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Home My WebLink AboutPermit Plumbing 1995-04-11FIELD RESID ENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER 225 Fifth Street Springfleld, Oregon 97 477 LOCATION OF PROPOSED WORK: ASSESSORS MAP:/26 -/ts TAX LOT: LOT:BLOCK:SUBDIVISION: To request an lnspectlon, you must call 726'3769. Thls ls a 24 hour recording. All lnspections requested before 7:00 a.m. will bemade the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the following work day. REOUIRED INSPECTIONS Temgiorary Electrlc Rough Mechanlcal - Prior to cover. Final Plumbing - When allplumbing work is complete. w w mSlte lnspectlon - To be made after excavatlon, but prlor to setting lorms. Water Llne - Prlor to filllng trench, Rough Plumbing - Prior to cover. Rough Eleclrical - Prior to cover- Electrlcal Servlce - Must be approved to obtaln permanent electrlcal power. Flreplace - Prlor to faclng materlals and framing lnsp. Framlng - Prlor to cover. Wall/Celling lnsulatlon - Prlor to cover. Drywall - Prior to taplng Wood Slovo - After lnstallation lnsert - After flreplace approval and lnstallatlon of unlt. Curbcut & Approach - After forms are erected but prior toplacement of concrete. Sidewalk & Drlveway - After excavation ls complete, forms and sub-base materlal ln place. Fence - When completed Streel Trees - When all required trees are planted. Final Eleclrical - When all electrical work is complete. Final Mechanlcal - When all mechanical work is complete. Flnal Building - When ail requlred lnspections have been approved and building is completed. Other MOBILE HOME INSPECTIONS Blocking and Set.Up - When ail blocklng is complete. Plumbing Connections - When home has been connected to water and sewer. Electrical Connection - When blocking, set-up, and plumbing lnspections have been approved and the home is connected to the service panel. Final - After all required inspections are approved and porches, skirting, decks, and ventlng have been lnstalled. PHON E STATE:ztP aOWNER: ADDRESS: CITY: NEW - REMODEL ADDITION DEMOLISH OTHER DESCFIIBE WORK: ADDRESS EXPIRES PHONECONTFIACTOFI'S NAME MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # GENEFIAL: PLUMBING RANGE ,f OF BDRMS _ OFFICE USE - WATER HEATER: r OF UNITS: FLOOD PLAIN: ZONING CODE SECONDARY HEAT: SQUARE FOOTAGE: OCCY GROUP: r OF STORIES: CONSTR. TYPE: HEAT SOURCE: rfl j. tl [-_l Underslab Plumbing/Electrical/ - Mechanlcal - Prlor to cover. [-l Footlng - After trenches are|J excavated. l-l Masonry - Steel locatlon, bond|J beams, groutlng. n Foundatlon - After forms are - erected but prlor to concrete placement. ffi Underground Plumblng - Priors to fllllng trench. l--l Underlloor Plumblng I Mechantcal Prlor to lnsulatlon or decklng. l---l Post and Beam - Prior to floorU lnsulatlon or decklng. l-_l Floor lnsulalion - Prior tolJ decklng. ll Sanltary Sewer - Prlor to fllllng - trench. n Storm Sewer - Prior to fllllng - trench. tl E tl E E tl QUAD AREA: r OF BLDGS: LAND USE: tl tl Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot T1 - ln terior - Corner - Panhandle - Cul-de-sac Setbacks PL.HSE GAR ACC N S E IS THE PROPOSED WORK TN THE - HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, thls applicatlon must be slgned and approved by the Historlcal Coordinator prlor to permit issuance. APPROVED: VALUE (A) X $/SQ. FT. Total Value Building Permit Fee State Surcharge Total Fec BUILDING PERMIT ITEM SQ, FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condiilon 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 sald ordinances. Fleceipt Number:_ Plans Reviewed By Date Plan Check Fee: Date Paid Received By: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Fix tu res Residential Bath(s) Sanitary Sewer Water Storm Sewer FEE @./2r4''h 2d(c) Mobile ome FT. N0 FT. PLUMBING PERMIT 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 