HomeMy WebLinkAboutPermit Building 1992-10-21LOT BLOCK:
SPRINGFIELO e'3sl
WOFIK:
JOI] NUML]EN
t\,^ S R rNl6 Fr eLO 1 1*t1/DVO l-r h
- TAX LOI:
SUBDIVISION
LOCATIOI.I OF PRO
ASSESSORS MAP:
RESID ENTIAL
PERMIT APPLICATION
lnspections:726'3769
Office: 726-3759
225 Fitll-t Street
Springtield, Oregon 97477
proNE: ? 2-G; tnq 9 -7Zto
ZtP:, g1Y1 1cirAl.L: O (C-ADDRESS
Fteu,/)
OWNER
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r.J L-
,ot{o N b\^
6-,-ILtt S S n
DESCRTBE woRK: - ho1utt---tc- lg x a\p oonzl f{=**'
or HEn,
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,.* X BEM.DEL ADDtrtoN -L- DEM.LI'H
to h.\6me
EXPIRES PI.IONEADD
Sctf LF\ Lr1 uctt
RESS(w
MECHANICAL:
- --
PLUMBING
CONTRACTOR'S NAME
GENERAL:
CONST.
CONTRACTON '
D(LKrr.Jb tr.Jttt\
ELECTRICAL:
-
D sxrprs l,*vNtoo
FLOOD PLAIN:-- -
ZONING
"OOr'
{I
I OF BDRMS:
SECONDAFIY tIEAT:
RANGE: ---
rL\D
{3-
_ OFFICE USE _
OCCY GROUP
SQUARE FOOIAGE: -WATER HEATER
, OF STORIES
LAND USE: -l-l IQUAD AREA:
, OF BLDGS
To request an inspection, you must call 726-3769. This is a 24 hour recording. All inspcctions requested before 7:oo a.m. will be
made the same working <lay, lnspectlons requested af ter 7:0O a.m. wlll be made lhc following work day'
REOUIRED INSPECTIONS
Temporary Electric Botrgh Machatrical -- Ptittt l'r
covcl.
Firral l'lurnbitrg - Wlrcn all
lrlrrrrrlrin-t1 wotl< is <:cltttllleto.tl
'lVf roundation - After forlns are
Aerected but Prior to conctete
placement.
Site lnspeclion - To be tnade
af ter excavation, but Prior to
setting lorms.
Unclerslab Plumbing / Electrical /
Mechanical - Prior to cover.
Footing - Af ter lrenches are
Masonry - Steel location, bond
beams, grouting.
Underground Plumbing - Prior
to filling lrench.
Underlloor Plumbing/ Mechanical
- Prior to lnsulation or decking.
Sanilary Sewer - Prior to f illing
trench.
Storm Sewer - I)tior to fillinq
trench.
Water Llne - Prlor to filling
trench.
Rough Plumbing - Prior to
cover.
flt'u-tng - Prior to cover'
].7 wrltlCeilinq htsulatiotr - Pri()r lo
,lA{"oror.
E"'*ull - Prior to taning'
Rouglr Electrical - [)tior tt.i
cover
Etectrical Service - MttsI t-rc
approved to obtain PcrmancnI
electrical power.
Fireplace - Prior lo facit-tg
materlals and f ramlng lnsP.
Wood Stova - Af tcr ittst;rll;ttiotr
Ctrrbcut & APProach - Af tctt
fottrts ;rte et"ectecl buI plior tr-r
placernent of cottcrete.
Sidewalk & DrivewaY - AItrrt
excavalion is cotrtplelr:' forttrl;
ancJ st.tlt-base trtltlt.:rial itr 1;l;tt:c.
Fence - Wtren cr.rtnl;lctecl.
Street Tt'ees - When all reqrtired
trees are Plantod.
Final Building - Wlten all
required inspections have been
approved and building is
cornpleted.
Other
MOBILE HOME INSPE TIONS
,K
l'--l Blockirr-c; arrd Sel'U1r - Wlrcrr allI -l lrlor:l<lrt<1 is r:<.ttttlrl,lt'
Final Electrical - Wltcn all
electrical work is contPlete.
Firral Mechanical - Wlten all
mecharrical work is <;omPlete.
Plrrrrrbirrg Cotrttectiolrs - Wllcl'l
lt<-lnre lras becn cortttr:cted to
walor and sewor.
Eleclrical Contrectiotr - Wlrctt
blocking, set-up, arrd plutttlling
inspections ltave been approvccl
and tlre honte is connected to
lhe servicc pancl.
