HomeMy WebLinkAboutPermit Building 1994-05-03SPR
RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
LOT;
2a
JOB NUMBER
225 Flfth Street
Sprlngfleld, Oregon 97 477
TAX LOT:
SUBDIVISION:
-
BLOCK:
ZIP:2STATE:CITY:
ADDRESS:
oWrueR:
NEW- BEMODEL ADDITION DEMOLISH OTHER-
DESCRIBE WORK:
ADDRESS EXPIRES PHONE
Czts /uh-
rila>.e
Dzt
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
r OF BDRMS:
- OFFICE USE -
LAND USE:
WATER HEATER:
ZONING CODE:
OUAD AREA:
r OF BLDGS:
SECONDARY HEAT:
SQUARE FOOTAGE:
OCCY GROUP:
* OF STORIES:
FLOOD PLAIN:
CONSTR. TYPE:
HEAT SOURCE:
# OF UNITS:
-
To request an lnspectlon, you must call 726-3769. Thls ls a 24 hour recordlng. All lnspectlons requested before 7;00 a.m. wlll bemade the same worklng day, lnspectlons reguested after 7:oO a.m. wlll be made the followlng work day.
REOUIRED INSPECTIONS
Temporary Electrlc \p[ Rough Mechanlcat - Prior to,4cover.
FZ.,}gtt Eteclrical - Prlor toSite lnspectlon - To be made
after excavatlon, but prlor to
setting forms.
Sanltary Sewer - Prlor to fllling
trench.
Storm Sewer - Prior to fllllng
trench.
Water Llne - Prlor to lilling
trench.
Rough Plumbing - Prior to
cover.
Vl Etectrical Service - Must be
J^{..approved to obtaln permanent
electrlcal power.
J-l ftreplace - Prlor to faclngu materlals and framlng lnsp.
ftfFramlng - Prior to cover.
;{W"tttCelllng lnsulatlon - Prlor to,.- cover.
J )dDrywall - Prlor to taplng.Lrz_}.-
Ef Wood Stove - After lnstallatlon.ta /W -5tuy2,
[1{ rlnat Plumbtng - When ail
f*plumblng work ls complete.
ffi flnat Electrlcal - When ail
.lA{-electrlcal work ls complete.
l-\]f Flnal Mechanlcat - When ailJ4mechanlcal work ls complete.
f\fl Flna! Bultdlng - When ail
Jf+Jequlred lnspectlons have been
approved and bullding is
completed.
B E
lnsert - After flreplace approval
and lnstaliatlon of unlt.
Curbcut & Approach - After
forms are erected but prior to
placoment of concrete,
Sidewalk & Driveway - After
excavation ls complete, forms
and sub-base materlal ln place.
Street Trees - When all requlred
trees are planted.
MOBILE HOME INSPECTIONS
Blocklng and Set.Up - When ail
blocklng ls complete.
Plumblng Connectlons - When
home has been connected to
water and sewer.
Electrlcal Connection - When
blocklng, set-up, and plumblng
lnspectlons have been approved
and the home ls connected to
the servlce panel,
Flnal - After all required
lnspectlons are approved and
porchos, sklrtlng, decks, and
ventlng have been lnstallect.
44aa
PHoNB 7^ 6 -9G 7,-
u<
,*,a) t,t 1H1-
RANGE:
l--l Underslab Plumblngl Etectrlcal /IJ Mechanlcal - Prior to cover.
ll Footlng - After trenches areIJ excavated.
I--l Masonry - Steel locatlon, bond|J beams, groutlng.
n Foundatlon - After forms are
'J erected but prlor to concrete
placement.
[-l Underground Ptumbing - Prlor]J to fllllng trench.
I--l Undertloor Plumblng/Mechanlcat
Prlor to lnsulatlon or decklng.
l--l Post and Beam - Prlor to flooru lnsulatlon or decklng.
n Floor lnsulallon - Prior tou decklng.
tl
tl
norher-
E
n Fence - When completed.
ii
APPROVED:
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterlor
-
Corner
-
Panhandle
-
Cul-de-sac
PL.HSE GAR ACC
N
S
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordlnance
adopted by the City of Springfield, includlng 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.
Receipt Number:-
A/,4
,V,+Pttfi RerGmtfBr-Date
7-Plan Check Fee
Date Pald:
Received By:
,- : in a.rfzza V bzrzl/,-?7
VALUE
(A)353-bs
X $/SQ. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
3s7@
/Gpf
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carporl
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) N/*
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
a
(c)
N0
FT.
Flxtures
Residentlal Bath(s)
FEE
@re
Plumblng Permlt
State Surcharge
Total Charge
PLUMBING PERMIT
ITEM
Sanitary Sewer
Waler
Storm Sewer
Moblle Home
. FT.
.'d;aE>/ tnsert / Ft reotace Untt
-
/2e'{tr
z/.fa
/{,o,
3oaDryer Vent
O-4
(D)
3
/.t -NNoz
9o {,o.2D t
Vent Fan
Mechanical Permlt
lssuance
State Surcharge
Total Permlt
MECHANICAL PERMIT
Furnace
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed application and. do hereby certlfy that all
lnformation hereon ls true and correct, and I f urther certlly
that any and all work performed shall be done in accordance
wlth the Ordinances of the Clty of Sprlngfield, 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 Divislon.
I further certify that only contractors and employees who
are ln compllance with ORS 701.055 wlll be used on thls
proJect.
I further agree to ensure that all requlred lnspectlons are
requested at the proper time, 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 remain
natu re
Date
the site at all during construction.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolltlon
State Surcharge
Total Mlscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Comblned)
7s
2Sb3
AMOUNT RECEIVED
BECEIVED BY
DATE PAID
VALIDATION:
BECEIPT NUMBER
Z-oov7*
FT,
THE PROPOSED WORK TN THE .
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcatlon must be signed
and approved by the Historlcal
Coordinator prior to permit issuance.
?r
CITY OF OBEGO'U
SPl{II\lGFIELO
225 PTFTE STRBEf,
SPRr!{GFTBID, OREGoN 97477
INSPBCTION REOTIEST
OPEICE: 726-3759
The.lollowing project
zontng, and does not require specific land use
as submitted hm the
approval.
{Zz 726-376e 5-34_Lt
BLBCTRICAL PERHIT APPLICATION
City Job Nunbe r
COHPIATB FEB SCEEDTII,B BBLOII
h
Authoriz€d Srgnature
OF INSTALTATION
I,&GAL
JOB DBSCRIPIION
Ftnc\7.v'*c fliltttx-
Permits are non-transferable and expire
lf vork is not started vlthln 180 days
of lssuance or lf nork ls suspended for
180 days.
2. COIIISACTOR INSTAIJ.ATION OI{LT
Electrical Contractor
Address
ci Phone
Supervisor Llcense Number
Expiration Date
Constr Contr. Number
Expiration Date
Stgnature of Supervlsing Electrician
t o*"r" Nw,,e Fiu,l '- i Tt>z/a
Address 44 { ,rl .Z- (r
A. Nev Residentlal-Single or
Multi-Family per dvelling unit.
Service Included:
/2643.F
rtems cost sum
1000 sq.ft. or less v- $ 85.00 3€,"
Each additional 500
sq. ft or portion
thereof _u-_ g 15.00 _/_u 4
Each Manuf'd Home or
Modular Dvelling
Servlce or Feeder $ 40.00
B. Services or Feeders
Installation, Alterations
or Relocation:
1
200 amps or
201 amps to
401 amps to
601 amps to
0ver 1000 am
Reconnect 0n
Iess
600 amps
1000 amps
,PS
1y
/volts
$ s0.00
$ 60.00
$100.00
$130.oo
$300.00
$ 40.00
y -' phone, n^ -{67?
c.Temporary Services or'Feeders
Installation, Alteration or Relocation
200 amps or less $ 40.00
over 401 to 600 amps
-
$ 80.00
over 600 amps or 1b00-v6T[s see uBn affi
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circult $ 35.00
Each Additional' Clrcuit or vlth Service
or Feeder Permit $ 2.00
B. Hiscellaneous (Servlce/feeder not included)
D.
