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Home My WebLink AboutPermit Building 1993-10-04RESIDENTIAL PERMIT APDLICATION lnspections: 726-3769 Of f ice: 726-3759 SPrII,tGFIELD JOB NUMBER 225 Fitlh Street Springfield, Oregon 97 477 -t/--ll: Ct)LOCATION OF PROPOSED WORK: ASSESSORS MAP # / 7O3Zs7 t-O?Soo TAX LOT:+ 33oo LOT: -- BLOCK:SUBDIVISION CITY: --- STATE ZIP:QTqa 7 IlI2H NEROWNER: Fr 6t-o- ot(.67# * S pRt,tigqNl NEW >< REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK PHONEEXPIRESADDRESSCONTRACTON'S NAME SEt*' AI SG E N ERAL: NE fuoti ELECTRICAL: PLUMBING MECHANICAL: COi!ST. CL1NTRACTOR " u1 FI-OOD PLAIN: ZONING CODE: t\\ \ _ OFFICE USE -. r OF BDRMS: HEAT SOUFICE: RANGE: CONSTR. TYPE WATER HEATEFI: # OF BLDGS: - -. - OUAD ABEA SECONDARY HEAT: SOUARE FOOTAGE: LAND USE: # OF UNITS OCCY CROUP: t\ , OF STORIES, - -l + To req,resttan in:ipection, you rnust c.rll 726-11769. This is a24hour recording. All inspections requested before 7:00 a.m. will be made the..same working day, inspections requested after 7:OO a.m. will be made the lollowing work day' REQUIRED INSPEC IONS [--l Temporary Electric Site lnspection - To be made after excavation, but Prior to setting fortns. Understab Plumbing / Eleclrical/ Mechanical - Prior lo cover. Maionry - Steel location, bond beams, grouting. Foundation - Aftcr forms are erected but prior to concrete placement. Underground Plumbing - Prior to f illing trench. Underlloor Plumbing/ Mechanical - Prior to insulation or deckir,g. Post and Beam - Prior to floc)r insulation or decking. Floor lnsulation - Prior to decki ng. SanitarY Sewer - Prior to filling trench. Storm Sewer - Prior to filling trench. Waler Line - Prior to filling trench. Rough Plumbing -- Prior to cover. nough Mechanical - Prioi'to cover. Rough Electrical - Prior to cover. Electrical Service - Must be approved tc obtain Permanent electrical power. Fi;"cplrce -- Prtor :J rauirrg m;terials and framing !irsP. Final Plumbing - When all plurnbing work is complete. Final Electrical - When all electrical work is complete. Final Mechanical - When all mechanicai work is complete. E tr' K:.:l:..:1.- Arter trenches a:e fttu-'ng - Prior to cover' f-l Orywall - Prlor to taPi69 Wood Stove - After installation. lnsert - After fireplace alrproval and installation of uriit Curbcr-rt & APProach - Af ter forms are erected but Prior to placement of concrete' Sidewalk & DrivewaY - After ev.cavation is cor.'rPiete, forms and sub-base material in Piace' Street Trees - UJhen atl required trces are clatrted Wall/Ceiling lnsulatioir -' Pri<.rr to cover. X[$,3J'lsir? ;#ji* fl ',,.,. approved a.rd building is completed. Final - After all required inspections are aPProved and porches, skirting, decks, and venting have been installed. Other MGBILE HOME INSPE TIONS Blocking and Set'UP - When all blocking is comPlete. Plumbing Connections - When home has been connected to water and sewer. Eleclrical Connection - When blocking, set-up, and Plumbing inspections have been aPPrOVed and the home is connected to the servlce Panel. iJ E n q lV /la r r tl tl [] [-l Fence - When comPleted. tf tl ADDRESS: PHoNE: 7ql ^A??Z 2"fi E T Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Setbacks P.L.HSE GAR ACC N S E lS rHE PROPOSED WORK lN TrlE HISTORICAL DISTFIICT, OR ON THE HISTORICAL REGISTER? --lf yes, this application must be signed and approved bY the Historical Coordinator prior to permit issuance. APPROVED BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This i-rernrit is grantcd rin thc cxpress condition thirt thc said construction shall, in all respects, conform to the Ordinance aool;tecJ by the Cily of Springfiel<i, including the Dcvclopnrent Codc, re<lulating the construction and use ol bluildi;igs, anc! may bc suspended or revoked at any time upon violation of any provisions of said ordinanr;es' Date Paid: - %-22-- Recci pt N u^oor,- - /2- D>- Received ewctiP:v B /o_*;23 Plan Check Fee: BUILDING PERMIT VALUT: zae. I (A) ?9 / 69 SQ. FT. X $/SO. FT. qze ITEM Main Garage Carport Total Value Building Permit Fee Stale Stlrcharge Total Fee Systems Dcvelopment Charge is due on all undeveloped properties within the City linrits which are being improved' SYSTEMS DEVELOPII'ENT CHARGE (SDC)##zr ?.