Final - After all required
inspections are aPProved and
porches, skirting, decks, and
vcrrtitrg ltave Irlren irrstalled.
X ><
l.Vf Post and Beam - Prior to floor
,JAinsu lation or rtecl<irrg.
Kl""?1,i;suration - Prior to
tl
K
t_I
T)E_
# OF UNITS, J* - r-,- -.- -
coNSrR. rvpe: -VJJ
HEAT SoUR cE. -EW_
t_l
tl
lnserl - AIter firclrl;rr;c ;t1r1ttov'tl
ancl ins;titllatiorl ol tttrl[.
LI
Lot Ia(;cs
Lot s(1. f tg.
l-ot oovor:rg0
ToJrograplty
Total height
l-ot ly1.ir.r
Itltt-'ltrrl
Cr lt r tcl
[';tttlt:rtrtllr:
-,, Cttl'(l(r':;;t(;
liotlr;t(;l(s
FISE GAN ACC
lL
PI ,
N
_fHE PROPOSED WORK lN TFIE
t1 ISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
---._lf yes, thls appllcation must be signed
.rnd approved by the llistorlcal
Coordinator prior to permit issuance.
APPROVED:E-
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit ls 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 Co(le, regulating the construction and use of
buildings, and ntay be suspended or revoked at any time
Plr ()vlcw
Plan Check Fee:
Date Paid
Receipt Nurnl)
Rccciverl
upon violation of ii ions of said ordinances
BUILDING PERMIT
= VALUE \
M,A17
(A)
SO. FT. X $/SQ, I"T4aL- tuIDITEM
Main
Garage
Carport
Total Value
Bullding Pernrit Fee
State Surchargc
Total Fee
/7o'n
bf3
/JJ,OS
Systems Development Charge is due on all uncleveloped
properties withln tl're City limits which are being improved.
SYSTEMS DEVELOPMENT CHARG
(R) #
E (SDC)
1uL -#
ADDITIONAL COMMENTS
#Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
'Storm Sewer
Mobile Home
FEE
(c)
PLUMBING PERMIT
I-TEM
t'.1 "_ _
FT,
[-T.
l=T.
Plunttring Pcrrnit
State Surcharge
Total Charge
MECHANTCAL PERMIT
Furnace
Exhaust Hoorl
Vr.lnt Fan N"-
Wood Stove/lnserti Fireplace Unit
Dryer Vent
(D)
Meclranical Permit
lssuance
Stale Surcharge
Total Permit
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
informalion hereon is lrue and correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertalning to the work described
herein, and that 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 with ORS 701.055 wlll be used on this
proiect.
I further agree to ensure that all required inspections are
card
te at
from the st t, that the perm
of plans ll remain
address is readablerequested at the proper time,
s located at the front
and the approveof the p
I times durion the
Signatu
Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut f t
Demolition
Stalc Str rc lt,;tr11r-'
Total Miscellaneous Permits (E)
)
VALIDATION:
RF-CEIPT NUMBER _68_
DATE PAID 7L
TOTAL AMOUNT DUE (excltrrling clt.:cttit;al)
(A, B, C, f), rtnrl [. Oritttlrittr:tl)
AMOUNT RECEIVED
RECEIVED NY
??5,oo
/o'z/*go
/oA#L
Evergreen 258{83J1684
Anna H.r
Esc6o/ep683-l990
4
l;i
R
JOHN E. HARTIN AND ANNA H.MARTI N
.onr.y!.nd w.,,.nu ro--r:!!lq't-Ls-LILL-s-tY{9Ll!pJI}Sl!-.!-.-S}v-t99.--
husb6nd a vlfa
prop.rty lm o, rrclrrnb.lna.t,.rc.gl r tp.cllicrllY xt lorrh ha[ln. balltt dtut ln tha
Strtr ol Ortgroo,
Beg
Add
lnnlng at a t on tho North llna of Lot l, ln Clark t l{arhbr.rrncrr
G'.nlr., thr lollowlng dlcdbrd nrl
Coun r v ol - - -L_a_t!o- ----- - --.
Itlon to spr
Pla
po ln
lngf
Lano County t Recordr, 13
loId, aa Pla5f cot East ol the Northwost cornGr ol ealdttod and rocorded at Pago 7? ol Voluroe 2,
Lot, and run .thonce South 67.6r1 !eet, thence EaBt 129 foo t, thoncc North
129 feat to67.64 f60t to
Cho place of
th6 North llne.of 6a1d lot and thonca }lolC
lnnlng, ln Lane countY, Orogon.
