HomeMy WebLinkAboutPermit Building 1995-5-23
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
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ASSESSORS MAP'
LOT'
OWNER:
ADDRE"'"
CITY'
DESCRIBE WORK: ~A
NEW ~ REMODEL
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25"
BLOCK:
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STAT'" '
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. ADDITION
CONTRACTOR'S NAME "
GENERAL:
PLUMBING:
MECHANICA' .
t'?W.A..JM
-
ELECTRICAL'
~W~
QUAD AREA:
· OF BLDGS:
OCCY GROUP:
1- t-tJ III
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. OF STORIES:
WATER HEATER:
DEMOLISH
OTHER
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.
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
t6.
TAX LOT' //~CfO
SUBDIVISION: 0lA6jhLlld, fr-ur
, PHONE:
7'1-:-_ -9. )" ? r
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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
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ACe' I
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" 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.
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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
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'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
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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
.
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.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
,.....---.--. '...... ~.". .,. ~ --
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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
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