HomeMy WebLinkAboutPermit Building 1992-8-20
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
DESCRIBE WOR~'
NEW
REMODEL
I CONTRACTorl" NAME
<:;ENI,IML:
PLUMBING:
\'
MECHANICAL: __ '\~__
ELECTRICAL: __ ~).
QUAD AREA -\-R\\ lLU
. OF BLDGS: \
I OCCY GROUP: -~
I . OF STORIES: -_\
I
L
I
I
WATER HEATER:
. SPRINGFIELD
DEMOLISH
OTHER
.
q ~ \[R4'
JOB NUMBER
SUBDIVISION:
PHONE:' \ ~ ~O -~l oY ~
l.{ Y\41, I }
ADDRESS
CONST.
CONTRACTOR'
EXPIRES
PHONE
. - -- --.-----...-------.----------.------
- OFFICE l\SE -
LAND USE \ \ \ \
. OF UNITS: \ I
CONSTR. TYPE: JL.N
HEAT SOURCE:
RANGE:
FLOOD PLAIN: )
ZONI'NG CODE: l~ ) ~
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: _~
To request an inspection, you must call 726.3769. Ttlls Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be
maelc the same working clay, in:ipccttons requested after 7:00 a.m. will be made the following work day.
I I Temporary Electric
CI
Site Inspection - To bt~ !n;:Jdc:
.lftcr CXCtJvlllion, but prior to
selling fOri liS.
D
Undcrslab Plumbing' Electrical I
Mechanical - Prior 10 cover.
K""A Fooling - After trenches are
~ excavated.
D Masonry - ~tCCI location, bond
beams, grouting.
f"\:/r Foundation - After forms are
~ erected but prior to concrete
placement.
D Underground Plumbing - Prior
10 filling trench.
I\::7f Underlloor umbln eehanleal
~ _ Prior to rl;:,u'<.l,,~.l or decking.
~ Post and Beam - Prior to floor
~ insulallon or decking.
I"\:/r Floor Insulation - Prior to
~ decking.
o Sanitary Sewer - Prior to fitling
trenell.
~ Storm Sewer - Prior to filling
~ trench.
I I Water Line - PrIor to fllting
trench.
fv(Rough Plumbing - Prior.to
~ cover.
REQUIRED INSPECTIONS
rv1'" Rough Mechanical - Prior to
~ cover.
~A Rough Electric:!1 - Prlur to
~ cover.
D Electrical Service - Must be
approved to obtain permanent
electrIcal power.
D
Fireplace - Prior to faclna
lTlilterlals and framing Insp.
,RT Framing - Prior to cover.
'NT Wall/Ceiling Insulation - Prior to
~cover..
~ Drywall - Prior to tapIng.
D Wood Stove - After Installation.
D Insert - After tlreplace approval
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prlor to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material in place.
D Fence - Wilen completed.
D Street Trees - When all required
trees are planted.
~ Final Plumbing - When all
~ plumbing worl< Is complel.e.
K71 Final Elcctrlcnl - WIlen all
J.6J cleGtrlcal wot'l< Is complete.
~ Final Mechanical - When all
~ mechanical work Is complete.
~Inal Building - Wilen all
~requlred Inspections have been
approved and building is
completed.
DOlher
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approvod
and the homo is connected to
the servIce panel.
D Final - Aller all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot faces
Lot sq. Itg.
Lot coverage
Topography
Total height
BUILDING PERMIT
44?;'
ITEM
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fcc
PLUMBING PERMIT
ITEM
Fixtures
Resldenllal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
Lot Type.
Inlerior
Corner
Panhandle
Cul.de.sac
_ Selbacks
P.L. HSE GAR ACC
!. THE PROPOSED WORK li\i TH[~~
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
N
------
..L_ ___ _.-- --
Y:L_ __ ____
If yes, this application must be signed
and <lpproved by tllO Hj~.lorlctll
Coordinator prior \0 pel/nit i~suancc.
~l__J_L-.J
APPROVED:
:11~!iO &.s;m
(A)
4-
N'
FT.
FT.
FT.
(C)
Dryer Vent
Wood StovellnscrtlFlreplace Unit
N'
/
/1C1.00
?J/~
/~,-:S .7~
.
