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HomeMy WebLinkAboutPermit Building 1994-05-101 RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WOBK: a 3q JOB NUMBER 225 Fifth Street Springfleld, Qregon 97 477 TAX LOT SUBDIVISION: ASS RS MAP ZD BLOCK: PHONE: tg 5PRl0GF,FL0 OR 4zZIP:STATE: -7tl6-L 7SqB7t A) CITY: ADDRESS: OWNER: |.TEW ( BEMODEL ADDITION DEMOLISH OTHER Edru Ho MDESCRIBE WORK: I,F ELECTRICALi ,t7 tL rt 5 ^ t{%-q 7 MECHANICAL: ADDRESS EXPIRES PHONECONTRACIOR'S NAME CONST, CONTRACTOR # GENERAL: PLUMBING sRS[- \ ZONING CODE: * OF BDRMS: WATER HEATER RANGE: * OF UNITS: QUAD AREA: Y OF BLDGS: LAND USE: "'iT\'\= - SECONDARY HEAT SQUARE FOOTAGE: OCCY GROUP: * OF STORIES: CONSTB. TYPE: HEAT SOURCE: To.request an inspection, you must call 726-3769. Thls ls a24hour recording. All inspections requested before 7:00 a.m. will be made the same working dax inspections requested after 7:00 a.m. will be made the following work day, REOUIRED INSPECTIONS f,'"^oorarY Electric lxl Rough Mechanical - Prior to,a\cover. fYl nough Electrical - Prior tol4cover. VfElectracat Service - Must beR.approved to obtain permanent electrical power. pf final Ptumbing - When ail.flplumblng work is complete. ,X"Site lnspection - To be made after excavation, but prior to setting forms. Underslab Plumbing/ Electrical/ Mechanical - Prior to cover. Footing - After trenches are excavated. Masonry - Steel location, bond beams, grouting. Foundation - After forms are erected but prior to concrete placement. Underground Plumbing - Prior to filling trench. on ng. Ro ugh Plumbing - Prior to 'Final Electrical - When all electrical work is complete. I\if,lPost and Beam - Prior to floorlAinsulation or decking. &:'"ll;;suration - Prior to KmXrY Sewer - Prior to fillins ffl Storm Sewer - Prior to filling ntrench. ,Ky;:nline - Prror to rirrins Ktr"rn,ng - Prior to cover. fVwallrCeiling lnsulation - prior to )A\cover. EI"v*''l - Prior to tapins' Fireplace - Prlor to faclng materlals and framlng lnsp. Wood Stove - After installation. lnsert - After fireplace approval and lnstallation of unlt. Curbcut & Approach - After forms are erected but prior to placement of concrete. Trees - When all required trees are planted ffi finat Mechanical - When ail,nmechanical work is complete. \f,]/Final Buitding - When ail 2.\required inspections have been approved and building is completed. Final - After all required inspections are approved andporches, skirting, decks, and venting have been installed. Other MOBILE HOME INSPECTIONS Blocking and Set.Up - When ail blocking is complete. Plumbing Connections - When home has been connected to water and sewer. Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. ,'I 7-7 Dnt{ +3Ho0D# t.Alsot) FLOOD PLAIN: E - Prior T l-_l Sidewalk & Driveway - After - excavation ls complete, forms and sub-base materlal in place. l-_l fence - When compteted. Lot faces Lot sq. ftg. Lot coverage Topography Total hei Lot Type X tnt"rio, - Corner - Panhandle - Cul-de'sacW Setbacks P.L.HSE GAR ACC N S W E I( IE PROPOSED WOfIK IN THE HI'STORICAL DISTRICT, bN Oru THE H ISTORICAL REGISTER? lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit 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 buildings, and may be suspended or revoked at any time BUILDING PERMIT VALUE /ss# 1Ls,zs PI ewed By 45523/1 /9b?3c 3*tl*+ttl (A)'l Receipt Numbe upon violation of Plan Check Fee: any provisions 7 Date Paid: Received/6? +:-2b?1o/' ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee SQ. FT. X $/SO. FT.nSgG €6.4 r of said ordinances.1 Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) *'\-G t\ ADDITIONAL COMMENTS ITEM Fixtures Resldential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home N" 4 /o^ lu FEE FT. FT. FT. c3 (c)t q/Ot3/" 574eta) PLUMBING PERMIT Plumblng Permlt State Surcharge Total Charge Wood Stove/ lnsert/ Flreplace Unlt Dryer Vent f,o 2 5,g,'/0,@ / r28 /zPo 7{z*37,55(D) 1,^t N o N0 4- ,7F Vent Fan Mechanical Permlt lssuance State Surcharge Total Permlt MECHANICAL PERMIT Fu rnace Exhaust Hood By slgnature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all lnformation 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 Springf ield, and the Laws of the State of Oregon pertaining to the work described hereln, and that NO OCCUPANCY will be made of any structure without permission of the Building Safety Divlsion. I further certify that only contractors and employees who are ln compllance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain 6, tm I t Date ignature on the on MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - lt Curbcut - ft Demolltion Total M Su ha aneous Permits (E)7DATE PAID AMOUNT RECEIVE RECEIVED BY VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excludlng electrical) (A, B, C, D, and E Combined) {(" sdt*e*re y'*i- rzilazr ts ra ....r9a acLU The lollowlng protect as submlttad.hae the lollowing ili"ri,s, ;id?bes nct roquire tps4h r; :;:'c 'rse Aie 225 FIFTII STREET Elec t ri Address SPRTNGFIELD oREGoN 97477 : INSPECTI0N RBQUESTz 726-37 OFFICE: 726-3759 1. LOCATION OT ON I,EGAL DESCRIPTI JOB DESCRIPTTON Permits are non-transferable and expireif vork is not started vlthin 180 daysof issuance or if vork is suspended for 180 days. 2. COI{TRACTOR INSTALI,ATION ONLY ca1 Contractor I I ^)Ci one Supervisor e Ntimber Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Ovners Name Address ELECTRICAL PERilIT APPLICATION BELOV New Residential-Single