ~Yc~~~~1~~~ . ?2-9"-""i='! 21./5" .............. ...-/ TOTAL SDC S .{.Z'? I Y . " 507.01 FIXl:URE l,lNIT,CALCIJ.L,AflON TABLE: :!":;'~','r (111,C'" Fi'.~ 'q:-: L';;:: t';:Ji\"dC,"1 = F:.~u;e lini:s (;,'0'::: For (cmooc~~. ('...:lc~ll:~:c O~)!y ill,.T ;,d.,:l:i(ln:il ~:',.:tJ;l':.) . !!1'1.'.cE8 OF L':.::l FI:-:TLJl-.E , FIXTURE TYPE I.;EI'.' FIX1UGES ECL'i\'.:,LEIH U::lTS G31hlub............... Drinking Fo:.mt3in.. Floor Drain.............. ................. Interceptors For Gre2se/Oil/SolidsjE:c......, Interceptors For Sand/Auto WashjEtc.................. Laundry Tub/Ootheswasher............ .... .... ....... ..... ,.. Clotheswaliher . 3 Or More..................................... Mobile Hdme Park Trap (1 Per Trailer).................. Recep)or F(>r Refrigerator/Waler St.atiQfljEtc:......: Receptor For Commercial Sink/Dishwasher /Etc.. Shower, Single' Stall................,................,.............., Shower, Gang..................,............... ...............-........ S!nk, Bar, CommerciaL....................................:...... , Urinal, Stall/Wall....................................................... Wash Basin/Lavatory, Single.................................. Water Oosel. Public Installation............................. v~rater Closet, Private....................... ...-....-........ ....... Miscellaneol:s: I , .. .":. . ....... ' ."'." .'- . ,. , I ,': Tor;..L FIXTURE UNITS .:.":":). , 2 , . . .. '. 3 G 2 ,,6. 6 1 3 2 1/Head 2 2 1 5 4 ~ J Based on assessed value, If imp:ovements occurred after annexation date in table, CREDIT CALCULATION TABLE: calculate credits separates. Ii Rate per $1,000 Assessed Value Year Annexed Year Annexed L 1979 or before 1980 1981 1982 . 1983 1934 .1985 $3.21 3.13 3.08 2.96 2.82 2.63 2,51 1936 1987 1933 1989 1990 1991 1992 Rate per $ 1,000 Assessed Value $ 2.24 1.93 1.57 1.18 0.79 0,44 0.28 .. C<:edit for Parcel or Land Only If Applicable Improvem~nt (rt after annexation date) X $ - '(Rate X Assessed Value) X S (Rate X Assessed Value) CREDIT TOTAL "', RUNOFF COEFFICIENTS FOR STORM DRAINAGE '. Resid entia!. .......... ."......"....", ,,,....,,.. :,:".. .....,,,, 0,4 Commercial.""...."...................."............""..... 0.9 I nd ustrial................."............,....................."..., O. ~ 5 Governmenlal..........."..".......,.................."....., 0.5 ..... ,---. , . = ~ = S IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT