HomeMy WebLinkAboutPermit Building 1997-05-19.RESIDENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759
LOCATION OF PROPOSED WORK
Vessessons MAp;
/ Lor'
SPR ELc,
efr,
JOB NUMBER
225 Fifrh Street
Sprlngllelcl, Oregon 97477
TAX LOT:623233o Uoor
BLOCK:
-
SUBDIVISION
PHONE:
I d
STATE:
(
(ztP
7+
CITY:
ADDRESS:
OWNER;
NEW-- REMODEL ADDITION DEMOLISH OTHER
OESCBIBE WORK:
ADDRESSNAi)(t1./-
ME
EXPIRES :, PHONE
CONTRACTOR'S
PLUMBING:
GENERAL:
ri,lecHarurcat:
ELECTRICAL:
CONST.
CONTBACTOR ,i
- OFFICE USE -
LAND USE:
/ OF UNITS:
QUAD AREA;
r OF BLDGS:
SECONDARY HEAT:
SOUARE FOOTAGE:
WATER HEATER:__
OCCY GROUP:
* OF STORIES:
FLOOD })LAIN:
ZONING CODE: __
CONSTR. TYPE:
HEAT SOURCE:
To request an lnspecllon, you must callmade the same worklng day, Inspection
n femporary Etectric
726-3769. Thls ls a24 hour rccordlng, Alls requested af ter 7:00 a.m, wlll be mado
REOUIRED INSPECTTONS
Rough Mechanlcal - prlor tocover.
Rough Electricat - prior tocover,
lnspections requestec, before 7:00 a.m. wlll belhe lollowlng work day.
l--l Finat ptumbins _ When ail
-
ptumblng work ls complete.
Final Electrical - When ailelectrical work is complete.
Final Mechanical - When allmechanical worlr ls camplete,
&Flnal Building - When ailrequired lnspecilons have beenapproved and buildlng iscompteted.
Slte lnspection - To be madcafter excavation, but prior tosettlng forms.
[-l UnOerslab plumbing/ Etectricat/
-
Mechanlcal - prloi to cover,
f-l Foorlng - After trenches are
-
excavated.
Masonry - Steel locatlon, bonc.lbeams, groutlng.
Foundatlon - After forms areerected but prlor to concreteplacemont.
[-l UnOerground plumblng - prioru to flltlng trench.
l-l Underrtoor plumblng/ MechanicalPrior to lnsulailon or clecklng.
Post and Beam - prlor to floorlnsulatlon or decklng,
Eleclrical Servlce - Must beapproved to obtaln permanent
electrlcal power.
fl Flreptace - prtor to factng
-
malerlals and framlng lns{
MPraming - prlor to cover.
Floor lnsulation - prior todecklng.
Sanitary Sewer - prior to filling
trench.
Slorm Sewer - prior to filllng
trench.
Water Llne - Prlor ro filling
trench.
J-l Orywail - prtor to taptng.
l-l Wooa Stovo - Alrer tnstailatton
Curbcul & Alrproaclr - Afterforms are erected but prlor toplacemcnt of concrete,
Wall/Ceiling lnsulation _ prior tocover.
Sidewalk & Driveway - Afterexcavation ls complete, formsand sub.base materlal in place.
Fence - When completed
Plumbing Connections - Whenhome has been connected towater and sewer.
MOBILE HOME INSPE TIONS
lnserl - After flreplace approvalano lnstallatlon ol unlt.
[-_l Btocking and Ser.Up - When alt.J blocklng is cornpleie.
Electrical Connection - Whenblocking, set-up, and plumbing
lnspections have been approvedand tlte home is connected tothe servlce panel.
FInal - After all requiredinspections are approved andporches, sklrting, rlecks, andventlng have been lnstalled.
tl Rough Plumblng - prior to
cover.[--l Street Troos - When all required
-
trees are plantod.
rl
rl
I
, OF BDRMS:...-
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterlor
-
Corner
-
Panhandle
-
Cul'de'sac
IS THE PROPOSED WORK TN THE ,
HISTORICAL DISTRICT, OR ON
TIJE HISTORICAL REGISTER?
-
lf yes, thls applicatlon must be slgned
and apProved bY the Hlstorlcal
Coordinator prlor to permlt issuancer
APPROVED:
By slgnature, I gtate and agree, that I have caro,ully examlned '
tlre completed appllcatlon and do hereby certlfy that all
lnformatlon horeon ls true and rtorreot, and I lurther c€rtlly
that any and all work performed thall be done ln accordance
wlth the Ordinanccs of tho Clty ol Sprlngfleld, and the Laws
o{ the Statc ol Orcgon pertalnlng to lho work descrlbed
hereln. and that NO OCCUPANCY wlll bs made of any
structure wlthout pertnlsslon of the Bulldlng Safety Dlvlslon,
I lurther certlly that only contractors and employees who
are ln cornpllance wlth ORS 701.055 wlll be used on thls
proiect.
