HomeMy WebLinkAboutPermit Building 1992-10-22
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RESIDENTIAL
PERMIT APPLlCAFIOI\t
Inspections: 726.3769
Oltice: 726.3759
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!B NUMBERilal ~~ 1_
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225 Fltth Street
Springfield, Oregon 97477
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LOCATION OF PROPOSED W9l{K: j. I -) 0
ASSESSORS MAP: I '7 ( )P'd!]~()
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TAX LO'!: ;. a ""I CA4( )( )
SUBDIVISION'~ ~
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OWNER' ~ 9r ~ L '" r~
ADDRES/9: :J_L; r~ tP.diI
CITY: ,~AAt,f..p.I/~ STAT",6?R
DESCRIBE WORK: (~.) ~ + d3~.M-uL I rnOJ\.u)\ ~
NEW V REMODEL ADDITION DEMOLISH OTHER I )
CONST.
t1 onfHrl!2,JU,Ef\ CONTAAC~OR · EXPIRES PHONE
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FLOOD PLAIN: ~. J
ZONING CODE: (1)Jc..J
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LOT:
CONTRACl
GENERAL:
PLUMBING:
MECHANICA' .
ELECTRICAl'
QUAD AREA: \ RJ\) LJ
:~;Y B~:::~: ~ \
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. OF STORIES:
y./
WATER HEATER:
BLOCi'"'
- OFF~CE USk
LAND USE: \ \ r':Y )
. OF UNITS: ,
CONSTA. TYPE: J1....~
HEAT SOURCE: -~ f' J
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RANGF'
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PHONF'
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ZIP: _9 7 ~7
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. OF BDRMS:
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SECONDARY HEAT'
SQUARE FQOTAGE:
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To roquesl an Inspocllon, you must call 726.3769. This is a 24 hour rocordlng. All Inspections roqueslod;bofore 7:00 a.m, will be
made the same working day. Inspections requested after 7:00 B.m. will be made the following work day.
REQUIRED INSPEtTIONS
o Temporary Electric
D Site Inspoctlon - To be made
after excavation, but prior to
seltlng forms.
o Undcrslab Plumbing/Electrical I
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouti.ng.
-1'\ti Foundation - After forms are
~ erected but prior to concrete
Placomen~
o Undorground Plumbing - Prior
10 IIIl1ng trench.
o Underfloor Plumbing/MechanIcal
- Prior to Insulation or decking.
o Post and Boam - Prior to floor
In,sulatlon or decking.
o Floor Insulatlo~ - Prior to
decking, .
o Sanltery Sewer - Prior 10 lilting
r"'- trench. ~
O Storm Sewer - Prior to filling
trench.
I'\1l Water Llno - Prior 10 tilling
f trench.
o Rough Plumbing - Prior to
cover.
o Rough MechanIcal - Prior to
cover.
D Rouah Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Final Plumbing - Whon all
plumbing work Is complete.
D Final Electrical - When all
electrical work Is complete.
o Final MechanIcal - When all
mechanical work Is complete.
.
~Inal Bulldlng- When all
o Fireplace - Prior to facing equlred Inspections have been .
malerlals and framing Insp, approvod e~d b IIding Is
. completed. fj:(~
pFra3tO~a~O:~DOthor .~,
o Watl/Celllng Insu~n - Prior 10
cover.
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~Electrlcal Connection - Whon
blocking; sot.up, and ptumbing
, '. nspecitlons:ti~ve be,en'approvod
and the home Is connected to
- Ihe sorvleo panot,." '
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~.; nal,:;'. A.',ler.~!I..r~~~'re.d;j.,., .
. , ,. ._~. ',. . _: ~, . ..' ~~_p.~.~~l.o0~{are,:aPR.r9r:~ed ,and., ,','
o Street Trees - When all roqulred . Io',"porches;t.sklrtlng;idec~s; a'nd'" ".l',
trees are planted. . . " ve.ntlng tlsve.been,lnstalled:'.
o Drywell - Prior 10 laplng.
o Wood Stove - After I~stalla't.lo~. "
o Insert - After fireplace approval
and Installation of unit.
o Curbcut & Approach - Alter
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - Altor
excavation Is complete, forms
and sub,base material In place.
o Fence - When comph~ted.
MOBILE HOME INSPECTIONS
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'fic:i ~I~cklng ~n~ ~et.up - w~en all
, blooklng Is complolo,
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fl. Plu:"blng Connecllons - Whon
homo.has boen connectod 10
water and sewer. .
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LOI facos
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Lot sq, flg,
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Lot coverago
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Topography
Total height
Panhandle
Cul.do.sac
BUILDING PERMIT
ITEM SQ. FT. X $/SQ, FT.
Main
< '
Garage
,~OC~r \\90,
Total Value
Building Permit Fee
Slate Surcharge
Total Fee
(A)
Setbacks
HSE :G'AR 'AC~ I
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W
,E
VALUE
A~::ie
\~P,~)
1.Q3
LfD~3
S'r:~J'=:-i.~EV. ~LOPMENT. CHARGE ~DC)
~#/ ~ .~,'I"i:'? (B) qYlo40
PLUMBING PERMIT
ITEM
Fixtures
Rosldontlal Bath(s)
N'
Sanitary Sewer
FT.