OIINER INSTALI,ATION
The lnstallatloh ls belrig made on
property I ovn vhlch is not intended
for sale, lease or rent.
-Each installation
Pump or irrigation
Slgn/0utlinb Lightlng-
Llmited EnergY/Res
-
Limlted EnergY/Comm
Cl tY
$ 40.00
$ 40.00
$ 20.00
$ 36.00
5. STIBTOtrAL OP ABOVE
5Z'State Surcharge
TOtraL
,
RBCEIVBD
.ture:
.oO
<aow
CTTY OF
Fire & Life Safety
as sutimitted hae lhe fo llowingrequire specific land
Zonino
Tos qwov/
and
tl
DATE:
FD-] 6
sfq* 'a#1Deto
Authorized
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
Building Department
Springfield Fire Department
Structural Damage to Buildino
Address or Jocation of bui.lding N.ZL
Name of ot/ner l-)e_
Type of building D-
hg,Store , I,/a reho use, etc. )Estimated value of building 6e ,oo
tqD33tbt4
dCfl'
TO:
FROM:
SUBJECT:
(Dwel'li
$
Estimated I oss to bui.tdinq (3d,ooo
Date of fire - rL/
Location of damage jn buiiding Cr)6+B.-t looZlz-
/
Roof, l^Jal I , Exteri 0f, I nterior, etc.J
Structural weakness as a result of the fire pu F ebtz r,
(
<--
(B urned raf
Additional pertinent information
EJectrical Hazard
ters, Beams,oists, etc.
cc:5q
( r{'1r'1
S i gned
n9, 0ut'l ets, etc. )
'?r'
Permit No:
Address:
lssued by 54fr/
a
Date:
1
2
R OFFICE USE ONL
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 the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
A My general contractor tc
Contractor registration num
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.8 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 lnformation Notice to Property Owners about Gonstruction Responsibilities on the
reverse side of this form.
-f=3* 9y'
ure pp cant Date
CONSTRUCTION CONTRACTORS BOARD
0244J Bl91
3
WHITE COPY TO ISSUING AGENCY PERM]T FILE
PINK COPY TO APPLICANT
OR
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to P.roperty Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 70"10"55(5),
passed by the 1989 Oregon Legislature.
lf y6u are;acting as your own contractor to construct a new home or make a substantial imprwement to an
existing structure, you can preyent many problems by being aware of the following responsibllities and areas
of concern
EMPLOYER RESPONSIBILITIES
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction oi iriptorrer-nen,t of a iesidential structure, you will, in most instancgl, bliuled to be an
,,employer" and the peopie'you-hii6.will be "-employges". As the emplQyel, you must comply with the following:
n's Withholdin Tax Law: As an employer, you must withhol d rncome taxes from.employee wages at
the t rme em ployees are pai will be liable for the tax-paym ents even if you'don't actUally withhold the
tax from your employees. For more information, call the Oregon Departpent of Revenue al 3/8-3390.
, t- .: t ,-'a
Unemployment lnsurince ?ix: As an employer, you are required to pay'a tax for unbmployment insurance
mployeesFpr.mor.einformation,calltheoregonEmploym9ntDivisionDHR
a|378-3224.
Workers'Com nsation lnsurance: As an emPloYer;you are subject to the Oregon Workers' Compensation
w, and must obtain workers compensation insurance for yo ur employees. lf you fail to obtain workers'
compensation insurance, you may be sublect to penalties and w[tl be'liable for'all claim costs if one of your
employees is injured on the job. For more information, call the Workers ' Compensation Division DIF al 57*74?4.
U.S. lnternal Reven
You w
the lnternal Reven
orHER RESPONSIBILITIES AND AREAS OF CONF-FRN:
must withhold federal
dn't actu,ally withliold
income tqx frpm employees'wages.
the tax. For more information, call
Ccde Oorndiance: As.the permit holder for this prqect, you,are responsible for resolving any fetilure to meet
code requirements that,may be brodght to your,attention through inspections.'
