HomeMy WebLinkAboutPermit Mechanical 1994-6-17
. SPRINGFIELD
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK' ~ --rC)?) /." ,f-:/J/Tl' r"n /~6'/,
XASSESSORS MAP' /70 '2 ~f'" '2-~
LOT'
BLOCI"
OWNER:
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ADDRESS" "J 'i /' J
CITY: '- y,j
D~SCRIBE WORK.~~f/ /L//k/I<
REMODEL Y1 ADDITION
I
NEW
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
L,.,,,.II"?
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STATE: ~/J/
4dab
DEMOLISH
OTHER
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JOB NUMBER
225 Flflh Slreel
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION'
"" \ 2... CJ1.)
PHONF'
7c2h -062,P/
ZIP:
t?7Y7%
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g~u;=
ADDRESS
CON ST.
CONTRACTOR'
PHONE
1
MECHANICAL:
ELECTRICAl.
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7l}/ E, <)~ '-I~ Zt;7S'D-n/2 }/"1' 74~?:
EXPIRES
- OFFICE USE -
QUAD AREA' LAND USE: FLOOD PLAIN:
. OF BLDGS: . OF UNITS' ZONING CODE:_
OCCY GROUP: CONSTR. TYPE: . OF BDRMS:
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGF' SQUARE FOOTAGE:
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.
o Temporary Electric
o Site Inspection - To be made
, after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
I Mechanical - Prior to cover.
o Footing - After Irenches are
excavated.
o Masonry - Steel location, bond
.beams. grouting.
O Foundation - After forms are
erected but- prior to concrete
placement.
o Underground Plumbing - Prior.
to filling trench. '
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking,.
o Floor Insulation - Prior to
decking. '
0' Sanitary Sewer - Prior to filling.
trench. ~
,
o Storm Sewer - Prior to filling
trench. . .
'0 Waler Line - Prior to filling
!trench. .
0' Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
~ Rough Electrical - Prior to
~ver.
'. ........
o Elaelrlcal Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to cover.
o Wail/Ceiling Insulation -:... ~rlor to
cover. .'
o Drywall - Prior 10 tapin'g:
o Wood Stovo - After Installation.
o Insert - After f1rep!ace approv~l
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placemont of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
o Fence - When completed.
o Street Trees - When all required
trees are planted. ..
o Final Plumbing - When all
plumbing w9rk Is complet.e.
~ Final Electrical - When all
~ electrical work Is complete.
'1':71' Final Mechanical - Whcn all
~echanlcal work Is complete.
o Final Building - When all
required Inspections have been
approved and building Is
completed.
o Other
"
MOBILE HOME INSPECTIONS
o Blocking and Set,Up - When all
blocking Is ,complcte.
o
Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, set.up, and plumbing
Inspections have been approvcd
and the home Is connected to
the service panel.
o Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
.'
Lot faces
LOI ~ype .
Lot sq. Itg.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de-sac
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(. THE PROPOSED 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.
Se t bac ks
HSE GAR Accl
I PL.
IN
Is
Iw
IE
BUILDING PERMIT
ITEM sa. FT. x $/sa. FT. - VALUE
Main
Garage
Carport
Total Value
Building Pormlt Fee
State Surcharge
Tolal Foo
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
"
.
(B)
PLUMBING PERMIT
ITEM FEE
Fixtures
Rosldentlal Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sower FT.
Mobllo Home
Plumbing Permit
Stato Surcharge
Tolal Charge (C)
MECHANICAL PERMIT /
Furnaco /1'- ~,111// $4(}.
v'/.
Exhausl Hood
"
Vent Fan N'
Wood Slovellnserl/Flreplace Unit
Dryer Vent
Mechanical Pormll
Issuance
State Surcharge
J~... ~m<<A
(D)
Total Permll
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
ft
Demolition
Slale Surcharge
TOlal Miscellaneous Permlls (E)
TOTAL AMOUNT DUE (excluding clectrlcal)
(A, B, C, 0, and E Combined)
;.c.; 0-0,
IO~
.7,5
.4r
21-':. 20
~ --.
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r
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition lhal the said
construction shall, In all respects, conform Lo the Ordinance
adopled by the Clly. of Springfield, Including the
Development Code, regulating the construcllon and use of
buildings, and may be suspended or revoked at any lime
upon violation of any provisions of said ordinances.
Plan Check l1lle'
Dale Paid:
Receipt Number'
Received By:
Ii/A-
Plans Rovlewlld By'
Dalo
Systems Development Chargc Is duc on all undeveloped
properties within the City limits which arc bclng Improved.
ADDITIONAL COMMENTS
By signature. I slate and agree, that I have carefully examined
the completed application and do hereby cerllly that all
Information hereon Is true and correct, and I furlher certify
that any and all work performed shall be done In accordance
wllh the Ordlnancos of Ihe City of Sprlnglleld, and the Law.
ofthe State of Oregon pertaining 10 the work described
herein, and Ihal NO OCCUPANCY will be made of any
slructure 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 thl.
proJecl.
I further agree to ensuro that all requlrod Inspecllons are
rOQuested at the proper time, that each address Is readable
from Ihe slreel, Ihat the pcrmlt card Is localod at Ihe front
of the property, and the approved set of plans will remain
on the site at all times during construction.
,4ature/?"~ ,/.0// /, ~L
Dat""
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VALIDATION:
RECEIPT NUMBER
DATE PAlO
AMOUNT RECEIVED
RECEIVED BY
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Permit #: 9 ~ 7' rJCI
Address: ~SO ) ..A-,ItC.\'mu?5..)
ISSUedbY:~~ Date: &/~c;/
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701 ,055(4), requires residential construction permit appli-
cants w/w 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:
fa
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D
I. 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 or offered for sale
before or upon completion.
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
& 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 infonnation 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.
//?,~LII ~ A_~/-:ff'
(Signature-of permit applicant)
;( - /7' 9Y
(Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
..
,.... ,:-.. \-.
- ][nformation- Notice to Property Owners
, . ",About Construction Responsibilities
-......1....--" ....;.......,-L- "._' ""_. . .......- ','
.,'.... . ': ". \\ Note: This Information N9ti,ce [0 Property Owners I,lbOut Construction Responsibilities,
, . wdrdeveloped by the 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 persons not registered with the Construction Contractors Board to do labor in con~tructing 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 ~omply 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, andiTI~'st
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you. mllY
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 requirem.~nt~
that may be brought to your attention through inspections. " , X
,,oJ' .....
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.
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