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Home My WebLink AboutPermit Electrical 1992-3-26 RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 LOCATION OF PROPOSED WORK: 6&:!i?9 _h?-f'~ ",,?7' ASSESSORS MAP: /'/-C?Z-? S"- 3.~ ;I ~,rr I/SA' ~cq- <d~ '-'0-/ 4,P~D , - / DESCRIBE WORI,.{ V 0 )"00 f\n n\L \. ADDITION ~ LOT" OWNER' ADDRESS' CITY' NEW REMODEL CONTRACTOR'S NAME GENERAl' PLUMBING: MECHANICAl' ELECTRICAl' QUAD AREA: 4: R SF, . OF BLDGS: \ OCCY GROUP: t(.::) . OF STORIES' \ WATER HEATER: BLOCK' STATE' ~A>. . JOB NUMBER 92~/ ~9 225 Fifth Street Springfield. Oregon 97477 TAX LOT' SUBDIVISION' Ot5::;;:~ PHONE: 72~-7?? / ZIP' q-;;> r;>g drv-\ lh ()YV DEMOLISH OTHER ~ EXPIRES ~ONE ADDRESS CON ST. CONTRACTOR' REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. !Xl Rough Electrical - Prior to cover. D Electrical Service - Must be approved to obtain permanent electrical power. D Fireplace - Prior to facing materials and framing Insp. o Framing - Prior to cover. lV1 Wall/Ceiling Insulation - Prior to t.,.C..J cover. ~ Drywall - Prior to tapIng. D Wood Stove - After Installation. D Insert - After fireplace approval and Installation of unit. D Curbcut & Approach - After forms are erected but prior to placement of concrete. D Sidewalk & Driveway - After excavation is complete, forms and sub-base material In place. D Fenco - When completed. D Street Trees - When all required trees are planted. . FLOOD PLAIN' ZONING CODE: ~ 1) \2) . OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE: la'lL - OFFICE USE - \ \ \ \ \ CONSTR. TYPE: V!\J LAND USE: . OF UNITS' HEAT SOURCE: RANGE: To request an Inspection, you must call 726-3769. ThIs Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be made the saene working day, Inspections requested atter 7:00 a.m. will be made the following work day. D Temporary Electric D Sltc Inspection - To be made after excavatIon, but prior to setting forms. D Undcrslab Plumbing/ElectricalJ Mechanical - Prior to cover. r7l Footing - After trenches are L.,CJ excavated. D Masonry - Steel location, bond beams, grouting. [KJ Foundation - After forms are erected but prior to concrete placement. D Underground Plumbing - Prior to filling trench. D Underfloor Plumblngl Mech.nlcal - Prior to insulation or decking. o Post and Beam - Prior to floor Insulation or decking. C!J Floor Insulation - Prior to decking. D Sanitary Sewer - Prior to filling trench. D Storm Sewer - Prior to filling trench. D Water Line - Prior to filling trench. D Rough Plumbing - Prior to cover. D Final Plumbing - When all plumbing work is complete. rJl Final Electrical - When all IJL-J electrical work is complete. D Final Mechanical - When all mechanical work is complete. lXJ Final Building - When all required Inspections have been approved and building is completed. DOther MOBILE HOME INSPECTIONS D Blocking and Set.Up - When all blockIng Is complete. D Plumbing Connections - Wilen home has been connected to water and sewer. D Electrical Connection - When blocking, set4up, and plumbing Inspections have been approved and the home is connected to the service panel. D Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. Lotae . --- -.. Lot faces .t.L- Setbacks IS THE PROPOSED WORK IN THE I PL. I I I I HISTORICAL DISTRICT, OR ON HSE GAR ACC lot sq. fig. Interior IN I THE HISTORICAL REGISTER? Lot coverage Corner c/'l7T If yes, this application must be signed S /:<'1 and approved by the Historical Topography ~51' Panhandle Coordinator prior to permit Issuance. Total height Cul-de.sac W 1/' IE E//;7 . APPROVED' BUILDING PERMIT ITEM SO. FT. X $/SO. FT. VALUE Main Garage Carport II?:> L'71 '?~. ?C> '7~ ~;c. Total Value /79. S- c> ~ 9~, IR9:.C/~ SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ff q I -e /Ct> Building Permit Fee State Surcharge Total Fee (A) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) N' Sanitary Sewer FT. Water FT. FT. Storm Sewer Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove! Insert/Fireplace Unit .Dryer Vent MeChanical Permit Issuance Slate Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk fI Curbcut fI Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) '27 9. ~~ (A, B, C, 0, and E Combined) 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 Ordinance adopted by the City 01 Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plan Check Fee: //h.L:8 i, (3 -"1"Z--- 2..,737 fLV\N'-S-- Date Paid: Receipt Number' Re~ By: e'~:vieweci By -;;> -2.. <i ~ 72... Date Systems Development Charge is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information hereon Is true and correct, and I further certify that any and all work performed shall be done In accordance with the Ordinances of the City of Springfield, and the Laws of the Slate of Oregon perlalnlng to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Building Safety Division. I further certify that only contractors and employees who are In compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspectlons are requested at the proper time, 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 SIt~lIlltil dur c. onstructlon. ,/ Signature ~ 0 (Ql ~ )- Datp VALIDATION: /2..eJ RECEIPT NUMB~ ~ ( f) DATE PAID tV .c-f.)