HomeMy WebLinkAboutPermit Building 1995-04-13SPFIT]tGFIELE,
RESID ENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759 qr,
JOB NUMBER
225 Fifth Street
Springfleld, Oregon 97477
ZLOCATION OF PROPOSED WORK:
ASSESSORS MAP:TAX LOT n24 o,/
LOT
-
BLOCK:SUBDIVISION:
-PHON E
STATE:
z
CITY:
ADDRESS:
OWNER:
NEW
-
REMODEL ADDITION DEMOLISH OTHER
-
DESCRIBE WORK:
PLUMBING:
ADDRESS EXPIRES PHONECONTRACTOR'S NAME
MECHANICAL:
ELECTBICAL:
GENEBAL:
CONST.
CONTRACTOR #
RANGE:
# OF BDRMS
_ OFFICE USE -
WATER HEATER:
FLOOD PLAIN
g OF UNITS:
QUAD AREA:
I OF BLDGS:
SECONDARY HEAT:
SQUARE FOOTAGE:
OCCY GROUP:
* OF STORIES:
ZONING CODE: _
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, 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, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
REQUIRED INSPECTIONS
n Temporary Etectrlc lXl Rough Mechanical - Prior toJ.Gcover.
Slte lnspectlon - To be made
after excavatlon, but prior to
settlng forms,
Underslab Plumblng / Electrical /
Mechanlcal - Prlor to cover.
Footlno - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Prior
to fllllng trench.
Underlloor Plumblng / Mechanlcal
- Prlor to lnsulatlon or decklng.
Sanltary Sewer - Prior to filllng
trench.
Storm Sewer - Prlor to fllllng
trench.
Water Llne - Prlor to filllng
trench.
Rough Plumblng - Prior to
Rough Electrlcal - Prlor to
cover,
Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flreplace - Prlor to faclng
materlals and framing lnsp.
Wood Stove - After lnstallatlon
lnserl - After flreplace approval
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Drlvewav - After
excavatlon ls complete, forms
and sub-base materlal ln place.
Fence - When completed
Slreet Trees - When all requlred
trees are planted.
[fr Final Plumbing - When ailJA(plumbing work is complete.
ffi final Electrical - When ailF( electrical work ls complete.
F7 ftnat Mechanlcat - When ailA mechanical work is complete.
ffi flnat Building - When ail
Z{ required lnspections have been
approved and building is
completed.
K
,&-^lng - Prlor to cover'
pfW"tllCelling lnsulatlon - Prlor to
flover.
XDrywall - Prlor to taolng'
Other
MOBILE HOME INSPE TIONS
Blocking and Set-Up - When all
blocking ls complete.
PJumbing Connections - When
home lras been connected to
water and sewer.
Electrical Connection - When
blocking, set-up, and plumbing
lnspections have bccn approvcd
and the home is connected to
the servlce panel.
Final - After all required
inspections are approved and
porches, skirtlng, decks, and
ventlng have been installed.
tvf Po"t and Beam - Prlor to floor
zAi nsulatlon or decktng. ft@fi4
Fll Floor lnsutallon 4 Prior to
zlX{decktns.
,ak zre, ? 7 fza
LAND USE:
tl
fl
tl
E
E
E
E E tl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Ty
- lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setback
PL.HSE GAR ACC
N
S
E
\ IS THE PROPOSED WORK TN THE -
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this applicailon must be slgnedand approved by the Historlcal
Coordinator prlor to permit issuance.
APPROVED:
BUILDING PERMIT
"-s,'>
+ /.r.
(A)
r:D
-rf
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
/k-E
40,
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 Ordinanceadopted by the City of Springfield, including the
Development Code, regulating the construction and use ofbuildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Receipt Number:_
Plans Reviewed By Date
Date Paid
Fleceived By
Plan Check Fee:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties withln the City limits which are being improved.
FEE
/5 ao
/zo
,4af),
/a*
N0
FI
Mobile Home
Residential Bath(s)
Sanitary Sewer
Water FT.
Storm Sewer FT.