Water
FT,
Storm Sewer
FT.
Mobllo Home
Plumbing Pormlt
State Surcharge
Tolal Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Van t Fan
N'
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobllo Homo
State Issuance
Stato Surcharge
Sidewalk
fl.
Curbcul
It
Demolition
State Surcharge
FEE
/}:=') p:J
A ,c::;.w
1~.oU
In5W
~~ ~~5
to 8 d5
{2f
I os CO
c-Jn .ct)
~llS
Total Miscellaneous Permits' (E)
TOTAL AMOUNT DUE~IUdlng eloctrlc:;) ~':):5!>~'2.,
(A, B, C, D, and E Comu',,~", '(c!).:JP..q-=< ) I
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C" THE PROPOSED W.ORK J~J THE._. -'I I,. i
"lII!'\'ISTORICAL DISTRICT, OR ON ".' .
THE HISroRICAr:'REGISTER? . I
If yos, this appllcallon must be signed '''.
and approved by tho Historical
Coordinator prior to permit issuance. '
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition Ihal the said
const.ruction shall, in all respects, conform to ttlC Ordinance
adopted by the City 01 Sprlngflold, including the
Development Code, regulating the construction and use of
buildings, and may be sw;pended or revoked al any time
upon violation of any J)rovislons Of/said ordinance5.
Plan Check Fce: ~
Date Paid: __
Receipt Number:
Received BY/
Plans Reviewed By
Dale
Systems Development Charge 15 due on all undeveloped
properties within tllD City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I state and agree, Olat 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 the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and thai NO OCCUPANCY will be made of any
structure without permission of the Building Safety DivIsion.
I further certify that only contractors and employees WllO
are In compliance with OAS 701.055 will be used on this
project.
I further agree to ensure thai all required inspections arc
requested at tho proper timo, that each address Is readable
from the street, that the pormit card is located at the front
of the property, and the approved set of plans wIll remain
on tho site a'lJ IiIllC)7dllrln\l cons,yucllon. ~ ~
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VALIDATION: ~r-I_( ~ '
RECEIPT NUMB~I(). _ r'CW
I 3Jl..o \
DATE PAID . . ~I._.
AMOUNT REqEIVr(} , . _~-:'tt.~u
RECEIVED B~~
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Permit No: qA 1:11./ =Ii;
Address: cY IpD ~(}'JU /L (J)1
Issued b~.Ji() ') Date: (O/1;q; ~
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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 ~PPlicable 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. 1 1 I understand that I must register as a construction contractor if the structure is sold
or offered for sale before be~rm~let~. ~
3, A.~ My general contractor is i u,.. .v Q J\LQ f PI
r Contractor registration number 4LD4- ~ .
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
I 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.
_ .~Af/hu (, ~~~
s~ature of Permit Applicant - il
/ () -:J- ),' '1 J.-
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFOR_TION NOTICE TO PROPERTY O~ERS
ABOUT CONSTRUCTION RESPONSIBILITIES ......_~
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NOTE: Jhis Ir]formation Notice to Property Owners About Construction Responsibilities
was developed by ttie 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 time employees are paid. You will be liaole 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 t~e Oregon Employment Division DHR
at 378-3224.
Workers' Compensation Insurance: As an employer, you are subjecHo 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 p~nalties and will be liable for all claim costs if one of your
employees is injured on the job. For mqre, information, call the Workers' Compensation Division DIF at 373-7434.
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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 buildil)g officials at the appropriate times so they can perform
the require'd 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
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SPRIAIELD
DEVELOPMENT SERVICES
PUBLIC WORKS
METROPOLITAN WASTEWATER MANAGEMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726.3753
MOBILE HOME P~D MN,UFACTURED HOME AGREEMENT
UNITS TO BE PU.CED IN A PARK
As required by the City of Springfield Development Code and/or the State of
Oregon, I understand and agree, as sho.n by my signature on this form, that .ith
~h P 0 'al 0) the attacp~d~p}\l~its for a home to be located at
J GlI);?~~ ~~~ ' Springfield, Oregon, City Job Number
. , I .ill meet or exceed the belov listed minimum setbacks.
Home Setbacks
10 feet from a park building
20 feet from any public street
5 feet from any rear space line or interior space line
5 feet from the edge of a park street
2 feet from the interior edge of a park side,'alk
Accessory Structure Setbacks
10 feet from a park building
20 feet from any public s tree t
5 feet from the edge of a park street
2 feet from the interior edge of a park side.alk
3 feet from an interior space line or rear space line
I further state, by my signature below, that I have been provided .ith the
rollo.ing information:
Manufactured Home Blocking Requirements
Kinimum Requirements for Permanent Steps
- Electrical Connection
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jt/~;2 2- -92-
Date