HomeMy WebLinkAboutPermit Building 1994-08-23GFIELD
D7
JOB NUMBER ?/tz 8,/
225 Fifth Street
Sprlngfleld, Oregon
TAX LOT:
R
P
IESIDENTIAL
ERMIT APPLICATION
lnspectlons: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:7 <t-F-t IJJ -
ASSESSORS MAP:/) -e7 -'?z
LOT BLOCK:SUBDIVISION
Trlt-A1]a-6PHONE:
<i'rr{ 1 JSTATE:ZlPi
r\
OWNER:B,lt srr" uu
ADDRESS:
CITY:
s7'
SP FD
NEW
-
BEMODEL ADDITION X DEMOLISH OTHER
ADDBESS EXPIRES
.l\!L 14.,7 /'2 t 3\
DESCRIBE WORK:
PLUMBING:
MECHANICAL:
ELECTRTCAL:
PHONECONTRACTOR'S NAME
GENERAL:i , \r{,L
CONST.
CONTBACTOR #
- OFFICE USE -
ZONING CODE:
FLOOD PLAINLAND USE:
A OF UNITS:
SECONDARY HEAT:
SQUARE FOOTAGE:
, OF BDRMS: .-OCCY GROUP:
r OF STORIES:
OUAD AREA:
r OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspectlons requested before 7:00 a.m. wlll be
made the same worklng day, lnspectlons requested after 7:OO a.m. wlll be made the following work day.
REOUIRED INSPECTIONS
l--l Temporary Electrlc
S{ nough Electrlcal - Prlor to
----"\cover.
K
X
Rough Mechanlcal - Prlor to
cover.
Flnal Electrical - When atl
electrical work is complete,3
E Foundatlon - After forms areJAr erected but prlor to concrete
placement.
Slte lnspectlon - To be made
after excavatlon, but prlor to
setting forms.
Underslab Plumblng/ Eleclrlcal /
Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Underground Plumblng - Prior
to fllllng trench.
Underlloor Piumblng / Mechanlcal
- Prlor to lnsulatlon or decklng.
Posl and Beam - Prlor to floor
lnsulatlon or decklng.
Floor tnsulatlon - Prlor to
decklng.
Sanltary Sewer - Prlor to fllllng
trench.
Storm Sewer - Prlor to fllllng
trench.
Waler Llne - Prlor to filllng
trench.
Rough Plumblng - Prlor to
cover.
Electrlca! Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Framlng - Prlor to cover.
WallrCelllng lnsulallon - Prlor to
cover.
Drywall - Prlor to taplng.
Wood Stove - After lnstallatlon.
lnsert - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Drlveway - After
excavation ls complete, forms
and sub-base materlal in place.
n Fence - When completed.
Streel Trees - When all requlred
trees are planted.
Flnal Buildlng - When att
requlred lnspectlons have been
approved and building is
completed.
MOBILE HOME INSPE TIONS
K
[-_l Blocking and Set.Up - WheJr all.J blocklng is complete.
Flnal Plumbing - When allplumblng work is complete.
Final Mechanlcal - When all
mechanlcal work ls complete.
Plumbing Connections - When
home has been connected to
water and sewer.
Electrical Conneclion - When
blocking, set-up, and pluqbing
inspections have been approved
and the home ls connected to
the servlce panel.
Flnal - After all required
inspectlons are approved andporches, skirtlng, decks, and
ventlng have been lnstalled.
tl
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X
X
F
XE
X.
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5r7U
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WATER HEATER:RANGE:
E
tl
Other
-
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total fl€lght
Lot Type _
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
PL.HSE GAR ACC
N
S
E
i 15 THE PROPOSED WORK tN THE -
HISTORICAL DISTRI T, OB ON
THE HISTORICAL REGISTER?
-
lf yes, thls applicatlon must be slgned
and approved by the Historlcal
Coordinator prlor to permit issuance.
APPROVED:
-#"
3% &*z*t. ' Z:=r_(A) -'^ 3? 5
VALUE
56.2-
I
X $/SQ. FT.
24Vzz.zZpz- rza
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT,
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permlt 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
bulldings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.L
e-44y/uuz=
By
Plan Check Fee:
Date Paid
Receipt Number:
Received
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)c2/€s.
Systems Development Charge ls due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Resldential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
lP
.-?zt)-
No
FT.
FT,
PLUMBING PERMIT
Plumbing Permlt
State_ Surcharge
Total Charge
J)t *)na), -E(c) /cr
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
Mechanical Permit
lssuahce
State Surcharge
Total Permit
By slgnature, I state and agree, that I have carefully examlned
the completed appllcation and do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther certify
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work described
hereln, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Divislon.
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on this
project.
I further agree to ensure that all required lnspections are
reguested at the proper tlme, that oach address is readable
from the street, that the permlt card ls located at the front
of the property, and the approved set of plans wlll remain
on the site at all times durlng construcflon.
Date
{n",r,u
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)gr
Z-
.tt/l,ilr&t
3?
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Comblned)
,,:':i
FT.
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan No
225 FTFTE STREET
SPRTNGFIELD, OREGON 97477
INSPECTION REQUEST:
OFFTCE: 726-3759
1.TI INSTALI^|ITr0N
LEGAL DESCRIPTION
/^e7^22'q/ ?/zaary>
JOB
Permits are non-transferable and expireif vork is not started vithin L80 daysof issuance or if vork is suspended for
180 days.
2. COI{TRACTOR INSTALI..ATION ONLY
Electrical- Contractor
Address
Ci ty Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
r11
Ci ty ne 2?/-?/%
OVNER TNSTAII,ATTON
The installation is being made onproperty I ovn which is not intendedfor saLe, lease or rent.
