HomeMy WebLinkAboutPermit Building 1994-12-20RESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726.3769
Office:726-3759
SPR
LOCATION OF PBOPOSED WORK:Qqos .? Srnt sT
//n/JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 91 4Zl
ASSESSORS MAP:-L 2_TAX LOT:
LOT
-
BLOCK:SUBDIVISION:z* aw.'iol"^{r'^z- ?k.
lnspectlon, you must call 726'3769. Thls ls a24hour recordlng. All lnspecilons requested before 7:00 a.m. wlll bete worklng day, lnspections requested after 7:00 a.m. will be made lhe followlng work day.
REQUIRED INSPECTIONS
Temporary Electrlc
To request an I
made the sam
Slte lnspectlon - To be made
after excavation, but prior tosettlng forms.
Underslab Plumblng / Electrical /
Mechanlcal - Prlor to cover.
Footlng - After trenches are
excavated.
Masonry - Steel locatlon, bond
beams, groutlng,
Foundatlon - After forms are
erected but prlor to concrete
placement.
Underground Plumblng - Prior
to fllllng trench.
Underlloor Plumblng/ Mechanlcal
- Prlor to lnsulatlon or decklng.
Post and Beam - Prlor to floor
lnsulatlon or decklng,
Floor lnsulallon - Prlor to
decklng.
Sanltary Sewer - Prior to filling
trench.
Slorm Sewer - Prlor to filllng
trench.
Water Llne - Prlor to filllng
trench.
Rough Mechanlcal - prlor to
cover.
Rough Electrlcal - prior to
cover,
Eleclrlcal Servtce - Must be
approved to obtaln permanent
electrlcal power.
ffi Flnal Ptumbing - When a['f" Olumbing work ls complete.
l-Vl flnal Elecrricat - When altW electrical work is complete.
ry
F
Flnal Mechanical - When allmechanical work ls complete.
Flnal Building - When ailrequlred Inspectlons have beenapproved and building ls
completed.
m
tr
tr
m
m
tr
m
B
[-l Flreptace - Prtor to factng
-
materlals and framlng lnsp.
W
W
W
Framlng - Prlor to cover.
Wall/Celtlng lnsulatlon - prlor to
cover.
Drywall - Prlor to taplng.
Wood Stove - After lnstallatlon.
Curbcut & Approach - After
forms are erected but prior toplacement of concrete.
Sidewalk & Drlveway - After
excavation ls complete, forms
and sub-base materlal in place.
l-l Pence - When completed
Slr€st Trees - When all required
trees are planted.
Other
MOBILE HOME INSPECTTONS
Plumbing Connecllons - When
home has been connected to
water and sewer.
Electrical Connection - When
blocking, set.up, and plumbing
lnspections have been approved
and the home ls connected to
the service panel.
Flnal - After all required
inspectlons are approved andporches, sklrting, decks, andventlng have been installed.
l-l lnsert - After flreplace approval
-
and lnstallatlon of unlt.
Blocklng and Set.Up - When altblocklng ls complete.
ztP
x
STATE:
PHONE:U.tz
7
fr.7 //' ,/OWNER:
ADDRESS:
CITY:
R Lb41 'fA?
DEMOLISH OTHER
DESCRIBE WORK:
ADDRESS EXPIRES PHONE
CONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
PLUMBING:
GENERAL:
CONST.
CONTFIACTOR #
V
tnl- OFFICE USE -
r OF BDRMS:
LAND USE:
ZONING CODE:
FLOOO PLAIN:
CONSTR. TYPEi
* OF UNITS:
SECONDARY HEAT:
SQUARE FOOTAGE:
HEAr souRce(r4/ez^tl * ^,+n
OCCY GROUP:
C OF STORIES:
QUAD AREA:
* OF BLDGS:
WATER HEATER;-RANGE:
E Rough Plumblng - Prlor to
cover.
7
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
X
"orn",.
-
Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK TN THE -
HISTOFIICAL DISTRICT, OB ON
THE HISTORICAL REGISTER?
-
lf yes, this applicatlon must be slgned
and approved by the Historlcal
Coordinator prior to permit issuance.
APPROVED:
P,L,HSE GAR ACC
N
S
E
?aea
z'/3 )
t 13'E2
IOS IT{
(A)
4bs
,(^ "P(
9.uS+32 q;s*, lS.g
X $/SO. FT. = VALUE
,{'-6;?" %:-/z t
a
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SO. FT,
Main
Garage
Carport
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 Ordlnance
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
any provisions of said ordlnances.,/zs,{r
Plans Reviewed By
Z
upon violation of
Plan Check Fee: .
Date Paid
Receipt Number:
Received By:
s DEV.FLOffiz-PMENT CHARGE (S c)SYSTEM
r-?v @ //
Systems Development Charge is due on all undeveloped
properties within tlre City limits which are being improved.
ITEM
Fix tu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
io.3--
3 5.{q
3
q
No
FT.
FT.
FT.
S-4.\,,I &P
PLUMBING PERMIT
Plumblng Permit
State Surcharge
Total Charge
5O*
(c)
FEE
soqe-
ADDITIONAL COMMENTS
\
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan N" I
Wood Stove/ lnsert / Flreplace Unit
Dryer Vent
.F-
\ o-qar
JS * 3%ql*l
(D)
G. co
i 5.se-
€r2
Mechanical Permit
lssuance
State Surcharge
Total Permit h,' AOsl-b.
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certify that all
lnformation hereon is true and correct, and I f urther cerilfy
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 pertaining to the work descrlbed
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Divislon.
