The URL can be used to link to this page

Home My WebLink AboutPermit Building 1993-12-06RESID ENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK:2 JOB NUMBER ?srca7 225 Fifth Street Springfield, Oregon 97 477 rAX Lor O-7aC,ASSESSORS MAP )anz- / q 4 .1- LOT BLOCK:SUBDIVISION: PHONE STATE:ZIP:FCITY: ADDRESS: OWNER: NEW - REMoDEL 4'aoDrloN DEMOLISH OTHER DESCFIIBE WORK: ELECTRICALi ADDRESS EXPIRES PHONECONTRACTOR'S NAME CONST. CONTRACTOR # G EN ERAL: PLUMBING RANGE: - OFFICE USE _ LAND USE: WATER HEATER: ZONING CODE:* OF UNITS: QUAD AREA: * OF BLDGS: SECONDARY HEAT: SQUARE FOOTAGE: OCCY GROUP: r OF STORIES: CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-3769. Thls ls a24hour recording, All inspections requested before 7:00 a.m. will be made the same working day, lnspectlons requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS Temporary Electric Site lnspection - To be made after excavation, but prior to setting forms. Underslab Plumbing/ Electrical/ Mechanical - Prior to cover. Footing - After trenches are excavated. Masonry - Steel location, bond beams, grouting. Foundation - After forms are erected but prior to concrete placement. Underf loor Plumbing/ Mechanical - Prior to insulation or decking. Sanitary Sewer - Prior to filling trench. Storm Sewer - Prior to filling trench. Water Line - Prior to fllllng trench. Rough Plumbing - Prior to cover. Rough Mechanical - Prior to cover. Rough Eleclrical - Prior to cover, Final Plumbing - When all plumbing work is complete. Final Electrical - When all electrical work is complete. Final Mechanical - When all mechanical work is complete. Plumbing Conneclions - When home has been connected to water and sewer. Electrical Connection - Whenblocking, set-up, and plumbing inspections have been approved and the home is connected tothe service panel. ,K E X x ,K l-l Underground Plumbing - priortJ to filling trench. ffi Framing - Prior to cover.t.z\{ pf WattlCeiting tnsutation - prior to{cover. po*rll - Prior to taplns. Electrical Servlce - Must be approved to obtain permanent electrical power. Fireplace - Prior to facing materlals and framlng lnsp. Wood Stove - After installation lnsert - After fireplace approval and installation of unit. Curbcut & Approach - After forms are erected but prior toplacement of concrete. Sidewalk & Driveway - After excavation is complete, forms and sub-base materlal in place. l-_l Fence - When compteted. Street Trees - When all required trees are planted. Final Building - When ail required inspections have been approved and building is completed. Other MOBILE HOME INSPE TIONS .K [-l glocking and Set-Up - When ail.- blocking is complete.l\/Post and Beam - prior to ftoor!\|. insulation or decking. ffi,4loor lnsulation - Prior toLIA{ decking. E. Final - After all required inspections are approved andporches, skirting, decks, and venting have been installed. a{a&a t i a't -7477 MECHANICAL: FLOOD PLAIN: # OF BDRMS: - fI E GAR ACCP.L.HSE N S E Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type v - lnterior - Corner - Panhandle - Cul-de-sac tbacks ..-1S THE PROPOSED WORK lN THE' HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be slgned and approved bY the Historical Coordinator prior to permit issuance. APPROVED 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 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' Date Receipt Numbe Plans Fleviewed By Plan Check Fee: Date Paid: Received By: BUILDING PERMIT VALUE /4H2,* /22,€o/3 /ze,as F," (A) 54t4, ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee SQ. FT. X $/SQ. FT. =6.( ,? .=o SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Resldential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT, FT. PLUMBING PERMIT Plumbing Permit state surcharge Total Charge Wood Stove/ lnsert/ Fi replace Unit Dryer Vent MECHANICAL PERMIT zi l.ti , ,V{ (D) €2 N0 / 5,oo /a@Mechanical Permit lssuance State Surcharge Total Permit Fu rnace Exhaust Hood Vent Fan By signature, I state and agree, that I have caref ully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, 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 ln compliance with ORS 701.055 will be used on this proiect. I Iurther agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain Date at all times during construction. MTSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -- ft Curbcut -- ft Demolition State Surcharge Total Miscellaneous Permits (E)to //o 3 DATE PAID AMOUNT RECEIVED RECEIVED BY VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, O and E Combined) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. /AT 77/ '{- 4 "f * -71,Ls, SPrlIN(;FIELO h, JoB NuMBE " ?=6? 225 Fifth Street 8? Springfield, Oregon 97 477 LocAIoN oF pRoposED woRK: aze ?a ;rzr fr' RESIDENTIAL PERMIT APPLICATION lnspections:726'3769 Olfice: 726-3759 ASSESSORS MAP: aTAX LOT: LOT: -- BLOCK:SUBDIVISION I boPHONE ZIP:STATE: 2D 6ft--k finCITY: ADDRESS: OWNER: t,:*-1 b"ot g AeJ DEMOLISH OTHERITNLJ ( a--DESCRIBE WORK:b^ NEW- REMoDEL ---/ A PHONEADDRESSAME L-05qL 'S ,*rL 0*,,1*-{ra* b EXPIFIES MECHANICAL: CONTRACTO PLUMBING GENERAL: CONST. CONTRACTOR ' SE_ VV - OFFICE 'I OF BDRMS: RANGE: FLOOD PLAIN: ZONING CODE SECONDARY HEAT SOUARE FOOTAGE: CONSTR. TYPEI HEAT SOURCE: LAND USE: # OF UNITS OCCY GROUP: * OF STORIES: QUAD AREA: # OF BLDGS To request an inspection, you must call 726-3769. This is a24 hour recording. All inspections requested before 7:oo a.m. will be made the same working day, lnspectionS requested after 7:00 a.m. will be made lhe following work ciay. REOUIRED INSPECTIONS Temporary Electric Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is comPlete. Site lnspection - To be made a(ter excavation, but Prior to setting forms. Rough Electrical - Prior to Final Eleclrical - When all electrical work is comPlete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Perrnanent electrical power. Final Mechanical - When all mechanical work is complete. T(Z/Footino - After trenches are ,A{ excavaied.Fireplace - Prior to facing ,naterials and framing lnsP. K Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting. ff rra-ing - Prior to cover' Other lV/Foundation - After forms are JAderect"d bur prior to concrete placement.Wall/Ceiling lnsulalion * Prior to cover. Underground Plumbing - Prior to filling trench.l--l Drywall - Prior lo taning MOBILE HOME INSPECTIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation dPostand Beam - Prior to floor .rlAt insulation or decking.lnsert - After firePlace aPProval and installation of unit. Blocking and Set.Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcul & ApProach - After forms are erected but Prior lo placement of concrete. Plumbing Connections - When home has been connected lo 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. Storm Sewer - Prior to lilling trench. Sidewalk & DrivewaY - After excavation is comPlete, forms and sub-base material in Place. Water Line - Prior to filling trench.l_-l Fence - When completed Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. K Rough Plumbing - Prior to cover. Street Trees -- Vvhen ::ll rr:quireci trr)es are plante(l. caT 5p WATER HEATER: E tl E E tl E tl il Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type - lnterior -_ Corner - Panhandle - Cul-de-sac N Setbacks PL.HSE GAR ACC S ISTHE PROPOSED WORK IN THE HISTORICAL DISTRICT, OFI ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: E E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is eranted on the express condition that the said constructic,rr sltalt, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Cocle, regulating the corrstruction and use of buildings, and may be suspended or revoked at any time violation of any provisions of said ordinances /84 eviewed By u4#'-P h u pon k Fee: Receipt Nutnber: Rccei ved /2-ffi*o'fuvo (A) Vt f,Yd./al X $/SO. FT.VALUE //.tc /P-? 3/9."? Total Value Building Permit Fee State Surcharge Total Fee 4*o384,ss BU!LD ITEM Main Garage Carport ING PERMIT SQ. FT. v9q Systems Development Charge is due'on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS ITEM Fixtures Besidential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE N0 FT. FT. -2s2eF'i. (c) o l,=u2GF PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fireplace Unit Dryer Vent MECHANICAL PERMIT (D) N0 Mechanical Permit lssuance State Surcharge Total Permit Fu rn ace Exhaust Hood Vent Fan 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 Orclinances of the City of Springfield, and the Liws 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 f urther agree to ensure that all required inspections are requested al the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans w nal u :-e Date the site at I tim n ons tn ton MTSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -- ft Curbcut _- ft Demolition State Surcharge Total Miscellaneous Permits (E) DEEI DATE PAID AMOUNT R RECEIVED VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) .73 SYSTEMS D EVELo P * =*r,"l r^ -tftH_ E r.TRlq,' fN<ru biz:ct< R44! R.E_,a, ;iEBA<RAT:E ffi i SPRINGFIELD RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Oflice: 726'3759 h, JOB NUMBER q i i6ez 225 Fifth Street Springfield, Oregon 97 477 3 Ea,% tn,A tE-LOCATION OF PROPOSED WORK: 2_TAX LOT:77 -ASSESSORS MAP: LOT: -- BLOCK PHONE 3s+4 ZIP (g-€, 9z v77STATE: -Q Rfu -7 Y7 - 79, Yo L*,'t EL TW CITY: ADDRESS OWNER:dn Ave, NEW _-- REMODEL ADDITION DEMOLISH OTHER EJt)o0DESCRIBE WORK: EXPI RES PHONEADDRESS /o-3|-toe00 Sco F-,0 ?%-/6^I CONTRACTOR'S NAME MECHANICAL ELECTRICAL: CONST. CONTRACTOR # G EN ERAL: PLUMBING PeTo Q. €ll Ekc RANGE: Y OF BDRMS: OUAD AREA: _ OFFICE USE _ LAND USE: ZONING CODE: FLOOD PLAIN WATER HEATER: r OF STORIES: r OF UNITS: SECONDARY HEAT SOUARE FOOTAGE: OCCY GROUP: --CONSTR. TYPE: HEAT SOURCE: To request an inspection, you must call 726-376g. This is a 24 hour recording. All inspections requested before 7:00 a.m. will be made the same working day, lnspections requested after 7:00 a.m. will be rnade the following work day. REQUIRED INSPECTIONS Temporary Electric Rouglr Mechanical - Prior to Final Plumbing - When all plumbing work is comPlete.er, Site lnspection - To be made alter excavation, but Prior to setting {orms. Rough Electrical - Prior to Final Electrical - When all over e lectrical work is comPlete. Underslab Plumbingl Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Perrnanent electrical power. F-Z Final Mechanical - When