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HomeMy WebLinkAboutPermit Building 1993-09-25IELO RESID ENTIAL PERMIT APPLICATION lnspections: 726'3769 Of f ice: 726-3759 JOB NUMBER 225 Flfth Street Springfield, Oregon 97 477 LOCATION OF PROPOSED WORK: ASSESSORS MAP:TAX LOT LOT - BLOCK:SUBDIVISION: - To request an inspection, you must call 726-3769. Thls ls a24hour recording. All lnspectlons requested before 7:00 a.m. wlll be made the same worklng day, lnspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS Temporary Electric Flnal Plumbing - When all plumblng work ls complete. 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 -beams, grou Foundation erected but placement. Underground Plumbing - Prlor to filling trench. Underlloor Plumbing/Mechanical - Prior to insulation or decking. Post and Beam - Prlor to floor insulation or decking. Floor lnsulation - Prior to decklng. Sanitary Sewer - Prior to fllllng trench. Storm Sewer - Prior to filllng trench. Waler Llne - Prlor to fllllng trench. Rough Mechanical - Prior to cover. Rough Electrical - Prior to cover. Electrical Wall/Ceiling lnsulation - Prlor to cover. Drywall - Prior to taplng. Wood Stove - After lnstallation. lnsert - After flreplace aPProval and installation of unit. Curbcut & Approach - After forms are erected but prior to placement of concrete. Sidewalk & Driveway - After excavation ls complete, forms and sub-base material ln place. [-l Fence - When completed Street Trees - When all requlred trees are planted. Flnal Electrlcal - When all electrical is complete. cal - \\then all al work ls complete. Flnal Building - When all required lnspectlons have been approved and building is completed. Other MOBILE HOME INSPE TIONS Blocking and Set.Up - When all blocklng ls complete. Plumblng Conneclions - When home has been connected to water and sewer. Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the horne is connected to the servlce panel. Final - After all requlred inspections are.approved and porches, sklrtlng, decks, and ventlng have been installed. PHONE: ZIP:STATE:7 CITY: 7 (F/.<5f ADDRESS: OWNER: NEW - REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK: ELECTRICAL: ol PHONEEXPIBESADDRESS DID It tt )&zGENERAL: PLUMBING MECHANICAL: CONST. CONTRACTOR #CONTRACTOR'S NAME FIANG E: - OFFICE USE - ZONING CODE: FLOOD PLAIN: SECONDARY HEAT: SQUARE FOOTAGE: OUAD AREA: r OF BLDGS: LAND USE: WATER HEATER: OCCY GROUP: * OF STOBIES: CONSTB. TYPE: HEAT SOURCE: # OF UNITS: - Rough Plumbing - Prior to cover. atnr-u E E tf E fl E tl E tl lnsp. - Prior to cover. fl tl E E # OF BDRMS:- E Lot laces Lot sq, ltg. Lot coverage TopographY Total helght Lot Type ? - lnterior - Corner - Panhandle - Cul-de'sac ks \IS-1 HE PROPOSEO WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be slgned and approved bY the H lstorlcal Coordinator prior to permlt issuance. APPROVED: t ACCP.L.HSE GAR N s W E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said constructlon shall, in all respects, conlornr to the Ordinance Receipt Number:- cD_^Wte,-' thendelcnudnciofStedhepnadobyvp onti useand oflatlUnheconstrucCode,nt sDeveregopme metlatUSdanyrevokedorbependeay inances,rdsaidooflonsprovisany Recel bulldlngs, and m' upon vlolatlon of Plan Check Fee: Date Pald: BUILDING PERMIT |TEM sQ. FT. X $/SQ. FT. = VALUE (A) Total Value Bulldlng Permlt Fee State Surcharge Total Fee Maln Garage