HomeMy WebLinkAboutPermit Mechanical 1999-06-23SPRINGFIELDRESID ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
7f otre tJOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97 477
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:2
LOI:
-
BLoCK: SUBDIVISIoN:
TAX LOT:Aoruo
PHONE:
I STATE:ZIP:Qz q<RCITY:
ADDRESS:
OWNER:
ADDITION DEMOLISH OTHERelE-
-(DESCRIBE WORK:
NEW- REMOD
ADDRESS
on law rcs
EXPIRES ,A PHONE
PLUMBING:
CONTRACTOR'S NAME
GENERAL:
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
a e
-------rcattintrffrscen
Oreg
Center rSELB,fiif#|
WATER AUXtgq
- OFFICE regon Utilitycation Cenier. Tho-se rul es afe set forthQUADfiSTTLAND USE: - tn QAH Sl52-0{ir-001C GtocuftO/IB\BSA0O1-_
0090. You may obtain* oF BHTFSM TFTHE wffiXtmrrs:les by
ter. (occY@ERMIT&iiOTn.TYPE:
-nurnber
for the trQftiBgn6qfieatien__
is 1-8, OF S@NEDFQBAT SoURCE:HEAT:
DAYPERIOD BANGE:SQUARE FOOTAGE:
n Underslab Plumblng/ Electrlcal/
-
Mechanlcal - prlor to cover.
tl
To request an ln
made the same
n Temporary Etectrlc
Slte lnspectlon - To lre made
after excavatlon, but prlor tosettlng forms.
Footlng - After trenches are
excavated.
Foundatlon - After forms are
erected but prlor to concreteplacement.
Post and Boam - prior to floorlnsulatlon or decklng.
Floor lnsulation - prior to
decklng.
cover.
Electrlcal Servlco - Must beapproved to obtaln permanent
electrlcal power.
l-l Flreptaco - prlor to factng
-
materlals and framlng lnsp.
l-_| Framlng - prlor to cover.
l-l Walt/Celting tnsutatlon - prtoru cover.
Rough Mechanlcat - prlor to
cover.
Rough Electrlcal - Prlor to
cover.
Wood Stovo - After lnstallatlon.
Curbcut & AJrproaclr - Afterforms are erected but prior toplacemont of concrete.
Sldewrlk & Drlvewav - Afterexcavatlon ls complete, formsand sub.base materlal ln place.
Plumbing - When allumblng worl( ls complete.
Flnal Electrlcal - When altelectrical work ls complete,
nal Mechanlcal - When allmechanlcal work ls complete.
Flnal Building - When allrequlred lnspectlons have beenapproved and bullding iscompleted.
her
MOBILE HOME TNSPESTIONS
spectlon, you must call 726'3769. Thls le a24hour recordlng. All lnspectlons requested before 7:oo a.m. wlll beworklng day, lnspectlons requested after 7:oO a.m. wlll b9 made the followlng work day.
REQUIRED INSPECTIONS
Masonry - Steel locatlon, bondbeams, groutlng.
f] ia'flii:;"i;l#.,-trns - Prror [l Drywarr - prror to taprns
l--l Underttoor plumbtng/ Mechanlcat
Prlor to lnsulatlon or decklng.
lnserl - After flreplace approvaland lnstallatlon ot unlt.
I-_l elocking and Ser.Up - When ail
-
blocklnO ls complete.
[-l Sanltary Sewer - prtor to fllllng'J trench.
n Plumbing Connectlons - When
-
home has been connected towater and sewer.
Eleclrlcal Connecllon - Whenblocklng, set.up, and plumblnglnspections have been approvedand the home is connected tothe service panel.
Final - After all requiredlnspectlons are approved andporches, sklrting, decks, andventlng have been lnstalled.
f-l Storrn Sewer - prtor to filIng
-
trench.
Water Llne - Prlor to filllng l--l Fence - lVhon coiaptetedtrench.
Plumbing - Prlor to Slreel Trees - When all requlredtrees are planted,
/eclr
tl
tl
Itl
I
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot TIDY
-.
lnterlor
-
Corner
"- Panhandle !
-
Cul-de-sac
ks IS THE PROPOSED WOFIK TN THE.' HtsroBlcAL otsTRtcT, oR oN
THE HISTORICAL REGISTER?
-
ll yes, thls eppllcatlon must be slgned
and approved by the Hlstorlcal
Coordlnator prlor tg permlt lssuance.
APPROVED:
P.L.HSE GAR ACC'
N
S
E
BUTLDING VhI.UE, i5LAru CHECK
AND BUILDING PERMIT
Thls permit is granted on the express condition that the said
constructlon shall, ln all respects, conform to the Ordindnce
adopted by the City ol Springfie1d, includlng tHe
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any tlme
upon violation of any provisions of said ordlnances.
Plan Gheck Fee:
Plans Reviewed By Date
Date Paid:
Receipt Num
Received By:
BUTLDING PERMIT i i, 'f
So. FT. X $/Se. FT. = VALUE
(A)
Total Value
Building Permit Fee
State Surcharge
Total Fee
ITEM
Main
Garage
Carport
Systems Development Charge ls due on all undeveloped
properties withln the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
|f-Mk-J^
N'
FT.
FT.
FT.
