HomeMy WebLinkAboutPermit Plumbing 1992-08-02SPRINGFIELO
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Office: 726-3759
Q?I 6lnJOB NUMBER
225 Fifth Street
Springfleld, Oregon 97 477
ASSESSORS MAP:TAX LOT:ooqq
LOT:BLOCK:SUBDIVISION
OWNER:PHONE:
ADDRESS: ---P.o .__ l')s-
CITY:STATE:oq ZIP:q lgot
DESCRIBE WORK
NEW =-. REMODEL
-_
ADDITION DEMOLISH OTHER
C]ONTRACToR'S NAME ADDRESS
CONST.
CONTFIACTOR #EXPIRES PHONE
CENERAL: _---
I:'LUMBING:,}t UO'0"
MECHANICAL:
trLtrCTFIICA L. -
_ OFFICE USE _
# OF BDFIMS
QUAD AREA:
* OF BLDGS: -
RANGE
ZONING CODE:
FLOOD PLAIN
CONSTFI. TYPE: -
HEAT SOURCE:
LAND USE:
# OF UNITS
SECONDARY HEAT:
SQUARE FOOTAGE:
OCCY GROUP:
* OF STORIES: -
WATER HEATER:
To request an inspection, you must call 726-3769. Thls is a24nour recording. All lnspections requested before 7:00 a.m. wlll be
rnadc the same working clay, inspections requested after 7:00 a.m. will be made the following work day.
REOUIRED INSPECTIONS
Ternporary Eleclric Rough Meclranical - Prlor to
oover.
Final Plumbirrg - When all
plumbing work is complete.
Site lnspection - To be madc
after excav:ition, but prio, to
setting forrrrs.
Rough Electrlcal - Prior to Final Eleclrical - Wlren all
electrical work is conrplete.()over.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain permanent
clectrical power.
Final Mechanical - When all
mechanical work ls complete.
Footing - After trenches are
excavated.Fireplace - Prior to faclng
rnaterials and framlng lnsp.
Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Ste()l location, bontJ
beams, grouting.Framing - Prior to cover.
OtherFoundation - After forms are
erected but prior to concrete
placenrent.Wall/Ceiling lnsulation - Prior to
oover.
Underground Plumbing - Prior
to filling trench.Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or rlecking.
Posl ancl Beam - Prlor to {loor
insL!lation or decl(ing.lnsert - After flreplace approval
and lnstallation of unit.
Floor lnsulalion - Prlor to
decking.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Conneclions - When
home has been connected lo
water and sewer.
Sanitary Sewer - Prior to fillingtrench. ).SO t Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Slorm Sewer - Prior to lilling
trench.
Sidewalk & Driveway - Afte.r
excavation is complete, {orms
and sub-base nraterial in place.
Water Line - Prior to f illing
trench.[-l Fence - When completed
Street Trees - When all requlred
trees are planted.
Final - After all required
lnspections are approved and
porches, skirting, decks, and
venting have been installed.
N
Rough Plumbing - Prior to
cover.
I.OCATION OF PROPOSED WORK:
t1 f ca]
f,lA- t9 t t
I
tl
E
tl
[l
fl
E
E
r
Wood Stove - After installation.
tl [-_l glocking and Set.Up - When ailu blocking is complete.
E tl
E
E
Lot faces
Lot sq. ftg.
Lot coverage
TopograPhY
Total height
Lot Type
v
_- lnterior
-
Corner
_- Panhandle
-.
Cul'de-sac
Setbacks
P.L.HSE GAB ACC
N
S
: THE PROPOSED WOBK IN THE
VISTORICAL DISTBICT, OR ON
I'I.IE HISTORICAL REGISTER? .---
lf yes, this application must be signed
and approved bY the Historical
Coorclin;rtor prior to pcrmit issuance'
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This perrnit is granted orl the express condition that the said
construction sirall, in all respects, conform to the Ordinance
adopted by the City of Springfield' including the
Developtnent Code, regulatirrg the construction and use of
buildings, ancJ may be suspended or revoked at any time
upon violation of any provisions of said ordinances'
Plan Check Fee: -=--_-
Receipt Nutnber:---
DatePlans Rcviewed By
Date Paid
Received BY:
BUILDING PERMIT
VALUE
(A)
SO. FT. X $/SO. FT.ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Systoms Devr:loptttc:nt Cltat -qtl ls ciue on all urlcloveloped
properties within thc City limits which are being improvcd'SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT
FEE
No
<<-oo
FT.
FT.
5-'.-7<(c)
J 1s
FT. E.
ss ooPlumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
(D)
N0
Mechanical Permit
lssuance
State Surcharge
Total Permlt
Fu rnace
Exhaust Hoo<l
Vcnt Fan
By signature, I state and agree, that I have caref ully examined
the cornpleted apl)lication and do hereby certify that all
inlormation hereon is true and correct, ancj l f urtlter certi{y
that any and all work petforrrecl shall be done in accordance
witlr tlrc orclirr;rrrcc:; ol tlrr: city of sprinl;f ir:ltl' ;rtrtl llrr: l.;rwl;
clf tlro {ll;rto ol Orct;otr lrcrt;rirlin1l to tlle wotk tlcscribccl
Ircrcin, ;rtl<l tlrat NO OCCL'PANCY will bt. tn;rdc o[ :rny
stnrcture without pernrission of the Buildin!l safety Division'
I lurthcr ccrtif y that ()nly contractors ancl r:mployees who
are in compliarrce with ORS 701'055 will be used on this
proiect.
I f urther agree to cnsure that all requi
requested at the proper time, that each
from the street, that the permit card ls
Signature
Date
q
of the ProPertY' and tlre aPProved
tructionduring c
red insPections are
address is readable
located at the (ront
of plans will remainMISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk .....--- ft
Curbcut
-
tl
Demolition
State Surcharge
Total Miscellaneous Permits (E)
VALIDATION:
RECEIPT NUMBETI
DATE PAID -tlatza
RECEIVED BY,-. _
AMOUNT RE,CE,IVEI)
a)lu__
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
s-).-)<
E
on the site at all
S-'.ls
roA
Permit No:Qalost-
Address I Ltlb O-Ar^.-,-.,oie-
ffi Stdq^0
Date:lssued
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 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 +L/-,n r\-, )
1
2
3
OR
rr i.l \ l,
Contractor registration numbe
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.B I 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 information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
s) el"a
nature o it Appl cant Date
CONSTRUCTION CONTRACTORS BOARD
o244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORIuaTION NOTICE TO PROPERTY OVH(ERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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 RESPONSIB!LITIES:
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 emrployer, you must withhold income taxes from employee wages at
liable for the tax payments even if you don't actually withhold thethe time employees are paid. You will be
tax from your employees. For more information, call the Oregon Department of Revenue at 378-33g0.
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' Compensationl-aqpensationinsuranceforyouiemployees.ityoufailtoobtainworkerS,
compensation insurance, you may be subject to penalties and will be liable for al{ claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at g7g-7494.
U.S. lnternal Revenue Service: As an employel you must withhold federal income tax from employees'wages.
ymentevenifyoudidn'tactuallywithholdthetax.Formoreinformation,call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF GONCERN
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.
and lnsurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and
tures, fire, or work that mu
omrssrons suc
st be re-done.
h as falling tools, paint overspray, water damage from pipe punc-
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, ts 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
4244J 1At24t89