Carport Systems Development Charge is due on all undeveloped properties withln the City limits which are being lmproved' ADDTTIONAL COMMENTS SYSTEMS DEVELOPMENT CHARGE (SDC) FEE (B) (c) Plumblng Permlt State Surcharge Total Charge Resldentlal Bath(s) Sanltary Sewer Water Storm Sewer Mobile Home PLUMBING P ITEM Flxtures MECHANICAL PER ,\ t5 T (D) Dryer Vent Unlt Mechanical Permlt lssuance State Surcharge Total Permlt Furnace Exhaust Hood Vent Fan Wood Stove/lnsert/ i By slgnature, I state and agree, that I have carefully examlned the completed applicatlon and do hereby certlfy that all ln{ormation hereon is true and correct, and I f urther certlfy that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield, and the Laws ol the State of Oregon pertainlng to the work descrlbed herein, and that NO OCCUPANCY wlll be made of any structure wlthout permisslon of the Bulldlng Safety Dlvlslon' I further certlfy that only contractors and employees.who are ln compllance wlth ORS 701.055 wlll be used on lhls project. I further agree to ensure that all requlred lnspectlons are requested at the proper time, that each address ls readable lrom the street, that the permlt card ls located at the front of the property, and the approved set of plans wlll remaln on the site at all times during constructlon' ignature Date l-z MISCELLANEOUS PERMITS Total Mlscellaneous Permlts (E) b A-- VALIDATION: RECEIPT NUMBEB DATE PAID AMOUNT RECEIVED RECEIVED BYTOTAL AMOUNT DUE (excludlng electrical) (A, B, C, D, and E Comblned) Aq:a--TV /v2 c/friEP /y'-^ r' ^' , ,,- Moblle Home Slate lssuance State Surcharge Sldewalk - lt Curbcut - fl Demolltlon State Surcharge-ila.;frr ' 'ffi 7a 1 LOCATION OF INSTALIJ\TION I,EGAL ON JOB DES(NIPTION Permits are non-transferable and expire lf vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CO}T1"ACf,OR INSTALI.ATION ONLY Electrical Contractor Address Ci ty Phone Supervisor License Ntimber .Expiration Date Constr Contr. Number Exp iration Date Signature of Supervising Electrician 0wners Name Address ab 3 g1s.oo ZE ELECTRI CAL PERH IT APPLICATION IL City Job Nuurber, 1l$ l. coHPLETB tBE ScTEDULE BBLov A Nev Residential-Single or HuIti-Family per dwelling unit. Service Included: Items Cost _< $ ss.oo # specific land 225 FIFTE SITEEf, SPRINGFIBLD, ORBGON 97477 INSPBCTION REQUEST: 726- OPFfCE: "726-3759 Authorized Signatwe. B s 40.00 Services or Feeders Installation, Alterations or Relocation: 200 amps or ]ess 20L amps to 400 amps _401 amps to 600 amps _ 601 amps to 1000 amps_ 0ver 1000 amps/volts Reconnect 0nly C. Temporary Services or Feeders Installation, Alteration or Relocation 1000 sq.ft. or less Each additional 500 sq. ft or portion t hereo f Each Manuf 'd llome or Modular DueIling Service or Feeder E 5. SUBTOTAL OF ABOVE 5Z State Surcharge TOTAL 200 amps or less S 40.00 201 amps to 400 amps _ $ 55.00 Over 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see [Brl Sum M $ s0.00 $ 60.00 $100.00 s130.00 s300.00 $ 40.00 D. Branch Circuits Nev, Alteration or Extension Per Pane1 s 3s.00One Ci rcui t Each Addi tional Circuit or vith Service or Feeder Permi t Miscellaneous (Service/feeder -Each installation Pump or irrigation $ Sign/0utIine Lighting- S Limi ted Energy/Res $ Limited Energy/Comm $ a66ve s 2.00 not included) 40. 