The URL can be used to link to this page

Home My WebLink AboutPermit Building 1992-03-23SPRINGFIELE) RESIDENTIAL PERMIT APPLICATION lnspections: 726'3769 Oflice: 726-3759 LocATloN oF PRoPosED woRK: ..f0g ASSESSOBS MAP:-J-o VQ -D l-oT:BLOCK: Zfr, JOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 TAX LOT:oozoS SUBDIVISION PHONE STATE: wVfuA -+ aV\ (eV, RESS:ADt) CltY: -.- ZIP.. vw(owNtln DEMOLISH OTHER DESCRIBE WORK NEW --- REMODEL - ADDITION P}iONEEXPI RESADDRESS ( C EN ERAL: PLUMBING: MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # CONTRACTOR'S,,NAME .'i'iTt=- RANGE: // OF UNITS LAND USE: SECONDARY HEAT: SQUARE FOOTAGET I OF STORIES: WATER HEATER: OUAD AHEA: r OF BLDCS: OCCY GROUP CONSTR. TYPE HEAT SOURCE: r OF BDRMS: ::".",-'.'::l;tng- To request an inspection, you must call 126-3169. This is a24hour recording. All inspections requested before 7:o0 a'm' will be made the same working day, inspections requested after 7:00 a.m. will be rnade the following work day' REOUIRED INSPECTIONS TemporarY Eleclric Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is comPlete. Site lnspeclion - 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. Foundalion - After forms are erecled but prior to concrete placentent. Underground Plumbing - Prior to ,illing trench. Underlloor Plumbing/ Mechanical - Prior to insulalion or deckin0. Sanitary Sewer - Prior to f illing trench. Storm Sewer - Prior to filling trench. Water Line - Prior to filling trench. Rough Plumbing - Prior to cover. Electrical Service - Must be approved to obtain Perfilanent electrical power. Fireplace - Prior to facing materials and framlng lnsP. Drywall - Prior to taPing. Wood Stove - After installation lnsert - After fireplace ap[)roval and installation of unit. Curbcut & APProach - After forms are erected but Prior to placement of concrete' Sidewalk & DrivewaY - Af ter excavation is comPlete, fortns and sub-base material in Place' Fence - When completed Street Trees - When all required trees are planted. Final Mechanical - When all mechanical work is comPlete. \[7 Rouoh Electrical - Prior to T{ f inat Electrical - When all ,,D"oui, /'-^tectrical work is complete. ,X X. *Vfinat Building - When all ,/Aequired inspections have been approved and building is completed. ff'"-ing - Prior to cover' ls;dwuttlceiling lnsulation - Prior to ,Jftover. Otlrer MOBILE HOME INSPECTIONS Blocking and Set'Up - When all blocking is complete. Plumbing Conneclions - Wlten horne has been connecled to water and sewer. Electrical Connection - When blocking, set-up, and Plurrlbing 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 been installec,. ]!7f Post and Beam - Prior to floor lA\.insulation or clecki ng. )S7/Floor lnsulalion - Prior to ,,JA\decxing. c x- t_l E tl D r fl tlr E r Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior -- Corner - Panhandle - Cul-de-sac Setbacl<s P.L.HSE N S E GAR ACC K BUILDING PERMIT ITEM SO. FT, Main -'{tD X $/SO. FT.VALUEfl;b - fr,!r{b- Garage Carport Total Value Building Permit Fee State Surcharge Total Fee zLotrp_60B*E' 1-,?3 (A) BUTLDING VALUE, PLAN CHECK AND BUILDING PERMIT This pernrit is granted on the express condition ttrat the said constru(;tion shall, in all resllccts, conform to tlte Otdinancc adopted by ttrc Cily of Springf icld, irrc;lucling tlte Development Code, regr.rlating the construction ancl use of builclirrgs, arrd may bc suspcnded or revol(cd at atty litnc u porl violation of any provisions of said ordirranccs. Plan Check Fee:--loe _?_ l, .ov IDate Paid Receipt Number:-- Rccei v t-/,f- PI s Rcviewed SYSTEMS DEVELOPMENT CHAR (B)ffL8B Systenrs Development Chargc is due on all undevcloped properties within the City limits which are being itnproved. PLUMBING ITEM Fix t u res PERM IT FEE Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home N FT. F'r. FT. Plumbing Permit State Surcharge Total Charge (c) ADDITIONAL COMMENTS MECHANICAL PERMIT Fu rnace Exhaust Hood Vent Fan No Wood Stove/ lnsert/Fireplace Unit' Dryer Vcnt Mechanical Pertnit lssuance State Surcharge Total Permit (D) By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information lrereon is true and correct, and I f urther certif y that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, and the Laws ol lhe Statc of Orr:g;orr 1:crt;rining lo tlre worl< dcscril>ccl hcrcin, and that NO OCCUPANCY will bc tn;rdc of any structure without pert-rtission of the Building Safety Division. I further certify that only contractors and employees who are in cornpliance witlr ORS 701.055 will bc used on this project. I {urther agree to ensure that all required irlspections are requested at the proper tinre, that each address is readable f rorn the street, that the pcrmit card is located at the f ront of the property, and thc approved set of plans will remain on the site at all times ring construction Signature Date 3 -3t 2> MTSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -- ft Curbcut -'- ft Demolition State Surchargc Total Miscellaneous Permits (E) VALIDATION: RECEIPT NUMAER DATE PAID AMOUNT R RECEIVED TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined)/aalb IS THE PROPOSED WOFIK IN THE }'IISTORICAL DISTFIICT, OR ON THE HISTOFIICAL FIEGISTER? ----_ lf yes, tlris application must be signed ancl approved by the Historical Coordinator prior lo permit issuance. APPROVED: F 1 2 Permit No: Address lssued 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 f it ith the permit. licable 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. My