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Home My WebLink AboutPermit Building 1995-06-28SPRINGFIELc) RES'D ENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PROPO WORK: v ASSESSORS MAP: LOT BLOCK: JOB NUMBER 225 Fifth Street Sprlngf leld, Oregon 97477 TAX LOT: SUBDIVISION: I : l+ PHONE: STATE:ZIP:CITY: ADDRESS: OWNER: i +L DESCRIBE WORK; NEW ,/- REMODEL ADD,T'ON DEMOLISH OTHEB ADDRESS EXPI RES PHONECONTRACTOB'S NAME MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # GENERAL: PLUMBING V - OFFICE USE - LAND USE: WATER HEATER: r OF UNITS: FLOOD PLAIN: ZONING CODE SECONDABY HEAT: SOUARE FOOTAGE;BANGE: QUAD AREA: * OF BLDGS: OCCY GFIOUP: I OF STORIES: CONSTR. TYPE: HEAT SOURCE: To request an lnspectlon made the sarne worklng ' you must call 726'3769. Thls ls a24hour recordlng. All lnspectlons requested before 7:00 a.mday, lnspections requested after 7:00 a.m. wilr be made the foilowrng work day. REOUIRED INSPECTIONS wlll be l-l Masonry - Steel tocatlon, bond.J beams, grouilng. Foundatlon - After forms areerected but prlor to concreteplacement. Underlloor plumblng / Mechanlcal - Prlor to lnsulatlon or decklng. Post and Beam - prlor to floorlnsulatlon or decklng. Floor lnsulallon - prlor todecklng. Sanllary Sewer - prlor to fllllngtrench, Slorm Sewer - prlor to filllngtrench. Water Llne - prlor to filllngtrench. r'd'fliifl;"ffil"ln'.'-o'nn - Prior ff[ oo*",r - prror to taprns. Electrlcal Servlce - Must beapproved to obtaln permanent olectrlcal power. l-l Flreplace - prtor to factng.J materlals and framlng lnspl ffi Framlng - prlor to cover.? Wall/Celtlng lnsulatlon - prlor tocover. l-_l Wood Stovo - After lnstailailon [-l tnsert - After ftreptace approval - and lnstallauon ot unlt. Curbcul & Approach - Afterforms are erected but prior toplacemont of concrete. Sldewalk & Drlvewav - Afterexcavation ls complete, formsand sub.base material in place. [-l fence - When compteted. ry [-l Finat Mechanical - When ail - mechanical work ls complete. ry Flnal Building - When altrequlred lnspections have beenapproved and building iscompleted. Other MOBILE HOME INSPECTIONS [-_l Btocking and Ser.Up - When ail - blocklng is complete. Plumbing Connections - Whenhome has been connected towater and sewer. Slte lnspectlon - To be made af ter excavatlon, but prior tosetting forms. m UnderslabPlumblng/Electrical/ n-f,Mechanlcal - prlor to cover. +J Temporary Electrlc Footlng - After trenches are excavated. Rough Plumblng - prlor to cover. Rough Mechanlcal - prlor to cover. Rough Electrlcal - prlor to cover, Flnal Plumbing - When allplumblng worl< ls complete. Flnal Eleclrical - When allelectrical work is complete. Eleclrical Connection - Whenblocking, set.up, and plumbingInspections have been approvedand the home ls connected tothe servlce panel. l--l Street Trees - When ail required - trees are planted. Final - After all requiredlnspections are approved andporches, skirilng, decks, andventlng have been lnstalled, -4r/: *' ,lrMF \\\ \ *wT-, OF BDRMS: -- rl Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Tvoe.v V'1 lnl"rio, - Corner - Panhandle - Cul.de.sac g ks PL.HSE GAR ACC N S E .-.ro THE PROPOSED WOFfK N ThE - HISTORTCAL DISTR|CT, Oir ON THE HISTORICAL REGISTER? - lf yes, thls applicatlon must be signedand approved by the Historlcai Coordlnator prior to permit lssuance. APPBOVED: VALUE state Surcharn" t{.63+ }.18 lq.uTotal Fee TI (A) X $/SO. FT. Ffn Total Value Building Permit Fee BUILDING PERMIT ITEM SO. FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMTT Thls permit is granted on the express condition that the saldconstruction shall, in all respects, conform to the Ordinanceadopted by the City of Springfleld, includlng the Development Code, regulating the construction and use olbulldlngs, and may be suspended or revoked at any tlme upon vlolation of any provisions of sald ordlnances. else/.tsFleviewed By T Dm- Receipt Numbe Recelved By: Plan Check Fee: Date Pald: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge ls duo