HomeMy WebLinkAboutPermit Building 1992-5-12
CO~ M ERCIAL/I N DUSTRIAL6
PERMIT APPLICATION
~
. JOB NUMBER 4~O{o f........~
225 Fifth Street, Springfield, Oregon 97477
INSPECTION LINE: 726.3769
OFFICE: 726.3759
LOCATION OF PROPOSED WORK: 2..'-50
ASSESSORS MAP:-P /7. (:> ~ - ~"1 _ ,
L~JLI.- <;;I
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TAX LOT: 4J..01) Jf5{)1? t./.tea::J
PHONE: 3 <44- ??-'I}-Cf
OWNER:Y()/1 t)1A-1 k)
ADDRESS' ~, 'S l / L.flHAJ
CITY: 0 {r,,~jC::;-
/..RJL$:.. ,-
l...J.
NEW
REMODEL
STATE: OIJ
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ADDITION ~ DEMOLISH OTHE@:.OC~/ ~~:
ZIP:
Q7LLo /
DESCRIPTION OF WORK'
ARCHITECT:
NAME
J..-.(OW'rJ.... ~~ -P~IL-
ADDRESS
PHONE
j
MECHANICA' '
ELECTRICA' '
lolA;'"
1/
II
II
ADDRESS
~Q.~
CONST.
CO NT RACTO R .
?,t.l4-_ q~4o,
,
EXPIRES PHONE
CONTRACTOR'S NAME
GENERAl' . '-'In LL'f-It-
PLUMBING:
~
it{
I PLUMBING I I MECHANICAL ,
I NO. FEE CHARGE I iD ~~L _CHABG9
lz Single Fixture /0 db ;;;.0<(0 1 Furnace/burner & vent
< 100,000 BTUs
I Relocated Bldg. 1 1 Furnace/burner & vent I
(new fix. add! I) > 100,000 BTUs II
1 Water Service , 60 It. 4t?~ 1 1 Floor furnace and vent 1
I Sanitary sewer<f.6 .1 z,5alOI 1 Suspended wall or floor ;11 1
Oft. mounted unit heater ....
1 Storm Sewer " 1 1 Appliance Vent ., I 1
It. separate '
1 Backflow Device 1 1 ~~,~,"'" 00"/ I 1
1 1 I I Vent Fan/Single ... 1
duct J
I 1 I I Vent System apart 1
from AC or htg. /
1 1 1 1 Mechanical exha t 1
/ hood and duct
1 I 1 / I
I I I Permit Issuance $10,00 I
1 TOTAL PERMIT 65~1 1 TOTAL PERMIT I
aUAD AREA: \ Qs\ ')0
I
OCCY GROUP' /T\J\
J
. OF BLDGS:
- ~FFI%UK
LAND USE: \ \ ~_)
. OF UNITe, ,
CONSTR. TYPE:-li.N
HEAT SOURCE:
HANDICAP ACCESS:
FLOOD PLAIN:
ZONING'
LIGHTING POWER BUDGET:
. OF STORIES:
WATER HEATER'
sa. FTG MAIN
sa. FT. P
702
$/sa. FT.
VALUE
x
sa. FTG ACCESS
X
X
TOTAL VALUE OF PRO.J~ ~ l~ ~
DATE~}j3 .I12...ay~/JY1 )
- , -
sa. FTG OTHER
PLAN CHECK F~
\y,\~
RCPP 44't'...! I
I BUILDING PERMIT
15% State
Surchara8
I MECHANICAL
15% State
SurcharQe
1 PAVING
Z9,S'()
/,-{S
, PLUMBING
f8S-
1l, 2 S-
, DEMOLITION
5% State
Surcharae
FENCE
VALUE $
1 SIDEWALK
I CURBCUT
FT.
SUBTOTAL
PERMITS
SYSTEMS
~~V~I_0P~g~T
~U7Z"!:.:,
~c.9~-322.f2
FT.
TOTAL PERMIT FEES I
EXCLUDING ELECTRICA'
I~'
.
REQUIRED INSPECTIONS
.
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It Is the responsibility of the permIt holder to see that all Inspections are made at the proper time. To request an inspection, call
726.3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready
for inspection. Requests received before 7:00 a..:m. will be made the same working day, requests made after 7:00 a.m. will be made
tho following work day. \. /
SITE INSPECTION: To be ,7\ R"""'" PI "JYIBING,
made after excavation, but c:;:fj "'C;TRJ~
prior to setup of forms. MECHANICAL: No work is to
be covered until these
inspections have been made
and approved.
PAVING: After gravel is in
place but prior to placing
asphalt or concrete.
x
UNDERSLA~ulviEii~
. ELECTRICAL'!
MECHANICAL: To be mado
before any work Is covered.
ATTIC DRAFT STOPS &
CURTAIN WALLS
v
FOOTINGS & FOUNDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel.in~place,'bu~.
prior to placjng concrete.
