HomeMy WebLinkAboutPermit Building 1995-03-24iESIDENTIAL
PERMIT APPLICATION
lnspectlons: 726.3769
Office: 726.3759
ELt)
JoB NuMBER ?- =- '
225 Fif th Street
Sprlngfleld, Oregon 97477
LOCATION OF PROPOSED WOFK:5<=>ASSESSORS MAP;e?2 1 TAX LOT:
LO'L BLOCK:SUBDIVISION
I
OWNEB:
ADDRESS:
CITY:
PHON E
STATE:ZIP:
NE =
?az2>a^
REMODEL ADDITION DEMOLISH OTHERNEW -?,L_
DESCRIBE WOFIK:
CONST,
CONTRACTOR .'ADDBESS EXPI R E PHON E
CONTRACTOR'S NAME
ELECTBICAL:
MECHANICA
PLUMBING:
GENERA
- OFFICE USE -
SECONDARY HEAT: _
SQUARE FOOTAGE
FLOOD PLAIN
QUAD ABEA:
, OF BLDGS
# OF BDRMS; _.-*
ZONING CODE:__
CONSTR. TYPE:
HEAT SOURCE:
# OF UNITS: _
LAND USE:
WATER HEATER:
-
RANGE:
To request an Inspecilon, you must call 726.3769. Thlsmade the safite worklng day, lnspecilons requested af
ls a 24 hour recorcllng. All lnspectlons requestccJ before 7:OO a.mter 7:00 a.m. wlll be made the followlng work day.
wlll be
REOUIRED INSPECTIONS
Temporary Electrlc Rough Mechanlcal - prlor tocover.w Flnal Plumblng * When ailplumblng worl< ls complete.
Slto lnspectlon - To be made
af ter excavailon, but prlor tosettlng (orms.
Rough Electrlcal - prlor to
cover.m Flnal Electrlcal - When allelectrlcal work is complete.
[--l Understab plumblng/ Etectrlcal/
-
Mechanlcal - prlor to cover.Electrlcal Servlce - Must beapproved to obtaln permanent
olectrlcal power.
f/] r,na Mechantcat - When ail!.- mechanical work ls complete.
Footlng - After trenches are
excavated.Flnal Building - When altrequlred lnspectlons have beenapproved and building is
completed.Masonry - Steel locatlon, boncj
beams, groutlng.
Flreplace - prlor to faclng
materlals and (ramlng lnsI
Framlng - prlor to cover.
Foundatlon - After forms are
erected but prlor to concreteplacom€nt,
[Z otnn'
Wall/Celllng lnsulatlon - prlor to
cover,
l/] Unaerground ptumbtng - priorr# to fllllng trench.Drywall - Prlor to taplng
[-l Underlloor plumblng / MechanlcalL--J - Prlor to lnsularto-n or oJJxrn[, l-_l Wood Stovo - Afrer lnstailailon
MOBILE HOME INSPECTIONS
Post and Beam - prlbr to floorlnsulation or decking,lnsorl - After flreplace approval
and lnstallatlon of unlt.
[--l Alocklng and Ser.Up - Wr]en al.J blocklng ls compleie.
Floor lnsulatlon - prlor to
deckl ng.Curbcut & Approach - After
forms are erected bUt prior toplacgmont of concrete.
Plumbing Connectlons - Whenhome has been connected towater and sewer.Sanltary Sewer - Prlor to flllingtronch. /
Storm Sewer - prlor to fllllng
trench.
Sidewalk & Drlveway - Afterexcavatlon ls completo, formsand sub-base materlal ln place.
Fence - When completed.
Electrical Connection - Whenblocklng, set.up, and plumbing
lnspections have been approved
and the home Is connected tothe servlce panel,
Water Llne - prlor to filling
tronch;
Bough Plumblng - Prlor to
cover.n Street Treos - When ail requtred
-
trees are planted.
Flnal - After all requiredlnspectlons are approved andporchos, skirilng, decks, andventlng have been lnstalled,
OCCY GROUP;
r OF STORIES:
r
E
Lot faces
Lot sq. ftg,
Lot coverage
Topography
Total helght
Lot Typt
-
lnterlor
-
Corner
_- Panhandle
-
Cul.de.sac
PL.HSE GAR ACC
N
S
E
THE HISTORICAL REGISTER?
