HomeMy WebLinkAboutPermit Mechanical 1994-11-01,{-
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ESIDENTIAL
ERMIT APPLICATION
lnspectlons: 726.3769
Offlce: 726.3759
LOCATION OF PROPOSED WOFIK:
ASSESSORS MAP:z
LOT:
,g
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97477
SUBDIVISION:BLOCK:
PHONE:
ZIP:STATE:
OWNER:
ADDRESS:
CITY:
-t'_
k\rDEMOLISH OTHER
DESCRIBE WORK:
NEW- REMODEL ADDITION
ADDRESS EXPIRES PHONE
4 ,t-\
PLUMBING:
MECHANICAL:
ELECTBICAL:
CONTRACIIOR'S NA
GENERAL:
CONST,
CONTRACTOR #
L
FLOOD PLAIN:
- OFFICE USE -
WATER HEATER:
# OF BDRMS
FIANGE:
QUAD AREA:
I OF BLDGS:
LAND USE:
OCCY GROUP:
* OF STORIES:SECONDARY HEAT:
SQUARE FOOTAGE:
CONSTR. TYPE:
HEAT SOURCE:
# OF UNITS: _ZONING CODE:
To request an lnspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspecilons 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.
REQUIRED INSPECTIONS
Temporary Electrlc lYl Rough Mechanlcal - prtor to
u,acover.Flnal Plumbing - When allplumblng work ls complete.
Rough Electrlcal - Prlor to
cover.[---l flnal Electrlcal - Wtren altlJ electrlcal work is complete.s
Understab Plumblng / Electrlcal /
Mechanlcal - Prlor to cover.Electrlcal Servlce - Must be
approved to obtaln permanent
olectrlcal power.
x Flnal Mechanlcal - When all
mechanlcal work ls complete.
Footlng - After trenches are
Flreplace - Prlor to faclng
materlals and framlng lnsp.
Final Bulldlng - When all
requlred inspectlons have been
approved and bulldlng ls
completed.Masonry - Steel locatlon, bond
beams, groutlng.l--l Framlng - Prlor to 6over.
Foundatlon - After formg are
erected but prlor to concrete
placement.
Other
Wall/Celtlng lnstrllatlon - Prlor to
cover.
Underground Plumblng - Prlor
to fllllng trench.l--l Drywall - Prlor to taplng
MOBILE HOME INSPE TIONS
Underlloor Plumblng / Mechanlcal
- Prlor to lnsulatlon or decklng.Wood Stove - After lnstallatlon.
Posl and Beam - Prlor to floor
lnsulatlon or decklng.lnsert - After flreplace approval
and lnstallatlon of unlt.
Blocklng and Sel.Up - Whep all
blocklng ls complete.
Floor lnsulatlon - Prlor to
decklng.Curbcut & Approach - After
forms are erected bttt Prlor to
placement of concrete.
Plumblng Connections - When
home has been connected to
water and sewer.
Sanltary Sewer - Prlor to fllllng
trench.Electrical Connection - When
blocklng, set'uP, and PlurDblng
lnspections have been approved
and the home ls conneoted to
the servlce Panel.
Storm Sewer - Prlor to fllllng
trench.
Sidewalk & DrivewaY - After
excavatlon ls comPlete, forms
and sub-base materlal ln Place.
Water Llne - Prlor to tllllng
trench.
Rough Plumblng - Prlor to
cover.
[--l Fence - When comPleted'
l-l Street Trees - When all requlred
I I it""" are Planted'
Final - After all requlred
lnsoectlons are approved and
oo-rlnu", sklrtlng, decks, and
ienttng have been lnstalled'
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Slte lnspectlon - To be made
after excavatlon, but prlor to
settlng forms.
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Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total tlelght
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
P.L.HSE GAR ACC
N
S
E
1 iS THE PROPOSED WORK tN THE -
HISTORICAL DISTRICT, OR ON,.THE HISTORICAL REGISTER?
lf yes, thls appllcatlon must be slgned
and approved by the Hlstorlcal
Coordinator prlor to permit lssuance.
APPROVED:
k
(A)
lv.4ain
Carport
Galage
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permlt ls granted on the express condltlon that the said
constructlon shall, ln all respects, conform to the Ordlnance
adopted by the City of Sprlngfleld, includlng the
Development Code, regulating the constructlon and use of
bulldings, and may be suspended or revoked at any tlme
upon vlolatlon of any provislons ol sald ordlnances.
Date
Becelpt Numbe
Date Pald
Recelved By:
Plan Check Fee:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undeveloped
properties wlthln the City limits which are being lmproved.
ITEM
Flxturest
Residential Bath(s)
Sanltary Sewer
Water
Storm Sewer
Mobile Home
FEE
N0
FT.
