HomeMy WebLinkAboutPermit Building 1994-11-04ESIDENTIAL
ERMIT APPLICATION
lnspections: 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
R
P
ASSESSORS MAP:
LO-l] BLOCK:
To request an lnspecilon, you must call 726-3769. Thl
made the same worklng day, lnspectlons requested
Temporary Electrlc
Slte lnspectlon - To be made
after excavatlon, but prior tosettlng forms.
Underslab Plumblng/ Electrlcal /Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
PRI ELE)
JOB NUMBER
225 Fifth Street
Springfleld, Oregon 97477e
TAX LOI 2d=---
SUBDIVtSiON: --
s ls a 24 hour recordrng. Alr rnspections requested before 7:00 a.m. wilr beafter 7:00 a.m. wlll be made the following work day.
REOUIRED TNSPECTTONS
Rough Mechanlcal - prlor to
cover.
?->?-Y >
Eleclrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
- When all
ls complete.
Flnal Mechanical - When allmechanical work ls complete.
Plumblng Connectlons - When
home has been connected to
water and sewer.
Eleclrical Connection - When
blocking, set-up, and plurqbing
lnspections have been approved
and the home is connected to
the service panel.
Final - After all required
lnspectlons are approved andporches, sklrting, decks, and
ventlng have been lnstalled.
[---l Finat ptumbins.J plumbing work
| ,zf Rough Electrlcal - prlor tot-I cover.fftflnd Electrical - When ail
-
electrical work is complete.c
I gl Foundatlon - After forms areH erected but prlor to concrete
placement.
Masonry - Steel locatlon, bond
beams, groutlng,
Underground Plumblng - Prior
to fllllng trench.
Underlloor Plumblngl Mechanlcal
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulatlon - Prlor to
decklng.
Sanltary Sewer - Prlor to fllllng
trench.
Storm Sewer - Prior to fllllng
trench.
Water Llne - Prlor to filllng
trench.
RouEh Plumbing - Prlor to
cover.
[l Flreplace - Prtor to faclngu materlals and framlng lnsp.
@framlng - Prlor to cover.
I e,{Flnal Building - When ail
'J requlred lnspectlons have beenapproved and building is
completed.
[-_l Blocking and Set.Up - Whep ail
-
blocklng ls complete.
WalltCblllng lnsulatlon - Prlor to
cover.
Drywall - Prlor to taping
Wood Stovo - After lnstallatlon.
lnserl - After flreplace approval
and lnstallatlon of unlt.
Curbcul & Approach - After
forms are erected but prlor to
placement of concrete.
Sidewalk & Drlveway - After
excavation ls complete, forms
and sub-base malerlal ln place.
Fence - When completed
Slroet Trees - When all requlred
trees are planted.
Other
MOBILE HOME INSPECTIONS
- 3 /// (ffirzt
STATE:ztP:
I
OWNER:
ADDRESS:
CITY:
PHONE
NEW
-.
REMODEL ADDITION DEMOLISH /
OTHER
DESCRIBE WORK:
ADDRESS EXPIRES PHONE
CONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
QUAD AREA:SC;rt t
- OFFICE USE -
LAND USE:
r OF BLDGS:
FLOOD PLAIN
r OF UNITS:ZONING CODE:
r OF BDRMS:
OCCY GROUP:
I OF STORIES;SECONDARY HEAT
SQUARE FOOTAGE:
CONSTR. TYPE
HEAT SOURCE:
WATER HEATER:RANGE:
\
tl
t]
E
tl
tl
E
E
fl
tl tl
I
tr
Lot faces
Lot sq. ftg.
Lot coverage
TopographY
Total [elght
Lot Typ.
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
i IS THE PROPOSED WORK TN THE -
HISTORICAL DISTBICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcatlon must be slgned
and approved bY the Historlcal
Coordinator prlor tg permit issuance.
APPROVED:
ADDITIONAL COMMENTS
PL.HSE GAR ACC
N
S
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
consiruction shall, in all respects, conform to the Ordinance
adopted by the City of Springfleld, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any tlme
upon violation of any provisions of sald ordinances'
Plan check r"", %' 2 3
,4= a-rDatePaid: -'z / -'
l.^s7 z/tq--fDEtePlansBy
Receipt Numbe
By:Rec
BUILDING PERMIT
VALUE
lo l5E.%2
13.8
Aez
(A)
P
SO. FT. X $/SO. FT,
gG.9
{.13+ 3? 6. t3-
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
DEVELOPMENT CHARGE (SDC)
uEAL Tb 4e'.6d @
SYSTEMS
ITEM
Fixlures
Besidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
6(c)
FT.
FT,
FT.
PLUMBING PERMIT
Plumblng Permit
State_ Surcharge
Total Charge
N0
Wood Stove/ lnsert/ Fl replace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permit
lssuahce
State Surcharge
Total Permit
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure wlthout permission of the Building Safety Divislon.
I further certlfy that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on thls
prolect.
