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Home My WebLink AboutPermit Building 1995-05-12RESIDENTIAL PERMIT APPLICATION lnspections: 726.3769 Office: 726-gti9 SPFl 2fr, JOB NUMBER 225 Fif th Street Springfleld, Oreg 97 477 LOCATION OF PROPOSED WOBK:4Jo /y. /B4 o* OWNER; PHONE: CITY: ZIP: ADDBESS: ,4 of/# STATE:r)R 3D /V" ADDITION DEMOLISH OTHER NEW_-_ BEMODEL DESCRIBE WORK: ADDRESS EXPIRES PHONE CONTRACTOB'S NAtVItr GENERAL: PLUMBING: MECHANICAL: ELECTBICAL: CONST. CONTRACTOR # il lt1,flHJi r,t - OFFICE USE - * OF UNITS: LAND USE: CONSTR. TYPE: _-- QUAD AREA: , OF BLDGS FLOOO PLAIN: zoNrNG "Orr.**Lw- SECONDARY HEATI SOUARE FOOTAGE: OCCY GBOUP: * OF STORIES:HEAT SOURCE: -_ ,' OF BDRMS: --- WATER HEATER:_- ASSESSORS MAP: LOT BLOCK: TAX LO'I: To reguest an lnspecilon, you must call 726-3769. Thl made the sanre worklng day, lnspectlons requested [-l femporary Etectrlc Footlng - After trenches are excavated. Masonry - Steel locatlon, bond beams, groutlng. s ls a 24 hour recordrng, Ail rnspectlons requested before 7:00 a.m, wiil beafter 7:00 a.m. wlll be made the followlng work day, REQUIBED INSPECTIONS ilEl$ffi'liJ"*J'r?i.fli" ,Xin:: Erectrrcar - prror to settlng forms. [-| UnOerstab ptumbtng/ Etectrical/H Mechanlcal - prior to cover.Electrlcal Servlce - Must beapproved to obtaln permanent olectrlcal power. Rough Mechanlcal - prlor to cover, Wood Stovo - After lnstallatlon. Curbcul & Approach - After forms are erected but prior toplacemont of concrete. Sldewalk & Drlvewav - After excavation ls complete, forms and sub.base materlal ln place. Fence - When completed. Street Trees - When all requlred trees are planted. [p[ rtnat ptumbing - When ailr-lplumblng work ls complete. ffiflnat Electrical - When all,.-\r electrical worl( is complete. r_l Final Mechanical - When allmechanical work ls complete. Foundallon - After forms are erected but prlor to concrete placement. Flreplace - Prlor to faclng materlals and framlng lnsp. (ttu'n'ng - Prlor to cover. f! WatltCelllng tnsulatlon - prlor toJ4cover. ( otr*u'l - Prior to taplng. ffiftnat Buildlng - When ail ,f\ requlred inspecUons have beer,approved and building iscompleted, [-l Underground Plumbing - prior.J to fllllng trench. Underlloor Plumblng/ Mechanlcal - Prlor to. lnsulatlon or decklng. Post bnd Beam - Prlor to floor lnsulatlon or decklhg. Floor lnsulation 4 Prlor to decklng, [-_l lnsert - After flreplace approval - and lnstallatlon of unlt. [--l elocking and Ser.Up - When ail|J blocking ls compleie. MOBlLE HOME INSPECTIONS P.lumblng Connectlons - When home has been connected to water and Sewer. Electrlcal Connection - Whenblocking, set.up, and plumblng lnspections have been approvedand the home is connected tothe servlce panel, Final - After all required inspections are approved andporches, skirtlng, decks, and ventlng have been lnstalled. l-l Sanltary Sewer - Prtor ro fiiling - trench. l--l Storm Sewer - prlor to fiillng.J trench. Water Llne - Prlor to filling trench, K3;*tl Plumblns - Prior to ..%eSaa- el eop tl fl tf l---l orhor tl n Lot faces Lot sg. ftg. Lot coverage Topography Total helght Lot I lnterior Corner Panhandle Cul-de-sac IS THE PBOPOSED WORK IN THE .,HISTORICAL DISTFIICT, OR ON THE HISTORICAL REGISTER? - lf yes, thls appllcailon must be signedand approved by the Historlcal Coordinator prlor to permit issuance. APPROVED: I State Surcharse 2-,95? /r7O BUILDING PERMIT ITEM SQ. FT. Garage VALUE 6/ o1_Total Fee (A) 53 5o X $/SQ. FT. Carport Total Value Building Permit Fee e€n 5{m^ BUILDING VALUE, PLAN CHECKAND BUILDING PERMIT Thls permit ls granted on the expreos conditlon that the saidconstruction shall, ln all respects, conform to the Ordinanceadopted by the City of Springfleld, including