HomeMy WebLinkAboutPermit Building 1995-11-22SPRIt\r FIELE,
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Of f ice:Zfr,
RESID ENTIAL
PERMIT APPLICATION
tions: 726'3769
726-3759
LOCATION OF PRO
ASSESSORS MAP:
POSED WOBK:
JOB NUMBER
225 Fifth Street
Springf leld, Oregon 97477
a/
TAX LOT:
rt
Z a
LOT: BLOCK: SUBDIVISION
OWNER:
STATE: C) P EGO,U -CITY:
PHONE:7/7-lo r<?
ADDRESS /_
ZIP:Q> q>p
\/ ADDtrtoN DEMoLIsH orHER
DESCRIBE WORK:
NEW--.- BEMODEL
PLUMBING:
ADDRESS EXPIRES PHONECONTRACTOR'S NAME
MECHANICAL:
ELECTHICAL
CONST.
CONTBACTOB ,f
RANGE:
r OF BDRMS:
- OFFICE USE -
LAND USE:
ZONING CODE:
FLOOD PLAIN
WATER HEATER:
I OF UNITS:
SECONDABY HEAT:
SOUARE. FOOTAGE:
QUAD AREA:
I OF BLDGS:
OCCY GROUP:
r OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspecilon, you must call 726-376g. This ls a 24 hour recording. All lnspections requested before 7:00 a.m. will be
made the sante worklng day, lnspections requested after 7:00 a.m. will be made the followlng work day'
REQUIRED INSPECTIONS
I TemRorarY Electrlc
Site lnspection - To be made
af ter excavation, but Prior to
setting {orms.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Piior
to f llllng trench.
Underlloor Plumbing/ Mechanical
- Prior to lnsulatlon or decking.
Post Lnd Beam - Prior to floor
lnsulation br decklng.
Floor lnsulation - Prior to
decking.
Sanitary Sewer - Prior to f llling
trench.
Storm Sewer - Prior to filling
trench.
Water Llne - Prlor to filling
trench.
Rough Plumblng - Prior.to
cover.
'Rough Mechanlcat - Prior to
cover.
Rough Electrical - Prior to
cover
Electrical Service - Must be
approved to obtain Permanent
electrlcal power,
Fireplace - Prlor to faclng
materlals and framing lnsP.
Final Plumbing - When all
plumblng work is complete.
F/Flnal Electrical - When all
lAelectrical work is comPlete.
\-7lFinal Mechanical - When all
,F{.u"nanical work ls comPlete'
E
Wall/Ceiling lnsulation - Prlor to
cover.
Final Building - When all
required lnspectlons have been
pproved and building is
completed
Other
MOBILE HOME INSPE TIONS
Blocking and Set-Up - When all
blocklng ls complete.
Plumbing Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set-up, and plumbing
lnspections have been approved
and the home is connected to
the servlce panel.
Final - After all required
inspections are approved and
porches, sklrting, decks, and
ventlng have been lnstalled.
,(ttuo.'ng - Prlor to cover'
fi otr*ull - Prlor to taping'
l-l Wood Stovo - After lnstallation
lnsert - After flreplace aPProval
and installatlon of unlt.
Curbcut & APProach - After
forms are erected btlt Prior to
placement of concrete.
Sidewalk & Drivewav - After
excavation is comPlete, forms
and sub-base material in Place.
Fence - When comPleted
Street Treos - When all required
trees are planted.
?5 *^o
6 ?z cl.a
A 1t),el?
w
E
E
tl
E
tl
E
n E
r
E
E
Lot faces
Lot sq, ftg.
Lot coverage
Topography
Total height
Lot Type
_- lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
ks
PL.HSE GAR ACC
N
S
E
S IS THE
HISTOR
APPROVED:
PROPOSED WORK iN THE.rcAL DtSTRtcI oR ONTHE HISTORICAL REGISTER?
-
lf yes, this application must be slgnedand approved by the Histoilcal
Coordinator prlor to permit issuance.
Total Value
Building Permit Fee
State Surcharge ,%& + ,€j
BUILDING PERMIT
VALUE
/ %?t
2
SQ. FT. X $/SQ. FT.
do
Total Fee (A)
ITEM
Main
Garage
Carport
^ 3t ,etVr
4qz;u,t<"_
,n
/?.5-),4t
750?
Py.[D_tNG VALUE, PLAN CHECKAND BUILDING PCNNAIT
Recei pt Number:---
DatePIans Flcviewed t3y
Receivecj By:
Date Paid
EMS DEVELOPMENT CHARGE (SDC)
(B)
SYST Systems Development Charge is due on all undevelopedproperties within the City linrits which are being improved.
ITEM .
Fixtures
Besidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
PLUMBTNG PERMIT
FEE
No
FT.
FT.
(c)
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
/.2',7f +td
-) ,/ 20-4A"(D)
..7//)
,/a,e
20
No
Mechanical permit
lssuance
State Surcharge
Total Permit
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have caref ully examlnedthe completed application and do hereby certify that alllnformation hereon is true ancl correct, and I f urther certifythat any and all work performed shall be done in accordancewlth the Ordinances of the Clty of Springf ield, and rhe Lawsof the State of Oregon pertainlng to the work descrlbedherein, and that NO OCCUPANCy will be macJe of anystructure without perrnission of the Building Safety Divislon.I further certify that only contractors and employees whoare in comptiance with ORS 701.055 wiil be used on thlsProiect.
