The URL can be used to link to this page

Home My WebLink AboutPermit 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