slgnature, I state and agree, that I have carefully examlned the completed application and do hereby cerilfy that all lnformatlon hereon is true and correct, and I f urther cerilfy that any and all work performed shall be done in accordance with the Ordinances of the City of Sprlngfield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCy wlil be made of any structure without permission of the Building Safety Divislon. I further certlfy that only contractors and employees who are ln compliance with ORS 701.0S5 wlll be used on thls project. I further agree to ensure that all required inspections are requested at the proper tlme, that each address ls readable lrom the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain on the site at all tlmes during construcilon. Slgnature Date MISCELLANEOUS PERMITS Mobile.Home State lssuance State Surcharge Sidewalk =- ft Curbcut --_- ft 5@ (E)Total Miscellaneous permi ts Demolition State Surcharge TOTAL AMOUNT DUE (excluding electricaD Z1r3:(A, B, C, Q and E Combined) VALIDATION RECEIPT NUMBER AMOUNT RECEIVED ( RECEIVED BY FT. DArE PA|D ?-/r-a_<- iVry SPFrIN(;F-tELO The following proiect ae aubmlued has the lollovring il^i"g, ;"d?Les not requiro specilic land use $ 40.00 2. CONTRACTOR INSTATTATION ONLY B. Services or Feeders Installation, Alterations or Relocation:Electrical Contracto Address 200 amps or less -'--' 201 amps to 400 amps -401 amps to 600 amps _ 601 amps to 1000 amps_ Over 1000 amps/vo1ts Reconnect only ci Phone Supervisor License Number s40 Exoiration Date Constr Contr. Number Temporary Services or Feeders Installation, Alteration or Relocation approval.L"'Df"225 FTrru STREET SPRINGFIELD, OREGON 9 INSPECTION REQIIEST: OFPICE: 726-3759 1. LOCATION OF INSTe I,EGAI DESCRIPTION JOB rm I s d non-s era ble and expire if vork is not started vithin 180 days of issuance or if work is suspended for 180 days. Exoiration Date Signature of Supervising Electrician Ovners Name Address The installation is being made on property I ovn vhich is not intended for sale, lease or rent. 0vners Signature: DATE: BLECTRICAL PERI{IT APPLICATION ob Nunber SCEEDIILE BELOV A. Nev Residential-Single or Multi-Family per dwelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home. or Modular Dvelling Sertice or Feeder s 8s.00 s 1s.00 200 amps''or fess 201 amps to 400 amps -0ver 40L to 600 amps Over 600 amps or 1000-GFs One Circuit Eaeh Additional Circuit or vith Service. or Feeder Permi t / Sum 00 00 ee ilBr a6ovE- $ 3s.00 s 2.oo aa = - 4 s300 00 00 00 00 00 00 S so. S 60. $100. s130. $ $ $ S 00 00 00 00 40 40 20 36 $ s $ s C 0040. 55. 80. D. Branch Circuits Nev, Alteration or Extension Per Panel ury%*?f6i*/7 OVNER INSTAL-LATTiON- E. Miscel-laneous (Service/feeder not included) -Each installation Pump or irrigation Sign/Out1ine Lighting- Limited Energy/Res Limi ted Energy/Comm SUBTOTAL OF ABOVE 52 State Surcharge 32 Administrative Fee TOTAL C,ITY OF OREGON RECEIVED 5 4 ,/: a?-7C-/?, 7 * Permit #: Address: Issued by:Date: Statem€nt: 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 andZ, and either box 3,{ or 38: B l. 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. OR w 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 noti$/ the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and dounderstand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. *-tt-?S of permit applicant) (White copy to issuing agency permit file, pink copy to applicant) ((Date) ?-aizr Inforrnation Notice to Property Owners About Gonstruction Responsibilities .i : - - lVrerr: This lnJitnnatio4 Nolice to.(roperty Owners about Constructian Responsibilities. ..