HomeMy WebLinkAboutPermit Building 1992-11-10SP]rI}lGFIELD
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RESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WOFIK:
ASSESSORS MAP:
LOT:
5€/JOB NUMBER
225 Flfth Street
Sprlngfleld, Oregon 97 477
TAX LOT
SUBDIVISION: ,' - ,
,/S,/<?
BLOCK:
PHONE
2222ZIP:STATE:/92.4
7q7-d"
rusi-
CITY
ADDRESS:
OWNEFI
Lr_A.DDITION DEMOLISI.I OTHEB
DESCRTBE woRK: 7,44€--e uf
NEW ---_ REMODI-:L
EXPIRES PHONEADDRESSCONIRACTOFI'S NAME
GENERAL: -QUU{a
PLUMBING
MECHANICAL:
CONST.
CONTRACTOR #
I v,,/QUAD AREA:
RANGE:
,{ OF BDRMS
WATER HEATER:
# OF STOFIIES
_ OFFICE USE _
ZONING CODE:
FLOOD PLAIN
CONSTFI. TYPE:
rR rv
SECONDAFIY HEAT:
SOUARE FOOTAGE:
LAND USE:
OCCY GROUP:
--_*--
# OF UNITS: --__-_-----
FIEAT SOURCE: --
To request an inspectlon, you rnust call 726-376g. Thls ls a24 hOur recording. All inspections requested before 7:00 a.m. wlll be
macle the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
REQUIRED INSPECTIONS
Temporary Electrlc [--l Rough Mechanical - Prlor tol-J cover.
Flnal Plumbing - When all
plumblng work ls comPlete.
Site lnspectlon - To be made
af ter excavation, but Prior to
setting forms.
Rough Eleclrical - Prior to Flnal Electrical - When all
electrical work is comPlete.cover.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover'
Electrical Servlce - Must be
approved to obtain Permanent
electrlcal power.
Final Mechanlcal - When all
mechanical work is complete.
Footing - After trenches are
excavated.[--l Fireplace - Prlor to faclnglJ materlals and framlng lnsP.
,(*-lng - Prior to cover'
ff-flnat Bultdlng - When all
/srequlred lnspectlons have been
approved and building ls
comPleted.Masonry - Steel location, bond
beams, grouting.
Other
Foundation - After forms are
erected but prior to concrete
placement.
Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.l-l Drywall - Prlor to taolng
MOBILE HOME INSPECTIONS
Underlloor Plumbing/ Mechanical
- Prior to lnsulatlon or clecking.Wood Stove - After lnstallatlon
Post and Beam - Prior to floor
lnsulation or clecking.lnsert - After flrePlace aPProval
and lnstallatlon of unlt.
Blocklng and Set.UP - When all
blocklng ls complete.
Floor lnsulallon - Prior to
decklng.Curbcut &APProach - After
forms are erected but Prior lo
placement of concrete.
Plumblng Connectlons - When
home has been connected to
water and sewer,
Sanltary Sewer - Prior to filling
trench.Electrical Connection - When
blocklng, set-up, and plumblng
inspectlons have been aPProvedStorm Sewer - Prior to fllling
trench.
Sldewalk & DrivewaY - Alter
excavation is comPlete, forms
and sub-base materlal ln Place.and the home ls
the servlce
Water Llne - Prlor to fllllng
trench.
Fence - When comPleted,
Rough Plumblng - Prlor to
cover.trees are planted ntl ng
panel.
lnstalled.
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Se J I'HE PFiOPOSED WORK IN Ti]E
-r-rsrontcAL DlsrRtcr, oR oN
THE HISTORICAL REGISTER? ----
lf yes, this application must be signed
and aPProved bY the Historical
Coordinator prior to permit issuance'
APPROVED
TopograPhY
Total height -
Panhandle
a
GAR ACC
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
buildirrgs, ancl may be suspended or revoked at any tirne
upon violation of any provisions of said ordinances'
Plans By Date
Beceipt Numbe
Plan Check Fee
Date Paid:
Fleceived BY:
VALUE
Qnn'D
(A)
X $/SO. FT.
IG PNBI
q4t1'.
ld;::-
Total Value
Building Perrlit Fee
State Surcharge
Total Fee
o -S
/{7r_
ITEM
Main
Garage
Carport
Systems Developtnent Charge is due on all undeveloped
properties within tlre City limits which are being improvecl.SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
N0
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permlt
State Surcharge
Total Charge
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
MECHANICAL PERMIT
(D)
No
Mechanical Permit
ls s u ance
State Surcharge
Total Permit
Furnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have caref ully examined
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I f urther certify
that any and all work performed shall be done in accordance
wlth the Ordinances of the Clty of Springtield, and the Laws
of the State of Oregon pertainlng to the work described
herein, and that NO OCCUPANCY will be made of any
structure without pernrission of the Building Safety Division'
I further certify lhat only contractors and employees who
are ln compliance with ORS 701'055 will be used on this
proiect.
I further agree t(-) ensure that all required inspections are
requested at the proper tinre, that each address is readable
from the street, tlrat the permit card ls located at the front
of the property, and the approved set of plans will remain
natu>G
Date
C
on the slte irnes during construction.
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk ---- ft
Curbcut .-- ft
Demolition
State Surcharge
Total Miscellaneous Permits
VALIDATION:
RECEIPT NUMBER Crs s
7rDATE PAID
AMOUNT FIECEIVED
RECEIVED BY
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)
P.L.HSE
W
E
Lot faces
.-- lnterior
Permit No:Qzt F,f r'
/J,'/D;D
1
2
Address:
lssued Date:
R OFFICE USE ONL
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:
- E< 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.
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.
atu o pp c
CONSTRUCTION CONTRACTORS BOARD
o244J 8191
3
OR
e
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
NOTE: This lnformation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with OFIS 701.055(5),
passed by the 1989 Oregon Legislature
INFORilTATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
lf you a
existing
Of concern
,.,i1 I ;rd].
EMPLOYER RESPONSIBILITIE.S:
re acting as your own contractor to construct a new home or make
structure, you can prevent many problems by being aware of the fol
to an
areas
lf you hire persons not registered with the Co_nstruction Contractors Bgard to do labor in constructing or assisting
in the construction or improvement of lr r'SLiOential structuie, you will, in mggt instanb'es,''be'ruled to be an
"employer" and 1[e peopie you hire will be "employees". As the employer, yo0:milSI p0ihply with the following:
:'.1.'
Oregon's Withholding Tax.!.awl As an employer, you must withhold income taxes frorp emplgyee wages at
uwillbeliablefortlretaxpayrnentSeVenif.youdon't:acIuallywithholdthe
tax from your employees. For more information, call the Oregon Department of Fe.yenue at 378-3390.
Unemployme4lgqqlqg Tax: As an employer, yo, "r" required to pay a tax for unemptoyment insurance
purposes on the wages of all employees.For more information, call the Oregon Employment Division DHR
at 578-3224
Workers' Compensation lnsurance: As an employer, 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 willbe'liable for all claim costs if onb of your
employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at 973-7434.
U.S. lnternal.Rev.enue Service: As an erlployer, you must withhold federal income tax from employees'wages.
You will be tiabte for the tai payment even if you didn't actually withhold the tax. For more information, call
the lnternal Flevenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN: : ,-,
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meel
code:requirements that.may^be'biought to your attention through inspections.
Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance
coverage for 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: Make sure you=have sufficient time to supervise your employee*
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.
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OH 97310-0151
Phone 503-37M621
0244J fi124t89