HomeMy WebLinkAboutPermit Building 1997-08-01NESDENTIAL
PEBNIIT APPLICAI'ON
lnspections: 726-3769
0lfice:726.3759
JOA NUMAER
225 Fifth Street
Sprl ng fteld, Oregon 97477
#LOCATION OF PFIOPOSED WORK;
ASSESS9RS uep: ,/2€7-*^fi rAx Lor 42€&
LOT
-
BLOCK:SUBDIVISION
PHONE:
z:,e: €)722&STATE:
.zQQ-.3/H
CITY:
ADDRESS;
OWNER:
-{ADDITION DEMOLISH OTHER
DESCRIBE WORK:
NEW- REMODEL
ELECTRICAL:
coco N
NADDRESS
ST.sTRACTOR EXPIRES , PHONECONTBACTOR'S NAME
MECHANICAL:
PLUMBING:
BANGE:
- OFFICE USE _
LAND USE:
ZONING CODE:
FLOOD PLAIN
WATER HEATEFI:
* OF UNITS:
SECONDARY HEAT:
SQUARF. FOOTAGE:
QUAD AREA:
r OF BLDGS:
OCCY GROUP:
* OF STORIES:
CONSTB. 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, lnspections requested after 7:00 a.m. wlll be made the followlng work day,
REOUIRED INSPECTIONS
Temporary Electrlc w Rough Mechanlcal - Prlor to
cover.
|Z Flnal Plumbing - When all
llu plumblng work ls complete.
Site lnspection - To be made
after excavatlon, but prlor to
settlng forms.
l-l Rough Electrlcal - Prior tou cover.
Flnal Electrlcal - When all
electrlcal work ls cgmplete.
Underslab Plumblngl Electrical /
Mechanlca! - Prlor to cover.Electrical Service - Must be
approved to obtaln permanent
electrlcal power.
w Final Mechanlcal - When all
mechanlcal work ls complete.
E Footlng - After trenches are
excavated.fl Flreplace - Prlor to faclng
malerlals and framlng lnsp
E Flnal Building - When all
requlred lnspectlons have been
approved and buildlng is
completed.Masonry - Steel locatlon, bond
beams, groutlng,Framlng - Prlor to cover.
Other
Foundatlon - After forms are
erected but prlor to concrete
placement.tl WalllCelllng lnsutatlon - Prlor to
cover.
Underground Plumbing - Prior
to fllllng trench.Drywall - Prlor to taplng.
MOBILE HOME INSPE TIONS
Underlloor Plumblng/ Mechanlca!
- Prior to lnsulatlon or decltlng.E Wood Stovo - After lnstallatlon.
Post and Beam - Prlor to floor
lnsulatlon or decklng.lnsert - After flreplace approvql
and lnstallatlon of unlt.
Blocking and Set-Up - When all
blocklng is complete.
Floor lnsulalion - Prior to
decking.Curbcut & AJrproaclr - After
forms are erected but prior to
placomont of concrete.
Plumbing Connections - When
home lras been connected to
water and sewer,
w Sanitary Sewer - Prior to fllling
trench.Electrical Connection - When
blocking, set-up, and plumbing
Inspectlons have been approved
and the home is connected to
the servlce panel.
Storm Sewer - Prior to fllllng
trench,
Sidewalk & Driveway - After
excavation ls complete, forms
and sub-base materlal in place.
Fence - When cciripleted.Waler Llne - Prlor to lilling
trench.Final - After all required
ingpectlong are approved and
porches, sklrtlng, decks, and
ventlng have been lnstalled,Rough Plumbing - Prlor to
cover,
Street Trees - When all roqulred
trees ar6 planted.w T
/:trt\ttrE At'_
# OF BDRMS:-
E
fl
E
E
tl
fl
.t ..1
rl:, 1
Lot laces
Lot sq. ftg.
Lot coverage
TopographY
Total helght
Lot lYPe
-
tnterlor
-
Corner
-
Panhandle !
-
Cul-de'sac APPROVED:
P.L.HSE GAR Acc
N
S
w
E
SO. FT. X $/SQ. FT. = VALUE
(A)
tBUILDING PER nirr
ITEM
Maln
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
Thls permit is granted on the express condition that the said
construction shall, ln all respects, conform to the Ordlnanceadopted by the City of Springfield, including the
Development Code, regulailng the construcilon and uee ofbulldlngs, and may be suspended or revoked at any ilme
upon vlolatlon of any provlslons of sald ordlnances.
Plan Check Fee: _
Date
Receipt Numbe
Date Pald:
Fleceived By:
AND BUILDING
BUILDING E, i5uRu cHEcK
PEBMIT
vhr-U
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undeveloped
properties wlthln tlre City llmlts whlch are being improved.
ITEM
Flxtures
Resldentlal Bath(s)
Sanltary Sewer
Water
Storm Sewer
Moblle Home
FEE
FT,
FT.
FT.
(c)'b
N.2_-v
PLUMBING PERMIT
J6o,7
8-t
Plumblng Permlt
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
4>
26.2
6,&
462
4*
Vent Fan
Mechanlcal Permit
lssuance
State Surcharge
Total Permlt
/4r?V,
,1
(D)
G
MECHANICAL PERMIT
Furnace
Exhaust Hood
No 2*
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certlfy that all
lnformatlon hereon is true ancl correct, and I f urther certlfy
that any and all work performed shall be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
hereln, and that NO OCCUPANCy will be made of any
structure wlthout permission of the Bulldlng Safety Divislon.
I further certify that only contractors and employees who
are ln compliance with ORS 7O1.O5S wlll be used on this
prolect.
I further agree to ensure that all requlred lnspections are
requested at the proper ilme, that each address ls readable
from the street, that the permlt card ls located at the lront
Slgnature
Date
set of plans I remaln
on the slte at I ti c
of the property, and the
on.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
--
ft
Curbcut
-
ft
Demolltlon
State Surcharge
Total Miscellaneous Perrnits (E)
ToTAL AMoUNT DUE (exctuding etectricatl ZPG-:'
(A, B, C, Q and E Comblned)
.fe
DATE PAID
AMOUNT RECEIVED
FIECEIVED BY
VALIDATION:
RECEIPT NUMBEFI
\
Plans Reviewed By
/gq.n_a*
Permit #:
Address:*-
Issued by Date
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 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 will be filed with the permit.
Fill in the appropriate blanks and initial boxes I andZ, and either box 3A or 38
m 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.
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 certiff that the information is correct and that I have read and do understand the Information
about ilities on the reverse side of this form.
C
permitof )
(TVhite copy to issuing ogency permit file,
pink copy to applicant)
Notice to
(s ignature (Date)
W
' '1
lll; 1 :i".";l! i ; i lli 1j.: ):ll:i !i ll'ji. :!l:,il t.! ,r ri .,.r ,:rl:l rrl \,i!_.:1 .
i, t'
SPFINGFIELD
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
Office: 726-3759
LOCATION OF PROPOSED WOFIK:
ASSESSOFIS MAP
LOT:
-
BLOCK:
ffi,
JoB NUMBE ^ ?6/22_
225 Fif th Street
Springf leld, Oregon 97477
TAX LOT:aalPz
SUBDIVISION:
2a
ZIP:STATE 4)ua>
PHoNE: aa'?-g7g€:
CITY;
ADDRESS:
OWNER:
NEW
-
REMODEL ADDITION DEMOLISH OTHEB
DESCRIBE WORK:
PLUMBING:
MECHANICAL: .-
EXPIRES PHONEADDRESSCONTRACTOR'S NAME
ELECTRICAL:
GENERAL:
CONST.
CONTRACTOR #
BANGF-:
r OF BDRMS:
- OFFICE USE _
LAND USE:
ZONING CODE:
r:LOOD I)LAIN
SECONDARY HEAT:
SOUARE FOOTAGE:WATER HEATER
I OF UNITS:
CONSTn. TYPE:
--
HEAT SOURCE:
QUAD AREA:
# OF BLDGS
OCCY GROUP:
* OF STORIES:
To request an lnspection, you must call 726-3769. Thls ls a24nour recordlng. All inspections requested before 7:00 a.m. will be
made the same worklng clay, lnspections requested after 7:00 a.m. wlll be macle lhe followlnq work day.
REQUIRED INSPECTIONS
l---l TemporarY Eleclric
ll
Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plumbing worl( is complete.
Site lnspection - To be made
after excavation, but Prior to
setting forms.
f :#"t: Eleclrical - Prior to W Final Electrical - When all
electrical wor|( is complete.
Underslab Plumbing/ Electrical /
Mechanical - Prior to cover.w Electrical Servlce - Must be
approved to obtain Permanent
electrlcal power.
Final Mechanical - When all
mechanical worl< ls complete.
Footlng - After trenches are
excavated.Fireplace - Prlor to faclng
materlals and framing lnsP.
F Final Building - Wherr all
required lnspectlons have been
approved and building is
complete d.Masonry - Steel locatlon, bond
beams, groutlng.w
B
Framlng - Prior to cover.
