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Home My WebLink AboutPermit Building 1992-12-14S,,'I!NGFIELO RESIDENTIAL PERMIT APPLICATION I rrs pections: 726'3769 Off ice: 726-3759 JOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 I-OCATION OF PROPOSED WORK: JLT --Wa-qq{E4E DBnl€sPRINGFIeLr>)PEAxl q ASSFSSORS MAP:LoT *tO7 [ruEE h{tr-t-s FtL6 72,slt-tDE7q TAX LOT: LOT:BLOCK:SUBDIVISION: 7+7 7 7+7- tL76?PHONE q7+77OREftNZIP:STATE: ADDRESS 6L+ tlooDcRESz DR,I(E- StBlENl e. $ARtcLEOWNER: -. EPRt NGFICI.DCITY: ?W R00M , ur.tDER 6rtsrtt,le G4gq6p NEW-__,-, REMoDEL- ADDtrloN -{- DEMoLtsH orHEB I)ESCNIBE WORK:Bebtzoolls S'toRA@Auutrror.l oF EXPIRES PHONEADDRESS No$E Setf Cor-rrotndeul coNrRACroR's NAME - $AJIIER GENE CONST. CONTRACTOR # PLUMBING: ...,-- MECHANICAL: - ELECTRICAL: - Y OF UNITS: CONS]R. TY L__ R.3 WATER HEATER: r OF BDRMS: _ OFFICE USE _ ZONING CODE: FLOOD PLAINLAND USE: RANGE: HEAT Sounce,\h\-SECONDARY HEAT: SOUARE FOOTAGE: OCCY GROUI': I OF STOt]IES: OUAD AREA: , OF B1..DGS To request an inspectlon, you must call 726-3769. This is a 24 hour recording. All inspectlons requested before 7:o0 a.m. wlll be rnsclc the same working day, inspections requested after 7:00 a.m. wlll be made the following work day. REOUIRED INSPECTIONS Tenrporary Electric Rough Mechanical - Prior to cover. Final Plumbirrg - When all plumblng worl( is complete. Site lnspection - To be tnade af ter excavation, but Prior to settin0 lorms. x Rough Electrical - Prior to x Final Electrical - When all electrical worl< is complete.cover, Underslab Plumbing/ Eleclrical / Mechanical - Prior to cover. Eleclrical Service - Must be approved to obtain permanent electrical power. Final Mechanical - When all mechanical worl( is complete. K Footing - nfter trenches are excavated.Fireplace - Prior to facing rnateriarls and framlng lnsP. E.Final Building - When all requlred inspections have been approved and building is completed.Masonry - Steel location, bond bearns, grouting. f[.tto*tng - Prior to cover' F7 wattlceilino lnsulation - Prior to AL"orut. ,fftv*all - Prior to ta,lng' B Other Foundation - After forms are erected but prior to concrete placemen t. Underground Plumbing - Prior to filling trench. MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulatiorl or decking;.Wood Stove - Af ter ln:;tallation. ,Xx Post ancl Beam - Prior to floor insulation or decl(ing.lnsert - After flrePlace approval and installation of unit. Blocking and Set-Up - When all blocking is complete. Floor lnsulalion - Prior to decki ng.Curbcul & Approach - After forms are erected but Prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to f illing trench.Electrical Conneclion - When blocking, set-up, and plumbing inspections have been apProved and the home is connected to the service panel. Slorm Sewer - Prior to filling trench. Siclewalk & DrivewaY - After oxcavation is complete, forms and sub-base malerial in Place. Water Llne - Prior to filling trench. Fence - When comPleted. Street Trees - When all required trees are planted. Final - After all required inspections are approved and porches, sklrting, decks, and ventlng herve been installed.Rough Plumbing - Prior to cover. \\r \ tl tl L] r tl fl [l r P.L. N GN FI S_ ttsS- E Lot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot Type- _- lnterior - Corner _-. Panhandle - Cul-de-sac Set IS THE F'ROPOSED WORK IN THE - r-ilsronrcAL Dtsrntcr, oR oN -ThIE I.IISTONICAL REGISTE,R? , lf yes, this application nlust be signed and aPProved bY tlrc Historical Coordinattor prior to pctnrit issu;rncc. APPROVED: ACC BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This perntit is grantecJ on the express conditiorl tllat th"r said construction shall, in all respects, confornr to ttle Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of builclings, ;rnrJ may bc suspended or revoked al any time n/o,Gz- 7 ode-- _ft P Plan Check Fee: Date Paid Receipt Num Recei Rcvicwed By upon violation of anY isions of said ordinances VALU 0o (A) X $/SQ. FT. o3 Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SO. FT. Main Garage Carport @.ro Systems Developtttcnt Cllargc is due on all undcvelopcd properties within the City limits which are being improved'SYSTEMS DEVELOPMENT CHA (B)W'",.PI'w D ON L COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT FEE N0 FT. FT. FT. (c) Plumbing Permit State Surcharge Total Charge Wood Stovc/ lnsert/ Fireplace Unlt Dryer Vcnt (D) NoVent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hoocl By signature, I state and agree, that I have caref ully examined the completecl application and clo hereby certify that all information hereon is true and correct, and I further certify that any arrd all worl< pelforme(l shall be dorrc'in accordance witlr tlrc Ordinance s oI tlrc City of Splinqf iclcl, and tltc [-aws of thc State of Orcgon pertaining to the worh clcscribcd hcroin, antl ttrat NO OCCLIPANCY will btl tnaclt-. of any structure wittlout pcrnrission of the Building S;rloty Division. I further certify tlrat ortly contractors and entployees who are ln compliance with ORS 701.055 will be used on this project. I f urther agree to ensure that all required inspections are requested at the proper time, that each address is readable {rom the street, that the permit card is located at the front of tlre property, and the approved set of plans will renlain Date n-K a all times during constructionthe si nat u re MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -_ ft Curbcut --- ft Demolition State Surcharge Total Miscellaneous Permits (E) VALIDATION: FIECEIPl' NUMt]EII DArE PA|D lo' t.]Y IVIAMOUNT TI RECEIVED TOTAL AMOUNT DUE (excluding electrical) (A, B, C, Q and E Combined) / /4lb C'TY OF SPP"UGFIELD,OFEGO'" SPIIIilGFIELfD The ioltowing project ag eubmltted hE rho io" -,, endZbesnot requlre specilic land ai,ir..::r'rgl. u8e Nev Residential-Single or Hulti-Family per dvelling unit. Service Included:Items Cost 1000 sq.ft. or }ess Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or Hodular DveIIing Service or Feeder $ Bs.oo $ 15.00 $ 40.00 Services or Feeders InstaIIation, Alterations or Relocation: 225 VTFT:E STREEf, sPRrNGrrBLD, ORBGON 974 INSPECTION RBOUBST: 72 OPPICE: 726-3759 1 77 6-4il6e EIJCTRICAL PERHIT APPLICATION 't LL-q7 City Job Number 'L ir tSillrailndt-LV-g, ggHf' --B FDI SCEBDT'LE BELOSAuiilririzsd C IJGAL DBSCRIPTION A B c D llo )"il t3 oz:77].,Sum JOB DBSCRIPTION n C iv C t,r.,1-= Permits are non-transferable and expire tf vork is not started vithin 180 days of lssuance or lf vork ls suspended for 180 daYs., 2. CONMACTOR INSTALI.ATION ONLY EIectrIcal Contractor Address ct Phone Supervisor License Number Explration Date constr contr. Number Explr atlon Date Stgnature of Supervlsing Blectrlcian 200 amps or less 201 amps to 400 amPs -401 amps to 600 amps - 601 amps to 1000 amPs- Over 1000 amps/volts Reconnect 0niy $ s0.00 $ 60.00 $100.00 $130.00 s300.00 $ 40.00 (^i 0vners Name \Qv\L\,\fL r t(a-€. Temporary Services or Feeders Installation, Alteratlon or Relocation 200 amps or less $ 40.00 ior "*ir to 400 amps - $ 55.00 over 4b1 to 600 ambs - $ 80.00 Over 600 amps or tbOO voTts see riBi' a5ffi Branch Circuits Nev, Alteration or Extension Per Pane} t.i I Address Ci ty J) PhoneT 4f t+1@ OIINBR INSTALI,ATION The installation is belng made on piop"tty I ovn which is not intended for sale, lease or rent. one circuit I $ 3s.oo 72il. Each Additional Circuit or vith Service or Feeder Permit I $ 2.OO Z A E. Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/0utline Lighting- Limited Energy/Res - Limi ted EnergY/Comm SUBTOTAL OP ABOVB 5Z State Surcharge TOTAL Slgnature: $ 40.00 $ 40.00 $ 20.00 $ 36.00 DATB:-Z-z- RBCEIVBD v\,t/fi&'1 5 31"5e JOB N0. qzt 65.{ CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (CoMI'IERCIAL & RESIDENTIAL) NAME OR COMPANY:t reVeU c Mp"e-rcuE LOCATION:GL'l \xloaocaEgf rvE ll oZ'BL+ \3 - o]-'100 DEVELOPMENT TYPE:LD e- - &\>D l'Tro BUILDING SIZE: I. STORM DRAINAGE IMPERVIOUS SQ. FT.\+1 2. SANITARY SEt,lER-CiTY OT SIZ x $0.192 PER SQ. FT X $39.78 PER PFU $ SUBT0TAL (ADD ITEMS 1,2, & 3)$ "-6 TOTAL _ C ITY SDC $ 'Lnbz $I3.62 PER PFU + $IO Mt^lMC ADMIN. FEE TOTAL-MI^IMC SDC Ft NO. OF PFU'S (See Reverse) 4- 3 TRANSPORTAT ION NO OF UNITS X TRIP RATE X COST PER TRIP x - x$401.05 X x $401 .05 x x $401 .05 4. ADMit'll STRAT I V E FEES BASE CHARGE (SUBT0TAL AB0VE) X .05 5. SANITARY SEt^lER-Mt,lMC 22- NO. OF PFU'S (Use PFU Total From Item 2 Above) MhlMC CREDIT IF APPLICABLE (SEE REVERSE) ,L I\ Kip Burdick SDC Coordinator ?.2-ab -o- 4- -o- l3 L TOTAL SDC $21u2- t c s 1 2 Permit No Address: lssued Date OR 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 be filed 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 num 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 form. 3 OR N*,"t&,W Signature of Permit Applicant CONSTRUCTION CONTRACTORS BOARD 0244J 8191 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 4 v INFORTIiXTION NOTICE TO PROPERTY OIUf{ERS ABOUT CONSTRUCTION RESPONSIBILITIES lf you are acting as yollr own cohtractor to construct a new home or make a substantihl existing structure, you can prevent many problems by being aware of the following respon of concern. improvement to an rsibiliftes and areas EMPLOYER RESPONSIBILITIES lf you hire persons not regrstered with,the Construction Contractors Board. to do iabor in constructing or assisting in the construction or improvement of a residential structuig you will,:in most instances, be ruled to be an "employer" and the people you hir:e will,60 "employees". As the employer, you mtjst comPty with the following: Oregon's Withhoiding Tax.L,aI! As an employer, you mugt. r{afil]nqO income taxes'from.ggployee wages at the time employeepiare paid. You will be liable for the tax payments even ifryou dooit actuFlly withhold the tax from your employees. For more information, call the Oregon Department of Revenue-at 378-3390. U nemployment I nsurance lax As an rimpioyer, you are required to piy a tax for unemployment insurance purposes on the wages of all ernployees. For more information, call the Oregon Employment Division DHR at !78-3224. Workers'Com ensation lnsurance As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers compensation insurance for your employees. lf you fail to obtain workers' compe{lsation insurance, you may be subject to penalties and W'ill be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 573-7434. U.S. lntern,al Revenue Service:, As a[ employer, you must withhold federal income tiax from employees' wages. mentevenitvoLdidn'tactuallywithholdthetax'Formoreinfoimation,call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN:. . Code Compliance: As the permit holder for this project, you are r.esponsible for resolving any failure to meet code requirements'that may be brou$ht to your attention through inspections. Liability a4d Property Damage lnsurance: Contact your insurance agent to see'if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, riiabr 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: Make sure you have the expertise to act as your own general contractor, to Jooidinate the work of rough-in and finish trades, and to notify building officials at the appropriate tjrnes,so'!.hey can perform the required inspections. . ,. lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 9ft110-0151 Phone 503-978-4621 NOTE: This lnJormation Notice to,Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 7O1O55(5), passed by the 1989 Oregon Legislature. o24N 10t24t89