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Home My WebLink AboutPermit Building 1992-08-18]'l:lINGFIEL() RESIDENTIAL PERMIT APPLICATION I rrs pect i ons: 7 26-3769 Office: 726-3759 ASSESSORS IVlAP: LOT: ?ztt s7JOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 TAX LOT:OAcYOO SUBDIVISION: PHONE:E(XAl<- ,4J---S h,b BLOCK OWNER: ,- ADDRESS: CITY: ..ya 1]TATE: hJEW --....._,-, RF-MODEL ADDITION DEMOLISH OTHER CONST. CONTRACTOR # ZIP:I EXPI RESCONTRACTOR'S NAME ADDRESS PHONE GENERAL: -- -OJd.@& PLUMBING: MECHANICAL ELECTRICAL: QUAD ABEA: // OF BLDCS OCCY GROUP:. I OF STORIES: -. _ OFFICE USE _ LAND USE: RANGE: FLOOD PLAIN ZONING CODE: # OF BDRMS SECONDARY HEAT: SQUARE FOOTAGE: // OF UNITS: -- CONSTFI. TYPE HEAT SOURCE: WATEN HEATER: To request an ins;rection, you must call 726-3769. Thls is a 24 hour recording. All inspections requested before 7:00 a.m. will be tnade the sarne working ctay, in:;pections recluested after 7:0O a.m. wlll be made the following work clay. REOUIRED INSPECTIONS Temporary Eleclric Rough Mechanical - Prior to cover. {-V rinal Plumbing - when all F{plumbing work is complete. F7 Final Electrical - When all fletectrical work is complete. lV(rinat Mechanical - when all J4necnanical work is complete. H final Building - When all ,,lslequired lnspections have been approved and building is completed. Site lnspection - To be made af ter excavation, but Prior to setting forms. Rough Eleclrical - Prior to cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Permanent electrical power. Footing - After trenches are excavated. Masonry - Steel location, bon(l bearns, grouting. Foundation - After forms are erected but Prior to concrete placerllent. Underground Plumbing - Prior to filling trench. MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Slove - After lnstallation Posl and Beam - Prlol to floor insulation or decking.lnserl - After flreplace approval and installation of unlt. Blocklng and Set.Up - Whr,'n all blocking ls complete. Floor lnsulation - Prior to decki ng.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 f illing trench.Electrical Connection - When blocklng, set-up, and plumbing inspections have been aPProved and the home is connected to the service panel. Slorm Sewer - Prior to filling tren c h. Sidewalk & DrivewaY - After excavation is comPlete, forms ancl sub-base material in Place. l--] Fence - When comPleted Final - After all required inspections are. aPproved and porches, sl<lrting, clecks, and ventlrrg helve been lnstalled.Slreel Trees - When all requlred trees arr: planted. tl Rough Plumbing - Prior to cover. LOCNTION Otr PT]OPOSED WORK: a.{ ,ESCRTBE woRK: -Wfu* Pz;-A*-r:z:ae ; -Yff\ E tl tl tl tl Water Line - Prior to filling trench. J--l Fireplace - Prior to faclngU materials and framlng lnsP. flttu-tng - Prior to cover' V1 watttceiling lnsulation - Prior to /a{pover. p3t'*all - Prlor to ta,ins' E E Other - E Lot faces Lot sq. ftg. Lot coverage TopograPhY Total height Lot Type - -. lnterior _-- Corner _- Panhandle - Cul-de-sac tbacks P.L.HSE GAR N S E .}IE F'HOPOSED WORK IN THE ITd.TORICAL DISTHICT, OR ON THE HISTORICAL REGISTER? . lf yes, this application lnust be signed an<.1 aPProved bY the Historical Coordirrator prior to pr-:tmit issuance' APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This perrnit is granted on lhe express condition that the s;lid consiruction shall, in all respects, conform to the Ordinance adopted by tlre City of Springfield, including the Developnrent CocJe, regulatirlg the construction and use of buildings, arrd may be susperrded or revoked at any time upon violation of any provisions of said ordinances' Receipt Number:-- -- DatePlans Rcvicwed BY Plan Check Fee Date Paid Receivecl BY BUILDING PERMIT ITEM SQ. FT. Main Garage VALUE (sg (A)34JL 5<J X $/SQ. FT. Carport ?;v-CTotal Value Building Permit Fee State Surchargc Total Fee llystolns [)c'vt:lolrttlc:nl Clrlrl;u is clue ott ;rll utttlcvr-'lo1"lcd properties within the City limits wlrich are being irnproved'SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) SanitarY Sewer Water Storm Sewer Mobile Home .&?.,' PLUMBING PERMIT FEE N0 / S.crD 7r ?r(c) FT. FT. FT. 1 Plumbing Permit State Surcharge Total Chlrrge Wood Stove/ lnsert/ Fireplace Unit Dryer Vent flz) MECHANICAL PERMIT /o oc (D)'2 No 7s Mechanical Permit lssuance State Surcharge Total Permit Fu rn ace Exhaust Hood Vent Fan By signature, I state and agree, that I have caref ully examined the completed application ancl <jo hereby certify that all ir-rfortnatiotr lrereon is trtte ancl correct, anti I f urthr:r' ccrtif y that any and all worl< pcr[<;rrnecl shall be done in accotdance with ll.tc Orclinartces of tht.r City of Springfir:lcJ, arrd tltr: L-aws o( tlrc lil;ltc of Otr,)1;otr l)clt.linil'l(l to llrr: wotk tlrll;t;til-rr:tl Irercin, ancl tltat NO OCCLIPANCY will bo tn;:<Jc of atry structure willrorrt pcrntission of the Building Safety Division' I turtlrer celti{y tll.rt only contractors and etnployees 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 at the propcr tilne, that eacl'r 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 gnature Date on the site times during construction. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk _---- ft Curbcut ----.-- ft Demolition State Surchargc Total Miscellaneous Permits (E) VALIDATION: RECEIPT NUMI]EFI 5?1^O d,? RECEIVED BY AMOUNI'n[CElVl:t) - - 72DATE PAID TOTAL AMOUNT DUE (exclucling electrical) (A, B, C, D, and E Combined) a3 A,CC __/S:D .7f OFSPR OREGO'U 225 FIFTE STREEI 1 ': SPRTNGFTELD, ORBGON 97 477 INSPECTI0N REQUBSTT 726-37 OPFICE: 726-3759 1 OF '' ,ri;; PrCiect i'' 'r '' .l.r,i croes ;r'r i ' I 6e uo?"- Z;ninl-- ^t$1,,eb SI"I!NGFtELO - .,-^ t^xawing PERHIT APPLICATION City Job Number COHPI,ETE FEE SCEEDUIJ BELOV of issuance or if vork is suspended for 180 days. 2 COMRACTOR OM,Y Electrical Contrac Addres Nev Residential-Sing1e or MuIti-FamiIy per dwelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Edch Hanuf'd Hone or Modular Dvelling Service or Feeder $ 8s.00 s 1s.00 s 40.00 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_ Over 1000 amps/volts Reconnect Only c. D. Branch Circuits Nev, Alteration or Extension Per Pane1 A Sum(ffi JOB Permits are non-transf, if vork is not started era andr expire 180 daysn Ci ty Phone,,3+3.1nl Supervisor ieense Ntimber ,r51C5 Expiration Date Constr Contr. Number Expiration Date E sqg Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less S 40.00 201 amps to 400 amps - $ 55.00 Over 401 to 500 amps _ $ 80.00 Over 600 amps or 1000 volts see rtBrr above s s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Signa of ing Electrician s Addres ci Phone The installation is being made on property I ovn vhich is not intended for sale, Iease or rent. Ovners Signature: One Circui t I Each Additional Circuit or vith Servigq or Feeder Permi I / g $ 3s.00 $ 2.00 35 IL E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/Out1ine Light ing_ Limited Energy/Res STIBTOTAL OP ABOVE 5Z State Surcharge TOTAL s 40.00 $ 40.00 s 20.00 s 36.00 5 DATE:"'l ,< lrrl RECEIPT *: RECEIVED BY: I f-t,)0,(no- FASX 346601-91 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 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 D Z WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 4ry 1 2 3 My general contractor is 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. OR 3. B..IYfl 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 certily 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. {)^,tt-/ /, ,Qo,. oa CONSTRUCTION CONTRACTORS BOARD 0244J Bl91 ??-' ," - INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Notice to Property Owners About Construction Besponsibilities was developed by the Construction Contractors Board in accordance with CIRS 701.055(5), iassed bl the \989 eegon Legislature. 'lf'you'areacting as your own conlractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern EMPLOYER RESPONSIBILITIES: 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 residential structure, you will, in most instances, be ruled to be an "ernployer" and the people you hire will be "employees". As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes {rom employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department o{ Rwenue at 378-3390. Unemployment lnsurance Tax As an employel you are required to pay a tax for unemployment insurance purposes on the wages of all employeea For more information, call the Oregon Employpent-Division DHFI al578-3224. /*" Workers' Compensation lnsurancg As an ernployer; you are subject to the Oregon Workers' 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 be liable for al{ claim costs if one of your employees is injured on the job. For more inforrnation, call the Workers' Compensation Division DIF at 373-7434. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. ymentevenifyoudidn'tactuallywithholdthetax.Forrnoreinformation,call the lnternal Revenue Service at 221-3960. OTHER BESPONSIBILITIES ANN AREAS OF CONCEHN: Code Compliance As the permit holder for this project, you are responsible for resolvinE any failure to meet code requirements that may be brought to your attention through inspections. Liabi and e lnsurance: Contact your insurance agent to see if you have adequate insurance coverage accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees lVlake 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 the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. -r If you have additional questions, write to Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 a244J fit24t89