HomeMy WebLinkAboutPermit Building 1992-08-11BESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Oflice: 726'3759
LocAroN oF pRoposED woRK: /11 -- y'Ont g
ASSESS.FT'MAP: - JZ23- 36 3/
roB NUMBE " -22-/oa t
225 Fifth Street
Springlield, Oregon 97 47 7h,
TAX LOT:o/
LOT:tlLO()K: SUBDIVISION:
I
S IATE
,r{l
-&R zrp:-4'1/7
u &-s- -- PH'N E: 7-/tAA 3-?-#
aza-?677 - (wev
tu1a
OWNLTR
ADDRESS: / 70
",',r, *ffiU.-
f>aDESCRIAE WORK
DEMOLISH OTHERNEW .- . REMODEL
-
ADDITION
Pt-toNt:EXPIRESADDRESS
CON
CON
ST.
TRACTOR #CONTRACTOT]'S NAME
GENERAL: - -fut:lfuz
MECFIANICAL
ELECTRICAL:
PLUMBING: &AI@E--
VN
, OF BLDCS
OCCY CII(}UI,
N O[J STORIEI;:.
_ OFFICE USE _
RANGE: ---
OUN D ARFA:
WAI ER I'lEAl t:R: - --
()oN:l rR. TYI)E
HEAT SOURCE:
r OF BDRMS:
SECONDARY HEAT:
SOUARE FOO]AGE:
FLOOD PLAIN:.
ZONING CODE:
t-AND USE: -
Y OF UNITS:
To requr,,st an inspection, you must call 726-3769. Ttris ls a24ttout recording. All inspections requested before 7:oo a.tn. will t.)e
macte the sarle working day, inspections requeste(l after 7:00 a.m. will be made the foltowing work day.
REOUIRED INSPECTIONS
l-l TemnorarY Electric V
w
Rough Mechanical - Prior to
cover.
[,7 Final Plumbino - Wltcrr allL4J plurnbing worli is conrt)lete.
[- | Site lns])ection - To be madelJ after excavation, btrt Prior to
Rough Electrical - Prior to [-i7 Final Eleclrical - When allE clectrical worl( is conll)lcle.cover
setting f ot ms.
Underslab Plumbing/ Electrical /
Meclranical - Prior to cover.
Electrical Service - Mtrst be
approved to obtain Permanent
electrlcal power.
.l Final Mechanical - Wltcrt all
meclranical work is cotnpletc.
B Fooling - After trenches are
excavated.Fireplace - Prior to faclng
materlals ancl framing lnsP.
W Final Building - When all
required inspections have beert
approved and building is
completed.Masonry - Stcel location, bond
beatns, grouting.a
tA
w
Framing - Prior to cover
Other
w Foundation - Af ter fornls are
erected but Prior to concrete
placcrllcnt.Wall/Ceiling lrrsulation - Prior to
cover
fl Underground Plunrbing - Pri<>r
to fillinll trenclr.Drywall - Pilor to taping
MOBILE HOME INSPECTIONS
w Underlloor Plumbing/ Mechanical
- Prior to insulation or dccking.Wood Stove - Af ter installation
f .Z Posl and Beanr - Prior to floorl-! insulation or decking.
I-17 Floor tnsulalion - Prior toLXI decxin0.
lnsert - After firePlace approval
and installation of unit.
Curbcut & Approach - After
forrns are erected but Prior to
placement ol concrete.
Blocking and Set.Up - Wttetr all
blocking is complete.
Plunrbing Contrectiotrs - Wlterr
Irome has been connected to
water and sewer.
Sanitary Sewer - Prior to fillittg
trench.Eleclrical Connection - Whcn
l)locking, set-up, and l)lurnbing
inspections have been approvc'(,
and the horne is connected to
lhe service panel.
Storrn Sewer - Prior lo f illing
trench.
Sidewalk & DrivewaY - After
exr:avation is complete, forms
and sub-base malerlal in Place.
Water Line - Prior to fillirtg
trench.l-l Ferrce - When comPleted
Street Trees - When all required
trees are planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.wl Rough Plumbing - Prior to
cover.
J
14q
tl
r
r
tl
E
r
Lot faces
Lot sq. ftg.
