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HomeMy WebLinkAboutPermit Building 1997-02-21RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726.3159 LOCATION OF PROPOSED WOFK: ASSESSOFTS MAP; LOT: OWNER: ADDRESS: CITY: N R :}PFlINGFIELD BLOCK: JOB NUMBER 225 Fif th Street SpringtletrJ, Oregon 97477 TAX LOI SUBDIVISION: -- PHON E: ZIP:€>?@/STATE: DEL .-DI U Z DEM CONTHACTOR NAME G ENERAL: ADDRESS - OFFICE USE - LAND USE: cover. CONST. CONTRACTOR ,EXPIRES PHONE PLUMBING: MECHANICAL ELECTRICAL QUAD AREA: I OF BLDGS: OCCY GBOUP: I OF STORIES: WATER HEATER: To request an inspecilon, you must call 726-3769. Thimade the sanre worklng day, lnspections requested Temporary Eleclric II OF UNITS:ZONING CODE: CONSTR. TYPE: -- , OF BDRMS HEAT SOURCE: -- SECONDARY HEAT: - SOUARE FOOTAGE: FLOOD I)LAIN Site lnspection - To [:e made af ter excavat jon, but prior tosetting fornrs. l-l Underslab plumbing/ Electrical/ - Mechanical - prior to cover. Footlng - Af ter trenches areexcavated. Masonry - Steel locatlon, bondbeams, groutin0. Foundatlon - After forms areerected but prlor to concreteplacement. [-l UnAerground ptumbing - prioru to fllllng trench. Underlloor plumbing/ Mechanical - Prior to insulation or decking. Post and Beam - prior to floorinsulation or decking, Floor lnsulation - prior to deckl ng. l-l Sanitary Sewcr - prior to f iling'J trench. Storm Sewer - l)rior to tilling t renc h. Water Line - Prlor to f illing tren ch. s is a 24 hour recording. All inspections requestecj be(ore 7:00 a.rnaf ter 7:00 a.m. will be macJe the followlng work day. REOUIRED INSPECTIONS Rough Mechanical - prior tocover.l-_l Finat ptumbing - When ail - plumblng worl< ls complete. [-l Final Etectrical - When ail - electrical wor[( is complete. l--l finat Mechanicat - When ail - mechanical worl< is cornplete. Rough Electrical - prior to will be Final Building - When allrequired lnspections have beenapproved and building iscompleted. Othor MOBILE HOME TNSPE TIONS [--l elockirrg and Ser.Up _ When ail - blockin0 is complete. Plumbing Connections _ Whenhome lras been connected towater and sewer_ Electrical Conrrection - Whenblocking, set.up, and plumbinginspections have been approvedand the home is connected tothe servlce panel. Final - Af ter all rcquiredrnspections are apploved andporches, sl<lrting, decks, andventlng have been installed. Rough Plunrbing - prior to cover. l(: /ar-r>>z tl RANG F.: [l Electricat Servtce - Musr be - approved to obtaln perrnanent electrlcal power. f-l fireplace - prtor to factng.J materlals and framing lnspl @ r,u^ing - Prlor to cover. ffiWaUtCeiling tnsulation _ prior to - cover. p o"*ull - Prior to taping. l-l Wood Stove - Afrer Instailation. I lnsert - Alter fireplace approvql - and installation of unit_ I-_l Curbcut & A1:prroach - After.J forms are erected bUt prior toplacement of concrete. [-_l SiOewatk & Driveway - Af rer - excav.ttion ls completc, (ortns and sub.base material in place. I-l Fence - When compteted. [-_l {;tr€ot Treos - Whon ail rcqutred - trees aro plantcd. P.L.HSE GAR ACC N S E try_-_ Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type .w - lnterior - Corner - Panhandle - Cul-de-sac ks iv-THE PFIOPOSED WORK iN THE HISTORICAL DISTRICT, OR ON T}IE HISTORICAL REGISTER? - lf yes, this applicatlon must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: VALUE {:& (A)12/6 X $/SO. FT. Total Value Building Permit Fee State Surcharge Total Fee @12.5e BUILDING PERMIT ITEM SO. FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This pcrrnit is grar.rted 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 buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plans Rcviewed i3y Date Receipt Numbe Plan Check Fee Date Paid Received By: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within tlrr: City linrits which are being improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumblng Permlt State Surcharge Total Charge AD DITIONAL COM M ENTS By slgnature, I state and agree, that I have caref ully examlned tl'le completed application and do hereby cerilfy lhat all