HomeMy WebLinkAboutPermit Building 1993-7-7
'--
.
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
SPJUNGFIELD
~.t@
~OCATION OF PROPOSED WORK:~~o61o ~()cJI~AA~
ASSESSORS MAP: , ., o~':l12d-____
~ \,ili.^+:
\yOIo ~0Cu~
4P\/ I ,^--~ilrQ .
A-rTdi.-koV'\ - f2.,p ~vOOVY"\
LOT'
OWNER:
ADDRESS:
CITY:
DESCRfBE WORK:
,NEW
REMODEL
ADDITION
CONTRACTOR:S NAME .
. ' ~ D,. ~- n"J~'
CENERAL: __.._~_LW~--':""
PLUMBIN("' n"'JV.....O.if"
MECHANICAL: o...v.~Y
ELECTRICAL' nu~.r
OUAD AREA:
\Q~)~)
\
a,.~ . _
.~-:-?, ~":. .~.
~ ~\,'
~:.."" ,.
. OF BLDGS:
OCCY GRqUP:
. OF STORIES: -::..' , -
WATER HEATER:
BLOCK'
STATF'
nR
",
,
JOB NUMBER
C) ~020q
225 Fifth Street
S'pringfleld. Oregon 97477
.~ ,11,,.,q
TAX LOT: _
(')/SI J
SUBDIVISION:
PHONE:
J ~(" -28torJ
ZIP:
q,'-I7I
i ~c.;t:t-. V 0 c) VY"'>
REQUIRED INSPECTIONS
t8f Rough Mechanical.'- ~~Ior to
cover. . .
K:::;7(" Rough Electrical -. Prior to
~ cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power. . ".
D Fireplace - Prior to fac1ng
materials and framing Insp.
18:( Framing - Prior t? ,~.?'..:r: .
~WalllCeiling Insulati6~ .....,.. 'Prior to
~cover.
{
~ Drywall - Prior to.ta~lng. ~
! . 1 Wood Stove - Alter 1r.5tallation.
D Insert - After flraola.:~ approval
and Installation ot unit.
LI C,:rbcul & Appro<-1:;h - ftl(ei
-- fori'll~ arc erected cut ;:ortC r to
placemc!lt of concrCia.
o
Sidcwaik & Ori'/cway -~ ,f..der
cycavation is comple',-:, !t;r!r~3
and sub-base mate:rial i~, p:::...:e.
DEMOliSH
OTHER
"
CONST.
4, CONTRACTOR II
EXPIRES
PHONE
o FW1ce - When compl6ted.
,
o Sl:cct Trees - Whc~\ ~i:I:H:quircd
tr,~ es are plantc<J, ' ---
.
FlpOD PLAIN:
ZONING CODE:
UJr-
. ADDRESS
4 ~ '.. ., .
. ..
- OFFICE USE -
'.
r,AN~; USE:
. OF UNITS:
\l\'\:\"~_
N OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
LfLfb
C'ONSTR~ TYPE:
. - .
\JrJ
&.""oJ-\~
To request an Inspection, you must ci'111 726-3769. This Is a 24 hour recordIng. Alllnspectlor.s requested before 7:00 a.m. will be
made the same working day. inspections requested after 7:00 a.m, w!ll be made the following work day.
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
~ Undersl~Electrical/
~ Mechanical - I-'nor to cover,
l"'i21" Footing - After trenches are
~ excavated.
D
Masonry - Steel location, bond
beams, grouting,
D Foundation - After forms are
erected but prior to concrete
placement.
D
Underground Plumbing - Prior
to filling trench. .
D
Underlloor Plumbing/Mechanical
_ Prior to insulation or decking.
D Post and Beam -': Prior to floor
insulation or decking.
~ Floor Insulation - Prior to
'~ decking. .
D Sanitary Sewer - IPrio~ to filling
trenctl. '
D Storm Scw~r - Prior to filling
trench. .
D Water Line :..- Prior to filli~9
trench.... '
.. \ ,... ~... \
. .. '., '," J
~ RouGh Plumbil!g -'''Prior '.0
~ cover, , I
HEAT.SOtJRCE:
RANGE:
~ Final Plumbing - When all
plumbing work Is complete,
R7f Final Electrical - When all
~ electrical work is complete.
f":/f Final Mechanical - When all
~mechanical worK Is cornplete,
~ Final Building - V,Jhen all
~ required Inspections have been
approved and bLdlding is
completed.
DOlher
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking is complete.
11 Plumbin~ Connections. - When
---' nome has be€..n connected to
water and ~e':Jcr_
C Electrical Connection - When
.oJ blockina. set.up, and plumbing
Inspections have been approved
and the home is connected to
the servIce panel.
