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Home My WebLink AboutPermit Building 1994-02-02RESTDENT!AL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 ?4?aEaJOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 LOCATION OF PROPOSED WORK: ASSESSORS MAP; LOT - BLOCK: A/. 0,/UML/r RODD r €7-D. TAX LOT: SUBDIVISION: krt*,/ r EL€a^/{Z{Kgrvnry PHONE; o<STATE: Rp 7 SPQ.zv&Fr L,LD 7au- zz /352 '/1/. ztPt ?7+7 7CITY: ADDRESS: OWNER: 72-A5 ,r/ DESCRIBE WORK: NEW - REMODEL ADDITION DEMOLISH OTHER tvttuX 71)4h .) ADDRESS EXPIRES PHONEElCONTRACTOR' MECHANICAL: ELECTRICAL CONST. CONTRACTOR # G ENERAL: PLUMBING I WATER HEATER: - OFFICE USE - ZONING CODE: FLOOD PLAINLAND USE: * OF UNITS: SECONDARY HEAT SQUARE FOOTAGE: OCCY GROUP: * OF STORIES: QUAD AREA: * OF BLDGS: CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-3769. Thls ls a24hour recording. All inspections requested before 7:oO a.m. will bemade the same working day, lnspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS Temporary Electric W X Rough Mechanical - Prior to cover. Final Plumbing - When allplumbing work is complete. Site lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to x tr tr Final Electrical - When alt electrical work is complete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover.Eleclrical Service - Must be approved to obtain permanent electrlcal power. Final Mechanical - When all mechanical work is complete. x Footing - After trenches are excavated.Final Building - When ail required inspections have been approved and bullding is completed. Fireplace - Prlor to facing materials and framing lnsp.Masonry - Steel location, bond beams, grouting.Fx Framing - Prior to cover. w-Foundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. ffi or*"'l - Prior to taPing MOBILE HOME INSPE TIONS Wood Stove - After installatlon. x Post and Beam - Prior to floor insulation or decking.lnsert - After flreplace approval and installation of unit. Blocking and Set.Up - When all blocklng is complete. Floor lnsulation - Prior to decking.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 filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Slorm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Llne - Prior to fllling trench. 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. E oo G o3* RANGE: # OF BDRMS: - fl r [-l Underground Plumbing - Prior'J to filling trench. [-_l Underlloor Plumbing/Mechanicat Prior to insulation or decking. il [-l other Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de'sac P.L.HSE GAR ACC N S E g BUILDING PERMIT ITEM Main Garage Carport SQ. FT. X $/SO. FT.VALUE r/tzc ??2a d78z ? Total Value Building Permit Fee State Surcharge Total Fee €d.fa 2-, 5= (A)fz-q BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is grantei 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'2z_'8E-Plan Check Fee; DatePaid: @ Receipt Numbe Received BY: 7-/-?ts s'Rev iewed By Date SYSTEMS DEVELOPMENT C (B) HARGE (SDC) .#tsryF Systems Development Charge is due on all undeveloped properties within the City limits which are being improved' PLUMBING PERMIT ITEM Fixtu res Besidenti FEE Bath(s)N0 Sanitary Water Storm Sewer Mobile Home Plumbl It State Surcharge Total Charge (c) ADDITIONAL COMMENTS MECHANICAL PERMIT Fu rn ace Exhausi Vent Fan Wood Stove/ lns replace Unlt Dryer Mechanical Permit Unrttn/D DJCT lssuance state surcharge Total Permlt (D) | 6'? ,-80(tJ 7; Z;,1; 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 Springfield, 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 Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain on the site times durin construction. Signature Date MTSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) VALIDATION: RECEIPT NUMBE DATE PAID AMOUNT R RECEIVED TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) ? 