(2(B) ADDITIONAL COMMENTSt )T "vti(ffi @, o 778 SNFT ITEM Fixtu res Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home F-EE N0 FT. FT FT. (c) PLUMBING PERM!T Plumbing Permit State Surcharge Total Charge Wood Stovei lnsel't/F'lrepiace -.inii Dryer Vent (D) N0Venl Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood By signature, i !;tatc and agree, ttrat I have carefully examined the completed application and do hereby certify that all informaiiorr hereon is tr+e and correct, and I f urthcr certif y that an',-:rnJ a!l work pr;riorrneo shall be done in accordance with the Orcjtna:'tces oi tire CIty of Springf ir:id, anci the Laws of the l'itaie of Oregc,n pertaining to,the work described herein ar)u that NO OCCUPANCY will be made of any structure without permission of the Building Safety Division. I further certify that only corltractors and employees who are in oompliance wilh ORS 701.055 will be used on this project. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut -- ft Demolition State Surcharge I {urther agree to errsure that all required inspectio.ns are requested at the propor time, that each address is readable f rom the street, that the permit card is located at the front of the property, and tlre aprproved set of plans will remain on the site at all ti ig nat u re Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electricai) (A, B, C, Q and E Ccmbrned) 3JSfl Date es during construction REcErpr NUVBW DATE PAID A.MOUNT R Ei VALiDATICN RECEIVED BY_ illzrP<-) Permit No: Address: lssued Date: R OFFICE USE ON STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIB!LITIES 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 pplicable blanks, and initial boxes 1 and 2, and either box 3A or 38 1 2 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. 3 My general contractor is , Contractor registration 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 ll 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. ! 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 th form. ln 1/ gn o rm pp cant ate CONSTRUCTION CONTRACTORS BOAHD 0244J 8191 , 2 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ', tai lf you aiO actingj as your own contractor to construct a n' existing structure, you can preven\ many problems by bei of concern ew home or make a substantial, impfo.vement to an ng aware of the following responsibilltles and areas EMPLOYER RESPONSIBILITIESi "': ' :" ' " lf you hire pefsons not registered with the Construction Contractors Boafd to do labor in constructjnO or assisting in the construction' or intprovement of a residehtial structure, 'you will, in most' instances, be'ruled to be an "employer" and the people you hire will be '.employees". As the emBloyer, you mUst comply with the following: Oregon's Wilhhqlding Tax Law: As ar] employer, yoq must wrttrhold incomg, talesfrgrn,ernployee wages at uwilll.beliableforthetaxpaymentseve0.ifryou.dgnltaqtuallywithholdthe tax from your employees. For more information, call the Oregon Departrlent of Revenuq,at 378-3390. Unem ent lnsuranie Tax tr.. :' , ;'- -l As an empioyer, you are required to pay a tax for unemployment insurance purposes on t at 378-3224. wages of all..employees. For more information, call the Oregon Employmerrt Division DHR Workers' Compensation lnsurance: As an.6mploye4 you are suh{ect to the'Oregon Workers' Compensation pensationinsuranceforyouremployees'lfyoufailtoobtainworkerS, compensation insurance, you may be subiect to penalties and'will .6e liable for all clairn costs if one of your employees is injured on the job. For more information, call the_rWorkers' Compensation Division DIF a1373-7434' U.S. lnternal Revenue.Se.rVice: As an employer, you must withhold federal income tax from employees'wages. menteVbnityci!1oian'tactuallywithholdthetax,Formoreinformation,call the lnternal Revenue Service tit 221-3960. .1 ,. orHER RESPONSIBILIflES AND AREAS OF CONQEBN: Code Gornpliance: As the permit holder for this prolect, you are responsible for resolving any failure to meet code requirements that maylbe brought to your attention through inspections. Liabil and F Dam lnsurance: Contact your insufance agent-to see if you have adequate insurance coverage acc ents anO omissions such 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 otlougft.in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. .