-\ *'as'devektped h1, the Cort.rtructitin A)firactors Board in a<:cordance with ORS 701.055(5). l\ I1'you arc acting as your" own contraotor to construct a ne w home or make a substantial improvement to an existing structure, you can prev.ent mary problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registe4ed with the Construction Contractors Board to do labor in constructing or assisting in the construction or ilnprovBment of a residential structure, you will, in most instances, be rufed to be an employer and the people you hire will be ernployees. As the employer, you must comply witli the following: Oregon's withholding'tax law: As an employer, you must withhold income taxes frorn employee wages at the time employees are paid. You will be liable for the tax payments even if you dont dctually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-80ql 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 Resoutees at378-3524. Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and nust obJain workers'compensation insurance for your employees. If you fail to obtain workers' compensation insur-ance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more informationj call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.Sr Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wa$es. You will be liable forthe tix paynient even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AHEAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code that may be brought to your attention through inspections. requireme.nts Liability and pnoperty 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 damage 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 Expertise : Make sure you have the expertise to act as your own general contractor, to coordinate the work ofrough-in and frnish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (POBox 14140, Salem, OR 97309-5052, 5A31378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 t/94 225 FITTE STRBEf, SPRINGFIBLD ,oRBGoN 97477 i, ;,:,:"'.:,r. INSPBGIION RBQT EST? 726-3769 0FPICE: 726-3159 lcal contractor L.R. BRABHAI4, INC. s68 l,I. "Q" ST., ctt SP FLD Phone 747-6638 Supervlsor Llcense Ndmber .I4735 ExP lration Date 10/1/95 Constr Contr. Number 08699 Expi ration Date I 2/18/95 st't.tt{GFtGLD nie f oilcr.ring projec{ zci-,lng, Bncl doos nol ?il,}?,;T ::, ir!"rlugomonrcer PERHIT APPLICATION LDL ,.1 . COHPLSTE TBE SCEEDULE BBLOII '' $b'*tf: irq {ilttot*t**":o *'*"" I,EGAL DESCRIPTIONJ2e3:7<*/>- /2. zae, n JOB DESCRIPTION ^ t -/ f P0 U ts€ ,).aak oEW rb6 O4,lfttfizE Pernits are non-transferable and explrelf vork ls not started vlthln 180 daysof lssuance or lf vork ls suspended for 180 days. 2. COtrTRACf,OR INSTALI,ATION ONLY I-Slngle or HuItl-Famtly per dvelllng unlt. Service fncluded:Items Cost 1000 sq.ft. or less Each addltlonal 500 SQ. ft or portlon thereof Each Manuf'd Home or . Hodular Dvelllng Servlce or Feeder $ 85.00 $ 40.00 B. Services or Feeders Installation, Alterations or Relocat lon: 200 amps or less -l -201 amps to 400 amps -401 amps to 600 amps _ 601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0n1y C. Temporary Services or Feeders Installatlon, Alteratlon or Relocatlon Sum w^:::"'" $ $ $1 $l $3 $ 50,ID50.00 60.00 00.00 30.00 00.00 40.00 40.00 55.00 80.00 e trBtr Slgnature of Supervislng Electrlclan Owners Lwytto-,a kouln eaarcss 3!10 {J , tqfu ct Phone 'l+b'rqB OIINER INSTALT,ATION The lnstallatlon ls belng made onproperty f ovn vhtch ls not intendedfor sale, Iease or rent. Ovners Slgnature: DATE: RECETPT D. Branch Circuits Nev, Alteratlon or Extenslon Per Panel One Ci.rcuit $ 35.00 Each Additional Circuit or vith Servlce or Feeder Permit $ 2.00 B. Hiscellaneous (Servlce/feeder not included) 200 amps or less $ 201 amps to 400 amps _ $ Over 401 to 600 amps .- S 0ver 600 amps or 1000 volts se -Each installation Pump or irrigation $ Sign/OutIine Lighting- $ Limited Energy/Res - $ Limited Energy/Comm $ above 40.00 40.00 20.00 36.00 5. ST,BTOTAT OP ABOVE 5Z State Surcharge ro?*r 57o fo rtt" 50,00 a RECEIVED J,5o Ctty Job n ^b". ?7%{ $ 1s.00