HomeMy WebLinkAboutPermit Building 1995-03-02SPRI}.GFIELO
RESIDENTIAL
PERMIT APPLICATION
lnspectlonsl 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:I I l^3 5o.,.T( S +iI Pl.. e-
JOB NUMBER ?50/b9
225 Filth Street
Sprlng(leld, Oregon 97477
ASSESSORS MAP:
toT:BLOCKI SUBDIVISION:
TAX LOT:
PHONE:
ftr)n7{7ZIP:
l,l Q e 7/r -zrttD
STATE:(}R
trro r\
CITY:
ADDRESS:
OWNEBT
Jou
ADDr,oN -4X
(,6)'rDESCRIBE WORK:
NEW- REMODEL DEMOLISH OTHER
ADDRESS
EXPIRES PHONEI5<
CONTRACTOR'S NAME
GENERAL:
PLUMBING;
Se/MECHANICAL:
ELECTBICAL;
CONSI
CONTBACTOR ,
5el
S<
R.SC \\rt
- OFFICE USE _
LAND USE;
WATER HEATER
RANGE
I OF BDBMS:
A OF UNITS:
OUAD AREA:
r OF BLDGS:
OCCY GROUP:
I OF STORIES:
SECONDARY HEAI:
SOUARE FOOTAGE:
FLOOD PLAIN:
ZONING CODE:CONSTR, TYPE:
HEAT SOURCE:
To reques
made the
t an lnspecflon, you must calsame worklng day, lnspectio
726.3769.Th ls is a 2,4 hou recordnsreqUEtedaf te 7:OO
ng AI ns pec ns regu ES ed be foa.m wl b e m ad e h fo lowi re 7:00 a.m wlll bensworkday,R E QU R E D N S P E cTt o N SI--l Temporary Electrtc X R o u9h M echant cal Prl o o Kcover.FIna PI um b lng Wh en
ijFil";*#lr,;,,i0?,""it:."
pl UM b In n work com pl et.e,
,X.Roug h EI ec trlca Prlor tocovor.,x,5,':;l Eteclrlcal Whe n al
il:*:,I r,r3g[i i 5, ::yj; ",,
L:g!.lg - After trenches areexcavated.
[1Tp_: Steet rocaflon, bondoeams, grouilng.
ca work S co mpl ete.
K ^Eleclrlcal Servlce _ Must be
,igl?tT i."fl:::, " permanen t
ll:tJ,r:" - prlor to factngmaterlals and framlng lnspi
Framtng - prlor to cover.
N [,3;;, #i;ilTl?,;"yffi?"iJ:
X ff l,*,,s:x;"YJ i?,,i,,."
" ^aPproved and building i;- -"""
completed.
K,:,"":l*,fi,l ; #8,. J: lT;,?"
tl ,'d'ffiffi;ll:l;1,-o,ns - Pr,or
,K
X m:l:eltlng rnsurauon - prror to
ffi otr*"'t - Prlor to raprng.
Othor
XY*f'1ffi*[,,ff]
,X"l'":mS^,,;:xl;, XJI
or to l oo r
,K;::ll;;surarron - Prror to
Wood Stovo _ After lnstallailon.
lxTll;,fll,L";?fl ;i,: a pp rova,
9j1b:r, & Approach _ Afterlorms are erected bUt prlor topracomcnl of concrete,
MOBILE HOME INSPE TIONS
Sanltary Sewer _ pritrench. or to filling
S-to_rm Sewer - prior to fllllngtrench.
8fff,T$,i"i.i"J;YL- When a,,
lllT-bi", connecrions _ when
,1.?I" h": been connected towater and sewer.
Waler Llno - prlor to filllngtrench.
l-9rStr Plumbtng - prtor tocover.
Sidewalk & Drlveway _ Afrerexcavatlon ls compitte, formsanc, sub.base materlal in place.
Fence - When completed,
fl ff :h?i".,.ti:x,#,;#i,:,;tnsPections have been approved
ilr^o _the ,home is connecred torne servlce panel.
,K L] ;ff:[ffi*"y^en arr requrred
,F_il:1 : After alt required
*:il?f ;:M:f{i"*lHt'
l----4An._-\sJ z-__
il
T
E
Lol faces
Lot sq. ftg,
Lot coverage
Topography
Total hel
Lol Type
)!v lnrcrlor
-
Corner
-
Panhandle
-
Cul-de-sac
s r-- lS THE PRoPOSED WORK tN THE .