00 40. o0 20. oo ciw Ui1 , vnone 74 7- /AO? OSNER INSTALI,ATION The installatlon is being made on property I own vhich is not intended for sale, Iease or rent. Ovners Signature: DATE: - RECEIVED BY 414 t fu/'d/'-/ SPRINGFIELO RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 72A8759 LOCATION OF PBOPOSED WO ASSESSORS MAP: JOB NUMBER 225 Filttt Strcet Sprlngtlclcl, Oregorr 97477 TAX LOT:, LOI: - BLOCK OWNER: CITY: ADO STATE: PHONE ztP NEW - REMODEL ADDITIO DESCRIBE WORK: GENERAL: ADDFIESS EXPIRES .1 PHONECONTRACTOR'S NAME ELECTBICAL: MECHANICAL: PLUMBING: CONST. CONTRACTOR # _ OFFICE USE - , OF BDRMS: r OF UNITS: HEAT SOURCE LAND USE:QUAD AREA: r OF BLDGST FLOOD PLAIN: ZONING CODE SECONDARY HEAT: SOUARF- FOOTAGE; OCCY GROUP: r OF STORIES: CONSTR. TYPE: -- WATER HEATEFI:FIN NGE: To request an lnspecilon, you must call 7 made the sanre worklng clay, lnspectlons 26'3769' Thls ls a 24 hour rccordlng. All lnspections requested belore 7:00 a.rn. wlll bercquested after 7:00 a.m. wlll be macje the followlng work day. REOUIRED INSPECTIONS l-_l Temporary Etectrtc f{aougtt - cover. ffiechanlcal - Prlor toq00 {Eleclrlcal - Prlor to Final Plumbing - When.allplumblng worl< ls complete. Slte lnsp€ctlon - To be madcalter excavation, but prlor tosettlng forrns. Rough Flnal Eleclrlcal - When allelectrlcal worl( is complete. cover I--l Underslab Plumblng/Etectricat/ - Mechanlcal - prlor to cover.Eleclrlcat Servlco - Must bcapproved to obtalrr permanent electrlcal power. f{rrnat Mechantcat - Whcn ail - mcchanical work ls cornplcto. Foollng - Alter trenches are excavated.Flnal Buildlng - When allrequired lnspectlons have beenapproved and buildlng is completed.[-l Masonry - Steet tocaUon, boncJ - beams, grouilng. Flreplace - Prlor to faclng materlals and framlng lnsp. l-l Framlng -. prlor to cover. Foundatlon - After forms areerecled but prlor to concrete placemont. Other Wall/Celling lnsulatlon - prlor to cover. [-l Underground plumblno - priorU lo fllllig trenctr [--l Drywall - Prlor to taptng. Tl Underlloor plumblng/Mcchanlcal Prlor to lnsulatlo-n or Oeckf ng. f-l Wood Stovo - Af tcr tnstailatlon MOBILE HOME INSPE TIONS Posl and Boam - prlor to floorlnsulatlon or decklng,lnserl - After flreplace approvaland lnstallatlon ot unlt. I-*l Blocking and Set.Up _ When ail - blocklng ls complete. Floor lnsulallon - prlor to deckl ng.Curbcul & A1:prroach - Afterforms are erocted btrt prior toplacemcnt of concret<:. Plumbing Connections - Whenhome has been connected towater and sewer.Sanllary Sewer - prlor to fllllng tronch, [-l Storm Sewor - l)rior to filting'J trench. Sidewalk & Drlveway - Afterexcavalion ls completc, formsand sub.base material ln place. Fence - Wtren completed. Electrical Connection - Whenblocklng, set.up, and plumblng inspcctions have been. approvedand tlre home is connected tothe servlce panel.Waler Llne - Prlor ro lilling trench. Rough Plumbing - prior tc) cover.[-_] Str€et Troos - Whcn all rcqutred - trees are planted. Final - Af ter all requiredInspections are approved andporches, sklrtlng, decks, andventlng have been lnstalled. SUBDIVISION: tl I Lot faces Lot sq. ftg. Lot coverage Topography Total helgh( Lot Typ- - lnterior - Corner - Panhandle l - Cul-de-sac backs IS THE PROPOSED WOFIK iN THE . HISTORICAL DISTRICT, OR ON TI]E HISTORICAL REGISTEFI? - lf yes, thls appllcatlon must be slgned arrd approved by the Hlstorlcal Coordinator prlor to permit lssuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the sald construction