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Home My WebLink AboutPermit Mechanical 1998-12-17nesroennAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 SP}lII\'GFIELD JOB NUMBER ?Etro 225 Fifth Street Springfleld, Oregon 97477 LOCATION OF PROPOSED WORK:I,1C N. .3 tlt L ASSESSORS MAP;I zJo 3 LOT TAX LOT:oz-(a t BLOCK:SUBDIVISION: PHONE: STATE ztP s+t C o.+a+5,5-V t -t8R11Hqcuc t-? D ialK, .Srr-ski r i Q7478-ss^t ADDRESS: CITY: NEW- REMODEL ADDITION DEMOLISH OTHER ROtt yz.6/rfSfa77 €.+r /tttt€DESCHIBE WORK: u n ru ADDRESS oAR 952-001- law res to on EXPIRES ,, PHONE in OAR 952-001-0010 CONTRACTOR'S NAME ATTENTIOI{ rules MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # GENERAL: PLUMBING """I8f;8dfiiffi ri rr r s ilillArsr*' ,YPE: ' o t#8fl{ Ffi terr'nrs-ngffi!fl ffi { ri D F0 R H EAr s o U R c E ; 1-800-mo[il4[AtN:l_s I SECONDARY HEAT: SQUARE FOOTAGE: LAND USE: ZONING CODE: # OF BDRMS: _ _ oFFtcE ffiFfg the center. (Note: the telephone numberfor the Oregon Utility Notification WATER HEATER: BANGE: THE wdn?{ UNrrS: To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:00 a.m. will be made the same worklng day, lnspections requested af ter 7:00 a.m. wlll be macJe the followlng work day. REQUIRED INSPECTIONS Temporary Elsctrlc Rough Mechanical - Prior to cover. Flnal Plumbing - When allplumblng work ls complete. n Site tnspectlon - To lre made|J after excavatlon, but prlor to settlng forms. Rough Electrical - Prior to Flnal Electrlcal - When all electrical work is complete.cover, Electrical Service - Must be approved to obtaln permanent electrlcal power. Final Mechanlcal - When all mechanical work ls complete. Flreplace - Prlor to facing materlals and framing lnsp. Flnal Building - When ail required lnspectlons have been approved and building is completed.Masonry - Steal locatlon, bond beams, groutlng. l-l Framlng - Prior to cover, E Foundatlon - Alter forms are erected but prlor to concrete placement. her Wall/Celling lnsulatlon - Prlor to cover. Underground Plumblng - Prlor to fllllng trench.Drywall - Prlor to taping. MOBILE HOME INSPECTIONSUnderlloor Plumblngl Mechanlcal - Prlor to lnsulatlon or decklng.Wood Stovo - After lnstallation E Post and Beam - Prlor to floor lnsulatlon or decklng.lnsert - After flreplace approval and lnstallatlon of unlt. Blocking and Set.Up - When all blocklng is complete. tl Floor lnsulation - Prior to decking.Curbcut & Alrproach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to fllling trench.Electrical Connection - When blocking, set-up, and plumbing lnspections have been approved and the home ls connected to the servlce panel. Storm Sewer - Prlor to fl.lling trench. Sidewall< & Driveway - After excavation is complete, forms and sub-base material in place. Water Llne - Prlor to filling trench. Fence - When coinpleted. $lreel Trees - When all requlred trees are planted. l-_] Final - After alt required 'J lnspectlons are approved andporches, sklrtlng, decks, and ventlng have been lnstalled.E Rough Plumbing - Prlor to cover. OWNER: n Underslab Plumbingt Electrical /lJ Mechanlcal - Prior to cover. I I l-| Footing - After trenches are|J excavated.E E fl E e-f,r- I a i:i Lot faces Lot sg. ftg. Lot coverage Topography Total height Setbac , IS THE PROPOSED WORK TN THE .. HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be slgned arrd approved by the Historical Coordinator prlor to permit issuance. APPROVED: PL.HSE GAR ACC N S E ': .h BUILDING PERMIT ' i ITEM SQ. FT. X $/SQ. FT.VALUE (A) Total Value Building Permit Fee State Surcharge Total Fee Main Garage Carport BUTLDING \IALUE, FINU 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 Reviewed By Date Fleceipt Numbe 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 Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home FEE (c) Nt PLUMBING PERMIT Plumbing Permlt State Surcharge Total Charge . FT. ADDITIONAL COMMENTS Wood Stove/ lnsert/ Flreplace Unlt Srdu€ /A*t &ru*c /C, ou /o, oo Z/. tt(D) t/lt - N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit Dryer Vent G*s MECHANICAL PERM!T Furnace Exhaust Hood By slgnature, I state and agree, that I have carefully examlned the completed application and do hereby certlfy that all lnformation 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 Sprlngfield, 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 perrnission of the Bulldirrg Safety Division. I further certify that only contractors and employees who are in compliance with ORS 7O1.O55 wlll be used on thls proiect. 