HomeMy WebLinkAboutPermit Building 1992-08-14sPn FIELE'
RESIDENTIAL
PERMIT APPLICATION
I rrs ;-roc t i ott:i: 726'376{)
( )llicr:: /1'(1"3/59 Zfr,
JOB NUMBER
q &\
225 Flf th Strcet
Slrri ng f leld, O re91<>n 97 47 7
LocAloN oF prioposED wottK: Ai!7.Llogfil./OgSr--.- SPRIATGEEL)-rOR- 97177
-ASSESSORS MAP:.rl T_+IANE-gT TAX LOT:t7-oi -tA- // -oPsM
SU BDIVISIO * FlttRrtt AbbErr,J -b kA|'/vtnpT
To request an irrs6.rection, yo'd.r+tust cali 71€i"37O9. Thts is:1 14 fr{)ur{acorrJi.ng.All lnsfect!ons !'equested hefore 7:00 a'm' wlll be
madc the same worklng day, inspections requeslcd after 7:00 a.m. wlll be made the followlng work day'
REQUIRED INSPECTIONS
7 flt
LoT: ,O BLOCK: A
TemporarY Electric
Site lnspection - To be made
af ter excavation, but Prior to
setting fornts.
Underslab Plumbing / Electrical /
Mechanical - Prior to cover.
Fooling - Af ter lrenches are
excavated.
Masonry - Steel locatiorr, llontl
be:lrns, grouting.
Foundation - After forrns are
erected but Prior to concrete
placernent.
Underground Plumbing - Prior
to filling trench.
Underlloor Plumbing/ Mechanical
- Prior lo insulation or decking.
Post and Beam - Prior to floor
insulation or decking.
Floor lnsulation - Prior to
decking.
Sanitary Sewer - Prior to filling
trench.
Storm Sewer - Prior to filling
trench.
Water Llne - Prlor to fillin0
trench.
l/l Rough Mechanical - Prior to
-
COVer.
Rough Electrical - Prior to
Final Plumbing - When all
plumbing work is complete.
Final Electrical - When all
electrical work is comPlete.
Final Mechanical - When all
mechanical worl< ls comPlete.
cover
Electrical Service - Must be
approved to obtain Permanent
electrical power.
Fireplace - Prlor to laclng
rnarterials and framlng lnsP'
Frarning - Prlor to cover.
Wall/Ceiling lnsulation - Prior to
cover,
Drywall - Prior to tapirlg.
Wood Stove - After installation.
lnsert - Afler flrePlace aPProval
and lnstallatlon of unlt.
Curbcul & Approach - After
forms are erected bul Prior to
lrlacement of concrete.
Sidewalk & DrlvewaY - After
excavation is complete, forms
and sub-base ntaterial ln Place.
[-_] fence - Wlren contPleted
Slroet Trees - When all rcqulred
trees are planttld.
Final Building - When all
requlred lnspectlons have been
approved and building is
completed.
Other
MOBILE HOME INSPE TIONS
'tiA
Blocking and Set.Up - When all
blocklng ls complete.
Plumblng Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocklng, set-up, and plumbing
inspections have been apProved
and the home is connected to
the service panel.
Final - After all required
inspections are approved and
porches, sklrting, decks, and
venting have been installcd.
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owNER: leall R 'nq'r<rzI5,'a A' Wu-uans PI.IONE:
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979777-tP:STATE: ORPRI^.IAFIFI_D
ADDRESS:Ar3R?r/
CITY:
NEW-==- REMODEL_X - ADDITION_X DEMOLISH OTHER
?YEEiDESCRTBE woRK: ilPAND 6A'$.5€
EXPI
7
PHONE
68AE{O7
CONST.
CONI'RACTOR #ADDRF.SS
3? aRENLL4F DP
EUoeU-E -QLL 37:ULt - -
CONTRACTOR'S NAME
CENERAL: _BRETT LEI4N- &^',57_.--
I'LUMBINGI
MECHANICAL:
t::Lt-:CTRICAl-:
-_:
# OF BLDGS
OCCY GROUP:I.4
P OF STORIES:
- OFFICE USE _
LAND USE:.
