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Home My WebLink AboutPermit Building 1994-08-10I RESIDENTIAL PERMIT APPLICATION lnspectlons: 726-3769 Office:726.3759 LOT SPRIlrlcFIELE' JOB NUMBER 225 Fifth Street Springfleld, Oregon 97477 CATION OF PBOPOSED WORK:?.q n16 MAP: q TAX LOT SUBDIVISION: - R;.1) 0r BLOCK: NEW - REMODEL ADDITION DEMOLIShI OTHER ( rl STATE:Dr^ztP ,4?Ll 77 q1 t AD = ?//c;7ct (-'raY tr 5 t lrl5 io/t* PulDESCRIBE WORK: OWNER: CITY: c ,q, 76 I I du tn 3 l.rr,*u.-5 /qilfro*r) PLUMBING: CONTBACTOR'S NAME GENERAL: MECHANICAL: ELEfiRICAL: CONTRACTOR-# CONST. sE- WATER HEATER: r OF BDRMS: - OFFICE * OF UNITS: LAND USE: ZONING CODE: FLOOD PLAIN RANGE: SECONDARY HEAT: SQUARE FOOTAGE: CONSTR. TYPE: HEAT SOURCE; OCCY GROUP: r OF STORIES; QUAD AREA: * OF BLDGS: To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:00 a.m. will bemade the same working day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day. REOUIRED INSPECTIONS Temporary Eleclrlc Rough Mechanlcal - Prlor to cover. Flnal Plumbing - When altplumblng work ls complete. Slte lnspectlon - To be made after excavatlon, but prlor to settlng forms. ffi"nn - cover. Eleclrlcal - Prlor to al Electrlcal - When all electrlcal work is complete. Underslab Plumblng/ Electrlcal / Mechanlcal - Prlor to cover.E Electrlcal Servlce - Must be approved to obtaln permanent electrlcal power. Flnal Mechanical - When all mechanical work ls complete. Footlng - After trenches are excavated.Flreplace - Prlor to faclng materlals and framlng lnsp. requl Buildlng - When all red lnspectlons have been approved and building isMasonry - Steel locatlon, bond compl beams, groutlng.K Framlng - Prlor,to cover. Foundallon - After forms are erected but prlor to concrete placement. Other Underground Plumblng - Prior to fllllng trench. 6ffitcetttng rnsutarlon - prtor toH cover. --/lcr,{orvwal! - Prlor to taplng. Underlloor Plumblngl Mechanlcal - Prlor to lnsulatlon or decklng. MOBILE HOME INSPE TIONS Wood Stove - After lnstallatlon. Post and Beam - Prlor to floor lnsulatlon or decklng.lnsert - After flreplace approval and lnstallatlon of unlt. Blocking and Set.Up - When ail blocklng ls complete. Floor lnsulallon - Prlor to decklng.Curbcut & Approach - After forms are erected but prlor to placement of concrete. Plumbing Connectlons - When home has been connected to water and sewer. Sanltary Sewer - Prlor to fllllng trench.Electrlcal Connection - When blocking, set-up, and plumbing inspections have been approved and the home ls connected to the servlce panel. Storm Sewer - Prior to fllllng trench. Sldewalk & Drlveway - After excavation ls complete, forms and sub-base materlal ln place. Water LIne - Prlor to lilllng trench. Fence - When completed. Rough Plumblng - Prlor to cover. Street Treeg - When all requlred trees are planted. Flnal - After all required lnspectlons are approved and porches, sklrtlng, decks, and ventlng have been lnstalled. tl PHONE: E E E E m t] E E E E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac k ( IS THE PROPOSED WORK IN THE - HISTORICAL DISTFIICT, OR ON THE HISTORICAL REGISTER? - lf yes, thls applicatlon must be slgned and approved by the Historlcal Coordinator prlor to permit issuance. APPROVED: P.L.HSE GAR ACC N S E BUILDING PERMIT ITEM SQ. FT. X $/SO. FT.VALUE .tll.A I ----iE 3% ed*rt;--frs-(A) qB'a?. Total Value Building Permit Fee State Surcharge Total Fee Main Garage Carport 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 bulldings, and may be suspended or revoked at any time e/o/q.r Plan By: date-By Receipt Numbe tst Date Paid: upon violation of any said ordinances, SYSTEMS DEVELOPMENT CHAR (B) G.E (SDC)Vth Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE 6(c) FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS ? t Wood Stove/ lnsert/ Fi replace Unit Dryer Vent MISCELLANEOUS PERMITS Moblle Home State issuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By slgnature, I state and agree, that I have carefully examlned the completed application and do hereby certlfy that all lnformation hereon is true and correct, and I f urther cerilly 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 descrlbed herein, and that NO OCCUPANCy will be made of any structure wlthout permission of the Building Safety Divislon. I further certify that only contractors and employees who are ln compllance with OFIS 70'1.055 wlll be used on thls proiect. I further agree to ensure that all required lnspections are requested at the proper tlme, 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 ptans will remaln on the slte at all times during construcu ( Date 7n. Slgnature TOTAL AMOUNT DUE (exciudtng electricat) (A, B, C, Q and E Comblned) r=.8- /y'2e>^2q {8. DATE PAID AMOUNT BECEIVED BECEIVED BY VALIDATION: RECEIPT NUMBER t- Plan Check Fee: N0 - FT. Bqo4+ CITY OF OREGON 225 FITfg STREET SPRTNGFTEID, OREGoN INSPECTION REQTIEST: OFFICE: 726-3759 Thi follqwlng prcii ,;;ng, And does ect ?: .:i.Jhani'l,rrl has thO not roqurie $pccritc iand use )f){- c. SPRTI\rGFIE,LO One Circuit Each Additional Circuit or vith or Feeder Permit PERI{IT APPIJCATION v gl'til?u* 726-3 Ctate 1 LOCATION OP LEGAL DESCRIPTION/?