I further agrco to onsuro that all requlred lnspectlons are
requested at the propor tlme, that oach addreEE le readable
from the slreet, that the permlt card l8 located at the front
of the property, and the approved set ol plans wlll remaln
on the slte at all times duri cons'tructlon
Slgnr
Date
atu re
VALIDATION:
RECEIPT NUMBER ,o3/
DATE PAID
AMOUNT RECEIVED
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
ACCP.L,HSE GAR
N
S
E
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permit is granted on the express condition that the said
consiructlon shall, in all respects, conform to the Ordlnance
adopted by the City ol Springfield, includlng the
Development Code, regulating the construction and use of
bulldings, and may be suspended or revoked at any time
upon violation of arry provisions of said ordinances'
Fleceipt Number:_--
Date
Plan Check Fee:
Date Paid:
Total Value
Building Permit Fee
;,";,-;;,;" /,40 +,8y'
Total Fee (A)
BUILDING PERMIT
VALUE
klatr.944
/zev-%*-ZZf -2-(
SO. FT. X $/SQ. FT.ITEM
Maln
Garage
Carport
Systems Development Charge ls due on all undeveloped
properties withln thc City linrits which are belng improved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS II
I
ITEM
Flxtures
Residentlal Bath(s)
Sanitary Sewer
Waler
Storm Sewer
Moblle Home
FEE
(c)
N0
FT.
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
. FT.
Wood Stove/ lnsert/Flreplace Unlt
Dryer Vent
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sldewalk -_- ft
Curbcut
--
ft
Demolitlon
State Surcharge
Total Mlscellaneous Permlts (E)
(D)
NoVent Fan
Mechanical Permlt
lssuance
State Surcharge
Total Permlt
MECHANICAL PERMIT
Fu rnace
Exhaust Hood
RECEIVEO BY
L
i:
I
Received By:
OREGONC,ITY OF
SPrr-<iF IELO
225 TIFTE
SPRINGFIEI,D oREsd|$
EI,ECTRICAL PERHIT APPLICATION
City Job Number Q 7 fn n<INSPECTION
OFFICE:' 726-375
1 LOCATION
zoning, and doos not require
'al.
JOB DESCRIPTION f;:r::-3 -7
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
Electrical Contractor
Add
Ci ty
,
WOBK
\SNOI
FOR
A
3 COHPLETE FEE SCffiDtII,E BELOS
Nev Residential-Single or
Expiration Da
Cons tr r.Number
Expi ion Date
ture of Supervising Electri
Ovners Name
Address ,l f{
Ci ty Phone
OSNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Omers Signa
DATE:
er dvelling unit.
ed:
1000 sq.ft. or less
Each additional 500
or portion
thereo
Each Hanuf'd Home- or
Modular Dvelling
Sertice or Feeder
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less I
201 amps to 400 amPs
-
401 amps to 600 amPs
-
601 amps to 1000 amPs-
Over 1000 amPs/volts
-
Reconnect 0n1Y
c.
D
E
SUBTOTAL OF ABOVE
52 State Surcharge
3Z Administrative Fee
TOTAL
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less $ 40.00
over 4b1 to 6oo amps
-
$ 8o.oo
or"i OOO amps or rbOO voTts see uB* aEF
Branch Circui ts : .-
Nev, Alteration or Extension Per Panel
One Circuit $ 35.00
Each Additional-cii"uit or vith Service
or Feeder Permit
-
$ 2.00
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation _Sign/OutIine Lighting_
Limited Energy/Res
Limited Energy/Comm
$ 40.00
Supervisor Lic r
$ 50.00 i,C.i t'
s 60.00
$100.00
s130.00
s300.00
$ 40.00
sq
$ 40.00
s 40.00
$ 20.00
$ 36.00
.oo
. s_r)
RBCETVED
ture:
5 5
SHATL
Items Cost Sum
$ 8s.00
$ 1s.00
S"!-t I 7q r-ezf {
/,'5- ''rf4. n t'-
November 13,1997
City of Springfield
225 Fifth Street
Springfield, OR 97477
Job Number :970783
I am requesting an extension to my residential building permit. I will be
finishing the work this 'weekend and I won't be able to schedule an inspection
until Monday November 17th in the late aftemoon, or Tuesday November
18th. My building repair permit expires the following day. If I haven't
passed the inspection, I won't be able to work on the building again until the
following weekend.