( .
CONCRETE SLAB: To be
made after all Inslab oulldlng
service equipment, conduit,
piping, accessories and other
ancillary equipment items are
in place but before any
concrete is placed.
FIREPLACE: Prior to placing
facing materials and before
framIng Inspection.
SPECIAL INSPECTIONS: In accordanco
Section 306 of tho State Specialty Code
a special inspector shall be employed
by the Owner I Contractor during
construction of the following work. A
copy of the special testing reports shall
be furnished to the Building Division.
r
'X
FRAMING: To bo mado aftor
the roof, all framing, flro
blocking and bracing- are in
place and all pipes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
STRUCTURAL CONCRETE: In
excess of 2500 P.S.1. (306 a.1)
STRUCTURAL WELDS:
Performed on the job. (2722 f)
UNDERFLOOR: Plumbing,
electrical, mechanical. To be
made prior to installation of
floor insulation, decking or
fioor shoathing.
INSULATION & VAPOR
BARRIER: To be mado aftor all
Insulation and required vapor
barriers are In place but
before any lath or gypsum
board Interior wall covering Is
appliod. .
FIRE & SEPARATION WALL:
Located and constructed
according to plans.
HIGH STRENGTH BOLTING:
During all bolt installation and
tightening operations. (306
a.6)
x
UNDERGROUND: PltJmbina.
electrical, ga~i\nltar'{ sewlll>
storm sew~. water 11nd
drainage lines. 1'0 be made
prior to covering or filling
trenches.
SPRAYED ON
FIREPROOFING: U.B.G.
Standards 43-8.
SPECIAL GRADING,
EXCAVATION AND FILLING:
During earthwork. (306 a,11 &
Chapter 29)
POST & BEAM: To be mado
prior to Installation of troor
Insulation, decking or floor
sheathing.
LATH AND/OR GYPSUM
BOARD: To be made after all
lathing and gypsum board,
Interior and exterior, Is In
place but before any .
plastering is applied or before
gypsum board Joints and
fasteners are taped and
finished.
GLU.LAM BEAMS: Inspection
Certificate by an approved
agency, furnished to the City's
Building Division before
beams aro placed. (2501 U.B.G.
STDS. 25.10,11),
STRUCTURAL MASONRY: (3'06
a.7) .
FLOOR INSULATION &
VAPOR BARRIERS: To bo
made prior to installation of
decking or floor sheathing,
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base material in
placo.
*In addition to the inspec-
tions specified, the Building
Official may make or require
other Inspections of any
construction work to ensure
compliance with .the Building,
City or Development Code.
MASONRY: Steol location,
bond beams grouting or
verticals In accordance with
UBC 2415.
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof covering.
CURB AND APPROACH
APRONS: Aftor forms aro
erected but prior to placing
concrete.
Y--. FINAL PLUMBING
r
-:/-- FINAL ELECTRICAL
'X
SITE PLAN REVIEW BOARD: Must be requested 2 days In advanco
of the date you wish Inspection. All project conditions such as
landscaping, parking lot striping, etc. must be completed before
requesting this Inspection. ; I
FINAL BUILDING: Requested after the final plumbing, electrical,
...... mechanical and Fire Department inspections are made and
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been issued by the Building Division
and posted on the premises:
FINAL MECHANICAL
,
FINAL FIRE'DEPARTMENT
ADDITIONAL COMMENTS'
PLANS REViEWED BY
c;f~~~
DATE 'fi // Yrz....
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information
herein 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 certify that only contractors and employees
who are In compliance wl!h ORS 701.055 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that project address Is readable from the
street, that the permit card Is located at the front of the property, and the approved set of plans will remain on the site at all
,-./times during n'structlon. r--Il \
/~Ignature C~d G'7~ Datp
DATE PAID: <//2-/5' 2..
RECEIVED BY: ~
VALIDATION:
AMOUNT RECEiVED: <. 22 ,C"a 2-
4t:. ~~ 4
. .
RECEI PT N'
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Permit No: 9200/5
Address: 2/S0 L.A-u-AV4
Issued by:. /~
,
Sr.
9"/2-1'7/
Date:
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 in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. I '"'><.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,
3. A,I
, My 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, r--.....----- J 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 Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
~/~
Signature of Permit Applicant
.s- - I 'J-..... q;;-.
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORITION NOTICE TO PROPERTY OAERS
ABOUT CONSTRUCTION RESPONSIBILITIES
'. . .i.-
NOTE: - ~ This,lnforrnation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
pass~d by, the.W89 OregQn Legislature.
" ,.., .- ,
It'y~u 'ar~"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 riot 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 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 information, call the Oregon Employment Division DHR
at 378-3224. - .
_r-- .
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 DIF 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 Summer SI. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378.4621
0244J 10/24/89