HomeMy WebLinkAboutPermit Building 1995-02-03INGFIELC,ESIDENTIAL
ERMIT APPLICATION
B
P
lnspecl
Offlce:
tlons: 726-3769
726-3759
JoB NUMBER f<Aa?a
225 Flfth Street
Sprlngfleld, Oregon 97477
ilin -a']it
ASSESSORS MAP:TAX LOT
SUBDIVISION:LOI BLOCK:
')L(olL ZIP:
(
{STATE:
PHONE:
*7zr-- ?*ct q
j <)a
CITY:
ADDRESS:
OWNER:
DESCRIBE WORK:
ADDRESS EXPIRES PHONECONTHACTOR'S NAME
GENERAL:
PLUMBlNG:
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR ''
V^)
\
- OFFICE USE -
FLOOD PLAIN:LAND USE:
ZONING CODE:
r OF BDRMS:
WATER HEATER:FIANGE:
CONSTR. TYPE:
HEAT SOURCE:SECONDARY HEAT:
SQUARE FOOTAGE:
OCCY GROUP:
* OF STORIES:
QUAD AREA:
r OF BLDGS:# OF UNITS: _
To request an lnspectlon, you must call 726'3769. Thls ls a 24 hour recordlng. All lnspecilons requested before z:oo a.m. wlll bemade the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the followlng work day.
REQUIRED INSPECTIONS
Temporary Eleclrlc Rough Mechanlcal - Prlor to
cover.l--l Flnal Ptumblng - When ailu plumblng work ls complete.
Slte lnspectlon - To be made
after excavatlon, but prlor to
settlng forms.
Masonry - Steel locatlon, bond
beams, groutlng.
Underground Plumblng - Prlor
to fllllng trench.
Underlloor Plumblng / Mechanlcal
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decklng.
Floor lnsulatlon - Prlor to
decklng.
Sanltary Sewer - Prlor to fllllng
trench.
Slorm Sewer - Prlor to lllllng
trench.
Flreplace - Prlor to faclng
materlals and framlng lnsp.
ffirrnfng - Prlor,to cover.
Rough Eleclrlcal - Prlor to
cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
olectrlcal power.
cover.
Flnal Electrlcal - \Mren all
electrlcal work ls complete.t
Flnal Mechanlcal - When all
mechanlcal work ls complete.
Buildlng - When alt
ulred lnspectlons have been
approved and bulldlng ls
completed.
Other
MOBILE HOME INSPE TIONS
Blocklng and Set.Up - Whep ail
blocklng ls complete.
Plumblng Connecllons - When
home has been connected to
water and sewer.t
Electrical Conniction - When
blocklng, set-up, and plurgblng
lnspectlons have been approved
and the home ls connected to
the servlce panel.
FInal - After all required
lnspectlons are approved andporches, sklrting, decks, andventlng have been lnstalled.
[\Z(Pounaatlon - After forms areAerected but prlor to concrete
placement.
E
E
tl
tl WaltlCelllng lnsulatlon - Prlor to
[-l Water Llne - Prlor to filllngu trench.l--l Fence - When completed.
t] 3;,:"?"
Prumbrns - Prror to 11
l--l Orywall - Prlor ro taptng.
[--l Wooa Stove - Aft6r lnsrailartoh.
l-l lnsert - After flreplace approval
-
and lnstallatlon of unlt.
Curbcut & Approach - After
forms are erected but prlor lo
placemont of concrete.
Sldewalk & Drlveway - After
excavatlon ls complete, forms
and sub-base materlal ln pldce.
Slreet Trees - When all requlred
trees are planted.
LOCATION OF PROPOSED WORK:
I
rtDl
-1R\0 \\\
I-l Underslab Plumblngl Electrlcal/lJ Mechanlcal - Prlor to cover. I I
ffiooilno - After trenches arelcexcavated.tltl
tl
tl
E
i
t t': "rjl t, '
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterior\,A corn",
-
Panhandle
-
Cul-de-sac
backs S THE PROPOSED WORK TN THE.
HISTORICAL DISTRICT, OR ON
THE HISTOFIICAL REGISTER?
-
lf yes, this applicatlon must be slgned
and approved by the Hlstorlcal
Coordinator prlor to permit lsSuance,
APPFIOVED:
E
PL.HSE GAR ACC
N
S
E
VALUE
'/.to
State Surcharge )gb
Total Fee (A)
, 1"45
8" Qq
X S/SQ. FT.
":#26. /aGalage721
Carport
Total Value
Building Permit Fee
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, ln all respects, conform to the Ordlnance
adopted by the City . of Springf ield, inctudlng the
Development Code, regulating the constructlon and USe of
buildings, and may be suspended or revoked at any tlme
upon violation of any provisions of sald ordinances.
