HomeMy WebLinkAboutPermit Building 1995-03-31t.
:
i
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726.3759
LOCATION OF PBOPOSED WOFIK:
INGFIELE)
JOB NUMBER 6Z
225 Fifth Street
Springfield, Oregon g7 472
7y7
TAX LOT:Ac 3:(1ASSESSORS MAP:3 7 4 ,lr>r !c)
LOT:BLOCK:2 y'srno^ ?lq*SUBDIVISION:
PHONE:
STATE:ZIP:
2
.C
OWNEB
ADDRESS:
CITY;
DEMOLISH OTHEBADDrroN X
DESCRIBE WORK:
NEW- REMODEL
ADDRESS EXPIBES PHOI!E
CONTRACTOR'S NAME
MECHANICAL:
ELECTBICAL:
PLUMBING:
GENERAL:
CONST.
CONTRACTOR 'f
- OFFICE USE -
WATER HEATER
ZONING CODE:
FLOOD PLAINLAND USE:
Y OF UNITS:
BANGE:
SECONDARY HEAT:
SQUABE FOOTAGE:
# OF BDRMS: .--...-OCCY GROUP:
* OF STORIES:
QUAD AREA:
I OF BLDGS:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726.3769. Th
made the same worklng day, lnspections requested
ls ls a 24 hour recordlng. Alr rnspecilons requested before 7:00 a.m. wilr beafter 7:00 a.m. will be made the followlng work day.
REOUIRED INSPECTIONS
Temporary Electric B
tr
Rough Mechanlcal - prlor to
cover.l-_l finat ptumbing - When ail.J plumblng work ls complete.
Slte lnspection - To be madeafter excavatlon, but prior tosetting forms.
Rough Eleclrical - prlor to
cover.[Fl flnat Etectricat - When ail"{r electrical work is complete.
[--l Understab plumblng/ Electrical/
-
Mechanlcal - prlor to cover.Elestrlcal Servtce - Must beapproved to obtaln permanent
olectrlcal power.
Final Mechanical - When allmechanical work ls complete.
m Footlng - After trenches are
excavated,
Masonry - Steel locatlon, bond
beams, grouting.
tr Flnal Building - When allrequired lnspections have beenapproved and building is
completed.
[-l flreptace - prtor to factng
-
materlals and framlng lnsp.
m
tr
tr
Framlng - Prlor to cover.
m Foundatlon - After forms are
erected but prlor to concreteplacement.
Othor
Well/Celtlng lnsulatlon - prlor to
cover.
Underground Plumbing - prior
to filllng trench.Drywall - Prlor to taping
tr
tr
tr
Underlloor Plumblng/ Mechanical
- Prior to lnsulatlon or decking. I J Wood Stovo - After lnstallatlon.
MOBILE HOME INSPECTIONS
Post and Beam - Prlor to floorinsulation or decking,[-_| lnsert - After fireplace approval
-
and lnstallatlon of unlt.
[--l Blocking and Set.Up - When ail
-
blocklng ls complete.
Floor lnsulation - Prlor to
deckl ng,Curbcut & Approaclr - After
forms are erected but prior toplacemont of concrete.
Plumbing Connections - Whenhome has been connected towater and sewer.
l-l Sanitary Sewer - Prior to fiiling
-
trench.
[--| Storm Sewer - Prior to fiiltng
-
trench.
Sidewalk & Drlvewav - After
excavation ls complete, forms
and sub-base material ln place.
Fence - When completed.
Electrical Connection - Whenblocking, set-up, and plumbing
lnspectlons have been approved
and the home ls connected tothe service panel.
l--l Water Line - Prior to fiilingu trench.
Stroet Trees - When all requlred
trees are planted.
Final - After all requiredinspections are approved andporches, sklrtlng, decks, andventing have been lnstalled.
7
jiRnr',r.--'
E
Rough Plumblng - Prlor to
cover.
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typ
:, vvy' rnr"rro,P.L.HSE GAR ACC
N
S
W
E
t-THE PROPOSED WORK TN THE .
-- Corner
-
Panhandle
-
Cul-de-sac
HISTORICAL DISTRICI, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this applicatlon must be signed
and approved by the Historlcal
Coordinator prior to permit issuance.