HtsroRlcAL DtsTBtcT, oR oN
THE HISTORICAL REGISTEFI?
-
lf yes, thls appllcatlon must be slgned
and approved by the Historlcal
Coordlnator prlor to permlt lssuance.
APPROVED:
13
PL.GAR ACCHSE
N
S
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls pelmlt is granted on the express condltlon that the sald
constructlon shall, ln all respects, conform to the Ordlnance
adopted by the City of Springfleld, lncludlng the
Development Code, regulatlng the constructlon and use ol
bulldlngs, and may be suspended or revoked at any tlm€
upon violation of any provislons ol sald ordlnances'
lewedPla
'7
Recelpt Numbe
Date Pald
Recelved
Plan Check Fee a3
Total Value
Bullding Permit Fee
State surcharse Or' + 5,/'
Total Fee (A)
VALUE
42/\4,7^ \
6{
X $/SQ. FI.
-SL.Z,- 44b
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
-/2a*
/9.4 /r
Systems Development Charge ls duo on all undeveloped
properties within the City limits which are being lmproved'SYSTEMS DEVELOPMENT CHARGE (SDC)
I
(B) 4 44 V//
ADDITIONAL COMMENTS
ITEM
Flxtures
Resldentlal Bath(s)
SanltarY Sewer
Water
Storm Sewer
Moblle Home
PLUMBING PERMIT
No
/ ,fo t ,7o
FEE
?2,n3
FT.
FT.
FT,
-{o2;va
b/^'(c)
Plumblng Permlt
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
Mechanical Permlt
lssuance
Statesurcharge ,?rf '{
Total Permlt (D)
MECHANICAL PERMIT
/o o'
@
^ Or-
/"0
Fu rnace
Exhaust Hood
Vent Fan No/
By slgnature, I state and agree, that I have carelully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon ls true and correct, and I further certlfy
that any and all work performed shall be done ln accordance
wlth the Ordlnances of the Clty of Sprlngfleld, 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 Dlvlslon'
I further certlfy that only contractors and employees who
are ln compllance wlth ORS 701.055 wlll be used on thls
prolect.
I further agree to ensuro that all requlred lnspectlons are
requested at the proper tlme, that each addr€ss ls readable
from the street, that the permlt card ls located at the front
of the property, and the approved set ol plans wlll remaln
on the slte at all times during constructlon'
Date
[tsn"tr,"
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk
-_
lt
Curbcut
--
ft
Demolltlon
State Surcharge
Total Miscellaneous Permlts (E)
TOTAL AMOUNT 0UE (excludlng electrical)
VALIDATION:
RECEIPT NUMBEB
DATE PAID
AMOUNT RECEIVED
(A, B, C, D, and'E Comblned)
2 4t 7t
RECEIVED BY
7
'l', 2
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759
LOCATION OF PHOPOSED WOFK:
SPrlI IELE,
JoB NUMBE n 4ft/€7
225 Fifth Street
Sprlngfleld, Oregon 97 4Zl
TAX LOT:OaASSESSORS MAP:
LOT:- BLOCK:SUBDIVISION
PHON E:
I
STATE:=,r, ? 2{2'=CITY:
ADDRESS:
OWNER:
DEM HERISH
DESCRIBE WORK:
NEW- REMOD
ADDRESS EXPIRES PHONE
ELECTRICAL:
CONTRACTOR'S NAME
MECHANICAL:
PLUMBING;
GENERAL:
CONST.
CONTRACTOR #
# OF BDRMS
- OFFICE USE -
WATEB HEATER:
FLOOD PLAIN
RANGE:
QUAD AREA:
, OF BLDGS
SECONDARY HEAT:
SQUARE FOOTAGE:
LAND USE:
OCCY GFIOUP:
r OF STORIES:
ZONING CODE:
--:_CONSTR. TYPE:
HEAT SOURCE:
# OF UNITS:
---
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspecilons requested before 7:00 a.m. wllt bemade the samo worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
REOUIRED INSPECTIONS
l--l remporarv Electrlc E H"T Mechanlcal - Prlor to fl Ftnar. ptumbing - when ailJ plumblng worl< ls complete.
