HomeMy WebLinkAboutPermit Building 1993-6-25
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WOR\<'
176"3,
Le. -' L
. ASSESSORS' MAP'
LOT:
~~
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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
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,
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~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
~
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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: ~
~
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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
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