-s?-ar-> '//22 JOB Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. COMRACTOR INSTALI,A:TION ONLI Electrical Contraetor Address Citv Phone Supervisor License Number Exoiration Date Constr Contr. Number Exoiration Date Signature of Supervising Electrician Ovners Name Address OIINER INSTALLATION The installation is being made on property I ovn vhich is not intended for sa1e, lease or rent. Orners Signa DATE: City Job Number "/1 ' 3. COHPI,STE FEE SCEEDUI,E BELOS ential-Single or Multi-Family per dvelling unit. Service Included: I tems Cos t $ 8s.001000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Sertice or Feeder $ 1s.00 $ 40.00 B. Services or Feeders Ins tallation, Alterations or Relocation: 200 amps or less 201 amps to 400 amPs - 401- amps to 600 amPs - 601 amps to 1000 amPs Over 1000 amps/voIts Reeonnect Oniy $ s0.00 s 60.00 $100.00 $130.00 $300.00 $ 40.00 Sum Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 201 amps to 400 amPs - Over 401 to 600 amPs - Over 600 amps or 1000 volt $ $ $ss 40.00 5s.00 80.00 ee uB, a6oE D. Branch Cireuits Nev, Alteration or Extension Per Panel c//'$ 3s.00 -Dncit%vhone?/2'ZVa Servicez $ 2.00 @3- E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/Out1ine Lighting_ Limited Energy/Res Limi ted Energy/Comm SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL *+ $ 40.00 $ 40.00 $ 20.00 $ 36.00 5 RECEIVED /./7?7 -.2. Address i Issued Date: a-2>,9Y 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 following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom 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 3.{ or 38: w 1. 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. 3A,. 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. B 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 notify the office issuing this huilding permit of the name of the contractor. OR I hereby certify thatthe above informationis correctand thatl ha Notice to Property Ownerqabout Construction Responsibilities d*-,r[- A^^Lt ve read and do understand the Information on the reverse side of this form. - Afu-? 1{iet{ffi 5rpermiip*6*1_ (White copy to issuing agency permit file, pink copy to applicant) (Date) Permit #, 7//( Inf ormation i&{cstu, prope rty Ownersangt {o;$Htion Responsrbl I iries r+'*s d*'r/r;ped by the Crsns#iclio,n Cintratrrtr,r ,Sor*rd lru sr."r"*r#r;r r:t tt,!tlt GpS I{j t.0SS{S). if y{}u are actittg a$ y*l-tr ow}] e {}ntrrnt: tor to cons{rucl & fiew h*rne *v *rakc a substant.ixl irnpr*vem*ga [{} an *xisting stp]Lturc, you can prevent many problems by being avare of the following responsitrilities and areas of conserfl. EM PLOYER NESPONSI BI LITIES: If you hire p*rsons mot registgred with xhs Constructir:n Contr*ct*rs Boxd to ds) labor in constn:cti.ng or assisting in the construction cr implove:xent *f a residential structure, you will, in most insta*ces, be ruled ta be an *rnployer and the people ycu hire will he employees. As the en"rployer, you mus[ comptry 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 rvill be Iiable for the tax payments even if you donlt'actually withholdthe tax from your'employees. For more information, call the Oregon Dept. of Revenue at 945-8091 Unemployment insurance t*x: As an empioyer, you are required to pay a tax for unernplcyment insurance purposes on the wages of all employees. For more information, call the Oregon Empioyment Division at the Depmtment of fiurnan &esources at378-3524. Workers'compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, anO *iist obtain workers' compsnsation insurance for your employees. If you fail to obtain workers' compensation insurance, you may besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredontlejob. Formoreinformation, cali the Workers' Compensation Division at the Departrnent of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an-ernpioyer, you must withhold federal income tix from employees' wa$os. You will be liabte for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at l-800-829-1040. OTHEH HESPONSIBILITIES AND AREAS OF CONCEHN; Code compliance: As &e permit holder for this project, you are responsible for resolving any failure to meet code requireme-nts that may be brought to your attention through inspections. . r Liahility and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint oyersprayr water damagefrom pipe punctures, fire, or work that must be re-done. 'Iime to supervise emplcyees: Make sure yr:u have sulTicient tirne to \uperuise yor.rr cmployees. 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 tirnes so they can pedorm the required inspections. If you have abdiiional Quesfions, write or cail the Construction ContractorsSoard (PO Box.14140, Salet!;SR 97309-5052, 5Ay378-4621). The Board is located at 700 Summer St. NL SuitoS00xin Salem. prop-own.pm4 1t94