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Home My WebLink AboutPermit Mechanical 1995-9-5 " ....~,. '-RESIDENTIAL PERMIT APPLICATION . SPRINGFIELD Ins pee lions: 726.3769 C(llice: 726.3759 L~CATlON OF PROPOSED WORK:_~ ASSESSORS MAP: ,1{O?-.~f)A \ OWNER:U\\ ~ (\ h~ \:), ~Q o-6&- PHONE: ADDRES~" q ~C) K~ 1 JP AJ n IV CITY- ,. J~ ~ - STATE: ~ ) I . LOT' BLOCK: .-.. q~o:1A4 JOB NUMBER 225 Fillh Slreel Springlleld, Oregon 97477 TAX LOT: (mnu SUBDIVISION: fi-.\ . \l\cK) ADDITION DEMOLISH ZIP:~ * ~ PHONE DESCRIBE WORK. NEW REMODEL CONTRACTOR'S NAME GENERAl' PLUMBING: f\ , . - ) MECHANICAl .('1t D~ ELECTRICAL: ADDRESS CON ST. CONTRACTOR N " EXPIRES - OFFICE USE _ QUAD AREA' LAND USE: FLOOD PLAIN' N OF BLDGS: N OF UNITS' ZONING CODE:_ OCCY GROUP: CONSTR. TYPE: N OF BDRMS: . OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER: RANGE' SQUARE FOOTAGE: _ To requesl an Inspecllon, you must call 726.3769. This Is a 24 hour recording. Alllnspecllons requested beloro 7:00 a.m. will be made the SllnlC working day, Inspections requested aCter 7:00 a.m. will bo made tho followIng work day. ~OU~I~ :~~h:~C~'P E~::~I~ S Cover. o Rough Electrical - Prior to cover. . o TOl11pornry Electric O Slto Inspection - To be mado after oxcavallon, but prIor to selling forms. o Underslilb Plumbing! Electrical! Mechanical - Prior to Cover. o Fooling - After trenches are excavated. o Masonry - Steel'locatlon, bond beams, grouting. o Foundation - Afler forms are erected but prior io concrete placemont. o Underground Plumbing - Prior to fllllnQ Irench. o Underlloor Plumblno/Mochanlcal - ~rlor to Insulallon or decl(lng. " o Post and Boa""....;. Prior to floor Insulallon or dockIng. o Floor Insulation - PrIor to decking. O Snnltary Sewer - Prior 10 fllllng lrench. o Storm Sewer - Prior to filling trench. ,... ~ , I o Water L1no - Prl~r' io filling trench. , . , . , \ \ II. o Rough Pluinblng ....;. Prior to cover. . o Electrical Service - Must be approved to obtnln permanent electrical power. o Flreplaco - Prior to facing materials and framing Insp. o ~D Framing - Prior to cover. Wall/Colllno Insulation '- Prior to cover. o Drywall - Prior to ta~lng. o Wood Slovo - Aftor Installation. " ... 0 Insert ":....,A.(ter fireplace approvlll . f and Installation of unit. . .~ o Curbcut & Approach - After forms are erected bul prior 10 placement of Concrolo. o Sidewalk & Drlvewa.v - Aller excavation Is complete, forms and sub.base material In place. o Fence - When com~leled. . / O. , Streol Troos - Whon all required treos are planted. ;t;. ~. o Final Plumbing - When all plumbing w9.rl( Is complet,c. o Final Eloctrlcal - When a/l electrical work Is complete. ~al Mechnlllcal - When all echanlcal work Is complete. Final Building - When all o requIred Inspections have been approved and building Is completed. o Othor .,...., MOBILE HOME INSPECTIONS o Blocking and Sol.Up - Whon all blocking Is complete. o Plumbing Connoctlons - When home has been connected to water and sewer. o Electrical Connoction _ When blocking, set.up. and plumbing Inspocllons have been approved and the home Is connected 10 the service panel. o Final - Aller all required Inspections are approved and porch os, sklrllng, decks, and vcnllng havQ been InstallOd. LOI facos: , Lot Type. \ I PL. ' , . Interior Lol sq! Itg. . - -'-- IN Lot coverage Corner Is Topography Panhandle Total height Cul.de-sac \w 1 \,11 " -: IE ," _S THE PROPOSED WORK IN T~': 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' BUILDING PERMIT ITEM SO. FT. J~ ! r X $/SO. FT. VALUE Main Garage ~\ Carport\ " " ., Tolal Value Buliding Permit Fee State Surcharge Total Fcc (A) SYSTEMS DEVELOPMENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM FEE Fixtures Residential Balh(s) N' Sanllary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit Stato Surcharge Tolal Charge (C) MECHANICAL PERMIT Furnaco Exhaust Hood Vent Fan N' Wood Stove/Insert/Fireplace Unit Dryer Vent Mechanical Perml t /cs,w L(j,W {. !lD aY/n -/lO Issuance 'T~ State Surcharge Total Permit (0) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It It Curbcul Demolition Slate Surcharge Tolal Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) cQL" &) . . . ~ , I APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT r This permit is granted on tho'-oxpress condillon that the said construction shall, In all respects, conlorm to the Ordinance adopled by: the City 01 Springllel,I, including the Development Code, regulating the COQ5lruction 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: Recelpl Number:.n Received By: , Plans Rcvlc-wCd\Py.....------- Dalo '----. :l, . Systems Development Charge Is due on all undeveloped properties within 1110 City limits which arc being Improved. ADDITIONAL COMMENTS . By sIgnature, I state and agree, thai I have carefully examined the completed applicallon and do hereby cerllfy that ali Information horeon Is true and correct, and I further certify that any and all work performed shall bo done 1n accordance with the Ordlnanc"s of the City ot Springfield. end the Laws of the Stato of Oregon porlalnlng to the worl< described herein, and that NO OCCUPANCY wili be made of any structure without permIssion of the Building Safely Division, I further certify that only contractors an~ employees who are In compllanco with OAS 701.055 will be used on this project. VALIDATION: RECEIPT NUMB"P / RJ l~ DATE PAID U', (c:::;~ g,.c:::::., . AMOUNT RrteeJJ.O ~--C2J.La J::JO '. RECEIVED ~'.;-j)//y~ ;J . / :.......) .,L":. . P,,,,,,.. q ~~ \ Address: C. ~:i:lJ )(IM1 f1L) Date: q. s. q::s Issued b . 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: lfz() I. I own, reside in, or will reside in the completed structure. [J 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 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 i rmation is correct and that I have read and do understand the Information Notice to Pro~~er out C~~esponsibilities on the reverse side of this form. ~/, ~ ~/~ f/ -~ . (Sign~ture of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) 'j ,\~ ~'-~ {-~, . . rnformation Notice to Property Owners \ 1': ,/ I, \-A~o~t Co~~tr~uction Responsibilities . Not~: This Information Nbtice to Pr~periy Owners about Construction Responsibilities was 'developed by the Construciion Contractors 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 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 punctures, fire, or work that must be ~~ . 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 tliey can perform the required irispections. 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 SI. NE Suite 300, in Salem. prop-own.pm4 1/94