HomeMy WebLinkAboutPermit Building 1995-10-12
~.,"
- .
:...t*"
I
RESIDENTIAL
V PERMIT APPLICATION
.
.
JOB NUMBER ~'5::Y6~
225 Fifth Street
Springfield, Oregon 97477
SPRINGFIELD ,.,.
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK: /.e;-~~ L.~~4 ~.
ASSESSORS MAP: /7 yP ?'< 7~ V /
o'YYoo
TAX LOT:
SUBDIVISION'
LOT'
BLOCK'
Z~T s.h'l(n~
ADDRESS' /~~ LAu~ --5/"-_
-'57~~.
/"
DESCRIBE WORK: .~~ ~7
-7~ /~~;>g
OWNER:
PHONE:
STATE: _~
&9"/ Y"? "?
CITY:
ZIP:
;q>~/~
.-
ADDITION
~
rf'~..z-
/'?
. // -""'i"?c::";:--.-.;.r ~
-. -
/ '
NEW
REMODEL
DEMOLISH
OTHER
CONST.
CONTRACTOR #
CONTRACTOR'S ~ME .
GENERAL: ~/i~/A?'~
("..00""" r' .
ADDRESS
EXPtRES " PHONE
~
--y
PLUMBING'
MEGHANI,..... I.
ELECTRICA' '
- OFFICE USE -
QUAD AREA:
# OF BLDGS:
OCCY GROUP'
# OF STORIES:
. WATER HEATER:
LAND USE:
FLOOD PLAIN'
ZONING CODE:_
# OF BDRMS'
# OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANGE: _
SECONDARY HEAT:
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.
REQUIRED INSPECTIONS
o Temporary Electric
o Rough Mechanical - Prior to
cover.
o Final Plumbing - When all
plumbing Work Is complel.o,
D Slto Inspoctlon - To be made
atter excavation, but prIor to
setting forms.
D Rough Electrical - Prior to
cover.
o Final Electrical"":" When all
electrical work Is complete.
o Undorslnb Plumbing/Electrical I
Mochanlcal - Prior to cover.
D Final Mochnnlcal - When all
mechanical work Is complete,
D Elec'trlcal Service - Must be
approved to obtain permanent
electrical power.
o
Footing - After trenches are
excavated.
fA?! Final Building - When all
qJ required Inspections have been
approved and building Is
completed.
o Fireplace - Prior to facing
materials and framing Insp.
o
Masonry - Steel location, bond
beams, grouting,
~ Framing - Prior to cover.
DOthor
D Foundation - After torms are
erected but prior to concrete
placement.
o Wall/Ceiling Insulation - Prior to
cover.
o Underground Plumbing - Prior
to filling trench,
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
o
Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Wood Stove - After Installation.
o Blocking and Set.Up - When all
blocking Is complete.
o
Post and Beam - Prior to. floor
Insulation or decking.
o Insert - After fireplace approv!ll
and Installation of unit.
,-
o Floor Insulation - PrIor to'
deckIng,
o Plumbing Connections - When
home has been connected to
water and sewer.
o Curbcut & Approach - After
(orms are erected bllt prior to
placement of concrete.
o Sanitary Sewer"':" Prior to (1Il1ng
trench.
o Electrical Connection - When
blocking, set.up, and plumbing
, InspectIons have been approved
and the home Is connected to
the service panel.
o Sidewalk & Driveway - After
excavation Is complete, (orms
and sub.base material In place.
o Storm Sewer - Prior to filling
trench.
D Water Line - Prior to filling
trench.
D Fence - When completed.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
D Rough Plumbing - Prior to
cover.
D Street Truos - When all required
trees Bre planted.
Lot facos Lot ~ype.
Lot sq. fig. Interior I PL.
IN
Lot coverage Corner
Is
Topography Panhandle
\W
TOlal height Cul.de.sac
IE
BUILDING PERMIT
ITEM SO. FT. X $/50. FT. VALUE
,';', ,
. ~ '"
:,"! '.
:'.
.'
i'~'
_~ 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.
Setbacks
HSE GAR ACC
'I
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Garage
"
"(hIs 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 provisions of said ordinances.
