HomeMy WebLinkAboutPermit Building 1995-01-20B
P,
lnspectlons: 726.3769
Offlce:726.3759
ESIDENTIAL
ERMIT APPLICATION
SP,l!NG FIELD
JOB NUMBER
225 Flfth Street
Sprl ng fleld, Oregon gZ 4?Z
LOCATION OF PROPOSED WORK:l\
- ASSESSOBS MAP:TAX LOT
SUBDIVISION:
- OFFICE USE -
+
SBNJdOUAO AREA:
I OF BLDGS:
LAND USE:
r OF UNITS:
CONSTR. TYPE:
HEAT SOURCE:
RANGE:
FLOOD PLAIN
ZONING CODE:
r OF BDRMS:
SECONDARY HEAT:
SOUARE FOOTAGE:
OCCY GROUP:
r OF STORIES:
WATER HEATER:G
PHONE:'3rlr
6(STATE:ZlPi
RJ
CR.9-Ar{t{D17L-LPb
wr.ko.
14 o1
OWNEB:
ADDRESS:
CITY
ADDITION DEMOLISH OTHER
OESCRIBE WORK:
NEW T REMODEL
ADDBESS EXPIHES PHONE
,l
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
To request an lnspectlon,
made the eame worklng ,
pt"-oorary Electrlc
,you must call 726'3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7:00 a.m. wlll beday, lnspectlons roquested after 7:00 a.m. wlll be made the followlng work day,
REQUIRED INSPECTIONS
[{ noueh Mechanlcal - prtor toacover. (44S F,/)
ryfJ# Electrlcal - Prlor to
ffiet""trtca! Servtce - Must be
^\ approved to obtaln permanent
electrlcal power.
[l Flreptace - prlor to factng
-
materlals and framlng lnsp.
tl Undcrslab Plumblng/ Electrlcal/
Mechanlcal - Prlor to cover.
lpfGootlng - After ttenches are
2Atexcavated. ' ,
Masonry - Steel locatlon, bond
beams, groutlng.
fl-]-Foundatton - After forms aref erected but prlor to concrete/ \placement.
l-l Unaerground Plumbtng - priorlJ to fllllng trench.
Slte lnspectlon - To be made
after excavatlon, but prlor tosettlng forms.
Prlor to n or decklng
Framlng - Prlor to
WallIC'elllng
cover.
GOVer,
i
lnsJlatlon - Frlor to
l-_l Flnal plumbtng - When ail.4 plumblng work ls complete.
l--l Flnal Etectrlcal - rAfiien ail'J electrlcal work ls complete.s
Flnal Mechanlcal - When allmechanlcal work ls complete.
Flnal Bulldlno - When allrequlred lnspecilons have beenapproved and bullding is
completed.
F otn"r /
MOBILE HOME INSPE TIONS
l-l Blocklng and Ser.Up - Whep ail
-
blocklng ls complete.
,'X'
X
X
;! eo"r and Beam - prtor ro ftoorlaL lnsulatlon or decklng.
]Vf Hoor lnsutallon - Prlor toy' { decktng.
E l*,;;ry sewer - Prlor to rllllns
X,";tg.Sewer - Prlor to rllllns
,ffi;|5llne - Prlor to rllllns
K,f** Plumblns - Prlor to
[--l Wood Stovo - After tnstailatton.
l-l lnsert - After flreptace approval
-
and lnstallatlon of unlt.
E*"":f S*"*i33,:"f i,1,;,il j"':
placoment of concrete.
\]SlOewatk & Drlveway - Afrerr,llexcavatlon ls complete, forms
and sub.base materlal ln place.
Drywall - Prlor to taplng
Fence - When completed.
Slroel Trees - When all requlred
trees are planted.
Plumblng Connectlons - Whenhome has been connected to
water and sewer.
Electrlcal Connectlon - When
blocklng, set.up, and plurpblng
lnspectlons have been approved
and the homo ls connected tothe servlce panel.
Flnal - After all required
lnspectlons are approved andporches, sklrilng, decks, andventlng have been lnstalted.
o/';
n ll
I
tl
Lot facss
Lot sq. ftg.
Lot coverage
Topography
Total [€lght
ry
A?,
Lot Typ(
X tnterio,
-
Corner
-
Panhandle
X crt.ou."u"
o
.S THE PROPOSED WOBK IN THE .
