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Home My WebLink AboutPermit Plumbing 1995-08-17------------: SPRI]tGFIELE) RESIDENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 sl h, JOB NUMBEB 225 Fifth Street Springfleld, Oregon 97 477 TAX LOT SUBDIVISION: LOCATION OF PROPOSED WORK: ASSESSOFIS MAP: LOT: - BLOCK: STATE: OWNER: CITY: ADD PHONE: ZIP: ADDITION DEMOLISH OTHERNEW- REMODEL DESCRIBE WOFTK: Et Er^TOtr^Al . ADDRESS EXPIRES PHONECONTRACTOR'S NAME MECHANICAL: CONST. CONTRACTOR # GENERAL: PLUMBING RANGE: , OF BDFIMS - OFFICE USE - LAND USE:FLOOD PLAIN WATER HEATER: C OF UNITS: SECONDARY HEAT: SOUARE FOOTAGE: OUAD AREA: r OF BLDGST OCCY GROUP: * OF STORIES: CONSTR. 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 samo worklng day, lnspections requested after 7:00 a.m. wlll be made the followlng work day. REQUIRED INSPECTIONS Temporary Electrlc Rough Mechanlcal - Prlor to cover. Final Plumbing - When all plumblng work ls complete. Slte lnspectlon - To be made after excavation, but prior to setting forms. Rough Eleclrical - Prior to Final Electrical - When all electrical work is complete.cover. Underslab Plumbing/ Electrical / Mechanlcal - Prior to cover. Electrlcal Service - Must be approved to obtain permanent electrlcal power. Final Mechanical - When all mechanical work ls complete. Footlng - After trenches are excavated,Fireplace - Prlor to facing materlals and framing lnsp. Final-Building - When all required lnspectlons have been approved and building is completed.Masonry - Steel locatlon, bond beams, groutlng.Framlng - Prlor to cover. Foundallon - After forms are erected but prior to concrete placement.Wall/Celling lnsulatlon - Prlor to cover. Underground Plumbing - Prior to fllling trench.Drywall - Prlor to taplng MOBILE HOME INSPE TIONS Underlloor Plumbing/ Mechanical - Prior to lnsulatlon or decking.Wood Stovo - After lnstallatlon Post and Beam - Prior to floor lnsulation or decklng.lnsert - After flreplace approvql and lnstallatlon of unlt. Blocking and Set.Up - When all blocklng ls complete. Floor lnsulation - Prior to decking.Curbcul & Approach - After forms are erected but prior to placemcnt of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to fllling trench.Electrlcal Conneclion - When blocking, set-up, and plumbing inspections have been approved and the home ls connected to the servlce panel, rm Sewer - Prior to {illing h. Water Line - Prlor to filling trelnch. Bough Plumbing - Prior to cover. Street Tr€es - When all requlred trees are planted. Final - After all required inspections are approved and porches, skirling, decks, and ventlng have been lnstalled. ZONING CODE: fl tl E tl T E E E E E E tl I other il [-.l Sidewalk & Drlveway - After 'J excavation ls complete, forms and sub-base material in place. I---l Fence - When completed.ll tl n Lot faces Lot sq. ftg. Lot coverage Topography Total helght Lot Tyl - Interior - Corner - Panhandle - Cul-de-sac IS THE PROPOSED WORK IN THE HISTORICAL DISTFIICT, OR ON THE HISTORICAL REGISTER? - lf yes, this appllcatlon mu"i be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED P.L.HSE GAR ACC N S E Total Vilue Building Permit Fee State Surcharge Total Fee VALUE (A) X $/SQ. FT. Garage Carport BUILDING PERMIT ITEM SO. FT. Main BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinanceadopted by the City of Springfield, includlng the Development Code, regulating the construction and use ofbuildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plans Reviewed Ely Date Plan Check Fee: Date Paid Receipt Number Received By: SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ITEM Flxtures Residentlal Bath(s) Sanitary Sewer Water Storm Sewer Moblle Home PLUMBING PERMIT FEE N0 FT+I)' Plumbing Permit state surcharse lL=* ,15 Total Charge FT. FT. oo ( (.) ADDITIONAL COMMENTS Wood Stove/ lnsert/ Flreplace Unlt Dryer Vent MECHANICAL PERMTT (D) No Mechanical Permit lssuance State Surcharge Total Permlt Furnace Exhaust Hood Vent Fan By slgnature, I state and agree, that I have carefully examlned the completed application and do hereby certlfy that all lnformation hereon is true ancl correct, and I f urther cerflfy 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 pertalning to the work descrlbed hereln, and that NO OCCUPANCy will be made of any structure without perrnission of the Bullding Safety Divislon. I