HomeMy WebLinkAboutPermit Building 1991-12-31nestoeruTtAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PRO ED WORK:
ASSESSORS MAP:
LOT:
SP]lI,{GFIELE,
h,
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97 477
TAX LOT
SUBDIVISIONBLOCK:
PHONE:
ZIP:STATE:
OWNER:
ADDRESS
CI
NEW
-
REMODEL ADDITION DEMOLISH OTHER
L-/
DESCRIBE WORK:
ELECTRICAL:
CONST.
S NAME DRESS EXPIFIES PHONER#
MECHANICAL:
CONT
GEN ERAL:
PLUMBING
l
RANGE:
_ OFFICE USE _
WATER HEATER
FLOOD PLAINLAND USE:
ZONING CODE:
* OF BDRMS:
r OF UNITS:
QUAD AREA:
* OF BLDGS:
OCCY GROUP:
# OF STORIES SECONDARY HEAT:
SQUARE FOOTAGE:
CONSTR. TYPE:
HEAT SOURCE:
To request an inspection, you must call 726-3769. This is a24 hour recording. All inspections requested before 7:00 a.m. w ill be
made the same working day, inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
Temporary Electric Rough Mechanical - Prior to
cover.
[-_l final PlumbinglJ plumbing work - When all
is complete.
Site lnspeclion - To be made
after excavation, but prior to
setting forms.
Rough Electrical - Prior to Final Eleclrical - When all
electrical work is complete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain permanent
electrical power.
Final Mechanical - When all
mechanical work is complete.
Footing - After trenches are
excavated.
nal Building - When all
Fireplace - Prior to facing
materials and framing lnsp.
required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.Framing - Prior to cover.
Other
Foundation - After forms are
erected but prior to concrete
placement.Wall/Ceiling lnsulation - Prior to
cover,
Underground Plumbing - Prior
to filling trench.l-l Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation.
Post and Beam - Prior to floor
insulation or decking.lnsert - After fireplace approval
and installation of unit.
Blocking and Set.Up - When all
blocking is complete.
Floor lnsulation - Prior to
decki ng.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
tren c h.Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Storm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Water Line - Prior to filling
trench.
Fence - When completed
Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.Rough Plumbing - Prior to
cover.
q\\8qn
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Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type --'
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
PL.HSE GAR ACC
N
S
E
.,,- THE PROPOSED WORK IN TH
HISTORICAL DISTRICT, OR ON
THE HISTOHICAL REGISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
ET
VALUE
BaS(A)
X $/SQ. FT.
BUILDING PERMIT
ITEM SQ. FT.
Mai n
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that t
construction shall, in all respects, conform to the O
adopted by the City of Spri ngfield,
Development Code, regulating the const
buildings, and may be suspended or
Plans Reviewed By Date
v:
e said
tnc
ce
upon violation of
Plan Check Fee
Date Paid:
Receipt Num
Rece
n and use of
d at any time
I OnS id ordinances
ng the
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT
FEE
N
FT.
FT.
(c)
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rn ace
Exhaust Hood By signature, I state and agree, that I have caref ully 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 Ordinances of the City of Springf ield, 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 f urther certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
project.
I f urther 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
property, and the approved set of plans will remain
atu
Date C-41
the s at all ti s construction.
of the
d
IZ. qL
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (tr)
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, D, and E Combined)15 qs \t.as
VALIDATION
RECEIPT NUMBE
DATE PAID
AMOUNT R
RECEIVED
FT.
p{RT\ouun:
NA.}IE: NOR}'LAN & J NAN GOO}I\ESS
ADDRESS
15 KAT]ItrEEN CCIURT
SPRINGI'IELD, OAIGON
17
PHONE:
344-4782
7 46-557A
0
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(
(
)
)
II-ITEREST IN PROPERTY: OWNER
(Indicate one: owner, contraet, purchaser,
option hoLder, other)
ffJNER OF RECORD:
NAME:SAMT
.d-DDRESS:SAME
PJ"IO}IE
1t'20CI
rAx LOT. #15AA
BY
SAIIE
17 01 23 12
ILA.P il, 17 A7 22 41
aI}xDr@\ra,n
Actlng Chairman, Land DevelopmenE Revi-er+ Conrmj-t.tee
xri.e i.nitXr
Date
PAFiTITION
ITIONAL APPROV M@
gxl"a.,N3
KATHIffiN UI,KT
k/AYa/6EWLA
(-)
JUL 1Z 1979
A E COUNTY
ING DIVISION \I
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FILE No: rLl ..1';"i i?