L-.J
Final - After all requIred
inspections are approved and
porches, skirting, decks. and
'/enting h;r:c been installed.
Lot faces
Lot sq. Itg.
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM sa. FT.
Main
S-H...ID
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary Sewer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
Lot Type -.
~Interior
Corner
Panhandle
Cul-de.sac
't_HE PROPOSED'W~RK IN iHE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historlcal
Coordinator prior to permit issuance.
Setbacks
I PL. HSE GAR ACC I
IN
Is
Iw
IE
X $/SO. FT. = VALUE
'7-.{"".':)~ Q4\7';)~
(A)
4-
;
FT.
FT.
FT.
(C)
Furnace
MECHANICAL PERMIT -"
.'
/70.$0
7!f;7.~3
/7q.03
SYSTEMS DEVELOPMENT CHARGE (SDe) #3
(B) /I 'bet"," ~
Exhaust Hood
Vent Fan
N'
/
Dryer Vent
Wood Stove/lnsert/Fireplace Unit
.
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMitS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Misceilaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
4(';) P "
2.,?O
42.40
M /v ,
/'5.,,&:J
I.A?D 0 ,
,7,J
"2..~.7r
01-//7
APPROVED:
BU!LDING VALUE, PLAN CHECK
AND BUILDING PERMIT '
This pe,rmit is granted on the express cQndition that the said
conslruction shall, in all respect,s, conform to the Ordinance
adopted by. the City of Springfield, including the
Oevelopmenl Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time'
upon violation'of any provisfons of said ordinances.
Plan Check Fee: ~J I () . 9~,
~l10ICl~
Receipt Number: + <:;(CJ /1...{
7~~'
Plans Reviewed By "
Date Paid:
ft,~m
/5ate
Systems Development Charge is due' on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
YAV:I--1
A ~~-,e rlL3z:-"{AlL(]dL
'pCi1Vn/.r /< ~/.A7q,).
,
By signature, I state and aglee, that I have carefully examined
the completed application and do hereby certify th~t alJ
~nformation hereon Is true and correct, and I further certify
that flny and all work'performed shall be done in accordance
with the Ordinances of the City of Springfield, and the "Law's.
of the State of Oregen pertaining to the work described
herein, and t~at NO OCCUPANCY will be made of any
str~cture without permission of the Building Safety Division.
I furth~r certify that only cornractors an9 employees who
are in compliance with OR,S 701.055 will be used, on this
project. .
I further agree to ensure that all requIred lnspcctio.ns are
requested at the proper time, that each address is readable
from the street, that the permit card Is located at I,he front
of the property. and the approved set OT plans will remain
on the site at all times during construction.
Xig~aturp ~'~< c../~
7/?/<::??
,
Oat..
VALIDATION:
RECEIPT NUMBER
I'
DATE PAin ,
94/7
7/7~7,
~2.. /2-
~ x....
,
AMOUNT RECEIVED
RECEIVED BY __
.
.
.-
'9 <: rJ 9::09
Address: /8ffc.. kCdflz/f?;()
Issued by' ,t:..~ Date: ?/r3
Permit No:
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:
1.1~'
...
I own, reside in, or will reside in the completed structure.
2.1~(
..r -
I understand that I must register as a construction contractori! 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 wt)o work on the struc-
ture must be registered with the Construction Contractors Board.
OR
~
3. B. I /<..11 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.
-L ~~- ~"'~
(- Signature of Permit Applicant .
7/7/9 (I
Date
CONSTRUCTION CONTRACTORS BOARD,
0244J 8/91 . .
WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
tit .
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
. .
. .
~
NOfE; This Il'1form~tion 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 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, YOl! 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 actu,ally withho!dthe ta~. 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 atlention through inspections.
Lii\bility 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 St. NE, Suite 3QO
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89
.-'
The !ollo :,.t O' ., ,"~;H-rl heo the following
zeninG and C.v,-",-" "I.... ".\.1.......... i. ~:f:c I:.nd usa
225 FIFTH STREET . approit'al.'
SPRINGFIELD, OREGON 97477 ZOni"f'_Vo.(2..-
INSPECTION REQUEST: 7?6-376~1:'11t:'i?
OFFICE: 726-3759 Oa.e - ...
. Authorized S:9n~;u - ~ 3.-GOHPhE-TE FEE SCHEDULE BELOV
1. LOCATION OF ~~~-r:;.N
/t2~c.. -",) A. Ne\l Residential-Single or
Hulti-Family per d\lelling unit.
LEGAL DESCRIPTION Service Included:
J'7~3 2 '7'2... 2.... Z;7S// Items Cost Sum
JOB DESCRIPTION
a.EJA7il?~/ AA T1./
AaJ I 77t),A )
.
