HomeMy WebLinkAboutPermit Building 1988-8-3
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LAND MANAr.r:MrNT OIVI~'ON
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General Land Use Application
FILE No~33-f?;
ACT! ON ..f11.F P
1.
PROPERTY LOCATION
Township 17 Range 02
17 02
Section 19-41 Tax Lot
19--4\
900
;lVl
902
Size
E.-~O
Zoning REP Plot #
Tax c00:1
,
.,
II.
Site Address Hayden Bridge Road
REQUEST /PROPOSAL ::t ~ lJ~_
1.72 A
h!2
H-ouS F_
Specific section of Lane Code requiring this application
III. IDENTIFICATION & OWNERSHIP
Applicant:
1. Name Jon Briscoif'.
Address 1830 Market Street
City Springfield. OR Zip 97477
Phone 746-7613
Owner:
Name Jon. Bri seop-
Address 1830 Market Street
City Springfield. OR Zip 97477
Phone 746-7613
2. Legal Interest Title Holder
Present use None
Existing Structures
Do you own any
adJoining property?
Map
x
Contract Purchaser
Lessee
None
No
Acreage
Tax Lot(s)
Road Status:
State County X Publir,--Easement Fire Oist. SDringfie1d
""'file
Water Supply: Power Company EWEB
Public_On-site ~lell_Community System n.~
Sewage: ""lilt School Dist. Dis~~ 19
Publfc_On-site Septic_Community System _ Telephone Co. Northwest Bell
n.lllll! n.1llt
I (ue) have completed all the Rttached application requirements and certify that all statements are true and accurate to the
best of my (our) knowledge and belief. I am (He are) so authorized to submit this application ;IS evidenced by the 51~naturc
of the o3~r Sil;~S: rO j<f" ~yj;.vf: n <p ",.f'
'I *~C ~&-A--PJ~~f~'~ /~<P4~c)<p~.$/f9
~PJio.:lil'rr Dace ~"J . Uo1ce
Agent Bill Medford Real Estate pate 8-3-88
Agent Address 1216 Mohawk Blvd. Zip 97477_Phone 746-7613
4. Staff Comments
S;rn:: If AJor IN FI-oof; I-JA;z.M.6 AliA A r PM !"l.-O, Pl..A,.)
J'>-Itp-,pPn-
Pub 1 i c Works Dept, Land Management Di v. Courthouse/PSB 125 E. 8th Ave. FlJoene np Q7M\1
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LC 223388 PAFP
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VERIFICATION
SWR: FT. WTR:
MECHANICAL,FEE
STATE SURCHARGE
PLAN CHECK FEE
SDS
SI
PCK
EST. COMPLETION DATE
OTH
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51.
ISS
DEPOSIT **
10.00
10.00 CK
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RESIDENTIAL
PERMIT APPLICATION
.
Inspections: 726.3769
Office: 726,-3759
LOCATION OF PROPOSED ~~K: 8G\ 04
ASSESSOR,S MAP: \\ l)ri. \C\ 4- \
LOT'
',BLOCI<"
OWNER:aOl.VLj.. y<\',\ lei/'
ADDRESS - I ogW('hf".o \ Ct~ b..-
CITY: ~.-..,' ~'Y'I~{l;e..-I(">.P
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DESCRIBE WORK'
V\oH1
NEW
REMODEL
CONTRACTOR'S NAME
GENERAL: ~~~1~~/6f~~)
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PLUMBING'
r
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MECHANICA' '
E~ECTRICAL'01 j lY\iX~
STATF'
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JOB NUMBER
QI033l.:.
>.FR'
ADDITION
DEMOLISH
OTHER
225 Fifth Street
TAX LOT:
SUBDIVISION'
PHONE:
-'7 y ) - ()lj-.L.t.../
ZIP: 0('] l./JJ
ADDRESS
2~.'i' 5/0l717
CONST,
CONTRACTOR #
-;Ie; 2 :r, ~
, .
EXPIRES PHONE
r19/ '14'1--: !/f
- OFFICE USE -
OUAD AREA: c::. kl\.\Q --" LAND USE: .111 I FLOOD PLAIN:
# OF BLDGS' I # OF UNITS' 1 ZONING CODElf\-e:\ ~G-t)
OCCY GROUP: R.~-T \J\ CONSTR, TYPE: \/ fJ' # OF BDRMS: - ~ '
# OF STORIES:" '} HEAT SOURCE: G..."" I="A SECONDARY HEAT:
WATER HEATER: (;.A<-, RANGE: rr.,Ac... SQUARE FOQTAGEc9 f) qq
-+ ('\o+-"1:J~qn~.
To request an inspection, you must call 726.3769. This Is a 24 hour recording. All inspections requested before 7'00 ~'Ii1e
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
J;8:[ Temporary Elect~lc'
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior !o cover.
o Footing - After trenches are
excavated. ' \,
o Ma:,onry - ~teel location, bond
beams, grouting.
~Foundatlon - After forms are
J6.J ~rected but prior to concrete
placement:
REQUIRED INSPECTIONS
'l"":tif'Rough Mechanical - Prior to
~cover.
~Rough Electrical - Prior t~
~cover.
'K/'r Electrical Service - Must be
~ approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~Fr.aming - Prior to cover.
~Wall/Ceiling Insulation - Prior to
~. cover.
