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