HomeMy WebLinkAboutPermit Building 1993-6-15
~B NUMBER~~~~ 0
225 Fifth Street
Springfield, Oregon 97477
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R~IPE~TIAL
PgRMIT APPLICATION
Inspections: 726.3769
Olfice: 726.3759
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2 2... TAX LOT:
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LOCATION OF PROPOSED WORK: / /)4 I
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'r ASSESSORS MAP'
LOT:
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SUBDIVISION'
BLOCK'
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ZIP: 1'/ //7'.7
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OWNER' r;.. /y:? h
ADDRESS: ,- )0 41
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DESC~IBE WORK:
REMODEL Y-
OTHER
DEMOLISH
ADDITION
NEW
CONST,
'. CONTRACTOR'
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EXPIRES PHONE <7oQ .
Ped ;).;). -/'1f4)'?4-J 0'& * ,
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ADDRESS
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CONTRACTOR'S NAME
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GENERA' '
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PLUMBING'
MECHANICA' '
ELECTRICA' '
- OFFICE USE -
OUAD AREA: LAND USE: FLOOD PLAIN:
, OF BLDGS: . OF UNITS' ZONING CODE:
OCCY GROUP' CONSTR, TYPE: . OF BDRMS:
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: SQUARE FOOTAGE:
" .
To request an Inspection, you must call 726.3769, ThiS I~ a 24 hour recording, All Inspections requesled 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 Final Plumbing - When all
plumbing work Is complete.
o Rough Mechanical - PrIor to
cover.
o Temporary Electric
o Rough Electrical - Prior to
cover.
o Final Electrical - When all
electrical work is complete.
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Final Mechanical - When all
mechanical work is complete.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
~ Final Building - When all
JOr.J. required Inspections have been
approved and building is
completed.
...c-"7I" Footing - After trenches are
~excavated.
o Fireplace - Prior to facing
materials and framing Insp.
o Masonry - Steel location, bond
beams, grouting.
~ Framing - Prior to cover.
o Other
o Foundation - After forms arc
erected but prior to concrete
, placement.
o Wail/Ceiling Insulation - Prior to
cover.
o Underground Plumbing - Prior
to filling trench.
o Drywall - Prior to taping,
MOBILE HOME INSPECTIONS
o Undeflloor Plumbing/Mechanical
_ Prior to insulation or decking.
o Wood Stove - After I~stallation.
o Blocking and Set.Up - When all
blocking Is complete,
o Post nnd Beam - Prior to floor
insulation or decking.
o Insert - After fireplace approval
and Installation of unit.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Floor Insulation - Prior to
decking,
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sanitary Sewer - Prior to filling
trench. .
o Electrical Connection - When
blocking, set.up, and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material In place.
o Storm Sewer - ,Prior to filling
trench.
o Fence - When completed.
o Wator Line - Prior to filling
trenctl.
o .Final - After all required
inspections arc-approved and
porches, skirting, decks, and
venting have been Installed.
'0 Rough Plumbing - Prior-dO..
cover.
o Street Trees - When all required
trees are planted.
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Lot Type Setbacks IS THE PROPOSED WORK IN THE
I PL. ACC I " HISTORICAL DISTRICT, OR ON
Interior HSE GAR
IN I THE HISTORICAL REGISTER?
Corner If yes, this application must be signed
Is I and approved by the Historical
Panhandle Iw I Coordinator prior to permit issuance.
Cul-dc.sac IE I
APPROVED:
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Lot facos
Lot sq, ltg,
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM
SQ, FT,
X $/SQ, FT,
VALUE
Main
Garage
Carport
.~t (h.r~ ~o)
2424
Total Value
Building Permit Fee
-g~ro
/.93
40.43
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(6) --1IA
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath{s)
N'
Sanitary Sewer
FT,
FT,
Water
Storm Sewer
FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnscrtlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
2/;.0 '}
Curbcut sJ(,trJ;tm4CZJ
Demolition" l.
State Surcharge
;a~t3;
(E) , __,_,___
Total Miscellaneous Permits
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BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permil is granted on the express condition thaI the said
construction 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.
2.. '5 ,~ I!>
Plan Check Fee:
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved,
ADDITIONAL COMMENTS
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By signature, I state and agree, that 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
.wlth the. Ordinanctls of the City of Springneld. 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.
1 further certify that only contractors and employees who
are in compliance with QRS 701.055 will bo used on this
project.
I further agree to ensure that all required inspectiol\s 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 construction. .
Signaturp~g" ~ ~
Date
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VALIDATION: ~1/7~
RECEIPT NUM6En ~'77 (
DATE PAID td,// 5'"/9 7
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Permit No: ,9'.3<9 &5 .5 6
Address: /r9~/ /A~?;;J
Issued by: .~ Date: 41rJ
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~'
2,~(
I own, reside in. or will reside in the completed structure,
3, A,I
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
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
3, ~ 1~ 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.
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Signature of Permit 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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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This inform'ation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701,055(5),
: paSSed b'y'the 1989'Oregon Legislature,
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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:
II 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 witl) 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 Employmel'\t-Divislon 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 fall 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:
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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 insp'ections, - "
II you have additional questions, write to:
Construction Contractors Board
700 SU,mmer SI. NE, Suite 300
Salem. OR 97310-0151
Phone 503-378-4621
0244J 10/24/89