HomeMy WebLinkAboutPermit Building 1993-7-6
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
">(' ASSESSORS MAP: -,L2././ 2..
c!)ffi1 \
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LOT:
BLOCK:
~IJ1\G.J
OWNER:~J.{'+-HtJ'-{)E' S~.,,,,/'n?ck S.h~ IV'
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ADDRESS: . ~~ ~ 7 Y/~ IV' /VJ l) tJ NT
CITy:S131l111/iLFIEJ. D STATE: aR
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TAX LOT: ___-40 . <;
SUBDIVISION:
PHONP' ~~~-~~~~
ZIP; 9,,7,1/.? /'
,
DESCRIBE WORK: ...C:;~J.,_ )*(Yl,J I V l klo [\\ r\ Q fl~
NEW X. REMODEL ADDITION Dl~OllSH OTHER
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-r;9C/<
ADDRESS
.s",f,1I9 w
CON ST.
CO!"TRACTOR #
EXPIRES
PHONE
CONTRACTOR'S NAME
GENERAL'
PLUMBING'
MECHANIC^' .
ELECTRICAl'
~~AD~R~;.~Q '~Q;/~~ I,
N OF SLOGS: _ '- \ __
,OCCY GROUP _Ki-'LN\.
II OF STORIES:__
y./
WATER HEATER:
"
.,.
\ ' '.,. '. - OFFICE U~E -
L~ND USE: III \
;, OF UNITS: \ ':"
. ". \/0
CONSTR. TYPE:~ --
HEAT SOURCE: -bL....
y/
1.
FLOOD PLAIN:
ZONING CODE: _ UJ,I L----
5
SEiCONDARY HEAT: ("..J
SQUARE FOOTAGE: , .Q,[)?D..
It OF BORMS:
To r~Qucst an inspection, you must call 726-3769. This is a 24 hour recording. All inspections requested berore 7:00 a.m. will be
made the same working day, inspections requested after 7:00 a.m.. will be made the following work day.
o Temporary Electric
D Site Inspection - To be made
after excavation, hut prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
~ Footing - After ticriGhes are
~ excavated.
o Masonry - Steel location, bond
bearns, groutinu.
rYf Foundation - After forms are
~erectl}(l but prior to concrete
placernent. .
o
Underground Plumbing - Prior'
to fifling trench.
f'7f Underlloat "IU;"O!!l8I1.echan.u:.a?
~_ Prior to"l'nsulatio~ or decking.
f'C/1' Post and Beam - Prior to 'floor
~ insulation or decking.
~ Floor Insulation - Prior to
~decking.
d Sanitary Sewer - Prior to fitling
~trenctl. '
d Storm Sewer - Prior ~o filling
~ trench. .
I\.A Water.Line - Prior 10 filling
~ trench.
~ Rough Plumbing - ~rjor to
~ovcr.
....
RANGE:
REQUIRED INSPECTIONS
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BROUgh Mechanfcai' "'~..,('),r}or to
cover. ,.... t. ....,
. .
~ Rough Elcctr;cal - ;rior t~
~co\'er.
. ~ :
,
..... '.
"K7f Electrical Service - ML:st be
~ approved to obtain perrr.anent
electrical power. ,....' .'
o
. -. ~ ~.
-~'l;:;
Fireplace - Prior to facing
materials and framlngr!;'lsp.
1571 Framing - Prior I~ :.~ver. .
~ .~ ..
l"vf Wall/Ceiling InSUla!1~; 7.trlor 10
~covcr. . ')
...:(-
'~urywall - Prior tQ..t~,pih9~.
~ <:"..........f~,
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o Wood Stove - After instrl1lation.
D Insert -.~.fter flreplacf; aflproval
and insta!13tion of Unit.
I
L:.J
Curbcut & Approach - A.fter
fOlm~ are erected but priel" to
pracerncl"\l of concrete.
o Sidewalk & Driveway - I...ftcr
eJ< ::a:.Jation is corr;plcte, learns
and slJb.base materia! i:1 pl~.,:;e.
~~.: <..;-.
o ~(!Ilce - Wtlcn ccmph~ted. ~
~\;'COI Trocs - 'i;"Jti~1. ~W<lpi '00
I !f.:e$ are cl::mted. \,..,t,~.
IXr Final' Plumbing - When all
~Iumblngwcrkiscompteta
~ Final Electrical - When all
~ electrical work is complete.
~ Final Mechanical - When all
~.mechaniCa! work Is complete.
~ 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.