(c)
PLUMBING PERMIT
Plumblng Permlt
Stato_ Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
MECHANICAL PERMTT
Zo(D)
H
N0
NdechanieaJ+esrit
lssuahce
,&4t. J=9o
Furnace
Exhaust Hood
Vent Fan
State Surcharge
Tatal Permit
,7J-
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By slgnature, I state and agree, that I have caref ully examlned
the completed appilcation and do hereby certlfy 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 Sprlngfield, and the Laws
of the State of Oregon pertalnlng to tho work descrlbed
hereln, and that NO OCCUPANCy wlll be made of any
structure wlthout permission of the Bulldlng Safety Dlvislon.
I further certlfy that only contractors and employees who
are ln compllance with ORS 701.055 wlll be used on thls
prolect.
I further agree to ensure that all requlred lnspections are
requested at the proper time, that each address ls roadable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans wlll remaln
Date ?4
Slgnature
on the site at times during construcilon
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk _-- ft
Curbcut ---- ft
Demolltlon
State Surcharge
Total Miscellaneous permits (E)
TOTAL AMOUNT DUE (exctu.drns etectrica O 24 P
(A, B, C, Q and E Gomblned)
/<< 2-z
,ZG 2a
DATE PAID
AMOUNT BECEIVED
RECEIVED BY
VALIDATION:
FIECEIPT NUMBER
,1 |,: ri4
BUILDING PERMIT
ITEM SO. FT. x $/SQ. FT. = VALUE
FT.
FT,
Permit #:
Address:
Issued by:
permit applicant)
(White copy to issuing agency pennit file,
pink copy to applicant)
7
Date:
Fill in the appropriate blanks and initial boxes I and2,and eitherbox 34 or 38:
lv I l. I own. reside in, or will reside in the completed structure.Y,.J
trL 2' I understand that I must register as a construction contractor if the structure is sold or offered for s4et_ betore 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.
statem€nt: rnformation Notice to property ownersAbout construction Responsibirities
Note: oregon law, oRS 701.055(4), requires residential construction permit appli-cants who are not registered with the construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement ts requiredfor residential building, electrical, mechanical, and plumbing permits. Licensedarchitect and engineer appltcants, exemptfrom registiation under oRS 701.010(7),need not submit this statement. This statement will be fited with the permit.
// -/-?/
OR
tr 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 building permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have read and do understand the Information
Owners about Construction Responsibilities on the reverse side of this form.Notice to
(Signature (Date)
)
InlormatiodrNstice to Property Owners
AboutConstructionResponsibilities
I-,:
*,ri, aArrir)ia n, ,fr" Construciion Controctars Bottrd in ac:ccsrdant:e w'ith ORS 7A I '055('i)' ''
..,, r-^-.: ^",-.,lze:r rrrhrt:rnli;rl i, ;ting struclure'
ll you ;rre acting as your own contractof to construct I new home or make a substantiai improvemetlt to &n exls
you can prevent many froutems by berng awareo{ the foliowing responsibilities and areas of concsrn'
EM PLOYER RESPONSI BILITIES:
If you hire persons not registered with the Construction contractors Board to do labor in constructing or assisting in the
construction on improvement of a residential structure, you wifi, in most instances, be ruled t. be an employer and the people
youhirewillbeemployees'Astheemployer'youmustcornplywiththefollowing:
oregon,s withhotding tax raw: As an employer, you must rvithhold income taxe s from employee wages at the time employees
are paicl. you will beliable for the ,u* poy*"nr, "r"n if you don't actually withholcl the tax from your employees' For more
information, call the Oregott Dept' of Revenue at 945-8091'
unemployment insurance tax: As an employer, you are rcquired tc' pay a tax for unemployment insurance purposes on the
wages of alr emptoyees. For more informuilon, .uti the oregon Employment Divlsion at the Department of Human Resources
at378-3524 .,'-{
workers, compensation insurance: As an employer, you are subject to the oregon workers' compensation Law' and rfr"s
obtain workers, compensation insurpnce-fo, youi employees, If y_ou fail to obtain workers' compensation insurance' youmqy
be subjectto penalries and will be liable ro.uir"ruirn Jort, iton" otyoo."*ployees is injuredonir'"io!t I:1T* informdibn
call the workers, Compensation Division at the Department of consumeiand Business services at 945-7888'
U.S.Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages' Voulifiry
liable for the tax payment even if you dian't u"i,raity withhold the tax. For more information, call the Internal Revenue service
ar l-800-829-1040.
OTHEH RESPONSIBILITIES AND AREAS OF CONCERN;
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections' -'i
Liability and property damage insur&no$ contact your inslrance agent to see if you have. adequale insgrmce coverage for
accidenis anO omlssions *ch as falling tools, paint overspray, water damage from pipe puncture$-, ftre, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Experdse: Make sure you have the expertise to act as your own general cont.a.tor; to coordinate lhe work.of rough-in and finis!
traies, and to notify UuitOing off,rcials at the appropriatb tirnes so they can'petorm the required inspections-
.
If you have additional questions, write or call the Construction Contractors Board (P.O Box -l4l4fi,Salem, OR 97309-5052,
5A3878-4621). The Board is located at 700 Summer St. NE Suite 300; in Salem.
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