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)