HomeMy WebLinkAboutPermit Building 1992-06-15SPFII1\l IELO
RESIDENTIAL
PERMTT APPLICATION
lnspectiortr: i 26'3769
Of f ice: 726'lt;',9
LOCATIOI{ OI
JOE} NUMBER
225 Flfth Street
Springfield, Oregon 97 477
TAX LOT:
-E/@OSUBDIVISION:BLOCK:
A7o
ASSESSoF.:; i/AP: -1?22 3 /- 14
LOT: .--=,
PHONE:
ZIP: -
(
tll u-!++
OWNER: -
ADDftISS
OTHEN
DESCRIRE \^/oNK'
Ar.)l)lTl()N DtrMot,lsll -NEW --Y NEMODi:L
---
CONTRAC'IC)II'S NAME
GENERA. C'Uf,i,,J LL
t,LUMBINC:
MECI-{ANlr:.^l -- -
ELECTRICAI.
t,l ioNlEXPIRESAI)DRI':;S
7/b -_35//77^-Y-s ai*-32
CONST.
CONT
C]UAI} AI'It N
d oF []LD('i1;
OC(.;Y (;lt(rtll
, OF STOFilt :
-oF
LAND USE:
# OF TJNITS:
coNllrn. lYl'lR3"t u
\
''l ,lE
WAIER llEAlr.R: --
HEAI' SOURC[': -
ZONING CODE
RAN( il:: --
FLOOD PLAIN:
r OF BDRMS:
SECONDARY IlEAT:
SOUARE FOOIAGE:
rlt;l(lu ttl.. l.ir,rrd Wor;irrt; clay, in:rl)cctic,,rs ri;questt-'cl after 7.00.r.r1r- will l)c made ttrc followirlg work day
REOUIRED IhTSPECTIONS
Te'mJror :try Elec I rir)ll Rough Mc'clrartic:rl - Prior to
U C()Vef.
Site lnspectiotr - To be tnade
af ter r:ir:avatiorr, trut Priot to
settin0 lorlns.
Under sl :rb Plumbingl Electrical /
Mecharrical - Prior to (.:()ver.
otincl - After lrenches are
excavalod.
Masonry - Stet:l locatiorr, borrd
beams, 1;routittg.
Undcrground Pltrrrrbing - Prior
to {illirril trencll.
Uncle r lloor Plumbing/Mechanical
- Prirrr to insul.rtion or clc-ckirrg
Post :rnrl Beanr - Prlor to floor
insulalr, rn or cler;hing.
Floor lrrsulation * Prior to
deckir r,l.
Sanitary Sewer - Prior to fillirtg
trenc lr.
Slorrn Sewer - l'rior to fllling
trenr:lr.
Water Line - Prior to lilling
trencll.
Rough Electrical - Prior to
cover.
Electrical Service - Must be
aJrlrrovecl lo ol-rldin pcrrnanent
eloctrlcal l)ower.
Fir-eplace - Prior to fzrclng
materials and lraming lnsP.
raming - Prior to cover.
Wall/Ceilirrg lnsulation - Prior to
cover.
wall - Prior to taPitrg.
Wood Stove - After irrstallation.
lrrserl - After flreplace approval
anci installatiort of unit.
Curbcul & Approach - After
forms are erected but Prior to
plircemclrt oI corrcrete.
Sirlewalk & DrivewaY - After
excavation is cornplete, lorms
antl sub-base nurterlal in place.
Fence - Wherl comPleted.
Slreel Trees - When all required
trt.:es are l)lanted.
Final Plumbing - Wltctr all
plurnbing wor.li is collrl)lule.
Final Electrical - Wllc,l all
electrical worl< is cotttplete.
Final Mecharrical - Wltcn all
meclranical work is t:otltplett:.
inal Building - Wlrerr all
required inspections have bccn
approved and building is
completed. \\\
Other
MOBILE HOME INSPECTIONS
Blocking and Sel.UP - Whcrr irll
blocking is cornpletc.
Plumbing Cotrttectiotrs - Wltett
holne has been conrrected lc)
water and sewer.
Elec trical Colrrrectio n
-]
Wr,",.l
blocking, set-up, ancl pllrrrtbitt11
inspections have beert ;tlrprovucl
and the horne is connected t0
the service panel.
Final - After all required
inspections are approve(l an(l
porches, skirting, det:li:;, antl
venti ng havc. l-,een in:.;tirlled.
f1
STATE: (
3&
SRJ,\Lu
qc/
-/f-/founcltrrion - After forms are4
"ru"lur! l)ut prior to concrete
Placen lon t'
tl
Rough lrlumbirrg - Prior to
cove.r.
r
r
t_l
tl
fl
E
n
r
E
r
i_l
i-- ^Lr)t I;!oeS
Lol:r1. {t11.
[-oI r;ovct;tt;tt
I t, gro r;t aplty
FS\Lot Tyl)e
-1h-ierior
- Corncr
- Patrhancllc
Oul-clc-s:tc
Set ar; k t;
HSE
Tot;rl lrei<tlrt\
o{%
ZB,,
E
P.L.
