HomeMy WebLinkAboutPermit Building 1994-12-05t
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759
SP}lIt\.GFIELO
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97 471
LOCATION OF PROPOSEO WORK
ASSESSORS MAP:
LOT
-
BLOCK:
,z
TAX LOI.L D rt z azC
SUBDIVISION:
-pHoNE: bA{.oejy
Zt rt<f
A'ice 5 o 55o*/
lCrt t
ztPSTATE:()
N 7+h
OWNER:
ADDRESS:
CITY:
NEW
-
REMODEL ADDITION X DEMOLISH OTHER
-
DESCRIBE WORK:
ADDRESS EXPIRES PHONECONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR '
GENERAL:
PLUMBING
RANGE:WATER HEATER:
.f OF BDFIMS
- OFFICE USE _
SECONDARY HEAT: _
SOUARE FOOTAGE:
OUAD
ZONING CODE:
LAND USE:
r OF BLDGS:'f OF UNITS:
\.
FLOOD PLAIN:
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726'3769. Thls ls a 24 lrour recordlng. All lnspections requestecl before 7:00 a.m. wlll bemade the sanle worklng day, lnspections requested after 7:0O a.m. wlll be macJe rhe following work day.
REQUIRED iNSPECTIONS
lYffoottng - After trenches arelA{excavated.
B
K
,K
E
,tr
Temporary Eleclrlc
Slte Inspectlon - To be made
after excavatlon, but prlor to
settlng forms.
Underslab Plumblng/ Electrical /
Mechanlcal - Prlor to cover.
Masonry - Steel locatlon, bond
beams, groutlng,
Foundallon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Prior
to fllllng trench.
Sanltary Sewer - Prior to f illing
trench.
Slorm Sewer - Prior to fllling
trench.
Water Llne - Prlor to filling
trench.
Rough Plumbing - Prior to
cover.
Electrlcal Servlce - Must be
approved lo obtaln permanent
electrlcal power.
Flreplace - Prlor to facing
materlals and framing lnsp.
Framlng - Prlor to cover.
Wall/Celllng lnsutatlon - Prlor to
cover.
Drywall - Prlor to taping
Wood Stove - After lnstallation
lnserl - After flreplace approval
and lnstallatlon of unlt.
Curbcul & Approach - After
forms are erected but prior to
placemcnt ol concrete.
Sidewalk & Driveway - After
excavalion is complete, forms
and sub-base rnaterial in place.
[-_] fence - When completed
Streel Trees - When all requlred
trees are planted.
ffifinat Ptumbing - When ailar plumblng worl( ls complete.
ry Final Electrlcal - When all
electrical work is complete.
Flnal Mechanical - When all
mechanical work ls complete.
Final Building - When all
requlred lnspections have been
pproved and building is
completed.
Other
MOBILE HOME INSPE TIONSV U n d e rl I oo rzPtffiSii-dttit ec h a n I c a IA{ - prior tohisorffior deckrng.
[/ Rost and Beam - Prtor to ftoorla lnsulatlon or decklng.
NZ Ftoor lnsulallon - prlor toz5{ decklng.
Blocking and Set.Up - When all
blocklng ls compteie.
i
Plumbing Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set.up, and plumbing
lnspections have been approved
and the home is connected to
the service panel.
Final - After all required
inspections are approved andporches, sklrting, decks, and'
ventlng have been installed.
az/77
': 7 <f " >
E
E
E
[--l Rough Mechanlcal - prlor tot-"J cover.
X:n:: Erectricar - Prior to
tl
r
it..
t4.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Tyf. _
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK TN THE -
HISTOFIICAL DISTFIICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this applicatlon must be slgned
and approved by the H istorlcal
Coordinator prlor to permlt issuance,
APPROVED:
PL.HSE GAR ACC
N
S
E
Total Value
Building Permit Fee
state surcharge Lf) + /,f z
Total Fee (A)
VALUE
/ 2?2 .sa/28 /o-'c
35?c ?6y'20
X $/SQ. FT.
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls 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.
Reviewed By
-tt/tZz*-
"
3,(3,'
zs
Date Paid
Receipt Number:
Received
Plan Check Fee:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) 4/za.cs
Systems Development Charge is due on all undeveloped
properties withln the City limits which are being improved.
Fixtures
Residentlal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
2*+ /,70
FEE
Ct\D4
2n4b(c)
N0
FT.
fur
- ,?O
Plumblng Permit
State Surcharge
Total Charge
PLUMBING PERMIT
ITEM
. FT.
