HomeMy WebLinkAboutPermit Building 1993-02-02E
H
lnspections: 726-3769
Office: 726-3759
INGFIELE,
R
P
SIDENTIAL
RMIT APPLICATION
Zfr,
JOB NUMBER 9719c>/
225 Fifth Street
Spri ngfield, Oregon 97 477
*
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:/7078>31 TAX LOT:4?aa
LO-l: BLOCK:SUBDIVISION
?/f:Ag:Afpf,FnPHONE:
ZIP:STATE:2R
OWNER:
ADDRESS:
CITY:
4-ADDITION DEMOLISH OTHER
DESCRIBE WORK:
NEW_- REMODEL
ADDRESS EXPI RES PHONECONT
GENE
PLUMBING
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
illl- OFF]CE USE -
* OF BDRMS:
FIANGE:
* OF UNITS:
LAND USE:QUAD A
OCCY GROUP:
# OF BLDGS
WATER HEATER:
* OF STORIES:SECONDARY HEAT
SQUARE FOOTAGE:
CONSTR. TYPE:
HEAT SOUFICE:
To request an inspection, you must call 726-3769. This is a24hour recording. All inspections requested before 7:00 a.m. will be
made the same working day, inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
l-l Temporary Electric
L___l IYf Rouglr Mechanicat - Prior toA( cover.
,KfWl Electrical - Prior toSite 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.
Underground Plumbing - Prior
to filling trench.
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
Post and Beam - Prior to floor
insulation or decking.
Floor lnsulation - Prior to
decki ng.
Sanitary Sewer - Prior to filling
trench.
Storm Sewer - Prior to filling
trench.
Water Line - Prior to filling
trench.
Rough Plumbing - 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.Electrical Service - Must be
approved to obtain permanent
electrical power.
Fireplace - Prior to facing
materials and framing lnsp.
Wood Stove - After installation.
lnsert - After flreplace approval
and installation of unit.
Curbcut &Approach - After
forms are erected but prior to
placement of concrete.
Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Fence - When completed
Street Trees - When all required
trees are planted.
K
x
8
fl-]zFinal Building - When all
.ft, required inspections have been
approved and building is
completed.
]Yf Framing - Prior to cover.rz_l\
ffiwatttCeiling lnsulation - Prior toFcover.
ffiotr*ull - Prior to taPing'
Other
MOBILE HOME INSPECTIONS
Blocking and Set.Up - When all
blocking is complete.
Plumbing Connections - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
4zr>>
I
FLOOD PLAIN:
ZOftfff.fO .;rrrM
tl
E
E
tl
E
tl
E
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
i . ro THE PROPOSED WORK lN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTEB?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
HSE GAB ACCP.L.
N
S
E
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
buildlngs, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.<6,_4
iewed ByPI
Plan Check Fee:
Date Paid
Receipt Number:
Received
7 .
33
(A)?c,*s
/a.a ,rz-
X $/SO. FT. = VALUE
/21/-ge
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
SYSTEMS DEVELOPMENT CHARGE (SDC) #(B) \te&z
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
#*200
-'
fr,*
42v(c)
No
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
./5.o-
,75
(D)
@
).
7gZ,
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
No3
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 f urther certify
that any and all work 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 ORS 701.055 will be used on this
project,
I further 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
natu re
Date
X,
on the site at all mes during construction
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)DATE PAID
VALIDATION:
RECEIPT NUMBER
AMOUNT REC
RECEIVED BY
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Combined)//en er
4#/
FT.
,
Permit No:
Address:
lssued by
+n.=iL
4 nO./Date:c{-rd,-*1 f
2
OR OFFICE USE ONLY
STATEMENT:
INFORMATTON 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 completion.
3.A 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 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
reYerse side of this form.
^/?b/g ure of it pp cant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
Date/ "
/
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
qssol
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
lf y6u drO"dcting as your own contractor to construct a new home or make a substantid imfu6vement 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 tlT e Qonstruction Contractors Boaf.d.to do labor in constructjng or assisting
in the constructlon or impr6vement of a'residential structure, you wiil, in most instances, be'ruled to be an
"employer" and the people you hire will be "employees". As the employer, you must comply with the following:
gregon's Withho_lding Tax'Laul:, As qn.employey, you must withhold income taxeS from employee wages at
the time employees are paid.. You will. be tiable for the tax payrnents even ilyou dont actual[r withhold the
tax from your employees. For more information, call the Oregon Department of Revenqlp,d 378-3390.
Uger4ployment I nsu rance Tax
..1 - ..r. - ,:
As an 6mployer, you are required to pay a tax'foruneriiployment insurance
purposes on the wages of alf employees, For,rnore infor.rlnation, catrl. tl;re Oregon Ernployment Division DHR
at 378-3224. . -
Workers' Compensation lnsurance: As an',Srirployer; you are subjeict,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 wifl be liable for.all claim costs if one of your
employees is injured on the job. For more information, call the Workers' C,.gmpensafion Division DIF at $.73-7434.