on all undeveloped propertles withln the City limits which are belng lmproved. Besidential Bath(s) No - FEE (c) FT. FT. FT. Plumbing Permlt State Surcharge Total Charge PLUMBING PERMIT ITEM Fixtures Sanitary Sewer Water Storm Sewer Moblle Home ADDITIONAL COMMENTS Wood Stove/ lnsert/ Flreplace Unit Dryer Vent 6(D) N0Vent Fan Mechanlcal Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rn ace Exhaust Hood By slgnature, I state and agree, that I have cars,ully examlned the completed applicatlon and do hereby certlfy that all lnformatlon hereon is true and correct, and I f urther cerilfy that any and all work performed shall be done in accordance wlth the Ordinances of the Clty of Sprlngf ield, and the Laws of the State of Oregon pertalnlng to the worl< descrlbed hereln, and that NO OCCUPANCY wlll be made of any structure wlthout permission of the Buitdlng Safety Divislon. I further certlfy that only contractors and employees who are ln compliance with ORS 70'1.055 wlll be used on thls prolect. I further agree to ensure that all required lnspecilons are requested at the proper tlme, that each address ls readable from the street, that the permlt card ls located at the front and the approved set of plans wlll remaln I times during constructlon.te al Date \ Slgnature of the on the MISCELLANEOUS PERMITS Moblle Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition Total Miscellaneous Permits (E) 60-r3 TOTAL AMOUNT DUE (excluding clectrical) (A, B, C, D, and'E Comblned) \6o.01 ( VALIDATION: RECEIPT NUMB R DATE PAID AMOUNT RECE RECEIVED BY g i,:: R-\U-.\Tre- V Permit#: Address Issued by:Date: I Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38: 1. 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 or offered for sale before or upon completion. 3,A.. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. 38. I will be my own general contractor If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this huilding permit of the name of the contractor. I hereby certify that the above information is correct and thatl have readand do understand thelnformation Notice to Property Owners about Construction Responsibitities on the reverse side of this form. 6^zn?f (Signature of permit applicant) (White copy to issuing agency pennitfile, pink copy to applicant) OR (Date) Y Iflformation Notiee't6'Pr,bperty Owners r ..:" . 3=i; r' About Construction Responsibilities ;:; ,-.-GS Note: Th!.1Infbrmation Nbtice to Property,Oryney.s about Construction Respansibilr;-W{i was deveiopect by the Co;nstruitiin Conrraitors Board in accordance with ORS 701 .05.r(5)*i If you ;u'e acting as your own contractor to cclnstruct a new hclme or make a sr"ibstantial improvelnent to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of, concern. ., l EM PLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvemcnt of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire rvill 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 ihe time employees are paicl. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more infbrmation, call the Oregort Dept. of Revenue at 945-8091. 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 informati<m, call the Oregon Employment Division at the Department of Human REsources at378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and irurst obtain workers'compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may bebiibjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable forthe tax payment even if you didn't actually withhold the tax. For more information, call the Intemal Revenue Service at I-800-829-1040. OTHEH RESPONSIBTLITIES AND AREAS OF CONCEHN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremen6 that may be brought to your attention through inspections. Li*itity and property damage insurance Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions *uch as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your emfloyeer. Bipertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rcugh-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspectioni. If you have additionai questions, write or call the Construction Contractors Board (PO Box l4l4},Salem, OR 97309-5052, 5O3t37S-4621). The Board is located at 700 Summer St. NE Suite 300, in Salern' prop-own.pm4 1t94 CITY OF SPRINGF'ELD, OREGO'U st,Frlt\.c;FtELO 6ubn ...,,has ths loll n oroiect-obes ncn !pecilic *fi,1.'J',"$[ e.PFr('val' INSPECTfON REQUEST z 726-37,9?