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HomeMy WebLinkAboutPermit Building 1995-5-23 ~n1,a. L,A~ /L I 'J ~~bc] AiR. ']4/ j'~} RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 LOCATION OF PROPOSED WORK: /7,/)3 ASSESSORS MAP' LOT' OWNER: ADDRE"'" CITY' DESCRIBE WORK: ~A NEW ~ REMODEL . /~ 2.. J 25" BLOCK: ~4i!n 2.../ r rv ~~ , df7) ~ STAT'" ' tJ)< t".NAIM.7 ~ ."I7;;H?A/:::...? '~ ~.~. . ADDITION CONTRACTOR'S NAME " GENERAL: PLUMBING: MECHANICA' . t'?W.A..JM - ELECTRICAL' ~W~ QUAD AREA: · OF BLDGS: OCCY GROUP: 1- t-tJ III \ m I . OF STORIES: WATER HEATER: DEMOLISH OTHER ~Uo<1' . rf//30 JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 t6. TAX LOT' //~CfO SUBDIVISION: 0lA6jhLlld, fr-ur , PHONE: 7'1-:-_ -9. )" ? r ~ ZIP: "'7 ~ 7 7 ADDRESS' CON ST. CONTRACTOR' PHONE , - OFFICE USE - 'Yt 'V1\ ' LAND USE: <'~II,')() .' · OF UNIT'" I vf\1 EXPIRES FLOOD PLAIN: ZONING CODE: _/.-1)12- . OF BDRMS: 0 SECONDARY HEAT: - SOUARE FOOTAGE: -i9-q,q 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 SBme working day, Inspections requested after 7:00 a.m. will be made (he following work day. REQUIRED INSPECTIONS o Temporary Electric O Site Inspection - To be mado after excavation, but prIor to setting forms. o Underslab Plumblng/Electricall Mechanical - Prior to cover. tvr"Footlng - After trenches are ~xcavated. o Masonry - Steel location, bond .beams, grouting. o Foundation - After forms are erected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. o UnderUoor Plumbing/Mechanical - Prior t~: Insulation or decking. , o Post 'and Beam - Prior to floor Insulation or decking, O. Floor Insulation """'- Prior to deckl ng. D Sanitary Sewer - Prior to filling trench. ~ Storm Sewer - Prior to filling ~rench, o Water Line - Prior to filling trench. D Rough PI.umbtng - Prior to cover. CONSTR. TYPE: HEAT SOURCE: - RANGE: D Rough Mechanical - Prior to cover. "I':7r 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. ~Fra~lng - Prior to cover. o Wall/C'elllng Insulallon - Prior to cover. o Drywall - Prior to taping. o Wood Stovo - After Installation. o Insert - After fireplace approval and Installation of unit. o Curbcu! & Approach - After forms are' erected but prior to placement of concrete. o Sidewalk & Driveway - After excavation Is com pi etc. forms and sub-base material In place. o Fence - When completed, o Street Trees - When all required trees are planted. ., o Fln.1 Plumbing - When all plumbing worl< Is complete, , , ~ Final Electrical - When all ~electrlcal work Is complete, D Final Mechanical - When all mechanical work Is complete. 'f;?f Final Building - When all ~equlred Inspections have been approved and building Is completed, DOthor MOBILE HOME INSPECTIONS D Blocking and Set.Up - Wh~n all blocking Is complat., ,/' o PJumblng Connections - When home has been connected to water and sewer. o Electrical Connection - When blocking, sel.up. and plumbIng Inspections have been approved and the home Is connected to the service panel. o Final - After all required Inspections are approved and porches, skirting, decks, and venting have been Installod, Lot faces Lo( TY. V I~terlor Lot sq. 'ftg. . , '\. \ Lot coverage Corner Topography Total helghl Panhandle W (1;t ,) Cul-de;sac Setbacks ' I P.L. HSE GAR IN Is Iw "1 E ' _. ACe' I I I I I " IS THE PROPOSED WORK tN THE. "'HISTORICAL DISTRICT, OR ON THE HISlORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior to permit Issuance. \ , ".. ';.:'~ ';':;:.,~:~:\~7~;'. BUILDING PERMIT ITEM SO. FT. X $/SO. FT, ~ VALUE "S- <J 39 5 (p ,$0 4.53 (A) ~,O~ DEVELOPMENT CHARGE (SDC)1f=, ~ , (B) J1lqo~ Main . , Garage Carport~ 4-~b I &-z.o /1:>/'0 J <I/'O ~~& -'" \.:. Total Value Building Permit Fee .., ~:!> + 1,'10 State Surcharge ~ To(al Fee SYSTEMS PLUMBING PERMIT ITEM FIxtures Residential Bath(s) N' Sanitary Sewer FT. FT. FT. / / Water Slorm Sewer Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnaco Exhaust Hood Vent Fan N' Wood Stove/lnsert/Flreplace Unll Oryer Vent Mechanical Permit Issuance State Surcharge Tolal Permit (D) MISCELL.