HomeMy WebLinkAboutPermit Mechanical 1999-12-29!iPFrINGFIELT'
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Oflice: 726-3759
LOCATION OF PROPOSED WOFIK:
ASSESSORS MAP:
2.lOB NUtvIBER
225 Fifth Street
SprirrgflelrJ, Oregon 97477
TAX LOT:
q
\l*.^.. o..r-"4 ?.os*\i ^.,\ C p.a,ru,.r^ Ct<-PHONE:
ZIP:STATE:
OWNER:
ADDRESS:
CITY:
NEW r REMODEL ADDITION DEMOLISH OTHER
DESCRIBE WORK:
GENERAL:
ELECTRICAL:
ADDRESS EXPIRES 1 PHONECONTFIACTOR'S NAME
MECHANICAL:
PLUMBING:
CONST.
CONTRACTOR #
RANGE:
r OF BDRMS:
- OFFICE USE -
LAND USE:
WATEB HEATEFI:
FLOOD ])LAIN
r OF UNITS:
QUAD AREA:
'T OF BLDGS:
SECONDARY HEAT:
SQUARE. FOOTAGE:
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:O0 a.m. wlll be
made the same worklng day, lnspectlons requested af ter 7:0O a.m. wlll be made the followlng work day.
REQUIRED INSPECTTONS
Temporary Eleclrlc Rough Mechanlcal - Prior to
cover.
Flnal lrlumblng - When all
plumblng worl< ls complete.
Slte lnspectlon - To be made
after excavatlon, but prlor to
settlng forms.
Rough Electrical - Prior to ,B Flnal Eleclrlcal - When all
electrlcal work.ls complete.cover
Underslab Plumblng / Electrlcal /
Mechanlcal - Prlor to cover.
Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
Final Mechanical - When all
mechanical work ls complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framlng lnsp.
Flnal Buildlng - \Aihen all
requlred lnspectlons have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prlor to cover,
Foundallon - After forms are
erected but prlor to concrete
placement.
Other
Wall/Celling lnsulatlon - Prlor to
cover,
Underground Plumblng - Prlor
to fllllng trench.[-l Drywall - Prlor to taplng.
MOBILE HOME INSPE TIONS
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng.Wood Stove - After lnstallatlon.
Posl and Beam - Prlor to floor
lnsulatlon or decklng.lnsert - After flreplace approval
and lnstallatlon ol unlt.
Blocking and Set.Up - When all
blocklng ls cornplete.
Floor lnsulation - Prior to
deckl ng.Curbcut & l\pprroach - After
forms are err.'cted but prior to
placement of concrete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
Sanltary Sewer - Prlor to fllling
trench.Electrical Connection - When
blocklng, set.up, and plumbing
lnspections have been approved
and the home ls connected to
the servlce panel.
Storrn Sewer - Prior to fllllng
trench.
Sidewall< & Driveway - A(ter
excavation ls complete, forms
and sub-base materlal in place.
Waler Llne - Prlor to filling
trench.
Slreel Trees - When all requlred
trees are planted.
Flnal - After all required
inspectlons are approved and
porches, sklrtlng, decks, and
ventlng have been lnstalled.
Bough Plumblng - Prlor to
cover.
LOT:
-
BLOCK:SUBDIVISION:
-1'\\ - \-13 )
=l5.\N^\e
ZONING CODE:
T
E
E
E
tl
E
E
E
[]
EE
tl
tl
tl
E
tl
E
fl
tf Fence - When cclrrpleted.
E
PL.I{SE GAR ACC
N
S
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Typ,
-
lnterlor
-
Corner
-- Panhandle
-
Cul-de-sac
Set IS THE PROPOSEO WORK IN THE .
HISTORICAL DISTRICT. OR ON
THE HISTORICAL REGISTER?
-
It yes, thls appllcatlon must be slgned
arrd approved by the Hlstorlcal
Coordinalor prlor to permlt lssuance.
