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Home My WebLink AboutPermit Building 1993-6-25 n .I? ., - RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 LOCATION OF PROPOSED WOR\<' 176"3, Le. -' L . ASSESSORS' MAP' LOT: ~~ I' OWNER: -+,., >- . $o:.-k....\+<- ADDRESS: ~ J'2 <:. L 2-<: I~J CITY' <'IO.,..,_:....J J. . , SPRINGFIELD '5-1 J z S-~ 2"2- ~ BLOCK' STATE: l"'I('l... DESCRfBE WORK:.A~7ZI~ 00c:;0U-,A'1=. .- NEW ~_ REMODEL ADDITION DEMOLISH CONTRACTOR'S NAME GENERAl' A~ "'~'('" PLUMBING: It MECHANICAl' I' 1 ELECTRICAl' 'I OUAD AREA: . OF BLDGS: OCCY GROUP' . OF STORIES: WATER HEATER: OTHER ADDRESS CONST. CONTRACTOR · .. JOB NUMBER qB6;7~ . - OFFICE USE - LAND USE: . OF UNITS' CONSTR. TYPE: HEAT SOURCE: RANGf' 225 Fifth Street Springfield, Oregon 97477 2/ .3 r~-L TAX LOT' SUBDIVtSION: ~cu..J...... PHONE: "'"IU") _el:.':l..""\ ZIP: 0...., L.\" EXPIRES PHONE FLOOD PLAIN: ZONING CODE: . OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: To request an inspection, you-must call 726-3769. This Is a 24 hour reco:'dlng. All inspections requested before 7:00 a.m. will be made tile same w?rking day, Inspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS o Tc~pOrary E,lcctrlc o Site Inspection - To be made alter excavation, but prior to setting forrT!s. o Underslab Plumbing/Electrical I Mecha,"!ical - ,Prior to cover. K.:;rfooling - After trenches are ~ excavated. o Masonry - Slcel location, bond beams, grouting. o Foundation - After forms are erected but prior to concrete . placement. o Underground Plumbing - Prior to filling trench. ,0 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 :rench. o Storm Sewer - Prior to filling trench. " o Water Line - Prior to filling . .... trench. v~ \ . - o Rou?h Plumbing - p:~ior to cover. '. : ' o Rough Mechanical - Prior to co...ur. ~ROU9h,Elcctrical - Prior to ~ ~over. o Electrical Service - Must be approved to obtain permanl;nt electrical power. o Fireplace - Prior to facing materials and framIng Insp. gFraming - Prior to cover. o Wall/Ceiling Insulation - Prior to cover. o Drywall - Prior to taping. o Wood Stove'- After lnsta!lation. o Insert - After fireplar;e approval and installation of unit. o Cllrbcut & Approach - A ftcr forms are erected but prior to placcrncrlt of concrete. Cl Sidewalk & Driveway - After J excavation is complete, form:> ar.:.J sub-base material in r!2CC. o Fence - \Nhen completed. r . 1 Street Trees - W~len all required tn:iJ~ are planted. . o Final Plumbing - When all plumbing work Is complet.e. "'f'V71 Flnol Electrical - When all ~ eleclrical work is complete. o Final Mechanical - When nil mechanical work IS complete. F;7( Final Building - When all ~requlrcd insflectlons have been approved and building is completed. DOthor MOBILE HOME INSPECTIONS o Blocking and Sol.Up - When all blocking is complete. r--1 Plumbing Conn!:'ctions - When home has been connected to waler 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 -- inspectlon~ are approved and porchcs, skirtlng. decks, and' '/entlng nave been Installed. .. Lot faces Lot Type Lot sq. Itg. Interior I p.L. Lot coverage Corner I N I Topography Panhandle Is Iw Total height Cul.dc-sac IE BUILDING PERMIT ITEM SQ. FT. X $/SQ. FT. VALUE Main Garage --1!4 ~ Carport k?Jo( ,~ J9(p ~4-IO a7~ Total Value ~.S.o J.93 I-D.43 SYSTEMS DEVELOPMENT CHARGE (SDC) //7<5 Building Permit Fec Slate Surcharge Total Fee (A) (B) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) N' Sanitary Sewer FT. FT. / / / Water Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove/Insert/Fireplace Unit' Dryer Vent Mechanical Permi t Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It Curbcut ft Demolition State Surcharge LJI A.i ) .#Q/#"a..; .. -- .. ~ --2503 I Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D. and E Combined) 4S4tP Setbacks HSE GAR ACC i --j I -_.~ , I I I ~ ,......~, ~E PROPOSED WORK IN THE HISTORICAL DISTRICT. OR ON fA},K THE HISTORICAL REGISTER? .r:J..L. If yos, this application must be signed and approved by the Historical Coordillato~ prior to permit issuance, APPROVED' BUILDING VALUE, PLAN GHECK AND BUILDING PERMIT This permit is granted (In ttle express condition that the said' construction shall, in all respects, conform to the Ordinance adopted by the Cily of Springfield, including the Development Code, regulating the conGtruction and use of buildjng~;, and may be suspended or revoked at any time upon violation of any provisions of said ordinances, Plan Check Fee: ? <=;. G:I Date Paid: Recei pt Number' Received . _ ___ ~tNLP' Pia Reviewed By r __~h.'5A 1 7D-;;!e/' Systems Development Charge is due' on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS -5.