HomeMy WebLinkAboutPermit Building 1996-11-27
RESIDENTIAL
,PERMIT APPLICATION
Inspections: 726.3769
Orflce: 726.3759
LOCATION OF PROPOSED WORK: _
Jf.J~2... e:5
ASSESSORS MAP:
LOT'
.
SPRINGFIELD
.
JOB NUMBER ~/ 5"5' J
225 Fifll' Slreel
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
t!J 26-J?-o
,
1Ia:~
,,0E?:t.H_/~Ln
JI
BLOCK'
OWNER:
ADDRECC,
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-. f /
0(;;,74 d~z-
<,~?J)
CITY:
-.
STATE:
~,
PHON"" 72~ -gJ~E;
-4 72~ -~<t~<f>
7"11 - 'I ,?o.:,
ZIP: 9?r./1!-
NEW
REMODEL
DESCRIBE WORK: fiAJt5.tI ~'P1.J~( ~ /"J7'!--,
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ADDITION
DEMOLISH
OTHER
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
LJ/.UAJ&e
MECHANICAl'
A-'1AJ'A//'4'
/7vv J/JM
ELECTRICAl'
ADDRESS
CONST,
CONTRACTOR .
EXPIRES PHONE
..
- OFFICE USE _
QUAD AREA'
. OF BLDGS:
OCCY GROUP:
. OF STORIES:__
WATER HEATER:
LAND USE:
. OF UNITS:
CONSTR. TYPE:_
HEAT SOURCE:
RANGE'
FLOOD PLAIN:
ZONING CODE:
. 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. will be
made the sarTle working day. Inspecllons requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
o Temporary Electric
o Site Inspection - To be made
afler excavatIon, but prior to
sellIng forms.
o Underslab Plumblngl Electrical!
Mechanical - Prior to Cover.
o Footing - Atter trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
o Foundallon - After forms are
erected but prior to concrete
placement. .
o
Underground Plumbing - Prior
to flfIlng trench,
o
Underfloor Plumbing/Mechanical
- Prior to Insulatlon or decldng.
o
Post and Bcam - Prior to floor
Insulation or decking.
D Floor Insulation - Pr,l~'r to .
. decking. I '
, ,
r".\ .
D Sanitary Sewer - Prior to fHlIng'
trench.
o Storm Sewer - Prior to fillIng
trench:
o Water Line - Prior 10 filling
trench.
D Rough Plumbing - p'rior 10
cover.
o Rough Mechanical - Prior to
cover.
o 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.
~ Framing - Prior to cover.
l'V'r'waIl/C'elling Insulation - PrIor to
~ cover.,
~ Drywall - Prior to taping.
o Wood Stove - After Instal/allon.
o Insert - Afler fireplace app'roval
and installatIon of, unit.
--,\.
W Curbcut & Approach - After
\ (orms\are erected bllt prior 10
placement of concrete.
o Sidewalk & Drivew3Y - After
excavation Is complete, forms
and sub.base material In place.
o
Fence - "Vtlen completed.
o
Street Trees - When all required
trees are planted. ,\
o Final Plumbing - When all
plumbing W9rl( Is complet.e.
~ Final Electrical - When all ....,
~eleclrical worl< Is complele, ,'}
~ Final Mechanical - When all ~~.~3\
~mcchanicar worl( Is comPlele.~ g
1Vf Final Building - When all
~equired Inspections have been
approved and building Is
completed.
o Other
~-
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocklntJ Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
block!nu. set-up, and plumbing
Inspections have been approved
and tile horne is connected to
the service panel.
o
Final - After all required
Inspections arc approved and
porches, sldrllng, decks, and
venting hnve been Inslnlled.
I
. . ~
Ie,' I
.' I
Lol Type Setb-.cks IS THE PROPOSED WORK IN THE
I P,L. ACC I .... HISTORICAL DISTRICT, OR ON
HSE,GAR
InterIor IN I THE HISTORICAL REGISTER?
