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Home My WebLink AboutPermit Building 1993-6-28 ....., ...-.- l . RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Olfice: 726<1759 SPRINGFIELD LOC/,nON OF PROPOSED WORK: 4/o/'~ p.##~~/~~ ASSESSORS MAp. J 7-L::>?' -:z? - ~'7' LOT: . BLOCK: . JOB NUMBER ~"3'c:7~.?2 225 Fifth Street Springfield, Oregon 97477 ~T~ TAX LOc ~e:;-~~ SUBDIViSION: PHONE: 71/~-~~"7't!!r t?-7~.!rYS"rx 77/ ZIp. ~7~?? OWNER _ -//~--L ~I!!:>~V ADDRESS.. '~~- CITY ~~~Z? ,i or L;'- DEScFllBE WORK ,,4'?Z': ~~,............ _ ~ 7~2rt~/""?/ NEW __. REMODEL ADDITION X DEMOLISH OTHER_ STATF. ~;<. .11r p- \,\~ CONST ~ CONTRACTO'A7 NAMs,_ ADDRESS CONTRACTOR . ~rJ.RA PHONE ~::~~::'~~:~"'7 TC'7 c~...~,..yJj'}~IIn-{~", l oCCfXn 4.u.'1~ 3'14-\3~ MECHANICA,~~\N:\ q/ 4~O(1 L0 5 'tV1: L rrlY2s0 (A~lq.3 :~-.q...2-18( ELECTRICAL' ~l l t.)(\ Q ~ ~ cJq\.~ JY/(JY)I?t/!-rf- JY\-2ll0 \a.\ Dqs1RS1Ylt2. OUAD ARE,\-!}R--rV LJ . ,OF ~LDCS. _:g_~ _ .,..... . '; OCCI GROUp. . . .\ '. . OF STORIES: WATER HEATER: - OFFICE USE - LAND USE: _Ill 1 . OF UNITS: _ \ \ ,lON'sm. TYPE:.Y N ,. .-';~EAT SOURCE: E.~ .#?- RANGF. FLOOD PLAIN: U W' ZONING CODE: _ . OF BDRMS. SECONDARY HEAT: SOUARE FOOTAGE: J.!J..() To request ,In inspection, you must call 726.3769. This is a 24 hour recording. All inspections requested before 7:00 a.m. will be rnade the S:lrne working day, InspeG~ions requested after 7:00 a,m. wilt b( made the following work day, o Tcmporary Electric o Site Inspection - To be made aftl.,:r 2xcavation, but prior to setting forms. [] Underslnb Plumbin!)1 Electricall Mechnnical - Prior to cover. ~ Footing - After trcnctll.!s arc ~ 2xcavatcd. o Masonry - Steel location, bond beams, ~Jrouting. ~Foundation - After forms are ~ crcckej but prior to concrete placcrTH.:nl. o UJHlerground Plumbing - Prior to filling trench. 1V'1 Undcrtloor Plumbin~cchanica..D ~ _ Prior to insulation OrUE:!Chlny. rv1 Post and BC<lm - Prior to floor ~nsul;llion or decldng. "tVf Floo~ Insulation - Prior to ~~ccklng. [] Sanilary ~ewcr - Prior to filling tfl~ncll. o Storm Scwer - Prior to filling trcncil. D Walcr Line - Prior to filling trrmcn. o Rough Plumbing - Prior to cover. REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. 'tV1 Rough Electrical - Prior tq ~ Gover. ,..:,~~. o Electrical Service - Must be a.pproved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. fC7'f Framing - Prior to' cover. ~ ...,J....."., .--i..... :_ ~all/Ceiling Insulatio~ - Prior to ~ cover. ')....- , . ", ~ Drywall - Prior .!~ ta.~~g. o Wood Stove - After installation. o Insert - After fireplace approvi11 and in'Jtallaticn of unit. - ., [0] Curbcut & Approach - .A.ft~r forms are crected but prior to placement of concrete. o Sidewalk & Driveway -- After I~xcavation is complete, forms 3f"'ld sub.base material in place. o Fence - When completed. f ! Street Troo~ - \^{lwrJ D!I required trees ~re planted. .. . ',,\ o Final Plumbing - When all plumbing work is complete. r\71 Final ElectrlcDI - When all ~electrica' work is complete. r\71 Final Mechanical - When all ~ mechanical work is complete. ,rvfFinal Building - When all ~ required inspections have been approved and building is completed. o Other. ,-, ..~ ".J :'.\.\\ MOBILE HOME INSPECTIONS o Blocking and Set.Up - When all - blocking is complete. o Plumbing Connections - When home has been connected to water and sewer. r 1 Electrical Connection - When blocking, sel-up, and plumbing inspections have been approved and the home is connected to the servic.e panel. [J Final - After all requ!red inspeC':tions are approved and porches, skirting, decks, and venting have been installed. . ~HE PROPOSED WORK :N ~~E - Lot faces Lot Type Setbacks I PL , , , ACC I .'