HomeMy WebLinkAboutPermit Building 1993-07-09SPrlINGFIELE,
RESIDENTIAL
PERMIT APPLICATION
lnspections:726'3769
Off ice: 726'3759
?307scJOB NUMBER
225 Fifth Street
Spri ngfield, Ore}on 97 477
LOCATION OF PROPOSED WORK: -
ASSESSORS MAP:3 TAX LOT:3A2
SUBDIVISION:LOT:BLOCK:
To request an inspection, you must call 726'3769. This is a24hOur recording' All inspections reques'
made the same working day, inspections requested after 7:00 a'm' wiil be made the following work
ted before 7:00 a.."n. wlll be
day.
[-l remporarY Electric
Site lnspection - To be made
after excavation, but Prior to
setting lorrns.
Underslab Plumbing / Electrical /
Mechanical - Prior to cover.
Footing - After trenches are
excavaled.
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 lo insulation or decking'
Post and Beam - Prior to floor
insulation or decking.
Floor lrrsulation - Prior to
decki n0.
Sanitary Sewer - Prior to fillitig
trench.
Slorm Sewer - Prior to filling
trench.
Water Line - Prior tq filling
trench.
REQUIRED INSPECTIONS
X7 Rouoh Mechanical - Pricr to
/G(cove-r.
l'Vl/Rough Electrical - Prior to
,lA(corer.
a
,K
^x
fVf finat Building - When all
,,flrequired inspections have been
approved and building is
completed.
[-_] Electrical Connection - Vr/henI I blocking, set-uP, and Plumbing
inspections have been aPProved
and the home is connected to
the service Panel.
Final - After all required
inspections are aPProved and
porches, skirting, decks, and
ventirtEl have been installed.
Final Plumbing - When all
glumbing work is comPlete.
Final Electrical - When all
electrical work is comPlete.
Final Mechanical - When all
mechanical work is comPlete.
,Ktt'-ing - Prior tc' cover'
ffiw"ttlceiling lnsulation - Prior to
..l- -Bover.
X,Drywall - ?rior to taoing:
Electrical Service - Must be
approved to obtain Permanent
electrical Power.
Fireplace - Prior to facing
materials and framing lnsP'
Wood Stove - After installation
lnsert - After fireolace aPProval
and installation of unit'
Curbcrtl & APProach -' Aiter
fornrs are erected but Pricr to
pl3(:ernent of concrete'
SiCewalk & DrivewaY - Aiter
excavation is comPlete, forms
and sub-base material in Place.
Fence - When comPieted
Strcet 'irees - \lJhen ail 'equired
trees are Planted.
Other
MOBILE HOME INSPECTIONS
Blocking and Set'UP - When all
blocking is comPlete.
Plumbing Connections - When
home has been connected to
water and sewer.
PHONE:
STATE:
J.
LLEatz s;/d
CITY:
5,7OWNER: -
ADDRESS:ztP, ,?y' 77
ADDITIONt/DEMOLISH OTHER
DESCBIBE WORK
NEW=- REMODEL
ELECTRICAL:
PHONEEXPIRESADDRESS
MECHANICAL:
CONTRACTOR'S NAME
PLUMBING:
GENERAL:
CONST.
CONTRACTOR #
RANGE:
* OF BDRMS:
_ OFFICE USE _
LAND USE
ZONING CODE:
FI-OOD PLAIN
WATER HEATER
# OF STORIES
* OF UNITS:
SECONDARY HEAT:
SOUARE FOOTAGE:
OUAD AREA:
# OF BLDGS
OCCY GROUP: -'
-
CONSTR. TYPE:
HEAT SOURCE:
F Rough Plumbing - Prior to
cover.
-- O@aIA--
tl
E
E
E
E
E
il
E
rl
tl
Lot faces
Lot sg. fto.
Lot coverage
Topography
Total height
Lot Type-
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks
PL.HSE GAR
N
S
E
ACC
IS T.HE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordir-rator prior to permit issuance.
APPROVED:
VALUE
bttttf
/Z-*t->
--92*ffi,
(A)
X $/SO. FT.
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Ort to{ r-'
- 493
_ /9?63
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that thc 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 ordrnances.
Pran check ,"u, ---4O-!3
-
*f /Fy'- |
Plans Reviewed By Date
Date Paid
Receipt Number:-
-Received By
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
Aazon ,<o,oo
z-€o
5
/a ^ ,ro(c)
N0
FT.
FT.
FT.
PLUMBING PERMIT
FEE
50po
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
' ^ Aa -uZ.Orfr,7/
_ak{e)&
Wood Stove/ lnsert/Fireplace Unit
Dryer Vent
'C)
/o,4
:75
E
4INo .14/.)