Permits are non-transferable and expire
if \lork is not started \lithin 180 days
of issuance or if \lork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
O\lners Nanie~A Ll/~r
UJai l ~".~ 1 Av..L
Address JtJ/)(...
City 'l..o~
,
.Phone
7~-26~2l
OVNER INSTALLATION
The .installation is being made on
property I o\ln \lhich is not intended
for sale, lease or rent.
ovn~ur~~
~------------------------~--------------
. DATE:. 7/7/'JJ.
RECEIPT II: . '74/7
RECEIVED BY: .~/~
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Modular D\lelling
Service or Feeder
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see tin"
above
Ne\l, Alteration or Extension Per Panel
OneCi rcui t 1--- $ 35.00 ..:s.5.f'"o
Each Addi tional
Circuit or \lith Service
or Feeder Permit ~ $ 2.00~. ~
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 40.00
$ 40.00
$ 20.00
$ 36.00
31~
f.rr
-* .7->
.
,.
:J~-
,......
<.~ JOB NO. q~o 8(JGj
h'
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: AR-rH U!<. !/lfe:s-r
LOCATION: /O(JCO L-OC-I-II1-VEN AVE:. /7()?;. Z7Z"]. -075/1
DEVELOPMENT TYPE: LV/<' - AD!?/ nON
BUILDING SIZE: 23-1-Z2-(,N.C.L"{)~'f> ~)LOT SIZE SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. ~Ob
2. SANITARY SEWER-CITY
NO. OF PFU'S 7
(See Reverse)
3. TRANSPORTATION
x $0:192 PER SQ. FT.
(ql~
X $39.78 PER PFU
c: '2....,8 </-;;;
~
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
X $401.05
X $401.05
c:- -6- ')
----
$
X
X $401. 05 $
SUBTOTAL (ADD ITEMS 1,2, & 3) $ ?15~
4. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05
~/'i>(.:!..)
-... -
TOTAL-CITY SDC $ ?"I'-f ~
5. SANITARY SEWER-MWMC
NO. OF PFU'S Ai.A. x $13.62 PER PFU + $10 MWMC ADMIN. FEE $
(Use PFU Total From Item 2 Above)
-
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
0A~~ ~/iJ.;.!.,~
'-7] K1P Burdick
SDC Coordinator
$
TOTAL-MWMC SDC~-&- )
"- ....
TOTAL SDC $ ?Cf '-f ~...!.
FIXTURE UNIT CALCUlJ\Tld~TABLE: Number of New Fixtures X Unit-duivalent = Fixture Units (NOTE:"
For remodels, calculate only the NET additional fixtures)
-.
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
UNIT FIXTURE
EQUIVALENT UNITS
I
I
2 2-
1
2
3
6
2
6
6
1
3
2
l/Head
2
2
1 I
6
4 -+
Bathtub...... ...... ...... .............. ........ ................. .............
Drinking Fountain....................... ..............................
Floor Drain.................................... ......... ...................
Interceptors For. Grease/Oil/Solids/Etc.....,...........
Interceptors ForSand/Autci Wash/Etc...............;..
Laund ry Tub /Clotheswasher...................... ........ .....
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Refrigerator fWater Station/Etc........
Receptor For Commercial Sink/Dishwasher /Etc..
Shower, Single Stall.......................:.........................
Shower, Gang.:........................................................
Sink, Bar, CommerciaL............................................
Urinal, StallfWall.......................................................
Wash Basin/Lavatory, Single..................................
Water Closet, Public Installation...........................:.
Water Closet; Private...............................................
Miscellaneous:
I
TOTAL FIXTURE UNITS
7
CREDIT CALCULATION TABLE:
calculate credits separates.
I'
:!
Based on assessed value. If improvements occurred after annexation date in table,
Rate per $1,000 11
Assessed Value I
Year
: 'Annexed
Rate per $1,000
Assessed Value
Year
Annexed
I,
1979 or before
1980
1981
.1982
1983
. ')984
$2.83
2.76
2.71
2.60
2.46
2.33
1985
1986
1987
1988
1989
1990
1991
$2.16
1.90
1.60
0.25
0.87
0.50
0.16
J
Improvement Cd after annexation date)
X $
(Rate X Assessed Value)
X $ .'
(Rate X Assessed Value)
CREDIT TOTAL
=
Credit for Parcel or Land Only If Applicable
=
= $
RUNOFF COEFFICIENTS FOR STORM DRAINAGE..
,- ~.:.
Residential............ ..... ....................................... 0.4
CommerciaL.................................................... 0.9
I ndustrial......................... ..... ............................. 0.45
GovernmentaL................................................. 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT