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Home My WebLink AboutPermit Building 1994-04-28RESIDENTIAL PERMIT APPLICATION Inspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: LOT SPRINGFIELD \ BLOCK: JOB NUMBER 225 Flfth Street Springfleld, Oregon 97477 TAX LOT oo304 SUBDIVISION: ZlPi 7ceuzLk ,F*rrse PHONE: 7y' Z -'Z/ ^ * ADDRESS: oWNen: .n I ,..-..DEMOLISH OTHER DESCRIBE WORK: NEW - REMODEL ADDITION MECHANICAL: ELECTRICALi ADDFTESS EXPIRES PHONE CONST. CONTRACTOR #CONTRACTOR'S NAME GENERAL: PLUMBING \tr ' /1,,o, - OFFICE USE - I OF BDRMS: RANGE; QUAD AR ZONING CODE: FLOOD PLAIN:LAND USE: * OF BLDGS: WATER HEATER: SECONDARY HEAT SQUARE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: OCCY GROUP: A OF STORIES: To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:00 a.m. wlll be made the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day. REQUIRED INSPECTIONS Temporary Electrlc Rough Mechanlcal - Prlor to cover. Rough Electrlcal - Prior to cover. Electrlcal Servlce - Must be approved to obtaln permanent electrlcal power. Flreplace - Prlor to faclng materlals and framlng lnsp. Drywall - Prlor to taplng. Wood Stove - After lnstallatlon. lnsert - After flreplace approval and lnstallatlon of unlt. Curbcut & Approach - After forms are erected but prior to placement of concrete. Sidewalk & Drlveway - After excavation ls complete, forms and sub-base materlal ln place. Fence - When completed. Street Trees - When all requlred trees are planted. [-l Flnal Plumbing - When all|J plumblng work ls complete. ]V Plnal Electrlcat - When ailAelectrlcal work ls complete, Slte lnspectlon - To be made after excavation, but prior to setting forms. Underslab Plumblng / Electrical / Mechanlcal - Prlor to cover. Footlng - After trenches are excavated. Masonry - Steel locatlon, bond beams, groutlng. Foundatlon - After forms are erected but prlor to concrete placement. Underground Plumblng - Prlor to fllllng trench. Underlloor Plumblng/ Mechanlcal - Prlor to lnsulatlon or decking. Post and Bsam - Prlor to floor lnsulatlon or decklng. Floor lnsulation - Prlor to decklng. Sanitary Sewer - Prior to filllng trench. Storm Sewer - Prlor to fllling trench. Water Llne - Prlor to filling trench. Rough Plumblng - Prior to cover. g Flna! Mechanlca! - When all mechanlcal work Is complete. [V[ flnat Buildlns - When allfrequired lnspectlons have been approved and buildlng ls completed. pframlng - Prlor to cover. l-l WalltCelling lnsulatlon - Prlor to|J cover. O.ther MOBILE HOME INSPE TIONS Blocking and Set.Up - When all blocklng ls complete. Plumbing Connectlons - When home has been connected to water and sewer. Electrical Connection - When blocking, set-up, and plumbing lnspections have been approved and the home ls connected to the servlce panel. Flnal - After all required lnspectlgns are approved and porchos, sklrtlng, clecks, and ventlng have been lnstalled, E E tl CITY: STATE: # OF UNITS: - E E E E i::,.t.i\ Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Type - lnterior - Corner - Panhandle - Cul-de-sac THE PROPOSED WORK IN THE xSTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, thls appllcatlon must be slgned and approved by the Historlcal Coordinator prlor to permit issuance. APPROVED: GAR ACOPL,HSE N S W E VALUE Szoo 33 /oAfo (A) 5o Main tQnf 5Zq /o.ao Q6fo BUILDING PERMIT ITEM X $/SQ. FT, rZf(a. Total Value Building Permit Fee State Surcharge Total Fee Garage Carport SQ. FT. bSz- 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 Ordinance 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. ewed By 1/ P 7 aare Plan Check Fee: Date Paid Fleceipt Number Received By SYSTEMS DEVELOPMENT CHARGE (SDC)(B) il, /, Systems Development Charge is due on all undeveloped prcperties within the City limits which are belng improved. ITEM Flxtures Residentlal Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE (c) No FT. FT. FT. PLUMBING PERMIT Plumblng Permlt State Surcharge Total Charge ADDITIONAL COMMENTS 't-Ai ', l'-ll * , - I i*{ Wood Stove/ lnsert/ Flreplace Unit Dryer Vent (D) NoVent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood 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 certify that any and all work performed shall be done in accordance wlth the Ordinances of the City of Sprlngfield, and the Laws of the State of Oregon pertainlng to the work described herein, and that NO OCCUPANCY will be made of any structure wlthout permission of the Bullding Safety Divislon. I further certify that only contractors and employees who are ln compliance with ORS 701.055 will be used on this proiect. I further agree to ensure that all requlred lnspections are requested at the proper time, that each address ls readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain Date A^tu on the slte at all times durin g constructlon. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sldewalk - ft Curbcut - ft Demolition State Surcharge Total Mlscellaneous Permlts (E) P ' z(nl'c-<l ha TOTAL AMOUNT DUE (excluding electrical) (A, B, C, Q and E Comblned) / 3o,8t VALIDATION: RECEIPTNUMBER , ^ rL) 2_6 6AMOUNT RECEIVED RECEIVED BY DATE PAID *s,/qa r SP.^...CFiE,-] FIRE DEP.\iT}lENT qffitL 5r?{ o15 y uqt3 DATi: 4 13 /1+ I FiRE DA.'lPGT OR EL ECTR I CAL P. EPt)P.T HAZARD \103A+gTO: tront.t. SUBJiCT: Bujldin-o Departnent Springf ield Fi re DeParr-sent Structura'l Daniage to Bui 1di ng or l ocat'ion of bui l di ng tt bb Yclo^)q t>o\./n e r buiiCing j ng , Store, I^Jarehouse,etc. ) Address Narne of iyDe oi Est'inrated val ue of bui i di ng Estimated loss to building Date of fire sfrc n)) S 4l' lq+_ Location of damage in building ( Rcot , Structural weakness as a tr{al I , Exterior, Interior, etc result of the fire q I urned ra fters , Beams,Jojsts, etc.) Add'itjonal pertinent inforrnation E'iectrical Hazard CC U)"/ t -q4 (l.ii ri no, Siqned 1, lLq Cutlets, etc.) ,t 1 2 Permit No: Address: lssued Date: R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCT!ON 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: H. 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 reqistration number-. I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR 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 certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. gnature rm pp cant CONSTRUCTION CONTRACTORS BOARD 0244J 8191 3 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ?4etaz NOTE: This lnformation Notice to Property Owners About Construction Responsibilities 7O1O5s(5)inBoard withaccordance ORStheContractorsctiondevelopedWASbyConstru 1e 989th Oregon Legislaturebypassed -JINFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES lf you are"acting as your own contractor to construct existing structure, you can prevent many problems by of concern :" ir,", .. EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construbtion or iriprovem'ent'of a residential structure,.yoq-will, in most lnstancbs, be ruied to be an "emptoyer" "19 th" peopie iibu hire will be "employees". As thtiSmptoyer, yoti must cornply with the following: Oregon's Withh employe.r, you must withhold income taxes from -employee wages at the time empl qyees are pal d. You will be liable for the tax payments even if you donl!.actgally withhold the tax from your employees. For more information, call the Oregon Departrnent gf+Revgpu^e at 378-3390. I rc i.:. Unemploymenl lnsurance Tax As an employer, you are required to pay a tax for unemployment insurance @l.emp!oyee9Formore.jnformatipn,calltheor.qggnEmploy.qrentDfuisionDHR at 378-3224. Workers' Compensation lnsurance: As an enrployer, you are suhpct tothe 0fegoo tfforkers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers compensation.insurance, you may be subject to penalties and,willb€rliable,lor all cldim costs if'bne of your employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at 973-7434. i .!; a new home or make a substantial impitbvement to an being aware of the following responsibilities;and areas U.S. lnternal Revenue You wilt be I le the lnternal Revenue OTHER RESPONSIBILITIES AND AREAS OF CONGERN; must withhold federal income tax from employees' wages. idn't dctually wftfr.liold lfrd,tax. For more information, call Code Complianoe: As the per mit 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 Dantage lnsurance: eorrtact:1,iour insuran€e:aQ6htto see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint oversprtiy,titidtbr damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: fVlake sure you have sufficient time to suBervise 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 trades, and to notify building officials at the appropriate ttmes so they can perform the required ihspecti'6ns. " , ,:- ,l ."t, ;,.t,,.,,,,1,,,-. Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 lf you have additional questions, write to: o244J 10t24t89