ALSOT Bo at
to
78?6A001 09/06/BJ ELIrr000lrr
lr lrr. lrom rll .ncumb.rn6t.rclpt taxel lor tlacal tear 1983-81, a llcn
not yot payable
a polnt on tho North Ilno of Lt l, Clark t tlalh-
spilnqfteld, as plattod and recorded at Pag. ?? ol
ty orogon PIat Rocordrr 135 t6ot Ealt of the North-
lot, iun th6nco south 6?.6{ faelr thoncc w.!t 3
67.611 !eot,' thenco Eaa! 3 l6st to tho Polnt ol
Countyr, Orogon.
rneta
lume 2,t cort, th
0
fhr rrld
duo
p,op.rty, buE
.\_------:,
r-91--. re
tln
ot -_-_!g!-o----- ---rl.
'' John E. llartln and Anna l't. uartln
laljolnc lnrrumoll 16 61 tho lr. Yolunu,Y rt .td dard
MV Commbbn CrPlra
";.ir') .'
Prnonally apr.a.ad tha aooea ^lrid---. .,1 ,
B.ls.3S
Gra^tta'l ua,ru:__l_[[!_Pgg]_!!:_._"_t:__.r_u1c_g!o_q_Qliy1.
id.
Legal Description
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PLAT MAP
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AEEA MAP
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JOB NO.q Ltbzl
CITY OF SPRINGFIELD SYSTII4S DEVELOPMENT CHARGE
WORKSHEET
(C0MMERCIAL & RESIDENTIAL)
NAME OR COI4PANY:El.lN\ t9 **vxue
TA \70 >v52 I -O ovoo
LOCATION:I oLto Lt b
t-r to xlDEVELOPMENT TYPE:LDtr- _ AqeD
BUILDING SIZE:Lo
i. STORM DRAINAGE
IMPERVIOUS SQ. FT.
2 SAN IT ARY S EI{ER _CITY
J
(See Reverse)
TRANSPORTAT ION
NO OF UNiTS X TRIP RATE X COST PER TRIP
r ilCurJpE9 T SIZ . Ft.
L+b x $0.192 PER SQ- FT-
suBToTAL (ADD ITEMS 1,2, & 3)$
a- lb
X
X
X
x $40i.0s
x $401.05
x $401.05 $
4. ADM INIST TIVE F EES
BASE CHARGE (SUBT0TAL ABOVE) X 'os
5. SANITARY SEl,lER_Mt^lMC
NO. OF PFU'S $13.62 PER PFU + $10 Mt,lMC ADMIN. F EE$
TOT AL-C ITY c$adL
(Use PFU Total From
Ml.^lMC CREDIT IF APPL
Kip Burdick
SDC Coordinator
Item 2 Above )
ICABLE (SEE REVERSE)
t^&- 1
TOTAL-MWMC SDC o*
'25 12-
TOTAL SDC S 7U1A
Permit No:
Address:/v
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:
1 DA I own, reside in, or will reside in the completed structure.
2. H I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3.A
t/u/z
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. Br-al 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.
ly that the ion is correct and that I have read and understand
the Notice Owners about Construction Responsibilities on the
this
-21-reo Permit can e
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
t a
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
form
side
NOTE: This Information Notice to Property Owners About Construction Responsibilities
was developet Uy the Construction Contractors Board in accordance with ORS 701.055(5),
passe{ by tfie 19$9 Oregon Legislature. ..i
INFORFTATION NOTICE TO PROPERTY O\'gNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
i
li you ire acting as your own contractor to construct a new home or make a substantiil
existing structure, you can prevent many problems by being aware of the following respon
of concern.
improvement to an
rsibilitibs and areas
EMPLOYER RESPONSIBILITIES:
lf you hire persons not registered with the Construction Contraclors 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
the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the
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
purposes on the wages of all employees. For more information, call the Oregon Employment Division DHFI
a|378-3224.
Workers' Compensation lnsurance: As an employer, you are subject to the Oregon WortJiiCompensation
:ion insurance for your employees. lf you fail to obtain workers'Law, and must obtain workers' compensat
compensation insurance, you may be subject to penalties and will be liable f6r all claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7494.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.
ymentevenifyoudidn,tactuallywithholdthetax.Formoreinfoimation,call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code nce:As the permit holder for this project, you are responsible for resolving any failure to meet
code req that may be brought to your attention through inspections.
and lnsurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and omtsstons 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: 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 appfopriate 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 503-378-462'l
o244J 10t24t89