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Home My WebLink AboutPermit Building 1991-07-05IELO RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK ASSESSORS MAP: LOT: l/\d JOB NUMBER 225 Fifth Street Spri ngf ield, Oregon 97 477 TAX LOT SUBDIVISION / BLOCK PHONE: L la.-,c-ZIP:STATE: o1 9zqo 5 74e- Cn -b CITY: OWNER ADDRESS REMODEL ADDITION DEMOLISH OTHERl'/ DESCRIBE WORK: NEW EXPIRES PHONEADDRESS MECHANICAL: ELECTRICAL: CONST. CONTRACTOR #ooNTRACTOR',S NAME fu l? GENERAL: PLUMBING I -5.N QUAD AREA:3R:0- \ [J. t\\\- OFFICE USE _ WATER HEATER: * OF BDRMS: RANGE: # OF BLDGS LAND USE: ZONING CODE: FLOOD PLAIN * OF UNITS: SECONDARY HEAT SOUARE FOOTAGE: OCCY GROUP: * OF STORIES: CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-3769. This is a24hour recording. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS Temporary Electric Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing 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/ Eleclrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain permanent electrical power. Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Fireplace - Prior to facing materials and framing lnsp. xt Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting. ffi Framing - Prior to cover. E OtherFoundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.E-'o*'lt - Prior to tapins MOBILE HOME !NSPECTIONS 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 installation 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. Sanitary Sewer - Prior to f illing trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. ) ---l,. l Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Line - Prior to filling trench.l-_l Fence - When completed Rough Plumbing - Prior to cover. Slreet Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. rf\L, E r E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Setbacks leqo ,/f THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED P.L.HSE GAR ACC N S ,fu E A I BU!LDING PERMIT ITEM SQ. FT. X $/SQ. FT.VALUE aggo 282!- g!t (A)?/,? s Total Value Building Permit Fee State Surcharge Total Fee Main Garage Carport 560 /(/o 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. r/r/qr ewed ByPIans Receipt Numbe 53 7-A;6- Date Paid Received Plan Check Fee 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 (c) N0 FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fi replace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By signature, I state and agree, that I have carefully 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 Springf ield, 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 Divislon. 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 of the property, and the approved set of plans will remain on the site at all times during construction. 1n- / -qtDate Signatu re MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut f t Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) 7/. 7< ^eigG 3 AMOUNT RECEIVED RECEIVED BY DATE PAID VALIDATION: RECEIPT NUMBER I FT. 5t.t t lrJc:l'1I:L(J 225 FIFTB STREEI SPRTNGFTELD, OREGoN 97 477 INSPE6II0N REQLIEST:. 726-3769 OFFICE: 726-3759 1. LOCATION OT LEGAL DESCRIPTION ,;1<t:-t '<2- 34' {>/#ct,' JOB DESCRIPTIONdfr;+aa Permits are non-transferable and expireif vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CO}rrRACf,OR INSTALI,ATION O}TLY Electrical Contractor Address ci ty-Phone Supervisor License Ndmber Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician Owners Name J, 5. STETOTAL OP ABOVB 5Z State Surcharge TOTAL BLECTRICAL PERHTT APPLICATION % City Job Number 3. COHPI.ETB IIBB SCIIEDTILE BBLOS A Nev Residential-Single or Hultl-Family per dwelllng unit. Service Included:Items Cost 1000 sq.ft. or less Eaeh additional 500 sq. ft or portion . thereof Each Hanuf'd Home or Hodular Dwelling Service or Feeder $ 8s.00 s 1s.00 s 40.00 Services or Feeders Installation, Alterations or ReLocation: Z- Sum B 200 amps or less l/'' 201 anps to 400 amps _401 amps to 600 amps _ 601 amps to 1000 amps_ 0ver 1000 amps/volts Reconnect 0nly 00S so. $ 60. =" 00 s100.00 s130.00 s300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less $ 40.00 0ver 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see rrBrr above Address Ci ty Phone 7(4 -ZIYZ OVNER INSTALINTION The installation is being made on property I ovn vhich is not intended for saIe, lease or rent. ovners Signature: DATE:-2 2 *7/ D. Branch Circuits Nev, Alteration or Extension Per Panel one circuit S 35.00 Each Additional Circuit or vith Service or Feeder Permi t i $ 2.00 ZCI" /t2 E. Hiseellaneous (Service/feeder -Each installation Pump or irrigation $ Sign/Outline Lighting_ S Limi ted Energy./Res _ $' Limi ted Energy/Comm $ not included) 40.00 40.00 20.00 36. O0 tr,, Oa)Y RICETVED BY: ) r 26o54,b-, Pennit No:'(r32- 3oZ 5,42'o/ lssued -"---J,,4/q2,/Date I22 -a7 STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. 