HomeMy WebLinkAboutPermit Mechanical 1997-10-22
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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SPRINGFIELD
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JOB NuMBER' "9 ?/S-39
225 Fifth Streel
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK: $(-~ I ",b/>:t/~
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ASSESSORS MAP' /?,~:s '2~-/::2
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. TAX LOT' CJ///?
OWNER: /d...:d: .~ lJ,_"a,./ ~
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ADDRESS: 'X:J..I 'luY1-t;~""'7w!1 ~
CITY: ~ ./;,u STATE: . t9 t?
DESCRIBE WORK' ~_LP~ A..t.A>~ .tb~-:2u ~
NEW:>< REMODEL ADDITION DEMOLISH OTHERJ2..r'....~~~.u4_.
l-P 9114 ~ Y""~'1J" ~
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CON ST.
CONTRACTOR'
LOT'
CONTRACTOR'S NAME
GENERA' .
PLUMBINr-.
MECHANICAL: ~J4?f/~)':<'
ELECTRICAl'
<
QUAD ARE..'
. OF BLDGS'
OCCY GROUP'
. OF STORIES:
WATER HEATER'
BLOC\<'
ADDRESS
- OFFICE USE -
LAND USE:
· OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANG~'
SUBDIVISION'
PHONE:
?J/~ ~ J.f9t?S
ZIP: ---.!t7 ~7 7
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EXPIRES
.~
PHONE
FLOOD PLAIN'
ZONING CODE:
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be
made the same working day. Inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
settlng forms.
o Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
.beams, grouting.
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to IIIl1ng trench.
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
O Floor Insulation - Prior to
decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
O Water Line - Prior to lilling
trench.
(jI a.. 0 Rough Plumbing - Prior to
7). cover! .
[EJ Rough Mechanical - Prior to
~~c$.#5
o Rough Electrical - Prior to
cover.
o Electrical Servlca - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing lnsp.
o Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Slovo - After Installation.
o Insert - After fireplace approvlll
and Installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
o Fence - ""/hen completed.
o Street Treos - When all required
trees are planted. .
o Final Plumbing - When all
plumbing worl( Is complete.
. .
..-18. D Final Eloctrlcal - When all
... electrical work Is complete.
ri/1 Final Mechanical - When all
~ ?#~ &~omPlete.
o Final BUilding - When all
required InspectIons have been
approved and building Is
completed.
o Other
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MOBILE HOME INSPECTIONS
o BI~ck~ng and Set.up",- When all
blocking Is complete.
o Plumbing Connections - When
home has been connected' to
water and sewer.
o Electrical Connection - When
blockIng, set-up, and plumbing
Inspecllons have been approved
and the home Is connected to
the service panel.
o Final - After all required
Inspections Bre approved and
porches, skirting, decks, and
venting have been Installed.
I Lot Type' . ':{
I Lol faces
Lot sq,' Itg. Interior
.
Lot coverage Corner
Panhandle ,.
Topography
Total height Cul.de.sac
BUILDING PERMIT '11 " '1
ITEM SO. FT. X $/SQ. FT. a
Main
Garage
Carport
Tolal Value
Building Permit Fee
Slale Surcharge
TOlal Fee
(A)
Setbacks.
I P.L. 'HSE I GAR' Ace I
I N I I
I S I I
Iw I I
I E I I
BUILDING v~Ll1E, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that lhe said
construction shall, In all respects, conform to the Ordinance
adopted by the City of Springlleld, Including the
Development Code, regulating the constructlon and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
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VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
/ ') -::>
~. ~,.->
7'-~' ~~
. . .
:?cG.A~
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary S~wer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
Stato Surcharge
TOlal Charge
(C)
MECHANICAL PERMIT
Furnace 7/i~.P##~ ~.