- .., : , , . ...ii:: , lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503{f&4621 NOTE: This lnfolrmqtion Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. o244J 14t24t89 C'|Y OFT SID'IINGFII:LI') Ob225 FIFTB STREEf, The following proier:t as subntltted hae the fall zoi;in!t. and does not require specilic SPRINGFIELD, OREGON 97477 i''', i INSPECTION REQUEST: 726-3769 ., -,OFFICE: 726-3759 n.' :',-- -- I b, - r-\ j:2-- APPLICATION FEB SCMDULE BELOV Nev Residential-Single orHulti-FamiIy per dvelling unit. Service fncluded: I tems Cos t $ 8s.00 $ 1s.00 $ 40.00 Miscellaneous ( Service/feeder -Each installation Pump or irrigation S Sign/Outline Lightirg_ $ Limited Energy/Res S Limi ted Energy/Comm S t&il- 3 1 LOCATION OF fNSTALIJ\TI0Iil,*iroi-i.rrt:N,5T: IJGAL DESCRIPTION JOB DESCN PTTONPnc+4 A,XHF Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2 CONTRA TOR TNSTALTATION ONIY Elec cal Contractor L000 sq.ft. or less Each additional 500 sq. ft or portion t hereo f Each Hanufrd Home or -Hodular Dvelling Service or Feeder STIBTOTAL OF ABOVE 5Z State Surcharge TOTAL B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less ll 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ Over 1000 amps/vo1ts Reconnect 0n1y C. Temporary Services or FeedersInstallation, Alteration or ReLocation D.ranch Circuits Nev, Alteration or Extension Per Panel One Ci.rcuit S 35.00 Each Additional Circuit or with Service or Feeder Permit $ 2.00 Sum t Address Ci ty Supervisor Li Expiration Date Constr Contr.er Expi ra t i te of Supervising Electr an Ovners Address Ci ty Phone OIJNER TION The installation is being made on property I own vhich is not intended for sale, lease or rent. 200 amps or less $ 40.00 201 amps to 4oo amps - S 55.00 0ver 600 amps or 1000 volts see I'B'r above s s0.00 $ 60.00 $100.00 $130.00 s300.00 $ 40.00 50,oo not included) 40.00 40.00 20.00 36.00 u 0vnery Signature: ,M^** E 5 DATE: *: Phone e Ndmber RECEIVED B ,a a city Job Nunbet ? b/ 34(" CD JoB No. qbtbL+(o CITY OF SPRINGFIELD SYSTE!,IS DEVELOPMENT CHARGE I,I0RI(SHEET (comuERcrAl & REsroiuuar_) NAME OR COMPANY: LOCATION:5aq N /bry Sr./7o )2 ,?t -o 77oo DEVELOPMENT TYPE:L f,dN BUILDING SIZE: zz *zz (. .uoe< Favzr\L0T Sf Z F SQ. rt. I STORM DRAINAGE IMPERVIOUS SQ. FT.x $0.203 PER SQ. FT. 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) X $42.08 PER PFU TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP x - x $424.3I x _ x $424.31 X x $424.31 SANITARY SEt.lER-Ml,lMC N0. 0F PFU'S x $15.125 pER pFU + $t0 MI.IMC ADM FEE(Use PFU Tota'l From Item 2 Above) Ml,lMC CREDIT IF APPLICABLE (SEE REVERSE) TOTAL-MWMC SDC SUBToTAL (ADD ITEMS 1,2,3 & 4) 3 5. ADMINISTRATIVE FEES BASE CHARGE (SUBT0TAL AB0VE) X .os K p ick inator s $ 4 $ o 'l SDC Coord TOTAL SDC S ZI gZ9 /o 4 RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: PR LE) JOB NUMBER 225 Fifth Street Springfield, Oregon gl 477 TAX LOT: SUBDIVtStON: _- - PHONE: STATE:ztP: a 27>2 ADDITION DEMOLISH OTHER CITY: ADDRESS: OWNER: DESCRIBE WOFIK: NEW- REMODEL ADDRESS EXPIRES PHONE CONTFIACTOR'S NAME MECHANICAL: ELECTRICAL: CONST. CONTRACTOR / GENERAL: PLUMBING - OFFICE USE - SQUARE FOOTAGE: SECONDARY HEAT: FLOOD PLAIN QUAD AREA: g OF BLDGS: # OF BDRMS: --- OCCY GROUP: r OF STORIES: CONSTR. TYPE: HEAT SOUFICE: LAND USE: WATER HEATER:-RANGE: # OF UNITS: -_-ZONING CODE: To request an inspection, you must call 726-3769. Thl made the same working day, inspections requested ls ls a 24 hour recording. Ail inspections requested