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Home My WebLink AboutPermit Building 1994-12-02t/SPFtINGFIELElRESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP:D2 JOB NUMBER 225 Fifth Street Sprlngfleld, Oregon 97 471 ?;: a JT j LOT: - BLOCK: TAX LOT: SUBDIVISION: _ T 26^ 66PHONE: i.r I \<( ZIP: o STATE:C)Q.CITY: ADDRESS: OWNER: NEW - REMODEL -,x-- ADDrroN DEMOLTSH orHER {1< uc:A<-:t RGL.ola.)SL1a U24DESCRIBE WORK: ADDRESS EXPIRES PHONE R.t(, !\ELECTRICAL: CONTBACTOR'S NAME GENERAL:U.sw<,R MECHANICAL: PLUMBING CONST. CONTFIACTOR # - OFFICE USE - WATER HEATER: LAND USE:OUAD AREA: * OF BLDGS: SECONDARY HEAT: SQUARE FOOTAGE: # OF BDRMS: .--...-- RANGE: OCCY GROUP: * OF STORIES: FLOOD PLAIN: CONSTR. TYPE: HEAT SOURCE: # OF UNITS: _-ZONING CODE: To request an rnspecilon, you must cail 726-376g. Thls rs a 24 rmade the same worklng day, lnspections requested after 7:00 [-_l remporary Etectrtc hour recordlng. Alr rnspecilons requested before 7:00 a.m. wilr bet a.m. wlll be made the followlng work day. REQUIRED !NSPECTTONS Slte lnspectlon - To be madeafter excavatlon, but prior tosettlng forms.P{;;s,: Etectrical - Prior to I--l Understab piumblng/Etecrricat/ - Mechanlcal - prloi to cover.Electrlcal Servlce - Must beapproved to obtaln permanent electrlcal power.Footlng - After trenches areexcavated. Rough Mechanlcal - prior to cover. Wall/Celllng tnsulatlon - prlor tocover. l--l Flnat plumbing - When ail - plumblng work is complete. ffi flnat Electrlcal - When ailZteqlectrical work is complete. [-l Flnal Mechanlcat - When ail - mechanical work is complete. flrinal Buitding - When ailflVequlred lnspectlons have beenapproved and building iscompleted.l--l fUasonry - Steet ,ocailon, bond - beams, grouilng. Foundatlon - After forms areerected but prlor to concreteplacement. Underlloor plumblng/ Mechanlcal - Prlor to lnsulatlon or decklng. Post and Beam - prlor to floorlnsulatlon or decklng. Floor lnsulatlon - prior todecklng. Sanllary Sewer - prior to flllingtrench. [l Storm Sewer - prior ro filting - trench. Water Llne - prlor to filllngtrench. Rough Plumbing - prior tocover. [-l Flreplace - prtor to factng - materlals and framing lnspl ,Stt"-lng - Prlor to cover. [-l Underground p]u '- t"'ln;;;;;Jil."-blns - Prior ,!oo*au _ prtor to taptns l-l Wood Srove - Afrer tnstailation fl 1n":t, - After ftreptace approval - ano tnstallatlon of unlt. Curbcul & Approach - Afterforms are erected b(rt prior toplacement of concrete. Sidewalk & Drlveway - Afterexcavation is completo, formsand sub-base materlal in place. Fence - When completed. MOBILE HOME INSPESTIONS I Alocking and Set.Up _ When alt.J blocklng is complete. Plumbing Connectlons _ Whenhome has been connected towater and sewer. Electrical Connection _ When P]99kilg, ser.up, and plumbinfrnspections have been approvedand the home is connected tothe servlce panel. fll Street Trees - When ail requlred - trees are planted. Final - After ail requiredtnspections are approved andporches, sklrilng, decks, andventlng have been installed. a [-l otner Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Typ - lnterior - Corner - Panhandle - Cul-de-sac ks IS THE PROPOSED WOBK TN THE , HISTORICAL DISTRICT, OR ON THE HISTOBICAL REGISTER? - lf yes, thls applicatlon must be slgned and approved by the Historlcal Coordinator prlor to permit issuance. APPROVED: GAR ACCPL.HSE N S E 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 Ordlnance 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 upon violation of any provisions of said ordinances. Receipt Number:- Plans DateBy Plan Check Fee: Date Paid: Received By Total Value Building Permit Fee StateSurcharge'?f +'1f Total Fee (A) VALUE 2au,/Ar,toD*L- €l5 4 /o ze X $/SQ. FT. /70 Garage Carport BUILDING PERMIT ITEM SO. FT. Main Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B)p,/A ADDITIONAL COMMENTS ,KI 724/A2il ITEM Fixtures Residentlal Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Flreplace Unit Dryer Vent MECHANICAL PERMIT (D) N0 Mechanical Permit lssuance State Surcharge Total Permit Furnace Exhaust Hood Vent Fan 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 f urther certlly that any and all work performed shall be done in accordance wlth the Ordinances of the City of Springfield, and the Laws of the State of Oregon pertainlng to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Building Safety Divislon' I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this proiect. I further agree to ensure that all required lnspections are requested at the proper tlme, that each address ls readable from the street, that the permit card ls located at the front of the property, and the approved set of plans will remaln ><-,Slgnature ?r'Date on the site at I times during construction. 12 -2- MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -- ft Curbcut ---- ft Demolition State Surcharge Total Miscellaneous Permits (E)@ ;/,;Z DATE PAID AMOUNT RECEIVED RECEIVED BY VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Comblned) /r Zar'@- rl N /,p SPRINGFIELc, The followirrg :. r.rzoning, and L ,o, , 225 FIFTB STREET APPTOVAI. SPRINGFIELD, OREGON 97477 Zoning* Ll>C 0il62_t;g-q.If- A&rorbed Signaturey' i ^a.he INSPECTTON REQUEST.. 