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Home My WebLink AboutPermit Building 1994-06-15SPRINGFIELI) RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 ?fr, JOB NUMBER 225 Fifth Street Springf leld, Oregon 97477 ?, LOCATION OF PROPOSED WORK: .1 TAX LOT D2-b o IASSESSOFIS MAP: LOT: - BLOCK: SUBDIVISION PHONE: qz//7'/ bL. ZIP:.STATE: llu^l fl,ta , <oWruen; ADDRESS: CITY: ^=* tNF REM.DEL ADDtrloN DEMOLISH OTHEB DESCRIBE WORK: PLUMBING: MECHANICAL: ELECTRICAL: EXPIRES PHONEADDBESSCONTRACTOR'S NAME GENEBAL:ONdfu CONST. CONTRACTOR # * OF BDRMS: WATER HEATER: ZONING CODE: FLOOD PLAIN I OF UNITS: RANGE: SECONDAFIY HEAT: SOUARE FOOTAGE: LAND USE: OFFICE USE - \\\\ OCCY GROUP: I OF STORIES: OUAD ABEA: # OF BLDGS CONSTR. TYPE: HEAT SOURCE: To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspections requested before 7:00 a.m. wlll be made the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day. REOUIRED INSPECTIONS I femnorary Electrlc Rough Mechanlcal - Prior to cover. [-l Final Plumbing - When alllJ plumblng work ls complete. N7 flnat Etectricat - When all .i4 electrical work ls complete. lV1 Footlno - After trenches are,lA\e*".r"i"0. n X E K E E X Site lnspectlon - To be made after excavatlon, but prior to settlng forms. Underslab Plumblng/ Electrlcal / Mebhanlcal - Prlor to cover. Masonry - Steel locatlon, bond beams, groutlng. Foundatlon - After forms are erected but prlor to concrete placement. Underground Plumblng - Prior to fllllng trench. Underlloor Plumblngl Mechanlcal - Prlor to lnsulatlon or decklng. Post and Beam - Prior to floor lnsulatlon or decking. Floor lnsulatlon - Prior to decklng. Sanitary Sewer - Prior to fllling trench. Slorm Sewer - Prlor to filllng trench. Water Line - Prior to filling trench. Rough Plumbing - Prior to cover. T9'Rough Electricat - Prior to ,,,Acover. n Flnal Mechanlcal - When all mechanlcal work ls complete.Eleclrlca! Servlce - Must be approved to obtaln permanent electrlcal power. Flreplace - Prlor to faclng materlals and lramlng lnsp. lnserl - After flreplace approval and lnstallatlon of unlt. Curbcut & Apprqach - After forms are erected but prlor to placement of concrete. Sidewalk & Drlveway - After excavatign ls complete, forms and sub-base material in place. Street Trees - When all requlred trees are plantod. Flnal Buildlng - When all requlred lnspectlons have been approved and bulldlng ls completed. OIher MOBILE HOME INSPECTIONS Blocking and Set.Up - When all blocklng ls complete. Plumblng Connections - When home has been connected to water and sewer, Eleclrlcal Connection - When blocking, set-up, and plumblng lnspectlons have been approved and the home ls connected to the servlce panel. Flnal - After all required inspectlons are approved andporches, sklrtlng, decks, and ventlng have been lnstalted. KFramlng - Prlor to cover, lffiwatltColting lnsutatlon - Prlor toIJA(,cover. floo*ull - Prlor to taplng' [_l Wood Stove - After lnstallatlon. 7//^)foY . .^^--f,'e i J -rl .0,t$)\}) tl E n Fence - When completed. ( IS THE PROPOSED WORK TN THE, HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this applicatlon must be slgned and approved by the H istorlcal Coordinator prior to permit issuance. APPFIOVED: Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Type -{ ,,nr.no, - Corner - Panhandle - Cul-de-sac PL.HSE GAR ACC N s W E+ (A) 3 3Po*funt 2p VALUE l- tb7 Total Value Bulldlng Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main 3( ( Garage Carport x $/sQ. FT, 11c, ra BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Thls permlt ls granted on the express condilion that the said construction shall, in all respects, conform to the Ordinance adopted by the City . of Springf tetd, lnctuding the Development Code, regulating the construction and use of bulldlngs, and may be suspended or revoked at any fime any provisions of said ordlnances.aq /.s z Flecelpt Numoer, /27 7 7 ewed Date Pald Received upon vlolation of Plan Check Fee SYSTEMS DEVELOPMENT C (B) HARGE (SDC) /zc' vv Systerns Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Flxtures Flesldentlal Bath(s) Sanltary Sewer Water Storm Sewer Moblle Home FEE (c) FT. FT. PLUMBING PERMIT Plumblng Permlt State Surcharge Total Charge . FT. ADDITIONAL COMMENTS Wood Stove/ lnsert/ Flreplace Unlt Dryer Vent (D) N0Vent Fan Mechanlcal Permlt lssuance State Surcharge Total Permlt MECHANICAL PERMIT Furnace Exhaust Hood By slgnature, I state and agree, that I have caref ully examlned the completed appllcation and. do hereby certlfy that all lnformatlon hereon ls true and correct, and I f urther cerflfy that any and all work performed shall be done in accordance wlth the Ordinances of the City of Springfield, and the Laws of the State of Oregon pertalnlng to the work descrlbed hereln, and that NO OCCUPANCY wlll be made of any structure wlthout permission of the Building Safety Dlvislon. I further certlfy that only contractors and employees who are ln compllance with ORS 701.055 will be used on this prolect. I further agree to ensure that all requlred inspections are requested at the proper tlme, that each address ls readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remaln at all t es du Date structlon. MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sldewalk - ft Curbcut - ft Demolltlon State Surcharge Total Mlscellaneous Permlts (E) TOTAL AMOUNT DUE (excludlng electrlcal) (A, B, C, Q and E Comblned) D 6 VALIDATION RECEIPT NUMBER DATE PAID AMOUNT RECEIVED BECEIVED BY zlw N0 .;. ,.r.,..rnli I, I CITY OF SPR OREGON SPRIi-dFlELD sB subrnttt6d hm the fcllorvi roqulre sPeclfic land uss ntl.ecmrcAL PERurr aPPLrcATroN225 FTFTE STREET SPRTNGPIBLD, OREGON INSPBCTION REQTIEST: oFFICE: 726-3759 Tho loiiowing Project zoning, end cioes not 9Efaftl. 7 zo-z/ffin Lo L-City Job Nunber aa,'alP-)5773f-3. COHPI,ETE FEE SCffiDUI,E BELOS dential-Single or1. TOCATION OF LEGAL DESCRIPTION DESCRIFIION Electrical Contractor- Address Citv Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signature of Supervising Electrician 0vners Name Address Ci Phone 7y'/-25a4^ Multi-FamilY Per dvelling unit. Service Included:Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 Services or Feeders Installation, Alterations or Relocation: 200 amps or less 20L amps to 400 amPs -401- amps to 600 amPs - 601 amps to 1000 amPs- Over 1000 amps/volts - Reconnect 0n1Y Sum Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. COMRACTOR INSTALI.,ATION ONLY B s s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 $ s $ s C E Temporary Services or Feeders Insiallaiion, Alteration or Relocation 200 amps or less 201 amps to 400 amPs 0ver 401 to 600 amPs - Over 600 amps or. L000 volts 40 55 80 00 .00 .00 ee rrB, aEEE D. Branch Circuits Nev, Alteration or Extension Per Panel- One Circuit L-, $ 35'00 21" Each Additional Circuit or vith Service or Feeder Permi t ./ $ 2.00 22 Miscel-faneous (Service/feeder not included) OIJNER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent' -Each installation Pump or irrigation Sign/0ut1ine Light ing- Limited Energy/Res _Limited Energy/Comm SUBTOTAL OF ABOVE 52 State Surcharge 32 Administrative Fee TOTAL $40 $40 $20 $36 00 00 00 00Ovners S DATE: 5 RECETVED ture: Oo ,l/- 7 *o Permit #:"4 p7z/ Address Z Issued by:Date: Statemeht: 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 statement before a building permit can be issued. This statement is required-for resitlential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exemptfrom registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and}, and either box 3A or 38: 1. I own, reside in, or will reside in the completed sffucture. 2. 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 regis. #(Name) I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. K tr K OR 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 thatthe above informationis correct and thatl have read and do understand the Information Owners about on the reverse side of this form. a-/{_// applicant) (Whrte copy to issuing agency permitfile, pink copy to applicant) Notice to Property (Signature (Date) 4ll t r I '.Information Notice to property Owners' About Cq_nstruction Responsibilities .:i., -.;:, -1Ja-: ...vvlrv..sru ,,Note. '{'ltis lttlortrttttiort N?tiic'e to P.rpperty oy;ners ahout {'<tnsrru<.rinn Rr.,tltrtn.sibiliti", ' -'tulii-tzt'r,tlrt{tt:tl hr' the Citnstrucri.On errrg*rtrrs Bottrcl in accrtrrlcrtce w,tth ORS 701.055(S). If yclu arc it"cting as yoilr {}wtl c(intractor to constnlct a now horne ()r makc a sui:stantial inrproven.iernt l.o an existing strllcture,you can prevent marny problems by being aware of the lbllowing responsibilitrss and ueas of concem. EM PLOYER BESPONSIBILITTES: If you hire persons not registered with the Construction Contractors Board to do labor in constructiqg pr assisting in theconstruction or improvement of a residential structure, you will, in most inst4nces, be-ruled to be an "orptyo and the peopleyouhirewillbeemployees.Astheemployer,youmuStcompIywiththefoIlowing: Oregon's withholding.