LiabiIitf and Property Damago'lnsurance. corndot lour ihsuranc'e'a$entff see if you have adequate insurance
coverage tor aCcidents and omissions such as falling tools, paint overspf-ay,,ii8fer damage frorn pipe punc-
tures, fire, or work that must be re-done
Tirne to Supervise Employees Make sure you have sufficient time to supervise youi,employees'
Expertise: tvlake sure you have the expertise to act as your own general contractor, to coordinate the work
of rougfr-in 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, OR 9/310-0151
Phone 503-9784621
o24N 10t24189
UKE OSWEGO CUIMS OFflCE
PHONE: 1-800-473-5972
IVIUTL { L oF
ENUIVICLAlyy
Our Insured
PoIicy #
Claim *
D/toss
ENUI =LAWL'FE rls. co.
P.O. BOX 178e
IAKE OSWEGO, OREGON 97035
April 29, 1994
Rodney & Carol Temple
445 N. 25thSpringfield, oregon 97477
RE : Rodney & Carol TemPle
: HO?0253263: 01940000I080| 4/L3/94
Dear Mr. & Mrs. TemPIe:
lle are pleased to enclosed an advance payment under the
DweIling .or"i"g" portion of your policy, in the amount of
$2S,OOO:OO, payaftE to both yourself 1nd the Iien holders,
Glen and Nancy Briscoe. Per our 4/28/94 conversation, our
ii""f DweIIinb coverage payment will include not only the
Briscoe's but also tht oregon Department of veteran's
Affairs, to protect their lien holders interest.
AIso enclosed with this corresPondence please find a copy of
the spectra systems' estimate of repairs totalling
g89,598.67. it"t final amount was corrected to $89,107'41'
jte understand [iiit iou already have a.coPy of the Ehler's
estimate of repairs in the amount of $86'370'99'
per our discussions, we understand that you 1r9- going to act
as your own sub-contractor in connection with these repairs '
AccordinglY,o"'adjustmentisbaseduponthenetrepair
estimate, pri"i-t" irofit and overhead of the contractor'
For the p,.rpoJl;i iti".a:'""t*""i, we have used the Ehler's
estimate of r"p"it",-*itft i net toi'al amount of g7L'380'98'
We have made three adjustmenis to that estimate of repairs'
The first .ai""l*.n[ Invot;;;-removal of the mask and paint
costs of repair, totalling 5es6.60. we also adjusted the
square footag! ioi-the uoitiw.st bedroom, relative to drvwall
expense, r""ritiig i"-""ott;;-;ejustment reduetion of s71'40'
Wedidaddtotheestimatethetotalnetcostoftwoblade
f an electricat -ii*irr"" at_ .'-""t total of i275,78 ' The
original estimai-""i""i"a"a Ega ' eg f or resul ar I ight f ixtures '
Finally, tne lemolition .rra-f,i,rii"g-estifrate in the EhIer's
bid of $5,284:;;-;;;;;;"a Io'u" ;;!remelv excessive' ]re
reduced rhat .*""rrt- ti Ss , iio]60;'-ieaving 53 ' O 34 '25 f or
demolition and wreckaEe hauling'
The net adjusted total estimate of repairg is $6?,776.37,
Page 2
We have now issued $25,000.00 in advance towards thatDwelling Loss. The net Dwelling coverage balance wiII be$42,776.3?. We anticipate Home Office authority within thenext week to ten days, and the balance of the Dwelling Losswill be issued at that time.
[Ie understand that you are continuing work on the contentsrnventory information. PIease also submit your AdditionalLiving Expense invoices at the same time you submit thisContents information.
Should you have any questions during the adjustment of thecIaim, please do not hesitate to contact my office.
Very truly yours,
MUTUAL OF ENUMELAW
D9{/md
Del [{ill ams
Claims Representative
cc:AII Occasion Ins. Agency
340 A StreetSpringfield, Oregon 97 477-7LL2