-
lf yes, thls appllcailon must bB slgnedand approved by the Hlstorlcal
Coordinator prlor to permlt lssuance,
IS THE PROPOSED WOBK IN THE
HISTORICAL DISTFIICT, OB ON
APPROVED:
BUILDING PERMiT
VALUE
(A)
SO. FT, X $/SQ. FT.ITEM
Main
G arage
Carport
Total Value
Buildlng Permit Fee
State Surcharge
Total Fee
BUILDING VALUE, PLAN CHECKAND BUILDTNG PERMIT
Thls permlt ls granted on the express condlilon that the saldconstructlon shall, ln all respects, conform to the Ordlnanceadopted by the City of Sprlngfleld, tncludlng theDevelopment Code, regulailng the c-onstrucilon and use ofbulldlngs, and may be suspended or revoked at any ilmeupon violatlon of any provislons of sald ordlnances.
Plan Check Fee: _
Recelpt Number:__
DatePIans Revlewed By
Date Pald
Recelved By:
Systems Development Charge ls duo on all undevelopedpropertles wlthln ilre City limits which are belng lmproved.
SYSTEMS DEVELOPMENT CHARGE (SDC)
ITEM
Flx t u res
Resldential Bath(s)
Sanitary Sewer
Water
Storrn Sewer
Moblle Home
(B)
PLUMBING PERMIT
FEE
No
FT.
c>-
/a,e
FT.o 4e
FT.
Q
e?(c)
E
Plumblng Permlt
stato surcharge
Total Charge
re
ADDITIONAL COMM ENTS
Wood Stove/ lnsert/ Fireplace Unlt
Dryer Vent
/2/tr.
?a
(D)
-o,
22.2
e
0
MECHANICAL PERMIT
Mechanlcal Permlt
I ssu ance
State Surcharge
Total Permlt
Fu rn ace
Exhaust Hood
Vent Fan
By slgnature, r state and agree, that r have caref uily examrnedthe completed appllcatlon and do hereby cerilfy that alllnformatlon hereon ls lrue ancl correct, and I turther ceril(y
that any and all work performed shall be done In accordancewlth the Ordlnanccs of the Clty of Sprlngfield, and the Lawsof the state of oregon pertarnrng to tho work descrlbedhoroln, and that NO OCCUPANCy wlll be made of anystructure wlthout perrnission of the Bulldlng Safety Divlslon.I further certlfy that only contractors and employees whoare ln compllance wlth ORS 7Oj.OS5 wlll be used on thlsprolect,
I further agree to ensure that all requlred lnspecilons are
ted at the proper ilme, that each address ls readabl
he street, that the permlt card ls located at the fro
b3*+-s
reques
o
ntfrom t
of the nd the approved set of plans wlll remalnon the site mes durl onstructlon
Slgnatu
Date
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
State Surcharge
Sidewalk -....-..--- f t
Curbcut .__- ft
Demolitlon
State Surcharge
Total Mlscellaneous permlts (E)
VALIDATION:
BECEIPT NUMBER
DATE PAID
AMOUNT RECEIVEDTOTAL AMOUNT DUE (exctudtng etectrica 0 %3 3
(A, B, C, D, and'E Comblned)FIECEIVED BY
^2
ji .
/ ";*r* hZ-
Permit *: ?;fu7 3
Address
Issued
Statemert: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
follow in g statement b efore a buildin g pe rmit c an be is s ued. This statement is re quire d
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 appropriate blanks and initial boxes I and2, and either box 3,{ or 38:
w 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.
3A. My general contractor is
(Narne) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
w 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.
Ihereby the above information is correct and thatl have read and dounderstand the Information
Construction Responsibilities on the reverse side of this form.
3^J*l^95
of permit
(White copy to issuing agency pennitfile,
pink copy to applicant)
*
OR
Notice to
(Date)
Date:
Inlroiination Notice to Property Owners
About Construction Responsibilities
-Nole: 'l'his lnfonnatiutt Notutt to Property Owners abour Construction Responsibilities 'i' x,as"tlr:vr:lapet! b;t the Coiiititction Caltractt.tr.t Bourd in uccordance w,ith ORS 701.055(5).'
If you arc actir:g ils yrlui'()\&'n ccintrac{*r to cor}strucl I nt: w home or nrake a sui:stantial irnprcvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EM PLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Confractors.Boardto do laborin constructing,grassisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be aa employer and the people
you hire will be employees. As the employer, you must comply with the followipg;
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 tiable foiihe tax payments even if you don't actually withhold the tax from y'our 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 insurance purposes on the
wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resoures
at378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and nilst
obtain workers' compensation insurance for your employees. If you fail to obtain workersl compensation insurance, you,may
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformatign,
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 Internal Revenue Service
at I-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 requirements
that may be brought to your attention through inspections. , 'Y.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage ferr
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 as your own general contractor, to coordinate the workof rough-in
the required inspections.