Main ;"
c
Carport
Plan Check Fee:
~S,- Date Paid:
Total Value
~/h /5: ,-p Receipt Number'
Building Parmi t Fee
fj-' . .~- Received By:
State Surcharge
Total Fcc (A) /4. ?/;) Plans Reviewed By Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge Is due on all undeveloped
properties within tho City limits which are being Improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
Storm Sewer
FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Ven t Fan
N'
By signature, I state and agree, that I have carofully examined
the completed application and do hereby certlfy'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
structure without permission of the Building Safety Division.
I further cartl ty that only contractors and employees who
arc In compliance with ORS 701,055 will be used on this
project.
Exhaust Hood
Wood Stove/lnsertl Fireplace Unit
, Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
I further agree to ensure that all required Inspections are.
requested at the proper tIme, that each address is readable
from the street, that the permit card Is located at the front
of the property, and the approved s t of R s will remain
on the e at all t rln on tr lion.
n - /z.~r-51
MISCELLANEOUS PERIVIITS
Mobile Home
State Issuance
State Surcharge
Sidewalk II
Date
Curbcut
II
DemolItion
Slate Surcharge
VALIDATION:
Tolal Miscellaneous Permits (E)
RECEIPT NUMBER /qZ-;:c?
DATE PAIr> k:>;y:? . '9 s--
AMOUNT RECEIVE" /t:.-::2C?
~.
RECEIVED BY
TOTAL AMOUNT DUE (excluding cleptrlcal)
(A, B, C, D, and E Combined)
"
\Q
~
1 .
r
")
I
/37
g
"'-. "-.. I
A?:,,,= I'- "-..1
'-. D<: '"
.,y).:;l2-~ ,
~~~(I- ~~
"', (
/(.,' J Go
SiD r~I'..'\,c-t::::
c..
({'
IIII I
o..!
t S-c.c. . A
1 .. . "
Af'T''''O>< 'SGALc hI.- ~ 1-0
R.E: PA ,Q Qool= ST11.\.lc..-'-u'2...E
I. 1<6""'ou.:- \'2-o0~\~c..,. V'v--.~-rGta..Ip..,,--
~!
,...
'1
U
~~_n~. n_. ~ '-'- -i
i
i
,
P=-,,-
0-
?o"'<:...'-: ._nTI
1';:(..(.. -1:::,
2. \<"'''''0\,)1; OAJVl"'f..E-C>- 'i2,<>, 1:oof "P.,oA-,,-,,$
:,. 'R",-""Ovc OAomAc:;.eo \2,,;="'n=;~S
1.\, \Z.E.-;>LA<..E. "f.p.~,"E?-~
5,' l'2.E?L-<p-c-e \2..oo~ 'S4t.;~q..Jc:.e
(." !-lEu..> -Qoo~,,.) c:..:,
t!.'t( n"", 27'2... 0
32." I{ =- 544 0
N
d
'I
[l
-
'.'4
~,~'
I
I
,
,
'j
{v
I
r---......-
I .
-l!
~~
.0L"
(. ... J )
.,.. r.~ '--
I 1 ( I \
l. '-.' I ,; (.
. L"'~ I '
~-C:..~~
''1
~:!
N:I
..... .
}i
,
't!
~!
i
I
,
1
o
"--'
". ~,. .
LOi \<:5" \&..CO:. L\
r-\ \'-1.. \J lEv.> E.STfJ.,E'\
T L -# J7 -O~ -2.1 -l.H.O Lf'iOD .'
,
'.'
E.st CJ::> st '-/'15 ~ C.> rT1Pr-j-a2..JPI..- i L-"..?:,o n...
LoC.A""T 10 l.J: \ S-(.C- Ll'\u\2-h
!:)w,JGIL.', 'Ko!oCf2.."T ....IOt-l,..)~O,J
.~
. .
Permit#: ~/h".Yr
Address: /C:;-~ ~?J/9.A'. ?-- '
ISSUedbY:,/Z~ . Date: ~~.~S-.
'/#,- ~~ ~ , -
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:
[i]
o
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 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
~
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 Prope rs ab ut Co stru' Responsibilities on the reverse side of this form.
/0 ~ /2--7'5 -
(Date)
(",hite copy to issuing agency permit file,
pink copy to applicant)
.
.
#
"
.....
,
~
",,- ,',' -~::' ... '. ...
Information Notice to Property Owners
. .A~out C~nstruction Responsibilities
::a.....,..-.
. .-__ Note: This Information Notice to Property Owners about Construction Responsibilities
" wa~ developed by t;i" ConslTUct[onContractors 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
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 daJ,llage 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 petform 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.pm4
1/94