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Home My WebLink AboutPermit Plumbing 1993-02-09SPFlT^lGFIELE) HESIDENTIAL PERMIT APPLICATION lnspections: 726'3769 Ofiice: 726-3759 qr, JOB NUMBER 225 Fifth Street Springfie,d, Oregon 97 477 537 t), 1 44 /z LOCATION OF PROPOSED WORK: ASSESSOFIS MAP: 4o-e2-TAX LOT: BLOCK: SUBDIVISION: PHONE: ZIP:STATE: ( /D< CITY: ADDRESS OWNER NEW /nEMODEL ADDITIoN DEMOLISH oTHER DESCRIBE WORK: MECHANICAL: --=__=-- PHONEEXPIRESADDRESS Or)rt)R. CONTRACTOR'S NAME CONST. CONTRACTOR # CENERAL: PLUMBING r OF BDRMS: _ OFFICE USE _ ZONING CODE: FLOOD PLAIN WATER HEATER SECONDARY HEAT SQUARE FOOTAGE: OUAD AREA: " OF BLDGS: CONSTR. TYPE: HEAT SOURCE: LAND USE: # OF UNITS OCCY GROUP: * OF STORIES: To request an inspection, you must call 726-3 made the same working day, inspections req TemporarY Electric Site lnspection - To be made a{ter excavation, but Prior to setting forms. Underslab Plumbing / Electrical / Mechanical - Prior to cover' Footing - After trenches are excavated. Masonry - Steel location, bond beams, grouting. Foundation - After forms are erected but Prior to concrete placement. Underground Plumbing - Prior to f illing trench. Underlloor Plumbing / Mechanical - Prior to insulation or decking' Posl and Beam - Prior to floor insulation or decking' Floor lnsulation - Prior to decki ng. 769.This isa24hourrecording.All inspectionsrequestedbefore7:00am'will be uested after 7:00 a.m. will be made the following work day' REOUIRED INSPECTIONS Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is comPlete. Rough Electrical - Prior to cover. Electrical Service - Must be approved to obtain Permanent electrical Power. Fireplace - Prior to facing materials and framing lnsP' Framing - Prior to cover, Wall/Ceiling lnsulalion - Prior to COVCT f-l Drywall - Prior to taoing Wood Stove - After installation lnsert - After f irePlace aPProval and installation of unit. Curbcut & APProach - After forms are erected but Prior to placement of concrete. Sidewalk & DrivewaY - After excavation is conrPlcte, forms and sub-base material in Place' Street Trees - When all required trees are planted. Final Electrical - When all electrical work is comPlete. Final Mechanical - When all mechanical work is comPlete. fl Final Building - When all required insPections have been approved and building is completed. Other MOBILE HOME INSPECTIONS Blocking and Set'UP - When all blocking is comPlete. Plumbing Connections - When home has been connected to water and sewer. &'Sanitary Sewer - Prior to f illing trench. Slorm Sewer - Prior to filling trench. Waler Line - Prior to filling I Fence - When completed trench. Electrical Connection - When blocking, set-uP, and Plumbing inspections have been aPProved and the home is connected to the service Panel. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed.Bough Plumbing - Prior to cover. 7r^ , E E E tl r E r tl r E Lot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot Type -- - lnterior -- Corner - Panhandle - Cul-de-sac Setbacks PL.HSE GAR ACC N J E J 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' APPHOVED: VALUE (A) X $/SO. FT. Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, inctuding the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions oI said ordinances. Receipt 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 Fixtu res Residential Bath(s) Sanltary Sewer Water Storm Sewer Mobile Home FEE N0 n.1 lfo ry-1 )50 t<54 ,/ <. oo(_?J, FT. (c) 4o,* -4ar 3., PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fi replace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information hereon is true and correct, and I f urther certif y that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield, and the Laws of lhe 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 f urther 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 and the approved set of plans will remain 2 -Q, r*!.1Date of the prope on the site ctionimes durin X,onr.u 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)4&zs VALI DATION: RECEIPT NUMBER DATE PAID Zy'52 2 -7 -75 Z'AMOUNT RECEIVED RECEIVED BY -GE?-S /- r ft flfri) CITY OF OFEGO'U 1.OP if ts are non-transferable and expi re of is not started vithin 1g0 days 180 days. ce or if vork is suspende d for 2. COIITBACTOR TNSTALI.ATION ONIY ectrical Contractor Addr Ci ty Supervisor L Expiration Date Constr Contr.be Expirati te Signa of Supervising lClirn 0vners Nane Address cit Phone ON The installation is being made on property I ovn vhich is not intended for sa1e, lease or rent. Onners DATE: COT{PIJTB "FEB SCEEDTIIJ BELOI' Nev Residential-Single orHuIti-FamiIy per dv-Iling unit.Service fncluded: ftems Cost 1000 sq.ft. or less Each additional 500sq. ft or portion thereof Each Hanufrd Home or - Hodular Dvelling Service or Feeder 200 amps or less 201 amps to 400 amps -Over 401 to 600 amps -0ver 600 anps or 1000-ToT[s SPR,. -.FIELG, EIACTRICAL PERITT APPLTCATION City Job Nunber q s 8s.00 s 1s.00 225 PTFIE SIREET : SPRTNGPTEIJ, OREGON 97477 INSPECTTON REOIBSTz tZ6_3169oPPICB: 726-3159 l^DE _>_13\r 3. A. Sum s 40.00 B Services or FeedersInstallation, Alterationsor Relocation: 200 amps or less ,201 amps to 400 amps -401 amps to 500 amps -601 amps to 1000 amps-over 1000 amps/volts -Reconnect 0n1y C. Temporary Services or PeedersInstallation, Alteration or Relocation --Jf\r .I \\4100.00 .00 .00 .00 .00 .00 $so $60 s100 s130 s300 $40 s 40.00 s ss.00 $ 80.00 see I'Brt affi D. Branch Circuits Nev, Alteration or Extension Per Panel One Circuit Each Additional Circuit or vith Service or Feeder Permi t / s 3s.00 $ 2.00 nd) O{;- E. Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/OutIine Lighting- Limited Energy/Res Limited Energy/Comm s s $ $ 00 00 00 40 40 20 3 ST,BTOTAL OP ABOVB 5Z State Surcharge TOTAL Phone e Num RBCEIVED 5 6.00 DD SPR!,\lGFIELc, ITESIDENTIAL PERMIT APPLICATION lnspections:726-3769 Off ice: 726-3759 LOCATION OF PRO ASSESSORS MAP: LOT: JOB NUMBER h,225 Fifth Street Springfield, Oregon 97 477 TAX LOT: SUBDIVISIONBLOCK: PHONE: ZIP:STATECITY: OWNER: ADDRES NEW -.-- REMODEL ADDITION DESCRIBE WORK MECHANICAL: ------ PHONEXPIRESADDRESS ELECTRICAL CONTRACTOB'S NAME CONST, CONTRACTOR ' G EN ERAL: PLUMBING # OF BDHMS: QUAD AFIEA: * OF UNITS:ZONING CODE: WATER HEATER: * OFFICE USE - LAND USE: - RANGE: SECONDARY HEAT: SQUAFIE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: OCCY GROUP: r OF STORIES: To request an inspection, you must call 726-376g. This is a 24 nour recording. All inspections requested before 7:00 a.m. wlll be made the same working day, inspections requested after 7:00 a.m. will be made the following work day' REOUIRED INSPECTIONS [-_l remporarY Electric Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is comPlete. Site lnspection - To be made after excavation, but Prior to setting forms. Rough Electrical - Prior to Final Electrical - When all electrical work is comPlete.cover Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Permanent electrical power. Final Mechanical - When all mechanical work is comPlete. Footing - After trenches are excavated.Fireplace - Prior to facing materials ;rnd f raming lnsP. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover, Foundation - After forms are erected but Prior to concrete placement. Wall/Ceiling lnsulalion - Prior to cover. Underground Plumbing - Prior to f illing trench.[-_l orywall - Prior to taoi ng. MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.[-_l Wood Slove - After installation Posl and Beam - Prior to floor insulation or decki ng.lnsert - 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 to placement of concrete. Plumbing Conneclions - When home has been connected to water and sewer. SanitarY Sewer - Prior to f illing t re nch.Electrical Connection - When blocking, set-uP, and Plumbing inspections have been aPProved and the home is connected to the service Panel. Storm Sewer - Prior to filling trench. Siclewalk & DrivewaY - After excavation is comPlete, forms and sub-base material in Place. Water Line - Prior to filling trench. Fence - When comPleted Slreet Trees - When all required trees are Planted. Final - After all required inspections are aPproved and porches, skirting, decks, and venting have been installed.Rough Plumbing - Prior to cover. FLOOD PLAIN: r r tl E E E tl [-l other tl tl D tl T E E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Setbacks P.L.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. APPBOVED: VALUE (A) X $/SO. FT. Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted 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 Fleviewed By Date Fleceipt Nurnbe Plan Check Fee Date Paid Reccive(l By SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Fixtu res Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge N0 ADDITIONAL COMMENTS Wood Stove/ lnsert/Fireplace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By signature, I state ancJ agree, that I have caref ully 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 Springf ield, 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 f urther 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 z-l-'-)3 of the property, and the approve set of plans will remain es durin s ure on the site at ruction. ) MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolltion State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) d/s:VED) RECEIPT NUMB R VALIDATION DATE PAID AMOUNT BEC RECEIVED BY Date b# t 1 2 Permit No: Address: lssued Date: OR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4) , requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. This state- ment 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 38: 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. A My general contractor is , Contractor registration number-. 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 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 th rm. Z- l-? j Signature rmit A ant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8191 3 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INFORdATION NOTTCE TO pROpERTy OWNEHS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Notiee to Property Owners About Construction Responsibilities was dsreloped qy the Co4struction Contractors Board in accordance with ORS 7QlO55(S), passed by.the 1989 Oregon Legislature. lf you'are acting as your own Contractor to construct a new home or make a substantial improVement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an "employer" and the people you hire will be "employees". As the employer, you must comply with the following: 's Withholdi Tax Law: As an em ployer, you must withhold income taxes from employee wages at the time e are You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurancepuipose@mployees'Formoreinformation,ca|ltheoregonEmploymentpivisionDHR a|378-3224. v-gi[grs'lg[p$qation lnsurance: As an employer, you are subfect to the Oregon Workers)Compensation t-aw, anCrnust oOtain wort<ers' compensation insurance for your employees. lt you fail to obtain workers' 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 Workers' Compensation Division DIF at g7g-7474. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.Yymenteuenifyoudidn,tactuallywithholdthetax.Formoreinformation,caIl the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: ,ode Compliance As the permit holder for this project, you are responsible for resolving any failure to meet ode requirements that may be brought to your attention through inspections. Liability anQ Property Damage lnsurance: 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 punc- tures, 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 of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. lf you have additional questions, write to Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10t24t89 v-7 i-/lno Prole Qtu 225 FIFTB STRBEf, SPRINGFIELD oREGON 97477 INSPBCTI0N RBQUBST. 726-3769 BLECTRICAL PERHIT APPLICATION OFFTCE: 726-3759 1 LOCATION OT INST43q AJ, I =r, IJGAL DESCRIPTION JOB DESCN.IPTION SM*6ri Permits are non-transferable and expire if vork is not stalted vithin 180 days of issuance or if vlrk ls suspended for 180 days 2. CONTRAETOR INSTALLATION ONLY Electrical Contractor Address city- Phone Supervi'sor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Blectrician Owners Nanie L_! \R, as:-.jj citY Jo .( ( 3. coHPt n'rP rgg b Nunber SCTTEDULE BBLOIT A. New Residential-Sing1e or HuIti-Family per dvelling unit. Service Included: I tems Cos t Sum 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular Dvelling Service or Feeder s 8s.00 $ 1s.00 $ 40.00 Services or Feeders Installation, Alterations or Relocat ion: 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _ 601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0nIy c Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ 40.00 Over 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see rrBrr above D. Branch Circuits Nev, Alteration or Extension Per Panel one Ci rcui t L- S 35. OO 3LNEaclr Additional Circui t or vi th Service or Feeder Permit S 2.00 E. Hiscellaneous (Service/feeder not included) -Each installation Ptrmp or irrigation Sign/Outline Ligh t ing- Limi ted Energy/Res Limi ted Energy/Comm SIIBTOTAL OP ABOVE 5Z State Surcharge TOTAL BAoT t= B $ s0.00 $ 60.00 $100.00 s130.00 $300.00 $ 40.00 Address 539 A/ , /&sr cirv <Pfrt , tK. Phone 74?541e OSNER INSTALI,ATION The installatlon is being made on property I ovn vhich is not intended for sale, Iease or rent. ture: DATE: - ' *l\aZ RECEIPT *: -t.<f r $ $ $ S 00 00 00 00 40. 40. 20. 36. ot)r'Q-RECEIVED BY:bo^ M 5 <50 0 7/,7s Ovners ELE) RESIDENTIAL PERMIT APPLICATION lnspections: 726'3769 Office: 726-3759 JOB NUMBEFI 225 Fifth Street Springfield, Oregon 97 477 TAX LOI SUBDIVISION efr, 3? AJ tE S+ LOCATION OF PRO ASSESSORS MAP: PO E LOT: - BLOCK 1q1 tstLibL6Ri AN7 PHONE:Fn-n ro 17q27ZIP:STATE:6F_ rq 5r CITY: ADDRESS OWNER: >eptN6trtEi-'D 37 |\,ew X REMODEL ADDITION DEMOLISH OTHER SToeAcr€ (Hsi, DESCRIBE WOFIK PLUMBING: MECHANICAL: -- EXPIRES PHONEADDFIESS OrJ NtR n4rl -1WlnCONTRACTOR'S NAME CENERAL: ELECTRICAL CONST. CONTRACTOR ,' iltl_ OFFICE USE _ RANGE: # OF BDRMS WATER HEATER A OF UNITS: LAND USE: ZONING CODE: FLOOD PLAIN s OF BLDGS: - OUAD A CONSTR. TYPE: HEAT SOURCE:SECONDARY HEAT SQUARE FOOTAGE: OCCY GROUP: g OF STORIES: To request an inspection, you must call 726-3769. This is a 24 hour recording. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REOUIRED INSPECTIONS l-__l Temporary Electric ll Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is complete. Site lnspection - To be made after excavation, but Prior to setting forms. X.:;#: Erectricar - Pr;or to X.5i:;i,,?;i*:?,;#ffi[il: Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Permanent electrical power. Final Mechanical - When all mechanical work is complete. Footing - After trenches are Final Building - When all required inspections have been approved and building is completed. ed Fireplace - Prior to facing materials and f raming lnsP. Masonry - Steel location, bond beams, grouting. {tt"t'ng - Prior to cover' Other Foundation - After forms are erected but Prior to concrete placement.Wall/Ceiling lnsulalion - Prior to cover. Underground Plumbing - Prior to filling trench. MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation Posl and Beam - Prior to floor insulation or decking.lnsert - After fireplace aPProval and installation of unit. Blocking and Set-Up - When all blocking is complete. Floor lnsulation - Prior to' decki ng.Curbcut & Approach - After forms are erected but Prior to placement ol concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Conneclion - When blocking, set-up, and plumbing inspections have been apProved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & DrivewaY - After excavation is comPlete, {orms and sub-base material in Place. Water Line - Prior to filling trench. Fence - When comPleted Street Trees - When all required trees are planted. Final - After all required inspections are aPProved and porches, skirting, decks, and venting have been installed. n Rough Plunrbing - Prior to cover. I r E E E r r E E E E fl Drywall - Prior to taoing. r tl fl fl Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type X tnte.ior - Corner - Panhandle - Cul-de-sac Setbacks P.L.HSE GAR ACC N S E T rS THE PROPOSED WOFIK lN 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. APPROVED: BUILDING PERMIT ITEM SQ. FT. X S/SQ. FT, }m- IAtr- [rcD VALUE 43(A) Total Value Building Permit Fee State Surcharge Total Fee ss€et.?i Main Garage Caroort.e[!l.-iUM* BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted 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. /-2/ -?3 PI Reviewe By Date By: c95 CePlan Check Fee Date Paid Receipt Number: Rece SYSTEMS DEVELOPMENT CHARGE (SD ctpa Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE No FT. FT. (c) PLUMBING PERMIT ITEM Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/Fireplace Unit Dryer Vent (D) N0Vent 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 certif y 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 proiect. I f urther agree to ensure that all required inspections are requested at the proper time, that each address is readable f rom the street, that the permit card is located at the front and the approved set of plans will remain :/_k of the on the site I times du nstruction Xnn",ur" Date l-zz-1 MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft €eanolition bWA? Total Miscellaneous Permits (E) Surch 3g-? TOTAL AMOUNT DUE (excluding electrica\ /es-?O- (A, B, C, D, and E Combined) 72r2( t/DATE PAID RECEIVED BY - - AMOUNT RECEIVED VALIDATION: RECEIPT NUMBER (B) FT. dEEs 1-22 -23 Permit No ?zao G3 Address:ru lssued Date: R OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSTB!LtTtES Note: Oregon Law, ORS 701.055(4) ,. requires residential construction permitapplicants who are. not registered witn the Construction Contractors Board tosign the following statement before the building permit can be issued. This state-ment.is required for residential.hrrild.ing, elec[rical, meciiJnicai-ano ptumOin!permits. Licensed Architect and Enginell3Onlicants, exempt from registratioiunder ORS 701.010(7), need not suOhit tnid itatement. This statement wi[ befiled with the permit. Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38: 1. [ET I own, reside in, or wirr reside in the compreted structure. 2 -E? I understand that I must register as a construction contractor if the structure is sold' ot offered for sale before or upon completion. 3.A My general contractor is.-----.--- Contractor registration numbe I will instru.ct my general contractor that all subcontractors who work on the struc-ture must be registered with the construction contractors Board. OR /h* 3. B.F<l 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 Construltion Contractors 6oard and I will immediately notify the office issuing this building permit of the name ofthe contractor. ! hereby certify that the above information is correct and that I have read and understa ndthe lnformation Notice to Property owners about construction Responsibilities on the reverse side this form. l-zz"?3 gnat Perm cant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 J WHITE MPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INFORTvTATION NOTICE TO PROPERTY OvttNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE; -. Thig ln{ormation Notice to Property Owners ,,.rrVds developed Uy tfre Construction Contractors Board ':-$bssed by lhe 1989 Qie.gon Legislature. About Construction Responsibilities in accordance with ORS 701.055(5), ,\\\ )w home or make a substantial imprOement to ant "'.lf\ou are acting as your own bohtractor to construct a new nome ol maIe..a existing structure, you can prevent many problems by being aware of the following responsibilitbs and areas of concern EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or iriprovement of a residential structure, you will, in most instances, be'ruled to be an ,,employer,, and the p"opi" you hire will be "employees". As the employer, you must complywith the following: o n's Withholdi Tax Law: As an emPloYer, You must withhold income taxes from employee wages at the t rme em ployees are paid. You will be liable for th e tax payments even if You don't actually withhold the tax from your emPloYees. For mo re information, call the Oregon Department of Revenue at 378-3390. Unempl oyment lnsurance Tax: As an emPloYe r, you are required to pay a tax for unemployment i nsurance purposes on the wages oi aii emptoyees. For more information, call the Oregon Employrnentpivision DHR at 378-3224. vorkers, Compensation lnsurqnce: As an employer, you are subject to the Oregon workeid Compensation Law, and must obtain workers' compensation iniurance {or your employees. lf you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for'all claim costs if one'of your "rpioy"", is injured on thejob. For more information, callthe Workers' Compensation Division DIF at 573-74u. U.S. lnternal Revenue Service: As u will be ab r the tax Paym the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: -ode rance As the permit holder for this project, you are responsible for resolving any failure to meet that may be brought to your attention through inspections."ode requirements an employer, you must withhold federal income tax from employees'wages' ent even it you didn't actually withhold the tax. For more information, call !e9!ily-e!gItope$.@Contact.yourinsuranceagenttoseei{youhaveadequateinsurance coveragefor accroilnfi and omGsions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Superv ise 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 oilougE-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. lf you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-3784621 0244J 1At24189 225 F II. T I-I SIFFF I SPRINGFIELD, OH 9/4 / / (s03) 726-3753 DEVELOPMENTSERY'CES ADMINISTRATION PI,ANNING / BUILDING PUBLICWORKS M ET ROPOLITAN WASTEWAT ER M ANAGEM ENT DATE OF LETTER l4arch 31, 1989 DATE OF MEETING March 28, 1989 APPLICANT Albert and Dorothy Ziebert 2854 Vil1a l,lay Spri ngfi e1 o, 0regon 97478 SUBJECT City Journal Number 89partition of property 17-03-36.?4 Tax Lot, 00400 ference to oiscuss a proposed a ingfielo, 0regon. Assessor's ut Ma ATTENDANCE Applicant: Albert and Dorot.hy Ziebert; City staff: Greg Mott an<l Cindie Harmon. ACTION No formai acti on was taken, thi s meeti ng was hei 0 to provi oe'information prior to submitting a formal application for a Partition. DISCUSSION the applicant with The items oiscussed may not incluoe all issues which may be reviewed as part of the actual appl i cati on. 1. Assessor's Map 17.03.36-24 Tax Lot 00400 (ano 00502). There is an existing residence resioence locateo in the northeast corner of this property. ?. The property is zoned and has a Metro Pian Designation of Low Density Resioential. 3. The property is located on a north/south street. The Springfielo Development Code _ requires a minimum of 65 feet of frontage on north/south streets. A minimum of 20 feet is requireo for the panhandle. l^Ie oiscussed the Yariance process with the Assistant City Attorney. It was oetermined that two separate Variances coulo be applieo for (one for the minimum 65 foot frontage standard, and one for the minimum 20 foot panhanole wioth standard). -03 o pNorth 18th Street, S539 P re-App1 i ca 0 p I have enclosed two Variance applications. You need to provide answers to the Criteria for both Variance applications as part of your application. 4. 10 feet of right-of-way dedication woulo be required along North 18th Street. 5. A easement will neeo to be granted across the back property for the existing sewer. PROCEDURE 't Submit Parti ti on $200. application. The application is enc'losed. The application fee is 2, Submit two separate Mjnor Variance applications (one for the minimum lot frontage, one for the minimum panhanole wiot,h). The application fee is $75.00 per application. 3. Because you attendeo a Pre-Application Conference you are entitled to receive a 20% oiscount, when you submit your three applications. The total fee for submittal of all three applications will be $280. QUESTIONS Please call Development Cooe Aoministrator Greg Mott at 726"3759 if you have any questions regaroi ng thi s process. PREPARED BY \q",,ihn ddhrrrLa\ Cynthia L. Harmon Deve'l opment Permi t Coordinat,or Copy to: DRC Members