. HISTORICAL DISTRICT. OR ON Lot sq. flg. Interior HSE GAR IN I THE HISTORICAL REGISTEn? Lot coverage Corner If yes, this application must be signed Is I and approved by the Historical Topography Panhandle Iw I Coordinator prior to permit issuance. Tolal height Cul.de-sac IE I APPROVED: BUILDING PERMIT ITEM SO. FT. X $/SO. FT. VALUE Main Garage Carport /~f' .!?PD ~.26 h7ff Total Value Building Permit Fee ~2:S"'O State Surcharge ,~!3 Total Fee (A) .lh.'), u.3 SYSTEMS DEVELOPMENT CHAR9E ~S~) (8) lJ(:I PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) N' Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home / Plumbing Permit State Surcharge Total Charge (C). / MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' >' Wood Stovellnsert/Flreplace Unit '. Dryer Vent .t::x7l?VA 7JucTtaDt( /C- ft1/AJ -/S{rO JO.tPt::' ,7S- 7.&;7' Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It Curbcut II Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (axcludlng electrical) (A, 8. C, D. and E Combined) 9/.3~ '. BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that tile said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield. including the Development Code, regulating the con!>truction and use 01 buildings, and may be suspended or rcvoked at any time upon violation of any provisions of said ordinances. Plnn Check Fee: ~~,-~5 5"/~9 ':? ~_c;-~ Datc Paid: Receipt Number: _ ~ (g -"!,;r" /0%..1- Systems Development Charge is due On all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS ?~/ I .c.etl~ e~~_~7 /5 ~.tIU~ _ By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all in(ormatlon hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinanct:s of the City of Springfield, and the Laws of the State of Oregon pertaining to the work described herein, and .thal NO OCCUPANCY will be made of any structure without permission of the Building Safely Division. I further ce~!ily that only contractors and emproyee~ \vho are In com'priance with QRS 701.055 will be used on this project. I further agree to enSUlC that all required inspcction~ are roquested at the proper lime, 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 ~tll times dura-CO ~ignature J ~ ( ~ / \.. . Date:' r VALIDATION: fJ /1/ _ c:::::.. RECEIPT NU~ER _ ~((..~ DATE PAID U? 6:F) -Lf~ AMOUNT RE~IV~ ~/, l~ RECEIVEDC'?)//)Q ) \.. ./.- J . . . " .' .,' " Permit No:. q?{f'i flJ R .' Address: 4$4(~Orl . Issued b~/ffi -,-) DatE;!: (p.ff?>f!<. , . Fo.R o.FFICE USE o.NLY STATEMENT: INFo.RMATIONNOTICE TO PROPERTY OWNERS 'ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS701:055(4) , requires residential cgnstruction 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 QRS 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 3B: r~ /]' . 1: '-I I own, reside in, or will reside in the completed structure... , 2. I I 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.I\.uIMY g. eneral contractori:fu. '<T1Jv;\J..~~ / ' . - l ,.,..,AN . \ \ Contractor registration numbe d Q"f J () ,. , '. I will instruct my general contractor that all subcontractors who work on the struc- ture must be regisiered with the Construction Contractors Board. . OR 3. B.I I I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. If I change my mind and do hire a general contractor, I will ., contract with a contractor who is registered with the Construction.Contractors Board arid 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 Information Notice to Property Owners about. Construction Responsibilities on the reverse side of this form. . 'a~ rOOf"" 0 ~II ,pp;,.. Co.NSTRUCTlo.N Co.NTRACTORS Bo.ARD 0244J 8/91 - . , '. . ~'rLgk ~ ,. Da,e "'", ,,' '. WHITE COPY TO. ISSUING AGENCY PERMIT"FILE PINK CO.PY TO. APPLICANT' .' :. .. INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES w_" .. ~ . .. " , NOTE: . _. .l:his InforlT!ation Notice to Property Owners About Construction' Responsibiliti~s. was developed by the Construction Contractors Board in accordance with ORS 701.055(5),. _ . passe.cL by 11:)9. 