HomeMy WebLinkAboutPermit Mechanical 1996-02-05O/ 2D/
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JOB NUMBER
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
ESIDENTIAL
ERMIT APPLICATION
lnspectlons: 726.3769
Offlce: 726.3759
SUBDIVISION:
225 Flfth Street
Sprlngfleld, Oregon 9t 4?l
PHONE:
ZIP:
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s ?STATE:q-t Y ?7
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CITY:
ADDRESS:
OWNER:
NEW- REMODEL AODITION DEMOLISH OTHER
e._DESCRIBE WORK:f"
ADDBESS
".+S q
YYf-7 t)-ELECTRICAL:
CONTRA TOR'S NAME
GENERAL:
MECHANICAL:
PLUMBING:
CONST.
CONTRACTOR #
FLOOD PLAIN
- OFFICE USE -
LAND USE:
WATER HEATER:
r OF UNITS:
SECONDARY HEAT: _
SOUARE FOOTAGE
r OF BDRMS:
RANGE:
QUAD AREA:
r OF BLDGS:
OCCY GBOUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
ZONING CODE:
To request an lnspectlon, you must call 726'3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:oo a.m, wlll bemado the same worklng day, lnspecllons requested after 7:00 a.m. wlll be made the followlng work day.
REQUIRED INSPECT!ONS
Temporary Electrlc
Slte lnspectlon - To be mado
after excavatlon, but prlor to
settlng forms,
E Underslab Plumblngl Electrlcal I
Mechanlcal - Prlor to cover.
l-l Footlng - After trenches arelJ excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
tl Foundatlon - After forms are
erected but prlor to concrete
placement.
E Underground Plumblng - Prlor
lo fllllng trench.
tl Underlloor Plumblngl Mechanlcat
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decklng.
E Floor lnsulatlon - Prlor to
decklng.
Sanllary Sewer - Prlor to fllllng
trench.
Slorm Sewer - Prlor to fllllng
trench.
Bough Plumblng - Prlor to
cover.
Rough Mechanlcal - Prlor to
cover.
Rough Eleclrlcal - Prlor to
cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
ffiflnat Mechantcal - When ailR.mechanlcal work ls complete.
Flnal Plumblng - When allplumblng work ls complete.
Flnal Eleclrlcal - \Mren all
electrlcal work ls complete.e
Flnal Bulldlng - When all
requlred lnspectlons have been
approved and bulldlng ls
completed.
E
K
K
X
r--
[l Flreptacs - Prtor to faclng
-
materlals and framlng lnsp.
n lnsert - After flreplace approval
-
and lnstallatlon of unlt.
Framlng - Prlor to cover,
I
I
WalllCbltlng tnsdtatlon - prlor ro
cover.
Drywall - Prlor lo taplng
Wood Slovo - After lnstallatlon.
Curbcut & Approach - After
forms are erected but prlor to
placomont of concrete.
Sldewalk & Drlveway - After
excavatlon ls cornpletc, forms
and sub.base materlal ln place.
Streel Trees - When all requlred
trees are planted.
Ef ottrer (q Or;Z J
4+t sP' '
MOBILE HOME INSPE TTONS
Blocklng and Set.U
blocklng ls comple
p - Whep all
te.
Plumblng Connectlons - When
home has been connected to
water and sewer.
Eleclrlcal Connectlon - When
blocklng, set-up, and plurpblng
lnspectlons have been approved
and the home ls connected to
the servlce panel.
Water Llne - Prlor to fllllng
trench.l--l Fence - When compteted
r/s
2<a
EXPIRES PHONE
tl il
l-_] Flnal - After ail requtred.- lnspectlons are approved andporches, sklrllng, decks, andventlng have been lnstallect,
t.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total [elght
Lot Typo
-
lnterlor
-
Corner
-- Panhandle
-
Cul-de-sac
1 . lS r'HE PROPOSED WORK IN THE -
HrsroRlcAL DtsTRlcI, oR oN,.THE HISTORICAL REGISTEFI?
ll yes, thls appllcatlon muet be slgned
and approved by the Hlstorlcal
Coordlnator prlor to permlt lssuance.
APPROVED:
P.L.HSE GAR ACC
N
S
E
Total Value
Bullding Permit Fee
Slate Surcharge
Total Fee
VALUE
(A)
x s/so. FT.
Maln
Carport
Gar,age
BUILDING PERMIT
ITEM SO. FT.
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permlt ls granted on the express condltlon that the sald
constructlon shall, ln all respects, conform to the Ordlnance
adopted by the City of Sprtng(leld, lncludlng the
Development Code, regulatlng the construcilon and use of
bulldlngs, and may be suspended or revoked at any Ume
upon vlolatlon of any provlslons of sald ordlnances.
Plans Revlewed By Dato
Plan Check Fee:
Recelved By:
Date Pald:
Flecelpt Nu
SYgTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undeveloped
propertles wlthln tho Clty llmlts whlch are belng lmproved.
t
Resldentlai Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
N0
FT.
FT,
FT.
