HomeMy WebLinkAboutPermit Building 1992-10-2
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~ C~MMERCIAL/INDUSTRIAL.
PERMIT APPLICATION
225 Fifth Street, Springfield, Oregon 97477
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JOB NUMBER 92/-:?~
INSPECTION LINE: 726.3769
OFFICE: 726-3759
LOCATION OF PROPOSED WORK'
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TAX LOT: ~9//
ASSESSORS MAP'
OWNER" c:r""~h'l? U~ ., .r//~.#E,.r;t<K..
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ADDRESS: ~ y&"S' ?3Ai...1!...Y I/D:S"w' L~€
~P;#l/.AI.c.r/et..Z:> STATE:~;E:'.
-:"'O' - _O' ,
PHONE:
?~.Jfl Y'YV
CITY:
ZIP:
974177
DESCRIPTION OF WORK: !i?P#J44-T/'~.- 5/7E ~u."'~~~ dN'~$..,iif' ~b~'---
NEW.....K.- REMODEL ADDITION DEMOLISH OTHER VALUE:
NAME
ADDRESS
PHONE
ARCHITECT'
CONST.
CONTRACTOR'S NAME ADDRESS....,.. CONTRACTOR #
~ ~7,;> ;$€ 2/ ~ .
GENERAL'~"" ~/jIIf:'.k. ~ n#;1ff?J ~ '::;;>~rJ <t:~/A!i'
. 't?~~ :.1B '
PLUMBING>~rM~~A'JiV~, ~-~ "_:; ,.,.,,9o/~
MECHANICA' .
EXPIRES
PHONE
//-~- 2:7fE-~;;?::?
ELECTRICAl'
I PLUMBING
I NO, FEE CHARGE
IS'} S' I F' t ~Pl"i</j '5'7t?
Ing e IX ure?;"Z.a_IN.
Relocated Bldg.
(new fix. addt!)
'? 'Jt, , Water Service as'"
ft.
1//6/ Sanitary Sewer '1P
ft.
I 79.::;' Storm Sewer I'I~
ft.
I 2- Backflow Device '71/-;1 Y' /~ :20
MECHANICAL
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r:1-I4R(.n=
Furnace/burner & vent
< 100,000 BTUs
Furnace/burner & vent
> 100.000 BTUs
Floor furnace and vent
Suspended wall or floor
mounted unit heater
Appliance Vent
separate
Stationary evap.
cooler
Vent Fan/Single
duct
Vent System apart
from AC or htg.
Mechanical exhaust
hood and duct
Permit Issuance
$10.00
TOTAL PERMIT
&61:? ..0
TOTAL PERMIT
- OFFICE USE -
HANDICAP ACCESS:
FLOOD PLAIN:
QUAD ARE~'
# OF BLDG~'
LAND USE:
OCCY GROUP'
# OF UNITS:
CONSTR. TYP~'
ZONING'
# OF STORIES:
HEAT SOURC~'
LIGHTING POWER BUDGET:
WATER HEATER'
SQ. FTG MAl N
SQ. FT. $/ SQ. FT.
.~~~, :I ~.rL~
VALUE
9~~J)4j'
SQ. FTG ACCESS X
SQ. FTG OTHER J3LV/~ :;~~ X
/.-
"3"3.Y~
r
1:Z~ &>$9
TOTAL VALUE OF PROJECT
"4'eJY.!' "!'\'.>' #~..0"/~
PLAN CHECK FEi:~/' .~.RCPT#
DATF
BY
1 BUILDING PERMIT
15% Stat,e
SurcharQe
I MECHANICAL
15% State
Surcharae
1 PAVING
1f~. V,S'
tj/$. -
~.~~
1
I
I
SIDEWAL~ / I
~7'P FT.
I CURBCUT"""7='I?'1
l&Y_A,U Yo/' FT.
l#?W,a ~ ,/1
5% State
Surcharge
FENCE
VALUE $
PLUMBING
B~.Q~
9'3."''''
DEMOLITION
"2//. --.
'1' /. #0&>
12..P'~
I~, h,p
. I~/t>
TOTAL PERMIT FEES I
EXCLUDING ELECTRICAl
SUBTOTAL
PERMITS
SYSTEMS
DEVELOPMENT
/688./S'
i7a1l}'~~~C'&7'~r:>
1~?,.4?''''~4'#''''''-:,
~-7/7?~.
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/~,/5"
.
REQUIRED INSPECTIONS .
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It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call
726.3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready
for inspection. Requests received before 7:00 8.m. witl be made the same working day. requests made after 7:00 a.m. will be made
the following work day.
SITE INSPECTION: To be
made after excavation, but
prior to setup of forms.
y
ROUGH PLUMBING,
ELECTRICAL &
MECHANICAL: No work is to
be covered until these
inspections have been made
and approved.
UNDERSLAB PLUMBING,
ELECTRICAL &
MECHANICAL: To be made
before any work is covered.
