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HomeMy WebLinkAboutPermit Mechanical 1991-12-06SPRTNGFTELO 0fflce: INSPECTION LINE: mIIOOD STOVE/INSERT INSPBCTION APPTICATION CITY OF SPRINGFIELD BUILDING SAPETY DIVISION 225 ftfth Street Springfield, Oregon 97477 726-3759 726-3769 CITY OF OREQO'U Job Locatlon:3rB S 3SHr S+"4{ Assessors Hap *:I 1Of,'3lz.t Tax Lot *: 061AV t r-!p ,Ovner: Addresst 3 t s 3<f,tu Phone *: 1 L|L.r Ci ty:Statez C zip:q14)Y Value o t Stove/Inserts oo (pI ease c appropriate apPllance Preliminary Inspection is $15.00 (prior to installatlon of lnsert) lJood stoveTpettlt/rnsert permit Is-$15.00 + $.75 state surcharge + $10.00 Issuance. Type of Inspection Requested:\Je- Contractor:Ot^*,, Address. phone #: Ci ty:State:zip: Construction Contractors Registration *:ires: may be requi to removed. t) )vtq t Date FOR OFFICE USE REOUIRED INSPECTION( S) :PELLET/INSERT PRELIMINARY Date of Application:t2 v\r\ t Job *: q ob)q Total Amount Collected:-"c Receipt *:3)-Ob l,,r I By signing this permlt/appllcatlon, I agree to call for an inspection(s) as requlred <iZO-|tOgt. I siate thai-aII lnformatlon on this appllcation/permlt ls correct and inat f was provlded with the llood Stove Safety information for vood burning appliances and preliminary inspection standards. I further state that the appllance t'am tnstalling meets s,nol" emission standards as set by the 0regon Department of Environmental Quality or the Federal Environmental Protectlon Agency and I agree to provlde the testlng ipproual number to the inspector at the time of inspection. I also understand ttrit i-f I am requesttng a prellminary inspectlon, the vaII coverlng dst Checked for Dellnquencies: a Issued By: Checked for Historical Status: ;f{',,; I 1 2 Permit No Address: lssued by Date OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS701.055(4), requires residential construction permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permitcan be issued. This state- ment is required for residential building, electrical, mechanical, and plumbing permits. Licensed Architect and Engineer applicants, exempt from registration underORS 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 number-. B 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 Construction Responsibilities on the reverse side ol this form. 3 3 Rlr, Signature of Permit Applicant Date CONSTRUCTION CONTRACTORS BOARD 0244J 8191 WHITE @PY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT G 't I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. .:' ' OR /)'../ ./ ,4p. INFORTy'ATION NOTICE TO PROPERTY Ov,rrtERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnformation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.05S(S), passed by the 1989 Oregon Legislature. lf you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevenl many problems by being aware of the following responsibilities 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 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 must 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 Department of Revenue at 378-3390. Unemployment llqurance Tax: As an employer, 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 a|378-3224. Workers'Compensation lnsurance: 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, callthe Workers'Compensation Division DIF at 973-7434. 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: Code Compliance As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage lnsurance: 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 Su Em 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 503-378-4621 4244J 10124189 T Ft RESID ENTIAL PERMIT APPLICATION lnspections: 726-3769 Office: 726-3759 ?rcc;-zJOB NUMBER 225 Fifth Street Springfield, Oregon 97 477 LOCATION OF PROPOSED WORK:3 78 5 3ra ASSESSORS MAP:TAX LOT:P' qo, LOT:BLOCK:SUBDIVISION: tOWNER:PHONE ADDRESS:I I c CITY:STATE: DESCRIBE WORK: NEW- azx,iooe, /{-.ADDITION DEMOLISH OTHER CONTRACTOR ME ADDRESS CONST. CONTRACTOR #EXPI RES PHON E GENERAL: PLUMBING MECHANICAL: ELECTRICAL: _ OFFICE USE _ OUAD AREA: # OF BLDGS LAND USE:FLOOD PLAIN * OF UNITS:ZONING CODE: OCCY GROUP: * OF STORIES: CONSTR. TYPE: HEAT SOURCE: * OF BDRMS: WATER HEATER RANGE: SECONDARY HEAT: SQUARE FOOTAGE: To request an inspection, you must call 726-3769. This is a24 hour recording. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. REOUIRED INSPECTIONS l---l Temporary Electricll Rough Mechanical - Prior to cover.r-iFinal Plumbing - When all plumbing work is complete. Site lnspection - To be made after excavation, but prior to setting forms. ,EI.H*t: Etectrical - Prior to ^=. Final Electrical - When all electrical work is complete. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. 'lV1 Electrical Service - Must beAspptored to obtain permanent electrical power. Final Mechanical - When all mechanical work is complete. Footing - After trenches are excavated.Fireplace - Prior to facing materials and framing lnsp. ffi final Buitding - When allHequired inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover OtherFoundalion - After forms are erected but prior to concrete placement.Wall/Ceiling lnsulation - Prior to cover. Underground Plumbing - Prior to filling trench.p[ Orywall - Prior to taping41 MOBILE HOME INSPECTIONS Underf loor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation. Post and Beam - Prior to floor insulation or decking.lnserl - After fireplace approval and installation of unit. Blocking and Set-Up - When all blocking is complete. Floor lnsulation - Prior to decki ng.Curbcut &Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to f illing trench.Electrical Conneclion - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Waler Line - Prior to filling trench. Rough Plumbing - Prior to cover. Streel Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed.,K L /){hro(74t- <*<-/(< { i'. ztP, ?'7/ 7g E E r E E l--l Fence - When completed. Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON , O THE HISTORICAL REGISTER? YA lf yes, this application must be signed and approved by the H istorical Coordinator prior to permit issuance. APPROVED: 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 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 time violation of any provisions of said ordinances. Plans Reviewed By Date u pon PIan Check Fee Date Paid Fleceipt Number: Received By: BUILDING PERM!T ITEM SQ. FT. X $/SQ. FT. t VALUE /{,7t(A) Total Value Building Permit Fee State Surcharge Total Fee r?/uU, /5^',Zi Main Garage Carport Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT Zi ee(c) -2 N FT. FT. FT. 13 FEE Zoos Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fireplace Unit Dryer Vent (D) N0Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rn ace Exhaust Hood By signature, I state and agree, that I have caref ully 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 Springf ield, 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 permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction Signatu re Date MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) <a.7s 2a "_f 7-DATE PAID AMOUNT BECEIVED RECEIVED BY VALIDATION: RECEIPT NUMBER PL.HSE GAR ACC N S E C'TY OF SPR onEGorv S]"IIN(;F!ELE' 225 ETI"TB SIRBBf, SPRTNGETBU), OREGON 97477 INSPBCIIOII RBOtlBSf,: 726-3769 OPPICB: 726-3759 1 BI.ECTRICAL PERHIT APPI,ICATION city Job Nuuber ?toe z-l 3 COHPI,RIE TBE SCIIEDUIJ BBLOV A. Nev Residential-Single or Multi-Family per dvelllng unlt. Service Included:Items Cost 1500 sq;ft. or less Each additlonal 500 sq. ft or portlon thereof Each Manuf,d Home or -Modular Dwelling Service or Feeder $ g5.oo $ 15.00 $ 3s.oo B. Services or Feeders (10 Branch Circuits included). Installation, Alteratlons or Relocation: INSTALI.ATION'1.u LOCATION OP ? se ,7r(f I.BGAL DESCRIPTIOII Sum L Permlts are non-transferable and explrelf vork ls not started vlthln 180 daysof lssuance or lf vork ls suspended for 180 days. 2. CO}IIRACTOR INSTALI,ATION ONLT Electrlcal Contractor Address ct Phone Supervlsor License Number Exp lratlon Date Constr Contr. Number Explratlon Date Slgnature of Supervislng Blectrlcian Ovner's Name C d Address 3T ct t I C. Temporary Services or FeedersInstallatlon, Alteratlon or Relocation 100 amps or less 101 amps to 400 amps 7 401 amps to 600 amps 601 amps to 1000 amps- over 1000 amps/volts -Reconnect Only $ $ $ $ $ $ 200 amps or less $ 35.00 Over 600 amps or 1000 volts see rrBtr above 35 60 90 130 300 35 /^rtCU-t4,JJ-- 00 00 00 00 00 00 It Phone OITNER INSTALIJ\TION 7q6 ff rs* D. Branch Clrcults Nev, Alteratlon or Extenslon Per Panel One Circult Two to ten Clrcults Each Addtrl ten orportlon thereof s 1s.00 E Miscellaneous (Service/feeder not lncluded) -Each lnstallation Pump or irrigation $ 36.00 Slgn/outline Llghtlng- $ 36.00 Slgnal Clreuit or Iimited energy panel_ $ 36.00 St BToTAL OP ABOVB brt n9 5Z State Surcharge TOTAL s c 35. 50 $ $ 00 00 The installatlon is belng.made on property I onn vhlch ls not lntendedfor sale, Iease or rent. Ovners ture: DATB L-17 -r/ RBCEIPT *: / RECEIVBD 5 ?.42 6*,,o'