Lot coverage
Topograptry
Total height
Lot Type
-
lnterior
--
Corner
-
Panharrdle
-
Cul-de-sac
Setbacks
GNR ACC
k/
HE PFIOPOSED WORK IN THE
}'IIS'TOFIICAL DISTRICT, OR ON
THE HISTORICAL REGISTER? -
lf yes, tlris application mUst br-'signed
anrl alrproved by tltr: Flistotical
Coor<Jir-r;rtor prior to perntit isstlance.
APPROVED: --
BUILDING PERMIT
ITEM SO. FT.X $/SQ. FT,VALUE
Main
Garage
Carport
I,hbl)
*
3 -/-{6 ?'ZSE,I
Total Value
Building Permit Fee
St;rte Surclrarge
Total Fee
Jfr.;?
- ?,t39
/6e-,15(A)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This perrnit is granted on the express conditiorr lhat the said
construction shall, in all resl>ects, conform to llte Ordinance
adopted by the City of Springfield, int:luding the
Development Code, regulating the constructiorr ancJ use of
buildings, and nray be suspended or revoke<.j at any tirne
upon violation of any provisions of said ordirtances.nJzPlan Check Fee
Date Paid ,2
Receipt Numbet:-<)
Receivc
By
2fi-$Q,t_
[)ato
SYSTEMS DEVELOPMENT CHA
(B)
txfiff'p /7v
Systems Development Charge is due on all ttnclevcloped
propertics witlrin ttre City limits which are bcirtg itnprovecl.
PLUMBING PERMIT
ITEM
Fixt u res
Flesidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
5,xta V--
No
FT.
FT.
FT.
..27
Plurnbing Permit
State Surcharge
Total Charge (c)_7/-'re
ADDITIONAL COMMENTS
MECHANICAL PERMIT
Fu rnace
E.xhaust Hood
Vent Fan No/
Woo(l Stove/ lrrsert/ Fireplace Uni t
Dryer Vent
HtrlMechanical Permit
lssuance
State Surcharge
Total Permit (D)
By signature, I state and agree, that I have caref trlly examined
the conrpleted application and do hereby ccrtily that all
information hereon is true and correct, and I f urther certify
that any and all worl< perforttrcd shall bo donc itr;tt;t;ordance
with the Ordinances ol thc City of Springfielcl,:rtrtl tltc L;rws
of the Stale of Oregon pertaining to the worl< tlcscribed
Irorein, arrd that NO OCCUPANCY will bt: ttt;t<lr: o( arry
..;tructure without pertrtissiott of the Building Satcty Divis;ion.
I f urther certify that ortly contractors and etnlrloyees who
are in compliance with ORS 70'1.055 will be ttsed on this
proiect.
I f urther agree to ensure tlrat all required inspections are
requested at the proper time, that each address is readable
f rom the street, that the permit card is locatecl at the front
of the property, and the approved set plans will remaino
on the site t sdu cons ton
L
Signatu
/,
e4Date
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk ...- ft
Curbcut _=.- ft
Dcrnolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding clectrical)
(A, B, C, D, and E Combined)
@-57
PL.HSE
N ?zL
/z
1?lz
at
S
E
VALIDATION:
RECEIPT NUMB
DATE PAID
AMOUNT B
FIECEIVEO
rl
6A2.,5o
15r/o-'6
--
.2,
Permit No
Address:
lssued by Date:
STATEMENT:
R OFFICE USE ONL
INFORMATION N OTICE TO PROPERTY OWN ERSABOUT CON STRUCTION RESPONSIBIL ITIES
Fill in the appricable branks, and initiar boxes 1 and 2, and e ither box 3A or 38:
Note: oregon L"y,-grs701..05s(4),..requires residentiar^construction permitapplicants who are. not registei"i iritn ih" c;;;i;JJiion contractors Board tosisn the fotrowino,sl"t#fii;;i"[i1! oriroi-.6'il#ican be issued. rhis state_ment is required"fo.r residentlii oriioI^n.{:;ili[rr,'r""nanicar, and prumbinspermits' LicensedArcnitect anotligineer appricanis, erempt from registration}iHl? [:# lj#f1],' "L.i n ot J, t", i i i n i J 5ili.'#"; t ih iI ;i;#mEHiwi r r oe
1
2
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 soldor offered for sale before 6r upon completion.
Contractor registration nu
OR
I will instruct my general contractor that all subcontractors who work on the struc-ture must be registered with the construction contraiiois Board.
I will be my own general contractor.
lf I hire subcontractors, I will hire onty subcontractors registered with the Construc-tion Contractors Board. lf lchange my mind and do hiria general contractori lwillcontract with a contractor who is iegisiered with the Construition Contractors Board
and I will immediately notify the office issuing this building permit of the name ofthe contractor.