<E) . Gf ~ AMOUNT R~EIVE .0) f JCj RECEIVED tLJd) - - . CS'-< ......... _...J... ~. . . Permit No: Gt~()\4q . Address: 199iS9 f\'() i If\ ~ Issued br:f(j'().. ./ Date: dJ.f)5Q;:L i:OR OFFICE USE ONLY STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential coostruction 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 iP.,t71pPlicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: 1. I5:f2J 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 I 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. OR 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 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this fjr:A. j' M. /I h UJ '-(JL (j 7 - 7<. - q?_ rmit Applrcant . Date - CONSTRUCTION CONTRACTORS BOARD D244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INIRMATION NOTICE TO PROPER,fOWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ..-., .-.... NOTE: This Information Notice to Property Owners About Construction Responsibilities . . . was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed 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 RESPONSIBILITIES: If 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 378,3390. 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 information, call the Oregon Employment Division DHR 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. If you fail to obtain workers' 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 373-7434. 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 221,3960. 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 Properly Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overs pray, 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. If you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310,0151 Phone 503-378,4621 0244J 10/24/89 l1- .' 225 FIITH STREET ._. SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3~e OFFICE: 726-3759 SpnINGt=IELD _ Ci ty Job Number ~/</9 '\C\uthOrizOd Signature 1. LOCATION OF INSTALLATION 4 $?~ 9 h1?;"I-/l'? ?/ . l. EbE::(COHPLETE FEE SCHEDULE BELOV - A. New Residential-Single or Multi-Family per dwelling unit. Service Included: LEGAL DESCRIPTION 17-b2-?"- ~ ':3 /Ph zc:=> JOB DESCRIPTION Jti.//,Z7L5: /i'E?. ;f-~z:>/r/p~. Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for '180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Address Cit)' Phone Supervisor License Number Expiration Date Constr Contr. Number , Expiration Date \" Signature of Supervising Electrician Owners Name /~r:~ .#~~ . Address C:;B~ 77/.A1-//(/ City ~Prc..D Phone 72/--'/?2./ OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. "'\t ?t1~ fi/J: ~~~~~-:~~-:~~----~-------------- RECEIPT 11: lfJ/;W RECEIVED. BY: tLV\.."f'SL- 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dwelling Service or Feeder B. Services or Feeders Installation, Alterations or Relocation: Items Cost Sum $ 85.00 $ 15.00 $ 40.00 . ~ hod> ,200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amps to 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps/volts $300.00 Reconnect Only $ 40.00 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch.Circuits C. Temporary Services or Feeders Installation, Alteration or Relocation $ 40.00 $ 55.00 $ 80.00 see "Bl1 above New, Alteration or Extension Per Panel $ 35.00 One Circuit Each Additional Circuit or with Servi~ or Feeder Permit '~$ Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 'l'OTAL ?:90 fO.ro not included) $ $ $ $ (d).cD . .-' ~ '5.00- - (()?J.oV- 40.00 40.00 20.00 36.00 JOB NO. q":J.o {4-' CITY OF SPR"'FIELDSYSTEMS DEVELOPMENTttlARGE WORKSHEEf I . (COMMERCIAL & RESIDENTIAL) NAME OR COMPANY: re.FF J-/ e.AC-oc-K. LOCATION: C.BBq MAIf..j, ST. Ilo'Z."c>S?~ - 0&7-00 DEVELOPMENT TYPE: L.[)~.. ADo/noN tr'" ftJC.LcJPt'? OvUlHt<r"-lGr BUILDING SIZE: ~1 x /2 LOT SIZE SQ. Ft. 1. STORM DRAINAGE n. ~_ c. 7 0_5 IMPERVIOUS SQ. FT. ...,C.fl X $0.186 PER SQ. FT. .." (See Reverse For Runoff Coefficients If Actual Imperv. Area Is Unknown) 2. SANITARY SEWER-CITY NO. OF PFU'S X $38.55 PER PFU (See Reverse To Determine Total PFU'S) $ 3. TRANSPORTATIO~ NO OF UNITS X TRIP RATE X COST PER TRIP r X X X 5388.61 X $388.61 $ $ , '. ... . '." X"""-=" X 5388.61 . _. (Se~ Attachment C To Determine Trip Rates) . . . SUBTOTAL (ADD -t.. . h____." ITEMS 1,2, .. $ -- & 3)' $:~~7.~' 4. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X .05' s tf ?>!> TOTAL-CitY SDC S '11 ~ 5. SANITARY SEWER-MWMC NO. OF PFU'S x S13.25 PER PFU + S!() i'll-ilK ADMIN. FEE S - (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) I./~ . r ~~L.k. () Kip Burdick SDC Coordinator S ~ ';2./I'I-/n.. TOTAL-MWMC SDC S TOTAL SDC, S Cj I <fo