HomeMy WebLinkAboutPermit Building 1995-05-091146
RESIDENTIAL
PEBMIT APPLICATION
lnspections: t26-3169
Office: 726.9t59
LOCATION OF PROPOSED WORK:Z
JOB NUMBER
225 Fifth Street
Springfleld, Oregon 97 427
TAX LOI:
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ESSORS MAP:
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PHONE:
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CITY:
ADDRESS:
OWNER:
OTHER,o,, X DEM9LT'H
DESCRIBE WORK:
NEW_- BEMODEL AD
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CONTRACTOR'S NAME
MECHANICAL:
ELEfiRICAL:
EXPIRES PHONE
PLUMBING:
GENERAL:
CONST.
CONTRACTOR #DDRESS
4$7 A/,
hr.)
D<\)R{Da-
t
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- OFFICE USE -
WATER HEATER:
r OF STORIES:
LAND USE:
OCCY GROUP:
* OF UNITS:
FLOOD PLAIN:
ZONING CODE
SECONDABY HEAT:
SQUARE FOOTAGE:
, OF BDRMS: ..--
RANGE:
OUAD AREA:
* OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspecflon, you must call 726-3769.
made the same worklng day, lnspections reques
, Thls ls a 24 hour recordrng. Ail rnspections requested before 7:00 a.m. wilr beted after 7:00 a.m. wlll be made the followlng work day.
REQUIRED TNSPECTIONS
[--l Temporary Etectric Rough Mechanlcal - prior to
cover.Final Plumbing - When allplumblng worl< ls complete.
Slte lnspectlon - To be madc
after excavatlon, but prior to
setting forms.
]s7 nough Elecrrical - prtor to,/acover.f)4J Flnal Etecrrtcat - When ail,trlectrical work is complete.
Underslab Plumblng/ Electrical /
Mechanlcal - Prlor to cover.Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flnal Mechanical - When ail
mechanical work is complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framing lnsp.
[4J Final Buildins - When ail/arequired inspections have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.pl'Framlng - Prlor to cover.
,t
l(Twalllceltlno lnsulatlon - Prlor toJAcover.
X 'tr*ull - Prlor to taplng'
Foundatlon - After forms are Other
but prlor to concrete
placement.
Underground Plumblng - Prior
to fllllng trench.
MOBILE HOME INSPE TIONS
Underlloor Plumblng/ Mechanlcal
- Prior to lnsulatlon or decking.Wood Stove - After lnstallatlon.
Post and Beam - Prlor to floor
lnsulatlon or decklng.lnserl - After flreplace aPProval
and lnstallatlon of unlt.
Blocking and Set-Up - When all
blocking ls complete.
Floor lnsulallon + Prior to
decklng.Curbcut & Approach - After
forms are erected btlt Prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
waler and sewer.
Sanltary Sewer - Prlor to fllllng
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspections have bccn approvcd
and the home is connccted to
the service panel.
Storm Sewer - Prior to filling
trench,
Sidewalk & Drlveway - After
excavation ls completc, forms
and sub-base material ln place.
Water Llne - Prlor to filling
trench.
Fence - When completed
Rough Plumblng - Prior to
cover.
Slreet Trees - When all required
trees are planted.
Final - After all required
inspectlons are approved and
porches, skirting, decks, and
venting have been lnstalled.
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P.L.HSE GAR ACC
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ks IS THE PROPOSED WOBK TN THE '
HISTOFIICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be slgneC
unO aPProved bY the Historlcal
Coordinator prior to permit issuance'
n that the said
the Ordinance
adopted bY the CitY of SPringfield' in cluding the
Development Code, regulating the construction and use of
buildings, and maY be susPen ded or revoked at any time
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express conditior
consiruction shall, in all respects, conform to
Lot {aces
Lot sq. ftg.
Lot coverage
TopograPhY
Total helght
'"i' -
-- lnterior
g -
Corner
-- Panhandle
-
Cul-de'sac
upon violation of
Plan Check Fee:
Date Paid:
Receipt Number:
Received
any p rovtslon s of said ordinances.4s
ByPI
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
N0
FT.
FT.
Plumbing Permit
State Surcharge
Tolal Charge
FEE
FT.
(c)
BUILDING PERMIT
VALUE
fi4!"
2-7
)a#a
b
(A)
zs r fo{
SQ. FT.
3z-%
ITEM
Main
Garage
Carport
Total Value
Euilding Permit Fee
State Surcharge
Total Fee
X $/SQ. FT.
Systems Development Charge is due on all undeveloped
properties within tlre City limits which are being improved'SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) AZB
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
NoVent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure wlthout permission of the Buildlng Safety Divislon.
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on thls
proiect.
I further agree to ensure that all required inspections are
requested at the proper time, that each address ls readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
Date
mes duri constructlon
,;f,,"
on the site at
MISCELLANEOUS PERMITS
Mobile.Home
State lssuance
State Surcharge
Sidewalk _ ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous permils (E)
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, Q and E Combined)
7 z3
VALIDATION
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
5/ os{e
Z6
€ttv oFsPR,,VG OREGO'V
1. LOCATION-2-C,.)'lf OF NSTALI-A,TIONl) - jz,9).\a
225 FTY.IE STREET
SPRINGFIEI,D, OREGON 97 477
INSPECTI0N REQUESTz 726-3769
OFPICE: 726-3759
sPfll' :IELO
EI;ECTRICAL PERHIT APPLICATION
City Job Number 1'50 1,r3
3. COHPI,ETE FEE SCMDULE BELOII
A- Nev Residential-Single or
MuIti-Family per dvelling unit.