72 OFFICE: 726-3759 1 ON OF TION IJGAL DESCRTPTION z- JOB DESCRIPTION Permits are non-transferable and expire if work is not started vithin 180 daysof issuance or if.vork is suspentled for 180 days. 2.., CONTRACTOR INSTALLATTON OT.ILY Electrical- Contractor Add ress ci ty- Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician ..t Ovners Address Name e Ci ty Job Nurnber E+ COHPLETE FEE SCmDI,LE BELOV A. Nev Residential-Single or MuIti-Family per dvelJ-ing unir. Service fncluded: I tems Cos t 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or - Modular Dvelling Service or Feeder s 8s.00 s 15.00 s 40.00 Services or Feeders Installation, Alterationsor Relocation: ,J uge SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL ELESTRICAL PERHIT APPLICATION ?/1 DG G Sum B 200 amps or less S201 amps to 400 amps - $ 40L amps to 600 amps - $ 60L amps to 1000 amps- $over 1000 amps/volts - sReconnect Only $ 50 60 100 130 300 00 00 00 00 00 0040. ci OIJNER INSTALLATION The installation is being made onproperty I ovn vhich is not intendedfor sale, Iease or rent. Osners ignature: Phone 7 2r.4 c lr E Temporary Services or Feedersfnstallation, Alteration or Relocation 200 amps or less S 40.00 20L amps to 400 amps - $ 55.00 -0ver 401 to 600 amps - S S0.00 Over 600 amps or 1000-vofts see uBu aEiEE Branch Circuits Nev, Alteration or Extension per panel one circuit Z/S 35.00 ?<.d?Each Additional re Circuit or vith Serviceor Feeder Permi t s 2.00 Miscellaneous (Service/feeder not included) -Each installation C 5 Pump or irrigation Sign/0ut1ine Lighting- Limi ted Energy/Res - Limited Energy/Comm s 40.00 s 40.00 s 20.00 s 36.00 DATI: RECEIVED B 5 ?{ oo'e) r__L4F_ 37% ( Permit #: Address:31es Issued by:Date:z Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permtt can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom 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: l. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction conftactor if the structure is sold or offered for sate before or upon completion.p 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. w 3B. 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 huilding permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information owners about construction Responsibilities on the reverse side of this f6pp. /z-z-/ of permit (White copy to issuing agency pennitfile, pink copy to applicant) OR Notice to (Date) / 6ra)za, '!.\ ilnf0rmatidn Notice to Property Owners About Cons.truction Res pon sibilities lcre-i {hi,s l4forntarion Nottee.to Pqoperry Owners gbout Constrilctiaa Responsibili \'oS). "]rrtoped by the toinstruction' Coitractors Board in accordan.ce with ORS 7At.ass{5). ll. you are acting as ),our own contractor to cofistruct a new homc or nrake a substantial improvement to an cxisting structure, yolr can prevent many problems by being aware of the foliowing responsibilities and areas of concem. EM PLOYER RESPONSI BILITIES: If you hire persons not registered with the Cgrutrr:c1ion Qq4tractors Board t9 do.labol in conqtructl!$.or assisting in the construction or improvement qf a residential structure, yoq will, in most.instances, be rqled tobe ag empJgyer and the people you hire will be emplbyees. As the employer, you must comp{Y with the following: Oregon,s withholding tax law: As an employer, you must withhold income taxes from employe'ei wages at the time employees ur" puia. you will be-liable for the tax payments even if you dont actually withhold the'tax from your'einployees. For more information, call the Oregoti Dept. of Revenue at g45-8091 ' ': '. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance Pu{poses on the *og", of ull employees. For more information, call the OregonEmployment Division at the Defiarhenrof Hurnan,tasourc€s Workers, compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, andtr{us} obtain workersicompensation insurance for your employees. If you fail to obtain workers'comlrciYtiT tsu{u.9": you$ besubjecttopenaltiesandwillbeliableforaltclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreirformqtift; call the Workers' Compensation Division at the Department of Consumer and Business Seivices at9+S-Zgga. U.S.Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. You will be n"d;;thr "- puf*"nt "uen if you didn't aciually withhold the tax. For more information, call ihe Intemal Revenue Service at l-80G829-I040. OTHER RESPONSIBILITIES AND AREAS OF CONGERN: 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 inspections Liability and property damage insurance: 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 punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sutficient 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 trales, and to notify tuitoing officials at the appropriate times so they can perform the required inspectiorls. If you have additional questions, write or call the Construction Contractors Board (PO Box l4I4A' Salem, OR 97309-5052' 5031378-4621). The Board is located at ?00 Summer St. NE Suite 300, in Salem. prop-own.pm4 1t94