theDevelopment Code, regulating the constructlon ancl use ofbuildings, and may be suspended or revoked dt any timeupon vlolation of any provisions of sald oldlnances. sy'' VateRevi Receipt Numbe 7) Flecei Date Pald Plan Check Fee: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undevelopedproperties wlthln tl.le City limits which are being lmproved. ITEM Flxtures Resldential Bath(s) Sanitary Sewer Water Slorm Sewer Mobllo Home PLUMBING PERMIT ) No FT. FT. 6.4 FEE Plumblng Permlt State Surcharge Total Charge /Ffu 1, ZO, ?f f,4s (c) ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fl replace Unlt Dryer Vent MECHANICAL PERMIT (D) N0 Mechanical Permit lssuance State Surcharge Total Permit Furnace Exhaust Hood Vent Fan I further agree to ensure that all required lnspections arer€quested at the proper ilme, that each address rs readabrefrom the stre6t, that the permrt card rs rocated at the frontof the property, and the approved set of plans wlll remaln By slgnature, r state and agree, that r have carefuily examrnedthe completed appllcailon and do hereby cerilfy that alllnformatlon hereon ls true and correct, an; I f urther cerflfythat any and all work performed shall be done ln accordancewlth the Ordinances of the Clty of Springfield, and the Lawsof the stato of oregon pertarnrng to the worl< descrrbedheroin, and that NO OCCUPANCy wlll be made of anystructure wlthout permlssion of the Bulldirrg Safety Divlslon.I further certify that only contractors and employees whoare ln compllance wlth OHS 701.055 wiil be used on thls Prolect. on the slte at du constructlon. Date natureX; MtscELLANEOUS PERMTTS Mobile Home State lssuance Stato Surcharge Sidewalk _-- ft Curbcut -_ ft Demolltlon State Surcharge Total Miscellaneous permlts (E) TOIAL AMOUNT DUE (exctuding etecrrica,, -3?-?3(A, B, C, Q and E Combined) P.L.HSE GAR ACC N s E VALIDATION: RECEIPT NUMBEF - DATE PAID AMOUNT RECEIVED RECEIVED BY i73r.0 .- ' .: i;< FT, CITY OF OBEGO'V 225 FIFTE STREEf, SPRTNGPIBT.D, OnEGoN 97477 INSPECTION REQUESI: 726-3769 0PFICB: 726-3759 1. LOCATION lDi"< JOB DBSCRIPTION() LL.^*f^stYL.oo permits are non-trallsferable and expire if vork is not started vithin 180 days of lssuance or lf vork ls suspended for 180 days. 2. COIITRACTOR INSTALI^ATION ONLY Electrlcal Contractor Address 4ztf Fo, lo //o *I c1 Ynone O I 9?los'5 Supervisor License Number 3 s7g s Explration Date t0 -t -g{ Constr Contr. Number ?4 753 Expi ration Date I -et-?4 Slgna Supervlsing EIec 3 0wners Nane Address ci Phone OSNER ALI,ATION ; SPR!NGFIELO BIJCTRICAL PERHIT APPLICATION City Job Nunber 3. COHPI..ETB FEE SCEEDT'I,B BELOV A. Nev Resldential-Single or HuIti-FamiIy per dvelling unit. Service Included: I tems Cos t $ 8s.001000 sq.ft. or less Each additional 500 sq. ft or portlon thereof Each Hanuf'd Home or Hodular Dvelling Service or Feeder s 1s.00 Services or Feeders Installation, Alterations c-or Relocation: l) Sum $ 40.00 B 200 amps or less -- 201 amps to 400 amPs - 1uz 4OL amps to 600 amps 601 amps to 1000 amPs- Over 1000 amps/volts - Reconnect 0nIY C. TemporarY Services or Feede Installation, Alteration or 200 amps or less 201 amps to 400 amPs - Over 401 to 600 amPs 0ver 600 amPs or 1000ETfs D. Branch Circuits s s0.00 s 60.00 $100.00 s130.00 $300.00 $ 40.00 rs ReIoca t ion s 40.00 $ ss.o0 $ 80.00 see (Brt $ 40.00 $ 40.00 s 20.00 $ 36.00 a566 I The installatioh is being made on prop"tty I ovn which is not intended ior sa1e, lease or rent' Ovners Signature: Nev, Alteration or Extension Per Panel one circuir I $ 3s.oo g5- nr"n-eaai tional :l';:::":":il1,t""t"? g 2.oo Jts Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation - Sign/0utIine Light ing- Limited EnergY/Res - Limited EnergY/Comm SaeD E. SUBTOTAL OP ABOVE 5Z State Surcharge TOTALDATE: RBCEIVBD 5 5-1 Permit #: Address: Issued by:Date: a ;o5 Statement: 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 abuilding permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from 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 r and,z, and either box 34 or 38: w 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. 3A,. 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. 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 notiff 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 thelnformation Owners about Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) (White copy to issuing agency pennit ftle, pink copy to applicant) OR Notice to (Date) N- 38' I will be my own general contractor' Information Notice to Prbperty Owners AbCIut Constructiorl Responsibil itie*,:--.' !t'ofe; X&is lnfttt'gtutiutt Noficg ti Property {}w*ilers abaut Construr,tion ltesponsibilities ' * ryc.r.rl*ryerl$$s{f &v t&r'{lr;r.r'fxt-l:tion Crtntrrscr$r.s ^Sr?,?r.C in <scc*rtlartte vvitlt ORS 7CI1.{}55(5).' . If y*u are aeting ix$ yi.)ur lrwri *$rr{tilclor tc c*ils{rilcl e1 *c!v }:un":* *r murke a substantial inrprovement to an existing structure, you cilt.l prcveRt mimy prcblems by being aware of the f,oliowing responsibilitias and tueas of eoncem- EM PLOYER RESPON$IBILITIES: If y*u hire persons *ot reglsterecl with th* Construciion Cantractors Board to do labcr in construeting or assisting in the conslruc{iprr *r in:prove ment of a resicJential structure , 3 cru will. in ruost instances, be rtrled to tle an employer and the people you hire will i:e employe*s. Ag thr: employer, you inusl cornply with the following: Oregon's withholding tax law: As an ernployer, you must withholcl income tlxes from employee wages at the time employees are paid. You will tre liable f'crr thc tax payments even if you don't actually withhold the tax from your employees. For more information, cail the f)regor Dept. of Revenue at 945-8091 . Unemployrnent insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more informatiur, callthe Oregon Employment Division at the Department of tlumn'Bcmirr*s at378-3524 . , Workers'eompensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, andfiiilst ob.ain *grkplf'compensation insurance for your ernployees. If you fail to obtain.workers' c.ompqnsation insurance, yourqp besubjecttopi:naltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformati&r call the Workers' Compensation Division at the Department of Consumer and Business Services at945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You wlll be liable for the tax payment even if you didn't actually wittrhold the tax. For more information, call the Internal Revenue Service at I-800-829-1040. OTHEN RESPONSIBILITIES AND AREAS OF CONCERN: requirements Liability and property damage insurance: Contact y*ur insurance agent to see if you have adequate insurance coverage for accidents and omissions such as talling tonls, paint overspray, water damage trorn pipe punctures, fire, or work that must be re-done. fime to supervise emplnyees: Make sure you have sufficient time to supervise your employees. Expertisc: Make sure ynu have th* exprrtise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at {he appropriate times so they can perform the required inspections. If you have additional questions, write or cali the Construction Contractors Boar<I (POBox l4l[A,Salem, OR 92309-5052, 503/378-4621). The Board is locared at TCIO summer sr. NH suite 3tJ0, in salem" prop-own.pm4 1t94 Code compliance; As the permit holder for this project, you are responsible for resolving axy failure to meet code that may be brought to your attention through inspections. :