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Home My WebLink AboutPermit Building 1992-04-10INGFIELE' R ES ID ENTIAL PERMIT APPLICATION lnspections: 726'3769 Otlice: 720'3759 LOCATION OF PBOPOSED WORK; ht, JoB NUMBE^2zo]l%- 225 Fif th Street Springfield, Oregon 97 477 3a ASSESSORS MAP:/7 -43-TAX LOT: BLOCK:LOT: ZIP..SIATE: PHoNE: 7/4-zV.E CITY: --- -- ADDRESS: - OWNER: ---. .22DESC NEW ODEL ADDITION DEMOLISH OTHER EXPIRES PHONEADDRESSCONTRACTOR'S AME MECHANICAL: --- ELECTRICAL: CONST. CONTBACTOR # CENERAL: PLUMBING 5RN\D LAND USE:T:FLOOD PLAIN ZONING CODE: -, _ OFFICE[1 # OF STORIES: -- -.- WATER HEATER r OF BDRMS: HEAT SOURCE: - CONSTR. TYPE: SECONDARY HEAT: SOUARE FOOTAGE: r OF UNITS: OUAD AREA: * OF BLDGS:. OCCY CIIOUP: To request an inspection, you must call 726-3769. Thts ls a24hour recording. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested atler 7:OO a.m. will be made the following work day. REOUIRED INSPECTIONS l--l Temporary Electric Rough Mechanical - Prior to cover. Final Plumbing - When att plumbing work is complete. Site lnspection - To be made af ler excavation, but prior to setting fornrs. Bough Electrical - Prior to Final Electrical - When all electrical work is cornplete.cover Underslab Plumbing/ Eleclrical / Mechanical - Prior to cover.Electrical Service - Must be approved to obtain permanenl electrical power. Final Mechanical - When all mechanical work is complete. X Footing - After trenches are excavated.f)4J Final Building - When alt .larequired inspections have been approved and building is completed. Fireplace - Prior to facing materlals and lraming lnsp. Masonry - Steel location, bond beams, grouting.\/l Framing - Prior to cover. Foundalion - After forms are erecled but prior to concrete placement. Other Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.l--l orywall - Prior to taping. Underlloor Plumbing/ Mechanical - Prior to insulation or ciecking. MOBILE HOME INSPE TIONS Wood Stove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After flreplace approval and installation of unit. Blocking and Set-Up - When all blocking is complete. Floor lnsulalion - Prior to decking.Curbcut & Approach - After forms are erected but prior lo placement of concrete. Plumbing Conneclions - When home has been connected to water and sewer. Sanilary Sewer - Prior to filling trench- Slorm Sewer - Prior to filllng trench. Sidewalk & Driveway - After excavation is complete, {orms and sub-base material in place. Electrical Conneclion - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Waler Line - Prior to filling trench.l--l Fence - When compteted Rough Plumbing - Prior to Slreet Trees - When all required trees are planted. Final - After all required inspections are approved andporches, skirtlng, decks, and venting have been installed.cover. SUBDIVISION: K: \ RANGE: E Er E tl E if Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type v - lnterior - Corner --- Panhandle - Cul-de-sac Sclbacl<s PL,HSE GAR NCC N E 'S ]'HE PROPOSED WORK IN THE -HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? -_-,lf yes, this application must be signed and approvecl bY tho Historical Coortlinator prior to permit issuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is grantecl on the express condition that the said construction shall, in all respects, conform to the Ordinance adoptecJ by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any lime upon violation of any provisions of said ordinances' //#. evlP ?8.9 =3:-72 Received Plan Check Fee: Date Paid: ReceiPt Number: VALUE /lrc 5284 (A) 2,#Z v3 BUILDING PERMIT Total Value Building Permit Fee Stale Surchargc Total Fee z,.4.so+fis SO. FT, X $/SQ. FT.ITEM Main Garage Carport Systems Development Charge is clue on all urrdeveloped properties within the City limits which are being improved'sYSr EMS D EV ELo P, =*r,"l t ^?w ADDITIONAL COMMENTS ITEM Fixtures Flesidential Bath(s) SanitarY Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT FEE NN FT. FT. F-r. (c) Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fireplace Unit Dryer Vcnt MECHANICAL PERMIT (D) No Mechanical Permit lssuance State Surcharge Total Permit Furnace Exhaust Hood Vent Fan By signature, I state and agree, that I have carefully examined the completed application and clo hereby certify that all information hereon is lrue and correct' and I f urther certify that any and all work performecl shall be donc in accordance with the Orclinanccs of tlre City of Spring(ield' and tlte Laws of the State of Orellon pertaining lo llrc worl< dcscribed herein, ;rtrcl tltat NO OCCUPANCY will l.rc rrt;ttjc o[ any structure without pertnissiorr of the Building Safety Division' lfurthercertifythatonlycontractorsandemployeeswho are in compliance with ORS 701'055 will be used on this proiect. 