Service Incl-uded:Items Cost
L000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Manuf'd Home or
-Modular Dvelling
Service or Feeder
$ 8s.00
$ 1s.00
$ 40.00
B.Services or Feeders
Installation, Alterationsor ReLocation:
200 amps or less
20i. amps to 400 amps
-
401 amps to 600 amps
-
601 amps to L000 amps-0ver 1000 amps/volts
-
Reconneet 0n1y
C
D.
I.,EGAL DESCKTPTION
Permits are non-transferabl"e and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. CO}ITRACTOR INSTALLATTON ONLY
Electrical Contraetor
Address
city- Ph
Supervisor License r
Expiration Dat
Cons tr . Number
Exp tion Date
Signature of Supervising Electrician
0vners Name
Address
Ci ty Phone Z/Z-q/A,
Temporary Services or Feedersfnstallation, Alteration or Relocation
200 amps"or less $ 40.00201 amps to 400 amps
-
S 55.000ver 401 to 600 amps
-
S g0.00
Over 600 amps or 1000-voIts see "[, .95;;-
Branch Circui ts . ..
Nev, Alteration or Extension per panel
One Circuit
Each Additional _l/ s 35.00 @
Circui t or vi th Serviceor Feeder permi, _/_ $ Z.OO _4
Miscellaneous (Service/feeder not included)-Each installation
Pump or irrigation _ $ 40.00
,Sign/ou rline Ligh ting- i Io. oo
,tl1,l-,"g rnergy/fre; ': i ib. oor,rmi red Energy/Conn
-
S ii.OO
Sum
$ s0.00
$ 60.00
$100. 00
s130.00
$300.00
$ 40.00
OIIITER TNSTALI.ATTON
The installation is being made onproperty f ovn vhich is not intendedfor sa1e, J.ease or rent.
E
Ovners gnature:
DATE:5
RECETYED
-r SUB?OTAL OF ABOYE
ii,fl#fiiii".|ii5"0""
JOB DESCRIPTION
f+72' 4 .1t1, FaLl
?o2'a 3/fc?of
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 in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38:
K
trI
Notice
---->{"
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.
3B. 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 notit/ the office issuing this building permit of the
name of the contractor.
I hereby certify that the above informationis correct and thatl have read and dounderstand the Information
Owners about Construction Responsibilities on the reverse side of this form.
OR
Permit #: q {c; /dj
Address:
Issued by:Date:
)
//.(1
(Signature of permit
(White copy to issuing agency peftnit file,
pink copy to applicant)
to
(Date)
tr
trnforrnation Notice to property Owners1, &bqut-Gonstructien ffiesporn*ibilit*es'l . \. *.-- .-_'-
.Vo}e.?ltjsJrd.brirutttionNtlt,i,c,efuPrtssl1,rty{)wnersabout{"tlnstrwttionlles1sonsibilities
rua,i rlr lr'/,tprtl h1 the' Cnu.tlrrrction Crttttrat'ktrs Bosrt! in tti t rtrdanta tt.itlt ORS T0 1.0;5(5).
yol"l c&r1 pr*vent many probleurs by being aware of the folk:wing responsibilities an{ areas of csncem.
EMPLOYER RESPONSI BILITIES:
lf you hire persons n*t regislerecl with the Constructioir Contractors Br:ard to do labor in constructing or assisting in the
constfi"tction or irnprav*r':rent of a residei:tial stnlcture, you will, in rnost instances, be ruled to be an employer and the people
you hire will be employees. As the employer, yeiu must cornply with the fnllowing:
Oregonos withholding taN law: As an employsr, you must withhold income ta-res tiom employee wages at the time employees
are paid. You v'riltr be iiablc for the tax payments even if ynu don't actualiy withhold the tax from your emp-loyees. For more
inforrna{ion, cal} {he Oregon Dept. of Revenue at 945-B0g! "
Unemployment insnrance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For rnore information, call dre Oregon Employment Division at the Deparhentof}Ixxmn Rbsowr$*
at378-3524.
i' -:
Workers' compensation insurance: As an employer, you nre subject to the Oregon Workers'Compensation Law, and istrsl
obtain workers'compensation irsurance for your eruployees. If you fail to obtain workers' compensation ilsurance, you may
besubjecttopenaltiesanclwillbeliableforatlclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformation;
call the Workers' Compensation Division at the Department of Consumer and llusiness Services at945-7888.
U.S. Internal ltevenue Serviee: 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 acfually rvithhotd the tax. Fbr rnore information, call the Internal Revenue Service
at i-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliancel As the permit holder for this pro.ject, you are responsible for resolving any failure to meet code requirements
.!that may be brought to your attention through inspections.
:
Liability and property damage insurauce: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as failing tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise crnpl*yees: Make sure you have su{ficient time to supcrvise 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.
If you have additional questions, write or cail the Construction Contractors, Board (PO Box 14140, Salem, OR 97309-5052,
5a3l37\-4621). The Board is locared at 700 summer st. NIi suire 300, in salem.
prop-own.pm4
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