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 box 1 and either box 2A or 2Bl 1.J:- lown, reside in, or will reside in the completed structure. 2. A.My general contractor is Contractor registratio_n number I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR nature o mit Applicant Date CONSTRUCTION @NTRACTORS BOARD 0244') 1ry2ffi WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT I hereby certify that the above information is correct and that I have read and understandthe lnformation Notice to Property Owners about Construction Responsibilities on the reverse side ol this form. B. H[ will be my own general contractor. lf I hire subcontractors, I will hire only subcontractors reoistered with theConstruction Contractors Board. lf I chanoe my mind and Eo hire a oeneralcontractor, I will contract with a contrattor'who is reoistered with theConstruclion Contractors Board and I will- immediately-notify the officeissuing this building permit of the name of the contraitor. v/ , N A-t t-,.--rr .?2-q/ @s Address: II{FOHMATION NOTICE TO PROPERW OTUNEBS ABOUT CONSTRUCNON BESPONSIB|IMES It you are acting as your own contractor to construct a new home or rnalce a structure, you can prevent many problems by heing aware of the ent lltiesto an existing and areas of concern EIITPLOYER RESPOI|ISIBILITIB comply with the or assisting in be ruled to be an "employer" and the people you followlng: the construction or improvement ofa U.8. lntemal Bevenue $elice: you will, in.most instances, . As the enijiloyer, you must lf you hire person$ not registered with the Construction Contractors Board to do labor ln constructing Or@on's Withholding IqIl*aU: AS an employori )ou:rnust ntithhH inmme taGf frorn smptoy€8 $,ag$ 'Youwillbeliablefortheta(paymentsevwtifyotdon'tac,tuallywlthhold the tar from y6ur-employebs. For more information, call the Oregon Departnpnt of Rovenue at $/8{KM. Unernployment lnsuran@f4 As an employer, you are reguired to pay a ta( fur unemployment insurence pployees'Formoreinformatlon,calltheoregonEmploymentDlvislonDHR at 378(ru4 __ . Workers' CompensatfqLhqqrapsg: As an emptoyer, you are subjest to theOregon Workers' Compens*t compensattoh ifisurance for youi ilmployees. lf'you fall to obtaln wo*ers' compensation insuraneo, you may be subject to penalties and wlll be llable for all claim costs if one of your'employees is injured on the [ob. For more inforrnatlon, call the Wo*ars'Compensatlon Division DIF at 37$7434. As an employer, you must withhold fed€ral lncome tax frorn employeas' tax paymeirt even jf you didrr't actually withhold the tax. For more lnforma. Sarvice at 221-0$0. wage$.You will be liable forthe tion, call the lnternal Ranenue CT}IEH RE$PONSIEILI|TfES AHD AHEAS OF CONCERIII: lf you have additional questions, write to: Co-deSompliance: As the permit holder for this proiect, you are legponslble for resolving any failure t@irenqenisthatmaybebrotrghttoyourattentionthroughlnspections. : Liabilitv and Property Darnage lnsurance: Contact your lnsurance agent to see lf you have adequate issionssubhasfallingtools,palntoverSpray,waterdamage from pipe punctules, flre, or work that must be r*done' Time,io Superv ise Employee$ Make sure you have sutfiaient tlme to superulse your,,employees' Expertise: Make sure you have the expertise to act as your owl-g?qsral:eontrqctorn !o coordinate ifie-Ed-rfi-of rough-in and finish trades, and to notify bullding offlclals at the approprlate tlmes so they can perform the reguired lnspections. Construction Conlractors Board 700 Summer St. NE, Suite 300 Salem, gH 973100151 Phone 50e37&{S21 wuJ 10,24'Ss NOTE: This lnformation; 'Notlce to Property Owners Absut Constfucti0n Responsibilitiee was developed by the Consfruction Contractors"Board !q accirrdance with Ofr$ 701,'065{5}, passed by the 1989 Oregon LsgislatUfa. . ' '