ATTIC DRAFT STOPS &
CURTAIN WALLS
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FOOTINGS & FOUNDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel In place, but
prior to placing concrete.
FIREPLACE: Prior to placing
facing materials and before
framing Inspection.
,
FRAMING: To be made alter
the roof, all framing, fire
blocking and bracing are in
place and all pipes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
V'
CONCRETE SLAB: To be
made after all Inslab building
service equipment, conduit,
pi ping, accessories and other
ancillary equipment items are
in place but before any
concrete is placed.
INSULATION & VAPOR
BARRIER: To be made after all
insulation and required vapor
barriers are in place but
before any lath or gypsum
board interior wall covering Is
applied. .
i
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UNDERGROUND: Plumbing,
electrical, gas, sanitary sewer,
storm sewer, water and
d rai nage Ii nes. To be made
prior to covering or filling
trenches.
UNDERFLOOR: Piumbing.
electrical, mechanical. To be
made prior to installation of
floor insulation, decking or
floor sheathing.
FIRE & SEPARATION WALL:
Located and constructed
according to plans.
POST & BEAM: To be made
prior to installatton of floor
Insulation, decking or floor
sheathing.
LATH AND/OR GYPSUM
BOARD: To be made alter all
lathing and gypsum board,
Interior and exterior, Is In
place but before any
plastering Is applied or before
gypsum board Joints and
fasteners are taped and
finished.
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior to Installation of
decking or floor sheathing.
/.
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base material in
place.
MASONRY: Steel location,
bond beams grouting or
verticals in accordance with
USC 2415.
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CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof covering.
----4-- PAVING: After gravel is in
place but prior to placing
asphalt or concrete.
SPECIAL INSPECTIONS: In accordance
Section 306 of the State Specialty Code
a special inspector shall be employed
by the Owner! Contractor during
construction of the following work. A
copy of the special testing reports shall
be furnished to the Building)Divislon.
STRUCTURAL CONCRETE: In
excess of 2500 P.S.1. (306 a.1)
STRUCTURAL WELDS:
Performed on the job. (2722 f)
HIGH STRENGTH BOLTING:
During all bolt Installation and
tightening operations. (306
a.6)
SPRAYED ON
FIREPROOFING: U.S.C.
Standards 43.8.
SPECIAL GRADING,
EXCAVATION AND FILLING:
During earthwork. (306 a.11 &
Chapter 29)
GLU.LAM BEAMS: Inspection
Certificate by an approved
agency, furnished to the City's
Building Division before
beams are placed. 12501 U,SG.
STDS. 25.10,11).
STRUCTURAL MASONRY: (306
a.7)
"In addition to the inspec-
tions specified, the Building
Official may make or require
other inspections of any
construction work to ensure
compliance with the Building,
City or Development Code.
SITE PLAN REVIEW BOARD: Must be requested 2 days in advance
of the date you wish inspection. All project conditions such as
landscaping, parking lot striping, etc. must be completed before
requesting this inspection.
FINAL PLUMBING
FINAL ELECTRICAL
FINAL BUILDING: Requested after the final plumbing, electrical,
mechanical and Fire Department inspections are made and
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been issued by the Building DivIsion
and posted on the premises.
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
ADDITIONAL COMMENTS'
PLANS REVIEWED BY k . OAT" /e:>-2-92...
, . ~ ~h:FOT~.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information
herein is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordlnances
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 wlthout 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 r
street, that the permit card Is located at the fron~
{I es during constructlo'. - - ;:::>=- . -- ~
/-:: - .
, naturp r'7 .~
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proved set of plans will remain on the site at all
VALIDATION:
AM~UNT RECEIVEf" 11 (l '--/) n, \~
RECEIPT ': --1():~ri~
Date J~Ac/
/' /
DATE PAID: WI f\j!/t::J-fL
RECEIVED S~ A ,
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Permit No: @\ 8 \ a 13
Address: 'MW ~\l-\ht\ .
Issued by: ~~ Date: \fJ t'-c1.2......
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. ' ",-<' ,
~ I own, reside in, or will reside in the completed structure.
2. r
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon com~ion. _
I My general contractor il' ~t't1 A 'VC't 01~r ,
Contractor registration number t 03 \ C56 .
3.A"l-
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
I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construe.
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 an
the Information Notice to Property Own about
reverse side of this form.
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hat I have read and understand
truction Responsibilities on the
'.. ?'~
X SignMlJ..r:e of pe~~caf1t
0\.A 01)..,,\\ D 01"'5G. \'\
CONSTRUCTION tfdNTRACTORS BOAR; - '\
0244J 8/91
/@/f;t
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INFO"ATION NOTICE TO PROPERTY ctNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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11 t 1 I
NOTE: 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.
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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:
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 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.
'Vorkers' 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:
~ode Compliance: As the permit holder.for this project, you are responsible for resolving any failure to meet
;ode 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 overs pray, 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 's!. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378.4621
0244J 10/24/89