N
.S THE I)ROPOIiED WORK IN THE
l-{rsronrcAL DlsTRlCT, OR ONr \ | hTlll: l'llSrORlcn L nEGISTrrt., -\r-l-lr
lf yt.'s, tlris ap1.llication ntt,tl;I l)r-'signed
;rrrrl :rlrgrrovc<l try thr: lllstorical
(loorrlirr;rtor ptit,r to l)crrrlil il;suancc.
APPnovEDL) t A*
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
'I his perrllit is -<;r;rrrtr-.rl <rt-t tltc {)xpreslr corrdiliotr tlrirt tlte:;aid
construction shalll, itl all resDccts, c()rlfornt lo tlle Ordinance
adoptetl by tlrr: City of Sprin<tfield, int.lttrling the
t)eveloprrrcnt Cocie, r(J(l[llatirlQ the (]()r'tstructiorr arrd trse of
buildings, and nlay be susperrded '-)r l(lvoked at any tirne
upon violation of any provisions o( said ortlirrartces.
Ptan Check Fce:-- 3G,73-
G.\6.q2.Date
L
o 7
L
I lcr;eiverl
Rt,vir:werl By
D:rte Paicl
Receipt Nurn[-lt-'t:
BUILD!NG PERMIT
II EM SO, FT. X $/SO, FT.VALUE
3zS
/3b,?W@.httu) sZC --
-Ate2:'
(A)
&
L3
Iot;rl Valtrr:
[Jtrilrlirrg []rrrtrti t Feo
[,t a l,] S(.1 I (;ll;lrgc
Tot;rl Fee
["4;tirt
(i;rr,rr;,;
L);,tt1rort
S;ystems Dcvelopmr.rt'tt Clralge is tltte on all rrncicveloped
lrroperties witl-rirr thr: City litrtits whir:h irrc bsirrl; improved.
SYSTEMS D EV ELo P * u*r,"]'
^
*"qry&
ADDITIONAL COMMENTS
is
\5s
\o;
I I El"4
l ix ll,Ies
tlr"':;iclcntial t3ath(s)
Siarrilary {lr)wer
Wirl{)r
Stclrrrr Sr..:wcr
l,4olriic Iiott:';
FEE
\-'t tr\
(c)
No
FT.
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
Woort Stove/ lnsert / Fi replace Unit
l)ry.)r Vcnt
(D)
\+\-
V(lnl Fan
lvlr:r.l r,rnir:.rl l'ct'trti t
l:;l;tt;tttce
lil;itr.l Surclt;rrge
'[otal Pertttit
MECHANICAL PERMIT
[:u I It;tce
[:x]ratrst llood
No
By signature, I state atrcl agrec, that I lrave caref ttlly examined
the completed application and do hereby cr-'r tify lhat all
information hereon is lrue arld corrcct, and I {trrllrr-'r certily
that any arrd all work perlorlnecl shall be done itr a<;cordance
with tlre Orclinances of tl-tc Ci ty of SlrrintlIieltl, ;rntl lltc [;rwl;
of the Sl:rto of ()rc-'rlott pr:t l:tirring l() llle worli rlrll;criltt-'rl
lrcrein, ;rrrrl tlral N() f)C()Llt']ANCY will t)t-' ttt;rrlc of ;rtry
:;lruclurc witltr-rttt pctttti:;siotr c,I the [.]trilrlin!l S;rf"1y l)ivision.
I turther cettily lltal orrly ct.rtltractotl;;111d 911 rlrl1'lyct-'s who
arc ln cotnpli;rnce witlt Olls 701.O55 vrill bc rr:;ccl on this
project.
I further agree to erlsure th;rt all retlttired irt:;ircr;tions are
requested at the prolrer tirne, that e:rch addresr,; i:; readable
from the street, that the permit card is locater,J at the front
of the property,;lnd tlre approved set of plan:; will rentain
ctlon.
,{k/during con:;lruthe
!gnat
Date -Q t-,b_I{
MISCELLANEOUS PERMITS
Mobilc Home
St.rlc lssuance
lltatc Surcharge
SicJr-:walk -.
-
tt
Ctrrlrcut -- ft
Do rr r<-rli t io tr
Slill,.: Sttlcllal'gc
'loI ;rl Mil;t;r,'ll;tncou:; Pr:rtrti ts (E)
VALIDATION:
FiECEIPTNUMBER(a- It)ArE Pnll)
AMOUN T [IE(;E I
TOTA L AMOUNT DUE (excluding electrical)
(l\, t], C, D, and E Comtrincd)TtF.CEIVI_I)
55
AR
\g
all
TC
lssued
R OFFICE USE ONL
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, qnd initial boxes 1 and 2, and either box 3A or 38:
Permit No:
Address:
Date ln /S
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.
My general contractor is ,
1
2
3 A
Contractor registration num
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3.8 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.
L_-L Qz
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
(;-
S gnature of mit App cant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
,*rofruroN NorcE To PR.PERT, il*.r.