Slte lnspectlon - To bo mado
after excavatlon, but prlor to
settlng forms.
Rough Electrlcal - Prlor to tl Flnal Electrlcal - When altelectrical work is complete,cover.
Underslab Plumblng/ Electrical /
Mechanlcal - Prlor to cover.Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flnal Mechanlcal - When all
mechanlcal work is complete.
Footlng - After trenches are
excavated,l-l Flreplace - Prtor to faclng
-
materlals and framlng lnsp.
Flnal Buildlng - When all
requlred lnspectlons have been
approved and buildlng ls
completed.Masonry - Steel locatlon, bond
beams, groutlng.Framlng - Prlor to cover.tl Foundatlon - After forms are
erected but prlor to concrete
placement.
Othor
Wall/Celllng lnsulatlon - Prlor to
cover.
w Underground Plumblng - Prior
to fllllng trench.l--l Orywalt - Prlor to taplng.
Underlloor Plumblng/ Mechanlcal
- Prlor to_ lnsulatlon or decklng.
":
Post and Beam - Prlor to floor
lnsulatlon or decklng.
MOBILE HOME INSPECTIONS
Wood Stovo - Afler lnstallatlon
lnsert - After flreplace approval
and lnstallatlon of unlt.
Blocking and Set.Up - When ail
blocklng ls complete.
Floor lnsulallon * Prlor to
decklng.Curbcut & Approaclr - After
forms are erected bUt prlor toplacement of concrete.
PJumb{ng Connectlons - When
home has been connected to
water and sewer.
Sanltary Sewer - Prlor to filling
trench,Electrlcal Connection - When
blocking, set-up, and plumbing
lnspections have been approvcd
and the homo is connected to
the servlce panel.
Storm Sewer - Prlor to fllling
trench.
Sidewalk & Drlveway - After
excavation ls completc, forms
and sub-base material ln place.
Water Llne - Prlor to fllllng
trench.
Fence - When completed
Rough Plumblng - Prior to
cover.
Street Trees - When all requlred
trees are planted.
Final - After all required
inspections are approved andporches, sklrtlng, decks, and
ventlng have been lnstalled.
tl
fl
tl
E E
:'... t.p. i: ,f:1,;l'tLot faces
Lot sq. ftg.
Lot coverage
Topography
Total hetght
Lot.n_7e
. Interior
-
Corner
-
Panhanclle
_- Cul-de-sac
P.L.HSE GAR ACC
N
S
E
PROPOSED WORK IN THE.HISTOBICAL DISTFIICT, OR ONTHE HISTOFIICAL REGISTEFI?
-
lf yes, thls appllcailon must be slgnedand approved by the HistoilcalCoordinator prlor to permit issuance.
( IS THE
APPBOVED:
BUILDING PERMIT
VALUE
(A)
so. FT. x $/sQ. FT.ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Thls permit is granted on the expre6s condiilon that the sardconstruction shail, rn arr respecis,
"onrom io-rne ordinanceadopted by the City
. ol spiingriuiJ, includtng rheDe.velopment code, regulatlng in" "'on!'trl"iion "ro use ofbulldlngs, and may be suspended or revoked dt any ilmeupon violation of any provisions of sarO ofJlnances.
!r.t_LD_t.ryc VALUE, PLAN CHECKND BUILDING P'ERMif -"bYI\
Plan Check Fee:
Date Pald:
Date
Plans By
B
A
Beceipt Num
Feceived By:
EVELOPMENT CHARGE (SDC)
(B)
SYSTEMS D
nt Charge is due on all undeveloped
City limits whlch are being lmproved.
Systems Developme
properties wllhln the
ITEM
Flxtures
Besldenilal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
PLUMBING PERMIT
FEE
FI A ?-1-a'e
FT.
(c)
t_.F 2<.-7' t=rPlumbing permit
State Surchargo
Total Charge
A DDITIONAL COMMENTS
Wood Stove/ lnsert/Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
(D)
N0
Mechanlcal permlt
lssuance
State Surcharge
Total Permlt
Fu rnace
Exhaust Hood
Vent Fan
By slgnature, I stato and agree, that I have carelully €xamlnedthe compt6ted appltcatlon and do h";";;;orufy that anlnformatlon hereon ls true and correct, and I turtner c6rtlfythat any and all work performed shall Ue Ooie ln accordancewlth the Ordinanccs of the City of Sprf ngfi"li, and the Lawsof the Stato of Oregon pertalnlng to the work descrlbedhereln, and that No OCcUpANrCv *frr-Ue made of anystructure wlthout permlBBlon of the Bulldlr.,O S"tety Dlvlslon,I further cerilfy that only contractora anO-emptoyeos whoare ln compllance wlth ORS 701,055 wlll be used on thlgproJect.
