HomeMy WebLinkAboutPermit Building 1998-03-18RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
SPRINGFIELD
*fr,
LOCATION OF PROPOSED WORK:
ASSESSOBS MAP:
LOT BLOCK:SUBDIVISION
TAX LOT:
STATE:
PHONE:-ua%.3
CITY:
ZMc Vzr-Z>aAADDRESS:
OWNER:
zre, ?7frE
REMoDEL ,( ADDrroN 4 DEMOLISH OTHEB
DESCRIBE WOBK:
NEW
-ADDRESSE EXPIRES ,A PHONE
ELECTRICAL;
MECHAN
CONTRACTOR'S N
PLUMBING:
GENERAL:
CONST.
CONTRACTOR'f
RANGF-:
r OF BDRMS:
- OFFICE USE -
LAND USE:
WATER HEATEB:
ZONING CODE:
FLOOD })LAIN:
I OF UNITS:
QUAD AREA:
r OF BLDGS:
SECONDARY HEAT
SOUARF- FOOTAGE:
OCCY GROUP:
E OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an inspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All inspections requested before 7:00 a.m. wlll be
made the same worklng day, lnspections requested after 7:00 a.m. wlll be macle the followlng work day.
REQUIRED INSPECTIONS
Temporary Electrlc w
q
Rough Mechanical - Prior to
cover.w
w
w
w
Final Plumbing - When all
plumbing worl< is complete.
Slte lnspectlon - To be made
after excavatlon, but prior to
setting forms.
Rough Electrical - Prior to Final Eleclrical - When all
electrical work is complete.cover.
Underslab Plumblng/ Electrical /
Mechanlcal - Prlor to cover.Electrlcal Servlce - Must be
approved to obtain permanent
electrlcal power.
Flnal Mechanlcal - When all
mechanical work ls complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framing lnsp,
Flnal Building - When alt
required lnspectlons have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.4
W
Framlng - Prlor to cover.
Foundatlon - After forms are
erected but prior to concrete
placement.Wall/Celling lnsulation - Prlor to
cover.
Underground Plumblng - Prior
to fllllng trench.Drywall - Prior to taplng.
MOBILE HOME INSPE TTONSUnderlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decking.Wood Stove - After lnstallatlon.
Post and Beam - Prlor to floor
lnsulatlon or decklng.E lnsert - After flreplace approvql
and lnstallatlon of unlt.
Blocking and Set.Up - When alt
blocklng ls complete.
Floor lnsulation - Prior to
decking.Curbcut & AJrproach - After
forms are erected but prior to
placement of concrete.
Plumbing Connectlons - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plumbing
lnspections have been approved
and the home is connected to
the servlce panel.
Storm Sewer - Prior to filling
trench.
Sidewalk & Drivewav - After
excavation is complete, forms
and sub-base materlal ln place.
Water Llne - Prlor to filling
trench.
Fence - When coilpleted.
Streel Trees - When all requlred
trees are planted.
Flnal - After all required
lnspectlons are approved andporches, sklrting, decks, and
ventlng have been lnstalled.a Rough Plumbing - Prlor to
cover.fl
JoBNUMBE"@
225 Fifth Street
Spri ngf leld, Oregon 97477
a
Trf
E
Other
-
tl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Tyf
-_
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbacks , IS THE PROPOSED WORK TN THE .
HISTORICAL OISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be slgned
and approved by the Historlcal
Coordinalor prior to permit issuance.
APPROVED:
P.L.HSE GAR ACC
N
S
E
BUILDING PERMIT ' :
VALUE
(A)
7Total Value qfu+
ITEM
Main
Garage
Carport
Building Permit Fee
State Surcharge
Total Fee
SQ. FT. X $/SQ. FT.
This permit is granted on the cxpress 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.
Plans Reviewed By
E,
PE
Date
Recei pt Numbe
Plan Check Fee
Date Paid:
Received By:
i5lnru cHEcK
RM!T
BUILDING VALU
AND BUILDING
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
fn
P
(c)e
Nr
FT.
PLUMBING PERMIT
FT.
Plumbing Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
MECHANICAL PERMIT
_26.?(D)
No
Mechanical Permit
lssuance
State Surcharge
Total Permit
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby cerflfy that all
lnformation hereon is true anc, correct, and I f urther cerflfy
that any and all work performed shall be done in accorrJance
wlth the Ordinances of the City of Springfield, and the Laws
of the State of Oregon perlaining to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure without perrnission 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
proiect.
I further agree to ensure that all required inspections are
requested at the proper time, that each address ls readable
from the street, that the permit card ls located at the front
and the approved set of plans will remain
Slgnature
Date
of the prope
timeson the site construction
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Perrnits (E)
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, Q and E Combined)
/zri,4
VALIDATION:
RECEIPT NUMBER 2
DATE PAID
AMOUNT BECEIVED
RECEIVED BY
2
@72@
FT.
SPFI',r,GF'ELOf].81UZ ,sF,ffdrti*ifl#;r"CITY CREGON
Affutsed
225 FIFTE STREET
SPRTNGFTELD, oREGON 97471
INSPECTION REQUESTz 726-
OFPICE: 726-3759
EXP rie,trrne
't'r\\g ['E Rtvl\T SHALL
UNOER ftts PERMII ISNOl
ED ORIS
PERHIT APPLICATION
,,rRYTXi:Number Q I Oz )1
1. LOCATION OF INSTALLATION
c
DESCRIPTION
LLAS LB/€ills
Address ql ZO UA
Ci ty Phone 744-O \ b'a
q1 7B
OVNER INSTALT^A,TION
The instatlation is being made on
property f ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
DATE.:
City Job
COI{PLETE FEE SCEEDTIIJ BELOI{
Nev Residential-Single or
Multi-Family per dvelling unit'
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home- or
Modular Dvelling
Service or Feeder
s 8s.00
$ 1s.00
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
2. COMRACTOR INSTALI.^ATTON ONLY
Electrical Contractor Beacon Etectric
Acidress 25 B5 Roosevelt
Ci ty Etroene Phone 461 -)q1
Supervisor License Number 3485S
Expi ration Date l0 / L/98
Constr Contr. Number 8497
Expj.ration Date 1/n/qg
s of Su rvising Electrician
4 q5 NoPII{3h7\ sf
F,Y PERIOD.
