HomeMy WebLinkAboutPermit Building 1992-10-28
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DESCRIBE WORK: <-J IA J hi r:w-.n.t. ~o_ k-L'Uf
ADDITION DEMOLISH OTHER
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726,3769
Office: 726.3759
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ASSESSORS MAP:
LOT'
OWNER:
.ADDRESS'
CITY'
NEW
REMODEL
CONTRACTOR'S NAME
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GENERAL:
PLUMBING:
MECHANICA' .
ELECTRICAl'
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QUAD AREA: J] n )lU
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OCCY GROUP: t.\~-\;--\,J\J\
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. OF BLDGS:
. OF STORIES:
WATER HEATER:
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SPRINGFIELD
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JOB NUMBER -.9 d J L./ qq
225 Fifth Street
Springfield, Oregon 97477
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STATE:
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TAX LOT'
SUBDIVISION:
Q44-00
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ADDRESS
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CONST,
CONTRACTOR' EXPIRES
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PHONE
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- OFFICE USE -
LAND USE:-U.S.6-
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. OF UNITS:
CONSTR. TYPE:
HEAT SOURCE:
RANGF'
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FLOOD PLAIN: )
ZONING CODE:J..Cl (("
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. OF BDRMS:
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SECONDARY HEAT:
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,SQUARE FOOTAGE: c;;;y
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To request an Inspection, you must calt 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 SlIe Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior 10 cover.
o Footing - After trenches arc
excavated.
o Masonry - Steol locatlon, bond
beoms, grouting.
o Foundation - After forms are
erected but prior to concreto
placement.
o Underground PlumbIng - Prior
to filling trench.
o Underfloor Plumbing/Mechanical
_ Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking. .
~sanltary Sewer - Prior to filling
I trench. . ~
o Storm Sewer - Prior to filling
trench.
~WDter Line - Prior 10 filling
L:fI trench.
o Rough PlumbIng - Prior to
cover.
o Rough Mechanical - Prior to
cover.
o Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o FIreplace - Prior to facing
materials and framing Insp,
o Framlng:~- Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Slove - After I~stallatlon.
o Insert - After fireplace approval
and Installation of unll.
o Curbcut & Approach - Alter
forms are erected but prior 10
placement of concrete.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material In place.
o Fonco - When completed. '
o Stroet Treea - When 'all requIred: .
trees ore planted. .
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o Final Plumbing - When all
plumbing work Is complet.e,
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o Final Electrical - When all
elect~l~al, work Is complete.
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o Final Mechanical - When all
mechanical work 15 complete.
r!Flnal Building - When all
required Inspections have been
approved a(\;:.u~ld~
completed, \..U,1\1~' -
DOthor
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MOBilE HOME INSPECTIONS
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L:d tllocklng and'S!'t,UP..~ When all
blocking Is complete.
[Lt, PlumbIng Con~ectlons - When
home has been connected to
water and sewer,
[3;:lectrlc~1 Connection - When
blocking, set,uP,eri9 plumbing
. Insp~ctlons have been a.pproved
and .the home Is'connected to
the service panel: ..
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0F'na' '- After "all required
"Inspectione:a,,, 'a,,;iroved 8:'nd
porches:..sklrtln'g, 'de.c~'s~ and
venting have'been.lnstalled.
Setbacka.
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Lot facos,_ I . ~ '.
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Lol sq:'1l9"~':~
Lot coverage
Topography
Total hel ght
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BUILDING PERMIT:
ITEM. SO: FT: ,.
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X $/SO, FT.
VALUE
Main
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Garage
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Carport
41W:L
Tolal Value
cY~~ ,'3.)
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Building Permit Foe
State Surcharge
Total Fec
(A)
SYSTEMS DEVELOPM~~^cfHARGUSDC}""
ct\ \ 0 ' ?9J.q ~ ~ ~B) q'-ltp,:tU
PLUMBING PERMIT
~M F~
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT,
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge (C)
J<:::'CO
''''CO
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I~CD
(pc;:) ex:.J
.1\.'-3.~S
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MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnscrtlFlroplaco Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
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Tolal Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stata Surchargo
Sidewalk
ft
Curbcut
ft
Domolllion
Slate Surcharge
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Total Miscellaneous Permits (E)'
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
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I. . THE PROPOSED WORK IN THE .' '\
''''IIl'iSTORICAL' DISTRIGr, OR ON ,\
THE HISTORICAL REGISTER?