I hereby certify that the above information is correct and that I have read and understandthe lnlormation Notice to
3.8
is form.
pp cant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
Owners about Construction Responsibitities on the
)
-rA
te
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I
n biSiRespo litiesConstructionAbout
741hitORSw .055(5),cenaccordan ,
INFOk'ilAr ION NOl'lCE TO PROPERTY OvCNERS.-
AiOUr CONSTRIJCTION RESPONSIBII'ITIES
existing structure,you can Prevent many Problents bY being aware of the fol
a substantial imProvement to an
lowing responsibilities and areas
a
lf you are acting as your own iontractor to construct a new home or make
of concern
EMPLOYER RESPONSI BILITIES:
lf you hire Persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the constru ction or imProveme nt of a residential structure, you will,in most instances'be ruled to be an
"emploYer" and the PeoPle You hire willbe "emPlcYee s". As the emPloYer' You m ust comPlY with the following:
's With Tax Law:As an emPloYerr' You must withhold income taxes from e mployee wages at
the me employees are paid witt be liable for th e tax PaYments even if You don't actuallY with hold the
tax from Your emPloYee s. Fo r more informaticn, call the Oregon DeP artment of Flevenue at 378-3390.
UnemPl oyment lnsurance Tax
purposes on the wage sofall e
at 378-3224
Workers'Com nsation lnsu rance: As an employer, you are subiect to the Oregon Workers' ComPensation
Law, an must n workers c ompensat ion insurance for Your emp loyees. lf You fail to obtain workers'
comPensation insurance, You may be subiect tcr penalties and will be liabl e for all claim costs if one of Your
employees is ini ured on the iob. For more inform ertion, callthe Workers'ComPe nsation Division DIF at 373-7434'
and lnsurance:
coverage for acc idents omissions su
tures, fire, or work that must be re-done'
Time to supervise E[rployees: 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 rougf'-tn 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
Satem, OR 97310-0151
Phone 503-378-4621
As an employet', you are required
'9 PuV a tax for un",T?Iy'"nt insurance
mptoyees. ro, nlor"jn-toi*riion, ca[ i# orugon Employment Division DHR
u's' lnternal Hevenue service: As an employer' )'oY'TY'st withhold federal incoryre tax from employees' wages'
menteVenifyotrdidn't".tuarrvwiirrnorothetax.Formoreinformation,call
the lnternal Revenue Service at 22'1-3960' ri
OTHER RESPONSIBILITIES AND AREAS OF C()NCERNi
code eompliance: As the permit holder for this proiect, you are responsible for resolving any failure to meet
code requir*r"rii in"t *iv be brought to your attention through inspections'
Contact your insurance agent to See if you have adequate insurance
ch as fillling tools, paint overspray, water damage from pipe punc-
0244J 10t24t89
NOTE:This: lnformation Notice to P roperty
was develoPed bY ihe Construction Corttractors
passed [y the 1989 Oregqn Legislatulre.
JOB NO.nz tooz
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(C0MMERCIAL & RESIDENTIAL)
NAME OR COMPANY:
l1 LJ. lb q 9r.l-7 o ?-LL1 I - 04-70 ILOCATION:
L AoorTto A/DEVELOPMENT TYPE:
BUILDING SIZE 26(11.6 !;I"-gxre5) Lor sr
STORM DRAINAGE
iMPERVIOUS SQ. FT."{qo x $0.192 PER SQ. FT.
2. SAN ITARY SEt,lER-CITY
NO. OF PFU,S J X $39.78 PER PFU
(See Reverse)
3 TRANSPORTAT ION
NO OF UNITS X TRIP RATE X COST PER TRIP
A x $401 .05
A x $401 .05
X x $40i .05
SUBT0TAL (ADD ITEMS 1,2, & 3)sb1 Z
4. ADMINIS TIVE FEES
BASE CHARGE (SUBTOTAL AB0VE) X .05
TOTAL - C ITY SDC $
5. SANITARY SEWER-MI,,MC
NO. OF PFU'S $13.62 PER PFU + $10 Mt,lMC ADMIN FEE $
(Use PFU Total From Item 2 Above)
Mt,lMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-Ml^lMC SDC
Ki p Burd ck
sQ. Ft.
