HomeMy WebLinkAboutPermit Building 1992-5-14
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RESIDENTIAL
PEI1MIT ^I'PLlCMION
!II NUMHEIC -9b)Ol d) ,
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11l~'IH)r.ti.l!l": , 'G.37()~)
OIl'C0: /213<1/;,9
LOl;/,T1Ui'J (ll 1"1'101'00;1'1) WOI'II<: - ,__1/1-ro;;,,"
ASSE5S01i:; r,..IAP: _ J Oo-~m~~
LOT: _,__. __ _ _ BLOCK:
OWNEf1:
AODRES~.: .
CITY: _
SUBDIVISION:
PHONE: :::l'2~.lo"'~I] 1_ .
ZIP:-9~lL
DEscnlflE v.;.,JRI<: _ __a_o.M...A)~
NEW_Y REMODEL J- AI)DITICl~ DEMOLISH OTHER
I CONS"
CONTf1ACH" 'S NAME - ADDRESS CONTRACTOR # EXPIRES PHONE
GENUIAI 6\,JJ.Od"l\.,d.uJ~(J~ l:D24 ~~.\04JZ._\L\2H~7Llo2A 71
/'IIHAUIN(.-
MI:CIIANlt :/11 .
ELrCfRIC,\1
QUAl) Arll /,
o ~'G(,
7
II Of, DL[)( I~;
-.\\\ -=
aCG)' GRtlUI
II (1I- STOHlt' ,: ..__ u
WArEn HEAl' 1'1: __.
. - OFFICEID
LANIJ USE: _. _\ ~
. OF lINm;: -- --. J
CONSTR. TYI"~:__V--'o
HEAT SOUf1eE:_
RANGE: _.
FLOOD PLAIN: - -- 0 )
ZONING CODio: _ill.F-::::-':
" OF BDRMS:
SECONDARY HEAT: - - '-0 -
SQUAnE FOOTAGE: _ 43.
Tv lUquesl all Inspccti,m, you frLust c<J1I 72()-3769. ThIs Is II 24 tlOur recording. All Inspections requested before 7:00 .un, willllQ
rnad,~ the :~ilHH~ wo"~jllu clay. in:;pections rt:questc(l afte.. 7:00 a.m. will bo made the following work day. .
c=] TCl1ljJOl :lry Electl h;
[..'I
Sile In:.pectioll - To IJt~ Ill:lde
,If\l~r ,~...,;avillic.n. lad pl'ie'l 10
~ulllllO [(Hlll~.
CI
Ullell'I~,Llb PIUlllhino/Elcctrical1
Mcd.,u,ical - "1l1)l' to cover.
I'Ll Fnolillq - Afkl lll.:nche:; arc
.-( ......1~XC:IVdlt.(1.
CI MasorllY - ~10t;1 IOCC:ilinll, hOllCl
-. 1)1:,1111:", '1IouIIIlH.
~FOUlI(l:iliOIl - ^[l(~r fOllll~; arc
crcGt~(1 IJut plio!" [0 conClelC
pla':":"!l;nl.
CI
UIHII.:I{jfotmd Plumbing - Prior
to fitljn~l tlench.
o
Undcllloor Plulllbing/Mcchanicnl
- PdOI to Insulation or decking.
o
Post nnel Be.lIl1 - Prior to floor
insulation or (ICcl\ing.
CI
Floor Insulatiun - PrlOI 10
dccr.irlU.
o
SanltalY Sewer - Prior to filling
tlenl;ll.
CI
Stann :~cwcr - I"'rior to tilling
trend\.
CI
W.nter Une
tlt~fldl.
Pdor to lillillt)
CI
Rounh f'lumbinn
covc'I".
Pliol to
REQUIRED INSPECTIONS
[J
Rough Mechanical - Prior to
cover.
l~ Rough Elcclricnl - Prior 10
cover.
I~ Eleclrlcal Service - Must tJe
approved Iu olll,dn penJ\nnenl
electrical power.
[J
Fircptacl: -- I'do,. to laelnD
11Iiltcrlal:. anu 11<lllllnu In$p.
tpLF""TllnO - I~,;,,, to e.w.,...
o Wall/Ceiling Insulation - Prior to
cover.
I~ Drywall - Prior to tapinn_
o Wood Stove - After Installation.
o
Insert - After fireplace approval
and Installation of unit.
D
CurbeUI & Approach - After
forms au.: erected but prior to
placement 01 concrete.
[J
Sidewalk & Oriveway - After
excavation is complete, forms
and sulH.I;I~t': lllalcrlal in place.
[J
Fence - Wllcn c:ompl(~lcd.