shall, in all respects, conform to the Ordlnance adopted by the City of Springfleld, includlng the Development Code, regulating the constructlon and use of bulldings, and may be suspended or revoked at any tlme upon violation of any provisions ol sald ordlnances. Datc Pald Receipt Numbe Received By: Plans RcviewccJ By Date Systems Developmcnt Charge is due on all undeveloped properties within thc City linrits whiclr are being lmproved. ADDITIONAL COMMENTS VALIOATION: RECEIPT NUMBER DATE PAID AMOUNT REC TOTAL AMOUNT DUE (excluding clectrlr: (A, B, C, D, and E Comblncd) PL.HSE GAR ACC N S E VALUE (A) x $/so. FT. Total Value Building Permit Fee State Surcharge Total Fcc BUILDING PERMIT ITEM SO. FT. Main Garage Carport SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ITEM Flxtures Resldcntlal Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE (c) No FT. FT. PLUMBING PERMIT Plumblng Permlt State Surcharoe Total Charge Wood Stove/ lnsert/Flreplace Unlt trL I *3Qo (D) tMecnical NoVent Fan lssuance MECHANICAL PERMIT Furnacc Exhaust Hood State Surcharge Total Permit By slgnature, I state and agree, that I have carolully examlned the completed application and do hereby certlfy that all lnformation hereon is true and correct, and I lurther certlf y that any and all work performed shall be done ln aocordance wlth the Ordinances of the Clty of Sprlngf leld, and the Laws o{ the State of Oregon pertalnlng to thc work descrlbed hereln, and that NO OCCUPANCY wlll be mado of any structure wlthout perrnission of the Bulldlrlg Safety Dlvislon. I further certlfy that only contractors and employees who are ln compllance wlth ORS 701.055 wlll be used on thls proiect. I f urther agree to ensure that all requlred inspections are roquested at tho proper tlmo, that oach address ls roadable from tlro street, that the permlt card ls located at the lront of the property, and the approved set ol plans wlll remaln on the slte at all times durlng constructlon. sls o-Date MISCELLANEOUS PERMITS Moblle Home State lssuance State Surcharge Sldewalk - ft Curbcut - ft Demolitlon State Surcharge Total Mlscellaneous Perrnits (E) FTECEIVED D Plan Check Fee: - FT. TELI)Z/o JOB NUMBER EEB'ff'1.ISi'"o''o* lnsDections: 72G'37GS c-ltlice,726-3i59 ?rt, 225 Filth Street i-pli ngri,,ro, oregon 97477 1310 --N IL r oC,ATr\ o nssrssohs F PROPOSED WOT1K MAP TAX LOT: ISUBDIVISION: A L 3PHONE: i1Ll-77zlPSTATE: I1, h t. ? I ALADDRESS: CITY: NEW -\ ,_ RL:MODEL ADDITION DEMOLISH OTHER DESCRIBE WORK CONTRACTOR'S NAME ADDNESS CONST. CONTRACTOR #EXPIRES PHONE HG EN ERAL: ttl - l\,4ECHAN ICAL: -, ------ I')I,LJ MRING ELECTRICAL: OLJAD ARFA: It OF IlLDGli: . OCCY CROUP: s oF sTol-ltF-s: \N./ATER I-IEATER: lffiBrtt D- _ OFFICE USE _ DUSE:- llll-- --- yl It LA t'l N IlANGE:E Rough Mechanical - Prior to cover. Rough Electrical - Prior to FLOOD PLAIN: ZONING CODE; # OF BDRMS SECONDARY HEA-N SQUARE FOOTAGE: _J # oF UNITS, -- I Ra_a- 4 M_CC)NSTR. TYPE: - I_IEAT SOURCE -- -,.---aJ.