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Home My WebLink AboutPermit Building 1992-08-20S}'rlIll(;FIELD RESIDEi.ITIAL PERMIT APPLICATION lnsltoctionl;: /26'3769 Ollice: 72(i-3/{;9 LOCATION OF PTIO )oraaauors MAP: LOT: OWNER dnu-e-, ADDRESS:o POSED WOHK: sGO- fu.1- --J2o3-,2>- - JOB NUMBER z//5? 225 Fif th Strt>et Springfield, Ore\lon 97 477 PHONE:aa6- 2?2 TAX LOT BLOCK: SUBDIVISION: lrd AR 7lzzCITY:1-STATE:ZIP: DE,SCRIBE WORK EXPIRES PHONEADDNESS Oa CONTRACTOR'S NAME CONST, CONTRACTOR # MECHANICAL: ELECTRICAI.: CJ EN ERAL: PLUMBING NOUAD AREA: RANGE: g OF BDRMS: WATER IIEATER _ OFFICE USE _ ZONING CODE: # OF STORIES: - --SECONDARY HEAT: SOUARE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: LAND USE: - # OF UNITS:, OF BLDGS: - OCCY GROUP: To request arr inspection, you must call 726-376g. Thls is a 24 hour recording. All lnspections requested before 7:00 a.m' will be ma6c the same workirro day, inspections requested after 7:00 a.m. will be made the following work clay' REOUIRED INSPECTIONS Rough Meclranical - Prior to cover. Final Plumbing - When all plumbing worl( is comPlete. LJ Site lnspcction - -l-o bc mado af ter excav:ition, but Prior to settin0 forrns. [J Rough Electrical - Prior to Final Electrical - Wlren all electrical work is comPlete.(:over, Underslab Pltrmbing / Electrical / Mecl-ratrical - F)rior to cover. Electrical Service - Mtrst be :rpproved to obtain Permanent clcctrical Power. Final Mechanical - When all rnechanical worl< is comPlete. Footing - Af ter trenches are excavatccl.Fireplace - Prior to fart:lng rrtaterilrls ;rnd framlrrg lnsJ>. 'F(7/finut Buildins - When all .Arequired inspcctions havc been approved and building is cotnPletecl.L]Masonry - Steol locatiorr, bonrl bearrts, grouting. fr"" ing - Prior to cover' Other Foundation - After forms are erected but Prior to concrete placentent. Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trerlch.Drywall - Prior to laping MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulatiotr or clecking.Wood Stove - After installation Post and Beam - Prior to Iloor insulation or clecl<ing'lnserl - After firePlace aPProval and installation of unlt. Blocking and Set'UP - When all blocking is comPlete. Floor lnsulation - Prior to decki ng.Curbcut & APProach - After {'erms are erected but Prior to lttacetnent of concrete. Plumbing Connections - When horne lras been connected to water and sewer. Sanitary Sewer - Prior to f illing trenclt.Electrical Connection - When blocking, set-uP, arrd Plumbing inspections have been aPProved ancl the homc is conneclcd to the service Panel. rl Sirtewalk & DrivewaY - Aftcr ()x()avation is conlplete, forms rtrtrl sub-brrse ntatcrial in place.Storm Sewer - Prior to lilling t runc ll. Water Line - Prlor to filling lrench. [--l Fence - Wlren comPleted Final - After all required inspections are aPProved and porchcs, sklrting, decks, and venting have been installed.Rough Plurnbing -- Prior to cover. Slreet Trees - When all required trees are Planted. E 1_ NEW -,---__-- REMODEL - ADDITION DEMOLISH OTHER FLOOD PLAIN: E tl f---] Temporary Electric ll [] r [] E tl tl t_l tl Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - -_ lnterior - Corner -- Panhandle -- Cul-de-sac Sotbacks P.L.HSE GAR ACC N 5 E .-.S THE PROPOSED WORK IN THE HISTOBICAL DISTRICT, OR ON' THE HISTORICAL REGISTER? .- lf yes, this application must be signed ancl approved by the Historical Coordinator prior to pcrmit issuance. APPROVED BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is grantod orr the express con(iition that thc said construction slrall, in all rcspects, conform to the Or<jinance acloptcr.i by tlrc City of SprirrgfielcJ, inclr.rtlirrg thc Developtttr:nt Co(lo, reglulatirrg tlle constructir;n arr<j usc of builclin-qr;, ;rn<l trt:ry bc suspended or revokcd at arty titno upon violation of :tny provisions of s;rid orclitranccs. z>.4 Rovfowed ByPlans Plan Chcck Fcc: -- -... Date Paid Recei pt N urrtber:-..-- Receivecl l3y: BUILDING PERMIT ITEM SQ. FT. X $/SO. FT.VALUE /8 (A)zAs-E Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee /3 so*zst Systems Developtrtent Chargo is due on all undeveloped properties witlrin tlre City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtu res Flesidential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) NO FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fireplace Unit Dryer Vent (D) NoVent 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 apprlication and do hereby certify that all information hereon is true and correct, and I further certify that any and all worl< performed shall be done in accordance with the Ordinanccs of the City of Springfield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will 'be made of any structure without pcrmission of the Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this prolect. I f urther agree to ensure that all required inspcctions are requested at the prope r tinre, that each address is readable from the slrcc't, that tlro l)crrnit card is locatcrj at thc front o( llrr.r l.rropcrty,;ln(l tlrr:;rlrprovorl s;rlt of plan:; will rr'lrrr;rirr >€,nat Date on thc sito ;.rt rre:; duri ng..1 constructio MISCELLANEOUS PERMITS Mobllo Homo State lssuance State Surchargc Sidewalk _-- ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D and E Combined) 46s L) G DATE PAID AMOUNT RECEIVED RECEIVED BY __- VALIDATION: RECEIPT NUMBEB e/20/zz/ Date/ Permit No:oz//5o Address ?/zo /.A+<*sr or, '{- , Fit 1. 2. lssued Date: OR OFFICE USE ON 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. I in the blanks,and initial boxes 1 and 2, and either box 3A or 38 reside in, or will reside in the completed structure. z WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 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 Contractor registration 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 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 si this form. .P-po -72 natu Date CONSTRUCTION CONTRACTORS BOARD 0244J 8191 t INFORilI.ATION NOTICE TO PROPERTY OTYIIERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: Th-ts tnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), - pas$ed by. thq 1999 Oregon Legislature --lf you are acting as your own contractor to construct a new home or make a substantial imprwement to an existing structure, you can prevent many problems by being aware of the {ollowing responsibilities and areas of concern. EMPLOYER RESPONSI BILITIES: 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 employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department of Revenue at 378-33g0. Unemployment lnsurance Tax: As an em ployer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more inforrnation, call the Oregon Employment Division DHFI aL378-3224.>. Workers' Compensation lnsurance: As an employer; you are subjectto the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable'for atl claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at gZO-7494. U.S. lnternal Flevenue Service: As an employer, 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 CONCERN: 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 inspectlons. Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Em ployees: Make sure you have sufficient time to supervise 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. lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10t24t89