lnformation hereorr is true anct correct, and I f urther cerilfy that any and all work performed shall be done in accort1ance with the Ordinanccs of the City of Springfield, and the Lawsof the Stale of Oregon pertainlng to thc work described herein. and that NO OCCUPANCy will be made of any structure wlthout perrrission of the Building Safety Divislon. I further certify that only contractors and employees who are in cornpliance with ORS 70.1.055 will be used on thisprolect. | (urther agree to ensure that all required inspections are requested at the proper time, that each address is readabl from tlre street, that the permit card ls located at the tro of the property, and the approved set of plans will 7 -74-4,1 ,,4 /tosz^z trucu ring ctimes 47 atu re on tl'le site at Slgn Date Wood Stove/ lnsert/ Flreplace Unit Dryer Vent MISCELLANEOUS PERMITS Moblle Home State lssuance State Surcharge Sldewalk _ ft Curbcut --_ ft Demolition State Surcharge Total Miscellaneous perrnits (E) MECHANICAL PERMIT No Fu rnace Exhaust Hood Vent Fan Mechanical Permit lssuance State Surcharge Total Permit rol VALIDATION RECEIPT N DATE PAID AMOUNT R RECEIVED UMBER ECEIVED 6 BY 7rTOTAL AMOUNT DUE (excluding electricat) ___--(A, B, q D, and E Combined) SPr ,iFtELO 225 FIFTB STREET SPRTNGFTELD, OREGON 97477 INSPECTI0N REQTEST2 726-376 OFFICE: 726-3759 1 LOCATION INSTALLATION ;.,r-,,=;t-^.Q.L***** /-:*L**L ELECTRICAL PERHTT APPLICATION City Jo 3. COHPI^ETE FEE SCffiDTILE BELOII A. Nev Residential-Single or Multi-Family per dvelling unit. Service Included:ltems Cost b Nunber Q 1O I 80 I $ Bs.oo s 1s.00 $ 40.00 D0c JOB DESCRTPTION Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALLATTON ONLY '{a{,rt {c,*',a- \ Electrical Contractor €w tLc- Address 0'l< \4 Ci ty Phone Llb<)73t1 Supervisor License Number 4nt Expiration Date Constr Contr. Number + t(11 8< Expiration Date Signat fS rv ing triciano LbZ ,\,,, I OP f *L'- Sum 85OO ea{.rt'c B c D 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home. or Modular Dvelling Service or Feeder Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps -40i. amps to 600 amPS - 601 amps to 1000 amps- 0ver 1000 amps/volts s s0.00 s 60.00 s10o.0o $130.00 $300.00 $ 40.00 Temporary Services or Feeders Installation, Alteration or Relocation 200 amps''or less $ 40-00 over 4b1 to 600 amps - S Bo.0o Over 600 amps or fbOO voTts see rrgrr uffi![- Branch Ci rcui ts . .- Nev, Alteration or Extension Per Pane10vners Address *^ " T,A)d Ci ty OVI{ER INSTALLATION The install-ation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: DATE: One Circuit $ 35.00 Each Additional Circuit or vith Service or Feeder Permit $ 2.00 E. Miscellaneous (Service/feeder not included) -Each ins tal-lation Pump or irrigation - Sign/Out1ine Lighting- Limited Energy/Res Limited energY/Comm SUBTOTAL OF ABOVE 5Z State Surcharge 3Z Administrative Fee TOTAL I s40 s40 $20 $36 .00 .00 .00 .00 RBCEIVED B 5 led Signt Phone LM( Permit #: Address b Issued by:Date:Z Statemeht: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38: %d)own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3,A,. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 38. I will be my own general contractor. (4;e?de<,.+t A,U/y)tJ If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor I hereby certify that the is correct and thatl have read and dounderstand the Information Responsibilities on the reverse side of this form. (Signature of permit applicant) (White copy to issuing agency permit file, pink copy to applicant) Notice to (Date) x. --., -'Abourt Can,tfructior* Flesponmih*$itles \ .i\ \."\ ,. .... .'l{."te: This {nJr;r*atlprxNatitqta Ryay,a:v11, Ou'ne rs ab*nt {-lr;nstnx'fir;n !*':;t>*n:;il.,iirriss . " -- ,t'd Tletcl*ited h.r' rii.' Cott,struclioi Cowr*ctrtrs ll**rrl i;z r;tt"ordsnce *,itlt {-i.ry.t 7{il 455(51. If you are acting as your own contractor to construct a new home or make a substantial improvemena tll an existing strucfrre, yl:u carrpr*veil.