U.S. I R ue Servi As an employer, yqu must with hold federal incop
WI e for the tax ent
the lnternal Revenue Service al 221
even i.f
'you didn't actually
-3e60.
withh old the ta
e, tE1, Jqom em ployees' wages.
x. FOr more information, call
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project; you are responsible for resolving any failure to meet
code requirements that may be brought to your attention through inspections.
Liabil and *nsurance: Contact yciur insuiancqagentto see if.you have adequate insurance
coverage acc nts and omissions such as falling tools, paint oversprd:jr, watertiimage from pipe punc-
tures, fire, or work that must be re-done.
:
'\d
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 the work
of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform
therequiredinspections. : | : :,
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 5m-s/8-4621
Responsibilities
oRS 701.055(5),
lnformation PropertyNOTE:This Notice to AboutOwners Construction
WAS the contractorsConstructiondevelopedby inBoard withaccordance
thepassed 1989by Oregon Legislature.
o24N 10t24t89
JoB N0.qb \qo I
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
I.TORKSHEET
(coHl'IERcIAL & RESIDENTIAL)
Lr NpA s\eoNAME OR COMPANY:
Tt+D bbl - oo oo
LOCATION:
GA?xoL T"6e*u ?*ta t-(
DEVELOPMENT TYPE:vo? -
BUILDING SIZE: ?%9,( €ot 5*wu LOT SiZ
I. STORM DRAINAGE
. Ft.
TMPERVi0US SQ. FT.
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
a X $42.08 PER PFU
3. TRANSPORTATION
coo? e}r+ *a,,r."tv f-.efAtL =-4.q2/T9(<gua
NO OF UNITS X TRIP RATE X COST PER TRIP
.2-80 x L{.1a
x $0.203 PER SQ. FT.
e
x $424.31
x $424.31
x $424.31
Sx
X $
4. SANITARY SEWER-Mt,lMC
(Use PFU Total From Item 2 Above)
Mt.lMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
SUBToTAL (ADD ITEMS 1,2,3 & 4)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBT0TAL ABoVE) X .05
$
ip Burd
6oz*2
+
SDC Coordinator
TOTAL SDC $l ob*?
hnAr.l
lL-\-1 Ll-
FIXTURE UNIT,CALCULA CN TABLE:ttumoerof NewFixtures ritEquivalent = FixtureUnits(NOTE:-
For remodels, calculSie only the NET additional fixtures)
NUI\4BER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS
Bathtub...
Drinking Fountain.
Floor Drain..
2
1
2
J
6
2
6
6
1
a
2
1
2
2
1
6
4
lnterceptors For G rease/Oil/Sollds/Etc..--... -.. --.. "'
lnterceptors For Sand/Atrto Wash/Etc. --.-.. ---.- -.... -
Laundry
Clothes-waEher - 3 Or More...
Mobile Hdme Park
Receptor For.RefrigeratorflVater Station/Etc----..'
Receptor For Commerclal Sink/Dishwasher/Etc-
Shower, Single Stall..
Shower, Gan9......-...-
Sink, Bar. Commercial
Urinal, StallflVall.....
Wash Basin/Lavatory, Single...---
Water Closet, Public lnstallation--
Water Closet, Private.....,
Miscellaneous:
ead/H
b(-
TOTAL FIXTURE UNITS
cREDlr GALCUT-ATIoN TABLE: Based on assessed value. lf improvements occurred after annexation date in table,
cajculate credits s
Credit for Parcd or Land Only lf Applicable
tmprovement (if after annexation date)
x$
(Rate X Assessed Value)x$
$
(Rate X Assessed Value)
CREDIT TOTAL
RUNOFF COEFFICTENTS FOR STORM DRAINAGE
Residential. .--...""""' 0'4
Commercial......-....-...---. -."..""""' 0'9
lndustrial"" """""""" 0'45
Governmental............... --.--..-.--..-.. 0'5
Year
Annexed
Rate per $1,0O0
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1979 or before
1980
1981
1982
1983
1984'1985
$s.21
3.13
3.08
2-96
2.82
2.68
L51
1986
1987
1988
1989
1990
1991
1992
S 2.24
1.93
1.57
1.18
0.79
0.44
0.28
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
1
C'TY OF SPR OREGO'U
OFFICE: 726-3759 Authorized
1. IOCATION OP INST
I,EGAL
,)
Electrieal Contractor
Address
Citv Phone
Supervisor License Number
Bxpiration Date
Slgnature of Supervising Electrician
Owners Name
Address
Ci ty
OIINER INSTALI,ATION
The installation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
Ovners Siguature:
DATB:
SPFTI\IGFIELO
es not require speci{ic land us€
BI,BCTRICAL PERI{IT APPLICATION
City Job Number 2Zt?o
PEE SCEEDTIIJ BBLOU
A. New Residential-Single or
MuIti-FamiIY Per dvelling unit'
Service Included:Items Cost
1000 sq.ft. or less S 85'00
additional 500
sq. ft or Portion
thereof
Each Hanuf'd Home or
Modular Dwelling
Service or Feeder
zoning, and
approval.