I further certify that only contractors and employees who
are ln compliance with ORS 701.055 will be used on thls
Project.
I further agree to ensure that all required lnspections are
requested at the proper time, 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 will remain
*
sdu g construction.on the site at
Signature
Date
MISCELLANEOUS PERMITS
Mobile Home
Stale lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, D, and E Comblned)
&67E[-o
DATE PAID
AMOUNT RECEIVED
VALIDATION:
RECEIPT NUMBER
l'1"
\
il
/h
RECEIVED BY
-,/-|
,oBEGO,lr.OF
225 FIFTr STREET
SPRINGFIELD, oREGoN 97 477
INSPECTION REQUEST. 726-3
oFFICE: 726-3759
Authorized
1. LOCATION OF TION
I^EGAL DESCRT dD
DESCRIPTION
Permits are non-transferable and expire
if vork is not started vithin 1B0 daysof issuance or if vork is suspended for
180 days.
2... CO}ITRACTOR INSTALT,ATION ONLY
Electrical Contractor
Address
ci ty- Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
att
Ovners Name
Add ress
OVNER INSTALI.^ATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
Ovners gna ture:
DATE:
SPR'NGFIELD
BLECTRICAL PERHIT APPLICATION
Ci ty Job Nurnber
A/\
COHPLETE FEE SCMDULE BELOV
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Tncluded:
I tems Cos t
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
-Modular Dwelling
Service or Feeder
$ 8s.00
s 1s.00
$ 40.00
Services or FeedersInstallation, Alterations
or Relocation:
not require
v?€-
L-w -c(+
A
Sum
B
200 amps or
20L amps to
40L amps to
601 amps to
Over 1000
Reconnec t
less
600 amps
1000 amps
amps
0n1y
s300.
$ 40.
./voI ts
$
s
s1
ST
00
00
00
00
00
00
50
60
00
30
C. Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or less S aO
201 amps to 400 amps
-
S SS
over 401- to 600 amps
-
$ gO
Over 600 amps or 1000-voT[s see
00
00
00
fi B" a6-o-
ciw D@ yn"". Zy'/7y' 3/
Nev, Alteration or Extension Per Panel
OneCircuit (/ S35.OO K.yEach Additional
Circuit or with Service-or Feeder Permi, 4 S 2.OO _Oy
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0u tline Lighting-
Limi ted Energy/Res
-Limi ted Energy/Comm
SUBTOTAL OT ABOVE
52 State Surcharge
32 Administrative Fee
TOTAL
D. Branch Circuits
r,
$ 40.00
s 40.00
$ 20.00
$ 36.00
5
RECIiIVED BY:
Zzoa--TZT
4?7
tr
tr
Permit #:
Address:
Issued by:Date:?a
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires resi.dential constructton permit appli-
cants who 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, exemptfrom 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 3B:
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.
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 huilding permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and that I have read and dounderstand the Information
about Construction Responsibilities on the reverse side of this form.
of permit applicant)
(White copy to issuing agency perrnit file,
pink copy to applicant)
OR
Notice to
2tu9,O, 3|-ZST.
X
E-H-Fu--- (D"t")-----
Information Notice to propenty SwrrNers" Absut Constructirysr F[esp*rxs$h*i$*iem
'&.'e"is r/{,vrl$p ed lsy th*'Carcslr${tion Cr:ntr*ttrsrs l3**rd in st:r:*rdcnr:t vvitl't S#S 7#i.S55f5J.,
[f you are acting as your owrl contract*r to co*struct e nr:w horne or :nake a s*bstan{ial impr*verxel}t to ll.n existing struclure,
you e&;1 pre vent rnany problems by- being aware of the foliowing responsibilities and areas of concern.
EMPLOYER RESPONSI BILITIES:
If you hire persons not rcgistered wi|h the Construction Cgntracterrs Board to do labor in constructing or assisting in the
construction or improvenrent uf a residential strueture, you will, in mcst instances, be ruled to be ;ui ernploy*r and the people
you hire rvill be employees" As the employeq yo* must comply with the following:
{)regon's withholding tax law: As an employer, you rnust withhold income taxes frorn empioyee wages atthe time employees
are pair:l. You will be liahle for the tax payments even if you don't aetually withhold the tax fiom your employees. For more
informatior"r, cali the Oregoll Dept. of Revenue at 945-8091.
Unemployment insr:rance t*x: As an employer, you are required to pay a tax for unemployment insurance pu{poses on the
wagesofallernployees. Formoreinformation,calltheOregonEmployrnentDivisionatthe DqpartrnentofHumanResourees
at378-3524.
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, *d;*
obtain workers' eompensation insurance for your employees. If you fail to obtain workers' compensation insurance, you@
bdsubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinfomfro\q,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue 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 Intemal Revenue Service
ar l-800-829-1040.
OTHEH RESPONSIBILITIE$ AND AREAS OF GONCEHN:
Code compliance: As the permit holder for this project, you are responsibie for resolving any failure to meet code reqr
that may be brought to your attention through inspections. .:
Liability and property damage insurance; Contact your insurance agent to see if you have adequate insurance coverage t'or
accidents and omissio*s such as falling tools, paint oyerspray, water damage frorn pipe punctures, tire, or work that must be
re-done.
Time t* supervise employees: Make sure you have sufficient time t* supewise your employees.
Expertise: Make sure you have the expertise to act as your 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 havle additional questions, write or call the Construction Contractors Board (PO Box l4l40, Salem, OR 97309-5052,
543n78-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem
prop-own-pm4
1t94