ADDITIONAL COMMENTS
z
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the front
on the
/slgnatrure
Z
site at al imes duri
of the property, and the a set of plans will remain
nstructi
Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Oemolition
State Surcharge
Total Mlscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, D, and E Comblned)
5.?39
\1t}ilVALIDATION
BECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
4-ss2:o(_
So.so.4 0s
54,{d
FT.
,/a;-; w ei
By slgnature, I state and agree, that I have carefully examlned
the completed applicailon and do hereby certlfy that all
lnformation 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 pertalnlng to the work descrlbed
herein, and that NO OCCUPANCy wlll be made of any
structure without permission of the Bulldlng Safety Division.
I further certify that only contractors and employees who
are ln compllance with ORS 701.O55 wlll be used on this
project.
CITY OF
The lol
225 FIFTE STREBT ionirrg
SPRINGPTELD OREGON 974 >o(L-
TNSPECTI0N REQIIESTz 726-3769 -5'OFFICE: 726-3759
1 LOCATTON OF
IJGAL DESCRTFIION
JOB DESCRIPTION
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspented for
180 days.
2. CONTRACTOR INSTALI.ATION ONLY
Electrical Contractor
Address
Ci ty Phone
Supervisor License Number
Expiratlon Date
Expiration Date
Signature of Supervising Electrician
.(
ovners Nane ?Uf fq: d.t@
Address /Ol I Al , 7 b iT,
Ci ty Phone ObQ'oOlg
OIJNER INSTALLATION
|:#l%3:?X.1-'ffXFX$*'f
i;'l;%
SPcl'NGFIELD
il3e
EI,ECTRTCAL PERUTT APPLICATION
City Job Nunber
SCffiDtILE BELOII
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
s 8s.00
$ 1s.00
$ 40.00
Services or Feeders
Instaflation, Alterations
or Relocation:
A
B
200 amps or
20L amps to
401 amps to
60L amps to
0ver 1000
Reconnec t
less
600 amps
i.000 amps
Sum
ee rrB* aEoie
not included)
40.00
40.00
20.00
3s: =t;7{;aT
amps/voIts
0nly
s300
00
00
00
00
00
00
$ s0.
s 60.
s100.
$130.
(
$
s
s
$40
C- Temporary Services or Feeders
Installation, Alteration or Rel-ocation
D. Branch Circuits
Nev, Alteration or Extension Per Pane1
one Circuit t-/ S 35.00 SSooEach Additional
Circuit or vith Service
or Feeder Permit $ 2.00
200 amps or less
201 amps to 4OO amps
-Over 401- to 600 amps
0ver 600 amps or 1000-?6lfEs
Miscellaneous ( Service/feeder
-Each installation
Pump or irrigation $
sign/outline Lighting- $
t imited Energy/Res
-
$
Limited Energy/Comm S
40.00
55.00
80.00
The installation is being made on
property f ovn vhi.ch is not intended
for sale, lease or rent.
E
Ovne ignatu
5
RECEIVED o
Pi ^ t .+l)tV?^
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTA,L
Constr Contr. Number
*Alrtritijtjll-
1011 i.t 71}i 1i1'
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ATTACHMENT 81
JOB NO.a4 Zztf
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENI CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NA},IE OR COI,|PANY
L0CATION: 1e1/il ?4'/
DEVELOPMENT TYPE:
BUILDING SIZE t 'r/E'OT SIZ Ftf
1. rymtffi
IMPERVIOUS SQ. FT 3,t / ,*ooZ X $0.209 PER SQ. FT.
2. SANITARY SEhIER-CiTY
NO. OF PFU'S
(See Reverse)
7 X $43.26 PER PFU
3 TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x
-
x $436.19
x _ x $436.19
x
-
x $436.19
$d
$
SUBTOTAL (ADD ITEMS 1,2. & 3)s 417,er
4. SANITARY SEI^IER-MhII'4C
N0. 0F PFU'S x $17.19 PER PFU + $10 Mt^lMC AOMIN.FEE
(Use PFU Total From item 2 Above)
$
KFrZooEl-
Ml^ll4c CREDIT iF APPLICABLE (SEE REVERSE)
TOTAL-I'4I^IMC SDC
SUBTOTAL (ADD ITEMS 1.2.3 & 4)$ //?,ci
5. AI)UIMSTATIVF FFFS
(
/r-z F- 77
l'l
$
$r
) x .05
g. P.
