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Home My WebLink AboutPermit Mechanical 1994-02-10RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER ci +o l4q 225 Fifth Street Springfield, Oregon 97477 frh) LOCATION OF PROPOSED WORK: ASSESSORS rr,rAP, I] C3AL3{TAX LOT: I LOT - BLOCK:SUBDIVISION 1qL- 1r?3PHONE: OQ ZIP:STATE: M^)L q)4 )-) OWNER: ADDRESS: CITY: NEW - REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK: ELECTRICAL: iCar,.vr'r\g EXPI RES PHONEADDRESS to CONTRACTOR'S NAME MECHANICAL: CONST. CONTRACTOR # GENERAL: PLUMBING G RANGE: # OF BDRMS _ OFFICE USE _ LAND USE:FLOOD PLAIN WATER HEATER r OF UNITS: SECONDARY HEAT: SQUARE FOOTAGE: OUAD AREA: # OF BLDGS ZONING CODE: OCCY GROUP: * OF STORIES: CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-376g. Thls ls a24hour recording. All inspections requested before 7:o0 a.m' will be made the same working day, lnspections requested after 7:00 a.m' will be made the following work day' REQUIRED INSPECTIONS I TemporarY Electric Rough Mechanical - Prior to cover. inal Plumbing - When all plumbing work is comPlete. Site lnspection - To be made after excavation, but Prior to setting forms. Rough Electrical - Prior to Final Electrical - When all electrical work is comPlete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Permanent electrical power. Final Mechanical - When all mechanical work is comPlete. Footing - After trenches are excavated.Fireplace - Prior to facing materlals and (ramlng lnsP. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.l--l Framing - Prior to cover. Foundation - After forms are erected but prior to concrete placement. y'oter Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.[-_l Drywall - Prior to taoing. MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Slove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After firePlace aPProval and installation of unit' Blocking and Set'UP - When all blocking is comPlete. Floor lnsulalion - Prior to decki ng.Curbcut & APProach - After forms are erected but Prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-uP, and Plumbing inspections have been aPProved and the home is connected to the service Panel. Storm Sewer - Prior to filling trench. Sidewalk & DrivewaY - After excavation is comPlete, forms and sub-base material in Place. Water Line - Prior to filling trench. [--] Fence - When comoleted' Final - After all required inspections are aPProved and porches, skirting, decks, and venting have been installed.Rough Plumbing - Prior to cover. Slreet Trees - When all required trees are Planted' E E E E E E E r r Err E E E r E E --rLot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac ks P.L.HSE GAR Acc N S E _. THE PROPOSED WORK 'N THE HISTORICAL DISTRICT, OB ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: VALU E (A) X $/SQ. FT. Carport Mai n Garage Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT, 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 Spri ngfield, 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. Receipt Number:- Plans Reviewed By Date Date Paid Received By: Plan Check Fee: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties withln the City limits which are being improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) l5 oo ts 7<i N0 FT. FT. FT. PLUMBING PERM!T .f< Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS MECHANICAL PERMIT Fu rnace Exhaust Hood Vent Fan No Wood Stove/ lnsert/ Fireplace Unit Dryer Vent (D) Mechanical Permit lssuance State Surcharge Total Permit 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 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 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 7O1.OS5 will be used on this project. 'mit card is located at the f ront n sig I further agree to ensure that all inspections are requested at the proper ti each address is readable from the street, that the of the property, and on the si s durin Date app MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut -- ft Demolition State Surcharge Total Miscellaneous permits (E) TOTAL AMOUNT DUE (exctuding electricat) (A, B, C, D, and E Combined) tq -l< r l,nlq q C^) .s DATE PAID AMOUNT RECEIVED RECEIVED BY VALIDATION: RECEIPT NUMBER -\Nvel^ ,--tlt-rzt-,)t- J-,', ln, - -7< R Permit No:qqol L4q Address: )-l< lt t: uD SL e8 4,"1"rlssuedDate: OR OFFICE USE ONLY STATEMENT: !NFORMATION 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: d 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. 