HomeMy WebLinkAboutPermit Building 1994-05-01RESIDENTIAL
PERMIT APPLICATION
lnspections:726.3769
Office: 726.3759
PFlII\.GFI
JoB NUMBE a ?/aSa;
225 Fif th Street
Sprlngfleld, Oregon g7 4ll
LOCATION OF PROPOSED WORK:R7p
ASSESSORS MAPI 3-22^fr TAX LOT:
LOT
-
BLOCK:SUBDIVISION:
OWNER:PHON E/2ry
STATE:ZIP:CITY:E*
ADDRESS:
'3/>5 5.,
NEW
-
REMODEL ADDITION DEMOL|SH OTHEB
--
DESCRIBE WORK:
ADDRESS EXPIRES PHON E
CONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
CONST,
CONTRACTOR #
GENEHAL:
PLUMBING
26^ t
- OFFICE USE -
# OF BDNMS
ZONING CODE:
FLOOD PLAIN
SECONDARY HEAT: _
SOUARE FOOTAGE
LAND USE:QUAD AFIEA:
'r OF BLDGS
RANGE:
CONSTR. TYPE:
HEAT SOURCE:
OCCY GROUP:
I OF STORIES:
To request an lnspectlon, you must call 726-3769. Thls ls a24naur recordlng. All lnspecilons requestec, before 7:00 a.m. wl1 bemade the sarne worklng day, lnspections requested after 7:00 a.m. wlll be made the followtng work day.
REQUIRED INSPECTIONS
J-l femporary Electrtc Flnal Plumbing - When allplumblng worl( ls complete.
Slte lnspectlon - To be mado
after excavatlon, but prior to
s6ttlng forms.
Rough Electrlcal - Prior to
cover.
Underslab Plumblng / Electrical /
Mechanlcal - Prlor to cover.
Foundatlon - After forms are
erected but prlor to concreteptacemant.2ry'24fnf
Underground Plumblng - Prior
to fllllng trench.
Underlloor Plumblng/ Mechanlcal
- Prlor to, lnsulatlon or decklng.
Posl bnd Beam - Prlor to floor
lnsulatlon or decking.
Floor lnsulation * Prlor to
decklng.
Sanllary Sewer - Prior to filling
trench.
Storm Sewer - Prlor to fllllng
trench.
Water Llne - Prlor to filllng
trench.
Bough Plumblng - Prior to
cover,
Rough Mechanlcal - Prlor to
cover.
Electrical Servlce - Must be
approved to obtaln permanent
electrlcal power.
Flnal Electrical - When ailelectrical work is complete.
Flnal Mechanical - When all
mechanical work ls complete.
Flnal Building - When ailrequlred lnspectlons have beenapproved and building ls
completed.
Othor
[l Footlng - After trenches arelJ excavated.
l-l Masonry - Steel tocatton, bond
-
beams, groutlng.
w
Flreplace - Prlor to faclng
materlals and framlng lnsp.
V
tl
Framlng - Prlor to cover.
Wall/Celllng lnsulatlon - Prior to
cover.
Drywall - Prlor to taplng.
Wood Stovo - After lnstallatlon
Curbcut & Approach - After
forms are erected but prlor toplacemont of concrete.
Sldewalk & Drlveway - After
excavatlon ls complete, forms
and sub.base material ln place.
Fence - When completed.
Streel Trees - When all requlred
trees are planted.
MOBILE HOME INSPE TIONS
Blocklng and Set.Up - When allblocklng ls complete.
P.lumblng Connectlons - When
home has been connected to
water and sewer.
Eleclrical Connection - When
blocking, set-up, and plumbing
lnspections have been approved
and the home ls connected to
the service panel.
Final - After all required
lns'pectlons are approved andporchcs, skirtlng, decks, andventlng have been lnstalled.
n lnsert - After flreplace approval
-
and lnstallatlon of unlt.
/Pa
'. ., ::
EaTl{-*- _?-1e>
# OF UNITS. /
WATER HEATER:-
E
E
E
tl
E
tl
tl
tl
tl
: ,jl,.!*I$i
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Toral helght
Lot'I
. lnterior
-
Corner
-
Panhandle
-
Cul-de.sac
Set IS THE PROPOSED WORK IN THE .
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcailon must be slgnedand approved by the Hlstorlcal
Coordinator prlor to permit issuance,
APPROVED:
VALUE
?2,D(A)
X $/SO. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMTT
ITEM SO. FT.
Garage
Carport
BUILDING VALUE, PLAN CHECKAND BUILDING PERMIT
Thls permlt is granted on the expre6s condiilon that the saldconstruction shall, ln all respects, conform to the Ordinanceadopted by the City of Spri ngfield, lncludlng theDevelopment Code, regulatlng the constructlon and -use otbulldings, and may be suspended or revoked ,it
""V if .*upon violation of any provisions of sald cirdlnances.