*.,.izsd OFPICE: 726-3759 'r!' "- 225 FTFTE STREET SPRINGFTELD, oREGoN 97 417 1 ON OF INSTATI,ATION b A ELECTRICAL PERHIT APPLICATION ob Number 3. COHPLETE FEE SCEEDIII.E BELOV Nev Residential-Single or MuIti-Family per dvelling unit. Service Included:Items CostI,EGAI /3 JOB DESCRIPTION Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALI..ATION ONLY Electrical Contractor Address Citv Phone Supervisor License Number Expiration Date- Constr Contr. Number Expiration Date- Signature of SuPervi sing Electrician DESCRIPTIONzffi O/1t22 Sum Phone OVNER INSTALLATION The installation is being made on property I ovn vhich is not intended for safe, lease or rent' 0wners Signature: DATE: 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular DvelIing Service or Feeder s 8s.00 s 1s.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amPs - 401 amps to 600 amps - 60L amps to 1000 amPs- 0ver 1000 amps/vo1ts - Reconnect 0n1Y Temporary Services or Feeders Installa1ion, Alteration or Relocation 200 amps''or less 201 amps to 400 amPs -over 40L to 600 amps Over 600 amPs or 1000-voITs D. Branch Circuits Nev, Alteration or Extension Per Panel One Circui t Each Additional Circuit or vith Service or Feeder Permi t 2- E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigati-on - Sign/Out1ine Lighting-- Limi ted EnergY/Res - Limited EnergY/Comm o2 s s0.00 s 60.00 s100. 00 s130.00 $300.00 s 40.00 above .00 .00 .00 il8fl s40 $ss $so see C x rs Name Address Ci ty 7/r-f/e z zo Zeo s 40.00 s 40.00 $ 20.00 s 36.00 5 SUBTOTAL OF ABOVE 5Z State Surcharge 32 Administrative Fee TOTALRECETVED B s 3s.00 $ 2.00 ,/2-4..tL_----r--.-- OREGONCITY OF 225 ITI}TE STREET !'':. t '':,'.;:.-,'t"it-.--- SPRTNGFTELD, OREGON 97 471 INSPECTTON REQUESTT 726-3769 OFPICE: 726-3759 1.ON ON Permi t s non-transferable and exPire if vork is not started vithin 1B0 days of issuance or if vork is suspended for 80 days'., 2 COMRACTOR TNSTALTATION ONIY ELectrical Contractor Address Ci tv Phone Supervisor License Number Expiration Date SPFI FIELO .BIJCTRICAL PERUTT Ci ty Job Nunber 3. COHPIJTE FEE SCMDULE BELOV A Nev Residential-Single or Multi-Family per dvelling unit. service rncluded' ,a"*s cost L000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home- or uddular Dwelling Service or Feeder s 85.00 s 1s.00 $ 40.00 B. Services or FeedersI Installation, Alterations or Relocation: approval. Zonir ,rlllM__ (- ON Sum 200 amps or 201 amps to 401 amps to 60L amps to 0ver 1000 Reconnee t less , I4400 amps w 600 amps 1000 amps amps/vo1 ts 0n1y s s0.00 s 60.00 $100.00 s130. 00 $300.00s 40.00 Constr Contr. Expiratio te 5I of Supervising Electrician Temporary Services or Feeders Installation, Alteration or Relocation 200 amps"or less $ 40.00 over 4b1 to 6oo amps - $ 8o.oo Over 600 amps or rbOO voTEs see 'B" aEG- Nev, Alteration or Extension Per Panel One Circuit $ 35.00 Each Additional Circuit or vith Service ,or Feeder Permi r ----l $ 2.00 -28 Miscel-l-aneous (Service/feeder not included) -Each installation Pump or irrigation - Sign/Out1ine Lighting_ Limited Energy/Res _Limited Energy/Comm r C a Ovners Name Address Ci ty Phone TION The installa'tion is being made on property I ovn vhich is not intended for sale, Iease or rent. 0vners Signature: RECEI SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Admini.s trative Fee TOTAL D E $ 40.00 s 40.00 $ 20.00 $ 36.00 RECEIVED 5 <-t Oe.?z?.o30----:q-- -*r,/6 o/a, fon atarf I t clh/a 7d2 a?cau/7fiaaE a) .t/4a z/4*t/ *D* s,/o6 (rnP @ 7l*o ,€tutat @ 4o!) Oha /e?.?2/7 ?2 f" n)%u9 etfM; 6a y's,o' v4,'o D,ff. -' - /?.a5 - /bf 4/einr7(/ So,o' ) t