Plan Check r"u, f ?-3 3
Plans iewed By
/-z 4,
Becelved
Date Pald:
Fleceipt Nu
SYSTEMS DEVELOPMENT CHARGE (SDC)
'(B)L--:--:
Systems Development Charge is due on all undeveloped
propertles wlthln tho City limits which are being lmproved.
t
Resldenttai Bath(s)
Sanltary Sewer
Water
Storm Sevrer
Moblle Home
FEE
N0
FT.
FT,
(c)
PLUMBING PERMIT
ITEM
Fixtu res
Plumbirrg Permlt
State. Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permlt
lssuahce
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood By slgnature, I state and agree, that I have caref ully examlned
the completed appllcailan and do hereby cerilfy that all
lnformatlon hereon is true and correct, and I f urther cerilfy
that any and all work performed shall be done in accordance
wlth the Ordlnances of the City 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 permisslon of the Bulldlng Safety Dlvislon.
I further certlfy that only contractors and employees who
are ln compllance with ORS 7O1.OS5 wlil be used on thls
proiect.
I {urther agree to ensure that all regulred lnspections are
requested at the proper tlme, 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 wlll remaln
Date
3
on the slte at all times durl constructlon.
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk _- ft
Total Miscellaneous Permits (E)
ion
State Surcharge
Curbcut
Demolit
TOTAL AMOUNT DUE (exctuding electricat)
(A, B, C, D, and E Comblned)
/b /?6
DATE PAID
AMOUNT RECEIVED
HECEIVED BY
VALIDATION:
RECEIPT NUMBER
z/^ c
/ D/ate
--_---l
FT.
A4 qT
C;ITY OF OFEGO'V
SPRT 'IELO
The.followilrg.project as submlttrd ires ihr+ lo;zorirng, and doee not requlre r,pecii,c Ianll ,:s,approval.
l-.Dk
225 FIFTE STREET
SPRINGFTEI.J, OREGON 974
INSPECTION RIQIIESTz 72
OFFICE: 726-3159
LEGAL DESCRTPTION
JOB DESCRTPTION
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if r.rork is suspended for
180 days.
2. COMRACTOR INSTALTATTON ONLY B.
Electrical Contractor C.,erd
U
ETECTRICAL PERHIT APPLICATION
Job Number
3. COHPIJTE FEE SCffiDTII..E BELOS
A. New Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dvelling
Service or Feeder
$ 8s.00
s 1s.00
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less l/'
201 amps to 400 amps
-401 amps to 600 amps _60L amps to 1000 amps_
Over 1000 amps/volts
Reconnect 0n1y
C.
D. Branch Circuits
One Circuit $ 35.00
Each Addi tiona]
Circuit or vith Service
or Feeder Permi t 2- S 2.00
Date
1 LOCATI'3
ic-r
ON OF INSTALLATION
S 5u^[
tL
Sum
4agP
-.
Address
city q,hLrl ffi lzl"fr-tl qPhone
s s0.00
s 60.00
s1oo.00
s130.00
s300.00
s 40.00,ur" rrffPl-" ".,' e Num be r
Expiration D.t"
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"or less $ 40.00
201 amps to 400 amps
-
S 55.00
over 401 to 6oo amps
-
S 80.00
0ver 600 amps or 1000 vofts see uBu aE6ie
Address
Ci ty
3/o 33
Sp14 <r1 /Phone /db 7#1
New, Alteration or Extension Per Panel
Jao--(+
E. Miscell-aneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0utline Lightit g-
Limited Energy/Res
Limi ted Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAL
2 i20
--T U
OSNER INSTATTATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Signature
I
s 40.00
s 40.00
$ 20.00
s 36.00
€4"
DATE:
RECEIVED
c
5
, C.L5b3L
45aozo
Permit #:?5 2-O
Address:3/e .r, 7 a- 57.
Issued by:Date:
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residenttal construction permit appli-
cants wlta 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, exemptfrorn 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 3A 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
before or upon completion.
3,A,. 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 notiff the office issuing this huilding permit of the
name of the contractor.
I hereby certify that the above information is correct and thatl have readand do understand the Information
about Construction Responsibilities on the reverse side of this form.
EX
Properly Owners
=$do,*-&-a'9s
(Signature of permit
(White copy to issuing agency perrnit file,
pink copy to applicant)
Notice to
(Date)
,x
W
r
fnfdimation irlotice to property Owners
.fbo$ Coq:gtlyction BesponsibiIities
., .r .\. ' Ntrfe.' 'f his lnformation Ndtkp ry Property Owners about Construction Re,sytonsiltilities
oRS 70t.1ss(5).