3.
A.
Sum
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if work is suspended for
180 days.
D{
B
200 dmps or less t
201 amps to 400 amPs
-
401" amps to 600 amPs
-
601 amps to 1000 amPs-
0ver 1000 amps/volts
-
Reconnect 0nIY
c.Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less $ 40.00
over 4b1 to 6oo amps
-
$ Bo.oo
over 600 amps or 1000-vofts see I'B* above
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit - l-l $ 2.00 e4-,X
E. MiscelLaneous (Service/feeder not included)
-Each installation
Pump or irrigation
-
Sign/0ut1ine Lighting_
Limited Energy/Res
Limited Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
.s s0.00
s 60.00
s100.00
s130.00
s300.00
s 40.00
=o
D
$
$
$
s
40.00
40.00
20. 00
36.00
4
<)JLz
-3tc:TLRECEIVED
5
Permit #
Address:
Issued by Date 3*/€€€
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residentiol construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before q 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.
Fill in the appropriate blanks and initial boxes I and2, and either box 34. or 3B:
m l. 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
Qrlame) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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 notify the office issuing this building permit of the
name of the contractor.
I hereby certiff that the above information is correct and that I have read and do understand the Information
about Construction Responsibilities on the reverse side of this form.
OR
"ky'nof permit applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
Notice to
6^g
V
ir+
Iirforrnation Notice to Property *wnens
. About Coystfuction Re*ponsibiIitie*
I -:. -
''tt'tt^s det,clrtl,t:t/ h) tlte {.'olis-tl*Cfion ('.9ntrot'trsr.r l}o*rd itt rst't:orr&trtr:t *t!/t (/&.1 -ljl"{ij-t/,i/.
:,,
),ou can pr*l,ent qran) pr+blems. b;;.being ;llrare of the ibllo*'ing resp,;*sibilities-and areas o1'cotlc'em. :.,.1 :; . .] i:'
, .EMPLOYER RESPON$I BI LITI ES:
,vou hire will bc errploy'ees. As thi ernplol,'er. \ r)u nlust compll, rr ith the follo*'ing: .
:
Oregon'sx'ithholdingfaxl:rrv: A;anernpiover.\ournustu'ithholdincometaxesfiomemploveervagesatthetirncernplovees
are paiil, Y*ir rvill be liahle fbr the tax pa),'ments even ii'.r.'ou dcn't aetu*ll.v ivithhold the tax fioln Srour employees. Fr:r m*re
inlbrrnatiou. call the Or*gon Dept. of Revenue at 945-8091
Unemployment insuraxce tax: 1\s ar emplo)'er. you are recluired to pa)' a tax for unenrplo;-ment insurance purposes on the
!\,agescrfallenrployees. Formoreinfonnatiou"callt[,te,Qrego*Emplpyment Deparlment?f37$:35?4. j:i,]-- . .:rr{, -. ;i' r
U.S.InternalRevenue Serviee: l.sanernployer.voLrmustrvithholdfederalirrcomt: taxfrornernplo;ees'\\ages. Youivil!.be_
liabie for&e tili payment eve n ifyou didn't actually withhold the tax. For rnore inlbrmation. call the lnternalR6VenuOservice I
OT$**R ME$PSN$'BILITIES AND ARHAS OF CONCERN:
Cod*complianee: Asthi:pcr*rithoiderfirrthirpri:;cct.)(1rr arercsllonsiblelcrresoivingafir'triluretomct:tcodcrequirements
that may be brought to )'our allention through inspections.
Liahilit-v and propcrt-v darnagc insurance: Contact 1'our insurance asent to sec if vou have adequate insuranoe coverage for
accide4ts anclornissii:*s such as fa;ling tocls,paint oversptay, r.va,ter damage flom pipe punctl.ie;. tire. or rvork that rnust be
re-done.
trdde$, and tb no:i$/ building ofTiciels at the apprcpriate times so the.v can perfcrnn the required inspections.
, :
If you lrave aclditiona.lq:;eslier:'r:" rvritr: or call the {lonstruction Contractors lJoarcl {P0 Box 14140. Salem. OR 97 09-505]"
5031378-"tir2l). TheBaard is ltcateri at T{}0 Surrlrner Sr.\tr Suite 300, inSalem., :.
prop-orvn.pm4
U94
Workers' compensation insurance: As an e rnplol.'er, )i!u :ye subjelatto the f)regon Wr:lrlier;' Cor$Settsation,Law, and m$S
obtain workers'compensation insurai:ce ttir vour employees. Ifyou fail to obtain workers'cornpensation insurance, ,votr niaJl
be subiect to penalties and rvill be liable lbr all cla im costs ifone ofr-our ernployees is iniured on the tob. FoI more intbrmation- ,
carfilie Wu.(*id'ic'onrpensation DivTiion dt'the Deilzirtmbnt ofConruni.. ni,r.t irusiness sc'"r,i..rii i+s- 78881" ' .- ,
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