APPROVED:
Total Value
Building Permit Fee
State Surcharge t.1S +3'16
Total Fee (A)
VALUE
- 1; 7(-4/) -(-
_ tgry
,l
\ oc,31
lA Zo tL,rrqTb
k;4aB't7-
,E
BUILDING PERMTT
SQ. FT. X $iSQ. FT.ITEM
Main
Garage
Carport
BUILDING VALUE, PLAN CHECKAND BUILDING PERMIT
Thls permit is granted on the express condition that the saidconstruction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, includlng theDevelopment Code, regulating the construction and use ofbulldings, and may be suspended or revoked at any tlmeupon vlolation of any provisions of said ordinances.
Plans By
By:
ehs/ss, Ddte
(m* ,o aPlan Check Fee
Date Paid
Flecelpt Number:
Rece i.\rL-q-
SYSTEMS DEVELOPMENT CHAR GE (SDC) ,.#q\v'ffi(B)
Systems Development Charge ls due on all undeveloped
properties withln the City limits which are belng improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
FT.
PLUMBING PERMIT
Plumbing Permlt
State Surcharge
Total Charge
DITIONAL COMMENTS
o
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan No
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
Mechanical Permit
lssuance
State Surcharge
Total Permlt
By slgnature, I state and agree, that I have carefully examlnedthe compteted application and do hereby certlfy that all
lnformatlon 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 Clty of Sprlngf ield, and the Lawsof the State of Oregon pertainlng to the work descrlbed
hereln, and that NO OCCUPANCy will be made of any
structure without permission of the Buildlng Safety Divislon.I further certify that only contractors and employees who
are ln compliance wlth ORS 7O1.OS5 wlll be used on thlsprolect.
I further agree lo ensure that all requlred lnspections are
requested at the proper ilme, 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 wlll remain
(
on the slte at all imes du structlon.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut _-_ ft
Demolitlon
State Surcharge
Total Miscellaneous permits (E)
VALIDATION:
RECEIPT NUMBER
DATE PAID
z2_
AMOUNT RECEIVEDTOTAL AMOUNT DUE (excluding electricat)
(A, B, C, D, and E'Combined)
t o.1
RECEIVED BY
,37
N0
FT
FT.
LEGAL DESCRTPTION
JOB DESCRIPTION4lPq fo ftq n'q'
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. COIITRACTOR INSTALI.,ATION OM,Y
Electrical Contractor
Addr"""
ci ty- Phone
Supervisor License Number
Expiration D.te
Constr Contr. Number
Exoiration Date
Signature of Supervising Electrician
rrr
0vners Name
Address
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 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 _
60L amps to 1000 amPs_
Over 1000 amps/vo1ts
Reconnect Only
Temporary Services or Feeders
Installation, Alteration or Relocation
SPfl!NGFIELO
use
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
The following proi€ct ae submlttad has the
zoning, and does not require spocific lsnd
225 FTFTE STREET approval
SPRTNGFTELD, oREGoN 97 477
INSPECTTON REOUESTz 726-3769
OFFICE: 726-3759 Dcte
Authorlred
LOCATION OF INSTALT,ATION1
ELECTRICAT PERHIT APPLICATION
Ci ty Job Nu.mbe. ) 5O 2T L
Sgrrdur.@E SCMDULE BELOV
A. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
B
Sum
Eove
s s0.00
s 60.00
$100.00
$130. 00
$300.00
$ 40.00
ao
,tttl
C
200 amps or less
20L amps to 400 amps
-0ver 401- to 600 amps
Over 600 amps or 1000 voT[
s 40.00
s ss.00
$ 80.00
s see lrBrr a
Ci ty Ynone 7/L-170?
ovNER TNSTALLAT rot{t"r) 72/. -/ ssf
The installation is being made on
property I ovn vhich is not intended
for sa1e, Iease or rent.
D. Branch Circuits
E
Nev, Alteration or Extension Per Pane1
One Circui t t/ $ 35.00 ZAn
Each Additional
Circuit or vith Service
or Feeder permi t I $ 2.00 _2-f
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $
SignZOutline Lighting- $
Limited Energy/Res $
Limited Energy/Comm S
40.00
40.00
20.00
36.00OvneSi
5
RECEIVED
ture:
37'.qr,
w
tr
Permit #:? Solvz-
Address
Issued by:Date
Statem€nt: Information 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 a building permit can be 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 andZ, and either box 3A or 38:
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.
3,A,. 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 building permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have readand do understand thelnformation
Responsibilities on the reverse side of form.
(White copy to issuing agency perrnitfile,
pink copy to applicant)
)
Notice to
w
t
---vv
Information Notice to Property Owners
.'..-,Abot*tConstructionResponsibilities..
t :t" -;_7. .
- ': Note: "fhis lnjbnrrotbnNolice to Propertl, Ovrners ahout Construrtion Responsibilities '?t'
Ir,fl.r developed bv the Constiuction C()ntrlctors Boartl in u<:crtrdance with ORS 701.055(5).
Il'you ;ire ricting as your ()w$ conlractor to cor-lstn"let a rie $, home or rnake a substantial improvement to an existing structure,
you can preven[ many prcrblems by being aware.of the following responsibilities and iueas of concero. .r ,
EM PLOYER RESPONSIBILITIES:
If you hire persons not registered with the Constmction Contractors Board to ds labor -ry qonstr-uctiq& or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to-bean employer and the people
you hire will be employees. As the employer, you must cornply with the following: ,.
Oregon's withholding tax law: As an employer, you must withhold income taxes from'employee wagei at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax frorll youi employees. For more
information, call the Oregon Dept. of Revenue at 945-8091 '' ! i i' :i
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, call tfte Oregon Employment Division at the Deprtrnent of Humn Rssour@s
at378-3524..\. /
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, *A'*tSt
obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensadon insurarrce, yournf,a;
besubjecttopenaltiesandwillheliablefiorallclaimcostsifoneofyouremployeesisinjuredonthejob. Formqreinformatidir"
call the Workers' Compensation llfivision at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenueservice: As an employer, you must withhold federal income tax fromemployeeS''wages. You will tE
liable forthe tax payment even if you didn't actually withhold the tax. For more information, call the Intemal Revenue Servic-e
at 1-800-829-1040. "' :
OTHEH RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code
that may be brought to your attention through inspections.
requirement;
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as talling 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 supL'rvise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and frnish
trades, and to notify building officials at the appropriate times so they can perforrn the required inspections.
If you have atlditional qirestions, write or call the Construction Contractors Board (PO Box M140, Salerrt OR 97309-5052,
5031378-4621). The Board is located at 700 Sunrmer St. NE Suite 3fi). in Salem.
prop-own.pm4
t/94
ATTACHMENT 81
)NO 15o ZlL
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
l(au Louc-NA}4T OR COI'4PANY
You*N l1o> z 44b - oo-booLOCATiONzt bb
l-v App rTr ,-lDEVELOPMENT TYPE:
BUILDING SIZE
tffi(r$c';.t,rlere^{a\or sI
mBryi$ffi
IMPERVIOUS SQ. FT.24b X $0.209 PER SQ. TT
X $43.26 PER PFU
$17.19 PER PFU + $10 MI^IMC ADMiN.FEE
Above)
Ft
1
NO. OF PFU'S
(See Reverse)
3. TRANSPORTATTON
.
NO OF UNITS X TRiP RATE X COST PER TRIP
x .- x $436.19
x --
x $436.19
x
-
x $436-19
2. SANITARY SFI^'ER-CITY
4. SANITARY SEWFR-MWMC
NO. OF PFU'S
(Use PFU Total From Item 2
SUBTOTAL (ADD ITEMS 1,2. & 3)61 il
$
$
MI^I|,lC CREDiT iF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
SUBTOTAL (ADD ITEMS 1.2.3 & 4)s 5r1l
5. ANMTNISTATIVF FFFS
BASE CHARGE (SUBTOTAL ABOVE) X .05
5
SDC Coordinator
82. SDC
Date b 4
TOTAI SOC bbaL
$
$