HISTOBICAL DISTRIqI, OR ON
/.'THE HtsroRtcAL FEGISTEB?
lf yes, thls appllcatlon must be slgnod
and approved bY the H lstorlcal
Coordinator prlor to permlt lssuance.
APPROVED:
ADDITIONAL COMMENTS
GAR ACC'P.L,HSE
N 26
S
3S
E /S
\
BUILDING PERMIT
ITEM SO, FT.,
N.lain 'Z(/ 2- '"
Gaqase ? 2(
Garport
2Z/a+ /G?c
4bG.7 |
(A)
(o
/o
2a
= VALUE
" tlrrq', 'r/*,
Total Value
Bulldlng Permit Fee
State Surcharge
Total Fee
//r seas47:
X S/SQ. FT,
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permit ls granted on the express condltlon that the sald
construction shall, ln all respects, conform to the Ordlnance
adopted by the City of Sprlngfield, includlng the
Development Code, regulatlng the constructlon and u6e of
bulldings, and may be suspended or revoked at any tlme
upon vlolatlon of any provlslons of sald ordlnances.
PI r 3;i( iv
s5Plan Check Fee;
Date Pald:
Recelpt Number:
Recelved
SYSTEMS DEVELOPMENT CHABGE (SDC)
%a-r rr sff " g<-ls*rtr-g i#Systems Development Charge ls due on all undeveloped
properties wlthln tho Clty ilmits which are being lmproved.
ITEM
Flxturest
Resldentlai Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
?dt * ,,'3
FT.
FT.
(c)2n 7.q/
y'/
PLUMBING PERMIT
Plumblng Permlt
State. Surcharge
Total Charge
Mechanical Permlt
lssuahce
State Surcharge z,Ot t' /,79
Total Permit (D)
N0
"@"*:D
i a:l
LZ
7b
?
4 a
ao6r<{
MECHANICAL PERMIT
(4*r) 4 Fo
Dryer Vent
Furnace
Exhaust Hood
Vent Fan
Wood Stove/lns
aao -
/t,./af
By slgnature, I state and agree, that I have carefully examlnod
the completed appllcailon and do hereby cerUfy that all
lnformatlon hereon ls true and correct, and I f urther certlfy
that any and all work performed shall be done ln accordance
wlth the Ordinances of the Clty of Sprlngfleld, and the Laws
of the Stats of Oregon pertalnlng to tho work descrlbed
hereln, and that NO OCCUPANCy wlll bo mado of any
structure wlthout permission of the Bulldlng Safety Divislon.
I further certlfy that only contractors and employees who
aro ln compllance with OBS 701.055 wlll be used on thls
proJect.
I further agree to ensuro that all requlred lnspectlons are
reguested at the proper ilme, 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 wlll remaln
Date
-o
2
8.r
on the slte at all tlmes durln g constructlon
/ Slgnature
VALIDATION:
BECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
BECEIVED BY
MISCELLANEOUS PERMITS
Mobllo Home
State lssuance
State Surcharge
sidewark 3/3 - t
Curbcut 36. n
Demolltlon
State Surchargo
?o*,ffiTotal Mlscellaneous Permits
Lup G. <i l-t
3tGsZ
?t5
TOTAL AMOUNT DUE (exctudtng etecrrtcat)
(A, B, C, Q and E Comblned)
///.
41 . \a ')'.
4w
FT.
?.*
./o,oo
-/gf-
B
X,
Permit #:a
Address 2f73 ). /7b 21
Issued by:Date:I 'f-
Statemert: 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 residential 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 witl be filed with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 34 or 38:
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.
3B. 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 information is correct and thatl have read and dounderstand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
r/zo/q<
(Signature of permit applicant)
(White copy to issuing agency pennitfile,
pink copy to applicant)
OR
(Date)
F
,1.',
Information Notice to Property Owners
Abotrt.Cqnstruction Responsibilities .1
,"t_ .'