-,ANNlNc DtVtStON / E[{VIRONMENTALMANAGEI';IENTDEPARTMENT / l25EASTBTHAVE. / EUGENE,OR97401 / PHONE(503)687-4186
.ir.-1a Sheet I sf 2
CHUCK BAILEY, ARCHITECT
l.rAP PRXPARID BITAO:aflt I AMFTTF STRFFT, Fl_tGFNtr, GF.EC-ON
CHI]CK BAILEY, ARCHITECT
0 wlL|METrE STREET, EV-GE-NE, O
48s-331s 9740L
RAT}IBOW WATER }ISTRTCT
SEPTIC TANK
RA
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lane ccunty
ETECTRIC SERVICE:
ZONlNG:
WATER SUPPLY:
PERMIT #:
SEWAGE DISPOSAI.:
S.I. #:
DATE SUBMITTED:
RECEIVED BY:
EEE PAID:
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office use only
HNARING DATE:
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NORMAN & JEAN GOODNESS
15 KATIIIEEN COURT
SPRINGFIEID, oREGON.
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REYISED IOT e
IINES
CHUCK BAILEY, AH,C}IITECT
1740 WILI-AMETTE STREET, EUGENE, OREGON
48s-33 r 5 97401 Ir
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QCNDtTtQNAL APPROVAL
l-: JUL 1z 1979
LANE COUNTY
PLANNING DIVISION
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TO:
_Land Di vi s i on Sect'ion
_Regional Pl anni ng
_Pl anning Research
___Zon i ng Enforcentent
__Envi ronmental Heal th
_lwute. Poll utjon Control
_Soils Data
_Fl ood Management
-_Transportatjon
Pl anni ng
_Assessment & Taxat'ion
_Pa rks Di v'i s j on
_Lane Real Esta te Di v.
__Lane Public Safety
_Lane Publ'ic Lands
_ Lane Legal Counsel
__Housing & Comm. Dev.
A request f
received by
PROPOSAL
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C0NI'4ENTS (Reverse
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_-Lane [xtensi on Servi ce
__Lane Trans i t Di strict
__l_tane Reg. Air Pol . Auth.
_l uater Djstrict _-
Boundary Commission
Port of Siuslaw
Plan Dept
*)_c,tyor_W
SIrwra
_ll.l.l. Natural Gas
* )_Purj f ic N . l^/. Bel I
)/-l Pac'ific N.l^J. Powet'y'rL
Tri-Agency Dog Control
_- -LCDC
I School District
T trre District
#-[.-state
_ . _State
_ _State
State
g(/ state
Fo re s try_.
Hi ghway Di vi sion
Environ. Qualjty
Dept. of Lands
Fish & Game
__- 5tate Geol. & Mineral Indus.
_ _State Veterinarian
__Dunes Nat'l Rec. Area
__S i us I aw Nat' I Forest
__ t,/i I I amette Nat'l Forest
_-__-Bureau of Land Mgmt.
_ !oil Conservation Service
___Corps of Engineers
___Fed. Aviatjon Authority
Fed. Conmunications Conm.
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LANE COUNTY LAND MANAGEMENT DIVISiON.l25 [ast 8th Avenue, Eugene, 0regon 9740]
Phone' -€€J.406r a7- 37A+ffi-4s/8
or I and use acti on, as descri bed on Data Sunrntary and attached schemat'ic has been
the Planning Division. If sjgnificant impact is evjdent. please send conments
to I and Management Division bY
Specif.ic concerns of your agency should be addressed in addition to adverse impacts on
general livability of the area and 'its future development'
[or adclitional information, conta ct-_-.6&EA€- Zafzrel)2 -
DATA SUMrARy: Journal no. PA t511_4 Zone District fu
Apipl i cant Lot s'ize A .8q kze-r-
l'roperty Address ? 1 ?f;--U/iL/-S/ n!@ t\ap_- |-?:AB:_ZZ.=_3._?_
-SPrzttl4E-gaz4. rax Lot_.1@ 4- _s .A
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-21.44-4eL z1/24--t/zfk2,.llZCA .
Side May Be Used):
Parcel #l meets DEO standards f- See S-. T-.-#79- 370 , Parcel- #2-mbe
#79-664. G. Gray 6-13-85
g-l a- boJtomless sand- fi'lter sewage-di sposa-1 qzstem.---'-
ts conventional sewage disposal standards. See S.I.