SYSTEMS DEVELOPMENT CHARGE (SDC)"b
lL ~4 rp
. (B) ~f,e. -
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surchargo
Total Miscellaneous Perml ts (E)
TOTAL AMOUNT DUE (eXCluding electrical)
(A, B, C, D, and E Combined)
FEE
417.00
dLJ.OO
.
2. (l"
4;2..00
~/j). j.J.Q-C
__It;) "0
.7~
'7&:,,75
t;..3_!1-~1
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on tho express condition that tile said
construction shall, in all respects, conform to tho Ordinance
adopted by the City of Springfield, including the
Development Code, regulaling the construction and use of
buildln9s, <1nd may be suspended or revoked <11 <lny time
upon violation of an~ ~rBiSio s of said ordinances.
Plan Check Fcc: I \ '-) .
Date Paid: _Blj,,:l b.' _:_2L
Receipt NUlllbur:__ __ c=>_
Re~~~
. Plans~~wed By"
g~~L-
-o/-15ite
Systems Development Charge is due on all undeveloped
properlies within the City limits which are beino improved.
ADDITIONAL COMMENTS
__PA77l_ !.l._n_
By signature, I state aml agree, that I have caretully eX?lllined
the completed application and do hereby certify tl13t all
Information tlereon is true and correct, and I further certify
that any and all work performed shall be done in accordance
with the Ordinances of Ihe City of Springfield, and the Laws
of Ihe Stntc of Grenon pertaining 10 the worl< describcd
herein, and that NO OCCUPANCY will 'be made of any
~.Iructllrc without pcrll1i~;sion of the Building S<1lcty Division.
I further certify that (,nly contractors and cmployees WllO
;'Iro In compliance Witll QRS 701.055 will be lIsed on this
project.
I further agree to ensure IIlat all rCQuired inGpcctiom; arc
requested al the proper time, that each address is readable
from the street, that the permit card is located ;)t tile front
or the plOperly, and IlIC approved set 91 plnns will lemain
on the site ill all times during construction.
~y;~
''ij,J. 0,/12.-
><tgnalUrn
I
Datt"
VALIDATION: r-::! C1?
RECEIPT NUMBEFla- ~), -
DATE PAID Um . q
AMOUNT nEC~~.____0_~Je>'! n
n[CEIVI~D oy~\D~-- -.--
.
,. .
.
.
Permit No: q & \a:ft
Address' ~ 1 {\ \bk\thcv 1) G
Issued ~Y:-CJ\\j)(;V (SDate: 11 ~q~v
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, OAS 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 OAS 701.010(7), need not submit this statement. This statement will be
filed with the permit.
Fill i the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. 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
or offered for sale before or upon completion.
3. A.II
\
I My general contractor il'
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
I will be my own general contractor.
3. B.
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.
~;;J;/ ;4L1-4
Signaiure of Permit Applicanv
fY;;o/92-
DaM I
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORtTION NOTICE TO PROPERTY OtNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
. 'f i.- .
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 t~~ 1:98~ 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 Withholdin~ 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.
"Vorkers' 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:
.Jode Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
"ode 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 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 10/24/89
S...IINUt:IELO
~e~~wm ~j
~onin9 Bnd9 pro/ect "" submitled h . ., .-
225 FIITH STREET eppro~aJ. do,,", not require speCffic',~~L PERIIIT APPLICATn14-ION
SPRINGFIELD, OREGON 97477 ~ fi'1\ \
INSPECTION REQUEST: 726-3769 ZR"'"J\r Ci ty Job Number .......\ C'{ .
OFFICE: 726-3759 Date 'r ~ / --
~ COMPLETE FEE SCHEDULE BELOV
lot O~~N, <>t\If~{~(\'i~)j- A.
\nLE~~~ ~\hrD'
A JOB ~SCRIPTIQ~\ <:.
~. tlH('IUlT,.J
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Supervisor License Number
Expiration Date
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name \ fu l\A (\ N \ 0 ~ t ') D.
Address \rAi\ f\\~+fullY)
City~ it Ph~e-.1~ k\.C{nC{s
OVNER \ I~ALLATION
The 'installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
1;'~-~-~n~~. --'~~~-------
DATE: re')~/O'i- J/ " _
RECEIPT #: .' ,~. . I
RECEIVED DY: / .I\~
New ResldLRtial-Single or
Multi-Family per dwelling
Service Included:
uni t.