(D) zs7'4
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
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 f urther certif y
that any and all work performed shall be done in accordance
with the Orcjinances o{ the City of Springf ietcJ, and the Laws
of tire State of Oregc,n pcrtaining to the work cjescribed
herein, ancl that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I f urther ccrtify thal orrly corttractors and em1:loyees who
are in compliance with ORS 701.055 will be usect on this
proicct.
I f urther agree to ensure that all requirecj inspectio.ns are
requested at the propcr time, that each address is readable
the pcrmit card is located at the front
the approved set of plans will remain
lx,
t
Date
g natu re
f rom the srreet,
ot the propert
on the site st rull times during
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
@/I_,"/-lD trE?/a)
TOTAL AMOUNT DUE (exciuCing electrical)
(A, B, C, Q and E Combined)?a4k o/
a4?5
o G/
RECEIVED BY
-
VALIDATION:
RECEIPI NUMBER
DATE PAID
AMOUNT RECEIVED
-
p_ sl4atz
March 25,1994
City of Springfield
Development Services Depr
'225 Fiirh Street
Springfield, Oregon 97 477
DearDeanna Buckem:
My building permit #930986 is about to expire as of this date. Please renew this permit as work
continues on my residence at 580 Pacific Street. My son is my contractor, his fulltime position
and young family keep him very busy. We have accomplished many things inside the house this
winter but none of them relate to those needing inspection. Now that the weather will soon permit
outside venting, insulation, and other building assignments that need inspection,we can continue
toward finishing this projecr
Thank you for your courteous consideration of my requesl
z2
Shull
CITY OF SPR OFEGO'U
225 PTYTB STRBEf,
SPRTNGPIBU), OREGoN 97477
INSPBCTION RBQUESTz 726-3769,'
The as
zonrng, and does not requira epecilic land
approval.
SPRINGFIELD
EIJCf,RICAL PERHIT APPLICATION
City Job Nunber b
LDK
"1'61-QOPFICB: 726-3759 Ai.nnorized
ALI,ATION1.,ON OP
I,BGAL DBSCRIPTION
JOB DESCRIPTION
Permits are non-transferable and expire
if work is not started vithin 180 days
of lssuance or lf work is suspended for
180 days.
2. COIII?ACTOR INSTALI.ATION ONLI
Electrical Contractor
Address
Ci ty Phone
Supervisor License Number
Expiration Date
Constr Contr.. Number
Exp lratlon Date
Stgrature of Supervlsing Electriclan
Ovners Name
Address
Ct ty Phone 7
OTINER INSTALI.ATION
ssnx*J#EBDrrLE
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Hodular Dvelling
Service or Feeder
BBLOV
Nev Resldential-Single or
HuIti-Family per dvelling unit.
Service Included:Items Cost
A
Sum
t-- $ Bs.oo as.@
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
-
601 amps to 1000 amps-
0ver 1000 amps/volts
-
Reconnect OnIY
gS bs,|,
,/.r20
s so.oo
$ 60.00
s100. 00
$130. oo
$300.00
$ 40.00
c.Temporary Services or Feeders
Installaiion, Alteration or Relocation
200 amps or less
ZOf amirs to 400 amPs
-Over 401 to 600 amps
-
Over 600 amps or 1000 volt
Branch Circuits
s see rBtr a Sove
$ 2.00
a1ea
$
$
$
40
55.
80
00
00
00
D
7
Nev, Alteration or Extension Per Panel
'One Circui t
n."t, Additional
Circuit or vith Service
or Feeder Permi t
-
$ 3s.oo
B Hiscellaneous (Service/feeder not included)
The inr
proper
for
stallation is belng made on
-ty I own vhlch is not intended
Ie, Iease or rent.$ 40.00
$ 40.00
$ 20.00
$ 36.00Signature:
ST]BTOTAL OP ABOVB
5Z State Surcharge
TOTALDATE:1
RBCBIVBD
5 ffi
-Each installation
Pump or irrigation
Sign/OutIine Light ing-
Limited EnergY/Res
-
Limi ted EnergY/Comm
CITY OF SPR,INGFIELD, ORECO'U
SPllI,{GFIELD
225 FIPTE STRBET
SPRTNGFIBID, ORBGON_97477 ^rpfNSPECf,ION RE0UEST: . 726-3769-, L-I'J$--
"r the followin9
'; i-i:-ld uso
\
1.;.i;:.,.'' '--\Eg
JOB DBSCRIFTION
Permits are non-transferable and expireif vork is not started vithin 180 days
of issuance or if vork ls suspended for
180 days.
COITIBACTTOR INSTALI,ATION ONLY
ical Contractor
Address
ci
Supervisor Li
Expiration Date
Constr Contr.
Expirati
s
Ovners Name
Address
Ci ty Ph
ALI.ATION
The installation is being made on
property I own which is not intended
for sale, Iease or rent.
