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Home My WebLink AboutPermit Building 1993-07-26P,lINGFIELE, R ESID ENTIAL PERMIT APPLICATION lnspections: 726'3769 Office: 726'3759 ?fr, JOB NUMBER Qzo g 3-/ 225 Fifth Street Springfield, Oregon 97 477 zq ?s3_1 e Q_,h c-o - LOCATION OF PRO ASSESSORS MAP: POSED WORK:i1 o TAX LOT: SUBD!VISION 4( LOT:BLOCK: PHONE ?74 ZIP:STATE:oc, 2+6- {3 Pac 77+?rr. d 9, + CITY: 3rrADDRESS OWNER REMODEL ADDITION DEMOLISH OTHER RK:DESCRIBE WO *.*/, PHONEEXPIHESADDRESSAMEL. ELECTRICAL CONTRACTOR'S MECHANICAL: CONST. CDNTRACTOR # GENERAL: PLUMBING HPF,. €z 3 RSL, Q1 +ln )1 <(- lil * OF BDRMS: WATER HEATER: -- _ OFFICE USE - LAND USE: RANGE ZONING CODE: FLOOD PLAIN 'T OF LINITS QUAD AREA: g OF BLDGS: SECONDARY HEAT: SQUARE FOOTAGE: l OCCY GROUP: I OF STORIES: CONSTR. TYPE HEAT SOURCE: To request an inspection, you must call 726-376g. This is a 24 hour recording. All inspections requested before 7:o0 a'm' w .ro"'tn" same working day, inspections requested after 7:00 a.m. will be made the following work day' REQUIRED INSPECTIONS Rough Mechanical - P!'ior to covei'. Final Plumbing - When all plumbing work is comPlete. Rough Eleclrical - Prior to ill be fr tutnoorar, Eleclric ,E, X X tr IVI Electrical Service - IVlust be ,l^"pptored to obtai n Pe!'manent electrical power. K, Site lnspection - To be made after excavation, but Prior to setting forms. Underslab Plumbing/ Eleclrical / Mechanical - Prior to cover. Footing - After trenches are excavated. Masonry - Steel location, bond beams, grouting. Foundation - After forms are erecled but prior to concrete placement. Underground Plumbing - Prior to filling trench. U nderll - Prior on Posl and Beam - Prior to floor insulation or decking. Floor lnsulation - Prior to decki ng. Sanitary Sewer - Prior to f iiiitrg trench. Storm Sevrer - Frior to filling trench. cover, Fireplace - Prior to facing materials and framing lnsP. Wood Stove - After installation lnserl - After fireplace approval and installation of unit. Curbcut & APProach - A{ter forms are erected but Prior to placenrent of concrete. Sidewalk & Driveu,raY - P'fter excavation is comPlete, lorms and sub-base material in Pla':e. Final Electrical - When all electrical work is comPlete. Final Mechanical - When all mechanical work is comPlete. ,K K ,ft ; ;;,BJ'if :??;#J i?#' o"u "approved and buiiding is completed. X,y;;;Line - Prior to rirring Xf*: Prumbins - Prior to f--l Fence - When completed. ffir""t Trees - vJtren arl required \9?r:es are Planted. MOBILE HOME INSPECTIONS Electrical Connection -- When blocking, set-up, and plumbing inspections have been apProved and the home is connected to the service Panel. Final - After all required inspections are approved and porches, skirting, decks, and venting have be,:n installed. {tt"*'ng - Prior to cover' Fut wattlceiling lnsulation'- Prior to !4covet. ,(o,v*"ll - Prior to taping' F ,x. tr x, X Plum I I [-.l other [-l alocking and Set-Up - When alllJ blocking is comPlete. l--l Plumbing Connections - Whenu home has been connected to water and sewer. E T Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type X lnterior -- Corner - Panhandle - Cul-de-sac Setbacks QZ?,C 239.14" 15' IS THE PROPOSED WORK IN THE HISTOFIICAL DISTFIICT, OR ON THE HISTORICAL REGISTEB? =- lf yes, this application must be signe<J and approved by thc Hrstorical Coordinator prior to permit issuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granteci cn the express condilion that the saicJ construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, re(tulating the construction and use of buildings, and may bc suspended or revoked at any timc upon violation of any provisions of said ordinances. Plan Check Fee:q Date Paid: 1+Fleceipt Number:-q Received P icwed By e PL.HSE GAR ACC N 5 S /5 /4 E /G,a9 35 3,es(A) o Ll1 3,? 33t7,a,o lt b1 ,b32- X $/SO. FT. *b.2 Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SO. FT. Main Garage Carport = VALUE (A')LlLl 33L lY r SYSTEMS DEVELOPMENT CHAR (B) GE (sDC) g # tqsq 4"Systems Development Charge is due on all uncleveloped properties within the City limits which are being rmproved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE /agr /(4?aA &o (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Pcrmit State Surcharge Total Charge ADDITIONAL COMMENTSsGs /5 A +T 'q Wood Stove/ lnsert/ Fireplace Unit Dryer Vent 4.fo 42 -)-, 5a-24 1 /0,@ 3 93 Ps(D) ,/M(e, ?,@No _7 1. /3 MECHANICAL PERMIT Mechanical Permit lssuance State Surcharge Total Permit Fu rnace Exhaust Hood Venr Fan 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 urtiier ce!.tily that any and all work pcrformed shall be done in accordance with the Ordinances of the City of Springf ield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be nrade of any structure without permission of the Building Safety Division. I further certify that only oorltractors and employees who are in compliance with ORS 70'1.055 will be used on this project. I f urther agree to ensure that all required inspectio.ns are requested at the propcr time, that each address is readable from the street, that the permit card is located at the front const ction of the property, and the a ved set of plans will remain es duon the site at Date \Z / Signature MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - f t Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) VALIDATION: RECETPT |JUMBER_t\ DATE PAID - \ ) EDAMOUNT R BECEIVED TOTAL AMOUNT DUE (excluding electricai) (A, B, C, D, and E Combined) ?5ts9t @m@r E-'co'*""o (---*C,\*1b<,'ta!-p- Wkr,tze 225 FIFTB STREEf, SPRTNGFTEIJ, OREGON 974 INSPECTION REQIIEST. 72 oFPICE: 726-3759 1. LOCATION OT I.EGAL JOB DESCN PTTON Permits are non-transferable and expireif vork is not started wlthin 180 daysof issuance or if work is suspended for 180 days. 2. COT{TRACf,OR INSTALI,ATION ONLY Eleetrical Contractor ,1 f / A<id ress pnone 216/-s77 / 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder st'rilNGl"tGLI) $ 40.00 $ s0.00 $ 60.00 s100.00 s130.00 $300.00 $ 40.00 r Extension Per Panel s 3s.00 L-/ g 85.00 ES I $ls.oo l5--t--- I ab'i . , : .- ,.,. '^-.i -:, ,r,' r.: ,^.'! ELEGIT.ICAL PERHIT APPLICATI0N 776-376s Lp- city Job nu v., ? 3073/ i 't 'tt- -(tt 3. COHPI^ETB FEB SCffiDULE BEL0V tial-Single or HuIti-Family per dvelling unit. Service Included:Items Cost Sum 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_ Over 1000 amps/volts Reconnect Only Supervi sor License Ntimber 3 <-Z >S Expiration Date /C-/-Q f Constr Contr. Number 6,- r f, Z? Expiration Date ,/ )- rr(-? 5 Ci ty Phone 7#- G244 OIJNER INSTALI.ATION The installation is being made on property I ovn vhich is not intended for saIe, lease or rent. 0vners Signature: DATE: B ci c Temporary Services or Feeders Installation, Alteration or Relocation Signature of Supervising Electrician D. Branch Circuits tJvners Name Address <BS S 3 7U rr.Nev, Alteration 0ne Ci.rcui t Each Additional 200 amps or less $ 40.00 0ver 401 to 500 amps _ $ 80.00 Over 600 amps or 1000 volts see 'rBrt above ? I I Circuit or vith Service or Feeder Permi t STETOTAL OP ABOVE 5Z State Surcharge TOTAL ,/€c'Stco /CSroo s 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ Sign/OutIine Lighting_ $ Limi ted Energy/Res S Limi ted Energy/Comm S 00 00 00 00 AO 40 20 36 RECEIVED BY: 5 Permit No: Address: lssued by (- 1,1( Date: R OFFICE USE ONLY 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. A 1 2 3 My general contractor is , Contractor registration num 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 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 lnlormation Notice to Property Owners about Construction Responsibilities on the reverse s thi ?-7G 7 g rm pplicant CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 Date WHITE COPY TO ISSUING AGENCY PERM]T FILE PINK COPY TO APPLICANT INFORMATION NOTICE TO PROPERTY OWNEHS ABOUT CONSTRUCTION RESPONSIBILITIES 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. Oregoh Legislature. .: lf you are acting as your own contractor to construct a new home or make a substantial improiement to an existing structure, you can prevert many problems by being aware of the following responsibil.