HomeMy WebLinkAboutPermit Mechanical 1995-9-13
Inspections: 726.3769
Ollice: 726.3759
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L~CATION OF PROPOSED WORK: .7.? {tJ
, ASSESSORS MAP: J 7 t?2 :? ,
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RESIOENTlAL
PERr~IT APPLICATION
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JOB NUMBER
225 Flllh Slreet
Sprlnglleld, Oregon 97477
. TAX LOT:
~.j.S:./""t-?'")
BLOCK:
SUBDIVISION: _
PHONE:
?'Z& -7(;):(9
OWNER: -Dc< I".,...} nl'J /" rr h ("h /~
ADD'RESS" ?~(o LaKc..cn, r,,-,>, 1-,0
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CITY: ._"'i Prf'i'A13..f'. '",I-c/
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DES~RIBE WORK: . A) <"'_.ut) r:.u,.... c..1 c. c-P
NEW L.- REMODEL ADDITION DEMOLISH
STATE: ....Qjf:
ZIP:......2? ~'? ~
OTHER
CONTRACTOR'S NAME
GENERAL: /)0 "lJc....
ADDRESS
I? e.. ('",,'c/u <=l '(I UL--
CONST.
CONTRACTOR N
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t
PLUMBING'
MECHANICAL:
ELECTRICAL: r)fv A/e.,;.,.,...
EXPIRES
PHONE
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN'
N OF BLDGS: N OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: . OF BDRMS:
N OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: _ SQUARE FOOTAGE:_
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All Ins pee lions requested belore 7:00 a.m. will be
ma,do the same working day, Inspoctlons requested ofter 7:00 a.m. will be made lho rollowlng worl< day.
REQUIRED INSPECTIONS
o Tempornry Electric
O Slto Inspection - To be mado
' after excavation, but prior to
soltlng forms.
o Underslflb Plumblng/Electricall
' MechanIcal - Prior 10 cover.
c:J Footlng - After trenches are
excavated.
o Masonry - Steel locatlon, bond
beams, grouting.
o Foundation - After forms are
I erected but prior to concrete
placemont.
o
Underground Plumbing - Prlor
10 IlIlInQ trench.
o
Underlloor Plumbing/Mechanical
- Prior 10 InsulatIon or decl(lng.
o
Post nnd Boa~ - Prior to floor
Insulallon or dockIng.
o Floor Insulation - Prlor to
docKing.
o
Sanitary Sowor - PrIor to filling
trench.
o
Storm Sewor - Prior to filling
trench.
o
Water L1no - Prior to IiIllng
trench.
o
Rough Plumbing - Prior to
cover.
~ Rough Mechanical - Prior to
~ver.
~ Rough Electr~cnl - PrIor to
~vcr. .
o
ElectrIcal Servlco - Must be
approved to obtain permanent
eleclrlcal power.
o Fireplace - Prior to facIng
materials and framing Insp.
o Fram.lng - Prior to cover..
.0 Wail/Coiling Insulntlon -_ Prior to
cover. .
o Drywall - Prior 10 laplng.
o Wood Stovo - After Installallon.
o Insert - After fireplace approvel
and Installallon of unll. .
o
Curbcul & Approach - After
forms are erected but prior 10
placemont of concrulu.
o Sidewalk & Driveway - After
excavation Is compieto, forms
and sub.base malerlal In place.
o Fence - When com~leted.
o Street Troos - When' all r~qulred
trees are planted. .
o Final Plumbing - When all
plumbing wprl( Is complot,c.
~ Final Eloctrlcal - When all
~Iectrlcal work Is complote.
't5<1' Final Mechnnlcal _ When all
~echanlcal work Is completc.
o Final Building - When all
required Inspections have been
approved and building Is
completed.
OOthor
....
MOBILE HOME INSPECTIONS
o Blocking and Sel.Up - When nil
blocKing Is complele.
o
Plumbing Connections _ When
homo has been connected to
waler and sewer.
o
Electrical Connection - When
blocKing, sel.up. and plumbing
Inspections have been approvOd
and the home Is connected to
the service panel.
o Flnnl - Afler all required
Inspections are approved and
porches, sklrllng, docks, and
venting have beon Installod.
.'
Lot faces
Lol TYPO.