, OF BDRMS
WATER HEATER:RANGE:
OUAD ARF.A aq$u)
ZONING CODE:
FLOOD PLAIN
SOUARE FOOTAGE: --
SECONDABY HEAT:
\z^L* OF UNITS: -,
CONSTR. TYPE
HEAT SOURCE:
U Rough Plunrbing; - Prior to
cover.t_l
AAq-Z
L]
m
E
E
E
E
Nh
Nla
,lo
t,,/,
"lt
t1
Lot faces YJEST
Lot sq. fts. 1lw4L
Lot coverage
TopographY
rotar heisht 13'
Lot Type
X lnterior
-- Corner
--_ Panhandle
-
Cul-de-sac
Se ks
E
.HE F'ROPOSED WORK IN THE
}TTSToRICAL DISTRICT, OR ON
I-FIE FIISTORICAL REGISTEH? NO
lf yes, this application must be signed
and approved bY tlre Historical
Coordinzrtor prior to pcrmit issuance.
AF'PROVEDE
GAR ACCP.L.
N
5
BUILDTNG VALUE, PLAN CHECK
AND BUILDING PERMTT
This peililit is granted oll the cxpress conditiorl that tllc s'ri(J
oonstruction slrall, ir-r zrll respects, conforrn to the Ordinance
zrtlopted by ttre City of Spring(icld' irrcluci ing thc
Dcvr-.loptncnt Cotic, re1lul;rtirlg llte constrr'rction antl trse oI
brrilrlinlys, ;rttd tttaly [:r: sttslletldcc.J <lr rcvohccl at ally tilllc
-0:3t
E-zZ.2z--
Date
i
v
By:
Plan Chcck Fce: -..-'
Date Pair,l
Fleceipt Nutnber:
Rccei
upon violation of :rn isions of said ordinanccs.
BUILDING PERMIT
ITEM SO. FT. X
Main fl/22
Garase fu ^: ',4
Carport
fi-z-'Atf Z%.d
VALUE$/SQ. FT
D0
(A)
Total Value
Building Permit Fee
State Surcharge
Total Fee
_%-sa
--263a^ /s
Systems Developntent Charge is due on all undeveloped
properties within the City limits which are being itrrproved.SYSTEMS DEVELOPMENT CHA
(B)
R.QE (SDC)"2;
ff bbB9"
ADDITIONAL COMMENTS
ITEM
Fixtu re s
Flesidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
lt4obile lJcme
FEE
(c)
N0
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
,5-
(D)2€-2F
MECHANICAL PERMIT
-/s.=,/2-a
Mechanical Permit
lssuance
State Surcharge
Total Permit
Furnace
Exhaust Hood
Vent Fan
By signature, I state;rnd agree, that I llave caref ully examincd
the completccl application and do hereby certify that all
informatiorr hereon is true and correct, and I f urther certif y
that any and all work performecl shall be done in accordance
with the Ordinances of the City of Springf icld, and lhe Laws
ol tlre Statc of Oregotr pcrtaining to the work dcscrillctl
lrerein, arttl tlrat NO OCCTIPANCY will -lrr: nr;rtJc of any
structuro witltoul perttri:;sion of the Buildir-rc.; Salcty Divisiot't.
I f urthcr certify th:lt c),lly contractors and t-'ntployces who
are in cornpliance with OFIS 701'O55 will be used on this
proiect.
I f urther agree to cnsure that all required inspections are
requestec, at the proper time, that each address is readable
from the street, thirt thc permit card is located at tlre front
of the property, and tlrc'approvcd set of lllans will remain
8'rq.2
on the site construct ionall tim duri
Signatu
Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk _-- ft
Curbcut __-- ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
AMOUNT RECEIVEDiT-b,{.
FTECE|VED uY \=/)
UM
VALIDATION
RECEIPT N
DATE PAID
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
ZE.ZJ
FT.
N" /v4
C'fY OF OREG
5t'TilNGFTI:Lf,,
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ab
225 FIFTB STREET
SPRINGFTEI,D, ORBGON 97477
INSPECTION REQUBSTT 726-376
0PPICE: 726-3759
1 LOCATION OP INST
BLECTRICAL PERHIT APPLICATION
'>--\_-
City Job Number
COHPIJTE TEE SCEEDULE BELOII
IJGAL DESCRIPTION
JOB DES(NIPTION
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. CONTRACf,OR INSTALI^ATION ONLY
Electrical Contractor
Address
city- Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Address
Ci ty Phone V- -
OIINER INSTALLATION
The installation is being made on
property I ovn which is not intendedfor sale, lease or rent.