ABOUT CONSTRUCTION BESPONSIBILITIES
lr\l
lf you to anare acting aS your own Colltractor to construct a new home or make
existing structure, you can prevent many problems by being aware of the foll
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
uwillbeliableforthetaxpaymentsevenifyoudon'tactuallywithholdthe
tax from your employees. For more information, call the Oregon Department of Revenue at'378-3390.
Unemployment lnsurance Tax: As an em ployer, you are required to pay a tax for unemployment insurance
For more information, call the Oregon Employment Division DHRpurposes on the wages of all employees.
a|378-3224.
Workers' Compensation lnsurance: As an employer, you are subject to the Oregon Workeis' Compensation
@keis,compensationinsuranceforyouremployees.lfyoufailtoobtainworkerS,
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 973-7434.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.
a substantial imProrement
lowi ng responsibilitles and areas
You will be liable for the tax payment even if you didn't actually withhold the
the lnternal Flevenue Service at 22'1-3960.
tax. For more information, call
OTHER RESPONSIBILITIES AND AREAS OF CONCEHN:
Code iance: As the permit holder for this project, you are responsible for resolving any failure to meet
code requrreme nts 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 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 5A3-378-4621
This nformnationi
ructiConst ResonNoticenOwAboersutto ponsibilitiesNOTEIrtyPrope
n wit oh SR 741BoardrSnaccordaceContracto .055(s)was'deve Colopedby the nstruction
1
isl ure.atotheLeg1989bypassedregon
0244J 10124189
SIDlIIN(;F!ELC)
##ff?,r#'ffi
0b
225 FIFTB STRBEf,
SPRINGFIELD, OREGON 97477
INSPECTI0N REQTESTz 726-3769
oFFICE: 726-3759
1
Permits are non-transferable expi re
if vork is not started within 180 days
of issuance or if vork is suspended for
days.
2.COI,ITRACTOR INSTALI,ATION ONLY
PERHIT APPLICATION
City Job Number
COHPIJTE PEE SCEEDULB BELOII
Slgnrtu16-tu -Single or
HuIti-Family per dvelling unit.
Service Included:Items Cost
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Modular Dvelling
Service or Feeder
$ 8s.00
$ 1s.00
$ 40.00
Sum
EIect cal Contractor
Address
Ci ty
Supervisor Li
B. Services or Feeders
Installation, Alterations or
Relocat ion:
200 amps or less
201 amps to 400 amps
-401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 amps/volts
Reconnect Only
Ph
$
$
$
$
$
$
60.
100.
130.
300.
40.
00
00
00
00
00
00
50.
r
Bxpiration Date
Constr Contr r
Expirati Date
re of Supervising Electrici
0wners Name
Addr
ci Phone
ALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners ture:
Temporary Services or Feeders
Installation, Alteration or Relocation
c
200 amps or less $ 40.00
201 amps to 400 amps _ $ 55.00
0ver 401 to 600 amps _ $ 80.00
Over 600 amps or 1000 volts see "Bil above
I
D. Branch Circuits
Nev, Alteratlon or Extension Per Panel
one ci rcui t --]- S 3s. oo =5Each Additional
Circuit or vith Service
or Feeder Permit $ 2.00
E Miscellaneous (Service/feeder
-Each installation
Pump or irrigation $
Sign/Outline Lighting_ $
Limited Energy/Res $
Limited Energy/Comm $
not included)
40.00
40. o0
20. 00
5
DATE:
RBCET PT
SUBTOTAL OF ABOVB
5Z State Surcharge
TOTAL
OREGO'U
RECEIVED BY
/oa Iu d)
a ,
I
J0ll li0 I ?-a11O
CITy 0F Sp=ntNGFiELD SYSTEMS DEVEL0PMEI{T CtlARGE
WORKSHEET
(C0HHERCIAL & RESIDENTIAL)
*bo N %q ai st.LOCATiON:
C-F eAv ra to NlDEVELOPI'IENT TYPE:LL
BUILDING SIZE:'?-b .l 2 |
i. STORI'I DRAINAGE
IMPERVIOUS SQ. FT.4s b
(See Reverse For Runoff Coefficients
?-SANIT ARY SEI.IER -CITY
3 TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
x
x
x
y..l-- G
Kip Burdick
SDC Coordinator
LOT SIZ
x 50-186 PER SQ. FT-
If Actual ImPerv- Area
. Ft.
Is Unknown)
(i"" n"r"rse ffi PFU's)
s
S
s
s
s
S
S
x s38B-61
x $388-61
x s38s.61
(See Attachment C To Deternine t'l8r}Siiilt*,
rrEMS r,2, & 3) s Dq Bjj
4
s q{1
TOTAL-CiTY SDC S Nq92
5. SANITARY SET.IER-MWMC
NO. OF PFU'S X SI3.25 PER PFU .+ SlC HW'IC AIIHIN. FEE
(Use PFU Total From Item 2 Above)
I'lt.lt'lc CREDIT IF APPLiCABLE (SEE REVERSE)
TOTAL-SDC
e3
b
TOTA SDC S %'z
NAI.IE 0R C0I'1PANY, cptpt+ Mo sKs
ADI'IiNiSTRATIVE FEES
'BASE
CHARGE (SUBToTAL ABoVE) X .0s