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Home My WebLink AboutPermit Building 1992-06-02SI'FlIN(;FIELC) RESIDENTIAL PERMIT AIJPLICATION lnspect ions: 7:'il-3769 LO()A'I ION Ot PIIOPOSL:D WOIIK: - ASSESJSOIl:J I.'] AP: - LOT: /@z- _ Site lnspection - To be rnacle af leI cx(;;ivation, tiut Prior tr,r settllr(] l()rmS. Underslrrb Plurrr[>irtg/ Electrical / Mecharrrcal - Ptiur to covcr. Footirrg.l - Aftt-'r trenches are eXCaval o{1. Masonry - Steel location, bond b()ailrS, (lroutin0. Foundation - Altcr forms are erecte(l l)ut prior to concrete placent, rnt. Underground Pltrrrrbing - I'rior to lilltrrll tretlclt. Underlloor Plurrrbing/ Mechanical - Prtot to instll.rtlorl or (jecking. Post and Beam - Prior to floor insulation or decl(i r1g. Floor lrrsulatiolr - Prior to decki nil Sanilary Sewer - Prior to fillitig trenc ll. h, JoB Nurtaaen, 225 Fif th Street Springf icld, Otegort 974 i / ?zo7ze Q^ 1t,--t,a5__4 44_zsz_ rAX Lor: --O-? 6*A BLOCK:SUBDIVISION: ---_--- To recluest art lrspection, you must call 726-3769. Tlris ls a24now recording. All inspections requested before 7:O0 a.tr.t. will lle made the sanru'working rtay, inspections requestecl after 7:00 a.m. wlll be made the following work day. REOUIRED INSPECTIONS 'l-ernpolar y Eleclric Il Rorrgh Mechanical - Prior to[J cr>v,-.r I__l Rough Electrical - Prior to[-l cover. Final Plumbin(t - Wltt:n rrll plr.rrnbing work is colnl)l{.rte. {-7 Final Eleclricirl - Wlrcn all ,.,4etec trical wot'1. is cotttlrl.te. Stornr Se wer - Pr i()r to f I I li rlg trencll. Water t.irte - l)tior to fillirlU t rt:nc lt. Electrical Service - Must be approved to obtain perrrlanent electrical power. Fireplace - Prior to facing rnaterials and f rattting lnsP. Wood Stove - After installation. lnsert - After iirePlace aPProval and installation of unit. Curbcut & Approach - After forrns are erected but Prior to placement of concrete. I __l Sidewalk & DrivewaY - Afteri-J ex<:avation is ctitttpletc, lorttts arttl sub-lt;tsc rl)atorial in placc'. [] fence - Wltctt cornPletccl Strcet Trees - Wlren all required trees are lllartted. Final Mechanical - Wlrcn all lnechanical worl< is <;otttJrlelc. nal Buildit'tg - Wltcrr ;ill quired inspr:ctiotts tt.'tv,r bet:tt approved and l;uilding is completed. Other - MOBILE HOME INSPECTIONS Blocking and Set-Up - Whctr ;ill blocking is cornplete. Plumbing Cotrtrections - Wltt:tt home has been conrtt.'<)t{)d tc) water and sewer. Electrical Connecliotr - Witttt lrlocking, set-up, an<1 lrlutttbitrLl insl)ections ltave becrt itl)l)rovr'r, and the hotnc is conlc(;l(..)(l t(' the service pirtrel. Final - Af ter all reqtrllcti inspections ate approvc(l an(l porches, skirtirrg, decl<s, and ventin0 have lrcen inst;illec!. tl Eq {ttu-tng - Prior to cover' Mwattlceilin0 lnsulation - Prior toa(rcouer. fr'r*utl - Prior lo taPirrg' fl OWNER: - ADDRESS: CITY: -.- fuce--Zs@ PHoNE: €4e ZIP: -- -STATE: klz* -as 74(ul z<7 -z?7E ADDITION DEMOLISH OTHER DESCRIBE Vv(lnK: - NEW tlEMODf:t CONTTiACI()Ii CENI..I:IAL: 1'I.UMI}IN(; MECI.IANIC:AI ELECI RICAL: NAN,II Out/u(V EXPIRF:;l'llOI\lln t)DIlir-l;S CONST. CONTRACTOR # OUAD AREA: OCCY GROUI' -._.-_ f oF sTolllEsi - - - WATER HEATfR: - - FLOOD PLAIN: ZONING CODE: -..- r OF BDRMS: SECONDARY FI EAT ,, SQUARE FOOTAGE:RANGE: _ OFFICE USE _ LAND USE: CONSTR. TYPE: HEAT SOURCE: - # OF UNITS: LJ Rough I)lumbirrg - Prior trl covcr. tl tl n fl rr t_lr tI tI tl Lot faces Lot sq. ftg. Lot coverage TopographY Total height Lot Type -- lnterior -- Corner -- Panhandle -- Cul-de-sac Setb ks P.L.HSE GAR ACC N S E IS THE PROPOSED WORK IN THE . HISTOFIICAL DISTRICT, OR ON THE HISTOFIICAL REGISTER? - lf yes, this application must be signed and approved bY the Historical Coordinator prior to permit issuancc. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is grantcd on the express conditi<;rr tlt;rt tlle sai<l construction shall, in all respects, confortn lo tlte Of(linance acloptecl by the City of Springfield, irrcltrding the Development Co<Ie, rcgltrlating the constructiotr atrcl ttse of buildinqs, and may be :;ttspcnded or revol<crl ;lt .lny tirllo upon violation of any provisions of said orclittzrtrccs. D:r tr:Plans Fleviewed By Plan Check Fee Date Paid Recei pt Number:- --- - Fleceived By: VALUE lott??74€@o<2e4c/7q) zf(A) 2. X $/SQ. FT. / ,2' Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SO. FT. Mairr Garage Carport Systems Development Charge is due on all undeveloped properties within the City limits which are beirrg itnproved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B)p/fr ADDITTONAL COMMENTS ITEM Fixtu res Flesidential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE FT. FT. (c) NO FT. PLUMBING PERM!T Plumbing Permit