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Home My WebLink AboutPermit Building 1993-01-07PRIt\lcF!ELE)RCSII;NTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 JOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 2 h, LOCATION OF PROPOSED WORK:24' ASSESSORS MAP:/2 -=i4>> ?TAX LOT:2 LOT BLOCK:SUBDIVISION: PHoNE: 7 26^ <Z?>' STATE:ZIP: .O CITY: ADDRESS: OWNER: OT ER DESCRIBE NEW REMO EL-DDITION EXPIRES PHONE 7aPLUMBING: MECHANICAL: ELECTRICAL: ADDRESS I CONTRACTOR'S NAME GENERAL: CONST. CONTRACTOR # I OF BDRMS: - OFFICE USE _ ZONING CODE: FLOOD PLAIN RANGE: QUAD AREA: r OF BLDGS: SECONDARY HEAT: SQUAFIE FOOTAGE: CONSTR. TYPE: HEAT SOURCE: LAND USE: # OF UNITS OCCY GROUP: * OF STORIES: To request an lnspectlon, you must call 726-3769. Thls ls a24hour recording. All lnspections requested before 7:00 a.m. will be made the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day. REQUIRED INSPECTIONS Temporary Electric Rough Mechanicat - Prior to cover. Site lnspection - To be made after excavation, but prior to setting forms. Rough Electrical - Prior to Final Electrical - When all electrical work is complete.cover. Underslab Plumbing/ Electrical/ Mechanical - Prior to cover.Eleclrical Service - Must be approved to obtain permanent electrical power. Final Mechanical - When all mechanical work is complete. n Footlng - After trenches are excavated.W Final Building - When alt required inspections have been approved and building is completed. Fireplace - Prlor to faclng materlals and framlng lnsp.Masonry - Steel location, bond beams, grouting.l-fl Framing - Prior to cover. Foundatlon - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulatlon - Prlor to cover. Underground Plumbing - Prior to filling trench.[--l Drywall - Prior to taping MOBILE HOME INSPE TIONSUnderlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation. Post and Beam - Prior to floor insulation or decking.lnserl - After fireplace approvgl and installation of unit. [-/l Blocking and Set.Up - When ail!A blocking ls compleie. ffi Plumbing Connections - When -{s' home has been connected to water and sewer. Floor lnsulatlon - Prior to decking.Curbcut & Approach - After forms are erected but prior to placement of concrete.Sanitary Sewer - Prior to filling trench.ffi Etectrical Connection - When '-+ blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Slorm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Llne - Prlor to fllllng lrench. Fence - When completed Street Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. Rough Plumbing - Prior to cover. w 57AL> WATER HEAIER: tl E E E E E E E tl f-l Final Plumbing - When ail|J plumbing worl( is complete. tl Other - fl 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 IS THE PFIOPOSED WORK Fi .IHE.. HISTORICAL OISTRICT, OFI ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT -+his permit is granted on the express condition that the said 45nstruction 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 tlme upon violation of any provisions of said ordinances. Plans Reviewed By Dale Plan Check Fee Date Paid: Receipt Num Received By: X $/SQ. FT.VALUE@-r:-fuE z4 2*-: (A) 277b Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport /-n -r, - -6< art SYSTEMS DEVELOPMENT CHARGE (SDC)3'69#-B;m"ia,'Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home6q.*ta<6*-za FEE .", -^ (c)/<T FT. FT. FT. ,/rQ PLUMBING PERMIT Plumblng Permit State Surcharge Total Charge No ADDITIONAL COMMENTS Wood Stove/ lnsert/Fireplace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Furnace Exhaust Hood By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I f urther certify that any and all work performed shall be done in accordance with the Ordinances of the City of Sprlngfield, 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 further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permlt card ls located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Date 7-73 Signature MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) ,-25 2a O- /zfr:: TOTAL AMOUNT DUE (exctuding etectricaD / 5 ?D (A, B, C, Q and E Combined) 22// aAMOUNT RECEIVED RECEIVED BY DATE PAID VALIDATION: RECEIPT NUMBER /-r 7ffi Permit No:a?z2z>22 /y'za 4t< ?'t37;'Address: lssued