225 TIFTE STRBEf,
SPRII.IGPIEU)' OREGON 97477
iisrrctrou nseuBstt 726-3wv
Sum
Permits are non-trallsferable and expire
if vork is not started vithin 180 days
oi l""u"nce or if vork ls suspended for
180 days.
2. CO}TI?ASTOR INSTALI^ATION ONLY
$ 1s.00
$ 40.00
s so.oo
$ 60.00
$100.00
$130.00
$300. 00
$ 40.00
z<:3"_?
B
c
Services or Feeders
Insta1Iation, 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
-
Reeonnect OnIY
Expiration Date
Constr Contr. Number
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amPs
-Over 401 to 600 amps
Over 600 amps or 1000ETI
$ 40.
$ ss.
$ 80.'s see r'
00
00
00rgrr "fiffi
00
00
00
00
t
fr 7,,vnone 76-?ZFT
D. Branch Circuits
B.
Nev, Alteration or Extension Per Panel
one Circuit $ 35'00
Each Additional
Circuit or vith Service -oi r"eder Permit /AE $ 2.oo A7
Hiscellaneous (Service/feeder not included)
-Bach installation
Pump or irrigation
-
Sign/0utline Light ing_
Limited Energy/Res
Limited Energy/Comm
SUBTOTAL OP ABOVB
5Z State Surcharge
TOTAL
B7A
$ 40.
s 40.
$ 20.
S 36.
5
RBCEIVBD
6;*
CITY OF SPF"VGFIELD, OREGO'U
Pernits are non-transferable and expire
lf vork is not started vithin 180 days
of issuance or lf work ls suspended for
180 days.
2. @}II3ACTOR INS"TALI,ATTON ONLY
Electrical Contractor
Address
Citv Phone
Supervisor License Number
Expi ration Date
Constr Contr. Number
Exniration Date
Signature of Supervising Electrician
0wners Name
Address I
-]<.f, N. tb@
Ci ty Phone 14141+(-f-4
OSNER INSTALLATION
The installation is being made on
property I own vhich is not intended
for sale, lease or rent.
Omers ture:
SPAT,{GFIELO
B.
5. STETOTAL OP ABOVB
5f State Surcharge
TOTAL
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less L/
201 amps to 400 amps _
401 amps to 600 amps
-
601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect On1y
c.
D. Branch Circuits
Nev, Alteration or Extension Per Pane1
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Modular Dvel}ing
Servlce or Feeder
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permi t 7L
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less $ 40.00
201 amirs to 400 amps
-
$ 55.00
over 401. to 600 amps
-
$ 80.00
0ver 600 amps or rbOO voTts see *Bu affi
%
225 ?TYffi STRBEf,
SPRINCFIELD, ORBGoN
INSPBCTION REQTIBST:
OPFICE: 726-3759
97477
The following projecl as submltted hae the
zorirg, €,n'i does not require specific land ugr- - -approvrri. 'rre svvvr,v'-"- -E"Lgcxr'rcAl PERHTT APPLTCATToN
726-3769 Zoni City Job Nunber
cate 3,1:tr lqq 3. COHPI,ETE FBE SCEBDUI,E BBLOS
A. Nev Residential-Single or
Multi-FamilY Per dvelling unit.
Service Included:
o6-)I tems Cos t
$ 8s.00
$ 1s.00
$ 40.00
iYl trr rt3
1 IOCATION OFlr<.?
Sum
JOB
lAFvtr c tL r
r$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
i
-4.oo#
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
sign/outline Lighting- $ 40.00
Limited Energy/Res
-
S 20.00
Limited Energy/Comm $ 36.00
<Zoz-/lr 2,7a
$ 3s.00
$ 2.00
DATB:)
RBCEIVED
:1G,7'
Permit No:
Address:
lssued by
I-?S 2 N ILWS'.
, QB Date: ?lesl%
*lar/q+o*{ 7
1
2
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 completion.
A 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-l-{l will be my own general contractor.
lf I hire subcontractors, lwill 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
reYerse side of this form.
3
t p
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
Qztq ol
/,-'florr-./A ,/"tt
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 7O1.OSS(5),
passed by the 1989 Oregon Legislature.
lf you are acting as your own contractor to construct a new home or make a substantial improvement to an
existing structu,re,, yQu can prevent many problems by being aware of the following responsibilities and areas
of concern
EMPLOYER RESPONSIB!LITIES:
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
"employer" 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 frorr emptoyee 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 of Revenue at 378-3390.
Unemployment lnsurance Tax: As an employer, 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 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 all claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 973-74U.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.
ymentevenifyoudidn,tactuallywithholdthetax.Formoreinfoimation,call
the lnternal Revenue 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 meet
code requirements that may be brought 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 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.
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10124t89