I
s
$g*
1t1
14 "s
zlby
tgb2
4
SDC Coordinator
8 .+1z
AL SD $3qrra
FIXTURE UNIT CALCUIATIoN TABLE: NumUer of New Fixtures X Unrt Equivalent = Fixture Units (NOTE
For remodels, calculate only the NEJ additional fixtures)
FIXTURE TYPE
Bathtub.......
Drinking Fountain-.-------."""j""""r""'!""""""""""'
Floor Drain.
NUMBER OF
NEW FIXI-URES
x$
(Rate X Assessed Value)x$
UNIT
EQUIVALENT
FIXTURE
UNITS
Interceptors For Grease/Oil/Solids/Etc""""""""'
I nterceptors For Sand/Auto Wash/Etc""""" """"
Laundry Tub/Clotheswasher" ""
Clotheswasher - 3 Or More""""""
Mobile Home Park Trap ('l Per Trailer)"""""""""
n eceptot For Ref ri geratorAVater Station/ Etc- " " "
Hu""'prot For Commercial Sink/Dishwasher/Etc"
2
1
2
3
b
2
b
b
1
J
2
1l
2
2
1
6
4
Shower, Single Stall.---.."""'
Shower, Gang--
Sink, Bar, Commercial
Urinal, Stall/YVall..-.
Wash Basin/Lavatory, Single"
Water Closet,' Public lnstallation"'
Water Closet, Private..-..""
tvliscellaneous:
TOTAL FIXI-URE UNITS
cBEDrr CALCULATToN TABLE: Based on assessed varue. rf improvements occurred after annexation date in table'
calculate credits
I
eadH
Credit for Parcel or Land Only lf Applicable
lmprovement (if after annexation date)
(Bate X Assessed
CHEDIT
Value)
TOTAL =$
RUNOFF COEFFTCIENTS FOR STORM DRAINAGE
Residential---
Commercial.
lndustrial-....
G ove rn mental....... - - --- - -
a.4
0.9
0.45
0,5
Year
Annexed
Rate per $1,000
Assessed ValueYear
Annexed
Rate per $1,000
Assessed Value
1 985
't986
1987
1988
1989
1990
1991
$2.16
1.90
1.60
0.25
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
I L
II
.t
-l
C'TY OF
i-he f'drc*{ig project
.zonrng, and does not
225 FIFTB STREEf,CCpioval.
SPRTNGFTEIJ), OREGoN 97477
INSPBCTION REQIIBST
oFPICE: 726-3759
Authori:so
1. LOCATION OF
IJGAL DESCRIPTION
DESCNIPTION
Permits are non-transferable and expireif vork is not started within 180 daysof issuance or if vork is suspended for
180 days.
2. COIiITRACTOR INSTALI^ATION ONLY
Electrical Contractor
Address
ci ty- Phone
Supervisor License Ntimber
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervlsing Electrician
Ci ty 2V7
Phone v7 242
OTINER INSTALLATION
The installation is being made on
property I ovn vhich is not intendedfor sale, lease or rent
DATE
RECEIPT *:
RECEIVED B
lr
th€)following ab
PERHIT APPLICATION
COHPIJTB PEB SCEEDULE BBLOS
Nev Residential-Single or
MuIti-Family per dvelling unit.
Service fneluded:
Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
s 8s.00
$ 1s.00
$ 40.00
Services or Feeders
Installation, Alterations or
Relocation:
Temporary Services or'FeedersInstallation, Alteration or Relocation
sr'rilNGl=rI:Lo
One Circui t 4/-'
Each Additional
Circuit or vith Service
or Feeder Permit a
SUBTOTAL OF ABOVE
5Z State Surcharge
TOTAL
z 726-376
,ti":
aa riubrnitted
A
Sum
B
c
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
00
00
00
Bil
40
55
80
re
200 amps or less $
201 amps to 400 anps
-
$
0ver 401 to 600 amps $
Over 600 amps or 1000 vo1Es se lt aEoE
D. Branch Circuits
Nev, Alteration or Extension Per Panel
$ 3s.00
$ 2.00
v^*
j G'e
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $Sign/0utIine Lighting- $
Limi ted Energy/Res
-
$Limited Energy/Comm S
00
00
00
00
40
40
20
36.
5 7y4 #
/.?<lr zs
City Job Nu b", ?Z/A=
owners *^ . rffizr*,+f. &r:plE
Address /->a /ye- ,AZaT.
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/vo1ts
Reconnect Only