all /d'meclranical work 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.Framing - Prior to cover, KI o,^u, 4i# . t^€ Foundation - After forms are erected but Prior to concrete placement.Wall/Ceiling lnsulalion - Prior to cover. Underground Plumbing - Prior to filling trench.l--l orywall - Prior to taPing MOBILE HOME INSPECTIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation Posl and Beam - Prior to floor insulation or decking.lnserl - After firePlace aPProval and installation of unit. Blocking and Set-Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut & ApProach - Af ter forms are erected but Prior to placement of concrete. Plumbing Conneclions - 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. Storm Sewer - Prior to filling trench. Sidewalk & DrivewaY - After excavation is comPlete, forms and sub-base material in Place. Waler Line - Prior to filling trench. Fence - When comPleted. Street Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed.Rough Plumbing - Prior to cover. SUBDIVISION: - t tl tl tl E tl tl E tl D E tl E tl E E r E U Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type - lnterior - Corner - Panhandle - Cul'de-sac Setbacl<s PL.HSE GAR ACC N 5 -1S THE PROPOSED WORK IN THE I-IISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed ancl approved by the Historical Coordinator prior to permit issuance. APPROVED:E BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This perllrit is granted 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 Corle, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Recei pt Number:-_-- DatePlans Reviewed By Plan Check Fee: Date Paid Received By VALUE (A) X $/SQ. FT Main Carport Garage Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Systems Developrnent Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT FE,E N0 FT. FT. I FT. (c) Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/ Fi replace Unit Dryer Vent r4a) __ rZf ZSE /zrZ, 4 (D) Z at\D No /14_ Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rn ace Exhaust Hood 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 certi{y that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structurc without permission of the Building Safety Division. I further certily that only contractors and employees who are in compliance with ORS 701.055 will be used on this proiect. I f urther agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain tu rc Date l-;fi -7((7 on the site at al imes duri tion MTSCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk -- ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) y'a-o GA VALIDATION FIECEIPT NUMBER DATE PAID AMOUNT RECEIVED FIECEIVED BY -- TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Comblned) Z€ZS t OREGOII'A|Y OF 225 FIETE Sf,REEf, SPRTNGFTEIJ), OREGON INSPBCTION RBQTIBSI: 0FEICE: 726-3759 1f vorlc is no'tof issuance or 180 days. 2. COIfIRACTOR Tho followin 9747ilrins, ar'a 726pgrs %3;*_1,?ilXP$::#,frJI,; APPLICATION qe,\U8? 1. r,ocAEoN ,or msrar-r.Eft?o,x- \fiI'tl I -3a- City Job Hunber Service I tens 1000 sq.ft. or less Eaeh additional 500 sq. ft or portion thereof Each Hanufrd Home or -Hodular Dvelling Service or Feeder Services or Fee0ersInstallation, Alterations or Relocation: ldq. A,qry" -* trQSi cpt5 PEE\SOEEDUIJ BELOS Lonti JOB DESCRTSTION E Permits are transferable and expire Cos t s 85-00 '$ 15.,00 $ 40.00 s s0.00 s 60.00 s100.00 $130.00 s300. 00 $ 40.00 s 35.00 $ 2.00 f starteA vithin 180 daysif vork is suspended for ONLY I B E Electrical Contracto Address Ci ty enone:tcl3- lLS I Supervisor eense Number lesi S Expiration Date I f.r q+ Constr Contr. Number elo lto U Expiration Date of Supervising Eleetrician drt".- Ovners Name 200 amps or less I201 anps to 400 -amps 401 aurps t.o 600 .amps 601 amps to 1000 amps- over 1000 amps/volts -Reconneet 0n1y 50* C. Temporary Services or Feeders " Installation, Alteration or. Reloeation D. Branch Circuits Nev, Alteration or Extension per panel 200 amps or less S 40.00 201 amps to 4oo amps - $ 55.00 over 401 to 600 amps - $ go.oo Over 600 amps or 1000-!A[s see uBu aE6If Address Ci ty Pt'o""-l.-}:J i OgNER INSTALI.ATION The installation is being nade onproperty I ovn vhich is not intendedfor sa1e, lease or rent. Ovners Signature: DATE: RECEIPT One Circuit gach Addi tional Circuit or vith Serviceor Feeder permi t S,L SBTOTAL OF ABOVE 5Z State Surcharge TOTAL Hiscellaneous ( Servi celfeeder -Each installation Prrmp or irrigation $-Sign/0utline Lightingl- SLimited Energy/Res - SLimited Energy/Comn S 5 not included) 40.00 40- 00 20.00 36.00 BRECEI\TED I I (- R--6- Sum -. s- : Y) OREGO'UCITY OF SPF 225 FTVtfl STRBEf, SPRINGEBU), oRBGoN INSPECTION RBQTIBST: OFPICE: '726-3759 SPRTNGFIELO Tha following Proiect as submittad hae lhe r ,tiing, and does not require sPecific land usg13g1'p1gAl PERHIT APPLICATION gT4w?ruvet. 726-3 City Job Nunber ,) Ss Kes iden tial-Single or Date \>->o 3. COHPIJTB FEB SCMDUIA BBLOS A. Hulti-Family per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less $ Bs.oo 1. LOCATION OP IAGAL DBSCRIPTION JOB DBSCRIPTION Sum 74ti, Each additional 500 sq. ft or portion Electrical Contractor Address ci ty-Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Slgnature of Supervising Electrician Owners Name Address 2rt Ci ty Phone 747- fr,f7 permits are non-transferable and expire if vork is not started vithin 180 days of i""u.nce or lf vork ls suspended for 180 days. 2. CONTRACTOR INSTALI.ATION ONLY O9NER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. 0rners Signature: thereof Each Hanuf'd Home or Modular Dwelling Servlce or Feeder 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- 0ver 1000 amps/volts - Reconnect OnIY ST'BTOTAL OF ABOVB 5Z State Surcharge TOTAL Temporary Services or Feeders Inslallation, Alteration or Relocation 200 amps or less $ 40.00 over 4bt to 6oo amps - $ 8o.oo 0ver 600 amps or fbOO voTts see rrgrr .fiffi Branch Circuits Nev, Alteration or Extension Per Panel One Circui t 1 $ 35.00 -'< {4"' Each Additional Circuit or with Service or Feeder Permi t 4 $ 2.00 -e,"" Hiscellaneous (Service/feeder not included) -Each installation Pump or irrigation - $ sign/outline Lighting- $ t iili ted Energy/Res - $ $ 1s.00 $ 40.00 B $ $ $ $ 00 00 00 00 00 00 50. 60. 100. 40 130 $300 $ c i D B. 40.00 40.00 20.00 36.00 DATB: RECEIVBD o 5 1,3.'' u' -7U- -#T REgIDENTIAL - COYIYIERCIAL SIDETJ,JALK dcuwtt' )areurcetrotr}eern-SPFlINGFIELO 225 NORTI{ FIFTI{ gTREET 5PRll{cF |ELD, OREGohl 91 411 E}.IG INEERING D IVIg IOI.I o=rcE No. 126-)1>a IN9PECTION LINE: -126.3169 h, Jots ADDRE9g: 7 S zo 7o t AN 0 A *A99E9rcR9 FIAP NO.' g'UBDlVl9lON' TAX LOT NO. OdAlER,Rnv sETT€Lntrr€p ADDREee: 3g Zo |oc ANDA CIIY, S/2/NAFE/D RECEIPTNot 5lt+p * CHECKED FOR DELINAJENCIEg // cA9*.1 cl-.iEcK 5I6NED, L)AlE. STATET ore,'7lp.? 7 477 PHohrE Na74Z-789) rUOFK lci{, LLJOFK TO tsE FERFOR|IED EY: oUAER coNrRAcroR* G (€N ,e , TAylap SIDEIUALK' CURB 9lDE L-- 9EiBAC< _ GUR3-CUT: --t-' REStDEhiTlAL --r---' col-1ilERICA _ g=COND DRI\EUAY ( 5EE TRAFFIC ) R=AU|RE9 APPLlcATlofl FoR A SEcoND DRI\€IIJAY(T-4-1a) OR A COTJNTY APPLICATION FOR FACILITY PERr1IT (C W.2O3) IF IN THE I,]6.8. DATE G APPLICATION L"/' CoNTRACiOR ADDR=S5 REGrsrRAloN Noj A;+AI Ex?t=.s,8 P.a, BaY =o3 Za 6€ G,Pu/./€ oe€,77424 FHoNE:L FROCEDURE FoR lNgPECTlchl REaUE9T' aALL 12b-31ba (e,co@=R ) 9TATE YOUR CtT]r DESTGNAT=D JO3 NUrB=R, JO3 ADDR=39JypE tr INSPECTIOI'{ REaU=STED AND tlrr{EN YoU IUILL 3= READY FoR lNgP=c;lorl, CoNTRAcToRg oR otj,}.{ERg N,/.t-1= AtD Pi]ONE NL.tr-13ER , AU=gTg RECEI\ED E=rcRE 1@O Afi, TUILL 5= i-1A'= rH= 9AJ"1E DAY, REAUE9T9 /+?G? ,-;OO AI.1 UJILL BE IIADE TI]= NEXT I,UOR<ING DAY EXIgTI}{C BUILDING PEE1IT NO. (l= /@t t- AAt = \l Ft I !r9^9LL / 93 rc,A7#*T *YOUR CITY DE9I6NATED JO3 NO.r5rgEE tsOO< gIDEIUALK / DRI\€II)AYrcR ALL CONCRETE PAVING IUITI.]IN THE STREET RIGI{T OF UJAY, TO BE I1ADE AFTER ALL EXCAVATINC 15 COI,IPLETE A},.ID FOR|I IUOR< A}.ID gUB-BAgE HAiERIAL 19 IN PLACE CU@ / APPROACI-] APROI.{, AFTER FO315 ARE ERECTED tsUT PRIOR TO POURING CONCRETE. FEES: SIDE|,UALKS TOTAL FEFIIIT FEE: rlo.OO + aO.15/LF.( X ) OF IIJALK l'1 9 -TEaTT O.OO+|O.\>/L.F.(X) COI,lr1E R I CAL DRI\,€IUAYg SI1ALL HA\G 5'TO A'FLAIRS 3'. A" gTA\DARD ,3D * uJALK X, b i - /- I l'i I :"'i4\€ CAREFULLY EXAYINED it'lF COI.1PLETED APPLICATiON FOR PER'1iT, AND DO FiEREtsY CERTIFY TH,I.T ALL:Nrc31ATION I]EREON 19 TRLJE A\D CORR=CT, A\D I FURTI-.{ER CERTIFY TI.I,4T ANY AND ALL IIORK PERFOSIED9r;ALL BE DONE lN ACCoRDANCE tlllTH Tl-lE oRDINANCE9 G Tl-.]E clTY G 9PRINc,FIELD ,, A]D T}.]E LAI.1]9 G TI-.iESTATE OF OREGON PERTAINING TO THE IIJORK DESCRIB=D I-|EREIN, A\D THAT NO OCCUPANCY UILL BE I.1ADEG ANY STR,JCTURE tljlTiloJT PEBllS9loll oF THE BUILDING DlvlgloN. tFuRTriER CERTIFY TI{AT ONLY CONTRACTORgA\D EHPLOYEEg I.IJI.{O IN COI1FLIANCE IJITH OR' 1OIO5> IUILL 3E U9ED ON T{-]IS PROJECT. I n l+E LO REAUIRED INgPECTIOT.Ig APPLICATION FOR A SECOND DRIVEIIAY DATE:.Z APPLTCANT (PROPERTY O![NER) :/^ ADDRESS OF APPLICANT: 3g2T:/o,a--pA 4tr ADDRESS OF PROPERTY FOR 2ND DRIVE1TAY:Srza y'oc,+=r>.+ $tf Z4l-75 sg ( -onr= 4g71/+b)APPLICANT'S TELEPHONE NO. : The folloving conditions must be ansvered affirmatively in order for this applieation to be considered for approval: 1). Property is either a single family residence or duplex. YES k N0_ 2>. The proposed drivevay vi11 take direct access from a minor street (not-a tollector or irteriat street). yES )< N0 -.3). The drivevay viII have a minimum setback of 30 feet from the curb return of an interseetion (for corner lots). YES X N0-. 4). The proposed drivevay (parking area) must have a minimum depth of 18 feet betveen the front property line and the garage, carport, fence or vall, if any (identical to setback for garage). YES Y NO s).The second drivevay must have direct access to a garager earport, rear yard or the side yard vhere the vehicle, trailer or boat vill be stored. YES f N0_. If the vehicle, trailer or boat is to be parked/stored in the side yard, there must be a minimum setback of 5 feet betveen the stored vehicle and the side property 1ine. This setback is for fire fighting.access and to comply vith the intent of the zoning code. Setback satisfied? YES f N0_. The proposed parking/storage area must not create a vision obstruclion to adjacent property drivevays or .to. any vehicular movement on a public street. Satisfied? YESX N0 6). This application shall include an B L/2'r x 11rr draving shoving existing drivevays, and the proposed drivevay. Please include dimensions, and measurements to road intersections and/or bordering drivevays. All applications outside the city limits of Springfield that are vithin the Urban Grovth Boundary require a Lane County permit. 7). Applieant hereby agrees to install the requested drivevay to City of- Springfield standards. The apf,ticant further agrees to have 6r' of concrete in the sidevalk area adjacent to tlre proposed drivevay and further agrees to pave the area behind ihe back edge of ihe sidevalk, or drivevay apron, adjacent to the diir"r"y vith a miiimum depth of 3" of asphaltic concrete or vith a minimum J"ptf, oi 6" of portland cement eoncrete. The area behind the sidevalk sha11 be paved to the property line or for a distance of 4 feet vhich ever is greater. The applicant agrees that i.f he/she does not pave the area behind the sidevalk vithin'30 days 6f cutting the curb opening, the City_of-springfield has the authority of close the diivevay access by the removal of the curb cut. All incurred costs sha}l be assumed by the applicant and if unpaid, said cost shall become a lien of the ProPerty. Vhen this application is approved by the City, the applicant (p_roperty ovner) must obtain'i drivevay permit from the Public Vorks Department Engineering Division. PERMIT FEE a. 0n an i;nproved street (existing curb): $10.00 plus $.15 per lineal foot of eurb cut. b. 0n an unimproved street (not curbed): $12.00 c. On currently unimproved streets that are under construction: $12 .00. PROPERTY OIINER'S SIGNATURE: DATE: I *AFft2a4tD ftR A APPROVED BY: /g Aurss t'w7z{ i h u4 t-lt .U J 5 6 t=t-1UfZ5 7oq4 gor oPryg ry 70 --{-^AAAbt"'f I P.,dJDATE:7op caF 70? oF BUILDING PERMIT NO.: DATE: TRA 9-1 ATTACHMENT:City of Springfield Standard Dr Dated 1.0/B/82 aving No.3- 11 tl€ CuB -@ ] d-/ $s i)$i s-$ i f DA h c /h., 7' s)\|l \\ P \r 'l,n.t\t y vil ,44/pi"'Ir' , to,//" ,tfr/ z { _,14W1 { F""*t*J"Af f,o, vl zPia L C'TY OF 225 FIFTH STRSET SPRINGFTEU), oREGoN TNSPBCTION REQTIEST: oFFICE: 726-3759 1 LOCATION OF I,EGAL Z JOB DESCRTPTION @r7,&Ta'*t -,( He-,- ? Permits are non-transferable and expirelf vork is not started within 180 daysof issuance or if vork is suspended for 180 days 2. COIITRACf,OR INSTALI.ATION ONLY Electrical Co ntractor Seofield El ect r ic Address PO Box 2765 ci Eugene Phone 686-8612 Supervisor License Nrimber 508S Expiration Date 10- t-92 Expiration Date I 2-Z l-92 Signature of Supervi 1C].ern Ovners Name 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _601 amps to 1000 amps_ Over 1000 amps/volts Reconnect 0nly C. Temporary Services or Feeders Installation, Alteration or Relocation D. Branch Circuits Nev, Alteratlon or Extension Per Panel STIIIINGFIGLo 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or Hodular Dwelling Service or Feeder SUBTOTAL OT ABOVB 5Z State Surcharge TOTAL 200 amps or less $ 40.00 201 amps to 4oo amps - g 55.00 0ver 600 amps or 1000 volts see 'rBrr above Services or Feeders Installation, Alterations or Reloeation: One Ci.rcui t t/ $ Each Additional Circuit or vith Service or Feeder Permi t. 1 $ MisceLlaneous (Service/feeder -Each installation Pump or irrigation $ Sign/0utline Lighting_ $ Limited Energy/Res $ Limited Energy/Comm $ r,,r.i r:. . BLBCTRT 97477 CAL PBRilIT APPLICATION 726-3769 LDTZ City Job Number i:,,ro - -l,lm-[ri.Y 3. COI'IPI..ETB FEE SCHEDUI,E BBLOS Residential-Single or HuIti-FamiIy per dvelling unit. Service Included:Items Cost Sum Co B $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 $ 8s.00 $ 1s.00 $ 40.00 3s.oo 3y 2.00 Zn not included) 40.00 40. o0 20. o0 Address Ci ty Phone OITNER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. Ovners Signature: DATE: E e 10e.\ /t- 7.a-9#1.8.{-RECEIVED BY: 5 Constr Contr. Number 38i02 1 2 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 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 co mpletion A My general contractor is Contractor registration number 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. 3 OR la ate WHITE COPY TO ISSUING AGENCY PERMIT FIIT PINK COPY TO APPLICANT /t re rmit Applicant CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 I hereby certify that the above inlormation is correct and that t have read and understand the lnformation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. TNFoRM;;oN NoncE To pRopERTv owfens ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS rc1.055(5), passed. by-.the 1989 Oregon Legislature. , lf you are'acting as your own contractor to cohstruct a new home or make a substantial imlirdrrefflent to an existing structure, you can prevent many problems by being aware of the following resporisibilities and areas EiIPLOYER RESPONSIBILITIEE: 'i i ' : '?':' -;' lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improyemelt of a residentiat strqctLfre; .you will, in mdst instirltes, beiruled to be an "employer" an! the peopie you hire will be,'.'employees". As jhQ lemplbyer, yqg muqt comply wilh the following: n's Withholdi Tax Law: As an emp loyer, you must withhold income taxes'from employee wages at the t mployees are paid. You will be Hable for the tax pay.ments even if you don't-actually withhold therme e tax from your employees. For more information, call the Oregon Departrnent of Revenue d 378-3390. Unemployment lnsuiance Tqx: As an employbr, 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 a|378-3224. : Workers' Compensation lnsurance: As an employer, you are subiect to the Oregbn Workers' Compensation Law, an$ must obtain workers' compensation insuranee for your employees. lf you fail to obtain workers' compensation insurance, you may be subject to penalties and wilTbe'liable forall cldim cests if 'ond of your employees is iniured on the job. For mors info;mation, calllne "Wo$eJs' C,,1mPf.n1.lion Division DIF at 973-74U. ' \:, U.S. lnternal Revenue Service: As an employer, You wili 6e tiable for the tax payment even if yo the lnternal Revenue Service at 221:3960. lf you have additional questions, write to: you m,ust wilh,hold fgpelgl incomg.tax from employees'wages. u didn]t,actiiAlly.WitffiOld the tax. For more information, call OTHER RESPONSIBILITIES AND ABEAS OF CONCERN Code Compliance: Asthe,pefrnit holder for this project, you are responslble.lor.re$olving any failure to meet code requirenrentsthatfiay be,brought to your attention through inspectionrs.'. ' . Liability and Pruperty Da'rilage lnsurance:,-Contact your iri5urdhce.agent to see if y6u hive adequate insurance chasfallingtoo|S,paintoverspray;w.dterdamagefrompipepunc. tures, fire, or work that must be re-done. Time,to Sr,rpervbe Empkcyees: Make sure you have sufficient time to supervise your ernployeeS. i : hr '.-':l; . ti ' Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rougfr-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. -! ,_ I ,. . i - Construction Contractors Board D0 Summer St. NE, Suite 3oo Salem, OR 97310-0151 Phone 5m-3fru4621q J fit24tgg