before 7:o0 a.m. wiil beafter 7:00 a.m. wlll be made the following work day. REQUIRED INSPECTIONS [--l lemporiry Electric Rough Mechanical - prior to cover.Final Plumbing :. When a1plumbing work is coinplete. Site lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to Final Electrical - When ail electrical work is complete.cover, Underslab Plumblng/ Electrlcal, Mechanical - Prior to cover.Eleclrical Servlce - Must be approved to obtain permanent electrical power. Final Mechanlcal - When all mechanical work is complete. Footing - After trenches are excavated.Fireplace - Prlor to faclng materials and framlng lnsp. Final Building - When alt required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover. Foundation - After forms are erected but prior to concrete placement. Other Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.l--l Orywall - Prior to taping. MOBILE HOME INSPE TTONSUnderlloor Plumblng / Mechanical - Prior to insulation or decking.Wood Stove - After installation Post and Beam - Prlor to floor lnsulation or decking.lnserl - After fireplace approval and lnstallatlon of unit. Blocking and Sel.Up - When all blocking is complete. Floor tnsulalion - Prior to decking.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. W Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections havc been approved and the home is connected to the service panel. Storm Sewer - Prior to filllng trench. Sidewalk & Driveway - Af ter excavation is complete, forms and sub-base materlal ln place. Water Llne - Prior to filling trench.l-l Fence - When completed. Streel Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. tl Rough Plumbing - Prior to cover. 4^?r>A'b %r>-za LOT: E E E E tl E tl E tl E E tl r E E r Lot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac ks IS THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? -- lf yes, this application must be signed and approved bY the Historical Coordinator prior to permit issuance' APPROVED: PL.HSE GAFI ACC N S E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said consiruction shall, in all respects, conform to the Ordinance "O"pi"O by the City of Springfield' including the Development Code, regulating the construction and use of IuifOin'g", and may be suspended or revoked at any time upon vi-otation of any provisions of said ordinances' Plan Check Fee: DatePlans Reviewed By Receipt Numbe Date Paid Received BY: BUILDING PERMIT VALUE (A) SQ. FT. X $/SO. FT,ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee Systems Development Charge is due on all undeveloped properties within the City limits which are being improved'SYSTEMS DEVELOPMENT CHARGE (B) (sDc) ITEM Fixtures Residential Bath(s) SanitarY Sewer Water Storm Sewer Mobile Home rJ_P--tZa' /o PLUMBING PERMIT _q, FEE N0 FT. FT. ---z -2(c) r'/-- Total Charge l Plumblng Permlt State' Surcharge Wood Stove/ lnsert/Flreplace Unit Dryer Vent MECHANICAL PERMIT (D) No Mechanlcal Permlt lssuance State Surcharge Total Permit Fu rnace Exhaust Hood Vent Fan By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information hereon is true and correct, and I f urther certity that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, and the Laws of the State of Oregon pertaining 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 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all ti during co tion. Signature Date MlSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) ? -,?eA 7/t=DATE PAID AMOUNT RECEIVED RECEIVED BY VALIDATION: RECEIPT NUMBER ADDITIONAL COMMENTS g/za/qq ?g<nrr (r\)eLr lf LI tr t/t!- c f|/9ntT-1+5 eNO E L PG s K <) 7L//-68p2- ,s6q NLO! :z -{ An A< R'nt-* Fok ' tr*-t:utro " ' wHFN t s7vPrl;o frf PKos€cT EurAs A-s b ftrp€ A APD Futtas Accowco, T Pous - Potrtt Tttfi {tt* sof fff/o ConetuiE w m+^) *st o. oA- 9 t qz> g/za/eq X e.t UJ atF (,..r TIJ llC_ LI tr C u:- soB ff/o Con?167€ u,){N Tt^, c ft/ 6ruT1+6 l4ArO TpE RE Y w 17t1 rM TtrL F.tn*tulpG ft)lruvts, K c) '7./l-6 8z_ Sapt o- oA. 9 t qt> f I -AN*D F u N pJ A 4_o_q€tt_,T NO\J 4 ( q3 jq ln t a