APPROVED:
i ,|.
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pernrit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City ol Springfield, including the
Development Code, regulating the constructlon and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Reoeipt Number:-
Plans Rcviewed By Date
Plan Check Fee:
Date Paid:
Received By:
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
VALUE
(A)
Total Value
Building Permit Fee
State Surcharge
Total Fee
,l
X $/SQ. FT.
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
Nt
FT.
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharoe
Total Charge
. FT.
ADDITIONAL COMMENTS
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true and correct, and I lurther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinanccs of the City of Sprlngfield, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
herein, and that NO OCCUPANCY wlll be made of any
structure wlthout perrnission of the Bulldlrrg Safety Divislon.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 wlll be used on thls
proiect.
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls roadable
from the street, that the permlt card ls located at the front
of the property, and the approved
stru
-{D
=.{(,
:L)
on the site at all times d
Slgnature
Date
will remaln
AMOUNT RECEIVED
RECEIVED BY
RECEIPT NUMBER
DATE PAI[)
VAI-IDATION
Wood Stove/ lnsert/Flreplace Unit
Dryer Vent
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
--
ft
Oemolitlon
State Surcharge
Total Miscellaneous Pertnits (E)
/f.N
/9t f , y'J-
'i tL
No
/o oo
1,ro
Vent Fan
(D)
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust l-loorj
TOTAL AMOUNT DUE (excluding electrlcal)
(A, B, C, Q and E Comblned)
24,5p
I
I
*CITY OF SPF"VGFIELD, OREGON
)..r c1ilt -"3toC6 3i t{ '"/;)
225 FIFTE STREET
SPRINGFIEI,D, OREGON
INSPECTION RBQIIEST:
OFFfeF._ 126_3759 Autnorrzeo Srgnature
1. LOCATION INSTALLATION 4
SPI. .GFIELO
PEE SCffiDIII^E BELOS
A. Nev Residential-Single or
Multi-FamilY Per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or Portion
$ 8s.00
IV,t s 1s.00
uf'd Home or
elIing s 40.00
IF
NOI
FOB
*"#'*1,.::?xjit",1i#,,3;:#:tHl"lf
3flfo crRrca,, pERHrr App,,rcArroN
97 7l Zoning {l-ty Job Nun q/-s -
3
floo Sum
JOB DESCRI
I 1
Electrical Contractor
Address
Ci ty Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name o o "lt,,J'
Ci ty Phone 7 L{l 't131
Permits are non-transferable and expire
if vork is not started vithin 180 dals
of i""r.nce or if vork is suspended for
180 days.
2. COMRACTOR INSTALI.,ATION ONLY
OVNER INSTALLATION
The installation is being made on
piop"tty I ovn vhich is not intended
for sale, lease or rent'
DATE
200 amps or less * I
201 amps to 400 amPs ,(
401 amps to 600 amps
-
601 amps to 1000 amPS-
Over 1000 amPs/volts
-
Reconnect OnIY
C. TemPorarY Services or Feeders
Installaiion, Alteration or Relocation
200 amps"or less q {!'99
201 amps to 400 amPs
-
E :l'99
over 4b1 to 600 amfs -l S 80'00
Over 600 amps or 1O00ETts see rBr above
,*.4t-ffi- Nev, A1 teration or Extension Per Pane1
or
a@$ s0.00
s 60.00
$100.00
s130. 00
$300.00s 40.00
E
onecircuit 4 $35'oo
Each Additional
::';:il":'rll,ll,'"'"!b $ 2.oo Md
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/Outline Lighting-
Limited EnergY/Res
-
Limited EnergY/Comm
SUBTOTAL OF ABOVE
7% State Surcharge
32 Administrative Fee
TOTAL
s 40.00
$ 40.00
$ 20.00
$ 36.00
RECETVED
5 ,0
eaaress lCS{'Thvr;#P P}
Permit #
Address b5 thurStt
Issued by fl- wt, t (tr Date L
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note; Oregon Law, ORS 701.055(4), requires restdential construction permit appli-
cants who ore not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residentiat butlding, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 70 I .01 0(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 3,A or 38
l. I own, reside in, or will reside in the completed structure.