1 2 3 f\ruc k\/ My gerroal contractor isA Contractor registration num 11b2t 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. B. r+,r wiu be '.nr "*"B),}|mH i{;$ 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 certi the above i ation is correct and that I have read and understand the lnform Noti Owners about Construction Responsibilities on the of this ) -r o-qq re cant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8191 t WHITE C,oPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT --- INFoREATToN NoncE To pRopERTy diwruens ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Nolice to Property Owners About Construction Responsibilities was developed by the Construction Gontractors Board in accordance with ORS rc1 passed by the 1989 Oregon Legislature. .055(5), lf you are acting as your own contractor to conStruct a new home or make a substantial impqov6ment to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: j' lf you hire persons not registered with the Construction Contractors Bgard to do labor in construc.ling or assisting in the construction or improvement of a residential structurq; yglu will, in most instances, b9,:ruled to be an "employer" and the people you hire will be "employeeQ'1. As the dmployer, you must comply with the following: Oregon's Withlloiding'T,?il Law: As an employer, you must withhold income.taxes from employee wages at the time employees are-paid..You will,b-e liable for the tal payments even if youdon't actuglly 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 for unemployment insurance purposes on the wages of all ernplo)€es, For more information, callthe Oregon Employment Division DHR at 378-3224. Workers' Compensation lnsurance: As an employer, yoLr are-suhlect to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf, you fail to obtain workers' compensation insurancq you rnay be subject to penaltiesand wtll be'liable'fof al[ claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at gf3-7434. U.S. lnternal Revenue Service: As an employer, you must withhold federal income,tax from ernployees'wages. ymente,enifyoudidn,t.actudl]ywitnnoto.tnd'tax.Formoreinfoimation,call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Compliance: As the permit:holder for this prolect,you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liabilily and Property Udlr.laEe lnstirance:lGontact y6$r iriSurance agsrt to See if you have adequate insurance chasfallingtools,paintoversprdi,,saterdamagefrompipepunc- tures, fire, or work that must be re-done. Time,to Supervise,Employe6s: Make sure you have sufficient tirne to su pervise your empfoyees. Expertise: lvlake 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 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 503-378-4621 o244J 10t24t89 RINGFIELE, RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER 225 Fifth Street Spri ngf ield, Oregon 97 477 R ryLOCATION OF PROPOSED WORK: ASSESSORS MAP -z TAX LOT: LOT:BLOCK:SUBDIVISION PHON E: ZIP:STATE:CITY: ADDRESS: OWNER NEW - REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK ADDRESS EXPIRES PHONECONTRACTOR'S NAME MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # GEN ERAL: PLUMBING R,ANGE: # OF BDRMS _ OFFICE USE _ LAND USE: ZONING CODE: FLOOD PLAIN WATER HEATER * OF UNITS: SECONDABY HEAT: SQUARE FOOTAGE: OUAD AREA: # OF BLDGS OCCY GROUP: # OF STORIES CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-3769. This is a24 hour recording. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS Temporary Electric Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is complete. Site lnspeclion - To be made after excavation, but prior to setting forms, Rough Electrical - Prior to Final Electrical - When all electrical work is complete.cover. Underslab Plumbing/ Electrical/ Mechanical - Prior to cover. Electrical Service - Must be approved to obtain permanent electrical power. W Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Fireplace - Prior to facing materials and framing lnsp. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover OtherFoundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench. MOBILE HOME INSPECTIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After fireplace approval and lnstallation of unit. Blocking and Set.Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut &Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Line - Prior to filling trench. 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.Rough Plumbing - Prior to cover. ?/o ,, i Dl9zza .q+42727 E tl tl fl l--l Drywall - Prior to taping. E E tl tl E E E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac backs .- 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: P.L.HSE GAR ACC N S E 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 Ordjnance 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. Receipt Number:- Plans Reviewed By Date Plan Check Fee: Date Paid Received By: VALUE (A) X $/SQ. FT. Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport Systems Development Charge is due on al I undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fi replace Unit Dryer Vent ,/5- -" <f;-.{(D) N0 /hra'-2 Vent Fan Mechanical Permit lssuance State Surcharge Total Permit M ECHANICAL PERMIT Fu rnace Exhaust Hood 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 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 pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Building Safety Division. I f.urther certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this proiect. I f urther agree to ensure that all required inspections are e,t e- Sig natu re Date each address is readablerequested at the pro from the street, th permit card is the appof the pro on the at the front will remain times du MISCELLANEOUS 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) DATE PAID z-,//-?.-/ AMOUNT RECEIVED FIECEIVED BY VALIDATION: FIECEIPT NUMBER .-c //8.<<