HomeMy WebLinkAboutPermit Building 1993-8-11
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Ollice: 726.3759
LOCATION OF PROPOSED WORI<'
ASSESSORS MAp.
LOT:
J7~~-~-?~
-
DESCRIBE WORI(: _
NEW __ REMODEL
CONTRACTOR'S NAME
GENERAl.
PLUMBING.
MECHANIC'II I .
ELECTRICAl.
QUAD AREA -4 R. S~
. OF BLDGS. \
OCCY GROUP: _"^
. OF STORIES: ' \.
WATER fiEATER:
.
SPRINGFIELD
.
L~ '..
JOB NUMBER /' 5/t..:J,a<> ~ _ .
225 Fifth Street
Springfield, Oregon 97477
BLOCK.
SUBDIVISION:
TAX LOT:
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STATE:
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PHONE:2f"-7.;:z. X'~
ZIP:
Cf7Y- 79'
DEMOLISH
OTHER
-' ,.
~.~'7/1
'~, 11_
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ADDRESS
CONST.
C,)~!TRACTOR .
EXPIRES
PHONE
. ,
- OFFICE USE -
\ \ \ \
LAND USE:
. OF UNITS:
. CONSTR. TYPE: J.L..t...}
HEAT SOURCE:
... ,i'
RANG,E:
FLOOD P!..AIN:
ZONING CODE: _LD"e--->
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE: cJP$A,
To request an inspection, you must call 726-376~1. This is a 24 hour recordIng. Alllnspc.:;tlons requested before 7:00 a.m. will be
made the same "'"Jof.king day, inspections requested aftl?r 7:00 a.m. will tle made the following work day.
o Temporary Electric.,
D Site Inspe::tion - To be made
after exceJ'lation, but prior to
setting lorr':15.
o Underslab Plumbing/Electrical/,
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o
Masonry - Steel location, bond
beams, grouting.
o Foundation - After forms are
erected lJu t prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
_ Prior to insulation or dccki.,g.
o
Post and Beam - Prior to floor
insu!a!i0n or decking.
o Floor Insulation - Prior to
decking.
o
Sanitary Sewer - Prior to filling
trench.
o
Storm Sewer - Prior to filling
trench.
O Water Line - Prior to filling
trench.
o
Rough Plumbing - Prior to
cover.
REQUIRED !NSPECTIONS
11 Rough Mechanical - Prior to
Y cover.
D Rough Electri(;al - PriQr to
cover.
o Electrical Service - ~':ust be
approved to obtai n ~errnnnent
electrical power.
o Fireplace - Prior to facing
, materials and framing Inst).
J80 Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
D Wood Stove - After installation.
o Insert - After fireplace <.lpp~oval
and installation of unit.
o
Curbcut & Approach - After
fc,rms are erected but priur to
placement of concrete.
D Sidewalk & Driveway - Alter
excavation is complete, ferms
and sub-base material in place.
D
F?ncc - When complcf.ed.
D
Street Trees - Wher. :.:1 required
trees are planted. .
D
Final Plumbing - When all
plumbing work is complct.c.
II Final Electrical - When all
1.---1 electrical work is complete.
o Final Mechanical - When ail
mechanical work Is complete.
'fC"A Final Building':" When all
~reQuired inspections have been
approved and building is
completed.
o Other
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.
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connecled to
the service panel.
o Final - After all required
inspections are approved and
porches, skirting, decks, and
\fentlng have been installed.
Lot faces
Lot sq. llg.
Lot coverage
Topography
Tolal height
~,
BUILDING PERMIT
ITEM SO. FT.
Main
Garage
Carport
~
~
Total Value
Building Permit Fee
State Surcharge
Total Fce
Lot Type
.
SctbRcks
I' I '~
P.L. HSE GAR ACC I
~ '.
Is
Iw
IE
VALUE
~~~.BC>
'9::;1'0
?53
d_
~~ ,03
SYSTEMS DEVELOPMENT CHARGE (SDC)
...&-
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
Interior
COIner
Panhandle
CuI-dc-sac
X $/SO. FT.
/t/./c:>
(A)
(B)
N'
FT.
FT.
FT.
(C)
Dryer Vent
Wood Stovc/lnsertlFireplace Unit
N'
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
II
Curbcut
II
Demolition
State Surcharge
Tolal Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding el~ctrical)
(A, B. C, 0, and E Combined)
FEE
6'8,193
r . -....
.
IS THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON.
THIO HISTORICAL REGISTER?
If yes. this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construc.Uon :;;hall, in all respects. conform to lhe Ordinance
adopted by ihe Clly of Sprlngfielel, including the
Development Code. regulating the conslruct:on and use of
buildings..and may be suspended or revoked al any lime
UpOil violation of any provisions of said ordinances.
Plan Check Fee: ~<. So"3' _
Dale Paiel: _JLZc.;fJ
Reccipl Nurnbcr:~ 'Tt., 5'",
Rcce,ved Y' /<h4'~
- -~L?2~
PI ~ ReVIewed By
-1i!>41(z;L
f;Ct:
Systems Development Charge is duo.on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
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By signature, I state amI agree. that I have carefully examined
the completed application and do hereby certify Itlat all
i.nformation hereon is true and correct, and I further certify
lnat any and aI/ work performed shall be done in accordance
....vith the Ordinances of the City of Springfield. and the Laws
of the State or Oregon pertaining to the work described
herein, and that NO OCCUPANCY. will be made of any
structure without permission of the Building Safety Division.
! further certify that only conlractors and employees who
arc In compliance with ORS 701.955 will be used on this
project.
I further agree to ensure that all required inspcctio('ls arc
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 site at all times during construction.
>>gnature'~~~~
Date ~/.yr.3 '
VALIDATION:
CJ744
~/I:? />'1
I <:;.1 bJ
.......~l.
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVEn
RECEIVED BY
.
. ~
.
.
Permit No: 9 s I (J ~ 2-
Address: .M_?..) ~1 ;?,,()
Issued bY:~~ Date: #3
FOR 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 3B:
1. 1---.....,.
-- -
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
3. B.~r 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 form.
~~~
~~3.43
Datrf 7"
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
. .
INFORMATION NOTICE TO PROPERTY OWNERS
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 tile .J989 Oregon Legislature.
, - .
II 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.
EMPLOVER 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 eVl;ln 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 S'ervice at 221-3960. .
OTN::R 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 Insurance: 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!ral;les, and to notify building officials at the appropriate times so they can perform
the required inspettions. ... "..'. ~
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