1989.0r.e99n Legislature. ' .. t". " II you are acting as your own .contractor to construct a new home or make a substantial improvement to an existing struclure, you can pr.event many problems bybeing aware of the following responsibilities and areas of concern. . '... . _ . '.' . . EMPLOYER RESPONSIBILITIES: " . , If you hire persons not registered with the Construction Contractor!! ~oard. tQ do labor in constructing or assisting in the construction or improvement of a residential structi:fre, you 'will; in most instances, be ruled to be an "employer" and the peoplll you hire will be "employees;'. As ,the employe'r.yo~ must.comply with the following: . , , . "'. . . . . . - - - ,:. .. . .p Oregon's Withholding Tax Law: As anemplpyer, you.mu~t withhold income taxes from employee wages at the time employees a,re 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 ~evenue ~t 378-3390. 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 intormation, <;all the Oregon Employment Division pHR at 378-3224. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance. for your employees. It you fall to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim co~ts if one of your employees is injured on the job. For more inforlT!ation, call the Workers.'. Compensation Division'DIF at 373-7434. , , ' . . l_. _ . 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 'evenif you didn'Cactualiy withhold the tax. For more information, call the Internal Revenue Service at 221-3960. . OTHER RESPONSIBILITIES AND AREAS OF CONCERN: . . . Code Compliance: As the permit holder forJhisproject, you are responsible for. resolving any failure to meet code requirements that may be brought.to your,attention through..inspections. ", . ',' Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequ!ite 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 Ihe 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. . '. . . . If you have additional questions, write to: Construction Contractors Board 700 Summer. SI. NE, Suite 300 Salem', OR 97310-0151 Phone 503-378-4621 0244J"10/24/89 ., '\.-!: The foil. n r'^'oo' ^' rl'bmllted hag the fo"r.dog zoning, r;l~f _' 225 FIITH STREET approval. SPRINGFIELD, OREGON 97477 Zon'"' We.... INSPECTION REQUEST: 726-3769 lJ'1' l. ... OFFICE: 726-3759 Date 'hI) 0J , Authorized Signaturo \~ . 1. lL~A;.rION~~ J.NSTAL~ICW <-t. (\. 1. '\ $, f\.'S, \L~(\l . ~ - - ~ \ f\'RA~\ ~6~I4- C'f><?-tYJ ~ /)JOBA'.ESrnPTION,4- "') CJ.JJ ( IJ J I ..xLP Permits are non-transferable and expire I if york is not started vi thin 180 days of issuance or if york is suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical contract~~~r\ 0 {~ Address~ J'{\oo.~ ~ .J Ci ty f .i:Q~1l0 / Pho~~4~~ - tog~ Supervisor ~icense Number .;;....91'0- 5 \ $ . \ .q<:; Constr Contr. Number . D42.,q In \~. \rJ.CIS Expiration Date Expiration Date S''''';;;~.''~'''' Ovners Namecf\O){\ r 0 rol..:::J Address442A\ ffi(\ ~ _ City ~ ..Jd'Q ) Phone OIINER It s\.A~LATION The .insta1lation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: ~~~;~=--G-~~()~~--;;;~---- RECEIPT If: (I ;----" -I~S RECEIVED BY: ( x'f /J2v . "-=1 City Job Number - . COMPLETE FEE SCHEDULE BELOV A. Nev Residential-Single or Multi-Family per dvelling Service Included: uni t. Items Sum Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder $ 85.00 S 15.00 S 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps/volts Reconnect Only S 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 $ 40.00 $ 55.00 $ 80.00 volts see "B" above D. Branch Circuits Nev, Alteration or Extension Per Panel One Circui t I $ 35. 00 -~ Each Additional Circuit or vith Service or Feeder Permi t r4 $ 2.00 4 E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm not included) 5. $ 40.00 $ 40.00 $ 20.00 $ 36.00 ~gCJ.c) cJ I . VI '-:-J ~U~ SUBTOTAL OF ABOVE 5% State Surcharge TOTAL