HomeMy WebLinkAboutPermit Building 1993-05-06SPRINGFIELD
JoB NUMBE
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LOCATION OF PROPOSED WORK:
SUBDIVISION
ASSESSORS MAP:
225 Fif th Street
Spri ng f ield, Oregon 97 477
R ESID ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
TAX LOT
LOT:
-
BLOCK
ztPSTATEdL -filzt
PHoNE: 7Z 6
CITY:
ADDRESS:
OWNER
NEW =- REMODEL I/ ADDITION DEMOLISH OTHER
DESCRIBE WORK:
EXPIRES I'HON EADDRESSCONTBACTOR'S NAME
GENERAL:
PLUMBING:lrnh?
ll6h eMECHANICAL:
ELECTRICAL:
CONST,
CONTFIACTOR ''
FLOOD PLAIN: -.-
- OFFICE USE _
LAND USE:
SECONDARY HEAT
SQUARE FOOTAGE
ZONING CODE:
# OF BDRMS
* OF UNITS:
RANGE:
OUAD AREA:
r OF BLDGS:
OCCY GROUP:
I OF STOBIES:
CONSTR, TYPE:
HEAT SOURCE:
To request an inspection, you must call 726-3769. This ls a 24 hour recording. All inspectiorrs requested before 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.
REQUIRED INSPECTIONS
[-l Temporary Electric
ll
Rough Mechanical - Prior to
cover.
Site lnspection - To be made
after excavation, but Prior to
setting forms.
Underslab Plumbing / Electrical/
Mechanical - Prior to cover.
Footing - After trenches are
excavated.
Masonry - Steel location, bond
beams, grouting.
Foundation - After forms are
erected but prior to concrete
placement.
Underground Plumbing - Prior
to filling trench.
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
Post and Beam - Prior to floor
insulation or decking.
Floor lnsulation - Prior to
decki ng.
Sanitary Sewer - Prior to f illing
trench.
Storm Sewer - Prior to filling
trench.
Water Line - Prior to filling
trench.
Rough Electrical - Prior to
cover
Electrical Service - Must be
approved to obtain Permanent
electrical power.
Fireplace - Prior to facing
materials and framlng lnsP.
Final Plumbing - When all
plumbing work is completc.
Final Electrical - Whcn all
electrlcal work is complete.
Final Mechanical - Wrren all
mechanical work is cotnplete.
'1q{ final Building - When all
,)4quired inspections h;rve becn
approved and building ts
contpleted.
( t'"-'ng - Prior to cover'
p,o"*"ll - Prior to ta,ins
Wall/Ceiling lnsulation - Prior to
cover.
Other
MOBILE HOME INSPECTIOI{S
Blocking and Set.Up - When all
blocking is con)pletc.'
Plumbing Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set-up, and Plumbing
inspections have becn aPProved
and the home is connected to
the service panel.
Final - After all required
inspections are aPProv{ld and
Wood Slove - After installation.
lnsert - After firePlace approval
and installation of unit.
Curbcut & APProach - After
forms are erected but Prior to
placement of concrete.
Sidewalk & DrivewaY - After
excavation is comPlete, forms
and sub-base material in Place.
Fence - When comPleted.
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Driar la Ca-^^l Tr^-a k^^ -ll taarriraA narnhaq qkirt ina AarL.: enrl
WATER HEATER:
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IS THE PROPOSED WORK IN IHE
IJISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER? --
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPFIOVED:
ACCHSE
I
Lot faces
Lot sq. ftg.
Lot coverage
Topograph/
Total heiglrt
Lot Ty1)e
--- lnterior
- - Corner
--
Panhandle
--
Cul-de'sac
P.L
N
c
E
Settlac ks
GAR
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.