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 f ront and the approved set of plans will remain st ru on.the site at Date natu of the ProPerty' times during MISCELLANEOUS PERMITS Mobile Home State lssuance Stato Surcharge Sidewalk =-_.-- ft Curbcut -- It Demolition Slatc Surchar-t;e Total Miscellaneous Permils (E) DArE PAro ?.P-eZ - ?6 AMOUNT RECEIVED RECEIVED BY VALIDATION: RECEIPT NUMBER.- - TOTAL AMOUNT DUE (excluding elcctrical) (A, B, C, D, and E Combined) 73 J I 225 FIFTB STRBEf, SPRINGFTEID, oRBGoN 97477 INSPECTI0N REQUESTz 726-3769 0FPICE: 726-3759 1 LOCATION OF INSTALI,ATION IJGAL DESCRIPTION JOB DES(N.IPTION € Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if work is suspended for 180 days. 2. COI{TRACf,OR INSTALI,ATION ONLY Electrical Contractor Address Ci ty Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Name Address ELECf,RICAL PER}IIT APPLICATION Ci ty Job Number ?2a<o< 3. COI{PIJTE PEE SCEEDULE BELOV Nev Residential-Single or MuIti-FamiIy per dvelling unit. Service fncluded:Items Cost $ 8s.00 $ 1s.00 $ 40.00 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 Only C. Temporary Services or tFeeders Installation, Alteration or Relocation sr.t trNGl=tELr., STJBTOTAL OP ABOVE 5Z State Surcharge TOTAL die A Sum B $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 ,p.*, 200 amps or less S 40.00 Over 401 to 600 amps _ S 80.00 Over 600 amps or 1000 volts see rrBrr above Ci ty OITNER INSTALI..ATION The installation is being made onproperty I own vhich is not intendedfor sale, Iease or rent. Ovners ignatu x DATE: 5^- ,- &hone 772:-?za= D. Branch Circuits Nev, Alteration or Extension Per Panel one Circuit S 35.00 Each Additional Circuit or vith Service or Feeder Permi t A S 2.00 I Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation SSign/0utIine Lighting- $ Limi ted Energy/Res - S Limi ted Energy/Comm S E 4 00 00 00 00 40. 40. 20. 36. 5Y-oo ?-a RECETVED BY: 5 66-a 272,* l,r;-f* ifTk 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or -Modular Dwelling Service or Feeder 1 2 Permit No:?.2are - Address: lssued e: R OFFICE USE ON 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 38: 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. A My general contractor is_ Contractor registration n umber-. 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 hirea 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 certify that the above inlormation is correct and that I have read and understandthe lnformation Notice to Property Owners about Construction Responsibitities on the reverse side of this form. 3 OR gna of App CONSTRUCTION CONTRACTORS BOARD 0244J 8191 WHITE @PY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT y'-/a ^92 Date INFORTATION NOTICE TO PROPERTY OV7f.IERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnform-ation Notice to Property Owners About Construction Responsibilities was developed by the"dohstruction Contractors Board in accordance with ORS 701:055(5), passed by the 19QQ QregAn Legislature. --1f you are'acting as yout-own-contraQtor to construct a new home or make a substantial improvement to an existing structure, you can prevent mdny problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees". As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at uwillbeliableforthetaxpaymentsevenifyoudon'tactuallywithholdthe tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment lnsurance Tax: As an em ployer, you are required to pay a tax for unemployment insurance For more information, call the Oregon Employment Eivision DHRpurposes on the wages of all employees ar 378-3224. Workers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation pensationinsuranceforyouremployees.lfyoufailtoobtainworkerS' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your empioyees is injured on the job. For more information, callthe Workers' Compensation Division DIF at 373-784. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. You will be liable for the tax payment even the lnternal Revenue Service at 221-3960. if you didn't actually withhold the tax. For more information, call OTHER RESPONSIBILITIES AND AREAS OF CONCERN 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 lnsurance: Contact your insurance agent to see if you have adequate insurance uchasfallingtools,paintoVerSpray,waterdamagefrompipepunc. tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficient 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-tn 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 0244J 10t24189