HomeMy WebLinkAboutPermit Building 1992-12-23RESIDENT'AL
PERMIT APPLICATION
lnspections: 226-3169
Office: 726.3159
LOCATION OF PROPOSED WORK:
PrlING FIELE)
o
JOB NUMBER
€G7
v
7A
ASSESSORS MAP;/7^e
LOT TAX LOT:v1
BLOCI(:
PHONE:
ZIP:
-?-
STATE:
OWNER:
ADDRESS:
CITY:
DEMOLISH OTHERADDITIONNEW-.-- REMODEL
DESCRIBE WORK:
NAME DD
EXPIRES PHONEI,f.
CONTRACTO
MECHANICAL:
ELECTRICAL:
CONST.
COI\,I.RACToR #
GENERAL:
PLUMBING
_ OFFICE USE -
QUAD LAND USE:FLOOD PLAIN* OF BLDGS:A OF UNITS:ZONING CODE:
OCCY GROUP:
C OF STORIES:I
CONSTR. TYPE:
HEAT SOURCE:
# OF BDRMS: .__=--
WATER HEATER FIANGE:
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an inspection, you
made the same working day,
must call 726-3769' This is a 24 hour recording. All inspections requested before 7:00 a.m. will beinspections requested after 7;00 a.rn. wiil be made the f.ilowing work day.
REQUIRED INSPECTIONS
Temporary Electric Rough Mechanicat - prior to
cover.Final Plumbing - When altplumbing work is complete.
Sile lnspection - To be made
after excavation, but prior to
setting forms.
Rough Electrical - prior to Final Eleclrical - When allelectrical work is complete.cover.
Electrical Service - Must be
approved to obtain permanerlt
electrical power.
Final Mechanical - When allmechanical work is complete.
.N Footing - After trenches are
excavated.Fireplace - Prior to facing
materials and framlng lnsp.
Vf Pinat Buitding - When ail{ \required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.
fftto-'ng - Prior to cover.K Foundation - After torms are
erected but prior to concrete
placement.
Other
Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.Drywall - Prirtr to taping
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
MOBILE HOME INSPECTIONS
Woocl Stove - After installation
Post and Beam - Prior to floor
insulation or decking.lnserl - After fireplace approval
and installation of unit.
Blocking and Set.Up - When all
blocking is complete.
Floor lnsulation - Prior to
decking.Curbcut & Approach - After
forms are erected but prior toplacement of concrete.
Plumbing Conneclions - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plunrbing
inspections have been approved
and the home is connected to
the service panel.
Slorm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Waler LIne - Prior to filllng
trench.[-l Fence - When conrpleted
Slreet Trees - When all required
trees are planted.
Final - After all required
inspections are approved andporches, skirting, decks, and
venting have been installed.
Rough Plumbing - Prior to
cover.
225 Fifth Street
Sprlngfietd, Oregon g7 4ll
-rG
7/<-z
[-l Underslab Plumbing/ Electrical/
-
Mechanical - Prior to cover. I I
5+O
tl
E
tl
EE
/--rJrry'
Lot laces
Lot sq. ttg.
Lot coverage
TopograPhY
Total height
Lot Typrv.
-
lnterior
--
Corner
-
Panhandle
-
Cul'de-sac
PL.HSE GAR ACC
N
S
E
IS 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'
APPROVE.D
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express conditiorr that the said
consiruction shall, in all respects, cortform to the Ordinance
,Ooptu.i by the City of Springfield, including the
Developtnent 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'
Fleviewed
)
DateP
Plan Check Fee
Date Paid
Receipt Number:
Received
BUILDING PERMIT
VALUE
n{f,/?
,tr,
(A)
2
SO. FT. X $/SQ. FT.
9s
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)+B
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
No
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
<
ADDITIONAL COMMEN
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood By signature, I state and agree, that I have carefully 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 701.055 will be used on this
project.
I further agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from the street, that the permit card is located at the front
of the property, and the approved set of plans will remain
Date d-
K*^
on the site at all times duri ng construc on.
_CI?-*ture
-"Az; - ?;z
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding etectricat)
(A, B, C, D, and E Combined)
-
AMOUNT RECEIVED
RECEIVED BY
DATE PAID
VALIDATION:
RECEIPT NUMBEFI
3C2=-
/<-5-€2-
Thc i:ttcwino prolecl
zc.n,nE, a(nd coes nct
apptoval.
as submhted has the
i'equlre specific land
SPFlIl{GFIELO
BLECTRICAI PERHIT APPLTCATION
City Job Nunber
225 FTTfx STREET
SPRTNGFIEID, oREGoN 97477
INSPECTION REQIIEST
OFFICE: 726-3759
z 72683769 rc,)t I )-])--?:
Aulhorizod 3. COHPLETB FEE SCMDULE BELOU
A. Nev Residential-Single or
HuIti-FaniIy per dwelllng unit.
Serviee Included:
qz STALIATION--
lct t-h) \
OF INn
LEGAL DESCRIPTIONr 1)3 3i^t 2-, l].,o I
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Hodular Dvelling
Serv.ice or Feeder
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or Iess \201 amps to 400 amPs
-
401 amps to 600 amPs
-
601 amps to 1000 amPs-
0ver 1000 amPs/volts
-
Reconnect OnIY
200 amps or less
201 amps to 400 amPs
-
0ver 401 to 600 amPs
Over 600 amps or 1000
One Circui t
Each Addi tional
Circui t or r+i th Service
or Feeder Permi t 1
STNTOTAL OF ABOVE
5Z State Surcharge
TOTAL
Items Cost Sum
s 8s.00
s 1s.00Permits are non-transferable and expire
if vork is not started vithin 180 days
of i".r"nce or if vork is suspended for
180 days.
2. CONTRACTOR INSTALI,ATION ONLY
DESCRIPTI
E1e rical Contractor
Address
Ci ty
1 Are"i,6
s 40.00
B
-^o\U o
Phone
s s0.00
$ 60.00
$100.00
s130.00
$300.00
s 40.00Supervisor Licen.s umber
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name
l/.JAddress
Ci ty ne,+l-?/s3
TemporarY Services or Feeders
Insiallation, Alteration or RelocationC
$
s
$
40.00
D
,-76ITs se
Branch Circui ts
Nev, Alteration or Extension Per Panel
5s.00
80.00
e rrBrr a5ove
$ 3s.00
s 2.oo uy
not inclr.rded)
40.00
40.00
20. oo
a
OSNER INSTALI.ATION
The installation is being made on
piop"tty I own vhich is not intended
tor sa1e, ]ease or ren('
()rners Signature:
E Miscellaneous (Service/feeder
-Each installation
Pump or irrigation $
iigilzortline Lighting- tt,lilitea Energy/Res
-
S
CITY OF OBEGO'U
RECEIVBD
io
5
00
1.
n-1 q
Permit No:q I t;l .l
Address:
lssued b
3
Date: 'D)>, lr, n
f-l^)
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITI ES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permitapplicants who are not registered with fhe Construction Contractors Board tosign the following statement before the building permit can be issued. This state-ment is required for residential b!ilding, elecirical, mechanical, and plumbingpermits. Licensed Architect and Engineer applicants, exempt from registratioiunder ORS 701.010(7), need not submit this statement. Thib statement will befiled with the permit.
Fill in the applicable blanks, and initial boxes 1 and z, and either box 3A or 38:
'1
2
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.
My general contractor is ,
Contractor registration number-.
3 A
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. t21 I I will be my own general contractor.
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 certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
q'r
Date
WHITE COPY TO ISSU]NG AGENCY PERMIT FILE
PINK COPY TO APPLICANT
l olat \
ure o rm cant
CONSTRUCTION CONTRACTORS BOARD
0244J Bt91
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
' ,, -I lf you dre dcting as your own contractor"to cbiritruct a new home or make a substantial
existing structure, -you can prevqnt mqny problems by'being aware of the following respon
of-concern.
Unem
'"' ':'" ' "'
U '
nt lnsurance Tax: As an em
purposes on the wages of all employees
to an
and areas
lf you hire persons not registered with the Construction ContraCtors.BOard to do labor in constructing or assisting
in the constructio" ;; #fi;a*Jni:ot a iesioentiat structy[e, v9u yvill, !1 moqt in$ance,s, be ruled to be an
,,emptoyer" a,;rd. ine peoBie you hire will be ''emp!oye€g-, As tlre brnplqyqr, you must cbmply with the following:
Oregon's Withholding Tax Layv: As an employer, you must withhold income taxes, tr91 e^mnffyee wages at
uwillbeliableforthetaxpaym9ntsevenif,youdon'tactuallywithholdthe
tax from your employees. For more information, call the Oregon Department of Revenue.at 378-3390'
ptbyer, you are required to pay a tax for unemployment insurance
For rnore information, call the Oregon Employmenl Division DHR
at 378-3224
Workers' Compensation lnsurance: As an employer, you are subiect to thd Oregon Workers' Compensation
pensationinsuranceforyouremployees.lfyoufailtoobtainworkerS,
compensation insurance, you may be subject to penalties and will'be liable for all claim costs if one of your
employees is injured on the job. For more information, call the Wof91s' Cgmpensation Division DIF at 373-7434-
U.S. lnterqatEp_vqLue Service: As an erlrplpyer, you must withhold federal, incglne tax from employees' wages.
menteVenifyoudidn,tactuallywitnnoHtheitax.Formoreinformation,call
the lnternal Revenue ServiCe"at'-221-396b."'
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code CorRplidnce: As the,permit, holder for this projeot, you are responsible for rosolving any failure to meet
co$lEqilil€trrenta.that may be broughl le,four attestion thhough'inspeotions.
i, l:. ,.,.-,i;r I ''-i iii r 'li , '.: , ,' .ii(r - t :\ it 'i, Jl 'lf .. :' .:;i.-
Liabiliiy And Prdperty.Daniage lnsuihnce:, OOntact yugr,insurdrlOe.ag'ent to see if you have adequate insurance
chasfallingtoolS,paintoverspray,waterdamagefrompipepunc-
tures, fire, or work that must be re-done.
hi,E,.,i*i.:ll., , .ii .]r;,.;i?ii.';r'':: - : ;riffi"l:li '.::;i : , i, I :''-'-i'i.tr''i
Time td Supervise Employees: Make sure you have sufficient time to supervise your employees.
i;p'!':t 1l
Expertise: 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 al the appropriate times so they can perform
the required inspections. . i'
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
NOTE: This lnforrlation Notice to Property Owners
was developed by the Gonstruction Contractors Board
passed by the 1989 Oregon Legislature.
About Construction Responsibilities
in accordance with ORS 701:055(5_)'
o244J 10t24t89
f ?&t(f*
/7/, I ?&
/t*,7;:** //,/??e
I&***--l,l /2<-
;'Z-fu ilnfl
,//;
@-?-r/-*t<*
ej.j
<L*, Ctt-,<Jaaadav
,?L a
-ZZz-r--/--
@r, . 7zl zz
€7a3-zr( - ?/€d
oY-
11'q
b