Signature:
RECEIPT *:
Nev Residential-Single or
Hulti-FamiIy per dvelling unit.
ncluded:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular DveIIing
Service or Feeder
B. Services or Feeders
fnstallation, Alterations or
Relocat ion:
Items Cost Sum
$ 8s.00
$ ls.00
$ 40.00
s s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
c
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
0ver 1000 amps/volts
Reconnect 0nly
Temporary Services or'FeedersInstallation, Alteration or Relocation
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circui t u-/ $ 35.00 47{-s>-o'
Each Additional
Circuit or vith Service
or Feeder Permi t Z S
E Miscellaneous ( Service/feeder
-Each installation
Pump or irrigation $Sign/outline Lighting- SLimited Energy/Res $Limited Energy/Comm S
not included)
40.00
40. o0
20. 0o
36. OO
200 amps or less $ 40.00
201. amps to 400 amps
-
S 55.00
Over 600 amps or L000 volts see I'Brr above
2.OO / t-
SMTOTAL OF ABOVB
5Z State Surcharge
TOTAL
RECEIVED BY:
5 ?= -4-/a{@#
Brft
/? ez-za,y'i o9a -
ovners tt"^. Tbrqt hy'zzl4.Z--
JOB N0 . 12\o5o-
CITY0FSPRINGFIELDSYSTEMSDEVELOPMENTCHARGEWORKSHEET
(C0MHERCIAL & RESIDENTIAL)
1s*?A.f,rlt rlM 5
NAME OR COMPANY:t-\
LOCATION:Z 2-+a l..\loB 110 4Zbl - ozbDo
DEVELOPMENT TYPE: UPF- -- APP T-T tOS.\
BUILDING SIZE:OT SIZ a. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT..ttC-x $0.192 PER SQ. FT
2. SANiTARY SEl,lER-CITY
(See Reverse)
X $39.78 PER PFU
3 PORTAT ION
NO OF UNiTS X TRIP RATE X COST PER TRIP
\
4 ADMI ISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABoVE) X -os
5. SANITARY SEt^lER.MI/.IMC
x $401.05
x $401.05
x $40i.05
Item 2 Above )
ICABLE (SEE REVERSE)
$
TAL -S
TOTAL -MC SDC
X
A
X
SUBTOTAL (ADD irEMS 1,2, & 3) $ 1qE
a v
NO. OF PFU'S $13.62 PER PFU + $10 MWMC ADMIN' FEE $
(Use PFU Total From
MI^,MC CREDIT IF APPL
Kip Burdick
SDC Coordinator
-e*3-r-l/
TOTAL SDC $gbb9
s
s
1
2
Permit No:
Addres{
lssued Date:
OR OFFIGE 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
underORS 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 pon com n.
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 certify 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
I t-/q-92
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
na u t p an t
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91
)
)
INFORMArION NOTICE TO PROPERTY OWIYERS
ABOUT CONSTRUCTION RESPONSIBILITIES
ti 'you
"r"l.ting rr rj,bwn contractor to construct a new home or make
existing structure, you can prevent many problems by being aware of the fol
a substantial improvement
lowi ng responsibilitles and
to an
areas
of concern
EMPLOYER RESPONSI BILITIES:
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
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 Revenue at 378-3390.
Unemployment lnsurance Tax: As an employer, you are required to pay a tax fo
purposes on the wages of all employees. For more information, call.the Oregon
at 378-3224.
'Vorkers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation
r unemploymen! insurance
Employmentpvision DHR
Law, and must pbtain workers' com.pQnsation ingrryance fpr your employees. lf you fail to obtain workers'
compensatioh insurance, you may 6e sdbjdct tofenalties,'dnd will be liable for all claim cciVs if one of your
employees is injured on the job. For rTale jnformatiori, call the Workers' Compensation Divisi6n DIF at 973-7434.
,1 \
U.S. lnternal Revenue Service: As an em ployer, you must withhold federal income tax from employees'wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
-ode iance. As the permit holder for this project, you are responsible for resolving any failure to meet
e requirernents 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
coverage for accidents and omissions such as falling tools, painl overspray, water damage from pipe punc-
tures, fire, or work that must be re-done.
Time to Supervise Employees: lvtake 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 finiqh trades, and to notify building officials at the appropriate times so they can perform
the required inspections. ' .
I
lf you have additional questions, write to Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
ation Notice to Property Owners About Construction Responsibilities
Was deveJopep
BQssdd 4y thp
nio BContractors oard acn ancecord thwi 701ORSh.055(5),
reILegislatu
\,/
NCIFE:,)
a244J 10124189