general contractor is , Contractor registration number-. I will instruct my general contractor that all subcontractors who work on the struc-re must be registered with the construction contractors Board gna Perm cant J z> t 2- Date in 3 OR A 3.B I will be my own general contractor. lf I hire subcontractors, l.will hire only subcontractors registered with the Construc-tion Contractors Board.. lf I change my mind and do hire-a general contractor, I willcontract with a contractor who is registered with the Construition Contractors ioardand I will immediately notify the ofiice issuing this building permit of the name ofthe contractor. l.hereby certily that the above information is correct and that I have read and understandthe lnformation N.otice to Property owners aoorl-bonstruction nlsponsioitities on thereverse side of this form. o"r"o)r.IUY "I o N co N rBAcro RS BoAR D flf,,[Es8,'llJ? JB?l,JIGrqc ENcy PERM I r Fr LE A^ lNFORturl, rON NOTICE TO PROPERTY Or"r,c,RS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: r Thig lnformation Notice to Property Owners About Construction Responsibilities was devalloped by itie Construction Contractors Board in accordance with OFiS 701.055(5), paqsed by tfre 1989 Oregon Legislature. lf you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: lf you hire persons not reglstered 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 you hire will be "employees". As the 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 paid. You 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 Department 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 employees. For more information, call the Oregon Employment Division DHR at 378-3224. Workers' Compensation lnsurance: As an employer, you are subject 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 penalties and will be liable for all claim 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 Service: As an employer, you must withhold federal income tax from employees'wages. You will be liable for the tax payment even if you didn't actually withhold the tax For more information, call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet co$lequilements that may be brought to your attention through inspections. Liabi and lnsurance: Contact You r insurance agent to see if you have adequate insurance coverage for accidents an omissions 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 sufficient time to supervise your employees' Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish irades, 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 503'378-4621 0244J 10124189 \ SPrlI o h, TAX LOT: SUBDIVISION LOCATION Of' PROPOSED WOR ASSESSORS MAP: JOB NUMAER RESIDENTIAL PERMIT APPLICAT!ON lnspections: 726'3769 Of tice: 726-3759 225 Fifth Street Springfleld, Oregon 97 477 PHONE STATE: OWNER ADDRESS: CITY SH -.- OTHER DF-SCRIBE WORK: NEW __-- REMODEL ADDITION EXPIRES PHONE 3MECHAN CONTRACTOTI'S NAME ELECTRICAL: CONST. CONTRACTOR # G E N ERAL: PLUMBING E_US lIU- OFFICE I OF BDRMS: WATER HEATT-:R " OF STORIES RANGE: * OF UNITS: LAND USE: ZONING CODE: FLOOD PLAINOUAD AFIEA: r OF BLDGS: SECONDARY HEAT: SOUARE FOOTAGE: OCCY GROUP: - -=- 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 macle the same working day, inspections requested after 7:00 a.m. will be made the following work day. R UIRED INSPECTIONS Temporary Eleclric ugh Mechanical - Prior to Final Plumbing - When all plunrbing worl( is cornplete.cover. Site lnspection - To be made after excavation, but Prior to setting (orms. Rough Electrical - Prior to Final Electrical - Wlren all electrical work is complete.cover. Underslab Plumbing / Electrical / Mechanical - Prior lo cover. Electrical Service - Must be approved to obtain Permanent electrical power. inal Mechanical - When all mechanical worl( is complete. Footing - After trenches are excavated.Fireplace - Prior to facing materials and framing lnsp. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting. Other Foundalion - After forms are erected but prior lo concrete placenlent. Underground Plumbing - Prior to filling trench. MOBILE HOME INSPESTIONS Underlloor Plumbing/ Mechanical - Prlor to insulation or decking.Wood Stove - After installation Posl ancl Beam - Prior to {loor insulation or decl<ing.lnsert - After f lreplace approval and installation of unit. Blocking and Sel-Up - Wlren all blocking is cornplete. 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 waler and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plurr)bing inspections have been aJrproved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - Af ter excavation is conrplete, forms and sub-base material in place. Water Line - Prior to filling lrench. Fence - When completed. Streel Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirtlng, decks, and venting have been installed. Rough Plumbing - Prior to cover. FZt fl r tl r T E rl tl E tl r tl l--| Framing - Prior to cover. [--l watttceiting tnsulation - Prior tot--J cover. l-_l orywall - Prior to taping. tl E Etl []tl IS THE PROPOSED WORK INJ'HE. HISTORICAL DISTFIICT, OR ON THE HISTORICAL REGISTER? - lf ycs, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac P.L,HSE GAR ACC N J Set E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in .lll respects, conform to the Ordinance adoptecl by the City of Springfield, including the Developtnent Cocie, regulating the construction and tlse of buildings, anrJ may be suspended or revoked at any lime upon violation of any provisions o( said ordinances. DalePlans Reviewed By Fleceipt Numbe Plan Check Fce: Date Paid Receivecl By BUILDING PERMIT ITEM SQ. FT. X $/SQ. FT.VALUE (A) Main Garage Carport Systems Developnrent Charge is due on all trndeveloped properties within ttre City limits which are being improved. SYSTENrS-DE1/ELOPM ENT CHARG E (SDC) (B) ADDTTIONAL COMMENTS ITEM Fixtu res Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT [:EE NO FT. FT. FT. (c) Plumbing Permit State Surcharge Total Clrarge Wood Stove/ lnsert/ Fireplace Unit (D) Dryer Vent N0Vent Fan Mecl-ranical lssu ance State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood By signature, I state ancl 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 urther certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springlield, and tlre Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be nrade of any structure without pertnission of the Building Safety Division. I further certify that only contractors and employees who are in compliance witlr ORS 701.055 will be used on this prolect. I further agree to ensure that all required inspections are requested at the proper tirne, that each address is readable from the street, that the permit card is located at the f ront y, and ttre approved set of plans will remain ture - Da ont site at all tirn uring constructio of theMISCELLANEOUS PERMlTS Mobile Home State lssuance State Surclrarge Sidewalk --- ft Curbcut ---- f t Demolition Statc Surcharge Total Miscellaneous Permits (E) llw lr,a AS?r RECEIVED BY -- AMOUNT RECEIVED DATE PAID VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) Total Value Building Permit Fee State Surcharge Total Fee t Liso--c<is sr'tilN(;FaELr) ah 225 FIFTB STREEf, SPRINGFIELD, oREGoN 97 INSPECTI0N REQUBST: 7 OPFICE: 726-3759 1. LOCATION OF IJGAL DESCT,IPTION /702 ltn 2-D & JoB DESCRIPTION t frn rr.,rr)),t) Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. COI\ITRACf,OR INSTALI,ATION ONLY Electrical Contractor fl*fYrVll Address r;9f E. =a'ry"' Ci ty Phone TclZ-Wys'- Expiration Date ,"9/tv/{*s Signature of Supervising bate Gl )41,i't 3. COUPIJTE FEB SCEEDULE BELOU Slgnature r-04. N"r, B"*id""tia1-Single or APPLICATION a 2A3a-A Hulti-Family Per dvelling unit. Service fncluded:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular DveIIing Service or Feeder s 8s.00 s 1s.00 $ 40.00 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 0niy Sum B $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 clarn c. D. Branch Circuits Nev, Alteration or Extension Per Panel one ci rcui t t/' $ 35. OO 3 S Each Additional Circuit or vith Service or Feeder Permi I / $ 2.00 > Hiscellaneous (Service/feeder not included) -Each installation Ptrmp or i rrigat ion Sign/0utIine Lighting- Limited Energy/Res SUBTOTAL OF ABOVE 5Z State Surcharge TOTAL 37 (- Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less S 40.00 201 amps to 400 amps $ 55.00 Over 600 amps or 1000lolts see "B, above Ovners nane tbAil? r'kae;lffn Address eay'f DtzzSZAJ ci ty-Phone OITNER INSTALI.,ATION The installation is being made on property I own vhich is not intended for sale, Iease or rent. ovners Signature: E 00 00 00 00 $40 $40 S20 s36 DATE: RECET *: RECEIVED BY: a ?z 5 T 3P.85 Supervisor License Ndmber 3o t Z S Expiration Date lO " /,- ?'? constr contr . n ^v", ;p/3582 Permit No: Address: lssued by I own, reside in, or will reside in the completed structure. 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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 38 1 2 OR I understand that I must register as a construction contractor if the structure is sold or offered for sale oru po nco mpletion 3.A is Contractor registration numbe I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 3.8 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 lnformation Notice to Property Owners about Construction Responsibilities on the reverse side of this atu App cant Date UCTION CONTRACTORS BOARD 8/91 WHITE COpy TO tssulNc AGENCY pERMtT F|LEPINK COPY TO APPLICANT rNFoH;roN NorcE To pRopERT" o*^*=** ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnforrnation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with OFIS 701.055(5), passed py the 1989 Oregon Legislature. lf you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: lf 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 you hire will be "employees". As the 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 paid. You 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 Department of Revenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployfirent insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division DHFI at 378-3224. Workers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers' compensation insurancer you may be subject to penalties and will be liable..for al{ claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 373-7434. U.S. lnternal Revenue Service: As an employer,you must withhold federal income tax from employees'wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the lnternal Flevenue Service at 221-3960. 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 requirements that may be brought to your attention through inspections. Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions 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 sufficient time to supervise your employees 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 qilestions, write to:Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OFI 97310-0151 Phone 503-378-4621 o244J 10124189