Other
Foundallon - After forms are
erected but prior to concrete
placement.
Wall/Celling lnsulation - Prlor to
cover,
Underground Plumbing - Prior
to f llllng trench.@o"*u' - Prior to taning
MOBILE I.IOME INSPE TIONS
Underf loor Plumbing/ Mechanical
- Prior to lnsulatlon or decking.Wood Stove - After lnstallation.
Post and Beam - Prior to floor
lnsulation or decking.lnsert - After flrePlace aPProval
and installation of unit.
Blocking and Set.Up - When all
blocking is cornplete.
Floor lnsulalion - Prior to
decking.Curbcut & ApPrroach - 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 f illing
trench.Electrical Connection - When
blocking, set-up, and Plumbing
lnspections have been aPProved
and the home is connected to
the service panel.
Storm Sewer - Prior to f illing
trench.
Sidewalk & DrivewaY - After
excavation is comPlete, forms
and sub-base material in Place,
Water Line - Prlor to filling
trench.
Fence - When comPleted
[:treel Trees - When all required
trees are Planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been lnstalled.Rough Plumbing - Prlor to
cover.
E
E
E
E
n
tl
E
Vr
E
E
tl
fl
tl
E
fl
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
--
Corner
-
Panhandle
-
Cul-de-sac
P.L.HSE GAR ACC
N
S
E
IS THE PROPOSED WORK iN THE
HISTORICAL DISTRICI, OR ON
THE HISTORICAL REGISTER?
-
lf yes, this application must be signedand approved by the Historical
Coordinator prior to permit issuance.
APPFIOVED:
BUILDING PERMIT
VALUE
%,"_'
(A)
?/,:b--7.4V
gd.?7
SO. FI. X $/SQ. FT,ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fec
BUILDING VALUE, PLAN CHECKAND BUILDING PERMIT
This pernrit is granteci on the cxpress condition that the saidconstruction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, inctudtng theDevelopment Code, regulating the construction and Lse ofbuildings, and may be suspended or revoked at any timeupon violation of any provisions of said ordinances.
Receipt Number:_._
Plans Reviewecl By Date
Plan Check Fee
Date Paid
Received By
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undevelopedproperties within U.re City linrits which are being improved.
ITEM
Fixtures
Residentlal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
PLUMBING PERMIT
FEE
N0
a2(c)
FI
FT.
FT.=fe
*Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fi replace Unit
Dryer Vent
MECHANICAL PERMIT
(D)
No
Mechanical Permit
lssuance
State Surcharge
Total Permlt
Fu rnace
Exhaust Hood
Vent Fan
By slgnature, I state and agree, that I have caref ully examlnedthe completed application and do hereby certify that alllnformation hereon is true ancl correct, and I f urther certlfy
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Lawsof the State of Oregon pertaining to thc work describedherein, and that NO OCCUPANCy will be made of anystructure without perrnission of the Building Safety Division.I further certify that only contractors and employees whoare in compliance with OFIS 7Ol.O55 will be used on thisproiect.
I further agree to ensure that all required inspections arerequested at the proper trme, that each address is readabre
from the street, that the permit card ls rocated at the front
Signature
Date
'/1
.im
y, and the app set of plans will
durin struction.
of the propert
on tlre site at
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk _.-- ft
Curbcut ---_ ft
Demolition
State Surcharge
Total Miscellaneous perrnits (E)
TOTAL AMOUNT DUE (excluding etectrical /4A2(A, B, C, D, and E Combtned)
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
2a/ea
" 225 FIFTE STREET
SPRTNGFTELD, oREGoN 97477
INSPECTION REQLIEST z 726-
OFPICE: 726-3759
1. LOCATION OF
LEGAI DESCRIPTION
JOB DESCRIPTION
SPRINGFIELO
l:;,1!l"Sl %[!?' ?i ?Uxl ;": :':" ;:
anproval.
ir.*i,.s LPL--
Date \L -5 \-5k
37n6$,'c,iz.xl Sigtriitlrr:.--,\-----'*". ^ - City "Job Nunber
3. COHPI..ETE FEE SCffiDUI-E BELOV
TION
,h.t
9kyt
ELECTRICAL PERHIT APPLICATION
Nev Residential-Single or
MuIti-Family per dvelling unit.