(c)2o
PLUMBING PERMIT
/{e
7rPlumblng Permlt
State Surcharge
Total Charge
ff
Wood Stove/ lnsert/ Flreplace Unit
MECHANICAL PERMIT
(D)
N0
Vent
Mechanical Permit
lssuance
State Surcharge
Total Permlt
6 oo;;ro' lt Tlr
%>d
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have caref ully examlned
the completed appllcatlon and do hereby certlfy that all
lnformatlon hereon ls true and correct, and I lurthercertlfy
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 perlalnlng to the work descrlbed
hereln, and that NO OCCUPANCY will be made of any
structure wlthout permission of the Bulldlng Safety Divislon.
I further certily that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on thls
proiect.
I further agree to ensure that all required inspections are
requ.ested at lhe proper tlme, that each address ls readable
f rom the street, that the permlt card ls located at the f ront
of the property, and the approved set of plans will remaln
t
times during const ruction.
Slgnatu
Date
on the site at
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
--
ft
Demolltion
State Surcharge
Total Mlscellaneous Permlts (E)
577
3
VAI-IDATION:
RECEIPT NUMB
DATE PAII)
AMOUNT RECEIVED
RECEIVED BY
TOTAL AMOUNT DUE (excluding electrlcal)
(A, B, C, Q and E Comblned)
,0L{
Permit #,370 g5 8
3ts s //,Address Z faN a
Issued by:Date:l 7
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note; Oregon Law, ORS 70 t .05 5 (4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement tifore a buitding permit can be issued. This statement is required
"for
resiientiat buildi;g, electrtcal, 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 appropriate blanks and initial boxes I and2, and either box 3A or 38:
@
.{. I own, reside in, or will reside in the completed structure.
Ta 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
'{ '{J before or upon comPletion'
3A. My general contractor ts
Oiame)
that all subcontractors
ntractors Board.
Contractor regis. #
who work on the structure must be
i5B. lwill be my own general contractor
il
I will instruct my general contractor
registered with the Construction Co:
OR
If I hire subcontractors, I w*r hire onry subcontractors registered with the construction contractors
Board. If I change my mind and hire u g"n"rur contractoqr wiil contract with a contractor who is
registered with the i6d ;;; w,l immedi"i"rv "",irv
the office issuing this building permit of the
name of the contractor
I herebY certifY that the above info rmation is correct and that I have read and do understand the Information
Owners about Construction ResPonsibilities on the reverse side of this form'
of permit aPP licant)
Notice to P
(Signature
(White copy to issuing agency permit file''
Pink coPY to aPPlicant)
(Date)
w
rat'lEmEry='r'..-
Irtdrrnaticn Notice to Property Owners
About Gonetruction Responsibilities
\t'
Note: This ln{orrnation Notice to Properry O*'ners about Construction Responsibilitits
v'as deve.lolted by the C*nstructirsn Contr*r:tors l\oard in accordcnce with ORS 7At.055{5).
If you are acting as your own contractor to consftucl. a new home or make *subetantial improvement to an:oxiRting srructure.you can prevsnt n:any problenx by being aware of the followiog responsffirtres and,.areas of cqneern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not regislered with the Construction Conractors Board to do labor in constructing or assisting in theconstruction or improvement of a residential structure, you will, in mo$ instances, be ruted to b* an errployer and the peopleyou hire will be employees. As rhe employer, you musi comply with &e followingi- -
orregonos withholding. tY ll*t As an employer, you must withhold income ta,res from employee wages
", * tr*. enrployesare paid' Ytru will be liable for the tax payments :ven if you don't actually wirhhold the tax fiom your empioyees. Fbr moreinformation, call the Oregon Dep.t of Revlnue at 945_S0gt.
unemployment insurance tax: As an employer,-Igu ao required to pay a tax for unernployment. insurancc purposcs ,,n ti,"wages of all en:rployees. For more information, caii the oregon Emplofren, n"p**"ni-at 3Tg-3524
workerts com;rensation insurance: As an employer, you are subject.to th1 oregon w'orkers,Compensation Law, ,nd *lJtobtain workers' compensation insurance ror yoyr.enwloyor. rr you fail to obtain-*ork"rr, .o*p*nrrti* inr**"*, )CIu rlar-be subject tti penalties and will be liable for atl claim ,orrt ir on" iri you, **ptoyees is injue<I on rhe job. For more infcrnratioir, {call the wotkers'conr;xnsation Division at *re neparrm-*ric.";-mer and fiusiness iervices ut gas-zstls. --
u'$' rnternal Revenue llervice:,As an employel you must withhold fbderar income tax from emproyees,wages.you wi* beliable for the tax payment even if you aion'i actualiy withhold th; ;. For more inrormation, call the lnternal Revenue serviceat 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS CIF CONCHHN:
fir;,:;x';*x,t Hrx,[i;1**;rl:#jil;l:u are responsihre for resorving any failure to rneff cmre requiremenf,r
Liability and prcperty d*mage insurance: contaet your insura:lce agent to sec if you have adequate .insur:u:ce coverage ibraccidents and omissions such rs falling tools, painr J-6;;;rer damag* frorn pipe punctures, fire, or work thar musr bcre-deine.
Tirne to supervise employees: Make sure you have sutficient time to supervise our ernplcyees.
Expertise: Malie sure :.1,o.1 have the expertise to act as yorr own general contract$r, to coordinate the work of rough_in and finishlrades' and to notily buikliiig oflieials at the appropriale tim"s so ?riey can perform the requireet inspections.
li#1ff;i'}i;:1;L::;llii#' :1 ;ilt|r;:Tffiffi ,:f iff;:I:,*r, (P0 Boi r 4 1 40, Sa'em, oi{ e?30e.s0s:,
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