I further agroo to onauro that all requlred lnBpeoilons ererequested at the propor trme, that each addrees rs readabrefrom the Btreet, that the pormrt card rs rocated at the frontof the property, and the approved set of plans wlll remalnon the slte at all times durlng construcilon,
z
Slgnature
Date
MISCELLANEOUS PERMITS
Mobile,Homd
State lssuance
Stato Surcharge
Sidewalk
--
ft
Curbcut
-- ft
Demollllon
State Surcharge
Total Mlsceltaneous permlts (E)
-
TOTAL AMOUNT DUE (exctuding clectricat)(A, B, C, D, and E Comblned)
*e=-
q^?>.
AMOUNT RECEIVED
RECEIVEO BY
VALIDATION:
RECEIPT NUMBER
DATE PAIO
N0
-_
FT.
-
SPFlINOFIELO
225 FIFTH STR.EET
SPRTNGFTELD, OREGoN 97477
INSPECTI0N REQUESTz 726-37
OFFICE: 726-3759
The tollorvlng Prolect
zoning, and does nor
{dlo-
Autilodred Signature
B5
require specitic i:rrC
apProval >D C-. ELECTRTCAL PERHTT APPLICATIoN
City Job Nunber ?50 3
SCMDULE BELOTI
%
1. LOCA'TION OF IN ON
LEGAL DESCRIPTION
JOB DESCRIPTION
Permits are non-transferable and expire
if work is not started vithin 180 days
of issuance or if vork is suspended for
I B0 days.
2. COI.ITRACTOR INSTALLATTON ONLY
Electrical Contraclss ABLE ELECTRIC
Address 551 1 MAIN
City SPRINGFIELD Phone 726-6701
Supervisor License Number 3023S
Iixpiration Date 10-1-95
Constr Contr. Number 92506
Expiration Date 7'1'6-95
Signatur e f Supervising Electrician
0vrrers Name .2.> zr/,4 lt rl
Nev Residential-Single or
MuIti-Family per dwelling unit.
Service Included:
A.
B
L000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular DveIling
Service or Feeder
Services or Feeders
Installation, Alterations
or Relocation:
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
Items Cost Sum
$ 85.00
$ 15.00
$ 40.00
,/ 0
$130.00
s300.00
$ 40.00
above
fo 'do
200 amps or Less /
201 amps to 400 amps
-401 amps to 600 amps
-601 amps to 1000 amps-
0yer 1-000 amps/voIts
-Reconnect 0n1y
s s0.00
s 60.00
s100.00
C Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or less S 40.00
20L amps to 400 amps
-
S 55.00
over 401_ to 600 amps
-
S 80.00
0ver 600 amps or 1000 voTls see I'8"
Add ress ,//6
City ff Sz-O phone
OI{NER TNSTALI,ATION
D. Branch Circui ts
New, Alteration or Extension per panel
Miscellaneous (Service/feeder not included)
-Each install-ation
Pump or irrigation g 40.00Sign/outline Lighting- S 40.00Limited Energy/Res
-
S 20.00Limited Energy/Comm S 36.00
f. 7y74
7 Lzs v.
The installation is being made onproperty I ovn vhich is not intendedfor sale, Lease or rent.
Ovners Signature:
E
5
DATE:
RECEI
RIiCBIVED B
7 u a L t0
-J
One Circuit S 35.00
Each Addi tionalCircuit or vith Serviceor Feeder Permi t S 2.OO
t _(oo 9.r'0
&&,
ET^ECTRICAL PERUIT APPLICATIONZoni
225 FIFTH STREET
SPRINGFIELD OREGON g747prto
INSPECTION REQTIEST:726;l76$xi,1
OFFICE: 726-3759
OF INST1.
LEGAL DESCRIPTION
JOB
b1e and exPire
thin 1"80 daYs
suspended for
180 daYs.