$ 7s.s7
6.0
82. SDC
ry
i nator
Date:
TOTAT SDC s 44o.63
FIXTURE UNtT CALCULA,T'1N TABLE: Number of New Fixtures x unit Equivatent = Fixture units(NOTE: For remodels, calculate only the ..iT additional fixtures)
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub.....
Drinking Fountain....
Floor Drain-
lnterceptors For Grease/Oil/Solids/Etc.
lnterceptors For Sand/Auto Wash/Etc.
Laundry Tub/Clotheswasher
Clotheswasher - 3 Or More.....
Mobile Home Park Trap (1 Per Trailer)
Receptor For Refrigerator/lVater Station/Etc
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Sta||..........
Shower, Gang
Sink: Bar, Comqercial, Residential Kitchen....
Urinal, Stall/Wall
Wash Basin/Lavatory, Ej.gglg.
Toilet, Public lnstallation.
Toilet , Private.I v-
Miscellaneous:.tTtat ropl .gnr
TOTAL FIXTURE UNITS F
CREDIT C.ALCULATION TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
calculate credits separates.
2
1
2
3
6
2
6
6
1
3
I 2
1
2
2
1
6
2
Z
adlHe
2
4
Year
Annexed
Rate per $1,OOO
Assessed Value
Year
Annexed
Rate per $1,OOO
Assessed Value
1979 or before
1 9BO
rget
1 982
1 983
1 984
1 985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
1 985
1 986
1 987
1 988
1 989
1 990
1 991
1 993
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
o.15
Credit for Parcel or Land Only lf Applicable
lmprovemenf (if after annexation date)
(Rate X Assessed Value)x$
(Rate X Assessed Value)
CREDIT TOTAL = $ KE&1OPEL
2
Permit #:
Address:/o// ,,t ), 7 kr
Issued by:Date:z
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
fo llow ing statement b efore a buildin g p e rmit can be is s ue d. This statement is re quire d
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 appropriate blanks and initial boxes I and2, and either box 3A or 38:
l. I own, reside in, or will reside in the completed structure.
2. 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.. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
K,
re
OR
38. I will be my own general contractor
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notiff 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 do understand the Information
Responsibilities on the reverse side of this form.
u /r,1rr
(of
(White copy to issuing agency perrnit file,
pink copy to applicant)
(Date)
Notice to
\_/
Information Notice to'Property Owners
About Construction Responsibilities
. Note: '{lzis lxJr;s"rwatioi,n N*tit:e tn Prrsper{y Owners.abont {)*nstruction Re,
u'a,s developed ht'rhe Constrirtiitt C(tfilractors Bonrd in act'ortlunt:e vvith
sponsibilities
()RS 7CIt.0ss{5).
you can prevenf rx;ury problems by king aware of the foliowing respansibilities and areas of concem.
EMPLOYER RESPONSIBILITIES:
If you hire perserns not registered with the Construclicll Contractors Board to do labor in constructing or assisting in the
consxructinn or imprnvement of a n:sidential structurc, yor.r will, in most instances, be mled to be an employer and the people
you hire rvill be employe*s. As the employen, you rnust comply with the foii*wing:
Oregcn's withholding tax law: As an employer, yr:u must withhold income taxes from employee wages at the time employees
are paid. Yon witrl be liable f'r:r thr: tax payxxents even if you don't actually wilhhold the tax from your employees. For more
infcrmation, *al] the Oregon Dept" of Revenue at 945-8091 .
Unemployment insurance tax: As an employer, you are required to pay a tax for unernployment insurance purposes on the
wages of all employees. For more information, call the Oregon Ernployment Division at the Department of l{urwr Resourocs'Lt?78-3524 \,
Workers' compensation insurance: As an employer, you ar€ subject to the Oregon Workers'Co*p"n.urion Law, *d #$
obtain workers' compensation insurance for yaur employees. If you fail to obtain workers' comgensation insurance, youlmg
besutrjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Fornnoreinform4tiorq
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an empioyer, you must withhold federal income tax from employbes' wages. You will be
liable for the tax payment even if you didnt actually withhold the tax. For more information, call the Intemal Revenue Service
ar l-800-829-1040.
OTHEH HESPONSIBILITIE$ ANN AHEAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requireraents
that may be brought to your attention through inspections. I :'r,,
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as faliing tools, paint overspray, wa{er damage frorn pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your empioyees.
Expertise: Make sure you have the expertise to ae{ as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building offieials at the appropriate times so they can perforrn the required inspections.
If you have aeiditional queitions, write or call the C*nstruction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
5031378-46?1). The Board is iocateci at 700 Surnnrer St. NE Suite 30O, in Salem.
prop-own.pm4
1t94