{ *rany prob}*r:rs by bi:ing aware r:f tile {ollowing resp*nsibillaes;x-lcialens t'll"corir,:fir, . , EMPLOYER HESPON$I&ILITIE$: If you hire;:ersous nol rcgistered with the Constmction Contractors Board to clo la!:or in cr"rnrtrlriling or assisting it rhe construction or irytprovement of a residential structlrre, ,voil will, in rnr:st ins{ances, be rr"lied to h* an ,:mployer and t.he people you hir,: will he enrployees. As the emplover, you must comply with the fbllowing: Oregon's withhtilding tax law:' Al an einployer, you musf withhold inccrme taxes frorn employee wag*s at the time ernploy*es are paid. Yr:ri will be liatile frii the tax paymenfs even if you don'f actually withhoid the tax from your emplo.vees. For rnore information, call the Oregon Dept..of'Reveoue at 945-809t. Unemployment insurance tax: A.q an employer, yori are rectrnired to pay a tax for unernploynrent insurance purposes on the wagesofallemployees. Forn:loreint'ormqtioilicslltheOregunEmployrnentDivisionatthqDepartmentofHu$BnReqouges at 379-7524. r_r{ Workers' eompensation insurance: As an employer, yorr are subjeit to the Oregc,n'W'orkers'Con:pensation U;r-,r+*#F obtain workers'comnensation insurance for vour enrirlovees. Il vou fail to obtarn workers' coinpensalion insurance."vo-urnax, uei$;u.;eCt to'peiraltie's'elia *iriue ti'eutdroiuil .lui* inr,i iroir'" .;iyor.ir **ployees is in;ui€g on tie joh. lroi hroie info;nliffi call the Workers' Compensation Division at the llepartment ol Consumer and Br-*siness'Sitvice s el S45-7$88.' U.S. Internal Xteyenue Service: As an en-lployer, you must withho.lcl feilerel income t;xfrorn emr:lo_vees'\rages. You will be liableforthetaxpaymenteven ifycudrd*'taetuatrIyrvithholdthetax. Fcirmorci*f*rr"latio*.c:llitircl*t*n:allt*venuesenvice ar l-800-829-t040. OTh{Em Rffispor*srBllrTrHs ANm AmEe$ sF osf,{0Effif{: Code eompliance: As the pern:it forthis project, you are responsihle frrr resolving arry faiiure to meet.code re?.ii*Kg.L' that may be brought to your attention Liabilif and property damage insur"ance: Contact your insurance agpil{ to s*e i['you have adeqr:at* i*surar:cc c{lx]'i:rage f,or accidentr; and omissions such a; {aliing tootrs, paint uve rspra}, water damage h"orn pipe punctures" firc, or work that must be re-done. Time t* supervlse e*:g:X*yees; h,4akc sure you l:ave sufficient tirnc to s*pervise your empl*,vees. Hrpertise : Make sure you have the expertise to act as your own general confractor, to cnordinate the wr:rk of r*ugh-in and finish trad*s" and to notify huildi*g officials at the appropriate times so they can perform thq r*quiied inspections. -i:-- l If you have additional questions, i.vrite or call the Ccnstruction Coxtractors Board (P0 Br:x 1.1.;,:1.0, Sale m, OR 9?309-5052, 5fi3{37*-4621). The Bcard is located ar 700 surnrner sr. Ng sr,rite 300, in salem. prop<rwn.pm4 t/94 RESIDENTIAL PERMIT APPLICATION lnspections:726.3769 Of fice: 726.3759 LOCATION OF PROPOSED WOFIK: 03 15 Underslab Plumbing/ Electrical/ Mechanical - prior to cover. Footlng - Af ter trenches are excavated. Masonry - Steel locailon, bonclbeams, grouting. Foundatlon - After forms areerected but prior to concreteplacement. 3 Floor lnsulation - prior to decki n g. Sanitary Sewer - prior to fiiling trench. Storm Sewer - [)r.ior to filling trench. [--l Water Line - prtor ro fiilinglJ trench. | /l $ougtt Plunrbing - prior ro - cbver. SPFlIhrGFIELD JOB NUMBER q 225 Fif lh Street Sprlngflel<J, Oregon 9Z 477J&) OWNER: ADDRE CITY:STATE DESCRIBE WOR NEW REMODEL ADDITION DEMOLISH OTHER .LOT: BLoCK: ASSESSORS MAP: COI.ITRACTOR'S NAME GENERAL: PLUMBING MECHANICAL: ELECTRICAL OUAD AREA: N OF BLDGS: OCCY GROUP: , OF STOBTES: ___ WATER HEATER Site lnspection - To be made af ter excavation, but prior tosetting forms. TAX LOT: SUBDIVISION CONST. CONTBACTOR # _ OFFICE USE - ADDRESS CONSTR. TYPE: HEAT SOURCE: LAND USE: / OF UNITS: _-- EXPIFIES PHONE FLOOD I)LAIN: ZONING CODE # OF BDRMS: -=- SECONDARY HEAT: SQUARE FOOTAGE: Final Electrical - When ailelectrical worl< is complete. Final Mechanical - When allmechanical worl< is cornplete. Final Building - When altrequired Inspections have beenapproved and building