HomeMy WebLinkAboutPermit Mechanical 1995-8-7
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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ASSESSORS MAP'
LOCATION OF PROPOSED WORK: ?:~ ./!~A4~.(~.Z>~
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DESCRIBE WORK: _~}/ /'T~ 6~
LOT-
OWNER:
ADDRESS:
CITY'
NEW
REMODEL
CONTRACTOR'S NAME
GENERA' .
PLUMBING'
MECHANICAL:~~
ELECTRICAl'
BLOCK:
STATE:
~~-
.
JOB NUMBER
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225 Fifth Street
Springfield, Oregon 97477
TAX LOT: /&::;"?~~
SUBDIVISION-
PHON'"
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ZIP:
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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?~
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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
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'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.
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Setbacks
'HSE'GAR'ACCI
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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>
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Mechanical Permit
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Issuance
p~
n
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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
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Dat~ 1>- '7- 95
VALIDATION:
RECEIPT NUMBER / jgG,-:< /
DATE PAID ~ ?'51 S-
AMOUNT RECEIVED 2~. ';:;?t:?
RECEIVED BY ~----......-
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Permit#: 9?/~~"2.
Address: ~ ~ ~ ;~.~.?":::>
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Issued by: ~ _ Date: tJfii?-..> --::;iI ~-
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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.
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(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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InfOrmation Notice to Property Owners
About Construction Responsibilities
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Note; This Information Notice to Property Owners about Construction Responsibilities
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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.
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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.
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