HomeMy WebLinkAboutPermit Building 1992-1-23
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CITL~ '.R7A'LUVJ 'AI'll STATE: c:P~ ZIP: <?'7-Y'55"
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. I ' /
REMODEL ADDITION DEMOLISH
'-
., ~ ~ \t.
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK'
ASSESSORS MAP'
1'7/'/<'
LOT'
DESCRIBE WOR)<'
NEW X.
CONTRACTOR'S )lAME
GENERA" (YlA}-vrM,,/
PLUMBING: AihiJ Fl~
MECHANICAI,;J/AJ..ri.R.A.....
ELECTRICAl' - ,^7f7/Cr t:fftT
QUAD AREA:
. OF BLDGS:
/
;::-~
Z
C<'=7.
OCCY GROUP:
. OF STORIES:
WATER HEATER:
.
.
q//4'7~
SPRINGFIELD
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
10A7L ))A-/J~
??
OTHER
ADDRESS
CONST,
CONTRACTOR'
PHONE
,
.,
- OFFICE USE -
LAND USE:
//2-n
?
EXPIRES
FLOOD PLAIN:
ZONING CODE:-L?!.DR
. OF BDRMS' Z X '3
SECONDARY HEAT'
SQUARE FOOTAGE: 2,"11)1
TO request an inspection, you must call 726-3769. This Is a 24 hour recording. AI/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.
o Temporary Electric
r:;zr Site Inspection - To be made
~fter excavation, but prior to
setting forms, ser"'~<::J
o Underslab PlumblnglElectrical1
Mechanical - Prior to cover.
lV'r Foo~lng - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting.
K/1 Foundation - After forms are
~rected but prior to concrete
placement.
K71 Underground Plumbing - Prior
l,.C:!-to filling trench,
1V"f Underlloor~rfIeChani~
~ - Prior to Insu a on or aecKing.
~ Post and Beam - Prior to floor
~Insulation or decking.
-t=:::71 Floor Insulation - Prior to
~decklng,
l'VI Sanitary Sewer - Prior to filling
~trench.
'"F;7I Storm Sewer - Prior to flIUng
~ trench.
)';7f Water Line - Prior to filling
~trench.
fC7f' Rough Plumbing - Prior to
~cover.
. OF UNITS'
CONSTR. TYPE: 2.6/
HEAT SOURCE:S ~.H.:.~_
RANGE: :&:=> /:'--7' .
REQUIRED INSPECTIONS
~ Rough Mechanical - Prior to
cover.
~ Rough Electrical - Prior to
~cover.
K::7f Electrical Service - Must be
~ approved to obtain permanent
electrical power.
o Fireplace - Prior to facIng
materials and framing Insp.
~ Framing - Prior to cover.
~Wall/Ceillng Insulation - Prior to
~ cover.
~ Drywall - Prior to taping,
o Wood Stove - After Installation.
D Insert - After fireplace approval
and Installetlon of unit.
K7I Curbcut & Approach - After
~ forms are erected but prior to
placement of concrete.
L><f Sidewalk & Driveway - After
....xcavation is complete, forms
and sub.base material In place.
o Fence - When completed.
D Street Trees - When all required
trees are planted.
~ Final Plumbing - When all
~plumblng work Is complete.
~ Final Electrical - When all
...L::::::::=:L electrIcal work is complete.
~ Final Mechanical - When all
~meChanlcal work Is complete.
1':J( Final Building - When all
~ required Inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete,
D Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
biocking, set.up, and plumbIng
Inspections have been approved
and the home is connected to
the service panel.
o Final - After all requIred
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot TYP" ,-'
Lot faces -5.- Setbacks .S THE PROPOSED WORK IN THE
Lot sq, ftg, ~~ Interior I PL. HSE GAR ACC I HISTORICAL DISTRICT, OR ON
II I I THE HISTORICAL REGISTER?
Lot coverage 25.~ Corner N If yes, this application must be signed
L217, S 4fp' I and a p proved by the Historical
Topography Panhandle Iw I Coordinator prior to permit issuance.
Total height ~ ~de.sac 5'
IE ,S', I APPROVED:
BUILDING PERMIT
ITEM SQ, FT,
X $/SO, FT.
3'7. 7 c
,4./,0
VALUE
:L7~~.~t:J
te.4U.I)D
Main
24ft
-(bf)
Garage
Carport
/03i9L~':
4317.5
7/.J7
1fp/.7f
SYSTEMS DEVELOPMENT CHARGE (S~~ta'
(B) 'll:l:>1:l:>8-
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
PLUMBING PERMIT
ITEM
FEE
Fixtures
? I ~
Residential Bath(s)
N' :;2. -f- 2.
,?,ZD,lJtJ
Sanitary Sewer
FT,
FT,
Water
Storm Sewer
FT,
Mobile Home
Plumbing Permit
State Surcharge
Ih"t)
'<{'3fo~
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
z
<9,<'>0
J;, t:JO
Vent Fan
N'
/...