~NEOUS PERMITS Mobile ,Home Slate Issuance Stale Surcharge Sidewalk ft Curbcul ft Demolition Slate Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding elec(rlcal)' (A. B. C, D, and E Combined) " ~92.5' /0/0 FEE '''~ ~ '21/ ,5/ APPRqYEn,. BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permllls granted on (he express condition that lhe said construction shall, In all respecls, conform 10 the Ordinance adopted by the Clty':ol Sprlngfl'1)d, Including the Development Code~regulallng the construction and use of buildings, and may be suspended or revoked al any time upon vlolallon of any provisions 01 said Ordinances. Plan Check Fee: 3t'.o.7:? '~1:!'S- Receipt Number' /7t'? '5' 2- Rec7~~' PlansVleviewed By Date Paid: ~~r t D'l'fl Syslems Oevelopmenl Charge Is due on all undeveloped properties within the City IIml(s which are being Improved. ADDITIONAL COMMENTS ~~ ~/~r~f .. ~ By signature, I stale 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 Ordlnancus of the Clly of Springfield, and the Laws of the State 01 Oregon perlalnlng to the work described herein, and that NO OCCUPANCY will be made of any struclure without permission of lhe Building Safety Division. I further certify that only contractors and employees who are In compliance with ORS 701.055 will be used on this protect. I further agree to ensure that all required Inspections are requested at the proper time; that each address Is readable from the streel, that the permit card Is localed at the fronl 01 the property, and the approved sel 01 plans will remain onXe ~' times during cO~lon. Slgnature~A./ ~/ 4- - r/ Date' -:;--23-9'-=> , VALIDATION: RECEIPT NUMBER /7 ~ ? "3 5" '::<~- 9.S- AMOUNT RECEIVED '2.'9/.-1-7 RECEIVED BY -./ ~~ DATE PAID . .' .B NO. 94-1/:'(':' CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: D6NNA LONe,.. LOCATION: J&Z? ;-I,4YPE-A1 13R.. RP /70,?'2-6>7-/ -; /400 CAfl-P~ r DEVELOPMENT TYPE: Lptz - ~/.;::/,-6t- 4D{:)ITION fkpt..- 'PAveMC/olT BUILDING SIZE: 14-"42. I'-fx'Z-o LOT SIZF SQ. Ft. I. STORM DRAINAGE IMPERVIOUS SQ. FT. 8r.,e, X $0.209 PER SQ. FT. rC.. 'il/1.i ) 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) X $43.26 PER PFU c;- - ) .'----. ..-/ 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP x X $436.19 X $436.19 X $436.19 G-) ~ $ X X $ 4. SANITARY SEWER-MWMC NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADM FEE (Use PFU Total FrDm Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ TOTAl-MWMC SDC $ r--; ~ $ / 8 / 4/ SUBTOTAL (ADD ITEMS 1,2,3 & 4) 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) ~'-~Lc.k.- '-'-'1 Kip Burdick SDC Coordinator X .05 Date:# c; 9 07~ ......... .-/ TOTAL SDC $ 190~ D . . Permit #: 94-" .//~ Address: /623 ~ti:r-=-/Y/~~~ Issued by: 0/;>$ -<- Date: S- -"2 ;J' ~ 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 filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: o D 1. 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 IXl 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 p~"ty Owners about Cons n Responsibilities on the reverse side of this form. /~~./ ~40/ ')--2-3-9S- (Signature of pe~pplicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . ~ ' ,........ ... ~ -~'., ... "'- '~" '][nformation-Notice to' Property Owners :. _ About Gon.~tr~.ction Responsibilities ,.....---.--. '...... ~.". .,. ~ -- , , . " -~ ."\. , ---' No/e: This Informa/ion Notice to Property Owners about Cons/rue/ion Responsibili/ies., ivas "developed by theCOI;~/~~~7roit tonirac/o;~' Board in accordance with ORS 701.055(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,ofth~ following resP9nsibilities 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 mostinstances, be ruled. to be an employer and the people you hire will be employees. A~ the employer, you must comply with the following: , ' . Oregon's withholding tax law: As an employer, you mu'st 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 DepL 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 information, 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 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 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 Intemal Revenue Service at 1-800"829-1040. 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 su!=h 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 act as your own general contnictor, to coordinate th~ work of rough-in and finish trades, and to noiify building officials at the appropriate times so they can perform the required inspections. . , , If you have additional questions, write or call the Construction Contractors,Board (PO Box'14'140: Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem: prop-own.pm4 1/94 "'.