HomeMy WebLinkAboutPermit Mechanical 1993-11-12FI
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
? ,s/72 iJOB NUMBER
225 Fifth Street
Springf ield, Oregon 97 477
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:TAX LOT:/o ouo
SUBDIVISION:LOT
-
BLOCK:
PHON E:
4 tqoi0e-zlP
(,t
l/l STATE:
40
CITY:
ADDRESS:
OWNER:
NEW
-
REMODEL ADDITION DEMOLISH OTHER
t)tDESCRIBE WORK:
G EN ERAL:
ELECTRICAL:.
EXPI RES PHONEADDRESS
1q 4Kt -qL*e
t0a0 _s
CONTRACTOR'S NAME
PLUMBING
MECHANICAL:
CONST.
CONTRACTOR #
RANGE:
* OF BDRMS:
- OFFICE USE _
LAND USE:
ZONING CODE:
FLOOD PLAIN
WATER HEATER
* OF UNITS:
SECONDARY HEAT
SQUARE FOOTAGE:
OUAD AREA:
* OF BLDGS:
OCCY GROUP:
Y OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an inspection, you must call 726-3769. Thls ls a 24 iour recording. All inspections requested before 7:00 a.m. will be
made the same working day, lnspectlons requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
[_l Temporary Electricll KW: Mechanicar - Prior to E-'lX al Plumbing - When all
mbing work is complete.
Site lnspection - To be made
after excavation, but prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain permanent
electrlcal power.
Et Final Mechanical - When all
frechanical work is complete.
Footing - After trenches are
excavated.Fireplace - Prior to facing
materials and framing lnsp.
Final Building - When all
required inspections have been
approved and building is
completed.Masonry - Steel location, bond
beams, grouting.Framing - Prior to cover.4fr 1aL
Foundation - After forms are
erected but prior to concrete
placement.
ffi ottrer
Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.Drywall - Prior to taping.
MOBILE HOME INSPE TIONS
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.Wood Stove - After installation.
Post and Beam - Prior to floor
insulation or decking.lnsert - After fireplace approval
and lnstallation of unit.
Blocking and Set-Up - When all
blocking is complete.
Floor lnsulation - Prior to
decki ng.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanilary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the servlce panel.
Storm Sewer - Prior to filling
trench.
Sidewalk & Driveway - After
excavation ls complete, forms
and sub-base material !n place.
Water Line - Prior to filling
trench.
Fence - When completed.
Streel Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
"l{Rough Plumbing - Prior to
r-cover.
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I ,O THE PROPOSED WORK IN THE' HISTORICAL DISTRICT, OR ON
THE HISTOBICAL REGISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
PL.HSE GAR ACC
N
S
E
BUILDING PERMIT
ITEM SQ. FT. X $/SO. FT,VALUE
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee (A)
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
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Date Paid:
Receipt Num
Received By:
Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
.2?tzt ).
N0
FT.
FT.
FT.
Plumbing Permit
State Surcharge
Total Charge
4r/c/,/,{do
7r
(c)ls,?r
ADDITIONAL COMMENTS
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
.z' OttG2.
Vent Fan N0
Wood Stove/ lnsert/ Fi replace Unit
Dryer Vent
4.#. ln)E i w* t/';'i'a-'2:)
Mechanical Permit
lssuance
State Surcharge
Total Permit
,r4 /il t {-ctO/.---t r
/o ,o*
7r'
(D)2-i;?r
By signature, I state and agree, that I have caref ully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, 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 permission of the Building Safety Division.
I further certify that only contractors and employees who
are in compliance with ORS 701.055 will be used on this
project.
I f urther 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 is located at the front
ol the property, and the approved set of plans will remain
on the site at all times duri ng cons ti
X,,nn^ru
t
MISCELLAN EOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
VALIDATION:
RECEIPT NUMBER
DATE PAID 3
AMOUNT RECEIVED
RECEIVED BY
3-o
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)4l ,'"
Plan Check Fee:
-
Plans Reviewed By
I
Permit No:
Address:
lssued by
))2/
3i&<-)12
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91
/Date:
/ /- /'?-a<1l la- /-/'
Da-Ie
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
aMs
R OFFICE USE ON
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment 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 permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
I own, reside in, or will reside in the completed structure.
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
2
Contractor reqistration nu mber-
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B. []]:1 I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
My general contractor is ,
,
OL
t re mt
E:1-
I-1
INFORiIATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
ng as you r own contractor to conitiuct a new home or make a Substantial i anlf you are acti
existing struct
of concern,
ure, you can,p.rgvent many problems by being aware of the following responsibilitles ahd areas
EMPLOYER RESPONSIBILITIES:
ll 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 structure, you will, in most instanceq, be ruled to be an
;:"rpfoy"r;'
"nJ the people you hire will be 'iemp1oyees". As the employer, you must'coniply ryjth the following:
Orego n's Withholding.Tax Law: As an ernployer, you must withnotO incomg laxes-frpm Bmptoyee wages at
the time employees are paid. You will be liab-le
tax from your employees. For more informatio
for the tax payments even if you don:t actualfy withhold the
n, call the Oregon Department 9f Revenuggt 378-3390.
; . .':-l' ., .. :
Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance
rnp|oyees.Formqreinformation,calltheoregonEr,nploym-entDivisionDHR
a|378-3224.
Workers' Compensation lnsurance: As an employer, you are su$ect to the Oregon Workers' Compensation
@inwtrkers'compenSationinsuranceforyouremployees.lfyoufailtoobtainworkers'
compensation insurance, you may be subject to penalties and will Ue'lihble for all claim costs if ^onil of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-74U.
u.s.tl@Asan
Yoarlll be liabLe for the tax payment
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As ttle perrnit hotder for this project, you are responsible for resolving any f ailure to meet
code requirements that may be brought to your attention thiough inspections
LiabilitY and Pr'operty Damage lnSuiaflCe:; Corttadltdirr iilsurance.'agent td see if you have adequate insurance
sionssuchasfallingtools,paintoversprdy,.w*iir.damagefrompipepunC-
tures, fire, or work that must be re-done.
Time to Supervise Employees Makeisure you have sufficient time to supervise your employees
':'3i
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
lf you have additional questions, write to: Consitruction Contractors Board
7OO Summer St. NE, Suite 3O0
Salem, OR S/i11G0151
Phone 50S9&4621
employer, you must withhold federal income tax from employees'wages.
'even if you didn'f.actually withhold the.tax, For more information, call
NOTE: This lnformation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Oregon Legislature.
o24N 10t24t89