D Underground Plumbing - Prior ~ Drywall _, Prior to taping.
to filling trench. ~
NUn~~f~~ {,I~:~!;~~~~,i,~ 0 Wood Stove - After installation.
~ Post and _ Beam":"" P.rior to floor
~ insulation or decking. .
.;:::::A'" Floor Insulation - Prior to
~decking,
~ Sanitary Sewer - Prior to filling
~trench.
~ Storm Sewer - Prior to filling
~ trench.
~Water Line - Prior to filling
~ trench.
:l:5<(, R~ugh Plumbing - Prior to
J- ...over.
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 - After
excavation is complete, forms
and s.ub-base material in place,
D Fence - When completed.
. 0 Stree:t Trees"""":' When"all required
trees are planted. "
,
K:A'Final Plumbing - When all
, ~plumbing work is complete.
'~Final Electrical - When all
-t:SJ ~rectrical work is complete,
"- ' .
~Final Mechanical - When all
BJ ~echanical w(:>rk is complete.
\
~Final Building - When all
~ iequlred inspections have been.
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blocking is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
10 Electrical Connection - When
blocking, set-up, and plumbing
I 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 ~ Lot Type.
Lot sq, ftg, 92kJo ........-Interior
Lot coverage ~fi Corner
Topography >~II. Panhandle
Total height ~I Cul-de-sac
BUILDING PERMIT
ITEM SQ, FT.
X $/SQ, FT,
?fl.,
iLJ I
Main
ftOO'-/
Garage
,~c:..Cj~
ICld-.D
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
Setbacks
I P,L. HSE GAR ACC
IN
S
W 501
IE
VALUE
I~,I~O.~
:D ,OT]
P-D ,d.SJ ~
502?~
- 2.5,1.(-
~27.~
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
filA
,
PLUMBING PERMIT
ITEM
Fixtures
.3
:2,
Residential Bath(s)
N'
'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'
5"
Wood Stovellnsert/Fireplace Unit
Dryer Vent
Mff I.IAlE
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
i..wa Co. ~ H::;
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
30..0
-'-92..~o
2?2 eM>
//.10
'233/0
?:,p-.!>
4.So
/5. 4"0
=?DO
Z.~p
3D.SO
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_4--.k.53'
-L65.""
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. THE PROPOSED WORK IN THE."....
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
. ,
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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, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
':2.,;;;} S ,3d-.
41"l k',
Receipt Number: \ 17')01,
Received By: IS;:0R
Pla~~~~-
Plan Check Fee:
Date Paid:
5"i.~hL
Dat~ -
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 all
Information hereon is true and correct, and I further certify
that any and all work performed shall be done In accordance
with the Ordinanc~s of the City of Springfield, and the Laws
of the State of 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.
I further agree to ensure that all required inspections are
requested at the proper time: that each address Is readable
from the street, that the permit card Is located at the front
of the property, and the approved set of plans will remain
on the s~.te at al times during constru~tion.
~~
Signatu e
Date
.J>3a~'11
VALIDATION:
2L> 2 24-
\- 2-0 -'5'1
AMOUNT RECEIVE; ;-6 117 fb ,5"2
#~~
RECEIPT NUMBER
DATE PAIf'
RECEIVED BY
. ."....
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Permit No:
9/b33cP
3l,c;1 ~Aou �
~ Date: S-)e-9/
Address:
Issued by:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
fOllowing statement before the building permit can be issued. 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 box 1 and either box 2A or 2B:
1".~ I own, reside in; or will reside in the completed structure.
2. A.~, My general contractor is JICI<: ~/.A' J:::.
Contractor registration number 45'2 r g
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. L.....J 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 (10 hire a !;jeneral
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
reverse ~ %~s, fo:m.~ ,
( /(/V'-'~ /~ '-3J-11
Signature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1190
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
<e.
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
, '
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NOTE: '). ",Th'is..lf\fQrmation Notice to' Property Owners About Construction
Responsibilities was developed by the Construction Contractors Board in
~oc6fdanc~ with' QRi:3',i01.055(5), passed by the 1989 Oregon Legislature,
- ~ \ - \ ~.
. , ~ ~ . .....;- . - . (', '.
il you'are acting as your own'corMactor 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 Co'ntractors 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 musi 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 378-33S0.
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.
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Workers' Comoensation Insurance: As an employer, you are subject to the Oregon Wor"ers' Compensa-
tion Law, and must obtam \IlIO~er5' oompeJ:1SatiOI1'.irtstrancefor your employees. If you fal[:1o obtain workers'
compensation insurance, you may Qe !3l1qj~! to penalties and will be liable for all claim costs il one 01
your employees is injured on the1ob': 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 informa-
tion, call the Internal Revenue Service at 221.3S60.
OTHER RESPOl\ISIBILlTIES AND AREAS OF CONCERN:
Code Comoliance: As the permit holder for this project, you are responsible tor resolving any failure
to meet code requirements that may be brought to your' attention, through inspections,
Liability and Property Damap.e Insurance: Contact your insurance agent to see if you have adequate
insurance coverage tor accidents and omissions such as falling tools, paint overspray, water damage
from pipe punctures, fire, or work that must be r&<lone,
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
ExDertise: 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 tlmes so
they can perform the required inspections.
If you have additional questions, write to:
Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-37&4621
0244J 10124189