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HomeMy WebLinkAboutPermit Mechanical 1995-8-7 r; " RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 -. ASSESSORS MAP' LOCATION OF PROPOSED WORK: ?:~ ./!~A4~.(~.Z>~ / ?-c:>3' ~<:.< ~/=3'- ~"'5 ~.,.rz4l-'" Z;:>~<<;" . - , -, - ~ ~~ ./??..#(!~.i.:i'?.C::> <;-~~ .-' r DESCRIBE WORK: _~}/ /'T~ 6~ LOT- OWNER: ADDRESS: CITY' NEW REMODEL CONTRACTOR'S NAME GENERA' . PLUMBING' MECHANICAL:~~ ELECTRICAl' BLOCK: STATE: ~~- . JOB NUMBER '/ :> /7C'> "'2..... 225 Fifth Street Springfield, Oregon 97477 TAX LOT: /&::;"?~~ SUBDIVISION- PHON'" ./~-/~'T ZIP: q?~.>? '50<;,~. . ~j-'J"-~ - ,-, - ~J1I' / ?-q /,,~~~~~,.c- :t:~/'~~ ~ OTHER ADDITION DEMOLISH ADDRESS CONST. CONTRACTOR' PHONE REQUIRED INSPECTIONS o Rough MechanIcal - Prior to cover. o Rough Electrical - Prior to cover. o Electrical Service - Must be approved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. o Framing - Prior to cover. o Wail/Ceiling Insulation - Prior to cover. o Drywall - Prior to taping. o Wood Stovo - After Installation. o Insert - After fireplace approvI!11 and Installation of unit. o Curbcut & Approach - After forms are erected but prior to placement of concrete. o Sidewalk & Driveway - After excavation Is compiete, forms and sub-base material In place. o Fence - When completed. o Street Trees - When all required trees are planted. EXPIRES - OFFICE USE - QUAD AREA' LAND US". FLOOD PLAIN: . OF BLDGS: · OF UNITS' ZONING CODE:_ OCCY GROUP: CONSTR. TYPE: . OF BDRMS: . OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER: RANGF' SQUARE FOOTAGE: 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 same working day, Inspectlons requested after 7:00 a.m. will be made the following work day. o Final Plumbing - When all plumbing w9rk Is complet.e. o Final Electrical - When all electrical work Is complete. o Final Mechanical - When all meChanIcal work Is complete. o Final Building - When all required Inspections have been approved and building Is completed. ~ Other . ,*/~~r?~ . .<:;~ C:::;_yr/./~ ~,~- '" -- MOBILE HOME INSPECTIONS o Blocking and Set.Up - When all brocklng 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 15 connected to the service panel. o Temporary Electric. o Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumblng/Electrlcal/ Mechanical - Prior to cover. o Footing - After trenches Bre excavated. o Masonry - Steel location, bond beams, grouting. o Foundation - After forms are erected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. . o Underfloor Plumbing/Mechanical - Prior to Insulation or deckIng. o Post and Beam - Prior to floor Insulation or decking. o Floor Insulatlon:- Prior to decking. o Sanitary Sewer - Prior to filling trench. o Storm Sewer - PrIor to fllllng trench. o Water Line - Prior to fillIng trench. - . o Rough Plumbing - Prior to . cover. o Final - After al/ required Inspections are approved and porches, skirting, decks, and venting have been Installed. Lot faces Lot TY. Lot sq. Ilg. Interior I PL. IN Lot coverage Corner Is Topography Panhandle Iw Total height Cul-de-sac IE .":' .,:;J'<: \~\~., ~,' 'IS THE PROPOSED WORK IN THE - : \. - "'HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior to permit Issuance. ~ Setbacks 'HSE'GAR'ACCI I I I BUILDING PERMIT ITEM SO. FT_ X $/50. FT. = VALUE Main Garage Carport '. , , ... ,.... ~ Total Value Bul/ding Parmi t Fee State Surcharge Total Fee (A) SYSTEMS DEVELOPMENT CHARGE (SDC) (B) 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 Furnaco Exhaust Hood Vent Fan N' Wood Stovellnsert/Flreplace Unit Dryer Vent "Z> .~.r/p~ Mechanical Permit ~ . /c:?--' --*- 263e> Issuance p~ n ~ State Surcharge Total Permit (0) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk Il Il Curbcut Demolition Slate Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) " , APPROVEr" BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted.on the express condition that the said c'onstructlon shall, In all respects, 'conform to the Ordinance adopted .l?Y .the, City of Springfield, Including the Development Codet'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- Date Paid: Recel pt Number' Received By: Plans Reviewed By Date Systems Development Charge Is.due on all undeveloped properties within tho City limits which are being Improved. ADDITIONAL COMMENTS By signature, I state and agree, that I have carefUlly examined the compteted 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 lhe City of Springfield, and the Laws of the State 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 Inspections 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 appr ed set of plans will remain on the s~te at I tim~s du g cons uc1l0n. Slgnatur V '-0 Dat~ 1>- '7- 95 VALIDATION: RECEIPT NUMBER / jgG,-:< / DATE PAID ~ ?'51 S- AMOUNT RECEIVED 2~. ';:;?t:? RECEIVED BY ~----......- {/~~ .~ . . Permit#: 9?/~~"2. Address: ~ ~ ~ ;~.~.?":::> . , Issued by: ~ _ Date: tJfii?-..> --::;iI ~- .. r Statement: Information 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 following statement before a building permit can be issued. This statement 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 appropriate blanks and initial boxes I and 2, and either box 3A or 3B: Il1 D I. 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 Dr offered for sale before or upon completion. D 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR - II'I 3B. 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. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to P perty O"rs a",t Construction Responsibilities on the reverse side of this form. , ~ f-7-9s (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) . . ...- 0, .' '- . -, . -. -" . InfOrmation Notice to Property Owners About Construction Responsibilities .......,.. '..... .. .' . Note; This Information Notice to Property Owners about Construction Responsibilities .. ~. ....... -...... '.... . was developed by the Constntctior!,C(!ntractors Board in accordance with ORS 701.055(5). 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 Dept of Revenue at 945-809]. 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, cal] the Oregon Employment Division at the Department of Human Resources at 378-3524. 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 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 Interna] Revenue Service at 1-800-829-1040. 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. 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 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 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 addliionarq~esti~ns, write or call the Construction Contractors Board (PO B~x~14l40; Salem;-OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St NE Suite 300, in Salem. prop-own.pm4 1/94