-_2144 l-o request an inspection, you musl call 726-3769. This is a24 hour recording. All inspections requested before 7:00 a.m. will be macie the same working cl:ry, inspections requested atler 7:OO a.m. will be macte the following work day. REQUIRED INSPECTIONS [-_l Ternporary Elcclrictt Site lnspection - To be rnarJe af ter excavation, but prior tcr setting forms. Undersl ectrical/ Meclranic to cover, Masonry - Ster:l location, bond bearns, groutin0. Foundalion * After {orrns arr-' erecteci but prior t0 concrete placement. Underground Plunrbing - Prior to filling lrer'rch. U nderf Mechanical - Prior to u a on or decking Post and Beam - Prior to lloor insulation or decl(ing. Floor lnsulation - Prior to decl(ing. Sanitary Sewer - Prior to f illing t rcn c tl. Storm Sewer - Prior to filling trench. Water Line - Prior to filling tr(]nch. Rough Plumbing - Prior'to cover. OOVCI, Electrical Service - Must be approved to obtain permanent electrical power. Fireplace - Prior to faclng rnaterials and f raming lnsp. Wood Stove - After installation lrrserl - After fireplace approval and installation of unit. Curbcut & Approach - After forms are erected but prior to placement of concrete. Sidewalk & Driveway - Af ter excavation is complete, forms i:ntl srrb-basc.. ntatcrial in place. Ferrce - When completed Street Trees - When all required trees are planted. IYT Final Electrical - Wlren all4\clectrical work is complete. ,K Final Plumbing - When all plumbing worl( is complete. Final Mechanical - When all mechanical worl< is complete. ,x }< X E EI I::j;::"- Arter trenches are K A E E B r, K K X Vl f inal Buildino - When allJ^\.r..qr, r"d i nsp"ections have been apprroved and building is completed. ffiotn-'ng - Prit>r to cover' f\/ w;rttlcciling tnsulation - Prior to ,lA{ r:r>ver. D(otr*r'l - Prior to tarrins. Olher MOBILE HOME INSPE TIONS Blocking and Set-Up - When all blocking is complete. Plumbing Connections - When home has been connected to water and sewer. Electrical Conneclion - When blocking, set-up, ancl plumbing inspections have been approved ancl the home is connected to the service panel. Final - After all reqr-rired lnspections are approved and porches, skirting, decks, and venting have been installed. umbi lu nr r a r\/ l/'l I trl ,l -- EYt/ tl E ri tl tl fl Lot faces Lot sq. ftg. coverage Topography Total height Lot Type -- - lrrterior - Corner -- Panhandle -- Cul-de-sac S(ltbacl(s HSE GAR ACC//Fzoefi 129o 2G PL. N 2{)t J /o I E IS T}1 [ F'ROPOSED WORI( IN THE H tsTo RtcAL DtsTRrcr, o-g_*oN THE HISTORICAL REGISTEFI? : lf yes, this application must be signed and approved by tlte Historical Coordinator prior to permit issuance. APPFIOVED BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This pernrit is granted on tlre express condition that the said construction shall, in all respects, conform to the Ordinance adopted by tlre City of Springfield, including the Developrnent Code, regulatirrg the construction and use of buil<Jings, and may be suspended or revoked at any tinre violation of any provisions of said ordinances. lJ;rtc* 2* 3/zu pon /6[)lan Cltt:c;k ['cc /o-s -7L Date Paid Receipt Number:. VALUE oo/fuFO (A) _f6?a Z6 Total Value Building Permit Fee State Surcharge Total Fec X $/SQ. FT. BUILDING PERMIT ITEM SO. FT. Main Garage Carport a4enrh Systems Developnrent Clrarge is clue on all undeveloped properties within tlre City limits wlrich are being improved'SYSTEMS DEVELOPMENT#tsfile ADDITIONAL COMMENTS)lITEM Fixtu res Residential Bath(s) Sanitary Sewer Water , Storm Sewer Mobile Home PLUMBING PERMIT FEE N0 (\-) 4 FT. FT. FT. - /%-?: Plumbing Permit State Surcharge Total Chargc 463ffii Wood Stove/ lnsert/ Fireplace Unit MECHANICAL PERMIT Mcchanical Permit ?v4 Ooo _ _( t__--- (D) N0 .b.