Signa
BLBCTRICAL PERHIT APPLICATION
City Job Number
3. COHPLETB PEB SCEBDULE BELOS
A Nev Residential-Single or
MuIti-FamiIy per dvelling unit.
Service fncluded:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
-Modular DveIIing
Service or Feeder
s 8s.00
$ 1s.00
s 40.00
Sum
B Services or Feeders
InstaIIation, Alterations
or Relocation:
200 amps or less \201 amps to 400 amps
-401 amps to 600 amps
-601 amps to 1000 amps-
0ver 1000 amps/volts
-Reconnect 0nly
D. Branch Circuits
SUBTOTAL OT ABOVB
5Z State Surcharge
TOTAL
Nev, Alteration or Extension Per Panel
one circuit / s 3s.oo #
Each Additional
Circuit or vith Service tscz) 99-
t not Feeder Permi-t . ru, $ 2.00 .1@
Vdfu,/ 1 // (tLt-.tt/u" --Tf
E. HiSgQllaneous (Service/feeder not included)
-Eath installation
Pump or irrigation
sign/OutIine Light ingl
Limited Energy/Res
-Llmited Energy/Comm
oo
$ s0.00
$ 60.00
$100.00
sr30.00
$300.00
$ 40.00
s
C. Temporary Services or Feeders
Installation, Alteratlon or Relocation
200 amps or less $ 40.00
over 401 to 600 amps
-
g 8o.oo
0ver 600 amps or 1000 voTts see ttgtt "ffi![-
t
ture:
_)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
5
DATB:
Phone
of Supervising Elect
r
te
RBCBIVBD
/os e1'.- rlLsr.
-*w"Ts_E-o
d-^-L-e*--,,r'
Permit No:
Address:
lssued by Date:
R 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:
1 . ]X I own, reside in, or will reside in the completed structure.
2. lEX- 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 ,
, (-//:
,/"r.-
Contractor registrati on 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 I-: 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, 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 above inlormation is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse of this lorm.
z /773
n ure of Permit Applica
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
Date /7
WHITE COPY TO ISSUING AGENCY PERMIT F1LE
PINK COPY TO APPL]CANT
?;-^4
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE:.- This lnforrnation Ndice to Property Owners About Construction Responslbilities
was devbloped by the Construction Contractors Board in accordance with ORS 701.055(5),
irassediby ttre 1989 Oregon Legislature. '1i.
lf you qre acting as your'own contractor to construct a new home or make a substantial improvement to an
existing structure, you can prev--ent many problems by being aware of the following responsibilitles and areas
ol concern.
EMPLOYER RESPONSIBILITIES:
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the constructicjn or irnproVerhent of a'residential structure, you will, in most irfitih"ibs, OEiuteO to be an
"employer" and lhdpeopie you hire will be "enip1oyees"."A,s the emfloyer, you musl compfy wlth the following:
Oregon's Withholding Tqx.Law:. As an' employern yqu must withhold income taxeg ,lrom,g,Epibyee wages at
the time employees are paid. You will be liable for the thx payments even if you don't'actgglly withhold the
tax from your employees. For more information, call the Oregon Departrnent oJiBryenuq at 378-3390.
Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of allemployee+ For more intormation, call the Oregon EmploytFnt'OlVision DHR
at 378-3224.
Workers' Compensation lnsurance: As an employer,'youare subject to therOregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers'
compensation insurance, you rnay be su$ect to penalties and will be tiable.for,all claim costs if onb of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 973-74U.
"tr'r,{. .: t,. it
U.S. lnternal Reve.nue Service: As an employer, yo.u must w-ithhold fe{eral inco-me tax from employees'wages.
ymqnt",inityoLdidn'taciual1ywitnrrotdtne.ta;.Formoreinfoimation,call
the lnternal Revenue' Service at 221-3960. L
OTHEB RESPONSIBI
Code Gom.plianee:
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 9/310-0151
Phone 50&378-4621
LITIES AND AREAS OF CONCERN: , .,, '-;-."-1 ,.
A&dh€ pqrpit holder for this proie,ct,, you,are resporreible.for resolving any failure to meet
code reqtrirements that may be brought to your attention through inspections
Liability andPrope rty Dimage lnsurance: Contact your insuranceAg'entto see lf you.have adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray, wdter dainage from pipe punc-
tures, fire, or work that must be re-done.
'',.
Time to Supervise Employees Makesure you have sufficient time to supervise yo0r emplolees:
Expertise: Make sure you have the expertise to act as yqur own general contractor, to cb0rdinate the work
of rough;in arid finish trades, and to notify build-ing offic.idls et the apbropriate tirne$ ..si ttr.ry can perform
o24N 10t24t89