~-~~5-. ,.c::>~M:b) . By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Jnlormation hereon is tru~ and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinancf;:s of the City of Springfield, and the Laws of the ,State pf Oregon pertaining to ;the work described herein, and that NO OCCUPANCY will be made of any structure without per,mission of the Building Safety Division. . I further cert.ify that only cortlractors and emplo,/ees who . are In compliance with ORS 701.055 will be used on this. project. I further agree to ensure that all requ!red inspectio,ns are requested at the propur lime, that cacll address is readable from the street, that tile permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during c'onstruction. lGignalUre ~ ~.,..a / . . DateJ _7~-7'r VALlDAl ION: 92/7 DATE PAID q2.v:~ ;c: AMOUNT RECEIVED ._~~_~_~$~(P RECEIVED BY __.~ ~~ RECEIPT NUMBER ~ 'I .:0 ., .. ~ . Permit No: 9207'!3CP /2 .~(;, ~t ~ - Date: h -2yf.,j 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 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 in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: 1. 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 1 . or offered for sale before or upon completion. 3. A.~ 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 . >< I, I will be my own general contractor. If 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 reverse side of this form. . ~ /..LN- Signature of Permit Applicant - d- :?!"-'13 Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 - WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT " .. INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ,. ...., ~.. .. .. . . , NOTE:' 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,the 1989 Qrego.n Legislature. IIyou are'acting as you! 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: II 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 taxe!, 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 fait tq .9btain workers' compensation insurance, you may be subject to penalties and will be liable for all clain:{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 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 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 sullicient 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. II 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 >.,~ "" '~e lo\loWlll9 225 FIITH STREET 1M lol\Owl'ng pTOio~,~~~~: ~~,..,";'O ,"pd use ELECTRICAL SPRINGFIELD, OREGON 974[cf.,lng, and does n INSPECTION REQUEST: 7261'\3'769, ('\(L.., ~ City Job Number OFFICE: 726-3759 Zoning~ ~jS?;> 3. COMPLETEJEE SCIlEDULE BELOII 1. LOCATION OF INSTALLATiON lUfe 00 -- J2c:. c.., &LA-t ~,oriZeclSigna - A. New Residential-Single or Multi-Family per dwelling unit. Service Included: LEGAL DESCRIPTION /7o~ 34 2.2.. '2-/3 JOB DESCRIPTION ,HeJT JU/!I / :\' Hr?L T5". Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. . . 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address City Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Name /Dn4 l l'CHIJ.LTE Address J2S ~ &A7LJ1) q~~.Phone 747-t')~21 City OIlNER INSTALLATION The 'installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: /- L /LI;tc ~~~~~~--------~:-~-~~5'j?---------- RECEIPT 11: q2/7 RECEIVED BY: ~ ~ -- 7'~o/Or~ Items Sum Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Bome or Modular Dwelling Service or Feeder $ 85.00 $ 15.00 $ 1,0.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less ~ 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 5CJ'tD c. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 $ 40.00 $ 55.00 $ 80.00 volts See "8" above D. Branch Ci rcuits New, Alteration or Extension Per Panel One Circuit Each Addi tional Circuit or with Service or Feeder Permit ? $ 35.00 $ 2. 00 ~ E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 Sign/Outline Lighting $ 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5. SUBTOTAL OF ABOVE 5iJ. CO 5% State Surcharge '?~ -.--....:- TOTAL &::"t1JI-. Bt'J a- ;___