@1frf /a.e Dryer Vent ar-& 3/,oo@ lssuance State Surcharge Total Permit Fu rnace Exhaust Hood Vent Fan -a 2O4t By signature, I state and agree, that I have caref ully exanrined the completecl application and do hereby certify that all information hereon is true and correct, and I f urthcr certif y that any and arll worl< performecl shall be done in accordance with the Orclinances of tlre City of Springf icld, and thc Laws of thc State o( Oregon pertaining to the work described herein, and lh.at NO OCCUPANCY will 'be made of any structure without permission of the Building Safety Division' I further certify that only contractors and employees who are in compliance witlr ORS 701.055 will be used on this proiect. I f urther agree to ensure tlrat all required inspcctions are requested at the proper time, that each address is readable lrom the street, that tl're permit card is located at the front of tl-re property, anci the approvecl set of plans will renrain on the site a I times dr.rring construction ( ignatu rc Date MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk --__ {t Curbcut ----- ft Demolition St;rtc Surcharg;c Total Miscellaneous Permits (E) D -.27/a7: 7? RECEIVE AY DATE PAID AMOUNT FI VAI.-IDATION: RECEIPT NUM TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) 44i***? 21 t?\v Recei/@.,2s24-t/ aA 2r.OO i0B N0.1u zbo CITY0FSPRINGFIELD-SI!E.I'ISDEVEL0PMENTCHARGEWORKSHEET (C0I'IMERCIAL & RESIDENTIAL) NAME OR COMPANY:Mt uUAF-P AL-t..ltJf ob - ooloo LOCATION:o DEVELOPMENT TYPE VVZ - TJ{-VI *? T SIZ . Ft. BUILDING SIZE: 1.STO DRAi AGE IMPERVIOUS SQ. FT.2boo x $0.192 PER SQ- FT- SANITARY SEWER-CITY NO. OF PFU'S IO X $39.78 PER PFU (See Reverse) ? 3. T SPORTAT ION NO OF UNITS X TRIP RATE X COST PER TRIP I XI .oo5 X $401 .05 X Y ADMINISTRATiVE FEES BASE CHARGE (SUBT0TAL ABoVE) X '05 5. SANITARY SEWER.Mt^lMC NO. OF PFU'S x $401 .05 x $40i.0s SUBT0TAL (ADD ITEMS 1,2, & 3)bse lo $13.62 PER PFU + $IO MhIMC ADMIN. FEE $zr59 4 (Use PFU Total From MbIMC CREDIT IF APPL ttem 2 Above) ICABLE (SEE REVERSE) TOTAL-MWMC SDC TOTAL SDCKip Burdick .*4t Go , ottlo- SDC Coordinator lo 2- s TOTAL-CiTY SDC $lqq,v qo FIXTURE UNIT CALCUIATI6N rngLE: r.rumoer of New Fixtures X ti.rn Equivalent = Fixture Units (NOTE For remodets, calculate only the Nfl additional Iixtures) NUMBER oF UNIT FIKIURE FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS Bathtub...-.-. Drinking Fountain-.--- Floor Drain. I nterceptors For Grease/Oil/Solids/Etc""""""""' lnterceptors For Sand/Auto Wash/Etc""""""""" Lau nd ry Tub/Clotheswasher""" Clotheswasher - 3 Or More""" Mobile Home Park Trap (1 Per Trailer)""""""""" Receptor For Ref rigeratorAVater Station/Etc" "" " Receptor For Commercial Sink/Dishwasher/Etc" Shower, Single Stall-...------..- Shower, Gang...-...---. Sink, Bar, Commercial...--.."-""""' Urinal, StallflVall--L Wash Basin/Lavatory, Single' Water Closet, Public lnstallation'Z ---6- Water Closet, Private..------- Ir4iscellaneous TOTAL FIXTURE UNITS lb CREDIT CALCULATTON TABLE: Based on assessed value. lf improvements occurred after annexation date in table' calculate credits I --z- --z 2 1 2 J 6 2 6 6 1 J 2 t /Head 2 Z 1 6 4 Credit for Parcel or Land Only lf Applicable lmprovement (if after annexation date) x$ (Rate X Assessed Val ue) X$ (Rate X Assessed CREDIT Value) TOTAL =$N,* . RUNOFF COEFFICIENTS FOR STORM DRAINAGE Residential-- Commercial 0.9 lndustrial-. .--------..