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Home My WebLink AboutPermit Building 1999-03-24Rf.SIDENTIAL PERMIT APPLICATION lnspectlons: 726-3769 Offlce:726-3759 LOCATION OF PROPOSED WORK; qffiN /6 JOB NUMBER 22s Fifth streer ??0 j? 1 Sprlngfleld, Oregon 97 477 TAX LOT 07/c oASSESSOBS MAP:t703 3 Zq LOT - BLOCK:SUBDIVISION: PHONE: ,a 72 1.':7L/'7ZIP:STATE: 7'/v 6r ?s CITY:Sftc o ADDRESS: OWNER:' 4/3 tlL ADDITION DEMOLISH OTHER DESCRIBE WORK: NEW- BEMODEL ADDRESS CONST. CONTRACTOR # Cw EXPIRES j PHONECONTRA TOR'S NAME GENEBAL: PLUMBlNG: MECHANICAL: ELECTRICAL: , oF STORTES: ...-..tsi,;:* , :f\i.]0NgflE0ElOURCe: -- Center is '! Er[ffi lity lephone n - OFFICE USE llow rules adopted by the Oregon UtiNotification C enter set forthOUAD AR LAND USE:_+001_00 0090. you mav, OF BLDGS: - * OF UNTTS: cailing the center.OCCY GROUP: -_ CONSTFI. typE:___+*nberforthe O wArER HEAIER: tBe Dnv pEBIOI:RANGE: -6E06eDfBY4l.EAr SOUARE FOOTAGE: To request an lnspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspectlons requested before 7:00 a.m. wlll bemade the same worklng day, lnspectlons requested after 7:OO a.m. wlll be macle the followlng work day. UI RED INSPECTIONS Mechanlcat - Prlor to! Temnorary Etectrlc Plumblng - When alt umblng work ls complete. Slte lnspectlon - To be mado after excavatlon, but prlor to settlng forms. h Electrlcal - Prlor to Electrlcal - When ailcover.cal work ls complete. [--l Underalab PtumblnglEtecrrlcat/ 'J Mechanlcal - Prlor to cover.Electrlca! Servlce - Must be approved to obtaln permanent electrlcal power. Mechanlcat - When all anlcal work ls complete. l-l Footlng - After trenches are|J excavated.Bulldlng - When alt Flreplace - Prlor to faclng materlals and framlng lnsp. lnspectlons have been I and bulldlng isMasonry - Steel locatlon, bond beams, groutlng, mpleted. - Prlor to cover. Foundallon - Aftdr forms are erected but prlor to concrete placemont. Other lCelllng lnsutatlon - Prlor to E Underground Plumblng - Prlor to fllllng trench.- Prlor to taplng E Underlloor Plumblngl Mechanlcal - Prlor to lnsulatlon or decklng. MOBILE HOME INSPECTIONS Wood Stovo - After lnstallatlon. Post and Beam - Prlor to floor lnsulatlon or decklng.lnsert - After flreplace approval and lnstallatlon of unlt. Blocklng and Set-Up - When ail blocklng ls complete. Floor lnsulallon - Prlor to decklng.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumblng Connectlons - When home has been connected to water and sewer. l-l Sanltary Sewer - Prlor to fllllngu trench.Electrlcal Connectlon - When blocklng, set.up, and plumbing lnspectlons have been approved and the home ls connected to the servlce panel. l--l Storm Sewer - Prlor to fllllng - trench. Sidewall< & Drlveway - After excavatlon ls complete, forms and sub-base malerial In place. Waler Llne - Prlor to fllllng trench. Fence - lVhen coi'rtpleted Streel Trees - When all requlred trees are planted. Flnal - After all required lnspectlons are approved andpgrches, sklrtlng, decks, ancl ventlng have been lnstalled. Flna Plumblng - Prlor to T E fl E E tl Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Type - tnterlor - Corner -- Panhandle ' - Cul-de-sac PL.HSE GAR ACC N S E k 1 rS THE PROPOSED WORK IN HISTORICAL DISTRICf,, OR ON THE HISTORICAL REGISTER? - ll yes, thls appllcatlon must be slgned arrd approved by the Hlstorlcal Coordlnator prlor to permlt lgsuance. APPROVED: VALUE 13.f9 0'1fr q)-/ 0 (A) .k tL,*-o - Total Value Building Permit Fee State Surcharge Total Fee _t${a _ 5,a{ x $/so. FT. BUILDING PERMIT ITEM SO. FT. Main Garage Carport BUILDING VALUE, I5MTU CHECK AND BUILDING PERMIT This permit is granted on the express condltlon that the sald construction shall, in all respects, conform to the Ordlnance adopted by the City of Springfleld, including the Development Code, regulating the constructlon and use of buildings, and may be suspended or revoked at any tlme upon violation of any provisions of sald ordlnances. Receipt Number:- Plans Reviewed By Date Date Paid Received By Plan Check Fee: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being lmproved. FEE bc6 (c) 3.tl l./,f t JY I FT. FT. N' FT. t Residential Bath(s) Plumbing Permlt State Surchar0e Total Charge PLUMBING PERMIT ITEM Fixtures Sanitary Sewer Water Storm Sewer Moblle Home ADDITIONAL COMMENTS Note: Building Inspector may require additional plans information, and/or fees for the completion of this project Wood Stove/ lnsert/ Fl replace Unit Dryer Vent lf-.d c /a,ll qs'.7 ftlu(D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood By slgnature, I state and agree, that I have carefully examlned the compl€ted appllcatlon and do hereby certlfy that ail lnformatlon hereon is true and correct, and I further certlfy that any and all work performed shall be done ln acconJance wlth the Ordinanccs of the Clty of Sprlngfleld, and the Laws of the State of Oregon perlalnlng to the work descrlbed herein, and that NO OCCUPANCY wlll be made of any structure wlthout permission of the Bulldlng Safety Dlvislon. I further certily that only contractors and employees who are In compllance wlth ORS 701.055 wlll be used on thls prolect. I further agree to ensure that all requlred lnspections are requested at the proper tlme, that oach address ls readable lrom the street, that the permlt card ls located at the front of the property, and the approved set of plans wlll remaln 7 Slgnature Date 7- zy on the site times d on. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolitlon State Surcharge Total Mlscellaneous Permits (E) rorAL AMoUNT DUE (exctudtns eteorrtca,l l:lJL- (A, B, C, Q and E Comblned) 0332i q VAl-IDATION BECEIPT NUMBER DATE PAII) AMOUNT RECEIVED BECEIVED BY r,t I Permit #: Address 31tqr?/ u/a,,;Date: 3 w Issued by:) Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following stotement before a building permit can be issued. This statement 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. tt 1. I own, reside in, or will reside in the completed structure 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. t 38. I will be my own general contractor If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and 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 do understand the Information Owners about Construction Responsibilities on the reverse side of this form. 3 z,( 77 (Signature of permit applicant) (White copy to issuing ogency permit file, pink copY to aPPlicant) OR Notice to roperty (Date) Fill in the appropriate blanks and initial boxes I and2, and either box 3,A or 38: {s.'$i_.,.nq,*it " Information Notice to Property Ourners Aboqt Construction Responsibilities Note: l'his Information Notice to Property Ov'ners about Constructiorz Respon,tibilities wus tlevekttrted by the Construction Contructors Bexsxl in accordattce vvith ORS 701.055{5). If you a.r"e :rq,:ting a$ your own contractor to construct a new home or make a substanti*l ir*provernent to ,m exisfing iitnlrttit"c. you can prcvent many pxrblenrs by being aware of the lbllowing rcsponsibilities and areac of concem. EIUIPLOYER RESPONSIBI LITIES: If you hire persons not registered with the Construction Conlractors Board to do labor in conslrucling or assisting in the ccrnstruction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the p*ople you hire will be employees. As the empioyer, you must comply with the following: Ortgtm's withholding lax Lnwl As an employert you must withhold incorne taxes from employee wage$ at the tirne employees are paid. Yau will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more infbrmation, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are requin:cl to pay a tax for unemployment insurancc purposcs on the wages of alt enrployees. For more information, call the Oregon Employment Departrnent at 378-3524. Worker's eompensation insurance: As an employer, you are subject to the Oregon Workers' Campensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you rnay be subject to penalties arrd will be liable for all claim costs if one of your employees is injured on the job. Fcr more infcrmiatlon. call the Workers' Conrpensation Division at the Department of Consunrer and Business Services at 94-5-7888. U,S.Internal R^evenue $ervice: As an employer, you must withhold federal income tax from employees'wages,You will tre Iiable for the tax payment even if you didn't actually withhold the tax. For more information, call the lnteroal Revenue Service at l-800-829-1040. OTIIER RESPONSIBILITIES ANt} ANEAS OF CONCEHN: Code cnmpliance: As ttre prmit holder for this project, you are responsible for resolving any failure to nrcet code requirenrcnts. that may tre brought to your attention tkough inspections. Liability and property damage insurancet Contact your insurance agent to see if you have adequate insumnce coverage fbr accidents and omisskrns such as falling tools, paint overspray, water damage,fu* pip* punctures, fire, or work thir must be redone. Time to supervise employe*s: Maks sure you have sulficient tfune ta supervise r.:ur ernployees. Expeltise: Make sure you have the expertise to a*t as your own general consactor, to coordinate the work of rough-i:r and finish trades, and to notify building oflicials at the appropriate times so they can perfi:rm the required inspections. If you have additional ques:ir:ns, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-&21). The Board is located at 700 Summer St. NE Suite 300, in Salem prop-own.pm4 t/94 SP401