or HuIti-Family per dvelling unit. Service fncluded: Items Cost approva!LDL A Sum C. Temporary Services or Feeders Installation, Alteration or Relocation 1000 sq. f t . or less t--- Each additional 500 sq. ft or portionthereof 6 Each Hanuf'd Home or Modular Dvelling Service or Feeder 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_ Over 1000 amps/volts Reconnect On1y STETOTAL OF ABOVE 5Z State Surcharge TOTAL $ 8s.oo _bs.4 g ls.oo ?a,n $ 40.00 s s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Ci ty OVNER INSTALI-ATION The installation is being made on property I own vhich is not intendedfor sale, lease or rent. s DATE: RECEIPT D. Branch Circuits Nev, Alteration or Extension Per Panel One Ci.rcuit S 35.00 Each Additional Circuit or vith Service or Feeder Permit S 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/outline Lighting- Limi ted Energy/Res Limi ted Energy/Comm Phone 7# -6?5? 200 amps or less _4 $ 40.00 201 amps to 400 amps _ $ 55.00 0ver 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see I'Brl fur aSoE 2/6r7d7T f b,lc 00 00 00 00 s40 $40 $zo s36 5 RECEIVED BY:-?32,-zo Willamalane a, A. Sinsle Familv - Detached I Single Family home NO OF UNITS B- Sinsle Familv - Attached NO OF UNITS C^ Multi-Familv Aoartment NO OF UNITS D. Manufactured Home Park NO OF UNITS unity Services Springfield Park & Recreation District )fob No. SYSTEMS DEVELOPMENT CHARCE HEET PHONE: Manufactured home not in a Park X $400 PER UNIT = X $370 PER UNIT = X $277 PER UNIT = X $280 PER UNIT = $ / rl $ $+ccn ADDRESS:STATE: LOCATION OF FROPOSED BU Street Address if Known: Platt Name:Tax Lot Number: DEVETOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling typeffik.) P 1 $ $ )(WPRD SDC 2. SDC CREDTT (lf applicable) SDC-payer must furnish proof of WPRD Credit approval. See SDC Credit Worksheet. 3. TOTAL WPRD NET SDC ASSESSED (lf SDC reduced for Credit) omm 1 ) City of rvt Date $ G) r'fiJ)?I d/ Permit No: Address: lssued Date:5 R OFFICE USE ON STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIB!LITIES 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 f rom registration underORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fir int applicable blanks, and initial boxes 1 and 2, and either box 3A or 38 \ My general contractor is , 2 I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3 OR A 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. 3.8 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 certily 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 side of this fo gnature m pp licantt at CON STRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 1 \! NOTE: This lnfrirmation Notice to Property Owners About Construction was developed by the Construction Contractors Board in accordance with ORS 701 passed by the 1989 Oregon Legislature. INFORMiTION NOTICE TO PROPERTY OW.NERS ABOUT CONSTRUCTION RESPONSIBILITIES lf you are acting as your own coniractor to construct a new home or make a substantial imfinhlement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. Lt EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Boa"rd to do labor in constructing or assisting in the construbtion or iriprovement of a residentlal structure, you will, in most instances, be'ruled to be an "employer" and the peopie you hire wtll be "eniployees'l # the empl6ye-r, you'must camply'with the following: Oregon's Wit!'rholdind Tax Law: As an employer, you.must;vyjthhold i,rcpm* gxes,frgm e'mplgyee wages at the time employees are paid. You will be liable Jor the tax payments even if,yoy don-t agtuelly withhold the tax from your employees. For more information, call the Oregon Department oJ Revenqe at 378-3390. . i I ,,.-..^ lllemployment lnsurance Tax: As an employer, you are required to pay a tax for unemplofment insurance purposes on the wages of all empleyees, For.rRore infprmation, call the Olqgon Employment Division DHR at 378-3224. Wq4fe5l Cqrnpensation lnsurance: As an employe[ you are sublect to the Oregdn tUorkers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fai! to obtain workers' compensation insurance, you may be subject to penalties and will'be lieble'tor all dlaim costs if,one of your employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at g7*74U. U.S. lnte!',?al Revenye Service: As an-.employer, you must withhold federal income tax from emolovees'wages. y,ent","nifyoLdidn'tactuallywitnrrototnetaj<.F.i,,o,"infoimation,call the lnternal Revenue'service at 221-3960. ': OTHER RESPONSIBILITIES AND AREAS OF CONCERN; 9qqg Q!tpli4!qe: As the permit holder for thispniect;-yol, are responsibte for resotving any faiture to meet code requirements that.may be biougfit to your.atteption through inspections. . Liability 5n6,Pr@erty,CramagU Insurance: Contact lour insurance agent to See if yciftrave adequate insurance coverage for accidents and omissions such as falling tools, paint overspray;,iwatel Bdmage from pipe punc- tures, fire, or work that must be re-done :: 1.- ' 'i.:J' I i-, : Irme':to suPgrvtse Emp :-'Make:sure you have:cufficient tirne fo supervise yotrr,ernployees Expertise-: Make sure you have the expertise to act as your own gener" "onio"tn, ,o'"oorjinrt""tne *orLof roush-in and finish trades, and to notify building officiars ar th; "ppiolii"i"-;;;* ,hJy "an performthe required inspections. e -' - - :'. -:"t vP: -'" rrrrreo ov rrrel lf you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97910-0151 phone 509-gZ&46210244J 10t24t89