Owners Signature:
DATE:
SPRII\IGFTELO
Nev Residential-Single orMulti-Family per dvelling unit.
Service fncluded:
I tems
The foilowlng proi€ct ss subi'nttleC trre th+ fr'rllot
zcn!n0, and-dbes not requiro apecriic land uso
approval.ELECTPJCAL PERHIT APPLICATION
72$_^?7 6e E_zJ 4 ,{Ci ty Job Numbe, 4/ZZ '*/
Aur irr.,r izor.r sisne.iure-/1fl&-*
"nrtt
r.org -tEE SCEBDT LE BELog
A
Cos t
$ 8s.00
s 1s.00
$ 40.00
Sum
L000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Hanuf'd Home or
-
Modular Dvelling
Service or Feeder
Services or FeedersInstallation, Alterationsor Relocation:
200 amps or less t€'
201 amps to 400 amps
-40i. amps to 600 amps
-601 amps to 1000 amps-
Over 1000 amps/volts
-Reconnect 0n1y
B
$
$
$
$
$
$
50 oo fu.--
00
00
00
00
00
.r (-
60
100
130
300
40.
C. Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or less g 40.00
201 amps to 400 amps
-
$ 55.00
over 401 to 600 amps
-
$ 90.00
0ver 600 amps or 1000 voTEs see ,8, aIffi
D. Branch Circuits
Nev, Alteration or Extension per panel
E.
one Circuit S 35.00
Each Additional
Circuit or vith Serviceor Feeder permit /4 $ Z.OO
"?Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0utIine Lighting-
Limited Energy/Res
-
Limited Energy/Comm
$ 40.00
$ 40.00
$ 20.00
$ 36.00
RECEIVED B
5. SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
-2,
,
o
ovners n" " F/< a 5r/<a<<-
eair";" *Zr-zF'
ATTACHMENT BI No. ?z /2 7/
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENI CHARGE
I^IORKSHEET
(COMHERCIAL & RESIDENTIAL)
NA},IE OR COI"IPAI'IY:
LOCATION:
<FDDEVELOPMENT TYPE:
BUILDING SIZE: OT SI
1. sM+_0ryNAGE
IHPERVIOUS SQ. FT.loo d'ADo'r.
AEEA
(/ttcuoss EAues)
2 SANITARY SFWFR-CITY PKorERr-l' Hts EX/;r/nG {erzc 5ysre.z,
X $43.26 PER PFU $
3. TRANSP0RTATT0N
NO OF UNITS X TRIP RATE X COST PER TRIP
. Ft.
X $0.209 PER SQ. FT
/ANO. OF PFU'S
(See Reverse)
x $436. 19
s436. 19X
x _ x $436.19
4. SANITARY SFl,lFR-|'4t^lMC
NO. OF PFU'S
(Use PFU Total rom Item 2 Above)
$
$
SUBTOTAL (ADD ITEMS i,2. & 3)6 o
$i7.19 PER PFU + $10 MI^JMC ADMIN.FEE $A
s /4G.t o
E) X .05
7- v- 74
Mt,lMC CREDIT IF APPLICABLE (SEE REVERSE)i TOTAI -MWHC SDC
SUBTOTAL (AOD ITIMS 1.2.3 & 4)
5. ANHINISTATIVE FFFS
(
Ha ig, P.
SDC
,70
/,3 z
$ /5 3,62
82. SDC
i nator
Date:
TOTAI SDC
44$
Permit #:
Issued by:
Address:
2Date:
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 3A or 38:
w 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.
3A,. 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.
OR
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 building permit of the
name of the contractor.
I hereby certify thatthe above informationis correctand thatl have readand do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
%/'k €- a3- 2
(Signature of permit applicant)
(White copy to issuing agency pennitfile,
pink copy to applicant)
w
(Date)
4
?L//2 F /
, .i ! .._
Informatioh Notice to Property Owners
..\
Note: '{his lnJonnation Notice to Prr;perty Awners aboLu
v, a s cl e v e I o p e. tl ht, th e e' o i s t r uc. t i oi'C ont ra c t rt r s B o a rrl i n
Construction
accordance with ORS 701
Il y'or.r arc: acting as y$ur own c$ntrac{or l() constnlcl a rxw lromc or rnake a substantial improvement to an existing stnlcture,
you cill prevent mauay problems by being aware of the following responsibilitres and areas of concem.
EMPLOYER RESPONSTBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
constniction or improvement of a residential structure, you will, in nrost instirnces, be mled 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 tues from employee wages at the time employees
are paid. You will be liable fbr the tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenlre 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 information, call t}e Oregon Ernployment Division at the Depar,fiirent of*Iuman Resouibes
at378-3524.
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mlrst
obt& workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurarrce, you=may
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more informatiqn,
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 emplolees'wages. You will be
liable foithe tax payment even if you didn't actually withhold the tax. Iror more information, call the Intemal Revenue Service
at l-800-829-1040.
'.:j'
OTHEH RESPONSIBILITIES AND AREAS OF GONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code
that may be brought to your aftention through inspections.
requirements
,
Liability and ppoperty damage insurance: Contact your insurance agent to see if you have adequate insumnce coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctnres, fire, or work that must be
re-done.
'fime to supervise employees: Make sure you have sufficient time t"o supcrvise 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.
If you have additional questions, write or call the Construction Contractors Board (PO Box l4l40,Salem, OR 97309-5052,
5031378-4621). The Board is located ar 700 surnmer st. NH suire 300, in salem
prop-own.pm4
t/94