by 1 2 R 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 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 is , Contractor registration numbe 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, lwill 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 lnlormation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. /-t -7s nature rm pp cant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8191 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 3 OR INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: Ihis lnficrmation Notice to Property Owners About Construction Responsibilities was developed by the eonstruction Contractors Board in accordance with ORS 701.055(5), . pa$rsed by t.he 1989 Oregon Legislature. ''If ircu are"acting as youi'6Vvn bontractor to construct a new home or make a substantial improrement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBI LITIES: 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 the time employees are paid. You will be liable for th tax from your employees. For more information, cal Unemployment lnsurance Tax: As an em ployer, 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. 'V_orkers' Compensation lngglglgg 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 more information, call the Workers' Compensation Division DIF at g7g-7414. U.S. lnternal Revenue Service: As an em ployer, 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 RESPONSIBILITIES AND AREAS OF CONCERN: -ode Com pliance: As the permit holder for this project, you are responsible for resolving any failure to meet .ode requrrem ents that may be brought to your attention through inspections. !tr!{ty and Property Dama 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 Make sure you have sufficient time to supervise your employees. Expertise; Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-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 97310-0151 Phone 5A3378-4621 must withhold income taxes from employee wages at e tax payments even if you don't actually withhold the I the Oregon Department of Revenue at 378-3390. 0244J 1At24t89 l-I i :l 7q 7 ' ',7, I I t I it,, I i\d Sr -S \n 90 (,', 1Di rl I eq ? \ rraD bd o IIf , t II I I Iiv is I ib I -rl ) t il?lF.'l,b I \ \ I JLo T q 5TRtrtrT >,.._.-;- I I I _d I ,a aa ?.25 IIII.'TII STRI|III sPruNGFIliLl), 0ltlicol{ 9747'l INSPIfGI'I0N REQUIIST ? 72-6-3 oFI'ICE: 7?.6-3751) 1. LOCATION OI' INSTALLATION LEGAL DESCRIPTION a JOB DESCRITTI Pcrnrits arc non-tralrsfcrable and cxplre lI vork is not started vlthin 180 days o( issuance or if vork ls suspentled for 180 days. 2. CO}NTACTOR INSTALINTION ONLY lilcc t rical Con t rac Ior Add r:css ci ty- l'hone Supcrvi.sor License Ndnrbcr Iixpiratiotr Date Iixoiration Datc Signaturc of Supcrvising Elcctrician Ouners Natne = PLECTRICAL PIIITHIT APPLICATION City Job Number ? COHPLIiTIT PEII SCNIiDULE DI]LOV Nev Residentlal-Single or HuItl-Family per dvelling unit. Service Incltrded: Items Cost 1000 sq.ft. or less Each addltlonal 500 sq. ft or portlon thereo f Each Hanuf 'd llome or Hodular Dr.relIing Service or Feeder $ 85.00 $ 1s.oo cl S 4o.oo Scrvlces or Feeders Installatlon, Alteratlons or Rclocatlon: E*Ai, 200 amps or less 201 anrps to 400 amps - 401 amps to 600 amPs - 601 amps to 1000 amps- Over 1000 amps/volts - Reconnect Only 200 amps or less 201 amps to 400 amPs - Over /r01 to 600 amps _ 0ver 600 amps or 1000 voltr LPR j. 't,6e 1 - I l-.l A Sum % D C D 5. ST'BTOTAL OT' ABOVB 5I State Surclrarge TOTAI, $300.00 $ 40.00 .00 .00 .00 s see rrBrr atrve s 2.00 qa,are z-* Temporary Services or Feeders InstaIIatlon, Alteration or Relocation $ 50.00 s 60.00 $100.00 $130.00 $40 $ss $80 Arld rcss City Dranch Clrcul ts Nev, Alteratlon or Extcnslon Per Panel One Cl rcul t Ilaclr Addi t ional Circui t or vi th Service or Feeder Permi t $ 35.00 - /-' OVNNR IN:;'I'ALLATION The installation is bcing made on propcrty I ovn vhich is not intended for sale, Icase or rent. Ouncrs Slgnature: fu>arhonc 7L E l'liscellaneous (Servlce/feeder not lncluded) -Each installation Plrmp or irrigation Sign/0u tline Liglr t lng- Liml ted Energy/Res s s $ s 00 00 00 00 40. 40. 20 36 oirr: RNCIiIPT ril.l('lirvlit) llY: a-c Con:;tr Corrtr. Number ' I i I I I i.; J,k