*|11*i As an employer, ybu must withhold income taxes from employee wages at the time employees are paid. You will be liable for the td payments even if you don't rictually withhold the tax fio* yo-ur employees. For more information, call the Oregon Dept. of Revenue at 945-9091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on thewagesofallemployees. Formoreinformation,calltheOregonEmploymentDivisionattheDepartmentofgumanResouiei at378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, *O ** obtain workrs'compensation insurance for your emplnyees. If you fail to obtain workers' "o*p"nrution insurarrce, yoern# besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredontirejob. Form;r;i#o;;i6; call the Workers' Compensation Division at the Department of Consumer and Busineis Services a:t g45-78g8. U.S. Intemal Revenue Service: As an employer, you must withhold federal income tax from einployees,wages. you will dliablC forthe tax payment even if you didn't actually withhold the tax. For more information, call the Intemal Revenue ServiC'e at I-800-829-1040. 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 that may be brought to your attention through inspections. Li*bility and property damage insurance: 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 punctures, fire, or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supr'rvise 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. If you have additionll questions, write or call the Construction Cbntiactors Board (PO Box l4l40,Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer Sr. NE Suite 300. in Salem.'. prop-own.prn4 1t94 Tlorz / CITY OF SPRINGFIELD SYSTEHS DEVELOPHENT CII^RGE I.IO RKS H EET' (col'THERCIAL & RESTDENTIAL) NAI.IE OR COI.IPAI{Y:L r LOCAT ION:/q64 //./Y 4 DEVELOPI'IENT TYPE: BUILDING SIZE: - I. STORH DRAINAGE IMPERVIoUS SQ. FT. 2. SANITARY SEtt'ER-CITY NO. OF PFU'S (See Reverse) 3 T siz 4si x so.2o3 PER SQ. FT. X 542.08 PER PFU x s424.31 x s424.31 Y $1s.lzs PER PFU + $10 Ml..lMC ADH FEE TOTAL-MWMC SDC SUBToTAL (ADD ITEI'IS 1,2,3 & 4) BTOT VE x .05 a. Fr. TRANSPoRTATIoTt NO OF UNITS X TRIP RATE X COST PER TRIP x _ x s424.31 x x S 4 SAN I TARY SEI\|ER-I4I1|I.IC NO. OF PFU'S BASE (Use PFU Total From [tem 2 Above) Hh'l,tc CREDIT IF APPLICABLE (SEE REVERSE) 5 tr 37 /.c z SDC Coordinator TOTAL SDC ,7t s FIXTUNE N'PE tr'Ul.',F[: Il L]l: t.,rE'J l:t.\I utiE::- TOTi.L FIXTUNE Ui{ITS Lr;{l I t: oLri\i'.1[,,17 l'IA I ullt: Ui.JITS Bathtub. Drinking Foutrl.rirl...... Floor Drain. .-.....'..:'.....'. lnl erceplors For G rea se/Oil/Solids/El c................. lnlerceplors For Sand/Aul o \(a s lrrlElc.................. Laundry Tub/Oothesrvaslrer.... Ootheswalher - 3 Or Mo1e.......... llobile Hdme Park Trap (1 Per Trailer)........ B ece p.t or F-or R ef rig era I orlVa t e r S t a t io n/ Et c........ Beceptor For Commerclal S inkr/D ishrvasher/Etc.. Shorver, Single'Stall.. Shower. Gan9........... S!nk, Bar. Commercial ' Urinal, Stalln\hll.... \1'aler Closel Public lnstallation... Water Closet. Prh'ate........ lliscellaneous: I 3 6 ,, 6 /Head 6 I 3, t, 2 2 1 6 CREDIT CALCULATION TABLE: Based on assesseC value. lf improvemenls occurrd a?,er annexation date in table. calculate crerihs se es. Credit for Parcd or lanC Onty lf Applicable X $ - (Rate X Assessed Value) lmprovement (rf after annexation date)xs (Rate X Assessed Value) CREDIT TOTAL Year Annexed Year Annexed Rate per 51,000 Assessed Value 19e6 r 937 1908 1*9 i O.an 1991 1992 s 2.24 1.93 1.57 1.18 0.79 0.44 0.28 1979 or before 19€O 1981 1922 1993 1934 '1995 s3.21 3.13 3.08 2.*5 2.82 2.69 2.51 1 RUNOFF COEFFICIENTS FOR STORM DRAINAGE Residential.. Commercial 0.4 0.9 IMPERVTOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT Eate per 51,OOO AssesseJ Value