Cornor II yes, Ihls application musl be signed
Is I i'lfld approved by Ihe Historical
Panhandle Iw I Coordinator prior to permit issuance.
CuI-dc-sac
IE I APPROVED:
Lot faces
Lot sq, ltg,
Lol coverage
Topography
Total height
BUILDING PERMIT
ITEM SO, FT, X $/SO,FT. VALUE
Main
Garage ,
Carport
1J,v/~1f ~J 240 ? 2.. ,'S:l .7?~'
ie'" ,~ 5~
TOlal Value
Building Permit Fcc
Slale Surcharge 3. {J 7- 2-- ~ ~
Total Fcc
(A)
c" p., , Sf;
5":f'J
7'~ 11
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Balh(s)
N'
Sanitary S~wcr
Water
1'1:
FT,
Storm Sower
FT.
Mobllo Homo
Plumbing Permit
Stalo Surcharge
Total Charge
(e)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood SlovollnsertlFlreplace Unit
Dryer Vent
t::::t2:-A,<',T ATd I~ '1111
Mechanical Perml t
Issuance
Slate Surcharge
,7J -t-- .4f"
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
. State Issuance
Stato Surcharge
Sidewalk
It
Curbcut
It
DemolitIon
State Surcharge
~ #tEY/h/?
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding oloclrlcal)
(A, B, C, 0, and E Combined)
FEE
A/-o1
/S-O"
-IC1 p--o
/2..0
2./rJ2D
f15]
.L#E-
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
adoplod by the City 01 Springfield, Including the
Development Codc, regulating the construction and use of
buildings, and may bc suspended or revoked at any time
upon violation of any provi5i~.s-':; said ordinances.
Plan Check Fee' c:;.?,"~ .
Date Paid:
Receipt Number
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within tho City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I state and agree, that I have carcfully examined
the completed applicalion 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 Slalo of Orogon porlalnlng to tho work doscrlbed
horoln, and Ihal NO OCCUPANCY will be mado of any
structure without.permission of the Building Safely Division.
I rurthcr certHy IIlat only contractors and employees who
are In compliancc. with ORS 701.055 will be used on thIs
project.
I further agree to ensure that all required Inspections are
r!3quesled 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 3511 times dg construction,
~nalure~ ~
'Date It/L-K C ()
~
VAliDATION:
RECEIPT NUMBER 2. '5 9 J /
DATE PAID //2- 0:t::;.
AMOUNT RECEIVED I~':>' 5:2-
RECEIVED BY _ d- ~
. - - -
.
Issued by:
.
'70/ ~/ I
/~$74 6/~be
~~ Date:Jpr~
Permit #:
Address:
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 flied with the permit,
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
[R
~
D
I, I own, reside in, or will reside in the completed structure,
2, I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion,
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
~ 3B. 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 information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
_J\pLA~ tl--?7-U
~;-~fPermi p ant) (Date)
(White c y to issuing agency permitflle,
pink copy to applicant)
.
.
'., ", \ ...:..
lin1ormtiliion'Notice ftO Propeiiy Owners
. /'" ,. ~b'2'uft ~onsiruc~ioi'i ResponsHOlilifties
.. ~... ..... .. '.. \
" ~,
:;Vote, This [nformatiO\ll'/mJce to-Property OWllers about COllstruction Responsibilities
IV"" developed by the Construction' Contractors Board in accordance with ORS 70[,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 constmcting 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 infonnation, 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 Il)ay
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job, For more infonnatioll,
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 pennit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections, J
I -
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
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees,
Expertise: Make sure you have the expertise to aetas 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 perfonn the required inspections,
,
, . , ,
If you haveadditiOmiI queStions, write or call the Construction ContractOr; Board (PO Box-14140, Salem, OR 97309-5052,
503/378-4621), The Board is located at 700 Summer St. NE Suite 300, in Salem,' . '
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