HomeMy WebLinkAboutPermit Mechanical 1992-4-22
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Ollice: 726.3759
L01'
.
SPRINGFIELD
BLOCK.
OWNER: _UL8:l!<'d~ :r:. ' ""?v:>(f1 ..a l ~..uv l
ADDRESS 56 ,.( i.~" dhJ "P..IL<..~.J w...
CITY: "Y> f /...... .1/____ .... (STATE: _Jt')~
DESCRIBE WORK:C:-:P.J/ ",
!B NUMBER /,20c;,06
225 Fifth Street
Springlield, Oregon 97477
TAX LOT:
OAiOJ
SUBDIVISION.
PHONE: -7</</ -/ I~ V::1..
Zlp.9 7Y 7 "7
NEW
REMODEL
JrJ.//-,",) ,::q....... D
r
ADDITION
!..t.,':'" > ()/NL-~.1 1_4.A.A<j<L
DEMOLISH OTHER
CONTRACTOR'S NAME
CENERAL: __O-u.J_Ai_e"tL
PLUMBING.
MECHANICA' .
ELECTRICA' .
OUAD AREA: ~
. OF BLDGS: _
OCCY GROUP:
. OF STORIES:
WATER HEATER:
ADDRESS
__~'-41'_&.AAO"'#
CONST.
CONTRACTOR'
EXPIRES
PHONE
- OFFICE USE -
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 bc
maclc the sanlC working day, Inspections requested after 7:00 a.m. will be made the follo~ing work day.
o Temporary Electric
o
Site Inspection - To be made
nfler excavation. but prior to
sotling forms.
o
Underslab Plumbing/Eleclrical/
Mechanical - Prior to cover.
o
Footing - After trenches are
excavated.
CI Masonry - ~teel location, bond
beams, grouting.
[J
Foundation - Afler forms arc
erectecl but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
o
Underlloor Plumbing/ Mechanical
_ Prior to insulation or decking.
o
Post and Beam - Prior to floor
insulation or decking.
"
o Floor Insulation - Prior to
decking.
O Sanitary Sewer - Prior to filling
trench.
o
Storm Sewer - Prior to filling
trench.
o
Water Line - Prio.r to filling
trench. "
o Rough Plumbj'!g - Prior to
cover. ... . '
. .
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o Rough Electrical - Prior 10
cover. :'
o Electrical Service....;.. Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
o Framing - p~ior to cover.
o Wall/Ceiling Il1sulatio~ -:- Pr,ior to
cover. :. .
, ,.~
o Drywall - Prior to !a~.jng.
o Wood Stove":' Alte,r installation.
o Insert - After fireplace approval.
and Installation of unit.
o Curbcut & Approach - After
. forms are erected but prior to
placement of concrete,
o Sidewalk & Driveway - Alter
excavation is complete, forms
and sub-base materIal in place.
o Fence - When completc(J.
o Street Trees - When all required
trees are planted,' ,
o
Final Plumbing - When all
plumbing work is complete.
D Final Eleclrical - When all
electrical work is complete.
~ Final Mechanical - When all
~nechanical work is complete.
o Final Building - When all
required inspections Ilave been
approved and building is
completed.
j8fOlher CA-5 I./.(Jr-~'.
MOBILE HOME INSPECTIONS
o Blocking and Sel-Up - When at!
blocking is complete.
o Plumbing Connections - Wilen
home has been connected'to
water and sewer.
o Eleclrical 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 installed.
J
Lot faces Lot Type.
I P.L.
Lot sq. fig. Interior IN
Lot coverage Corner
Is
Topography Panhandle
Iw
Tolal height Cui-de-sac
IE
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT. VALUE
Main
Gara~lc
Carport
------
Tolal Value
Building Permit Fcc
Stale Surcharge
Tot;! I Fee (A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(8)
PLUMBING PERMIT
ITEM FEE
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood /'
Vent Fan N'
Wood Stovellnsertl Fireplace Unit
Dryer Vent
&A-<5. i/lUt=
)'1?(,lj.
Mccllanical Permit
Issuance
Stale Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Horne
State Issuance
Slate Sllfcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, 8, C, D, and E Combined)
;e::, 0ltJ
kJ 0,:)
.7~
25.7>
7<.75"
Setbacks
HSE GAR ACC
,r., ....
.S THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, thls application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED: .
, ,
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, inclllcJing ttlC
Development Code. Icgtllalin~l the construction and lI:~C of
buildings, and may bc suspended or Jcvoked at any lime
upon vio/;llion of any provisions of said ordinances.
Plan Check Fcc:
Date Paid:
Receipt Number.
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I state and agree. that I have carefully examined
the completed application and do hereby certify that ail
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 State ot Oregon pertaining to the work described
herein, and ttlat NO OCCUPANCY will be madc of any
structure without permission of the Building Safely Division.
I further certify tha~ only contractors and employees who
are In compliance with ORS 701.055 will be useel on this
project.
I further agree to ensure that all required inspections me
requesled at the proper time, that each address is Icaclable
from the street, that the permit card Is located at the fronl
of the property, ;md the ilpproved set of plans will fCmain
'~~::l~~i~"~S_~~:;;~~ /
Dale ~ - ~ Q.. / r -2.
/
VALIDATION:
RECEIPT NUMBEI~
DATE PAin
4~/4
. I
f2 "V7?
?c::;.7.r
./~
AMOUNT RECEIVEn
RECEIVED BY
j. . ''"
.
.
Permit No: 920000
f
Address: . Qb ~/..bu /ftR. tV'"?
.Issued by' D ~ . Date: -f'h2/5'<
, ,
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 CDntractors'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 or3B:
1.1~1
--
,
2.-1 :><J
~ .......
I own, reside in; or will reside in the completed stweture:
I understand that I'must register as a constn:lction.contractorif the structure is sold
or offered for sale before ,or upon completion.
3..A.1
I My general contractor ie:
Contractor registration number
, .
.,
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 -j. .?<-. 1 I will be my own general. contractor.
'.If I hire, subcontractors, Iwill hire only subcontractors. registered with the Constrac" ... ';.. . ,lv
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 twill 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.
A-.~ -./~ tJ Q "__'jh__ j
. '''Sigriature of Permit ~pplicant .--
Y/2.Q /<7;>
Date I.
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT'
l
#~,' \",
INFO.ATION NOTICE TO PROPERTY c1NERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Pr,operty Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
passed by the 1989 Oregon legislature.
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 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 tie 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' 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 DIF at 373-7434.
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 th.is project. you are responsible for resolving any failure to meet
J . ._
code requirements that may be brought to your attention through inspe"tions:.
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
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