g
ris,-,-r- U:O3-J +a?O Job Location
Written Directions _
ubo,vision:,fi,
ILITY REPORT FOR SUBSURFAC
S
I
t. * ,/O-ry- 37()
lLo:---_ Blocl. __
SITE FEASIB E AND ALTEBNATIVE SEWAGE DISPOSAPPLICANT'S IJAME AND ADDRESS
WNEB'S NAME AND ADDRESS
ail reportto ()Applicant ()Owner
TRUCTURES NOW ON THE PROPERTY
lOrwSED USE OF PROPERTy
qTERSUPPLY
pno"4t_L e1/s
Phone -Prefer to pick up. Call -{95:*7--.-- (owner, etc.) when reaCy
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OAT E
Contror ?ft/ 77
SNTAL T.IANAGEI!1ENT
t
AUTHOqI lG t.,.'f U ii i
it Processing Section
ZaLADivis'iin of lVater polturion
NE COUNTY DEPARTIIENT OF ENVIPO|\TTI
: r;E
125 EAST 8TH A\i FNr iF Fr ri.ltrr\itr OPtrr:nrrr O-r^a\1 AO-, inal
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FEASIBILITY REPORT FOH
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B lock
SITE
APPL,CANT,S rl]AME AND ADDRE
OWN ER'S NA,!i[ AND ADDHESS
record,and that said
RFACE AND ALTERNATIVE SEWAGE DISPOSAL
so
STRUCTURES NOW Or.J THE pFl
(
TFOpOSED USE 0F pROpERTy
({Preterto pick can74b - 4 Z 4
WATEF SUPPLY
I hereby cerilfy that the above WITHIN ONE MILE OF THE CITY OF (No)contract purch aser,'
statements are true and accurate, and that Ipotential buyer ; _--.".-.-- realtcr or agent. I certify that (if not the owner) | am authorized to act for the own
Ilail report to ( )Appticant ( )Owner
OPERTY
owner is a ware and appro ves of this action
74
il1 dd ?h.n*9417---
, ete.) when ready.
have the fol low ing legal interest in the property owner of recotd;
e{ o{
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/-?-
TEST HOtEs READY
st. * tc-70-bd
TRS#c
-Dlrce
Approved X Da te
DATE ISSUED:
I NTER I OR
,
REAR
Correcti on
PERMI T
n
I nspecto . z0RD , i).,)r
L SIDE
K
FRONT
-2)0
,-t roved Dap
Date] -3-€/Comection Date
Cor:'ecti on Date
Inspe ctor
tnspector=1fuP- D
Approved Date Correcti on Date I n s pecto r_
Date
o-1.
Appro d Correcti on
recti on Date
,/n-/6-74lnsPe ctor
I nspector
N i E
Approved Date ,/e=14*4orI
ROUGH MECHANI CAL
Ap roved
Approved_ y'' Date
Date -LZ-Correcti on
R ERI CTI
nspecto r
z Correcti on Date .Inspe ctor
AIH / GYPSUM BOARD iNSPECTIONApproved Da te Correcti on Date Inspe ctor
Approv
/l.t00D sT
te 2-rt-# ,Correction Da te I nspe ctor
FINAL PLUMBING INSPECTION ",.'Approved ,/ Date ? - /; /{ t Correct j on Date--I nsp ector
FINAL INSPECT,ION BUILDING tr /IYOB]LE HOME E /AG
Approved "/ Dale Z-g-{4 /Correction D
PLACEMENT E
ate Inspe ctor
CERTIFICATE OF OCCUPANCY EApproved Da te
TEI'IPOtrARTCERTI
Insp.roved
FICATE OF
Date
t"17 4..t97
SDs P,rJ tz-t!-gf
A pp Insp.
a
LAN' C(|UNTY INSPECTION RTUORD
LANE COtlNTy, OREGON
DEPT. OF ENVIRONMENTAL MAr
JOB ADDRESS
TO
NOTE
CONSTRUCTION PERMITS
S INSPECTION DIV.JEMENT
CGIFIFIECTICIN NGITICE
DATE
BLDG. PERIVIT
,/
tl
(r,l45
k
FIE.INEiPECTIEtN FIECIUIFI EE'
Phone ciElT-4OCiEi FoFl APPFIoVAL INSPECTOR
T
LANE COIINTY, OREGON
DEPT. OF ENVIRONMENTAL MAr, iEMENT
Cc,FIFIECTICtN
CONSTRUCTION PERMITS
A INSPECTION DIV.
Nc,TICE
JOB ADDRESS 2 I K*4?/dtu c*-DArE /rO- t Z - I ,/
TO
NOTE
BLDG. PERMIT
I/,s*
I K U
I,AAI
P
t10 +-v t+1
5\\s
c 5 5-7 3 HE-tNEtPEcrtoN FIE.L'.E.E.,
Phone 6E|7-4OEi5 FoFl aPPFlovAL INSPECTOR A*DuB*Y
I
Permit No
Address:
lssued
1
2
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILIT!ES
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
underORS 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 38:
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
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 Corqtractors Board.
3.8 I will be my own general contractor.
lf I hire subcontractors, I will hire onfy subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contracto6 lwill
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 aboye information is conect and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Date
CONSTR UCTION CONTRACTORS BOARD
0244J 8191
Date:
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
3
OR
\
INFOTI'flATION NOTICE TO PROPERTY OIVftERS
ABOUT CONSTRUCTION BESPONSIBILITIES
NOTE: This lnformation 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 Oregon Legislature.
lf 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:
lf 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 lnsurance 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 lnsurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers'
compensation insurance, you may be subject to penalties and will be liable for al,l claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at g?3-74U.
U.S. lnternal Flevenue 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 lnternal Revenue Service at 221-3960.
OTHER HESPONSIBILITIES 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 lnsurance: 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.
lf you have additional questions, write to Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10124189