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Home My WebLink AboutPermit Mechanical 1992-10-14 ~ .. . RESIDENTIAL PERMIT APPLICATION Inspections(l26.3769 ) Office: 726.37~~ I . LOCATION OF PROPp,stjD(ItJ,.~:C, I ~0() l ASSESSORS MAP' I' I ).:JO( ') A . ~' OWNER: \ l~\) n \ \\'" ~O\~ J,ffir\ f\ Ii Gt5- ~ONE: '--1+\ -(d.,lf;n( \ ADORe.,.,,' (~/J() 0- i\lqX\tt\CU.UK. - . b0. . CITY,'0Ir)t5.ril - ~~ STATE: ( JlP~erG ZIP:J:J?tt~1 DESCRIBE WORK: n. (, ll, \.. 1\ O.rrtofJ ) - NEW REMODEL ~ ADDITION DEMOLISH OTHER LOT: CONTRACTOR'S NAME GENERA' ' :~C::::AL: ~0\Wi) ELECTRICAl' BLOCK' 'I . q& \440 i.1 I JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 H'i( (< '9-00') . TAX LOT: ~~ CJ- _ " '. SUBDIVISION: ", " " I, , :1 , , ADDRESS CONST, CONTRACTOR' EXPIRES PHONE , , " - OFFICE USE - OUAD AREA' LAND USF' FLOOD PLAIN' . OF BLDGS: . OF UNITS: ZONING CODE: OCCY GROUP: CONSTR. TYPE: . OF BDRMS' . OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER: RANGE: SQUARE FOOTAGE: , t '. 1 I To requesl an Inspection, you must call 726.3769, This Is a 24 hour recording, All Inspections requested before 7:00 a,m, will bo made the same working day. Inspections requested after 7:00 a.m. will be made the following work day: I~ Temporary Eloctrlc o Site Inspection - To be m3de after excavation. but prior to setting forms. o Undorslab Plumbing' Electrlcall 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/ Mechanlcat _ Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decklna. o Floor Insulation - Prior to docking. . o Sanitary Sewer - Pllor to filling trench. o Storm Sewer - Prlor to fllllnu trench. o Water Line - Prior to filling trench. o Rough Plumbing - Prior to cover. REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. o Rough ElectrIcal - Prior to cover. o Electrical ServIce - Must be approved to obtain permanent electrlcal 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 Stove - After I~sta"atlon. o Insert - After fireplace approval and Installation 0' unit. o Curbcut & Approach - After forms are erected but prior to placement of concrete. D Flnel Plumbing - When all plumbing work,ls completo, D 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 end building Is oom,"'" ctg5?) (. MOBILE HOME INSPECTIONS o Blocking and Sol.Up - When all blocking Is complete. . .. " :1 , , i , !:, i , " o Plumbing Connections - Wilen home has been connected to water and sewer. o ElectrIcal Connoctlon - When blockIng, set.up. and plumbing Inspections havo been approved and the home Is connected to the service penel. o Fenco - When completed. " , d'Flna' - After all required , ' , , ,_... ,,' InSI?~qllon.s~aie}i'piito~ed"e~d o Street Treas - When all required , ' ,por.ches. s~lr.lIng. ,d~cks, and trees are planted. '. . . , "venting 'havelbeen,lnstalled: ',' o Sidewalk & Driveway - After excavation Is complete, forms and sub.base material In place. 'I Sotbacks , . ; I, PoL, "HSE ',GAR' ACC ' I" .rn ;': >.r: l,t lo . ;" N .t.1 S Iw k LOI faces Lot sq.;'ftg. Lot coverage Topography Total height ",Lot Type, . ," . '.. 1~, .~~ Interior.':;-', .~ o- r. '. I' C6/1ier ,.." . ,.L~,", "( 'Pantiandle Cul.da.sac , ' BUILDING PERMI,T.' "I,;..>" ITEM SQ, FT, .,. X $/SQ, FT, = VALUE Main . Garage Carport Total Value Building Permit Fee Slate Surcharge Total Foe (A) SYSTEMS DEVELq.r.MENT CHARGE (SDC) (B) PLUMBING PERMIT ITEM FEE Fixtures Rosldontlal Balh(s) N' Sanitary Sewer FT, Water FT, Storm Sower FT, Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove/lnsert/Flreplace Unit Dryer Vont Mechanical Permit 7,C) ,00 / () ()() I')~ db,')0 Issuance State Surcharge Total Pormlt (D) MISCELLANEOUS PERMITS Mobile Homo State Issuance State Surcharge Sidewalk ft Curbcut ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrICal)c-\~' ~ (A, B, C, 0, and E Combined) .. ~ (A THE PROPOSED WORK IN THE 'lllllll"'iISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yos, this application must be signed and approved by the Historical Coordinator prior to permit Issuance. APPROI,(ED: ~ BUILDING VALUE, PLAN CHECK AND BUILDING' PERMIT This permit Is grantod on tho expross condition thai the said construction sllall,ln all respects. conform to the Ordinance adopted by the City of Springfield, including tho Development Code, regulating the construction and use ot buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordInances. Plan Check Foo' Dale Paid: Receipt Number: Racelved By: Plans Reviewed By Dato Systems Dovelopmont Charge Is due on all undovelopod properties within tho City limits which are being Improvod, ADDITIONAL COMMENTS By signature, I stale 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 tho Laws of the Stale of Oregon pertaining to the work described herein, and that NO OCCUPANCY will bo made of any structure without permission of the Building Safety Division. I furlt1er certIfy that only contractors and employees who arc In compliance with QRS 701.055 will be llsed on Hils project. I further agreo to ensure that 011 required Inspections arc requested at the proper time: that each address Is readable from the street, that the pormlt card Is located at the front of the proper nd the approved 5 I , pylns will remain on the at a/l lmes du lng con r clion.! j 7 ' I /I I j ':1/11', t /- VALIDATION: \ A-l RECEIPT NUMBER '0\ -~ .. DATE PAin ~ t Y \4- r...:. lJ---'" AMOUNT RECs..I~-1 ,-,r: h.S.1 j~ RECEIVED BY ~ A ') ../ .. ,..... . . Permit No: a~ Iv..,. VtJ ) Address: ~1J0) i'.cirri If!JLY- Issued b?' /)/m -> Qate: 1().I4.q~v 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 ii/Je plicable blanks, and initial boxes 1 and 2, and either box 3A or 3B: 1. r\ .A I own, reside in, or will reside in the completed structure. r 2, [7 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, Br 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 ~:~:t~~~~ilJ7;i;t C.""m'"oo ;;;j~' "" tho _""~ P"m;t'Appll,,"' a ~ CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT ...... ~ INFO_ATlON NOTICE TO PROPERTY c1NERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: Tliis Ir)formation 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 em'ployer, 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 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 suffici~nt 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 arid 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 SI. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89