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Home My WebLink AboutPermit Building 1993-8-16 c .:.' 'i ;. RESIDENTIAL PERMIT APPLICATION . Inspections: 726.3769, Office: 726.3759 LOCATION OF PRO~Or7-'\ ~RK: C\. 22\_0 ASSESSORS MAP: lJ6)O ~ fj al LOT' BLOCI<' '. JOB NUMBER q~\D0(a .. SUBDIVISION' OWNER: cOXi) ~ ') ~ ~.r '-W\ 1!~ Q ~ t\ l\.. PHONE: V \~ \ ~ O~ \ (L ADORES;>: L-\ ~J () ~ ('f5]Jl) 1 ffi t1 ~ Qtf (~\ 0 Y1 j LiZ Y.. , CITy:~\)l\ J n~V t '~.0J .' ST~TE:JlLloJ:;~~ z~~~ f4r)L}- DESCRIBEWORK:\n\l(\tnJ ~'L,L~\ ~f'lA1Y\ \ OOo1(}~~ . ) NEW REMOD';.t) ADDITION~DEMOLlSH -' OTHER .. / CONST, CONTRA~:qt:l~ NA~E " ADDRESS ~'" CONTRACTOR # EXPIRES GENERAL: .\ \U "''"){\ LX' .J PLUMBING' MECHANICAl' ELECTRICAl' OUAD AREA' \ R.I\)lu # OF BLDGS: _ '\ ' OCCY GRO\JP:" ~ ~ # OF STORIE~:" I WATER HEATER' "1_. - OFFICE USE - LA~D ~SE: ---1l.Ll-~- I # OF UNITS: ~, COt:JSTR, TYPE: , , Vf\J PL!- . PHONE ~c "<! FLOOD PLAIN: ZONING CODE: U)JL.. HEAT SOURCE: ...... ... # OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE: .!:SOf 0 To request an Inspection, you must call 726.3769. This Is a 24 hour recording, All Inspections requested berare 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. o Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. ,0 Underslab Plumbingl Electricall Mechanical - Prior to cover. K/( Footing - After trenches are }OoJ excavated, C~ ~er~~ o Masonry - Steel location, bond beams, grouting. , '1':7'f Foundation - After forms arc ~ crecte(J but prior to concrete placement. o Underground Plumbing - Prior to filling trench, ~ UnderlloC!(Piumbin~chanicj!.l) ~_ Prior to'lrl:;iUICillon 'hr deCKIng. K::7f Post and Beam - prior to floor !.OJ insulation or decking. K7f Floor Insulation - Prior to ~ deckir:'Q. r~l'Sanitary Sewer -:- Prior to filling . .-~ trench. ' D' Storm Sewer - Prior to filling trench, '0 Water Line - Prior to filling . trench. I.' . 1S21 Rough Plu"!'bing - Prior to ~ cover. ' RANGE: REQUIRED INSPECTIONS N1 Rough Mechanical..... 'prior to ~ cover. rvt 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. ~raming - Prior to cover. , K71' Wall I Ceiling Insulatiory - ~;Ior to ~ 9ove~ . ~ Drywall - Prior to.t~~i~9' o Wood Stove - After installation. D Insert - After fireplace approval and installation of unit. D Curbcut & Approach - After forms are erected but prior to placement of concrete. o Sidewalk & Driveway - After excavation Is complete, forms and sub-base material in place. D Fen,ce - When completed. o Street Trees - When all'requlred trees are planted. '. "f':7( Final Plumbing - When all ~ plumbing work Is complet,e. ~ Final Electrical - When all ~lectrlcal work is complete. rvr Final Mechanical - When all ~ mechanical work Is complete. r\:?T Final Building - When all ~ required inspections have been approved and building is completed. o Other MOBILE HOME INSPECTIONS D Blocking and Set.Up - When all blocking Is complete. o Plumbing Connections - When home has been connected to water and sewer. r-'~ ~ o Electrical Connection - When blocking, set-up. and plumbing inspections have been approved and the home is connected to the service panel. o Final - After all required inspections are approved and porchcs, skirting, decks, and venting havc been installed, Lot faces LOi sq. flg. Lot coverage Topography Total hcight BUILDING PERMIT SQ. FT. , i)Olo ITEM Main Garage Carport Total Value Building Permit Fcc State Surcharge Total Fee PLUMBING PERMIT ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home Plumbing Permit State Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan . Lot Type Interior Corner Panhandle Cul.de.sac Se I bac ks I I I HSE GAR ACC I I -~ I I P.L. IN S w -;--1 6l~,ao=~~~ (A) 4- N' FT. FT. FT. (C) Dryer Vent Wood Stove/Insert/Fireplace Unit N' I /8P-, .~D q.-I3 -. /-9713 SYSTEMS DEVELOPMENT CHARGE (SDC) r/3 (B) If L/-n~ Mechanical Permit Issuance State Surcharge Total Permit Mobile Home MISCELLANEOUS PERMITS (D) State Issuance State Surcharge Sidewalk It Curbcut It Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding clectrical) (A, B, C, 0, and E Combined) FEE .4rJ~O 2.6<> -V-~ -L22/A') 2, . b""P /5.00 /O.bO .?S . ~5. 75" 131.9>B . ( IS THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed anti approv~d by the Historical Coordinator prior" to permit issuance. -.. , AFPROVcD: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condiiion that the said construGtion shall, in all re-spl:cts. conform to the Ordinance adopted by th'3 City of Springfield, including the DcvelofJiTlent Code, rc~;ulating the construction and use of buildings, and may be suspended or revoked at any time ;~:nn ~:,:::i:::'f:S~'O""O"~\~"""'" Date Paid: ~)~ Receipt Number: \ _c0/h~ 7-oj(e . P Systems Development Charge is due' on nil undeveloped' properties within the City limits whicll are being improved. ADDITIONAL COMMENTS PAm 1 . ~~t!AC.. /~/T J.