Plumbing Permit
State Surcharge
Total Charge
,?fr,/,r
(c)
PLUMBING PERMIT
ITEM
Fix t u res
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
Mechanical Permit
lssuance
state surcharge ,7f t ,4r
Total Permit (D)
- \.Vent Fan
\o
)4
t{OrO1J,
./o do
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
No/
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby cerilfy that all
informatlon hereon is true and correct, and I f urther cerilfy
that any and all work performed shall be done in accordance
with the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertaining to the work described
hereln, and that NO OCCUPANCy will be made of any
structure wlthout permission of the Bulldirrg Safety Divislon.
I further certily that only contractors and employees who
are in compllance with ORS 7O1.O5S will be used on thisproiect.
I further agree to ensure that all requlred lnspections are
requested at the proper time, that each address ls readable
from the street, that the permlt card ls located at the front
e approved set of plans wlll remaln
Date
es ufln
of the property,
on the site
MISCELLANEOUS PERMITS
Mobile,Home
State lssuance
State Surcharge
Sidewalk _ ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous permits (E)
TOTAL AMOUNT DUE (exctuding electricat)
(A, B, C, D, and E Combined)?b,"t ,7f
DATE PAID
AMOUNT RECEIVED
BECEIVED BY
VALIDATION:
RECEIPT NUMBER
''' ',i-:,'
SO. FI. X $/SQ. FT. = VALUE
5e, ,- z/\T( * .*
2f^ / pt -t- A*- -
CITY OF SPR OFEGO'V
225 FIFTE STREET
SPRINGFIELD, OREGON
INSPECTION REQTIEST:
OFPICE: 726-3759
1
I.EGAL DESCRTPTION
JOB DESCRIPTION
Permits are non-transferable and expire
if vork is not started vithin 1B0 days
of issuance or if vork is suspended for
180 days.
lollcvr'ing proieci qs gubrr:ttiod h:.;r: tnsl
rg, and ci'Joa not I€qui!'r, op*ciiic !*riu
grral.
zrn,rg LD1L
V*'^L,,FLJ ln.
BI,ECTRICAI PERHIT APPLICATION
r
3. COHPI,ETE FBE SCffiDtII.E BELOV
A. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
Each additional 500
sq. ft or portion \thereof \ $ 15.00
Each Manuf'd Home. or
-Modular Dwelling
Service or Feeder $ 40.00
sPFilt,^ <lELl,
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
97 477
726-3769'".'.::ci:iignat;ro* N.114 . CiaV Job-N,rnbe
o Sum
b5*:
lp ?
2. CONTRACTOR INSTALT,ATION ONLY B.Services or Feeders
Installation, Alterations
or Relocation:ELectrical Contractor
Address 200 amps or less
201 amps to 400 amPS _401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/vo1ts
Reconnect 0n1y
Ci Phone
Supervisor License Number 3<l g2-s
Expiration Date 7s-
c
constr contr. llumber ? ( 7 4l
Temporary Serviees or Feeders
Installation, Alteration or Relocation
00
00
00
00
00
00
$s0
S60
s100
s130
s300
s40
40
55
80
e
Expiration Date
S of Electrician
ers Name
Address
Ci ty Phone 7trJ)?e
OVNER INSTALI.,ATION
The installation is being made on
property I ovn vhich is not intended
for saIe, Iease or rent.
Orners Signature:
DATE:
D. Braneh Circuits
Nev, Alteration or Extension Per Panel
one Circuit $ 35.00
Each Additional-
Circuit or vith Service
or Feeder Permit $ 2.00
200 amps''or less $
201 amps to 400 amps
-
S
over 4b1 to 600 amps
-
$
Over 600 amps or 1000-vofts se
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
-
S
Sign/out)-ine Lighting- $
Limited Energy/Res _ $
Limi ted Energy/Comm S
'q 6 .00
.00
.00uBu a6ffi-
not included)
40.00
40. o0
20.00
E
5
RECEIVED
LD
.-.-*1-,i-i
% t{,Llt /)
I
PRTNGFIELO
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP;
LOT:
a r4
JOB NUMBEB
225 Fifth Street
Spri ngf leld, Oregon 97 477
TAX LOT
?-- 7Au
BLOCK:
OWNER:
ADDRESS:
CITY:zlPSTATE:
PHONE:W*- ?:7 )=a2la-Esv
DESCRIBE WORK:
NEW- REMODEL ADDITION DEMOLISH OTHER
PLUMBING:
EXPIRES PHON ECONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
GENERAL:
CONST,
CONTRACTOR #
E_US
\
A OF BDRMS:
WATER HEATER
- OFF]CE
LAND USE:
ZONING CODE:
FLOOD PLAIN
* OF UNITS:
RANGE:
SECONDARY HEAT:
SQUARE FOOTAGE:
\\\
OCCY GROUP:
r OF STORIES:
OUAD AREA:
r OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon. you must call 726-3769 Thls ls a24hour recordlng. All inspections requested before 7:o0 a.m. will be
made the same worklng day, lnspections requested after 7:00 a.m. wlll be made the followlng work day
REOUIRED INSPECTIONS
[-l femporarY Electric
SIte lnspectlon - To be made
a{ter excavation, but Prior to
setting forms.