..:)N,,".,,I'hislnJr;l"ma1itlnNcsticeloPrtl.pertyownersctbotilCanstrut'tionr:',:-:,!:,i,:u:..,.-i,.;,
was rlevclgped by the (llo1strtu:tion Contractors Bcttrt"d in {}ccardnrzr:e x'irh ORS 70l'055(5)"
If you are acting i:rs ,vollr own contractor to constnlct a ilew home or rnake a substiintral improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concem. , rl , .i
EMPLOYER RESPONSI BILITIES:
If you hire persons not registered with the Congtruction Contractors Board to do labor in constructing or assisting in the
construction or improvemJnt of a residential structure, you will, in mo.st ius1ar.rg.gp, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following: '
g tax law: As an employer, you must withhold income d_"f ft1T emplo^yee wages at th€ time employees
3:"f#:t;:ffi?i,*"ruo," for the tax pbyments even if you don't actually wirhhold the tu* rL* your ernplovees. For more
information, call the Oregon Dept; of Reverue at 945-S09I.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance puposes on the
*ug", of u[ employees. For more infottnation, catl the Oregon Employment Division at the Departrnent of Heman Resoulmi
at378-3524 , |...1
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, andm&t.
obtain workers' cornpensation insurasce for your employees. If you fail to obtain workers' compensation i.nFurance, yoqquy
b"G;;i. p";;t[;;tii u" ii;ul. for all claim *rt, iror" oiyou, "*ployees
is injured on th9 jolt l:Lry* informadoq
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wdges. YoYiLbe
I"il;;il; puy-"rr even if you didn't acrually withhold the tax. For more information, call the Internal Revenue Serv?ti
at 1-800-829-1040. :''
OTHEH RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible fbr resolving any failure to meet code requirerqents.
thatmaybebroughttoyourattentionthroughinspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for ''
accidents and omissions such as ialling tools, paint overspray, water damage from pipe punctures, fire, or work that must k
re-done.
'fime to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Makesureyouhavetheexpertisetoactasyourowngeneralcontractor,tocoordinatetheworkofrough-inandfinish
trades, and to notify Uuitaing officials at the appropriate times so they can perform the required inspections.
lf you have additional questions, write or call the Construction Contractors Board (PO Box l4l40, Salem, OR 97309-5052,
5A3878-4621). The Board is iocated at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
I194
LEGAL DESCRTPTTON/7og zy' ao ,q oo- 7
225 FIYIH STREET
SPRTNGFTELD, OREGON 97477
TNSPECTTON REQUEST: 726-37
OFFICE: 726-3759
approval
Authorized1. LOCATION OF TNST ON
JOB DESCRTFTTON
Permits are non-transferable and expireif vork is not started vithin 180 diys
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATTON ONLY
Electrical Contractor
Address
ci ty-Phone
Supervisor License Number
Expiration Dut.
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
r'1
Ci ty
t-.D.(-ELECTRICAL PERHIT APPLICATION
city Job Number ?44
BELOg
A Nev Residential-Single orMulti-Family per dvelling unit.
Service fncluded:
ftems Cost
g?."
The following project as submitted has the
zoning, and does not require specific land
SPRIi|GFIELE'
1000 sq.f t. or l-ess L/
Each additional 500
sq. ft or portion
thereof €
Each Manuf'd Home or
-
ModuLar Dvelling
Service or Feeder
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
B
C
Services or Feeders
InstalIation, Alterations
or Relocation:
200 amps or less
20L amps to 400 amps
-40L amps to 600 amps
601 amps to 1000 amps-
Over 1000 amps/volts
Reconnect 0n1y
Temporary Services or Feeders
Installation, Alteration or Relocation
$ 8s.00
$ 1s.00
$ 40.00
s s0.00
s 60.00
$100.00
s130. 00
$300.00
$ 40.00
Sum
9S.aa
7S*
fu*
Hld,pnone ZE7-6,,1/f
ovNER rNSrALLArroN 7'C - 6goo Gt)
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Owners Signature:
DATE:
aEovE-
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Cireuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. MiscelLaneous (Service/feeder not included)
-Each installation
Pump or irrigation
sign/outline Lighting-
Limited Energy/Ret ,.-Limited Energy/Comm
200 amps or less L- S 40.00
201 amps to 400 amps
-
$ 55.00
over 401 to 600 amps
-
S 80.00
Over 600 amps or 1000 voT[s see "B"
4
s 40.00
$ 40.00
$ 20.00
s 36.00
5 zb?
//,d,/ aoe.
RECETVED B ilffi.
owners Name 7D€4 ,r,%r?fr*.<F
eddress 323? &Et<&- ..4 .