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 ls located at the front of the property, and the approved set of pians will remaln Slgnatu Date on the site at I times during construction. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Mlscellaneous Pennits (E) TOTAL AMO.UNT DUE (excluding electrical) (A, B, C, D, and E Comblned) 0iz 9qb LAMOUNT RECEIVED RECEIVED BY DATE PAI[) VAI-IDATION: RECEIPT NUMBER Lot Type - lnterior -_ Corner .- Panhandle l' - Cul-de-sac Plan Check Fee: - FL FT. /tz/, qqa/) t >/ril? r Permit #, d* /EE-) Address "70 / 3/Jl Issued by:Date: / Statement: lnformation 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 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 the blanks and initial boxes I andZ, and either box 3A or 38 +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 /(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 notify the office issuing this building permit ofthe name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. taltt /qa (Signature of permit applicant) (lVhite copy to issuing agency permit file, pink copy to apPlicant) I ---r-6M- t/,),,/ Information Notice to Property Oryvners About Construction Respon*ibitities Note: l'his Infrsrmation Natice to Property Ov,ners about Constructiort Responsibilitics was devektlted by the Constrttction Contructors Hoard in accoxlurtce with ORS V0l.{}55{5). If you ue acting a^s your own contactor to consffuct a new home or make a subsmndal improvement to an existing slructure. you can prevent many protrlenrs by being aware of the following responsibilifies and areas ol concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the construction contractors Bonrd to do Iabor in conslructing or assisting in the construction or improvement of a residential strueture, you will, in most instances, tre ruted to be an employer and the people you hire will be employees. As the employer, you must comply with the following: gregonrs withholding tax law: As an employer, you must withhold income taxes from employee wages at the tirae empk:yees are paid. you will be liable for the tax payments even if you doil't actually wirhhold the tax fxrm your employces. For more infomration, call the Oregon Depr. of Revenue et 945-8091' Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurauce purpo$es on the *ages of all employees. For more information, call the Oregon Employment Department at 378-3524 i Workeros campensatign insurance: As an employer, you are subject to the Oregon Workers' Cantpensation Law, anr! mustr obtain workers;compensation insurance for your employees. If you fail to obtain workers' conrpensation insurzutce, you rnay be sgbject to pnalties and will be liable for ail claim Costs if one cf your employees is injured r:n the job. For more infirrmatioa calt the Workers' Compensation Division at the Department of Ccnsumer and B*siness Servic*s at 945-78{t8. U.S,Internal Revenue Service: As an employer, you must withhold t'ederal income tix from ernployees' wages.You will be liable for the tax paymenr even if you didn'i actually withhold the rx. For nore information, calt the ltternal Revenue Service ar 1-800-829-lMO. OTHEH RESPONSIBILITIES AND AHEAS CIF CONCIEHN: Code compliance: As the permit holder for this project, you are responsible tbr resclving any failure to meet code requirerrenLs Liability and pnoperty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage fbr accidenis and orniisions such as falling tools, paint overspray, wat€r damage from pip punctures, fire. or work that must be re-done. Time to supenise employees: Make sure you have sufficient tirne to supervise our employees. Expertise: Make sure you have the expertise to act an yqr own general contracto[ to coordinae the work of rough-in and fini*t tracies, *nd to norify buildirrg o{ficials at the appropriate times so they can perform the required inspections' If you have adctirional questions, write or call the Construction Contractors Board PO Box 14140, Salem. OR 97309-5052, 5}3fi'18-&21). The Boiird is located at 700 Summer St. NE Suite 300, in Salem prop-own.pm4 l/94 sP-c0.1