2. COMRACTOR INSTALLATION ONLY
Electrical Contractor '
Address
Ci tv Phone
Supervisor License Number
Expiration Date
Signature of Supervising Electrician
Ovners Name
Address
The lollowing PIoig:1
zoning, and does Itur
aPProval'
as submitted.hct tho';c!!.t'
requiro sPeolt{i r'' 'r'' -' -
5PFt.-.iFtELo
ob Nunber
3. COMPLETE FEE SCMDULE BELOIJ
Nev Residential-Si'
Multi-FamilY Per d
Service Included:
ngle or
velling unlt'
Sum
A
B
D.
I tems Cos t
$ 8s.00
s 15.00
$ 40.00
40.00
55.00
BO. OO
ee rrBrr a[o?E-
Ci ty
OIJNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
Owners Signature:
DATE:
S{t1 Pn'"" 7/o - 27{/
t000 sq.ft. or less
sach additional 500
sq. ft or Portion
thereo f
Each Manuf'd Home' or
Modular Dvelling
Service or Feeder
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less /
201 amPs to 400 amPs
-
401- amPs to 600 amPs
-
601 amps to 1000 amPs-
0ver 1000 amPs/volts
-
Reconnect 0n1Y
200 amps''or less
201 amps to 400 amPS
-
Over 401 to 600 amPs
0ver 600 amps or fOOO-7ofTs
Branch Circuits
Nev, Alteration or Extension Per Panel
one circuit =gfr 35.00 g
Each Additional
Circuit or vith Service 7
or Feeder Permit 54 S 2'00
en@'
5o/'
ON
Permits are non-transfera-ii-"otf. is not started vi
of issuance or if vork is
Expiration Date
C-TemporarY Services or Feeders
in"i.ff"iio", Alteration or RelocationConstr Contr. Number
for
-
s s0.00
$ 60.00
s10o.0o
$130.00
$300.00
s 40.00
$
$
$
s
$ 40.00
$ 40.00
$ 20,00
$ 36,00
b
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/0ut1ine Lighting-
Linited Energy/Res
Linited Energy/Conn
2,,
I )a
RECETWD B Y:
5. SUBTOTAL OF ABOVE
lI s!^te Surcharge
i{r*r,nr.strarivJ ree
\
a
Permit #:q5o/63
Address
Issued by:Date:
Statement: Information 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 abuilding permit can be issued. This statement 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 pertnit.
Fill in the appropriate blanks and initial boxes I and2, and either box 34 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.
3.{. My general contractor is
(Name) Contractor regis. #
I will insffuct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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 noti$ the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and thatl have read and do understand the Information
trN
OR
Owners about Construction Responsibilities on the reverse side of this form.
3 -a-q
(Signature of permit applicant)
(White copy to issuing agency pennit file,
pink copy to applicant)
N2 to
(Date)
.r
$,'"
Information Notice'to Property Owners
About Construction Responsibilities
Note: 'l'his lnfonnurbn,Ngtire to Property Owners about Canstru{'tion Respansibilities ' '
N,qs tleveloped l;v the Con.slruction Cintractr;rs Boartl in a<:cordant:e with ARS 70t.A556).I
L
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you cirn prevent many problenrs by being aware of the lbllowing responsibilities and areas of concern.
EMPLOYER HESPONSIBILITIES:
If 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 struc(ure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. Asthe employer, you m.uEt.comply with the followingl
Oregon's withhotding tax law: As an employer, you must withhold income taxes from employee'wages at the time employees
are paid. You will be tiable for the tax payments even if you dont 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 the Oregon Employment Division at the Department of Human Rgsources
at378-3524.
!
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and-iifrsC
ob.tarn workers' compensation insurance for your employees. If you fail to obtain workersf compensation iJrsurance, you{nfy
beiubjecitopenaltie.sandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformatibd
call the 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 employeesi 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.
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
that may be brought to your attention through inspections.
requirements
:
LiSity and property damage insurance: Contact your insurance agent to see if you have adequate insuranee coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
Time to supervise employees: Make sure you have suificient 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 ro notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box l4l40, Salem, OR 97309-5052,
5031378-4621). The Board is located at 700 Summer St. NE Suite 3(X), in Salem.
prop-own.pm4
1194