further certify that only contractors and employees who are ln compliance with ORS 7O1.O5S will be used on thls Proiect. I further agree to ensure that all requlred lnspections are requested at the proper Ume, that each address ls readable from the street, that the permit card ls located at the front of the property, and the approved set of Date plans will remain the site at all times duri con lon lgnature MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sldewalk _ ft Curbcut - ft Demolitlon State Surcharge Total Miscellaneous Permits (E) TTOTAL AMOUNT DUE (exctuding etectricat) (A, B, C, Q and E Comblned) VALIDATION RECEIPT NUMB DATE PAID AMOUNT RECEIVE FIECEIVED BY i---:.-.\ Permit #: Issued by: q4rs/- Address Date: Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Inw, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the fotlowing statement before a building permit can be issued. This statement is required for residentiat buildtng, 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 and2, and either box 3,{ 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 upon completion.or 3A. My gea€{d 7 qgbLL 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 certify thatthe above information is correct and thatl have read and dounderstand the Information Notice to Property Owners a Construction Responsibilities on the reverse side of this form. (Signature of permit applicant) (White copy to issuing agency permitfile, pink copy to applicant) (Date) ..--.-_-- tr roPerty Owners Intormation Notic? to :::n:H;il'' Ahrout;ruilH# ResPonsibilities ,,:,:a:,ci -' rvore: 't-r r., i,1foflrr tttitttt No{,icer',i,,:;;::i::,:,,#-##,T,::::::JI:'i:fft5?f'#i'ti""'''' rf yr:u are acring a$ yo'.lr .)u#,n cont{aclor t$ confltrl}ct a ,,ew ho*-ie ur txake a substantiai irnprovemenl ts an exls you ciul pl.eveflL many prcblems by being aware of ths tollowi1g responSibilities and afeaS Of COnCem' EMPLOYEH HESPOHSI BILITIE$: If you hire persons not r*gistered with the Construction Contract*rs Bnard tq: do labror irr constructing or assisting in the constructi*n *r improverrent of a residential structure, you will, in most instances, be rniled t* be al employer and the people you hire will be ernpl*yees, As the employer, you must comply with the folk:wing: ()regon's withholding tax !aw: As an employer, you must withhald incarne tax*s fiom empL:yee wages at the time employees are paid. You wili be liable for the tax payments even if you don't actuallv rvithhold the tax from your empk:yees. F*r more informatian, cali the {}r*gon Dept. af Revenue at 945-tt0gl . Unemployment insurance t*x: As alt emplcyer. you arr required to pay a tax i"*r *n*rnpl*vmert insurance purposes on the wagss *f all *rnployees" F*r :,cr:re information, call the Oregon Ernployment Divisi*n at the Department of Human Resources at 378-3524. Workers'compensati** Ims*ran*e: .A.s a* employer, yoll {rre subj*ct to fhe Oregr:n Workers' C*mpensation Law, and must obtain wcrkers' cnmpensation insurance l"or yor-rr employees. {f y*u f*itr to cbtain workers' compensation insurance, you may besubjecttopenaltiesandr.villbeliableforallclaimcostsifonerfyturemplnyeesisinjnredanthejob. Forrnoreinformation, call the Weirkers' Compensarion Division at the Dep*rtrnent af Consutner and Business Services at 945-7888" ;r, | .l I ' I ,,iI'U.SlnterrrallRevenue Service: As an employer, you misr witfrnold federalrincome rax from employees' wages. you will bq liableforthetaxpeymenteven ifyoudidn'tactuallywithholdthetax. Formoreinl'ormatian.callthelntemaiRevenueServicb, ar t-80CI-829-1040. OTHER RESPONSIBILITIE$ AND AREAS OF CONCEHN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremqnts that may be brought to your attention through inspections. Liability and property damage insurancs Contact your insura*ce agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise ernployeesl Make sure you hav* sufficient tirne tc superl'ise vour empl*yees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the wark of rough-in and finish trades, and to natify building officials at the appropriate tirnes so they can perfonn the required inspections. If you have addirional questions, rvrite or call the C*nstruction Cantractors Board (PO Box 1414$, Salem, OR 9?309-5052, 5fi3/378-4621). The Baard is k:cared ar 7fl0 Summer St. I.{E Suire 30O, in Salem. prop-own.pm4 lt94 \