Receipt Number;_
DatePlans Reviewed By
Plan Check Fee
Date Pald
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undevelopedpropertles withln tho City limits which are belng lmproved.
ITEM
Fixtures
Resldenlial Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
PLUMBING PERMIT
FEE
N0
FT,
FT.
FT.
(c)
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
(D)
No
Mechanlcal Permit
lssuance
State Surcharge
Total Permlt
Fu rn ace
Exhaust Hood
Vent Fan
By slgnature, r state and agree, that r have caref uily examrnedthe completed appllcatlon and do hereby cerilfy that alllnformatlon hereon ls true and cofrect, and I f urther cerflfythat any and all work performed shall be done in accordancewlth the Ordinances of the City of Sprlngf leld, and the Lawsof the State of Oregon pertalnlng to tho work descrlbedheroln, and that NO OCCUPANCy wlll be made of anystructure wlthout permission of the Bulldlng Safety Divislon.I further certify that only contractors and employees whoare ln compllance with ORS 7O1.OSS wlil be used on thlsprolect.
I further agree to ensure that all required lnspections arerequested at the proper ilme, that each address rs readabre
from tho street' that the permrt card rs rocated at the frontof the property, and the approved set of plans wlll remaln
on the slte at al structlon.
Slgnature
Date
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk -- ft
Curbcut
--
ft
Demollllon
State Surcharge
Total Mlscellaneous permits (E)
TOTAL AMOUNT DUE (exctudtng electrtcat)
(A, B, C, D, and E Combtned)
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
P.L.HSE GAR ACC
N
S
E
-{
/? .^,
l
LOCATION OF PROPOSED WOFIK:
?fr,
JOB NUMBER
225 Flfth Street
Sprlngfleld, Oregon 97477
//17 ,il' lh 5/)
Spr,ttwfre/C r,.-'s;ESSOBS MAP:
LOT:BLOCK:SUBDIVISION:
PHONE:
STATE:ZIP:
ovrlruen:
ADDRESS:
CITY:
Gatw-qe
OTHERREMoDEL l/-t
/)
\
%'tltiett'* /n "-noJDESCRIBE WORK:
NEW
-
'|{
ADDITION DEMOLISH
PLUMBING:
MECHANICAL:
ELECTRICAL:
-
ADDRESS EXPIRES PHONECONTRA TOR'S NAME
GENERAL:
CONST.
CONTRACTOR ,'
rL\
\
4 P [,1.-,\t I, I
vx/
- oFFrcE usE -
r OF BDRMS:
RANGE:
LAND USE:
ZONING CODE:
FLOOD PLAIN:
* OF UNITS:
SECONDARY HEAT:
SQUARE FOOTAGE:
OUAD AREA:
* OF BLDGS:
OCCY GROUP:
I OF STORIES:
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons 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
Temporary Electric Rough Mechanlcal - Prlor to
cover.
Flnal Plumblng - When all
plumblng work ls complete.
Sitg lnspectlon - To be made
after excavatlon, but prior to
setting forms.
J---l Rough Electrical - Prlor toL--l cover-Flnal Electrlcal - When all
electrlcal work is complete.
Underslab Plumblng/ Electrlcal /
Mechanical - Prlor to cover.
Flnal Mechanlca! - When all
mechanlcal work ls complete.
Footlng - After trenches are
excavated.
Flnal Bulldlng - When all
Flreplace - Prlor to faclng
materlals and framlng lnsp.
lnspectlons have been
Masonry - Steel locatlon, bond
beams, groutlng.
approved and bulldlng ls
completed.
(ttu-'ng - Prlor to cover'
Olher
Wall/Celllng lnsulatlon - Prlor to
cover.
to fllllng trench.Drywall - Prlor to taplng.
MOBILE HOME INSPECTIONS
Underlloor Plumblngl Mechanlcal
- Prlor to lnsulatlon or decklng.tl Wood Stove - After lnstallatlon.
Post and Beam - Prlor to floor
Insulatlon or decklng.lnsert - After flreplace approval
and lnstallatlon of unlt.
Blocklng and Set.Up - When all
blocklng ls complete.
Floor lnsulation - Prior to
decklng.Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
Plumbing Connecllons - When
home has been connected to
water and sewer,
Sanllary Sewer - Prlor to fllllng
trench.Electrlcal Connection - When
blocklng, set-up, and plumblng
lnspectlons have been approved
and the home ls connected to
the servlce panel.
Storm Sewer - Prlor to lllllng
trench.
Sidewalk & Driveway - After
excavatlon ls complete, forms
and sub-base materlal in place.
Waler Llne - Prlor to filling
trench.
Fence - When completed.
Street Trees - When all requlred
trees are plant€d.
Final - After all required
lnspectlons are approved and
porches, sklrtlng, decks, and
ventlng have been lnstalled.Rough Plumblng - Prlor to
cover,
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
= ^70a
32'2"''
f>t,r: t{-€ E-
\\
WATER HEATER:
E
E
E
E
E
E
E
E
tl
E
E
tf Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
E
tl
E
E
E
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
I HE PROPOSED WOBK IN THE .
-,[sronrcnL
Drsrnrcr, oR oN
THE HISTORICAL REGISTER?
-
lf yes, thls appllcatlon must be slgned
and approved by the Historlcal
Coordinator prlor to permit issuance.
APPROVED:
PL.HSE GAR ACC
N
S
W
E
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
Total Value
Building Permit Fee
state surcharge /'/b * /,?3
Total Fee (A)
3b-tu
s?7
4/,@
, z37r
VALUEz'Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordlnance
adopted by the City of Springfleld, including the
Development Code, regulating the constructlon and use of
bulldlngs, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Receipt Number:-
f/zrhr
Plans ewed By I
2
( DaV[
Date Pald:
Received
Plan Check Fee 63
SYSTEMS DEVELOPMENT CHARGE DC)
(B)
Systems Development Charge is due on all undeveloped
properties wlthln the City limits which are being lmproved.
ITEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
(c)
No
FT,
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
. FT.
ADDITIONAL COMMENTS
al'
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permlt
lssuance
State Surcharge
Totat Permlt
MECHANICAL PERMIT
Fu rnace
Exhaust Hood By slgnature, I state and agree, that I have caref ully examlned
the completed appllcatlon and. do hereby certlfy that all
lnformatlon hereon is true and correct, and I f urther cerilfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprtngfield, and the Laws
of the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
structure wlthout permission of the Bullding Safety Divislon.
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 wlll be used on thls
project.
I further agree lo 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
Date
onY' Sls natu
the site at
set of plans will remainof the property, and the
ruction.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolltlon
State Surcharge
Total Mlscellaneous Permlts (E)
z5?3
TOTAL AMOUNT DUE (excludlng electrical)
(A, B, C, D, and E Comblned)4A
3L+
DATE PAID
AMOUNT RECE
RECEIVED BY
VALIDATION:
RECEIPT NUMBER
N? Ete*/->erc.+4 n,si*Z/ | ^Ql
/Lar?zr.z:
q*o=
Permit No
Address:
lssued b
'il\
Date:
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT GONSTRUCTION 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
fit with the permit
Fit int plicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
1 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.
2
OR
3
3.A My general contractor is ,
Contractor registration 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.
I 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 certily that the above information is correct and that ! have read and understand
the lnformation Notice to Property Owners about Gonstruction Responsibilities on the
reverse side of this
6-b-z
t Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
NSTRUCTION CONTRACTORS BOARD
8/91
)
rlrronil-anoN NoncE To pRopERTv dfunens
ABOUT CONSTRUCTION RESPONSIBILITIES
lf you are acting as your own contractor to bonstr uct a new home or make a substantial irnprovement to an
i elisting structulq, you, cqn prevent Tqn-y problems by being aware of the following responsibilitbs and areas
of concern
r
i . '..
EMPLOYER RESPONStBILITIES:
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'iesidential structure, you will, in most instdnces, be ruled to be an
"employer" and the people you hire will be 'lemployees". As the employer, you must comply with the following:
Oregon's Wilhholding Tax. t aw: As an employer, you must withhold income-taxes from employee wages at
the time erlployew.are.pqid. You will Qe.,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 Rer*enue at 378-3390.
: 'li .,:j :r. i .
Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all employees,-,For rnorq information, call the Oregon Employment Division DHR
a|378-3224.
i.r: J
Workers' Compensation lnsurance: As an employer, you are subject to the Oregron Workers'Compensation
Law, and must obtain workers' compensation insurance for your employees. ll you fail to obtain workers
compensation insurance, you may be subject to penalties and will be liable forall ctaim costs if one of your
employees is injured on the job. For more information, callthe WorXels' !3Epen:atign Division DIF at 973-7434.
U.S. lnter e must withhold federal income tax fpom employees'wages
uwl idn't aclually withholdJhe thx. For more information, call
the lnternal Revenue
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
9gqg Jg!tp!g!ge: As the,permit holder for this project, !rci.r,areresponsible for,resolving any failure to meet
code requirernerrts that may be brought to,,ysur attention ttinough'fhspections.
-Lr..
Liabilitf afrU PrUpeffy Ddfnage'lnsurance:- Contact your insurance agent to see;if you hdve adequate insurance
coverage for accidents and omissions such as falling tools, painl overspray;hte{er{dbmage 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 lhe work
ot roughin and finish trades, and to notify building officials dt'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 Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055($,
passed by the 1989 Oregon Legislature. 4:
o244J 10t24189