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/ Fireplace Unit
Dryer Vent
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Mechanical Permit
Issuance
State Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcul
It
Demollllon
Slate Surcharge
Tolal Miscellaneous Permlls (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
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.( .HE PROPOSED WORK IN THE.
-HISTOFiICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issu,ance.
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APPROVED'
Plan Check Fee'
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge Is duo on all undevelopod
properties within tI,e City limits which are being Improved,
ADDITIONAL COMMENTS
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By slgnalure, I stale and agree, lhat I have carefully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and I further cerllty
that any and all work performed shall be done In accordance
with the Ordinances of the City of Sprlnglleld, and the Laws
of the State 01 Oregon pertaining to the work described
herein, and thai 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 approved set of plans will remain
on the site at all times during construction.
Signature ~4~' '.77, &.e:/
Date / tJ- ;<:2. - 97
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVE!"
RECEIVED BY
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Pennit#: <97/539'
Address:...z< 2/ ,dk;q7'.#,?r/7:l:?6 ~..6'_
Issued by: ~ M Jr .. ~ Date: _ /~ .::? ::2 . '9?
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Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4). requires residenlial construclion permi/ appli-
canis who are not regislered with Ihe Conslruclion Conlraclors Board to sign the
following s/atemenl before a building permil can be issued. This stalemen/ is required
for residenlial building. eleclrical, mechanical, and plumbing permils. Licensed
archilecl and engineer applicanls, exempl from regislralion under ORS 70 1.010(7),
need nol submillhis slalemenl. This slalemenl will be filed wilh Ihe permil.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
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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 or offered for sale
before or upon completion.
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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
[] 38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If [ 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 pemlit 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 Property Owners about Construction Responsibilities on the reverse side ofthis form.
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(Signature of permit applicant)
/6- ;27-- 9'7
(Date)
(While copy 10 issuing agency permit file,
pink copy to applicanl)
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ni11ormal~~on NG~ice ~o Pllopeiiy Owners
Arool.J~ Cons~lli.llctioil ResLOolTIIsirom~ies
Nole: This Informlllion .vo/ice 10 Properly Owners ahoul Cons/rllclion Responsibililies
was developed by Ihe Conslrlle/ion Con/racial's BaliI'd in accordance I1'ilh ORS 701.055(5).
If you are acting as your own contractor to conslruct 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.
EilIiPLOYER RESPONSIBILITIES:
If you hire persons not registered with Ihe Construction Contractors Board to do labor in constructing or assisling in the
construction or improvement ofa residential struclure. you "ill. in most ins lances. be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon'swithholding tax law: Asan employer. you must wilhhold income taxes from employee wages at Ihetime employees
are paid. Von will be liable for the tax paymenls even if you don'l actually withhold Ihe tax from your employees. For more
information. call the Oregon Dep!. of Revenue at 945-8091.
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 Employmenl Department at 378-3524.
Workers' compensation insurance: As an employer, you are subject to Ihe Oregon Workers' Compensation Law, and must
obtain workers' compcnsation insurance for your employees. If you fail to oblain workers' compensation insurance, you may
be subject to penalties and will be liable forall claim costs if one of your employees is injured on the job. For more informalion.
call the Workers' Compensation Division at Ihe Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Sen-ice: As an employer, you musl withhold federal income lax from employees' ....ages. You will be
liable for the lax payment even if you didn't actually withhold the lax. For more information. call the Internal Re\enuc Service
at 1-800.829-]040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project. you are responsible for resolving any failureto meelcode requiremenls
that may be broughl 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. tire. on,ork Ihat musl be
re-done.
Time to supcn-ise employees: Make sure you have sufficient time to supervise your employees.
Expcrtise: Make sure you have theexpertiselo act as your own general conlraclor, to coord inate the work of rough- in and finish
trades. and to notify building ofticials at the appropriate times so they can perform Ihe required inspections.
If you have additional questions. write or call thc Construction Conlraclors Board (PO Box 14140, Salem. OR 97309-5052.
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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