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Home My WebLink AboutPermit Building 1994-9-1 '1e#~" RESIDENTIAL PERMIT APPLICATION Inspections: '726.3769 Otrlce: 726.3759 UPCATlON OF PROPOSED WORK\Co?. :3 :XSSESSORS MAP' \'1 () ~ Q. 'f'l LOT' .. BLOCt<'. OWNER' /~,,) ~ '. ,/ 0' ADDREC": /~ I'? ~vlJuf..J CITY: ~;m /n ...;,uu h'/e.7U4~ DESCRIBE WORK: NEW X REMODEL 1 CONTRACTOR'S NAME GENERAL: r' <f" A-u}VK;,(2 ,PLUMBING' MECHANICAl' ELECTRICAl' ~ 7 e.! STATE: :..11Z<Q...d'~ , M-'Jv<..A , ~ ~f'h'~ # . ~ c,,"1 F"'S c::.S' ADDITION , DEMOLISH OTHER JOB NUMBER 225 Fifth Street Springfield, Oregon 97 ' o ~ PrI. '~AXLOT: \\~('f)(\&\~\j SUBDIVISION: PHONI=' 7</~- X's::r..., ZIP: q ?';/7 '7 ADDRESS' CON ST. CONTRACTOR' PHONE EXPIRES - OFFICE USE,- , QUAD AREA: (C)ft' ))W LAND USE: WI FLOOD PLAIN: · OF BLDGS' I · OF UNITS: I ZONING CODE: /),,{l -. , ~.?" .-=< oCCY GROUP: CONSTR: TYPE: '. OF BDRMS: ~ 'J ". Fc.., ,.,.".-- . OF STORIES: HEAT SOURCE: , SECONDARY HEAT: WATER HEATER: .F- RANGI=. S SQUARE FOOTAGE: To request an Inspection, you must call 726.3769. This Is a 24 hour recording. Alllnspecllons requested belore 7:00 a.m. will be made the same working day, Inspections requested alter 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS ~ o Temporary Electric O Site Inspection - To be made after excavation, but prior to setting forms. O Underslab Plumbing/Electrical/ Mechanical - Prior to cover. ~ Footing - After trenches are l6l excavated. o Masonry - Steel location, bond beams, grouting. o Foundation - Alter forms are erected. but prior to' concrete placeme~t. o Underground Plumbing - Prior to /lIIlng trench. o Rough Mechanical ~ Prior to cover. . . o Rough' Electrical - Prlor'to . cover. o Electrical Service - Must be approved to obtain permanent electrical power. , o Fireplace - Prior to facing materials and framing Insp. o Framing - Prior to cover. o Wall/C'elllng Insulation - Prior to cover. o Drywall - Prior to taping. O Underlloor Plumbing/Mechanical -,Prior to Insulation or decking. 0 Wood Stove - Aft~r_ln~ta~latlOn. o Post and Beam - Prior to floor Insulation or decking. O Floor Insulation - PrIor to decking. ~anltary Sewer - Prior to filling )4.! irench. M Storm Sewer - Prior to filling r trench. . f'v(water Line - Prior to IIIl1ng ~ trench. o Rough Plumbing - Prior to . cover. o Insert - After fireplace ~pprovlll and Installation or~nlt., '. O Curbcut & Approach - After . forms are erected but" prior to , placement of concre!e. o Sidewalk & Driveway - After excavation Is. complete, forms and sub-base material In place. o Fence - When completed. o ,Street Trees - When all required trees are planted. ". ',\ ~ ~ o Final Plumbing - When all plumbing work Is comple(e. , , o Final Electrical - When all electrical work Is complete. o Final Mechanical - When all mechanical work Is complete. o Final Building - When all required Inspections have been approved and building Is completed. o Other MOBILE HOME INSPECTIONS o BlockIng and Set.Up - When all blocking Is complete. o Plumbing Connections - When home has been connected to water and sewer. - o Electrical Connection - When blocking, set-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 Installed. Lot faces L~t'~ype. Interior Lot sq. Itg: Lot coverage Corner Topography Total height Panhandle Cul-de.sac , . , ... "" ""'" . ~ ''',.,'.", ".~, . . ".:.., "':'I'I~,l".l \"'Jth'~;.lt ~).:.: , \ ":.:: :: '. " '.<.'., ;:":'::~.'-~'j\,,:" PP.L. IN Is Iw IE . BUILDING PERMIT ITEM SO, FT. X $/SO. FT. = VALUE '=3A1, ';>0 /,93. /"'" f/.5'7 SYSTEMS DEVELOPMENT CHARGE (SDC) , uG-B Main Garage Carport .#/1 IFJ)j, Total Val ue Building Permit Fee State Surcharge 3<?'