State Surcharge Total Charge Wood Stove/ lnsert/Fireplace Unit Dryer Vent M ECHANICAL PERMIT (D) N0 Mechanical Permit lssuance State Surcharge Total Permit Furnace Exhaust Hood Vent Fan 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 certif y that any and all work performed shall be done in accordance wlth the Ordinances of the City of Springf ield, artd lhe Laws of the State of Oregon pertaining to the work cJescribc'd herein, and that NO OCCUPANCY will be madc of any structure without permission of the Building Safcty Division. I further certify that only contractors and errtployees who are ln compliance with ORS 701.055 will be usetl on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is rcacl:rllle from the street, that the permit card ls located at the f ront of the property, and the approved set of plans will renrain -z-?zDate gnatu on the site at all times durin MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut -- tt Demolition State Surcharge Total Miscellaneous Permits (E) rOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) 2Z.E VALIDATION: RECEIPT NUMBER DATE PAID AMOUNT RECEIVED RECEIVED BY . ... 4e Za 2- 4z a?2 C., Permit No:?zo 776 Address lssued Date: R OFFICE USE ONLY 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, 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-. I will instruct my general contractor that all subcontractors who work on the struc- ture must be registered with the Construction Contractors Board. 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 aboye information is correct and that I have read and understand the lnformation Notice to Property Owners about Construction Responsibilities on the reYerse side of this form. /. Z. ?Z 2 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT qt, 1 2 3 OR C cw\,' ture m p cantt CONSTRUCTION CONTRACTORS BOARD 0244J 8191 r'lzJZ INFORIrATION NOTIGE TO PROPERTY O]TNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: . This lnfoirnation Notice to Property Owners About Construction Responsibilities was devbloped by the Construction Contractors Board in accordance with ORS 7O1.OSS(S), Bassed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBI LITIES: 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 378-33g0. Unemployment lnsurance Tax: As an em ployer, 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 at 378-3224. Workers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' CompensationLaw,andmnffipensationinsuranceforyouremployees.ltyoufailtoobtainworkers, 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 g7g-7404. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. even if you didn't actually withhold the tax. For more information, callYou will be liable for the tax payment the lnternal Revenue Service at 22'1-3960. 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 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 503-378-4621 o244J 1At24tB9 C'TY OF 1 LOCATION OF I.,BGAL DESGRIPTION/soz o S / o zGa(9 JOB DESCN,IPTION@az/ac 4e5, ,"@tr{ Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or if vork is suspended for 180 days. 2. CONTRACTOR INSTALI,ATION ONLY Electrical Contractor Address cit Phone Supervisor License Number Expiration Date constr contr. Number Expiration Date Signature of Supervising Electrician Address a city €,2n ,pho""@.J47:_227 7 s!,rrrNGl.tt:Lo ELECTRICAL PER}IIT APPLICATION Ci ty Job Number 7zo"7G COHPI..ETB PEE SCEEDULE BELOS Nev Residential-Single or HuIti-Family per dvelling unit. Service fncluded: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular DveIling Service or Feeder $ Bs.oo $ 1s.00 $ 40.00 Services or Feeders Installation, Alterations or Reloca t ion : 200 amps or less 201 amps to 400 amps -401 amps to 600 amps _ 601, amps to 1000 amps_ Over 1000 amps/vo1ts Reconnect 0nly Temporary Services or Feeders Installation, Alteration or Relocation oFPICE: 726-3759 i,':! 3. A. E Sum B $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 c 200 amps or less $ 40.00 201 amps to 4oo amps - g 55.00 over 401 to 600 amps - $ 80.00 Over 600 amps or 1000 volts see I'Brl ovners nane 4 ,rr; Z€ekdt&*x) Branch circuits aSoF -not included) 40.00 40.00 20. 00 36.00 *o ovNER rNSTALr,arroN @ 7y'C-b374 Nev, Alteration or Extension Per Panel One Circuit $ 35.00 Each Additional Circuit or vith Service or Feeder Permit $ 2.00 The installation is being made on property I or{,n which is not intendedfor sale, lease or rent. 0wners Signature: DATE: l'{iscellaneous (Service/feeder -Each installation Pump or irrigation $ Sign/Out1ine Lighting_ $ Limi ted Energy/Res S Limited Energy/Comm $ SIIBTOTAL OP AB0VE ,/21/,05Z State Surcharge TOTAL 5 RECEIVED + ( z Z 7,5 sr 5@ ila7E- o/a<