HomeMy WebLinkAboutPermit Plumbing 1992-3-16
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. JOB NUMBER ~'k..J. J-j..
"Q 225 Fifth Street
~...' Springfield, Oregon 97477
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726-3759 .
LOCATION OF PROPOSED' WORt<. D~lo
ASSESSORS MAP: \,(,~ ~ ~~
OV',i'NER: (j,\\ ('{\l\fU. ~ \\. '\W). .J-" "'\('(\~h PHONE: r l'tlo .rB ~L
ADDRES'" t) ?lJ~ L\ (\ ~ qr tl 01\'1' \ - , .
CITY:~ 15 ~. STATE: ]A 0 f\OO2 ~IP:-4ID~
DESCRIB~ WORK: ~ YJQ1ll:tOJ1!} ,t] g uex l~ f\O i'l1M ) -
NEW\/) REMODEL ADDITION -8- DEMOLISH OTHER
CON ST.
CONTRACTOR'
LOT-
CONTRACTOR'S NAME
:~:~::~: (~i), ,)\LO Y )
MECHANICAl'
ELECTRICAl'
OUAD AREA: ~eJ\)O
J
. OF BLDGS'
OCCY GROUP:
. OF STORIES:
WATER HEATER:
BLOCK:
ADDRESS
- OFFICE(SE-
LAND USE:- II {
. OF UNITS-
CONSTR. TYP~'
HEAT SOURCE:
RANG~'
SUBDIVISION'
EXPIRES
PHONE
FLOOD PLAIN:
ZONING CODE: ill 'f2..-;
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This is a 24 hour recording. All Inspections requested before 7:00 a.m. wlll be
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected but prior to concrete
place'!lent.
o
Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
- Prior to Insulatlon or decking.
o Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
~nitary Sewer - Prior to filling
LfIt~r~nch.
o Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanfcal - Prior to
cover.
D 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
Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
o Drywail - Prior to taping.
, -
D Wood Stove - After Installation.
o Insert - After fireplace approval
and Installation of unIt.
o Curbcut & Approach - After
forms are erected but prior to
placeme'nt" of concrete.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Fence ~ When completed.
o Street.Trees - When ~II required
trees are planted.
o
Final Plumbing - When all
plumbing work Is complete.
. D Final Electrical - When all
electrical work is complete.
D Final Mechanical - When all
mechanical work Is complete.
D 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.
D Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
D Final - After all required
, inspections are approved and
, porches, .skirting', decks, 'and
venting have been installed.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type.
Interior
Corner
Panhandle
_' Cul-de.sac
BUILDING PERMIT
ITEM sa. FT. x $1 sa. FT.
,
Main
Garage
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
'-. --,.
. . THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
It'yes, this application must be signed
and approved by the Historicai
Coordinator prior to permit issuance.
Setb,cks
I PL. HSE GAR ACC
IN
Is
Iw
IE
VALUE
SYSTEMS DEVELOPMENT CHARGE (SDC)
(8)
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
N'
FT.
FT.
FT.
l ffy"
(C)
Dryer Vent
Wood Stove/lnsert/Fireplace Unit
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 electrical)
(A, B, C, D, and E Combined)
FEE
4() [.D
~
4l ),uU
r)cD
4P: ~OO
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APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that 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.
Plan Check Fee:
Date Paid:
Recei pt Number
Received By:
Plans Reviewed ~y
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
with the Ordinances 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 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 Szt of pI ns will remain
00 ,.. ?~~ '"""ff""".'.
Signatur ./ -I' fl.., V ~
./
Date
VALIDATION: /'I"J('] 4
RECEIPT NUMBER \ }1'-"f .
DATE PAID M. 179 ,c..r~
AMOUNT RECEII(ED~4fL ,CK:J
RECEIVED BY ('7,( m )
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.
Permit No: q !J.(), - Ifl 1"
Address: ~~ 1.d=1_ K u j)
Issued b~tIU---6ate. (3 ,/b~ftL
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.
Fil~licable 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.
I
2. " 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 iF
Contractor registration numbf'r
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
17
_ / 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.
~~~t~ ;rff'12-
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORaTION NOTICE TO PROPERTY OAERS
ABOUT CONSTRUCTION RESPONSIBILITIES
'-, "',,-
-
N01E~ < This IAf~r~ktion Notice to Property Owners About Construction Responsibilities
" j I I was dEwelo'p,ed,byltie Construction Contractors Board in accordance with ORS 701.055(5),
J . , . ..'-. i P\issE!d ~y ilW1999 Oreg6n Legislature.
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'/' If you are acting as your own c'ontractor 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 cOrT1ply 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 51. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89