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Home My WebLink AboutPermit Building 1993-11-3 '0 . . , . ~ CO M M ERCIALlI N DUSTRIAL PERMIT APPLICATION .~ 225 Fifth Street, Springfield, Oregon 97477 ~ JOB NUMBER 93'/ -5"-::?6 INSPECTION LINE: 726-3769 OFFICE: 726.3759 LOCATION OF PROPOSED WORK: ~~9~ /W"AV# ~~- ASSESSORS MAP' /7-e>'2 - 3"Z -"3'/ TAX LOT: d'c?/~ OWNER' ADDRESS' CITY' ~/A"E" JA/#~n /.A.z~ ~~A?" -:57 '. '7_;~ . ,/ PHONF' -:::?7' 7~./e:- ~ /" STATF' ~- ZIP' ~~~ DESCRIPTION OF WORK: NEW REMODEL 4--D7? ~ ~bC> ~~. I.L.-/~;S;#~~.s:- ~~e-- /7;-~ , /10 /",r / "i"~~" __ r , . ADDITION;r DEMOLISH OTHER VALUE: NAME ADDRESS PHONE ARCHITECT' CONST, CONTRACTOR'S NAME ADDRESS <:<"3 ~~~ONTRACTDR # EXPIRES PHONE GENERAL:#~Rr /... "'h~ ~ ~;&..~ -'"77~"';>'p 5/A(.y ?.,"" 7~~-y'~:::> cr ;::::;:~~~ / - .. - '* PLUMBING NO, FEE Single Fixture Relocated Bldg. Inew fix. addtll Water Service ft. Sanitary Sewer ft, (./" Storm Sewer ~_ft. Backflow Device I MECHANICAL CHARGE I IOn 000 f'l-thDn1= I Furnace/burner & vent < 100,000 BTUs 1 Furnace/burner & vent > 100,000 BTUs I Floor furnace and vent I Suspended wall or floor mounted unit heater 4/0 I Appliance Vent separate I Stationary evap. cooler I Vent Fan/Single duct I Vent System apart from AC or htg. 1 Mechanical exhaust hood and duct 'I I Permit Issuance $10,00 ~;.p-I TOTAL PERMIT TOTAL PERMIT I OUAD AREA3 \~ I - OF~~h LAND USE: ~ ~Ll~ HANDICAP ACCESS: FLOOD PLAIN: ZONING: If\.~ ""\ . # OF BLDGf" # OF UNITS' CONSTR. TYPO' LIGHTING POWER BUDGET: oecy GROUP' # OF STORIES: HEAT SOURCE: WATER HEATER' SO. FTG MAIN SO. FT. 9~ X $IS0. FT. /.y.' /0 VALUE ./~~''3~ __0 SO. FTG ACCESS SO. FTG OTHER ....... .. X X TOTAL VALUE OF PROJECT I BUILDING PERMIT 15% State SurcharQe I MECHANICAL /5% State Surcharoe I PAVI NG IttJ'I.S6 ~25 I PLUMBING' DATE /b-S;--'?'~ BY ~.--~ L........-/........,........ ff I DEMOLITION t/~- . ~ '2.~ PLAN CHECK FE.E _ L? '9""3 RCPT# _~.~// FT, SUBTOTAL.'; PERMITS SYSTEMS . DEVELOPMENT I I -j /57.73 I $ 'Z<..o s~ m 5% Slate SurcharQe FENCE VALUE $ SIDEWALK I cURBCUT FT, TOTAL PERMIT FEES I EXCLUDING ELECTRICAl tf(=<,2.~ . REQUIRED INSPECTIONS . , r -'" , " It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call 726.3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready for Inspection. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made the following work day. SITE INSPECTION: To be made after excavation, but prior to setup of forms. Y SITE PLAN REVIEW BOARD: Must be requested 2 days In advance 0"( the date you wish inspection. All project condltlons such as landscapIng, parking lot striping, etc. must be completed before ~e t1ngthlslnspe~_'_.~lD ~.,...- ~_ . . \j "/?'M~~~_",,~a?~~// ~~~5' ~ NAL BUILDING: Requested after the final plumbing, electrlca( r -~ .. mechanical and Fire Department inspections are made and approved. No occupancy of the premises can be made until a Certificate of Occupancy has been issued by the Building Division and posted on the premises. UNDERSLAB PLUMBING, ELECTRICAL "& MECHANICAL: To be made before any work is covered. Y/ FOOTINGS & FOUNDATIONS: To be made after trenches are excavated and forms are erected, all steel in place, but prior to placing concrete. tIC .JWU!it! pLUMBING, ~ECTRICA~& MECHAI'II\,;Al: No work is to be covered until these inspections have been made and approved. ATTIC DRAFT STOPS & CURTAIN WALLS FIREPLACE: Prior to placing facing materials and before framing inspection. x FRAMING: To be made after the roof, all framing, fire blocking and bracing are in place and all pipes, chimneys and vents are complete and the rough electrical, plumbing and mechanical are approved. CONCRETE SLAB: To be made after all inslab building service equipment, conduit, piping, accessories and other ancillary equipment items are In place but before any concrete is placed. ;)(' INSULATION & VAPOR BARRIER: To be made after all insulation and required vapor barriers are In place but before any lath or gypsum board interior wall covering Is applied. Y' UNDERGROUND: Plumbing, electrir.jll nas, sanitary sewer, "...