-----""' 0'4 Year Annexed Rate per $1,000 Assessed ValueYear Annexed Rate per $1,000 Assessed Value 1 985 1986 1 987 1988 1 989 '1990 1991 $2.1 6 1.90 1.60 0.25 0.87 0.50 0.16 1979 or before 1980 1981 1982 1983 1984 $2.83 2.76 2.7'l 2.60 2.46 2.33 IMPERVIOUSAREA:TOTALLoTSIZEXRUNOFFCOEFFICIENT ?- Permit No: Address: lssued Date: OFFICE USE ONLY 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 befiled with the permit. Fill in the plicable blanks, and initial boxes 1 and 2, and either box 3A or 38: 1 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. My general contractor is , 2 3.A OR Contractor registration numbe 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. ! hereby certily that the above inlormation is correct and that t have read and understand the lnformation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. -L 6 -?3 ignature o t cant CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT Date INFORMXTION NOTICE TO PROPERTY OfiTNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Ndice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), 'passed by the 1989 Oregon Leg,islature. : '(':". .- : :' .' lf you ar'e actinQ ab yourown contraetor tb construct a new home or make a substantfrf.+dEi$rcm"ni to "nexisting structure, you canprevgnt many problems bylbeing aware of the following responsibilities and areas'ir . :ol concern :1.':' ' o; i EMPLOYER RESPONSIBILITIES: lf you hire pe{sols, not registered with the Construction Contractors Board tp do labor in constructing or assisting in the consrruction or iripfot'e#entbf a'rBsidentiAl structure, you wili, in miist instancgs, be'ftrted to be an "employer" andihq'pepple you hire will be "pmployees'0, As,t{r.e.FmRioyer,.you,p(t$t comply'with the following: -|{' Oregon's Withholding Tax.Law:, As a1,gmployer, you tnust.withhold incglJre- taxes f19rm emp,loyee wages at uwili6eliable,forthetaxpaymentsev.en.ifyoudonltactuallywithholdthe tax from your employees. For more information, call the Oregon Department of Flevenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance mployees.Formoreintormation,oal],theOr9gonEmploymentDivisircnDHR at 378-3224. Workers'Com sation lnsurance: As an employer, you are sarbiect to the Oregon VlA)rkers' Compensation Law, and must n workers' compensation insurance for your employees. lf you fail to obtain workers' compensation insurance, you may be subject to penalties and will be'lihble for allc{aim costs if'onb of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at g&7434. You will be liable for the tax payment even if you d r must withhold federal income tax from employees'wages. idn't actually withhold tn" U*. fdr more infoimation, call U.S. lnternal Revenue Service: As an employer, you the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Cqqp!!g!qe: As the permit holder for this proiect, you are responsible for resolving any failure to meet coOe requirements that may be brought to your attention through inspections. Liabil and .insurancb: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omrssrons suc h as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done Time.tO Supervise Employees: Make sure you have sufficient time to supervise your employees. Expertise: of rough-in Make sure you have the expertise to act as your own general contractor, to coordinate the work 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 o244J 10124189