7-5] , lS rHE PRoPoSED woRK lN 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: CITY OF OREGON SPRTNGFIELO h The tollowlng Proiecl zoning, and does not approval. PERHIT APPLICATION225 YTFTZ SlTEBf, sPRrlGRrBLD, OREGON 97477 INSPBcfIoN RBOI BSTz 726-3769 0FEICE: 726-3759 zoning LDfl-- CirY Job Nunber oa"Sqib- 1 IOCATION INSTALI,ATION IJGAL DBSCRISIION10e34 ooho ') Permits are non-transferable and expire if vork is not started vithin 180 days of lssuance or lf vork is suspended for 180 days. 2 COMNACTOR INSTALI,ATION ONLY ical Contractor Address c1 Phone Supervisor L Number Expi ration Date Constr Contr. Numbe Expi ration Date Slgnature of Supervising trician Ovners Name Address I Ci ty /^at lA OR. Phone--rr- . OITNER TNSTALI,ATION The installation is being made on property I ovn vhich is not intended for saIe, lease or rent. DATE: FEE SCEBDT'I,B BELOV A.ev Resi dential-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 Hanuf'd Home or -Hodular Dvel}ing Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 B Services or Feeders Installation, Alterations or Relocation: c. D. Branch Circuits 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ Over 1000 amps/vo1ts Reconnect 0nly Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less { $ 40.00 201 amfs to 4oo amps * $ 55.00 over 4b1 to 600 ambs - S 80.00 0ver 600 amps or 1b0O voTts see 'Bn aEF Sum $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 i Nev, Alteration or Extension Per Panel one circui t I $ 3s. oo 3$fEach Additional Circuit or vith Service or Feeder Permit - 5 $ 2.oo (oo'' E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/OutIine Light ing- Limi ted Energy./Res -Limited Energy/Comm STIBTOTAL OF ABOVE 5Z State Surcharge TOTAL $ s $ $ 40. 40. 20. 36. 00 00 00 00 BRBCBIVED 5 5 ( 1 2 lssued OR 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 underORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the applicable 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. A My general contractor is , Contractor reqistration nu mber-. I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. OR s. B. ;- I witt be my own "k^f","ntractor. 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. ! hereby certify that the above inlormation is correct and that I have read and understand the lnformation Notice to Property Owners about Construction Responsibilities on the reverse side ol this form. Permit No:Q q aasg Address l3sa N- rta-U^,^L NB Date: *)r1gs 3l ,q lq.r 3 CONSTRUCTION CONTRACTORS BOAHD 0244J 8191 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT NOTE: This lnformation Notice toProperty Owners About Construction was developed by the Construction Contractors Board in accordance with ORS passed by the 1989 Oregon Legistature. INFoR[iTTloN NoTIcE To PRoPERTY oW-NERS ABOUT CONSTRUCTION RESPONSIBILITIES , ., "- ..1 lf you are'acting as your own cohtractor to construct a new home or make a substant(al imprbvernent to an existing structure, you can preventmany problems by,being aware of the following responsibilitlbs and areas of concgrn. ., . .-:, . .-,., ,. . ' --- .r,. : li EIIPLOYEBRESPONSIBILITIES: '' i !" ''; lf you hire persons not registered with the Construction Contractors BOard to do labor in constlupting or assisting in the construction'or irn:plovement oJ'a re-sidential structure, you will, in nibst instinces;b'C ruled to be an "employer" and the people you hire.will be "employees". As the emptoyer, you inust cbmply with..the following: Oregon's Withholding Tax Lary:, As an employer, you must withhold income laxes from employee wages at the time em-ployees afe paid. You will be liable for the tax.payments even if you don:tAotually 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 un6mployment insurance purposes on the wages of all emplo!€€s,.For more information, call the Oregon Employment Division DHR at 378-3224. Workers' Compensation lnsurance: As an:employo[ ]ou are suhiectto the Oregbn hlorkers'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 E€'liable fof'a{l clhim costs,iftone of your employees is injured on the job. For more information, callthe Workers' Compengglion Division DIF at 973-7434. U.S. lnternal Revenue^,9grvice: fu qn emplgyer, you must withhold federal incoqne t4X trom employees' wages. ym9;t9,i1ityo-uoion't,aciUa!rl.ygntroldthet&E9.1,moreinfoimation,call OTHER RESPONSTBTLTTTES AND AREAS OF CONCER$: Code Compiianee: As the permit holder for this pro.iect, you are responsible for resolving any failure to meet code requirernents that may be brought to your attention through inspeCtions. LiabiliU an$ ProPehy DamdEe'lnsurbncb: Contact-your insrJra'n'ce agenttdsee if you hwe adequate insurance suchasfallingtools,paintoversprdyiwaferdahagefrompipepunc- tures, fire, or work that must be re-done. Time to;Sqp_erylg_b_@ployees: .Make sure you have sufficient time to supervise your en*ployees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, hnd 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 o244J 10124189 Permit No: Address: lssued Date: OR 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 sudmit this itatement. Thil statemeit wiil befiled with the permit. Fill in the a pplicable blanks, and initial boxes 1 and 2, and either box 3A or 38 1 2 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 befor.e or upon completion. My general contractor is_3 OR A 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.B 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 iegisiered with the Construition Contractors 6oard and I will immediately notify the office issuing this building permit of the name ofthe contractor. I hereby certily that the above inlormation is correct and that I have read and understandthe lnformation N.otice to Property Owners about Construction Responsibilities on thereverse side of this form. ? gnature m t lican CONSTRUCTION CONTRACTORS BOARD 0244J 8191 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT aa*l rNFoR;roN NoncE To pRopERTv oti-xens ABOUT CONSTRUCTION RESPONSIBILITIES r. A.. ng as your own contraetor to cbnstruct a new home or make a substantial ure:,Iou 9qn prevgntrgany problems by being aware of the following responsibi '1' ' .r ..,. lf you are acti existing struct of concern. to an and areas lf you hire persons not reg.istered with the Construction Contractors Boar! to do labor in constructing or assisting in the construction o, i.iprorement of ii"siO"niirr tttr"ture, y;gu wilt, in m6h instanc'e's, be-'ruled to be an ,,employer" a'10 ihe pefifieyou hire will be;'emptoyees" As the ?imployer,^!ou must col{rPly with the following: EMPLOYER RESPONSIBILITIES: : o 's Witli Law: As an employer, you must withhold income taxes from employee wages at the time emp are paid. You will be liable for the tax paymenls even if you don't actually withhold the tax from your employees For more information, call the Oregon D epartrnent of Revenue at 378-3390. Unemp loyment lnsurance Tax As an employer, you are required to pay a tax for unemiiloyment insurance mployees. For more informatipn, call the Oregon Employment'Division DHR U.S. lntern?l Bevenue 9ervice: As an employer, you ffifaymentev6nif youd the lnternal Revenue'service at 221-3960' ' purposes on the wages ol all e at 378-3224 Workers' Compensation lnsurance: As an employer, you are subiect to the Oregbn ltlorkers' Compensation pensationinsuranceforyouremployees.lfyoy.failtoobtainworkerS' compensation insurance, you may be subject to penalties ani will be liable lor ill cHim costs if bne of your erpioyee. is injured on the job. For more information, callthe.Workers' Compensation Division DIF at gf3-74%. mugt withhold federal income tax from employees' wages' idn;i'actually ryithhold ln" ta.1' Fdr more infoimation,iall _iO OTHER RESPONSIBILITIES AND AREAS OF CONCERN: - ,.,, Code Compliance: As the perfflit holder for thls project, you,are responsible for resolving any failure to meet coAe requirements that may be brought to your attention through'inspections, Liabilitv arld property Damhg'e lhsurafrib:icontact your ins.urance agerit to see if you have adequate insurance chasfallingtoolS,paintoverspray,vi6tbrdamagefrompipepunc- tures, fire, or work that must be re-done. - -. , :..'':.'.il:J',;;f -:- '.t-a?l -'., ;i Time to Supervi se Employees: fvlake.sure you have sufficient time to superVise your employees ., ) i: --.-..:.1\.-..' Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-rn 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 NOTE: This lnformation Notice to Propefi Owners was developed by the Construction Contractors Board About Construction Responsibilities in accordance with ORS 7OI.055(5), j o24N 10124189 JoB No . cl4rc20 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE }JORKSHEET (col'IMERCIAL & RESIDENTIAL) NAME OR COMPANY:bsnN 4 Ec1*xl o RE \, LOCATION:/15 z N . tLln t*t tlT ,D /7c v"4zb - oobo3 DEVELOPMENT TYPE:L"e-D nlaN BUILDING SIZE: EIII NA.UO6, E$/89 LOT SiZ a. Ft. I STORM DRAINAGE TMPERVIoUS SQ. FT.x $0.203 PER SQ. FT X $42.08 PER PFU (g 3 2. SANITARY SEWER-CITY NO. OF PFU'S (See Reverse) 5 TRANSPORTAT I ON NO OF UNITS X TRIP RATE X COST PER TRIP x - x $424.31 X x $424.31 x --- x $424.31 SANITARY SEl,lER-Mt,lMC N0.0F PFU'S x $15.125 PER PFU + $10 Mt^lMC ADM FEE (Use PFU Total From Item 2 Above) Mt,lMC CREDIT IF APPLICABLE (SEE REVERSE) TOTAL-l'll,,Mc SDC SUBToTAL (ADD ITEMS 1,2,3 & 4)$ l'7 . ADMINISTRATIVE FEES BASE CHARGE (SUBT0TAL ABoVE) X .05 d^^re-^-n:.A- t /ra /q4 $ 4 $ $ 0 Kip Burdick SDC Coordinator TOTAL SDC $ /<t5