andfinish
trades, and to notify building officials at the appropriate times so they can performt-\'-t ft-' \ ;
If you f,alsa[*it*aiqt
"(donr,
wrire or call the Consrrucrion
5Ay378-4621). The Board is located at 700 Summer St. NE Suite
prop-own.pm4
1194
in Salem.
r?' t'-:
14140, Sdldm, OR 97309-5052,
2'r? fis-
SPFlINGFIELf'
The lollowino orolecl as rubmttted has the lollowing
roning, andlbco'not require epecific land use
225 FIFTE STREET
SPRINGFTELD OREGON 974
JOB DESCRT
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
L80 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
Ci ty Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Ovners Name
DATE:
CAt PERHIT A?PLICATION
a Nr*a", ?P78/
SCMDULE BELOV
A. Nev Residential-Single or
Mul-ti-Family per dvelling unit.
Service Included:
I tems Cos t Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular Dvelling
Service or Feeder
s 8s.00
s 1s.00
s 40.00
I
INSPECf,ION REQUESTz 72
OFFICE: 726-3759
1 LOCATION OP3,
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less '/'
20L amps to 400 amps
-401 amps to 600 amps _601 arnps to,1000 amps_
0ver 1000 amps/volts _Reconnect Only
C.
D. Branch Circuits
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permi t Z;
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
-
$ go.0o
-Over 600 amps or 1000 voTts see rrBrr aEott
$ s0.00
s 60.00
s100. 00
s130.00
s300.00
s 40.00
s 3s.00
s 2.00
00
00
00
00
$2-e7-
eaaress ? |tp ?2772D7.
ci ry 57A 722m',one ;zZ - z ry
OVNER INSTALLATION
The installation is being made on E-
property I ovn vhich is not intended
for saIe, Iease or rent.
Nev, Alteration or Extension Per Panel
12-l--
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation S 40
Sign/0utline Lighting- $ aO
Limi ted Energy/Res $ 20
Limited Energy/Comm $ 36
SUBTOTAL OF ABOVE
52 State Surcharge
32 Administrative
TOTALRECETVET)
r(.
5 *O
I,EGAI DESCRIPTION/3e=a=-z%Da-?/
'l 2L -3 o rl3 l*-
611 '42,.1 3,,61L
f.tarri. tJ F r..rslt-rtt
(lr:,nirnr-rn i. t -,r $etr-'.i i ctlt: f'lan;:qmr-
?lJ5 f::i f ttr Ei'hreet
Snr j nclf i.eLr:1, LlH,, ";r'74'7-l
IJeirar f'lr" . $:'t.tt::ri
I ) l'hn qr-eenlrr:use ra j. L 1 h,rl r-rsed tnr q1r'rrwi nq comrnerci;rI
hart :i rn.l'Llrrr* cr'fi[]$.
{-\:t. ,J j r-nt:t..nc.i n itr,lr-r,-,.t j.:i fi i.-.ri,-1:l:g:+r- ri: .l n Lt*nt. ti:r- Lrr-.ti l. rJ j. rrcl per-m:i.'1:
t*:le:rnig:t.ictr-i .{:r::rr,- c (::i:lr1lrfit3r-t;:i;irl lir:rh r:lrEc:lr}ii{:lt-ti:iu,, tt:i l:t',t t..ttit"tt:i tr: t:1r-t:t'.t
hnr-tic:t,.tI'[::t.rr-ry (:r-(:[:r'i:i 1nr-,:L.t:,:cj ..:{: 94t} Sor.rth 4'.1;rd' lifrr"-j.rrq{:ii':'J.r-{"
{-lr-t:li:161 ,, I lir* qrf:lg:lrilrr::r-u:ir,} r.r:i. .1. .t l:iet rrr-r ,:iQr-:i, r:lt.i'b.utr-i:.i. gl.r'utt::1.:L.tr-*::
tierr-, 1: j. r::rr i. 1 t..i;,'r, ( (-: ) [::l i:rin[:{: j. c:irr r:-it [::ttr-rit i.\t]r':i r:; i.tl. tt..tra.l ]:t..t:i. I d i rit-i F:r-Lrrr
1::; Lr-r..tr:t:: r.tr",s.l. liirie",t.:.i. ;:.1. t- v [-:c:t:iii: "
'::i l
.,, '
'fhe pr-th1i.c uill I'JUT he pnrrrrit-ted in the Etr-lrc'tltre"
Sia.l. t::si u.ri .1..l' NUI- offrLtr i n thi s. Lrlt:i. l cl :i rrq "
<"*a.-,-r*rtT
5i. nr:: ar-r:i:J
elr"i it,*.1. .l t:t-r t:t
Rcrrir. F rlrr li a l. I ucl c:ri
[']rittamm HEi,r-h::;