2. 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
(Name)Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certiff that the above information is correct and that I have read and do understand the Information
Notice to property Owners about Construction Responsibilities on the reverse side of this form.
.-:sJ14{/z- ?-2 7
(Signature of permit aPPlicant)
(LYhite copy to issuing agency permit file,
pink copy to aPPlicant)
2
(Date)
tr
C-*,*
s r--,
h \ !.- \- ,
' - \ \r i -lr*orttrhiiorr,ffbtipe to Property Owners
',"i i .
--"-.-;',-"-*:Hl'v, t
Notc: 7'h!s lnibrmatirsn Notice trs loroperty Ov'ners about Crsnstru*iort Responsibilitias
y,us tle,-eltryted b;' tht Construction {ontr*ctors Eourd in rsccorulatte with ORS 70}.ASX5).
If you ue acting rls your own co*tractor to construct a new horne or make a substantial improvement to an existing structure,
you can prev*nt many pmiblenr.s by being aware of the I'sllowing responsibilities and areas of cgncem.
EMPLOYTR RESPONSISILITIE$:
If you hire persons not registered with the Constructior Conlractors Board to do labbr in construciing or assisting in the
construction or improvement of a residential structure, you will, in most insmnces, be ruIed to k an employer and the people
you hire will be employees. As the employer, you must contply with the following:
Oregon's withholding tulx law: As an employer, you must withhold income taxes from employee w{rg6s at the tinr employees
are paid. You will be liable for the tirx payments even if you don't actually withhold the tax from your employees. tsor more
infonnalion, call the Oregon Dept. of Revenue at 945-80?L
Unemployment insurance tax: As an employer, yor are required to pay a tax fbr unemployment insurance puryoses on the
wages of all employees. For more information, ca.ll the Oregon Employment Department at 378-3524 rV
Worker's cornpensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and mirlt
obtnin workers'compensation insurance for your employees. If you fail to obtain workers' con4rensation insurance, you rnay
be subj*t to penalties and will be liable for all claim costs if one of your employees is injurd on the job. For more infcrnration,
call the Workers' Comlxnsation Division at *re Deparlment of Consumer and Business Services at 9.15-7{ttt8.
U.S.Internal Revenue Service: .As an employer, you must withhold fbderal income *x from er*ployees'wages.Y*u will be
liable for the trx payment even if you didn't actually witlrtrold the tax. For more infonnatiorl, call the Internal Revenue Service
at 1-800-829-10,10.
OTHEH RESPONSIBILITIE$ ANO AREAS OF CONCERN:
Code compli*nce: As the permit holder for this proje*t. yrr* are responsible for resolving any railure to meet crxle requirernents
that nr*y he br*ught to your attention through inspections.
Liability and prupe$y dam*ge insurance: Contact your insurance agent to see if you have adequate insurance coverage lbr
accidents and omissions such as falling tools, paint overspray, water damage from pipe puncturcs, fire, or wor* that must be
re-done.
Tirne to supervise employees: M:ike sure you have sulficient tirnc to superuise our ernployees.
Expertise: M*ke sum you'have the expertise to act as yaur sml general uoiltrsctol to coordinate the rrmrk of rough.in and finieh
trades, and to notify building ollicials at the appropriatie times so they can perfon:r the required inspections.
: ' ' :-: \-. z.',:
If you have adclitional questions, write or call the Consfruction Conuactcrs Board PO Box 14140, Salem, OR 9?3W--1052,
503/378-462i ). The Board is located at 700 Summer St. t{E Suite 3(X), in Salem :
prop-own^pn:,i
t/94
SP4O1