Date
Receipt Numbe
Plan Check Fee:
Date Paid
Received By:
BUILDING PERMIT
VALUE
-- \--- -
2*
S' {o
_ __/-4_3_s4Lz(A)
SO. FT. X $/SO. FT.ITEM
Main
Garage
Carport
Total Valuo
Building Permit Fee
state surcharge
Total Fee
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved'SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
Residenti.il Bath(s)
Sanitary Sewer
Water
Storm Sev;er
Mobile Home
PERMIT
FEE
N0
FT.
(c)
PLUMBING
ITEM
Fix t u res
rf ____
f-I.---
Plumbing Permit
State Surcharge
Total Charge
Wood Sto're/ lnsert / Fi replace Unit
Dryer Vent
Mechantcitl Permit
(D)
MECHANICAL PERMIT
I ssu ance
State Surc:harge
Total Pernrit
Furnace
Exhaust Hood
Vent Fan Nl_
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 f urther 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 perrnission 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
proiect.
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
of the property, and the approved set of plans will remain
5-6 - 77
gnatu re
Date
on the site at mes during constr on.
MISCELLANEOUS PERMlTS
Mobile Home
State lssuance
state surcharge
Sidewalk
---
ft
Curbcut
--
ft
Demolitiorr
State Surcharge
Total Miscellaneous Permits (E)
4<A {
/3s-c -?3DATE PAID
VALIDATION:
RECEIPT NUMBER
AMOUNT RECEIVET)
RECEIVED BY _
/3TOTAL AMOUNT DUE (excluding c'lectrical)
(A, B, C, D, anrl E Conrbined)
)UA
Pt;rns ne-ril{v'ed sv
2 2
Permit No:
Address:
lssued by
//2f "wrL( s7:
, ,/( ,,- Date: 5-Z-73
1
2
R OFFICE USE ONLY
STATEMENT:
!NFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILlTIES
Note: Oregon Law, ORS701.055(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 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.
3 A
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.E<J-l will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf 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 inlormation is correct and that I have read and understand
the lnlormation Notice to Property Owners about Construction Responsibilities on the-
reverse side of this form.
f-6 - 7y
ure o mt lican Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to Propefi Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 70{.055(5),
lf you are actinQ as your own contractor to construct a new home or make a substantiallmpr$em€nt to an
i existing structure, you can prevent many problems by being aware of the following responsibiliffes and'areas
of concern
EMPLOYER RESPONSIBILITIES:
lf you hire pelsons not registered with the Construction Contractgrs Boar( to do labor in construgting or assisting
in the con'strlciiori or iriprovement of a residential structure, yoi.r witt,'ln moSt instinces,.$te rur"O to be an
"em'ployer'
"hO
the'peopie you hire wilt,Oe 'lemploy,ees". As thb qftp[6.!er, ydu--Fyit cgrnpfii Wtn-tne following:
Adanempjoyeiyoumu,$twit}inolainconig.}axestrom,eni.p|oy""wagesat
tnetrm@uwillbe.liablefortho!4xpaymentseven-ifyoudon,taqtuallywithholdthe
tax from your employees. For more information, call the Oregon Department of Revenue at 98-3390.
Unemployment lnsurance Tax: As an employer, you are required to pay a tax for tinemptoyment insurance
purposes on the wages of all employees.-.For more in{orrnation, call,the Oregon,Employment Division DHR
at.378-3224.
Workers' Compensation lnsurance: As an employer, you are subfect to the Oregdn Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers'
compensation insurance, you rnay be subject to penalties and will be liable for all ctaim costs if one of your
employees is injured on the job. For more information, callthe Workers'Compensation Division DIF at gT*7434.
U.S. lnternal Revgnue Service: As an employer, you must withhold federalincome tax from employees'wages.
ymentevenifyotldidn'taclqally.tilithholdtne,ux]Formoreinformation,call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Gompliance 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.
t,j
Liability artd Property Damage lhsurance: Contact your insurance a$ent 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 tradeq, and to notify building officials.atrtheappropriate time'q so they can perform
the required inspections. -; ' " ' ''-. '' -.- ' -
!f you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 3O0
Salem, OR 97310-0151
Phone 503-378-4621
o244J 1AP4t89