iscompleted. RANGE: To request an lnspectlon, you must call 726.3769. This ls made the sanre worklng day, lnspections requested af te Temporary Eleclric a 24 hour recordlng. All inspectlons requested before 7:00 a.m. wlll ber 7:00 a.m. will be made the following work day. REOUIRED INSPECTIONS i;.I"?: Mechanrcar - prior to E-fl;;1.?l:Tj?,?,;#l;i"iJ: Rough Electrical - prior to cover. Electrical Service - Must beapprovecl to obtain perrnanent electrical power. Fireplace - prlor to faclng materlals and framing lnsp. Framing - Prlor to cover. Wall/Ceiling lnsulation - prlor tocover. Other I-l Post and Beam - prior to ftoor.- lnsulatlon or decking. E ll.:1, : .l,lg, fireptace approvsl - and installailon ol unlt. [-l UnOerground ptumbing - prior.J to filllng trench.[--l Orywail - prior ro raping ,.-\ de rlloor/ P I u m bi n g /}U cchan ic at Pri or to\glgllctf or deck i nO.Wood Stove - After lnstallation. Curbcut & A1:prroaclr - Af terforms are erected but prior toplacemcnt of concretc_.. Sidewalk & Driveway - Afterexcavation is complctc, forrnsand sufr-base material in place. Fence - When completed. MOBILE HOME INSPE TIONS [--l Blocking and Set.Up - When all - blocking is complete. Plumbing Conneclions - Whenhome lras been connected towater and sewer. Electrical Connection - Whenblocking, set-up, and plumbinginspections have bcen approvedand the home is connected tothe servlce panel. Final - Af ter all requiredrnspections are approved andporches, sklrting, decks, andventing have been installed. PHON E ztP [-_l {;treet Trees - When all required - trees are planted. )'L Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac ks PL.HSE GAR ACC N S E ErHe pnoposED woBK iN THE HISTORICAL DISTFIICT, OR ON TI{E HISTORICAL BEGISTER? - lf yes, this appllcation must be signed and approved by the Historical Coordinator prior to permit issuance. APPBOVED VALUE (A) x $/so. r--T. BUILDING PERMIT ITEM SO. FT. Main Garage Carport Tolal Value Building Permit Fee State Surcharge Total Fec BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Tlris pernrit is grarrted on the cxpress condition that the said construction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, including the Development Code, regulating the construction and use ofbuildings, and may be suspended or revoked at any time upon violation of any provisions ot said ordinances. Receipt Number:_.._ Plans Rcviewed L3y Date Date Paid Received By: Plan Check Fee: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within thc City linrits which are being improved. ITEM Flxtures Residential Bath(s) Sanitary Sgwer Water Slorm Sewer Moblle Home (c) 0 N0 FT. PLUMBING PERMIT FT. FT. Plumblng Permit State Surcharge Total Charge ADDITIONAL COMMENTS By slgnature, I state and agree, that I have carelully examlned the completed apptication and do hereby certify f hat all lnformation hereon is true anct correct, and I f urther cerilfy that any and all work performed shall be done in accordance with the Ordinanccs of thc City of Springfield, and the Laws of the State of Oregon pertainlng to thc work descrlbed herein. and that NO OCCUPANCy will be macle of any structure without perrnission of the Buildir.rg Safety Divislon. I further certify that only contractors and employees who are in cornpliancc with OFIS 701.055 will be used on thlsproiect. I {urther agree to ensure that all required inspections are requested at the proper time, that each address is readable Slg ature Date set o lans will remain n.tru,lt ted at the front on the site durln from the street, that the pe of the property, and the ap rmit card is I Wood Stove/ lnsert / Fl replace Unlt Dryer Vent MISCELLANEOUS PERMlTS Mobile Home State lssuance State Surcharge Sldewalk - ft Curbcut -- ft Demolition Slate Surcharge Total Mlscellaneous Perrnits (E) MECHANICAL PERMIT N0 Furnace Exhaust Hood Vent Fan Mechanical Permit lssuanco Stato Surcharge Total Permlt (D) VALIDATION: RECEIPT NUMBER DATE PAID AMOUNT REC RECEIVED BY EI E rlrl0Qa- 1f''fo TOTAL AMOUNT DUE (exctuding clectrica ,l -.8=1fr (A, B, C, Q and E Combined)