,0
Street Trees - When all required
twes arc planl~(1.
o
Final Plumbing - WllQn all
plumbing worl< is COlllpttJIC.
o
Final Electric..1 - Wllt":11 :111
O[Cclrical worl;. is COlllfJIt:tC.
o
Final Mechanical - Wllt:1l :111
rllcclwnical worl< is C()111I1Ick.
~Fillal Buildin~J - WI,,;.. ;tll
.cquilcd ill~i1H;Ctlol1~; II:IV,: 111:"11
approved and buildirl!.l i~;
complelml.
DO'her
MOBILE HOME INSPECTIONS
o
OIocking Dnd Set-Up - Wtl(:ll :l.1I
blocking I~ complelu.
o
Plumbing Conncctiolls - Wllt!1l
Ilome has been connectl!c1 to
water and sower.
o
Electrical Conncc'ion - Wllt~n
tJlocking, sel-up, and plullIblnu
inspoctlon~ II<lVC ht)t~.1 ~IIJl')fOVl:d
and the hOlllo is COl'llll~l:I(.:d hI
tile scrvlce pilllCl.
o Final - After 311 ICquill:d
inspections arc npPlOvcd 3ml
porches, skirting, deck$, and
venting have IJecn ill~wrIO:(1.
~ ~
Lol Type. "
Lot faces Selbacks .S THE PROPOSED WORK IN THE
Lot SQ. fig. Interior I P.L. HSE GAR ACC I HISTORICAL DISTRICT, OR ON
IN I THE HISTORICAL REGISTER?
Lot coverage Corner If yes, this applicallon musl bc signed
Topography Panhandle Is I and approved by thc Historical
Iw I Coordinator prior to permit issuance.
Total height Cul.de.sac
IE I APPROVED'
BUILDING PERMIT
ITEM sa. FT. x , $/sa. FT.
VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Main
4-~()
14. \()
r 0'11&
This permit Is granted on the express condition Ihal the said
construction shall, In all respects, conform to the Ordinance
adopted by the City of Springfield, including tllC
Development Code. regulating th~ construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any proVisions of said ordinances.
Garage
Carport
Plan Check Fee:
Date Paid:
Total Value
Building Permit Fce
Iid.m
d.I\.-=)
Receipt Number'
Received By:
Stale Surcharge
Total Fce
(A)
Plans Reviewed By
Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge Is due on all llmJcvelopcd
properties within the City limits which are being improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
Residential Balh(s) N"
Sanitary Sewer FT.
Waler FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
Slale Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Vent Fan
N'
By signature, I stale and agree. that I have carefully examineu
the completed application and do hereby ecrU fy thai 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 Sprlngfield, and tile Lnws
of the State of Oregon pertaining to the worl~ described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify thai only contractors and employees who
are In compliance with ORS 701.055 will be ~Jsed on this
project.
Exhaust Hood
Wood SlovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
I further agree to ensure that all required inspections are
requested at the proper timo. that each address is readable
from the street, that the permit card Is localed al the front
of th roperty, and the approved set of plans will remain
on th site all time during consd
~~~^~ ./
Date
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
Curbcul
'1
Demolition
.'
State Surcharge
VALIDATION:
4lo'60
::~:I::I:UMBER ~~, 14 -e-rCJ= ......--.-...
AMOUNT RECEiVED I ~ .en ~
RECEIVED BY ~ ~) -
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
lo~-lo3
r'
".
.
.
.
Permit No: Cfd.nQ III
Address: M0-~~
Issued by:&:L~cU Da:cs~q2~
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 ~/ I I own, IMide m,. or will reside in the completed structure.
/ '
2. I I understand that I must register as a construction contractor if the structure is sold
or offered for sale before o~on completion. ~
3. A.~ My general contractor is DPQ1\-t'\lJi 2}f\\ <1...FR )
I Contractor registration number 4lo4,1')_
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 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.
~~/,.z:~
Sil:lnature of Permit Applicant
5-/iJ-7C-
Daie
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COpy TO APPLICANT
INFOR.TlON NOTICE TO PROPERTY O.ERS
ABOUT CONSTRUCTION RESPONSIBILITIES
~.
.,,~
NOTE: .\ \ i!hiS.I:~for.mation Notice to Property Owners About Construction Responsibilities
was develpped by the. Cons1ruction Contractors Board in accordance with ORS 701.055(5),
"pass~d by the, 198,9' Qregofl Legislature.
,,\ . .
- \ '. \ l' '.- \
)11 you .'a're acting as your o~n c~htractor 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. ",.
,
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' comper:1sation insurance .for your employees. If you fail to obtain workers'
compensation insuranc81 you may be subject to' pena~ies 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.
'. ;' 1'1 ,
., .
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 SI. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378.4621
0244J 10/24/89