Understab Plumblng I Eleclrlcal /
Mechanlcal - Prlor to cover.
gf nough Mechanlcal - Prior toAcover.
Vl Rough Electrical - Prior to
Acover.
Final Plumbing - When all
plumbing worl< is complete.
Final Electrical - When all
electrical work is comPlete.
Final Mechanical - When all
mechanical work is comPlete'
K
X
x
X.IVFootlng - After trenches are
J4->Lsy66y3166.
Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but Prlor to concrete
placement.
Underground Plumbing - Prior
to fllllng trench.
Sanltary Sewer - Prior to filling
trench,
Stqrm Sewer - Prlor to fllling
trench.
Water Line - Prlor to filling
trench.
Rough Plumbing - Prior to
cover.
Flreplace - Prlor to faclng
materlals and framlng lnsP.
ffrantng - Prlor to cover'
ffiwatltcelling lnsulatlon - Prlor to
Hcovef.
ffiow*"ll - Prior to taplng.
Etectrical Servlce - Must be
approved to obtain Permanent
electrlcal Power.
tnserl - After firePlace aPProval
and lnstallatlon of unlt.
Curbcut & APProach - After
forms are erected but Prior to
placement of concrete.
Final Building - When all
required insPections have been
approved and building is
completed.
Other
MOBILE HOME INSPECTIONS
Blocking and Set'UP - When all
blocking is comPlete.
Plumbing Connections - When
home has been connected to
water and sewer.
K
F--l Underlloor Plumblng/Mechanlcal F---.' wood Stove - After lnstallation| |
- Frtor to insulatlon or decking' I I
Vl Post and Beam - Prlor to floor
Jd.insutatlon or decklng.
\P[ Floor ]nsulallon + Prior to
F{decxlns.
Sidewalk & Driveway - After
Jxcavation ls comPlete, forms
and sub-base materlal in Place'
[--l Fence - When comoleted
Electrical Connection - When
blocKing, set-uP, and Plumh'ing
irrpections have been aP7roved
.nd the home is connected to
the service Panel.
t----l Street Trees - When all required
L-J lysgs are planted.
Final - After all required
insbections are aPProved and
oorches, skirting, decks, and
ventlng have been installed'
SUBDIVISION:
-
22/a,r
-
ffi-7zr-
ADDRESS
t ,1o
tl
n
n
tl
E
E
Lot Ty
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
",r,-',r, '
Setbacks
PL.HSE GAR ACC
N
S
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height w'
IS THE PROPOSED WORK TN THE ..
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this applicatlon must be slgned
and approved by the Historlcal
Coordinator prior to permit issuance.
APPBOVED:
state Surcha rse /? + /P{
VALUE
Total Fee (A)
2"4-4sr
X $/SO. FT.
f =t 7-r, -
Total Value
Building Permit Fee
BUILDING PERMIT
ITEM SO. FT,
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the expreGs condiilon that the saidconstruction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, inctuding the
Development Code, regulating the construction and use ofbuildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
r A:!'Plan Reviewed
/z?6 ?
Plan Check Fee:?
R
Date Paid
Fleceipt Number:
9 _€_
SYSTEMS DEVELOPMENT cHARGE (SDC)(B) tLSpz&
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
FEE
(c)
N0
FT.
Water
Mobile Home
Residential Bath(s)
Sanitary Sewer
Storm Sewer FT.
Plumblng Permit
State Surcharge
Total Charge
PLUMBING PERMIT
ITEM
Fix tu res
ADDITIONAL COMMENTS
MECHANICAL PERMIT
/,f,o
No
(
(D)4
ertiFireplace Uni
Mechanical permit
lssuance
State Surcharge
Total Permit
Fu rnace
Exhaust Hood
Vent Fan
Wood Stove/lns
Dryer Vent
By slgnature, I state and agree, that I have carefully examinedthe completed apptication and do hereby cerilfy that alllnformation hereon is true and correct, and I f urther cerilfythat any and all work performed shall be done in accordancewith the Ordinances of the City of Sprlngfield, and the Lawsof the state of oregon pertaining to the work describedherein, and that NO OCCUPANCy will be made of anystructure without permission of the Bullding Safety Division.I further certify that only contractors anO-emptoyees whoare in compliance with OFIS 7Oi.O55 will be usecl on thlsproject.
Signat
Date
n
I further agree to ensure that all required inspections arerequested at the proper ti me, that each address ls readablefrom the street, that the permit card ls located at the frontof the property,the approved set of plans will remaion the sit es duri
MISCELLANEOUS PERMITS
Mobile,Home
State lssuance
State Surcharge
Sidewalk --.----..-- ft
Curbcut tt
Demolition
State Surcharge
(E)Total Miscellaneous pe rrnits
TOTAL AMOUNT OUE(A, B, C, D, and E Com
(excluding clectricalt
bined).6{,72
2
R2
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
VALIDATION:
BECEIPT NUMBEFI
I'. - t,'*
?
FT.
-nl+,
-
-
-
-
%
-
-
--
B No. a5o*Go
CTTY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(coMt'IERcIAL & RESIDENTIAL)
NAME OR COMPANY' KAVIN 4 L lq2A Gteu-r5 H
LOCATION:4o r.4t-tt 6T.\ao-z o5 t-?- - o2+o I
DEVELOPMENT TYPE:VD 3 - Aopr O l*l-Tr / z.*-rrto DLL
BUILDING SIZE: 5x r-t (rrrcr-uee.s FrAve:) LOT SIZ
STORM DRAINAGE
IMPERVI0US SQ. FT.oq x $0.209 PER SQ. FT.
X $43.26 PER PFU
. Ft.
I
NO. OF PFU'S
(See Reverse)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X x $436. 19
x _ x $436.19
Y
4. SANITARY SEWER-MWMC
NO. OF PFU'S
(Use PFU Total From Item 2 Above)
Mt,lMC CREDIT IF APPLICABLE (SEE REVERSE)
2. SANITARY SEWER-CITY
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBT0TAL AB0VE) X .os
x $436. 19 $
x $17.19 PER PFU + $10 MWMC ADM FEE $.e
$
TOTAL-MWMC SDC
SUBTOTAL (ADD ITEMS 1,2,3 & 4)$ r-7-q
9
Burdi ck
Coordi nator
cq
K
Date: 4 $ \so:TOTAL SDC
Permit #:
Address 4
Issued 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 Board to sign the
following statement before abuilding permit canbe 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 eitherbox 3,{ or 38
W 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.
OR
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 huilding permit of the
name of the contractor.
Iherebycertify thatthe above information is correct I have read and do understand the Information
on the reYerse side of this form.
of permit applicant)
(White copy to issuing agency perunit file,
pink copy to applicant)
)
Notice to Property
a<- </6Dz
E
Informationilotice to Property Owners
About Construction Responsibilities
--- .'- .^ ,_ Note': This In{ormntiott Notice to Properry Owners.about Consrruction Respons-
--1-- }: -vias develope'd by the C*onsiiicttoidntrdctors Board tn accordence with ORS .iitil
trf you are acting as yottr owll contractor to construc{ a nt:w home cr make a substantial improvelnent to an existing structurc,
you can prevent many problems by being aw.are of the lqllowing responsibitities and areas of concern.
: EMPLOYEfi HESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing 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
vou hire rviil bc employecs. As rhe 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 paicl. Yau 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 ftu for unemployment insurance purposes on the
wages of all ernployees. For more information, call the Oregon Employment Division at the Department of Human Resoure$
at378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and must
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurarce, you may
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformation,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenue Service: As an employer, you must withhold federal income tax from employebs'wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at l-800-829-t040.
OTHEH HESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequaG insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as yourown generalcontractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can performthe requiredlnspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box t4t+0, Sqtem, OR 97309-5052,
5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. :
prop-own.pm4
U94