Cl Plumbing Connections - When
- home has been connected to
water and sewer. ..
[] Electrical Connection - When
blocking, set-up, and plumbing
inspection~ have been approved
and the home if; connected to
the. se/vice, panel.
~ ~ .., . .. .. .
'\ ..'> J . ~ ~ .. ~.
o Final ~ After all required
inspections are "approved and
porches, skirting, decks, and
vent!ng !"lave been installed.
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Lot faces Lot Type Setbacks IS THE PROPOSED WORK IN THE
----1
Lot sq. ftg. 2Sfl7o -X Interior I PL. HSE GAR ACC HISTORICAL DISTRICT, OR ON
.1 ~ 19~ /94-~ THE HISTORICAL REGISTER?
Lot coverage IL% Carlner If yes. this, application must be. signed
.(;2.7" Is 90 and approved by the Historical'
Topography Panhandle Iw Coordinator prior \'0 permit issuance.
15"~ I 5
Total height Cul.de-sac
IE 13 APPROVED'
124/45
4!f!- ;zr
1~~
_ '2~.
.c:; 3,1'
SYSTEMS DEVELOPMENT CHARGE (SDC)
.t/~~
BUILDING PERMIT
so. FT. X $/so. FT.
1~?l$.,F
//J9f_
ITEM
Main
\~;~,o
,~4.I'O
Garage
Carport
~ ~ .<:;"t, ~
Sb,2D
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N ' -::z.-
Sanitary Sewer
FT.
FT. /~1'
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C) .
MECHANICAL PERMIT
Fu rnc::ce
Exhaust Hood
Vent Fan
N'
4-
Wood Stovellnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State iS~l..iance
State Surcharge
Sidewalk
-It
Curbcut
It
Demolition
State Surcharge
L~.JF Lb. Sb/lZe.
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Total Miscellaneous Permits (E)
TOTAL A;;lOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
VALUE
/n :0:;)"44.
)~4S-f
3/ -1-7
FEE
/W~
c;-<';"
2./ <:j"fX'
/~.7r
22S':7.r
,.
0~
4.So
;2. ~e
/5 s.o
3.60
.dr; Fe
/I'? _ (H)
~~g
S".3
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.17-",."6
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BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express'condilion that the said
cons'trl;ction shall, in all respects,'conform to the Or9inance
adopted by! the City 'of Springfield, including the
Development Code, ~egulating the construction and use of
buildings, and may be suspended or revoked at any time
upon ,violation of any provisions of said ordinance;~
~~/ 'iB~81
~_~ -)'- 6. '(
Plafl Check Fee: .
Dale paid:
. ~Q~/
Receipt Numbor:_..CQ...~~
Received y: _~_~
~~.
Plan' Reviewed By('" ,
-0h<;h'?
, I Da)~
Systems Development Charge is due' on all undeveloped
. ,
prop.3r:ies within the City limit~ which are being improved.
ADDITIONAL COMMENTS nt. ..'
~71C!..u-jJO!Utlr- 2_.J~ L.-'-9;B
PA7H '#:{.
BY' signature, I state and agree, that I have carefully examined
the completed application and do hereby certify thaI all
!nformat:on hereon is true and correct, and I further canily
that an)' and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws I
of the ,State of Oregon pertaining to the work described
herein, and that NO OCCUPAN<?Y will be made of any
structure without permission of the Building Safety Division,
I further certify that only corrtractors and employees who
are In compliance with ORS 701.055 will be used on t~lis'
project.
I further agr.ze to ensure that all required inspectlo.ns are
requested at ~he proper time, that each address is re<!,dable
from the street, that the permit card is located at the front
of the property, and tile approved set of plans will remain
on the site at all es during construction.
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Date ~#'..r""" L '" /99"3-
d? q- ,
VALIDATION: q-? 0-/ /"l
RECEIPT NUMBER . ~ Lf-/
DATE PAID r~.la .~~ ori/:
AMOUNT ;~E~EIVE d .. _ Uf( (J I ~ I
RECEIVED BY \L~
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Permit No:
Address:
Issued b
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(~PPlicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
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.
3. A.I
I My general contractor is
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.I
\ ~)Will be my own general contractor.
(~f ,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
rev::Z:d~
Fgnature Of Permit Appiicant
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91 .
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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NarE: , This Information Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
. passed by Ihe 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 RESPONSII8ILITIES:
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' 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 forthis project, you are responsible for reSOlving any failure to meet
code requirements that may be broughUo 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