~4:/. (A) To(al Fee (B) PLUMBING PERMIT ITEM Fixtures ResldenUal Bath(s) N' Sanitary Sewer FT. <5'0.' , "320' 'Water FT. Storm Sewer FT. '<50 ' Mobile Home Plumbing Permit State Surcharge J~ /rJ,#?,ofJ, (C) Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove/lnsert/ Fireplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS MobUe Home State Issuance State Surcharge I Sidewalk " It Curbcut [ Demolition , It State Surcharge Tolal Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) " ~ FEE 2"5 7n Z~ /?n~ tb~ , 3.400 ,-/2'9,M I , " , - --. ; . --- - i /7//'1 . Setbacks. HSE GAR' ACe' I I I I I. ... THE PROPOSED WORK. IN THE _ ' '''HISTOI;1ICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this appUcatlon must be signed and approved by the Historical Coordinator prior to permit Issuance. ',' APj>ROVFn., 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 adopted by the City ,of Springfield, Including the Development Code. regulating the construction and use 01 buildings, and may be suspended or revoked at any time upon violation 01 any proviSions of said ordinances. Plan Check Fee: 2.'5' c9 3 -Y2-~/T.y /4t:JJ'D . ~ ~'-n~71 Date Paid: Receipt Number: Recelved& ...#~ PlanS~I~wed' By , , Systems Development Charge Is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS ~~/bf'~ .ei~'ZfZ/&I/- A.rJ& 7t1.II. #?&A?//-=J ~E A/iflbt/"eCi). At:JlJ, AIJ,If, JliH~/#; /'AoW~ jJKA?/T IS --f&;///.R'LfJ. ~ " By signature, I state and agree, that I have carefully examined the completed appUcatlon 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 lhe City of Springfield, and the Laws 0/ the State 01 Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without 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. J further agree to ensure that all required Inspections are requested at the proper t1me~ ~hat each address Is readable from the street, that the permit card Is located at the front of the property, and the approved set 0/ plans will remain on the site at all times durln~;~on. ;XSlgnature~ ~ ., (/ Datp CI-/-9't/' , VAUDATION: RECEIPT NUMBER ;f <;)7 7 J// /5',~ /71/ ? ~ , DATE PAIP AMOUNT RECEIVED RECEIVED BY . . Permit #: 1.#/] ~ Address: / (~2 ~ tImr QO....) 1M. KL Issued by: ~ Date: 9/15'1' 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: ~ ~ 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 Pr:~,ty Owners about C~ction Responsibilities on the reverse side of this form. Lffr/7'1', .~CX~ ?-/-;?~ (Signature of~t applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) {"J " 1\' -~.:. '\ . _.-, . ,',- \ '\,. \- . . xniJrm"aN61l Notice ''to Prbperty Owners . ". ., ,,,,Abou't Cons'tl:uc'tion Responsibili'ties i...--'0....;._\; J '" ~ ,-. .:. ~ \. _', I " >\(,'.... '~..,,>~>!"o't~: This Informa/ion fodc'e"~.'f:r{Jf!erty Owners abqu/ Construction Responsibili/ies. \ ">,Vci",aeveloped by the Construction 'Contrac/ors 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 of the following responsi~ilities and .areas of concern. EMPLOYER RESPONSIBILITIES:, If you hire persons not registered with the Construction Contractors Board to do lab~r in constructing or assisting in the construction or improvement of a resid~ntial structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you musl c9mply 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. o(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 .~~s, 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 Internal Revenue Service at 1-800,829- 1040. .. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the pe~it holder for this project, you are responsible for resolving any failure to meet code require~~nts 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 ov~rspray, 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 contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can p~rfo_rm the required inspections. , . ,-:,.... " .__\.:( ....-.................:.-.:...::.. . ,", .... '" If you have additional questions, write or call the Construction Contractors'B.oard {pO-Box 14140, Salein;OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Sa'iem. prop-own.pm4 1/94