Thank you for your consideration.
Sincerely,
,ttb"t tL
Elizabeth
$N \
\b ,fl
\D
\5bD$d-
t
q 101{3
Address o, t4 2^4 Strelf
Issued by://; Date:1T
statement: lnformation Notice to Property owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
conts who are not registered with the Construction Contractors Board to sign the
following stqtement before a buildingpermit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer appliconts, exempt from registration under ORS 70 t .010(7),
need not submit this stotement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 3,A or 38
x l. 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.
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 that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction ponsibilities on the reverse side of this form
7-3-7-
app
ftYhite copy to issuing agency permit file,
pink copy to aPPlicant)
OR
)(Signature (Date)
Permit #:
a
-\
a ',,, -- ., ,. :
Informition'Notice to Property Owners
: - ., ' AboutConstrqgtion Responsibilities
. -
1,,\trie.' Tlti.s hform1tion Nr*ige rb {ropqtl' Otr"ncrs uboul t'on:lrtrtittrr Resprtnsihilitia,t
\ \;*r\.1a1, cl,,pir{ h},the (lonstrirri# ('or?rncior.s Bourd itt,uc't:rtrelunce n'ith t)RS 1a1.055A1
!'0ttCanprev.l}ttnanyprr:blenrsb1,bgurga\Yareotthei*ilou,irrgresp9rrsibilirigsandareaso1.cQtrCgrn.
,verrrhirerri[[beqmplcl3,ees.Asthcernp}oyer.l'oui:rustcomp1yrviththefollorving':
Oregon,swithhollingtaxlarv: Asanernplo-ver..voutnustrvithholclincometaxcslionranployee\\'agesatthetirneelnplovees
are paid. you will be tiable {'or the tax pa}.rnents everl if ,rorr dr:n't;rctually r.vithhold the tax from ycur entplo,vees. For more
intirrmation"calltheOregon Dept. of Reventreat945-8091' !
Unemplo-vment insur:lnce tar: As an cmpli)-ve r. you are requirert to pay- a tax {'i:r unentplo-v*tent insttrance purposes r:ti the
wages 6f all enrployees. trjtr more infbrmation" call the Qregon l:nrployntent L)epar-ltnent.at 378-3524.,, .. i 'i , ,
Worke rs' corxpensatiErn insurance: As an e nrplover..you are subject tr: the Ore gon Wo:"f.,ei.9' Cornpensatior) l-arv, and m$31 '
c:il!'thc Workrrs' Contpunier !,,u [)ir iiirrn at thc Dephrtmcnl of Cottiunrct'entl Business Sqr vicetat 0''15-7888.
.
U.S. lnternal Revenue Seryiee: As an emplo)'er" you rnust rvitltliold lederal itlcotne tax from enrploy'ees' wages. You rvill bc .
liableforthetaxpaymenreven ifvoudidn'taciuallywithtroklthetax. Formoreintbrmatioitjeallthelt*e'rtalRer.tenu6service '
ar l-800i829-1040i,''; i'-- ----;
OTHHR RESPONSIBILITIES AND AREAS OF CONGERN:' - -'i):"::' ;
Codecornplianee; As{[ep*rmitholdertbrtitisplojcct.\r)u{}l'erespi:nsitrleforrcsolvingant'{ailuretorteetcoclcrequiretnenls
tlrat may be brought to vorrr atlentitrtt throtrgh inspections.
..,
Li*bilif-v and propert-.v- damagc insurancc: {lonti}ct y'our insrrrancc agent 1o see ify,'oir }ravJadequate insuraltce coverage for -
accidqr{q,gncl,omissions suc}r as lalling iool,s, paint o\grspra}: water datnage liom pipe punctures. fire. orrvorkthat lnust be
re-dr-rne. r
'fime to supervise emplovces: JUake srrre 3.'ou have sufficient f irne to sttpcn ise yotlr ernplo) ees.
trhdes. and to nr:ti$-. building officials at the appropriatc tirhes so they can perfcrnn the required inspections.
,it
nnd {lnish
lfyoul:ave additionalquestions.rvriteorcall theConstructior'!CorltraetorsBoarcl(P08oxl,ll40.Salem.OI{97309-5052,
503/378-.1621). The Board is located at 700 Surnnrer St. lr-E Suire 300, in S:rleni.
lrop-rrr,,r.nn,*
l/94