Interior
'LOI sq. ftg,
Lot coverage
Topography
Total height
Corner
Panhandle
Cul.de.sac
I P.L.
IN
Is
Iw
IE
Selbacks
HSE GAR
,
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.' ~ VALUE
Main
Garago
Carport
Totnl Value.
Building Permit Feo
State Surcharge
Totnl Foo
(A)
"
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Rosldonllal Bath(s)
N'
Sanitary Sewer
Water
FT.
FT.
Slorm Sowor
FT.
Mobllo Home
Plumbing Pormlt
Stato Surcharge
Total Charge
Ic)
FEE
MECHANICAL PERMIT
Furnaco ,-e~tAt!C ~.OO
Exhaust Hood
~
Vent Fan
N'
Wood StovellnsorllFlroplace Unit
Dryer Vent
Mochanlcal Pormlt
"" , -<J "
Issuance
State Surcharge , 75" -r, 1'';-
Total Permit (0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Slato Surcharge
Sidewalk
It
Curbcut
It
Demolition
Slate Surchargo
/ ..c). .-D
,
119,"0
J 2.0
?/- '2..0
Total Miscellaneous PormllS IE)
TOTAL AMOUNT DUE (excluding oloctrlcal) .. 0 (~ ~
(A, B, C, 0, and E Comblnod)
...
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:.. THE PROPOSED WORK IN ~~
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
ACC I
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~
,
il yes, Ihls applicallon musl bo slgnod
nnd approved by the Hlslorical
Coordinator prior to permit issuance.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granled on Ihe express condilion Ihalthe said
construcllon shall, In all respects, conlorm to lI,e Ordinance
adopted by the Cily of Springllelcl, including Ihe
Development Code, regulating the cOI')~truclion and use of
buildings, and may be suspended or revokod at any time
upon violation of any provisions of said ordinances.
Plan Check Fee: __
Date Paid:
Receipt Numbcr:.__
Received By:
Plans Revlcwed-dy"'-----'--
Dale
. Systems Development Charge Is duo on all undeveloped
properties within tho Clly IImlls Which nro being improved.
ADDITIONAL COMMENTS
......'\-.
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. By signature, I stale and agree, that I have carefully examined
the completed application and do hereby certify thai all
Information hereon Is true and correct, and I further certHy
that any and all work perlormed shall bo done In accordance
with the Ordinances of tho City 01 Sprlnglleld, and Ihe Laws
of the Stato of Oregon perlalnlng 10 the work described
heroin, and that NO OCCUPANCY will be made 01 any
structure wIthout permission of the Bulldll'lQ Safety Division,
I further certlfy that only contractors and employees who
are In compllanco with ORS 701.055 will be used on this
project,
I further agreo to ensure that all required Inspections are
requested at the propor time, that oach address Is readable
from the street. that the pormlt card 15 located at the front
ot the prOP1Q:rty, d tho approved set of plans will remain
on the site at II mes~durlng conslructio
Signature ,,// d #4/2 t7.A?
9'- /..:>- 0'-/
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VALIDATION:
15''LJD 7
DATE PAID q~// 3 'lJ
-I.' 6a
AMOUNT RECEIVED _.___~ _..!. .
.. RECEIVED BY _.. ~;7i- __..__
RECEIPT NUMBER
/
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Address:
.
9.<:;-" / ~~"]
"7 U LAK"it:H.JbI}
:~ Date: ?~y~_
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Permit #:
Issued by:
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. I own; reside in, or will reside in the completed structure.
~
D 3A. My general contractor is
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
(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
'S 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,ee. -tify that the above information is correct and that I have read and do understand the Information
Notice to F ~oper~y Owners abo~onstruction Responsibilities on the reverse side of th~ form.
lvCLU--d h1 {~J 7.- 13 - ':lS
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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][f'tfOrinati6n"NOtice to Property Owners
'., ,,--::..."-0..... _. '- . .~b,o-.ut ~?~str~ction Responsi bilities
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. '::.,N!?!e: This Informatio], "&o.li(;e:!Q.:~coperty Owners about Construction Responsibilities
was'developed 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 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 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
infonnation, 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 infonnation, 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 {!lay'
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more infonnation,
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 pennit 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 perfonn 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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