Items
Cost
Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion $
thereof 15.00
Each Manuf'd Home or
Modular Dwelling
Service or Feeder $ 40.00
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
201 amps to 400 amps'
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see liB"
above
Branch Circuits
New, Alteration or Extension Per Panel
E.
One Circui t t.--' $ 35.00 ~o
Each Additional
Circuit or with Service
or Feeder Permi t .:l, $ 2: 00 ~o
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$ 40.00
$ 40.00
$ 20.00
$ 36.00
5.
A /,tW
~:2..PS-
.d~ ,os
SUBTOTAL OF ADOVE
5% State Surcharge
TOTAL
. .OB NO. Cf'2,IO"\'t
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: DAvID L, CoL.LE:Y
LOCATION:_ (,,'4, ~\(.~\-\--r~AWK L~~E:
I\O':::,Z:l'-t?- - 0\(000
DEVELOPMENT TYPE: Lt/'IS'-
w/eMf!?
BUILDING SIZE: ('H34
\
I. STORM DRAINAGE
A'-DO \'\ 10'/-..1
LOT SIZE
SQ. Ft.
IMPERVIOUS SQ. FT. 4-1~
2. SANITARY SEWER-CITY
NO. OF PFU'S (
(See Reverse)
3. TRANSPORTATION
X $0.192 PER SQ. FT.
C:~:1I?5. )
---- ----
X $39.78 PER PFU
01~~
NO OF UNITS X TRIP RATE X COST PER TRIP
X
..-
X $401.05
X $401.05
X $401.05
G-- ')
- --
X
$
X
$
SUBTOTAL (ADD ITE~lS 1,2, & 3) $?0"'l~'::-
4. ADMINISTRATIVE FEE~
BASE CHARGE (SUBTOTAL ABOVE) X .05
G \~ -\5.)
---- --
TOTAL-CITY SDC $ '''7'06''=>'-I
5. SANITARY SEWER-MWMC
NO. OF PFU'S x $13.62 PER PFU + $10 MWMC ADMIN. FEE $
(Use PFU Total From Item 2 Above)
~~i-.&-
\j Kfp Burdick
SDC Coordinator
'1:,k~/c('l--
I
$
TOTAL-MWMC SDC~ ~~
------
TOTAL SDC $ :;'5'0 ".:>~
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
FIXTURE UNIT CALCULATI! TABLE: Number of New Fixtures X ulqUivalent = Fixture Units (NOTE:
For remodels, calculate only the NET additional fixtures)
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
UNIT
EQUIVALENT
FIXTURE
UNITS
Bathtub..................................................................... .
Drinking Fountain.....................................................
Floor Drain.................................. ............. .................
Interceptors For Grease/Oil/Solids/Etc.................
Interceptors For Sand/Auto Wash/Etc..................
Laund ry Tub /CI otheswasher...................................
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For RefrigeratorJWater Station/Etc........
Receptor For Commercial Sink/Dishwasher /Etc..
Shower. Single Stall.................................................
Shower, Gang.......................................... ...............
Sink, Bar, CommerciaL........... . .............
Urinal. StaIIJWall..................................... .................
Wash Basin/Lavatory. Single....... ...............
Water Closet, Public Installation...
Water Closet, Private....... ........... ...
Miscellaneous:
2
1
2
3
6
2
6
6
1
3
2
l/Head
2
2
1
6
\ 4
-z.
I
L(.
TOTAL FIXTURE U,\JITS
/
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1.000
Assessed Value
Year
Annexed
Rate per $1.000
Assessed Value
'I'
'I
,
1___.
1979 or before
1980
1981
1982
1983
1984
$2.83
2.76
2.71
2.60
2.46
2.33
1985
1986
1987
1988
1989
1990
1991
$2.16
1.90
1.60
0.25
0.87
0.50
0.16
Improvement (if after annexation date)
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
CREDIT TOTAL = $
Credit for Parcel or Land Only If Applicable
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
Resident lal........................................................ 0.4
Commercial.............................................. ........ 0.9
I nd ustrial........................................................... 0.45
Governmental................................................... 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT