HomeMy WebLinkAboutPermit Building 1994-10-07IELDR
P
ESIDENTIAL
ERMIT APPLICATION
lnspectlons: 726-3769
Office: 726.3759
JOB NUMBER 4qt +0D
225 Flfth Street
Sprlngfleld, Oregon 97477
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:TAX LOT ovo OC)
SUBDIVISION:
-PHONE:
STATE:ZIP:
d-
I
a f)-2-CITY:
ADDRESS:
OWNER:
NEW
-
REMODEL ADDITION "/
{+-DESCRIBE WORK:
DEMOLISH OTHER
ADDRESS EXPIRES PHONE
7qFL
ELECTRICAL:
CONTRACTOR'S NAME
GENERAL:
MECHANICAL:
PLUMBING:
CONST.
CONTRACTOR #
\
WATER HEATER
- OFFICE
LAND USE:
* OF BDRMS:
* OF UNITS:
RANGE:
SECONDARY HEAT:
SOUARE FOOTAGE:
OCCY GROUP:
r OF STORIES:
QUAD AREA:
, OF BLDGS
FLOOD PLAIN:
ZONING CODE
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspections requested before 7:00 a.m. wlll bemade the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
REOUIRED INSPECTIONS
X
tr'
X
tr
K
E
X
Temporary Electrlc
Slle lnspectlon - To be made
after excavatlon, but prior to
settlng lorms.
Underslab Plumblng / Electrlcal /
Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Prior
to fllllng trench.
Sanltary Sewer - Prlor to fllling
trench.
Storm Sewer - Prlor to filllng
trench.
Waler Llne - Prlor to filling
trench.
Rough Mechanlcal - Prlor to
cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power,
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Framlng - Prlor to cover.
WalllCelllng Insulatlon - Prlor to
cover.
Drywall - Prlor to taping.
Wood Stove - After lnstallatlon.
lnsert - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Drlveway - After
excavatlon is complete, forms
and sub-base materlal ln place.
Fence - When completed.
Streel Trees - When all requlred
trees are planted.
ffi finat plumbing - When ail'--\plumblng work ls complete.
E Final Electrical - \Arfren all
electrlcal work is complete.'
Flnal Mechanical - When ail
mechanical work ls complete.
f)/[ rlnat Buildtng - When alt
flrequlred lnspectlons have been
approved and building is
completed.
lVf u nae * t o@u mBTn? M ec h an Ic a t
Prlor toTT$Ifetfon or decktng.
lV[ Post and Beam - Prior to floor
)A tn"rt"tlon or decklng.
&*'-l;gsulatlon - Prror to
MOBILE HOME INSPE TIONS
Blocklng and Set.Up - Whe6 ail
blocklng ls complete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
Electrical Connection - When
blocklng, set-up, and plurgbing
lnspections have been approved
and the home is connected to
the service panel.
Final - After all required
inspectlons are approved and
porches, skirting, decks, and
ventlng have been lnstalled.
p[ Rough Ptumbing - Prior to
,,J4,cover.
\
sRN\r'\
Rough Electrical - Prlor to
cover.
[--l otherll
tl
E tltl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total tlelght
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
rS THE PROPOSED WORK IN THE.
HISTORICAL DISTRICT, OR ON
THE HISTOBICAL REGISTER?
-
lf yes, this application must be slgned
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
PL.HSE GAR ACC
N
S
E
^14
Total Value
Building Permit Fee
State Surcharge
Total Fee
VALUE
3h r*"r,,cs'
(A)
4l'-" '
9z !o
X $/SQ. FT.
/47.a7 {z :o
lv!ain
Carport
)Da
Galage
93oa
37 0a
' 49>q ?o.
fr,?'
BUILDING PERMIT
ITEM SQ, FT.
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
bulldings, and may be suspended or revoked at any tlme
upon violation of any provisions of said ordinances.
z-q
Reviewed By zra{v
Plan Check Fee
Date Paid
Receipt Number
Received
t4[,17
/)'M*
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)lcE Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures,
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
N0
j/t *ontat,2,€o--*s2-<zl oo#
3
FT.
FT.
FT.
(c)
sD ?-
PLUMBING PERMIT
Plumblng Permit
State_ Surcharge
Total Charge
ADDITIONAL COMMENTS
3h' E@ ,otXarr
P/t7H -/
Wood Stove/ lnsert/ Fl replace Unit
Dryer Vent
2N,
10 9a
?20 wattu' --$[-
Total Miscellaneous Permits
\o
(E)
Vent Fan
(D)
Mechanical Permit
lssuahce
State:surcharge
Total Permit
MECHANICAL PERMIT
Fu rn ace
Exhaust Hood
Nol
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certify that all
lnformatlon hereon is true and correct, and I f urther cerilfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprtngfield, and the Laws
of the State of Oregon pertaining to the work descrlbed
herein, and that NO OCCUPANCY wlll be made of any
structure without permission of the Building Safety Divislon.
I further certlfy that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
proiect.
I further agree to ensure that all required inspections are
er time, that each address is readable
that the permit card ls located at the front
du rin
req uested at the.
on
from tho st
of the set of plans wlll remain
structlon
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, Q and E Comblned)/3e,////
DATE PAID
AMOUNT RECEIVED
FIECEIVED BY
VALIDATION:
RECEIPT NUMBER
4 .!,r i
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolition
State Surchargo
I
\-
OBEGO'UOF
.) jrr.t,/jl;
225 FIFTII STRXET Z.:'r'r
1 LOCATION OF
zo'ring, and does not require specific land usa
SPRINGFTELED
ELECTRTCAL PERHIT APPLICATION
City Job Nunber
COHPLETE FEE SCMDUT^E BELOV
Nev Residential-Single or
MuIti-Family per dvelling unit.
Service fncluded:
I tems Cos t
1000 sq.ft. or less
Each addi.tional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
-Modular Dvelling
Service or Feeder
s 8s.00
s 15.00
$ 40.00
Services or Feeders
Install-ation, Alterationsor Relocation:
L-DL
SPRINGFIELD, OREGON 97!77 i1 -z4..t4INSPECTI0N REQUESTz 726=3769r-9-\ - ! t
OFFICE: 726-3759 tJ irrt
3
A
I^EGAL
JOB DESCRIPTION
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if.vork is suspented for
180 days.
2... CONTRACTOR INSTALhTTON OI.{LY
Electrical Contractor
Address
ci ty- Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician.(
Owners Name
Address 2731 N. )AL [F,
city V&Phone 724 - 9/6/
OVNER INSTALLATION
The installation is being made on
property I or^,n vhich is not intended
for sale, lease or rent.
Signature:
DATE:
200 amps or less
201 amps to 400 amps
-40L amps to 600 amps
-601 amps to 1000 amps-
0ver 1000 amps/volts
-Reconnect Only
Sum
B
s 50.00
s 60.00
s100.00
s130. 00
s300.00
s 40.00
C Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or less S 40.00
201 amps to 400 amps
-
g 55.00 7-
over 40L to 600 amps
-
$ 80.00
0ver 600 amps or 1000 voTEs see uB" aE6E
D. Branch Circuits
E
SUBTOTAL OF ABOVE
52 State Surcharge
32 Adnrinistrative Fee
TOTAL
Nev, Alteration or Extension Per Panel
One Circuit L-/- S 35.00 #-*Each Additional
Circuit or vith Serviceor Feeder Permi t Z S 2.00 _4"
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $Sign/Outline Lighting- S
Limi ted Energy/Res
-
S
Limi ted Energy/Comm $
?,FfTO-r-
00
00
00
00
40.
40.
20.
36.
RECEIVED
5
/7
Permit #:
Address:273e A/ -ZrT-
Issued by:Date:
Statem€ht: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Inw, 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 ftled with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38:
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.
t/q;
f,B
OR
X 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 notiff the office issuing this huilding permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have readand dounderstand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.rLL /2-2?-7'
1ftil"ut"re of permit applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
(Date)
.-\;
Infoimation Notice to Property Ownersi About Cons.truction Hesponsibilities
.. :
_. n). t{ol.e :. '{ltis lnfbrnttttion No,iiceto Property- Awners sbot$ (-onstruc:tion Responsibilftiei 1': -
11'rr.!' rlbvaloped hy the Cbnstructibn Cemtrtrt:tors Bourd in at:t'ordanr:t vt,ith ORS 7A | .055(5).
If you are acting as yolrr {-}wn contractor to construct a nt:w home or lnakc a substantial inrproverncnt to an oxisting structure.
you can prevent m;ury problems by being aware of the followlng responsibilities and areas of concern.
. EMPLOYER RESPONSIBIUTTES:
If you hire persops not registefed with the Constructiqrl Contractors Board to dq labor in constructing or assisting in tlre
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 ery.ployees. $s thg.employer, you must comply with &e following: . :
Oregon's withhb-Iding tax law: As an employer, you mttst withhold income taxes from employee wages at the time employees
are paid. You #ill be liable for the tifi payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091
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 &e Oregon Employment Division at the Department of Human Resouroes
at378'3524 . ..
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and-mu5r
obtain workers'compensation insurance for your employees. If you fail to obtain workers' compensation insuranqe, you.Eqy
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformedfu
call tlre Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at l-80G-829-1040.
OTHER HESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirementg
that may be brought to your attention through inspections. )r..
Liabilif and prop€rty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspr&y, water damage from pipe punctures, fire, or work that must be
re-done.
fime 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
trades, and to notify building officials at the appropriate times so they can perfcrm the required inspections.
finish
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
propown.pm4
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