~t9rm sew~ater and drainage lines. To be made prior to covering or filling trenches. UNDERFLOOR: Plumbing, electrical, mechanical. To be made prior to installation of floor insulation, decking or floor sheathing. FIRE & SEPARATION WALL: Located and constructed according to plans. POST & BEAM: To be made prior to installation of floor insulation, decking or floor sheathing. LATH AND/OR GYPSUM BOARD: To be made after all lathing and gypsum board, interior and exterior, is In place but before any plastering Is applied or before gypsum board joints and fasteners are taped and finished. FLOOR INSULATION & VAPOR BARRIERS: To be made prior to Installation of decking or floor sheathing. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete arid form work and sub-base material in place. MASONRY: Steel location, bond beams grouting or verticals in accordance with UBC 2415. ROOF SHEATHING AND NAILING: Prior to Installing any roof covering. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. FINAL PLUMBING V FINAL ELECTRICAL FINAL MECHANICAL FfNAL FIRE DEPARTMENT PAVING: After gravel Is ;n place but prior to placing ~sphalt or concrete. SPECIAL INSPECTIONS: In accordance Section 306 of the State' Specialty Code a special inspector shall be employed by the Ownerl Contractor during construction of the following work. A copy of the special testing reports shall be furnished to the Building Division. STRUCTURAL CONCRETE: In excess of 2500 P.S.1. (306 a.1) STRUCTURAL WELDS: Performed on the job. (2722 f) HIGH STRENGTH BOLTING: During all bolt installation and tightening operations. (306 a.6) SPRAYED ON FIREPROOFING: U.BG. Standards 43-8. SPECIAL GRADING. EXCAVATION AND FILLING: During earthwork. (306 a.11 & Chapter 29) GLU.LAM BEAMS: Inspection Certificate by an approved agency, furnished to the City's Building Division before beams are placed. (2501 U.S.C. STDS. 25-10.11). STRUCTURAL MASONRY: (306 a.7) *In addition to the Inspec- tions specified, the Building Official may make or require other inspections of any constructton work to ensure compliance with the Building, City or Development Code. U(\SC,O~~~II\Or\ ,~Go.n'~V0n~~ ~1I~~1 V PLANS REVIEWED BY /~ .:;:z...5- ~ DATE /#/..q~ '// /. . By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all Information herein 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 State of Oregon pertaining 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 tlme,.that project address Is readable from the street, that the permit card Is located az:JZthe front of th roperty, and the approved set of plans will remain on the site at all times during constructlo~ _ 1""'"\ Signaturp ~ ~ Datp /1":3 r .3 VALIDATION: AMOUNT RECEIVED: ~.57. /7' RECEIPT .:~07t:..c.. DATE PAID: //-"'r ~9 3 RECEIVED BY: ,. ~- - - ~ . . . .. .' Permit No: 9''3/5""~~ Address: ~~~ r~.~r Issued bY'L~te: ~~'?--~ 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 Dr 3B: 1. I {I I own, reside in, Dr will reside in the completed structure. 2. 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.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 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 orm~ _ _ --/. /7 /C--- ~~ H -3 ~'] Signature of Permit Applicant Date 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: ~)Tl:!is InforrQation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), ~ pass.ej:l."bY' ttle '198.9 Oregon Legislature. If you are acting as you-r 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 Dr 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 RESPONSI81L1T1ES 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 b'l 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 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 10124189 . . . JOB NO. .,.., 1'57(., " CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (PROFESSIONAL OFFICES & INDUSTRIAL) NAME OR COMPANY: MI~E: W.....lZ-D LOCATION: <t,?q ~ MA-IN "ST. DEVELOPMENT TYPE: "Ito1DUo;.-rIl-'P<1- - A.I>P\ 110M "'I.<.,.OSol,I"T.LOT SIZE \ /07.-":>7-....' - 00 \.00 BUILDING SIZE: It:, Jl GoO -:. 1. STORM DRAINAGE IMPERVIOUS SQ. FT. 0.5 x 2. SANITARY SEWER-CITY NO. OF PFU'S 0.5 X (See Reverse) 3. TRANSPORTATION SQ. Ft. 9e..C X $0.203 PER SQ. FT~ 91-4~ '--- .-/ X $42.08 PER PFU ~ -~ '---- .-/ NO OF UNITS X TRIP RATE X COST PER TRIP 0.5 X ,"Ie.. X .1<4- X $424.31 (l~'0 0.5 X X X $424.31 $ 0.5 X X X $424.31 $ 4. SANITARY SEWER-MWMC NO. OF PFUrS x $15.125 PER PFU + $10 MWMC ADMIN. FEE $ (Use PFU Total From Item 2 Above) TOTAL-MWMC SDC h MWMC CREDIT IF APPLICABLE (SEE REVERSE) 1'5 SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ Zy~- 5. ADMINISTRATIVE FEES BASE CHARGE (SUBTOTAL ABOVE) X .05 c\~~ [~~~ SDC Coordinator .\ O/l't /'1'2:> r I TOTAL SDC $ 2e.,o?~