(c)
PLUMBING PERMIT
ITEM
Flx tu res
Plumblng Permlt
Stato. Surcharge
Total Charge
ADDITIONAL COMMENTS+:j
Wood Stove/ lnsert / Flreplace Unlt
Dryer Vent
MECHANTCAL PERMIT
/e,a o
26?-
LP
,2//.U . // j.aP
/,Lo
N0
Mechanical Permlt
lssuahce
State Surcharge
Total Permlt
,7rt,4,
(D)
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have carofully €xamlnedlhe completed appllcailon and do hereby certlfy that alllnformatlon hereon ls true and correct, and I turther cerilfy
that any and alr work performed shal bo done rn accordance
wlth the Ordlnances of the Clty of Sprlngfleld, and the Lawsof the State of Oregon perlalnlng to tho work descrlbedhereln, and that NO OCCUPANCy wlll be made of anystructure wlthout permisslon of the Bulldlng Safety Dlvlslon.I further certlfy lhat only contractors and employees whoare ln compllance wlth OFIS 7O1.OS5 wlll be used on thlsproject.
I further agree to ensure that all requlred lnspecilons are
roquested at the proper ilme, that each address rs readabre
from tho street, that the permrt card rs rocated at the frontol the property, and the approved set of plans wlll remaln
mes durlng constructlon,
Date
on the slts at all
Slgnature
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk _- ft
Curbcut --- ft
Demolltlon
Slate Surcharge
Total Mlscellaneous permlts (E)
TOTAL AMoUNT DUE (exctu_dtng eteorrtca \ .%;rc_(A, B, C, Q and E Comblned)
2.o
ZO Z9D
AMOUNT FIECEIVED
RECEIVED BY
DATE PAID
VALIDATION:
BECEIPT NUMBER
225 FTFTE STREET
SPRINGFTELD, OREGON 9
TNSPECTTON REQTIEST:
OFFTCE: 72G-3759
1 LOCATION OF a
LEGAI DESCRTPTTON
-" " tollowing prorect as eubmlttod hss tirc lollowing
;, and does nol require epeeilic land uee
r., ;;OVQI.
Zon LDR
3.
str[1t}.(iF&ELO
EI,ECTRTCAL PERHTT APPLICATTON
Job Nunber
5==e
A
I tems Cos t
$ 8s.00
Sum
1000 sq.ft. or 1ess
Each additional 500sq. ft or portion
thereof
Each Manuf,d Home orModular Dvelling
Service or Feeder
's 1s.00
$ 40.00
B Services or FeedersInstallation, Alterat j.ons
or Relocation:
200 amps or less ./'
201 amps to 400 amps _-
401 amps to 600 amps
-
601 amps to 1000 amps-0ver 1000 amps./volts
-
Reconnect 0n1y
s s0.00
s 60.00
$ 100. 00
s130. 00
$300.00
$ 40.00
a.
-C Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps"or Less S 40.00
20L amps to 400 amps
-
S 55.00over 401 to 600 amps
-
S 80.000ver 600 amps or 1000-voTTs see rrgrr u[[r=
Nev, Alteration or Extension per panel
/,*
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Ou tline Lighting-
Limited Energy/Res
-
Limi ted Energy/Comm
COHPIJTE PEE SCMDULE BELOV
New Residential-Single orMuLti-Family per dv61ling unit.)ervlce lncluded:
JOB
Electrical Contractor
Address
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Address Z4 Z-3 N , /qrU
Ci ty PhoneTll 6 44zz
OVNER INSTALTATTON
The installation is being made onproperty f ovn vhich is not intendedfor sa1e, Iease or rent.
0vners Signature:
DATE:
Permits are non-transferable and expireif vork is not started vithin iAO a.V"of issuance or if vork is suspended for180 days.
2. COMRACTOR INSTATI,ATTON ONLr
2
4A
Signature of Supervising Electrician
0vners Name Fcnvo -{eor D. Branch Circuits
One Circuit $ 35.00
Each Addi tionalCircuit or vith Serviceor Feeder Permit 7? $ 2.00
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAI
s 40.00
s 40.00
$ 20.00
s 36.00
5
RECEIVED B
z7/. ea
Ci
Srrt D
Permit #:
Date: ?^7PIssued by:
a
Address
Statemeht: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon l,aw, 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:
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.
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.
W 3B. 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 building permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have read and dounderstand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
3'5 -76
(Signature of permit applicant)
(White copy to issuing agency perunit file,
pink copy to applicant)
OR
(Date)
-
el-l
V
tr
Information l*otice to Property Owners
. Nate: This Information Nuice to Property Owners about Construction Responsibilities-- vias rleveloped by the CbhiiructUn Cantractors Board in accordance with ORS 701.055(5),
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EM PLOYEH RESPONSI BILITIES:
If 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 "*pioy", 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 Dept. of Revenue at 945-8091 .
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources
at378-3524.
Workers' compensation insurance: As an employer, you arc subject to the Oregon Workers'Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you rnay
be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Intcrnal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be
liable forthe tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at l-80G.829-104.0.
OTHEH HESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liabitity 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 overspray, water darnage from pipe punctures, fire, or work that must be
re-done-
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertlse: 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 times so they can perform the required inspections.
'\-.
If you havehdditional questions, write or call the Construction Contractors Board{P0Box 14tr40, Salem,:OR 97309-5A52,
54y378-4621). The Board is located at 700 Summer St. NE Suite 30O, in Salem.
propown.pm4
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