I further agree to ensure that all required lnspections are
reguested at the proper time, that each address ls readable
from the street, that the permlt card ls located at the front
of the property, and the approved set of plans will remain
Date
son the site at all times durin constructlon
X,n",u,.u
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)6
TOTAL AMOUNT DUE (exctuding etectricat)
(A, B, q D, and E Combtned)
AMOUNT RECEIVED
BECEIVED BY
DATE PAID
VALIDATION:
RECEIPT NUMBER
6
SPEIalGFTELO
Tho following project
zoning, end doos not
8S
reauiro op'ecifio lar,d us€
225 FTFTE STREET
APPTOVAI'
SPRTNGFTELD, oREGoN 97477 Zct'ri
INSPECTION RxQt EST | 7fldr3769
OFFTCE: 726-3759
1.
Authorlzod signsturo 3 = eeilf'-rE- FEE scmDULE BELog
A- Nev Residential-Single orl4u1ti-Family per dvelling unit.Service Included:
ELEfiRTCAL PERHTT APPLICATTON
City Job Number t3b?-
I tems Cos t
$ 8s.00
Sum
P
I
o
1
are non-t ferable and expireis not started vithin 180 days
1SS uance or if vork is sus pen-ded for
days.
2. COMRACTOR INSTALLATTON ONLY
Electrical Contractor
Address
cit Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
t'1
Ovners Name
L000 sq.ft. or less
Each additional 500sq. ft or portion
thereof
Each Hanuf,d Home or
-Modular Dvelling
Service or Feeder
Services or FeedersInsta}lation, Alterationsor Relocation:
200 amps or less /201 amps to 400 amps
-40i- amps to 600 amps
-601" amps to 1000 amps-
Over 1000 amps/voIts
-Reconnect 0n1y
t
f.
80
s 1s.00
\s 40.00
60.
100.
$130.
$300.
$ 40.
B
D.
$
s
$
,O00
00
00
00
00
00
50
C. Temporary Services or FeedersInstallation, Alteration or Relocation
40.00
55.00
80.00
e rrBrr aE6IE
Nev, Alteration or Extension per panel
One Circuit $ 35.00
Each AdditionalCircuit or vith Serviceor Feeder permi r L/ $ 2.oo A
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting-
Limited Energy/Res
-Limited Energy/Comm
SUBTOTAL OF ABOVE
52 State Surcharge
3Z Administrative Fee
TOTAL
200 amps or Less S201 amps to 400 amps
-
$0ver 401 to 600 amps
-
$0ver 600 amps or 1000Er[s se
Branch Circuits
Addre's
Ci ty hone
OVNER
The installation is being made onproperty I ovn vhich is not intendedfor sale, lease or rent.
Owner
DATE:
E
$ 40.00
$ 40.00
$ 20.00
s 36.00
et
a
RECETVED B
--4-
5
)r,
Permit #:3oZ(
,45Address:
Issued by:Date:
statement: 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 noaid to sigi'the
following statement before abuilding permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exemptfrom registration uidff ORS 701.010(7),
need not submit this statement. This statement wilt be filed with the permit.
Fill in the appropriate blanks and initial boxes I and,2,and either box 3A or 38:
X- 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.
3A. 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.
" 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 certify thatthe above information is correctand that I have read and dounderstand thelnformation
Notice to Property Owners Responsibilities on the reyerse side of this form.
r
OR
.//-
(Signature of permit applicant)
(White copy to issutng agency perrnit file,
pink copy to applicant)
(Date)
*?
Construction ResPons
Infsrmation Notice to Property Owners
About Construction Responsibilities. .,:;
Note: 'l'his,lnformtttbn Notice. to Property {)wners @bout
was rlevelopett b1; the Constrw:tion'Cantractors Board in accordance with ORS
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prelgry rgany problerns by berle awe of r}e ry&rygg trye.$1$liti9q ry$ areas of csreera' ;l-, *; i.::
If you hire persons not registered with the construction contractors Board to do labor in conqtructing or assisting in the
construction or improvemJnt of a residential strulture, you wr]l, in most instances, be rule{, to be -an emp}oyer and the people
you hire will be employees. As the employer, you must comply with thp following: .
oregon's withholding tax law: As an employer, you must withhold income taxes from employe! wages at the time employees
are paid. you will ueliable for the tax paymentrl*n if you don't actually withhold the tax from your einployees' 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 information, cali ttre oregon Employment Division at the Departrrrent of Human Resources
i
Law, and must
at378-3524
Workers, compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation
obtain workers, eompensation insurance for your employees. If you fail to obtain workers' compensation insurance, you'may
be subject to penalties and will be liable for arl claim cost.s if one of your employees is injured on tie jolt f1|1ore informa(ibn,
call the workers, compensation Division at the Depa(ment of consumer 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
liabte forthe tax payment even if you didn'iactuatly withhold the tax. For more information, call the Internal Revenue Service
at 1-80G829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requireqents
that may be brought to your attention through inspections, .t ..
Liffity and property damage,insurance: Contact your insurance agent to see if you have adQquate insurance coverage for
accidpnis and omissions such as falling tools, paint overspray, water damage from pipe punctures, fife, ot work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Experdse: Make sure you have the expertise to ait as your own general contractor, to coordinate the work ofroulh-in and frnish
tries, and to nottfy tultAing officiits at the appropriate times -so ihey can perform the ibqurca inspectiorts.' '
If you have additional questions, write or call the Construction Contractors Board(PQBox 1414A, Salem, OR 97309-5052,
5031,378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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