If vou are acting as vour own contractor to construct a new home or make a substantial improvcrnent to an existing structure,
y0ucanpreventmanyproblemsbybeingawareofthefollowingresponsibllitiesandaretrsofconcern'
EM PLOYER NESFONSI BI LITI ES:
If you hire persqns 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 insfances, be ruled to b" an
"mpioyer
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 niust withhold income taxes from employee wages at the time employees
are paid. You will be liable for the'tax payments even if you don't actually withhold the tax from your employees. For more
information, call the Oregon Dept.'of Revenue at 945-8091.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment irsurance purposes on the
wagesofallemployees. Formoreinformation,calltheOregonEmploymentDivisionattheDepartmentofHurnanRemurirs
at378-3524
.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, andrniu*
obtaln workers'compensation insurance for your employees. If you fail,to obtain workers'compensation.insurance, yorr1nay '
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinform+lbnt
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal R.evenue Service: As an employer, 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 Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requireqqlp
that may be brought to your attention through inspections. ,l"l ,
Liability and property damage insurance: 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 punctures, 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 asyour own general contractor, to coordinate the work ofrough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have aclditionai questions, wrile or call thc Conslruction Contractors Board (PO Box l414},Salem, OR 97309-5052,
543n78-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
U94
NAHE OR COMPAI'IY
LOCATION:o5.,
DEVELOPMENT TYPE:
X
X
4. SANTTARY SFI^IFR-MWMC
ATTACHMENT 81 ;B N0.7f ooz o
(
$
SUBTOTAL (ADD ITEMS 1,2. & 3)s
$
s ,'/ 7..?d
7. gc
$17.19 PER PFU + $10 MI,IMC ADMIN'FEE t /
Above)
CITY0FSPRINGFIELDI-YIIF||SDEVELoPMENICI{ARGE
t^lORKSHEET
(COMMERCIAL & RESIDENTIAL)
I
b
4
BUILDiNG SIZE z^txz^' f lt ^o'/ "'l0TSiZ
sro&Y-DryNAGt
IMPERViOUS SQ. FT.?44 'Qt x so.zog PER sQ. FT.
2. SANTTARY SFWFR-CTTY
NO. OI PFU'S
(See Reverse)
X 543.26 PER PFU
TRANSPORTATTON
"
NO OF UNITS X TRIP RATE X COST PER TRIP
x $436.19
x $436.19
x $436.i9
Ft
1
NO. OF PFU'S
(Use PFU Total From Item 2
s
5
lt^'MC CREDIT IF APPLICABLE (SEE *tut*tlo.o.-*, ,r.
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
ANMINTSTATIVF FFFS
BASE (SUBTOTAL AB,OVE) X .05
/-t z{
Ma
SDC
E
,,3o
82 . SDC
i nator
Date
TOTAI SDC
s
q 2a Lze
FIXTURE UNIT CALCUL/-ION TABLE: {umber of Ncw Fix, s X Unir Equivarent = Fixture Unirs
(NQTE: For remodels, calculate only the NET additional fixturesl
FIXTURE PE
Bathtub..
urtnKrng Founta
Floor Drain...........
lnterceptors For Gre lids/Etc......
lnterceptors For Sand Wash/Etc
Laundry Tub/Clothes
Clotheswasher - 3 Or
Mobile Home Park Trap (l Trailer)......
Beceptor For RefrigeratorryVa Station/Etc
Receptor For Commercial rryasher/Etc..
Shower, Single Stall.
Shower, Gang........
Sink: Bar, Commercial, Residential
Urinal, StallMall
Wash Basin/Lavatory, Single.
Toilet, Public lnstallation.
Toilet, Private........
Miscellaneous:tTl* roel *ar
CREDIT CALCULATION TABLE: Based on e
calculate credits separates.
for Parcelor Land Only lf Applicable
TOTAL FIXTURE UNITS
improvements occurred after annexation date in table,
x$
(Rate X Assessed Value)x$
(Rate X Assessed Value)
$
NUMBER OF
NEW FIXTURES
UNIT
EOUIVALENT
FIXTURE
UNITS
')
I
2
3
6
2
6
adlHe
1
3
2
1
2
2
1
6
4
lmprovement (if after annexation datel
CREDIT TOTAL
d value.
Year
Annexed
ry{u ,", $ 1,ooo
/Assessed Value
Year
Annexed
Bate per $1,OOO
Assessed Value
$2.46
2.14
1.77
1.37
o.97
o.61
o.44
0.15
987
1 985
1 986
1 991
1 993
1
1
$3.46
3.38
3.32
3.21
3.06
2.92
2.7319
i979 or before
1 e80
1 981
1 982
1 983
1 984