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Home My WebLink AboutPermit Building 1991-01-08INGFIELE) RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER h,225 Fifth Street Springfield, Oregon 97 477 LOCATION OF PROPOSED WORK:ln ASSESSORS MAP:/ 2-27=?7-> V TAX LOT: + 9,1 BLOCK:SUBDIVISION c Ilk{p081OWNER:PHONE: ADDRESS:?rh str STATE:Ofa,c,l.t ZIP:ql+l1 CITY: DESCRIBE WORK:'x 2a/ NEW -_ FIEMODEL ADDITION *DEMOLISH OTHER CONST. ADDRESS CON EXPI RES PHONE G ENERAL:l PLUMBING: -MECHANICAL: {Sfqlll-t ELEcrRrcAL,4,' de!,ouf' el ec trl a ;xqAlla _ OFFICE USE _ QUAD AREA: # OF BLDGS LAND USE:FLOOD PLAIN: ZONING CODE* OF UNITS: OCCY GROUP: * OF STORIES: g OF BDRMS: Zzazr, d4.SECONDARY HEAT SQUARE FOOTAGE:WATER HEATER RANGE: 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 remporary Electric x 4 Rough Mechanical - Prior to cover.x Final Plumbing - When all plumbing work is complete. Site lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to M Final Electrical - When allE electrical work is complete. Fl Finat Mechanical - When allAl mechanical work is complete. cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain permanent electrical power.x Footing - After trenches are excavated.Fireplace - Prlor to facing materials and framing lnsp. p] Final Building - When allArequired inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.X E x' X Framing - Prior to cover.x OtherFoundation - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover, Underground Plumbing - Prior to filling trench.Drywall - Prior to taping MOBILE HOME INSPECTIONSx x ,x Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After fireplace approval and installation of unit. Blocking and Sel.Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut & Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. E Slorm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Line - Prior to filling trench. Slreel Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed.x Rough Plumbing - Prior to cover. 9ttDo CONTRACTOR'S NAME CONSTR. TYPE: HEAT SOURCE: r |_-l fence - When completed. E Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Setbacks P.L.HSE GAR ACC N S E S THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the H istorical Coordinator prior to permit issuance. APPROVED: BUILDING PERMIT ITEM SQ. FT.X $/SQ. FT.VALUE Main Garage Carport /pF/q Vzo 75v-- Total Value Building Permit Fee State Surcharge Total Fee '- d-50 fr (A)/*/ ,3 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 buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plan Check Fee: Date Paid 1Z'-e / Receipt Numbe Rec P Revi By SYSTEMS DEVELOPMENT CHARGE (SDC)', (B) ilaj_XA_ Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. PLUMBING PERMIT ITEM Fixtu res Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home I FEE ,/?4/D. N0 FT. FT. FT. ooPlumbing Permit State Surcharge Total Charge ,75 (c)75 ADDITIONAL COMMENTS MECHANICAL PERMIT Fu rn ace Exhaust Hood Vent Fan N0 d ryt ":rrtllnsert/Fireplace unit Dryer Vent cn Mechanical Permit cOlssuance State Surcharge Total Permit ,t{ (D)25,?g 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 further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, 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 f urther 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 on the site I ti s duri ng construction. [,nn",,,."W Date t- q-qL MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) VALIDATION: RECEIPT NUMBER V /Q 2 DATE PAID AMOUNT FIECEIVED RECEIVED BY _>3 TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) /*? /5 37. q= t'*r( D a actlY oF 225 FI,rta S]3.EET SPRTNGFTELD, OREGON 97477 INSPBGII0N REOIESTz 726-3769 OFPICE: 726-3759 1 LOCATION OP INST IJGAL DESCRIPTION :;r.nrNGl"rcLo CATTON aQ ct FEE SCBEDUI^E BELO1I A. Nev tial-Single or ti-Family per dwelling unit. Service Included: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or -Modular Dwelling Service or Feeder $ 8s.00 $ 1s.00 $ 40.00 B Services or Feeders Installation, Alterations or Relocation: B3 J 1 Sum JOB 6'.1 do.0)\,t,,-. Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. 2. CONTRACf,OR INSTALI.ATION O}TLY Electrical Contractor Q,rro trrc, ,, ?/o Address Po g,,.l33a 200 amps or less 201 amps to 400 amps -401 amps to 600 amps -601 amps to 1O0O amps- 0ver 1000 amps/volts Reconnect Only e- 00S so. $ 60.00city Q*u OQ cl)+qo Phone u?q.))q ] Srp"rri"o. fi cense Ndmber b l+1q 3 s100.00 $130.00 s300. 00 $ 40.00Expiration Date IO q7 constr contr. Number d aSYq Expiration Date bl ,-1, gna of Electrieian s Nanie Addres Ci ty Phone OVNER TION The installation is being made on property I ovn which is not intended for sale, Iease or rent. Ovners Signature: DATE: PT C. Temporary Services or Feeders Installation, Alteration or Relocation D. Branch Circuits ti SUBTOTAL OP ABOVE 5Z State Surcharge TOTAL 200 amps or less S 40.00 Over 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see rrBrr above New, Alteratlon or Extension Per Pane1 onE circuit I S 35.00 3$ OO Each Addi t ional Circuit or vith Service or Feeder Permit A S 2. OO -+'0 l'liseellaneous (Service/feeder not included) -Each installation Pump or irrigation S 40.00 Limited Energy/Res $ 20.00 Limited Energy/Comm $ 36.00 5 RECEIVED B oc) Ci ty 1 2 Permit No: Address: lssued Date 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 pplicable blanks, and initial boxes 1 and 2, and either box 3A or 38 I own, reside in, or will reside in the completed structure lnformation sid Notice to Property Owners about Construction Responsibilities on the this form. OR I understand that I must ister as a construction contractor if the structure is sold or shl pletion 3.A M contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 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 reve f,)a*eo-qL gnature m p licant STRUCTION CONTRACTORS BOARD Date 8t91 wHtTE @py To rssutNc AGENCY pERMtT FILEPINK COPY TO APPLICANT ,*ro,]no,o,] *o,cE ro pRopERr" ]",ur*t ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: .'This lnfoi'rnation Notice to Property Owners About Construction Responsibilities was developed by th'e Construction Contractors Board in aceordance with ORS 701.055(5), piassed by the 1989'Qregon Legislature. lf you are acting'as your 6wn contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern EMPLOVER RESPONSIBILITIES: 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 from employee 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 at 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 m.ore information, call the Workers' Compensation Division DIF at 973-7434. I U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the lnternal Revenue Service at 221-3960. OTHER HESPONSIBILITIES 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 ltrlake sure you have sufficient time to supervise your employees. Expertise: lt/ake sure you have the expertise to act as your own general contractor, to coordinate the work of rough-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 Salem, OFI 97310-0151 Phone 503-378-4621 o244J fi124189