[ftes and areas of concern -' EMPLOYER BESPONSIBILITIES: lf you hire persons not registered with the Construqtion Contractors Board to do labor in constructing or assisting in the construction or improvement of a rOsidential'structure, you wilJ, in niost instances, be ruled to be an "employer" and the people you hire will pe "employeeS','. As the'employ"r,'you'mus!ggmply With the following: Oregon's Withholding Tax Lawi As an employe u will be liable rI you must withhold incorne taxedfrom employee wages at for the tax.payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Depar:tment of'Revenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all.ernployees. For more information, call thg Oregon f.ry;ployment.Division DHR at 378-3224. Workers' Compensation lnsurance: As an employer, you are subiect;to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to'. obtain workers' compensation insurance, you may-be subject to penatties anO will be liable for all c'laim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 973-7434. U.S. lnternal Revenue,9ervi.ce: As qn epployer,-vou musJ rqvithhqld federal income tax from employees'wages. vm.9pt9vqlifv.oydidn't:actuallywithholdthetax.For-moreinformation,call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCEBN: , Code Compliance: As the:permit holder for this project, you are responsible for resolvrng any failure to meet code requiremgnts that may.Oe Uropn] to )rour, attention'tfiro"uen inspections. .: Liability and'Property Damagelnsurance: Contacl yourii'i5urance agent to see if you have adequate insurance coverage for accidents and om ons such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficienl time to supervise your employees. .- t r : i .?:il 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. lf you have additional questions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-$/84621 0244J 10t24t89 B No. 1>oq>* CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (C0MMERCIAL & RESIDENTIAL) NAME OR COMPANY:t 027 7 - oo30z LOCATION: 'Na,tt ,#EDEVELOPMENT TYPE:LO? SI sQ. Fr. BUILDING SIZE: 1. STORM DRAINAGE IMPERVIOUS SQ. FT.27 4 u x $0. lez PER sQ. FT. 2 SANIT ARY SEWER -CITY NO. OF PFU'S Ig X $39.78 PER PFU (See Reverse) TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP 3 I X X I .oo 5 x $401.05 x $401.05 x $401.0s 4 ADMINISTRATiVE FEES BASE CHARGE (SUBToTAL AB0VE) X .05 5. SANITARY SEL{ER-MI,,IMC NO. OF PFU'S g (Use PFU Total From Item 2 Above ) MhIMC CREDIT IF APPLICABLE (SEE REVERSE) R*L,L Kip Burdick SDC Goordinator $ $ SUBT0TAL (ADD ITEMS 1,2, & 3)s ta4o72 TOTAL-CITY SDC S IIiA* $13.62 PER PFU + $10 Mt,lMC ADMIN. FEE s 255!9 Z ?-o TOTAL-Ml^ll4c SDC TOTAL SDC (, s 51 6 I FXTURE UNIT CALCULAI - N TABLE: t'tumuer of New Fixtures X For remodels, calculate only the NEJ additional fixtures) NUMBER OF FIKI-URE TYPE NEW FIXTURES Bathtub....... Drinking Fountain-.--- Floor Drain.. """"""""""" I lnterceptors For Grease/Oil/Solids/Etc lnterceptors For Sand/Auto Wash/Etc" Laundry Tub/Clotheswasher Clotheswasher - 3 Or More.- Mobile Home Park Trap (1 Per Trailer) Receptor For RefrigeratorAVater Station/Etc"""" Receptor For Commercial Sink/Dishwasher/Etc" Shower, Single Sta|l........-...- Shower, Gang........... Sink, Bar, Commercial.. Urinal, StallflVall...ZWash Basin /l'avatory, Single-. -. ---... Water Closet, Public lnstallation..?-Water Closet, Frivate... ltrliscellaneous: TOTAL FIXTURE UNITS Equivalent = Fixture Units (NOTE: 'tl UNIT EQUIVALENT FIXTURE UNITS 2 1 2 3 6 2 6 b 1 3 2 1 /Head 2 2 1 6 4 CREDIT CALCUI.ATION TABLE calculate credits separates- Based on assessed value. lf improvements occurred after annexation date in table' 2 .83 x$8.Es 24'3 Credit for Parcel or l-and Only lf Applicable lmprovement (if after annexation date) (Rate X Assessed Value) X$ (Rate X Assessed Value) CREDIT TOTAL - $ RUNOFF COEFFICIENTS FOR STORM DRAINAGE 2+'e Year .Annqxed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value 1979 or before 1980 1981 1982 1983 1984 $2.83 2.76 2.71 2.60 2.46 2.33 1985 1 986 1987 1988 1989 1990 't991 $2.16 1.90 '1.60 o.25 0.87 0.50 0.16 IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT I ll t- z ___-^ t- L --T- l8 I