Wood Stove/lnsert/Fireplace Unit
Dryer Vent
2.
t'o 8-0
Mechanical Permit
33 (X)
/ C) #t)
/./'5"
.44.t05
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
J~ ,2S-
--1-1-.5'0
Sidewalk
;?"I"
~()
ft
ft
Curbcut
Demolltion
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
.-f[J/o. 40
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the e;-c.press condition that the said
construction shall, in all respects, conform to the OrdInance
adopted by the City of Springfield, nicluding the
Development Code, 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: N>>",~ ~ 4eJ
F
1'7 -/'j-~
Receipt Number' <'7)""
Receive~~~/Y)
Pian Revi ewed By
Date Paid:
~~~-
ate
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
IMLVe .6~, &~/Z> /~~O<P
I
,
I
By signature, I state 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 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 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 e" :r:ng c/,?~:t1~~, ;/
XSlgnature L ({/,// AYl/uLt/r
/ - ..:z3- ,?,p--
Datp
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
'?.)~ 7
I - '2 "l -Y>z.
d2.JI'L ~f)
~~'L
RECEIVED BY
. . JOB NO. '11l4iP,
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET '
(COMMERCIAL & RESIDENTIAL),
NAME OR COMPANY: ~\c..l-\t>.~ ..;. ,?1-\\\2-L-E.Y CooMt-€.\2..
LOCATION: (,,-c::.o e (0'3'2- ClA~Ot>.L.C
\1 0 ~ '"2- '2- '-{ "2- - 1"':>00
DEVELOPMENT TYPE: Moe.- t-..Ie:.w DuP\....E;,)(
e...."c,.. DW
BUILDING SIZE: "'7..,<ld-l '-1-(,,-,1.'2.4
LOT SIZE
SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT, ?1'::>L.. X $0.186 PER SQ. FT. ~ '?BCa'2..1.
(See Reverse For Runoff Coefficients If Actual Imperv. Area Is Unknown)
2. SANITARY SEWER,CITY
NO. OF PFU'S ?:;>-z.. X $38.55 PER PFU
(See.Reverse To Determine Total PFU'S)
$ I').?~b~
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
-z..
X \.ooS X $388.61
$ ,el ~
X
X $388.61
$
X X $388.61 $
(See Attachment C To Determine Trip Rates) I
SUBTOTAL (ADD ITEMS 1,2, & 3) $ 2-boo'l!
4. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE) X .05 5 I'?o~
TOTAL.CITY SDC 5 "2,,?1 ~
5. SANITARY SEWER,MWMC
NO. OF PFU'S
"?'2. x 513.25 PER PFU .;- $10 HI.me ADMIN. FEE $ '-+~'+~
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
~.~L~
'~ Kip Burdick
SDC Coordinator
('d"]..7/Q I
5 u,~
TOTAL,MWMC SDC. $ '-101'2.:=
TOTAL SOC $ ?1?B~
FIXTURE UNIT CALCU.'ON lABLE: Number of New Fixtur. Unit Equivalent = Fix1ure Units (NOTE:
For remodels, calculate only the NET additional fixtures)
FIXTURE TYPE
NUMBER OF
NEW FIXTURES
UNIT
EQUIVALENT
Bathtub........ ......,... .................... ........ ......... ...............
Drinking Fountain..,..,...... ................, ........,.. ....... ...",
Floor Drain.................,.. ...,.......................... ........., ...,
Interceptors For Grease/OU/Solids/Etc................,
Interceptors For Sand/Auto Wash/Etc.................,
Laund ry Tub /Clotheswasher............. ....., ................
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, StaIlJWall.........................................,..........,.,
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
'2.-
'2-
2-
1.1-
Ll
TOTAL FIXTURE UNITS
=
FIXTURE
UNITS
't
'-f
of
'-I
Ie..
"::>'2-
Based on assessed value, If improvements' occurred after annexation date in table,
CREDIT CALCULATION TABLE:
calculate credits separates.
r
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed,
1979 or before
1980
1981
1982
1983
1984
$2.66
2,64
2,53
2.41
2,19
2.04
1985
1986
1987
1988
1989
1990
Credit for Parcel or Land Only If Applicable '2-, (",1.0 X $ \ 0,0 b "2..1.0 "7~
(Rate X Assessed Value)
Improvement (if after annexation date) X $ =
(Rate X Assessed Value)
CREDIT TOTAL = S
RUNOFF COEFFICIENTS FOR STORM DRAINAGE
ResidentiaL..... ....,.......,..,..",..,.........."..,.."..,.. 0,4
CommerciaL....,......,....,..,..,....,..",.."..""..,....,. 0,9
Industrial.....,.. .....,..., .........""....,......",..,...,.,..... 0,45
GovernmentaL..,..."....,.."......",.................",.. 0,5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
Rate per S 1,000
Assessed Value
$1.69
1.35
1.15
0,92
0,59
0,23
.
. .
..
\.
.
.
Permit No:
4/ /".-f 70
r I ( (' -
Address: .{~C:-o - '::;'2 ;),i;}-z' )"r/ r
Issued 'by: ~ Date: /-2 ]-'7z.
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 or 3B:
1, I--::.,.,.--j I own, reside in, or will reside in the completed structure,
~ -.
I
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,I
I My general contractor i~
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..r -=-::::1' 1. will be my own general contractor,
, If I hire subcontractors, I will hire orily subcontractors registered with theiConstFuc'
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
rever~~ ;:~. () Jiihu/t; / -;J 3 7:J-
.......Sigmillfre of Permit Appiicani Date
/
CONSTRUCTION CONTRAC1ORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
, '
.
INFO.ATION NOTICE TO PROPERTY IvNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
~
.
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 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 Withholdinfl 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 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 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