I further agree to ensure that all required inspections arerequesled at the proper ilme, that each address is readabrefrom the street, lhat the permlt card ls located at the frontof the property, and the approved set of prans wirr remarnon the site at all times during construction.
2fu.,u,"
Date
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk _._- ft
Curbcut _ ft
Demolltlon
State Surcharge
Total Miscellaneous permits (E)
? "Er"'3b
TOTAL AMOUNT DUE (exctuding electricat)
(A, B, C, D, and E Combtned)
VALIDATION
FIECEIPT N
DATE PAID
AMOUNT R
RECEIVED
UMBER
ECEIVED
BY
G
This permit is granted on the express condition that the saidconstruction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, inctuding theDevelopment code, regurating the c-onstruction and use ofbuildings, and may be suspended or revoked at any time.upon violation of any provisions of said ordinances.
Pran Check r"i,
-11,39
-z-7-
FT.
CITY OF OREGO'U
approval.
Zoni
Date
69
Authorized
1. LOCATION OFz
I.EGAL DESCRIPTION
JOB DESCRIPTION
Permits are non-transferable and expire
tf vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
ci tv-Phone
Supervisor License Number
Exp iration Date
Constr Contr. Number
Expiration Date
Signature of Superv ising Electrician
225 TIFTE STREET
SPRINGFIEI,D, OREGON 97 477
INSPECTION REOUEST.. 726_37
0PFICE: 726-3759
\
Ci ty Phone
OIINER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
0vners Signature:
DATE:
SP]l*GFIELr,
ugo
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Admini.strative Fee
TOTAL
I : : l,?ixY!% s:?*, ff.lFrj[*,m.'m
ovners xame JailtJ.+ A$JzttG(-€
Address I < v,,
BI,ECTRICAL PERHIT APPLICATION
ci Job Nunber Q.{' @^ ?
3. COI{PI,ETE FEE SCEEDTILE BELOII
Nev Residential-Sing1e or
MuIti-Family per dvelling unit.
Service Included:Items Cost
L000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 8s.00
s 1s.00
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
-40L amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect 0n1y
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less $ 40.00
201 amps to 400 amps
-
$ 55.00
over 4b1 to 6oo am'ps
-
$ Bo.oo
Over 600 amps ot' 1OOO voTEs see ttgtt
"f,ffi
Nev, Alteration or Extension Per Panel
A.
Sum
B
c
D
s s0.00
s 60.00
$100.00
$130. 00
$300.00
$ 40.00
E
One Circui t L' $
Each Additional
Circuit or vith Service
or Feeder Permi I I S
Miscellaneous ( Service/feeder
-Each installation
Pump or irrigation _ $
sign/0utline Lighting- $
Limited Energy/Res T $
Limited Energy/Comm $
3s.00 3y
2.00 _x
I
not included)
.!
40.00
40.00
20.00
?ry d-o
-UJJ-'/.95T_2eqaRBCEIVED
5
77.
Permit #:/az
Address 22
Issued by:Date
Statem€nt: 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.
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.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.
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 notify 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 do understand thelnformation
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
/t --z(Signature of permit applicant)
(White copy to issuing agency peftnitfile,
pink copy to applicant)
OR
(Date)
-?-f
Fill in the appropriate blanks and initial boxes I and2, and either box 3,{ or 38:
X
,tr'
X
Inforrhation Notice to Property Owners
::
Note: '{his Information Notice to Propert'l Owners about Constru#ion Responsihilities-
was developerl by the Construction Contr*ctors Ba*rd in *ctordance with ORS 701.055(5).
If ycu are acting as yfiur own contraetor tfi ccnstr$ct a *f,w horne or n:ake a -cubstanti;d improvement to an cxisting stnlcture.
you cffn prevefit rnany problems by being aware of the following responsibiiities and are:rs of conceffi.
EMPLOYER HESPONSIBILITIE$:
lf you hire persons nct registered with the Construction Contractors Board to do labor in r:onstructing or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees, As the employer, you must comply with the following:
Oregon's withholding tax law; As an employer, you. must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't 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 informatioar, call tha Oregon Employment Division at the Department of, Huuran Resources
at378-3524
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Cornpensation Law, ard'{nust
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
be subject to penalties and will be liable for all claim.i*sts if one of your employees is injured on the job. For more informatid,
call the Workers' Compensation Division at the Department of Con$umer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. You will be
liabieforthetaxpaymenteven ifyoudidn'tactuallywithholdthetax. Formoreinformati*n,callthelnternalRevenueService
at l-800-829-1040.
OTHEH RESPONSIBILITIES AND AREAS OF CONCEHN:
Code compliance: As the permit holder for this pr*jeet, you are responsihie f*r r*nolving any failure tc rneet code requirements
that may be brought til y*ur attention thrcugh inspections"
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint oyerspray, water darnage freim pipe punctures, fire, or work that must be
re-done.
Time to supervise crnplo,yees: M*ke sure you have sufficier:t lirne to supervlse your employees.
Expertise: Make sure you have the experfise to act as your own general contractor, to cnordinate the work of rough-in and finish
trades, and to notify building o,fficials at the appropriate times so they can perform the required inspections.
trf you havo additional questions, write or call the Construction Contractors Board (PO Box 14i40, Salem, OR 9?3fi9-5052,
503/3?8-4521). The Baard is li:cated at 700 Summer St. hrE Suite 300, in Salem'
prop-own"pm4
lt94