Service fncluded:Items Cost Sum
A
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dvelling
Service or Feeder
B. Services or Feeders
InstalIation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps _40L amps to 600 amps _601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect 0n1y
C
S 85.00 s^.to
/ s is.oo /a -'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. CO}ITRACTOR INSTAILATTON ONLY
Electricaf Contractor
Address
city- Phone
Supervisor License Number
Expiration D.te
Constr Contr. Number
Expiration Date
Signature of. Supervising Electrician
Ovners Name
Address
cirybPhone ,4€-eue€'
s 40.00
s s0.00
s 60.00
$100. 00
s130.00
s300.00s 40.00
Temporary Services or Feeders
Installation, Alteration or Relocation
G
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
D- Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
200 amps''or less
20L amps to 400 amps
-Over 40L to 600 amps
-Over 600 amps or 1000-volTs
-Each installation
Pump or irrigation
Sign/Outline Lighting-
Limited Energy/Res
-Limited Energy/Comm
s
s
s
se
0040
55
80
e
.00
.00
rrBrr a6ov€
1?
$ 40.00
s 40.00
s 20.00
s 36.00
igna
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAI
DATE:
' ,-2*ERECEIVED B v-
5
-rG
Permit #:
Date: /?.Vr=Issued by
{Address
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 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, exempt from 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 andZ, and either box 3,{ or 38
w 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.
3,{. 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.
W 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 notiff the office issuing this building permit of the
name of the contractor.
I hereby certify thatthe is correct thatl have read and do understand the Information
on the reverse side of this form.
(Signature of permit applicant)
(White copy to issuing agency pennit file,
pink copy to applicant)
OR
Notice to
(Date)
F.-
Inf6*mation+{tdtice to property Swner*
- -{5bqut Goqptruction Responsi bil itiest-\ t- - \-r ,.-r
Notice to P ro p e. rt,tt Aw n e r s ab o Ltt C o n s t n rc. t i o n R e s p o n s ib il iti e s:
"Qoibtractors Boarcl in accordance y;irlt ORS 701.055tby
If y'ou are acting ils y{)ur {irvli contragtor to con-ctrucl lr ncw hotne or rnzLkt ii suirririrtliirl iniplrl, jrncui- to arr cxislins }i.1lciLtre.,
)'ou cafi prevgnt marry problerns by. berng 3ware { r}. foliowrng responsibrliues and area:i of concem.
I
EMPLOYEH RESPONSIBIUTIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constnrctlng or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an "*pioy", ancl the people
you hire will be employees. As the employer, you must comply with the following: I I
Oregon's withholding tax law: As an employer,'you must withhold income taxes from emptoyee wages at the time emJrloyees
arepaid. Youwillbeliablefortheraxpaymentsevenifyoudon'tactuallywithholdthetaxfromyoi:remploi,ecs. Fcrlrorc
information, call the Oregon Dept:rof Revenue at 945-809l
Unemployment insurance tax: As an employer, you are required to pa.y a tax for unemployment insurance purposes on the
wages of all employees. For more information, callthe Oregon EmploymentDivision at the DqBrartrpegtof F,Iqrnqqsesgirrq$
at378-3524.
Workers' compensation insurance: As an employer, you are sulrject to lhe Oregon Workers' Compeniation'i,r*,. unO tj
oblain workers' comperrsation insurance fol your employees. If you fail to obtain workers' cunpqlsation inpurance*yoll rnay
besubjecttopenaitiesandwillbeliablefoiallclaimcostsifoneofyouremployeesisinjurddonthejob..Fornir;reinfctrm4tion!
call the Workers' Compensation Division at the Department of Consurner and Business Sen'icei llt 945-7888.
US.Internal&,evenue Service: As an employer, you must withhold federai income tax fromemployeesrwides. *ti* *lff Ut
liable fqd{etax payment even if you didn't actually withhold the.crx. For more information, call the Internal Revenue Service
at l-800-829-1040.
OTHER RESPONSIBILITIES ANN AREAS OF CONGERN:
Code carnplianee: As ihe pcrmit holder f*r'tlri:; pi rl3ect, you are responsihle loi resc,lving any fiiilLrre to mcet cocie rcriirirtrrrt.. nts
that may be brourght to vour attention thror.rgh inspections.
\,
Liahilitlr .and property damage insurance: Contact your insurance agent lo srce if you have adequaie insurance covdrr:ge fbr
accidentr; and omissior.ls such as falling tools, paint overspray, water damage liorl pipe punctures, fire, or work that must be
re-done.
Time to supervise emplcvees: Make sure you have sufficient timc ttr superv isc 1'our employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and firiish
trades, and to notify building officials at the appropriate times so they can perform the requited inspections.
.-JIf you halte bdditional questions, write or call the Construction Contractors Boald {PO Box l4l40.Salern, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
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