If yes, Ihls application musl be Signed: :,:, Ir, I
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and approved by the Historical."
. Coordinator prior to perrnll issuance.
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APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the saId
constructlon 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.
Plan Check Fee:
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Dale
Systems Development Charge is due on all undeveloped
properlic:.; wllllln the City limits which are being Improved.
ADDITIONAL COMMENTS
By signature, I state and aUree, that I have carefully examined
tho completed appllcallon and do' hereby certify that all
Information hereon is true and correct, and I further certlly
that any and all worl< performed shall be done In accordnnce
with the Ordinances of the City of Springlleld, i1nd tile Laws
of the Stale of Oregon pertaIning to the work ucscribed
herein, and lhal NO OCCUPANCY will be Inude 01 any
structure without pcrrnlssl~n of the Building Safety Division.
I further certify that only contractors and employees who
arc In com,Plian.cc with 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 each 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 con~tru n.
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Signature ~ ~ 6.- 1/
Date Jo _t/?.2--
VALIDATION: t /'\ ~ 1
RECEIPT NUMBErt .__\!L. j -
DATE PAID -\-CJ.A.2.2~ V \
AMOUNT RECEIV~)!) (PI. .58 ~i({),IbJ
RECEIVED BY ~ ~
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Permit No: 3fl \L\G'~ $n I '
Address: <9 It;={) ~_ doll
Issued bY~ Date: IrL4Bq~v
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 i~apPlicable blanks, and initial boxes 1 and 2, and either bOX. 3A or 3B:
1, I( I I own, reside in, or will reside in the completed structure,
2. I I' I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion. L
3, A.I 0 My general contractor is '0_ r~ \'(\,~ - ~)~ _e oJ '
( Contractor registration number - ~~.'3ct1 '
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 Construe.
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.
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SignafU~rmit Applicant
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INFORMtlON NOTICE TO PROPERTY O_ERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: . .Thi~ Inf9r!11i!tion Notice t9. Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701,055(5),
passed by.the .1989 Qregon Legislature.
If yoo'are-actin'g as your own contractor to co~struct a new home or make a substantial improveme.nt'to an
. existing structure, you can pre)/entmany problems by being aware of the following responsibilities and areas
'of concern,' .
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors B9ard to do labor in constructing or assisting
in the construction or iinprovement of a residential structu're.- you will, in most instanc!ls, be ruled to be an
"employer" and the people you hire will b~ "employees", As the employer, you mllst comply with the following:
. " . .
Oregon's Withholding Tax Law: As an employer, yqu musfwithhold income taxes,from,employee wages at
the time employees are.paid, You will be liable for the t?x payments even if you don't actually withhold the
tax from your employees, For more information, call the Oregon Depar:tment 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,
Workers' Compensation Insurance: As an employer, you are subjectto the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees, If you fail to obtain workers'
compensation insurar:lce,- 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 vyithhold federal income tax from employees' wages,
You will be liable for the t"!x payment even'if y()u qidn'i 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 Properly 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
0244.J 10/24;89
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DEVELOPMENT SERVICES
PUBLIC WORKS .
METROPOLITAN WASTEWATER MANAGEMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(503) 726,3753
MOBILE HOME AND MANUFACTURED HOME AGREEMENT
UNITS TO BE PL.,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 vith
~h ~pro~f the attache~~.ermits for a home to be located at
~f) 1111 n I ::/tn~ , , Springfield, Oregon, Ci ty Job Number
CYI~ I viIi 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 sidevalk
Accessory Structure Setbacks
10 feet from a park building
20 feet from any public street
5 feet from the edge of a park street
2 feet from the interior edge of a park sidevalk
3 feet from an interior space line or rear space line
I further state, by my signature belov, that I have been provided vith the
folloving information:
Manufactured Home Blocking Requirements
Minimum Requirements for Permanent Steps
- Electrical Connection
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Signatl\:}
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Date