<3 #li!DUlIIcn By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all l.nforma.tion hereon is true and correct, and I further certify that any and all work ~e~f,ormed ,shall be done in accord?nce with the Ordinanct:s 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 with ORS 701.055 will be used on this project. I further agree to ensure that all required inspectio(ls arc 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 he approved set or plans Will remain on the site at all tl elunng CTfnstruc 0 l. / Xignaturc /J r~ Date ~bn -9L ' /I . ,~ VALIDATION: RECEIPT NUMB?6; " qq~ ~ DATE PAID ~~c\{() .c...{'~_ AMOUNT RE~JD _1--\..(\ TQ~b RECEIVED B}7)~ ,,-' \ ,. '.. .. . .,' Permit No: C13\DLb.' .~ Address: g~( ./) ~D0 f1nJ.Je)j0 I Issued by:ti<LO~ Date: ~,I,~) 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. rc.tl. I own; reside in, orwill reside in the completed structure. I 2. I' 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 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 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. ~~M dJ$hr ~'g arure oi PermitJ'Ppn~ ~-/1o-:-13 lYaie CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT . . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ( ..... . ~ '. NarE: This Information Notice to Property Owners About Construction Responsibilities was developed by the 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 Contract<?rs 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. 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 .;. .. '. -. \ .JOB NO. 93/07 b CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: S,E3:.VlE t! kArHY R6AY , LOCATION: q~(p /-(JU..{AVEN Ave. DEVELOPMENT TYPE: L OlZ- - A-Pt:> f If ON / 7 {) ':!7 ].. 7 7- I - 6 'f 3 00 BUILDING SIZE: LOT S I'ZE SQ. Ft. 1- STORM DRAINAGE IMPERVIOUS SQ. FT. 557 X $0.203 PER SQ. FT. ~302) 2. SANITARY SEWER-CITY NO. OF PFU'S 8" X $42.08 PER PFU 0%."~~ (See Reverse) ~ 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X X X $424.31 X $424.31 X $424.31 G- ) "- .-/ $ $ 4. ~ANITARY SEWER-MWMC NO. OF PFU'S x $15.125 PER PFU + $10 MWMC ADM FEE $ (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ TOTAL-MWMC SDC ~ SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ 'f'fq"?.!. 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X .05 JG ~LJc.... 7 /'2-1/17 G7 Kip Burdick 'f SDC Coordinator (~~~ ,f z..o TOTAL SDC $ ,72.- FIXTURE UNlT~CALCU~N TABLE: Number of New Fixtures.;it Equivalent = Fixture Units ~1>Jq!E~ For remodels. calculate only the NET additional fixtures) . . NUMBER OF UNIT FIXTURE FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS Bathtu b................................. .................................... Drinking Fountain..................................................... Roor Drain............................. ................................... Interceptors For Grease/Oil/Sollds/Etc................. Interceptors For Sand/Auto Wash/Etc.................. Laundry Tub /Clotheswasher.......................... ........~ Clotheswa~~er - 3 Or. More...,..............,....",,,,,,,,,,,,, Mobile Hdme Park Trap (1 Per Trailer)...:.............. . Receptor F(>r Refrigerator fWater Station/Etc........ Receptor For Commercial Sink/Dishwasher /Etc.. Shower, Single.StaIL.............................................. Shower, Gang........................................................... Sink, Bar, CommerciaL........................................... Urinal, StallfWaIL.................................................... Wash Basin/Lavatory, Single.................................. Water Closet, Public Installation............................. Water Closet, Private............................................... Miscellaneous: / 2 1 2 3 6 2 6 6 1 3 2 l/Head 2 2 1 6 4 2. -z. 2. "f TOTAL FIXTURE UNITS 'l CREDIT CALCULATION TABLE: calculate credits separates. I Based on assessed value. If improvements occurred after annexation date in table, Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value $3.21 3.13 3.08 2.96 2.82 2.68 2.51 1986 1987 1988 1989 1990 1991 1992 S 2.24 1.93 1.57 1.16 0.79 0.44 0.28 L 1979 or before 1980 1981 1982 1983 1984 '1985 Credit for Parcel or Land Only If Applicable x $ (Rale X Assessed Value) X $ = (Rale X Assessed Value) CREDIT TOTAL = $ -.'~p~e~ent [If after annexation date) . .. . -,. RUNOFF COEFFICIENTS FOR STORM DRAINAGE ..", Resldential....................;......................;.:..;;...... 0.4 CommerciaL.................................................... 0.9 IndustriaL.......................................................... 0.45 GovernmentaL................................................. 0.5 IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT