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Home My WebLink AboutPermit Building 1993-05-13CO M M ERCIAL/ I N DUST RIAL PERMIT APPLICATION 225 Fitlh Street, Springfield, Oregon 97477 SPRII{GFIELE, e JOB NUMBER 7z//7a INSPECTION LINE: 726-3769 OFFICE: 726-3759 TAX LOT: K 2LOCATION OF PRO S ASSESSORS MAP: NEW - REMODEL ADDITION DEMOLISH OTHER -../ .. STATE: VALUE:/Qary ZIP: P5--*>*u- 5r r-4<NE:?r7-?/7/ ??v Zy'za>OWNER: DESCRIPTION OF WORK ADDRESS CITY:a.?. ARCHITECT: CONST, CONTRACTOR'S NAME ADDRESS CONTRACTOR # EXPIRES PHONE or il^r a tNta. MECHANICAL: - ELECTRICAL: NAME ADDRESS PHONE GENERAL: PLUMBING NO.FEE CHARGE5Single Fixture /d zQh.e Relocated Bldg. (new f ix. addtl) l/Water Service 42a tt ?o.o" (//Sanitary Sewer- 22z2tt.?a.e Storm Sewer ft. Backflow Device TOTAL PERMIT /?a.* MECHANICAL Nr)trtrF CHA RGF Furnace/burner & vent < 100,000 BTUs Furnace/burner & vent >100,000 BTUs Floor furnace and vent Suspended wall or f loor mounted unit heater Appliance Vent separate Stationary evap. cool er Vent Fan/Single duct ,V,;,/6* Vent System apart from AC or htg. Mechanical exhaust hood and duct Permit lssuance $10.00 TOTAL PERMIT _ OFFICE USE *53T)LAND USE ZONING* OF UNITS: HANDICAP ACCESS: FLOOD PLAIN LIGHTING POWER BUDGET: WATER HEATER: CONSTR. TYPE: HEAT SOURCE: OCCY GROUP: * OF STORIES: QUAD AREA: # OF BLDGS SQ. FT.$/SQ. FT.VALUE ,o.ooo TOTAL VALUE OF PROJ X X X SQ. FTG MAIN SQ. FTG ACCESS SQ. FTG OTHER RcPr, 6r=7PLAN CHECK FEE DATE BY1a-2C<=_37<2 BUILDING PERMIT u?.f,o PLU M BI NG /%.e DEMOLITION 5% State Su rch arq e ?.d7 5% State Surcharge ?.b M L los-so FENCE VALUE $ 5% State Su rcharoe .?f SIDEWALK FT. SUBTOTAL PERMITS 7a?,2*t PAVI N G CURBCUT FT. SYSTEMS DEVELOPMENT .l TOTAL PERMIT FEES EXCLUDING ELECTRICAL I lo I a 2/?-6765 .ec\L I ?ZO REQUIRED INSPECTIONS It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call 726-3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready for inspection. Requests received before 7:OO a.m. will be made the same working day, requests made after 7:00 a.m. will be made the following work day. SITE INSPECTION: To be 1/ RoucH PLUMB|NG, pAVtNG: After gravet is in made after excavation, but prior to setup of forms. UNDERSLAB PLUMBING, ELECTRICAL & MECHANICAL: To be made before any work is covered. FOOTINGS & FOUN DATIONS: To be made after trenches are excavated and forms are erected, all steel in place, but prior to placing concrete. CONCRETE SLAB: To be made after all inslab building service equipment, conduit, piping, accessories and other ancillary equipment items are in place but before any concrete is placed. K uNDERGRouND: Prumbing, electrical, gas, sanitary sewer, storm sewer, water and drainage lines. To be made prior to covering or filling t renc hes. UNDERFLOOR: Plumbing, electrical, mechanical. To be made prior to installation of f loor insulation, decking or floor sheathing. POST & BEAM: To be made prior to installation of floor insulation, decking or floor sheathing. FLOOR INSULATION & VAPOR BARRIERS: To be made prior to installation of decking or floor sheathing. MASONRY: Steel location, bond beams grouting or verticals in accordance with UBC 2415. ROOF SHEATHING AND NAILING: Prior to installing any roof covering. ELECTRICAL & MECHANICAL: No work is to be covered until these inspections have been made and approved. ATTIC DRAFT STOPS & CURTAIN WALLS FIREPLACE: Prior to placing facing materials and before framing Inspection. FRAMING: To be made after the roof, all framing, fire blocking and bracing are in place and all pipes, chimneys and vents are complete and the rough electrical, plumbing and mechanical are approved. INSULATION & VAPOR BARRIER: To be made after all insulation and required vapor barriers are in place but before any lath or gypsum board interior wall covering is applied. place but prior to placing asphalt or concrete. SPECIAL INSPECTIONS: ln accordance Section 306 of the State Specialty Code a special inspector shall be employed by the Owner/ Contractor during construction of the following work. A copy of the special testing reports shall be furnished to the Building Division. STRUCTU RAL CONCRETE: In excess of 2500 PS.l. (306 a.1) STRUCTURAL WELDS: Performed on the iob. (2722 tl HIGH STRENGTH BOLTING: During all bolt installation and ti ghtening operations. (306 a.6) SPRAYED ON FIREPROOFING: U.B.C. Standards 43-8. SPECIAL GRADING, EXCAVATION AN D FILLING: During earthwork. (306 a.'11 & Chapter 29) GLU-LAM BEAMS: lnspection Certif icate by an approved agency, furnished to the City's Building Division before beams are placed. (2501 U.B.C. sTDS. 25-10,11). STRUCTURAL MASON RY: (306 a.7) "ln addition to the inspec- tions specified, the Building Official may make or require other inspections of any construction work to ensure compliance with the Building, City or Development Code. ---4 { FIRE & SEPARATION WALL: Located and constructed according to plans. LATH AND/OR GYPSUM BOARD: To be made after all lathing and gypsum board, interior and exterior, is in place but before any plastering is applied or before gypsum board joints and fasteners are taped and f inished. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete and form work and sub-base material in place. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. In\ By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein is true and correct, and I f urther certify that any and allwork 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 OFIS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that project 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 on the site at all times during construction. DateSi gnat il ( DATE PAID RECEIVED VALI toN AMOUNT REC RECEIPT I: FINAL PLUMBING /FINAL ELECTRICAL FINAL MECHANICAL FINAL FIRE DEPARTMENT o N SITE PLAN REVIEW BOARD: Must be requested 2 days in advance of the date you wish inspection. All project conditions such as landscaping, parking lot stri ping, etc. must be completed before requesti ng this i nspection. FINAL BUILDING: Requested after the final plumbing, electrical, mechanical and Fire Department inspections are made and approved. No occupancy of the premises can be made until a Certificate of Occupancy has been issued by the Building Division and posted on the premises. PLANS REVIEWED BY DATE CITY OF SPP,,VGFIELD, OFEGO'V 1. LOCATION OP I.,EGAL DBSCRIPTION JOB Permits are non-transferable and expire if work is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. COTITRACTOR INSTALI,ATION ONLY Electrical Contractor Address Ci ty ELBCTRTCAL PERIIIT APPLICATION City Job Nunber Dh r. coHPLETE FEE ScEBDULE BELos A. Nev Residential-Single or HuIti-Family per dvelling unit. Service Included:Items Cost 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 $ 15.00 $ 40.00 B Services or Feeders InstaIIation, Alterations or Relocation: . 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amp Over 1000 amps/volts Reconnect Only c 225 FIFTE STRBBT SPRTNGPTEIJ), ORBGON 97477 INSPBCTION REOUBST: 726-3769, , OPPICE: 726-3759 klH DATE: % -Each installation Pump or irrigation sign/outline Lighting- Limited Energy/Res Limi ted Energy/Comm seRtrcrrelo SUBTOTAL OP ABOVB 5f State Surcharge TOTAL I+a lab Sum ?,50.00ls E- -s 4T-^ ynone %2{Z Supervisor License Number 3EZ: , Explration Date Constr Contr. Number Expiration Date v / Signa of Supervising Electrician 0rtrners Address ci ty-Phone OSNER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for saler, lease or rent. 0vners Signature: C. Temporary Services or Feeders Installation, Alteration or Relocation I 60.00 $100.00 $130.00 $300.00 $ 40.00 200 amps or less $ 40.00 201 amps to 400 amps - $ 55.00 over 401 to 600 amps - $ 80.00 Over 600 amps or 1000 voTts see I'Btr aEotG- I D. Branch Circuits Nev, Alteration or Extension Per Panel B. Hiscellaneous (Service/feeder not included) $ $ $ $ 40.00 40.00 20.00 36.00 Or.5 RBCBIVBD a ed has One Circuit Each Additional Circuit or with Service or Feeder Permi t 7 $ 3s.00 $ 2.00 JOB NO.qztlqL CITY o, iOO,NGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (C0MMERCIAL & RESIDENTIAL) 6+zoert JfucNAME OR COMPANY t1q L N. 4242 St /7o z7 ooo-olql7LOCAT ION : cc: ftggTqoorvt Bt-P(.-DEVELOPMENT TYPE: OT SIZ sQ. Ft.BUILDING SIZE: 1. STORM DRAINAGE IMPERViOUS SQ. FT. aL N A x $0.192 PER SQ. FT. SANITARY S Et.lER_C ITY NO. OF PFU,S 7 X $39.78 PER PFU (See Reverse) TRANSPORTATIoN Narr'Eo Ag fue Abfffi.MeNr NO OF UNITS X TRIP RATE X COST PER TRiP x x $401.05 x $401 .05 A x $401.05 SUBT0TAL (ADD ITEMS 1,2, & 3)$ 278 4. ADM INISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X .05 TOTAL.CITY SDC s zqz 7.8. 5. SANITARY SEWER-MWMC $I3.62 PER PFU + $10 MI.IMC ADMIN. FEE $ 3 $ $ *u NO. OF PFU'S (Use PFU Total From Item 2 Above MWMC CREDIT IF APPLICABLE (SEE REVERSE) Kip Burdick SDC Coordinator ) TOTAL-MWMC SDC TOTAL SDC ZTTL -+ 5 $ "-11-a+ tg13 FIXTURE UNIT CALCUIATION I ABLE: Number of New Fixtures X Unit E,r ,.valent : Fi{ure Units (NoTE: For remodels, calculate only the Nfl additional fixtures) NUMBER OF UNIT FIXTURE FIXTURE ryPE NEW FIXTURES EOUIVALENT UNITS Bathtub....... Drinking Fountain...... Floor Drain.. I nterceptors For Grease/Oil/Solids/Etc'" "" " " "''" I nterceptors For Sand/Auto Wash/Etc" " """ """" 2 1 2 .) o 2 o o 1 .) 2 1/ 2 2 1 6 4 Laundry Tub/Clotheswasher Clotheswasher - 3 Or More..-..--.... Mobile Home Park Trap (1 Per Trailer)""""""""" Receptor For RefrigeratorAVater Station/Etc"""" Receptor For Commercial Sink/Dishwasher/Etc" Shower, Single Stall-...-.....-.. Shower, Gang.....--..-- Sink, Bar, Commercial.. Urinal, StallflVall............ Wash Basin/Lavatory, Single-......"' Water Closet, Public lnstallation" I z Head Water Closet, Private..-.. Miscellaneous: TOTAL FIXTURE UNITS CREDIT CALCUI_ATIoN TABLE: Based on assessed value. lf improvements occurred after annexation date in table' calculate credits Credit for Parcel or Land Only lf Applicable lmprovement (if after annexation date) x$ (Rate X Assessed Value)x$ (Rate X Assessed CREDIT Value) TOTAL =$ RUNOFF COEFFICIENTS FOR STORM DRAINAGE Residential.. Commercial lndustrial..... Governmental-.-.........---.. 0.4 0.9 0.45 0.5 Year AnnexedYear Annexed Rate per $1,000 Assessed Value 't985 1 986 '1987 1988 1989 1990 1 991 $2.16 1.90 1.60 o.25 0.87 0.50 0.16 1979 or before 1980 1981 1982 1983 1984 $2.83 2.76 2.71 2.60 2.46 2.33 IMPERVIOUSAREA=ToTALLoTSIZEXRUNOFFCOEFFICIENT 7 I Rate per $1,000 Assessed Value Permit No: Address: lssued by 1 2 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, ahd 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 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. OR 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 form. a -,".{ - g1 DEIE - Date: WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 3 nature t pp t CONSTRUCTION CONTRACTORS BOARD 0244J 8191 ) INFORiiATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES lf yoti are acting as your own contractor to construct a new home or make a su to an ex isting structu[-q, you can prevent many problems by,being aware of the following 'and areas of COncern EMPLOYER RESPONSIBILIT*S:: ' ' :;:. - i'i T I" - tf you hire pelggqs not registered with the Construction Contractors Board,o do,l1b,o_t.[::::,Hll"g or assisting in the constrtrption or iriprovement of a residen(ial structur-e, you'will, in most instances,,Qe ruled to be an ,,employer" and the peopie you hire will be "employees". As the emplpyer, y,Qu ilust comply wifr the following: s Wlt Tax i!' , Law: As ?ne mployer, /ou:tTl ust withhold income taxes from employee wages at the time emP are paid.will be liable for the,t4x payments eveQ.if you don't actuallY withhold the tax from your employees. For more information, call the Oregon Deparlmefrt of Revenue al 378-3390. . . i:. , ,r ' :,4i:,',l' '" ' ": 'i" r' t Unemployment lnsuiance'ihx: As an employer, you are required to pay 6 tax for une.mpioYTTt insurance rnp[oye9s..For'no'*'information,calltheoregonErnploymentDivisionDHR at 378-3224. Workers'nsation lnsurance: As an employer, you are subiect to. the Oregon Workers' Compensation Law, and must n workers' compensation insurance for your em ployees. lf you fail to obtain workers' compe nsation insurance, you may be subiect to penalties and will'be liable'for atl ciaim costs if on'6 of your employees is injured on the job. For more information, call the Workers' Compensation Division Dl F at 373-7434 U.S. lnternaf Rgwrygsqlylgg. AS-an plnployel,,yqy mYSt withhold lggg'.tlincome tax from employees'wages' i*ient.even..itvo,u,.aion,1,99!uqtty*ithho!di1e|tax:For'rnoreinformation,call the lnternal Revenue Service at 221-3960. . .i.. OTHER RESPONSIBILITIES AND AREAS OF CONCERN; Code Gornpliance: rAs the permit hsl.der for this project, you are responsible for resolving ahy failure to meet ;oaelElir6ents that r,nAy be brought to yourattention througth irrspections''-' Liabi and lnsurance OontaCt your insurance agent tO'See lf you hhve adequate insurance ch as falling tools, paint overspray, water damage from pipe punc-coverage acci Oents and omissions su tures, fire, or work that must be re-done. Time to Supervise Make sure you l"lave sufficient time to supervise your employms' 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 limes so they can perform the required insPections. - ...i, ' lf you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Phone 5m-s/84621 About Construction Flesponsibilities in accordance with ORS 701.055(5), NOTE.nformation was developed passed by the to OwnersThisNoticePmpefi ContractorsConstruction Boardtheby Legislature.1989, Oregon 0244J 10/24189