HomeMy WebLinkAboutPermit Mechanical 1999-9-1
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
LOCATION OF PROPOSED WORK: -Lo ~ If C ,'" ;/
ASSESSORS MAP' /70 '3 j If ;Z 2.- ' .
LOT'
CITY'
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990 =i7t/
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT' OS$' l'~
SUBDIVISION:
BLOCK:
STATE:
PL
OR
OWNER' ;r}/l, "j)(//( CP"I.!
ADORES!" . / /'l .? q 0 A K f/Yle A cI l'JUJ . P
'-:'P..f'rV
OESCR/BE ORK' fI~1 .t7tMf#.
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NEW I REMODEL ,1~ODFIi10NL vuu tu DEMOLISH
^-rrI=NTIOI\l:U'''~v'. ;~_ n,,,nnn UtilitY
~I W rules aool""U VI'" \ s are set Ton"
CONTRACTI ,Q.~.tJ~M~enter. 'Those rUheO~D.DRE~)1'
NO liiCallc" 010 throug ~. vv-
GENERAl 'nnAR~2-001-0. '. ~_n;,,"nttherulesbY
n090. YOU may UUlU'" - ~ie: the telept10~'"
PLUMBING:'" \l" __J.....,...,...ontAr.(N .. _..:I..:....~t1"n
....(11111~~..-... r gonUillILY''-l''.n'''-~
MECHANICA,,"mbBl~~~ "'r/}),,1_~444' .., LJ T) ,., ....
~Cef1tP"-I~ ,-~.... , 'V'
ELECTRICAl'
QUAD AREA-
. OF SLOGS:
OCCY GROUP'
. OF STORIES:
WATER HEATER'
PHONE: -.6 1',( - ,{)7 qr;
.-
ZIP: ('. -; '-'l~-?
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OTHER
CONST.
CONTRACTOR' EXPIRES "" PHONE
in-:2..')'}-) /O-j-Od
N01'ICE:
THIS FERMITg=ft}:/a~ t;=7Hc~if0fU~
A0T.IORIZED ~ERMFH&NST
GGMMENCEDOO~~lIID('IM!:n !:nf.l
ANV 1/10 DAY Fm8WARY HEAT:
SOUARE FOOTAGE:
- OFFICE USE -
LAND USE:
. OF UNITS:
CONSTR. TYPE:
HEAT SOURCE:
RANGF'
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All Inspections requested belore 7:00 a.m, will be
made the same working day. Inspections requested after 7:00 8.rn. will be made the following work day.
D Temporary Electric
D Slto Inspection - To be mado
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underlloor Ptumblng/Mechanlcal
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking. '
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to Hlllng
trench.
D Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mochanlcal - Prior to
cover.
D Rough ElectrIcal - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping,
D Wood Stov. - After Inslallallon.
D Insert - After fireplace approval
and Installation of unit.
D CurbclIt & Approach - After
forms are erected but prior to
placemont of concrete.
D Sidewalk & Driveway - After
excavation Is compiete, forms
and sub-base material In place.
D Fence - When con,pleted.
D Struet Trees - Wh~n all required
trees are planted. .
C ~~I Plumbing - When all
p~umblng W9rl( Is complet.e.
D Final Electrical - When all
electrical work Is complete.
/'fJ Flndl Mechanical - When all
~6chanlcal work Is complete.
D Final Building - When all
required Inspections have been
approved and building Is
completed.
DOthar
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete,
D Plumbing Connoctlons - When
home has been connected to
water and sewer;
D Electrical Connection - When
blocking, 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
porchos, skirting, decks, and
venting have been Installed.
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"
L~l ~yp. ';.' , .:.:.< 1?1 :\,:i:\:1 _S THE PROPOSED WORK tN THE.
....';.1:,""
Lot faces Setbacks,
Lot sq. ftg. Interior I P.L. H$EIGAR ACe' I 'HISTOJ:lICAL DISTRICT, OR ON
- I I THE HISTORICAl, REGISTER?
Lot coverage Corner ..t!- _,. If yes, this appll~atlon must be signed
" S I Clnd approved, by the Historical
Topography Panhandle I Coordinator prlot to permit Issuance.
Total height Cul-de-sac _V1.__
E I APPROVEP'
BUILDING PERMITi
ITEM SO. FT.
'~
"
x $/SO, FT. =
VALUE
Main
Garage
"
Carport
Total Value
Building Permit Foe
State Surcharge
Total Fec
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
FIxtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
Storm Sewer
FT,
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stove/lnserll Fireplace Unit
DrY"'J:i- tV!',/?
MechanIcal Permit
J,) ~
If'W
JV,r),)
;,)7/
2C..w
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
01
TOTAL AMOUNT DUE (excluding clectrlcal)
(A, B, C, 0, and E COmbined)
. .r..,. ..~ 'I.
BUILDING VAL\:JE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on tho express condltJon that the saId
construction shall, In all respects, conform to the Ordinance
adopted by the City, of Springfield, Including the
Dovelopment Code, regulating the constructlon and use of
oulldlngs, and may be suspended or revoked at any tIme
upon violation of any provisions of said ordinances.
Plan Check Fee:
Date Paid:
ReceIpt Number.
Received By:
Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS /7
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By signature, I stale and agree, that I have carefully examined
the completed application and do hereby eertHy 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 Ordlnanc~s 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
arc In compliance with ORS 701.055 will be used on this
project.
I further agree to ensuro 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 ali tlm2. during construction.
s,gnaturo4~~~
Date q _ J - c; q
,
VAI.IDATION:
RECEIPT NUMBER' !l? )'/ ()LI
DATE PAID q /1 I q 'f
AMOUNT RECEIV~D 17 JC.fP
RECEIVED BY ,A/ ~
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Permit#: ~~~V
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Address: / DL q ()a.~ h1 jadO~
Issued by: /2 ~ - Date: q/L)..!qC/
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Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential cons/ruction permit appli-
cants who are not registered with the Cons/ruction Contrac/ors Board to sign the
following statement before a building permit can be issued. This sta/ement 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 submi/this statemen/. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
52J
D
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,
D
3 A. 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
D, 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I 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 permit 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 about59Jtruction Responsibilities on the reverse side of this form.
~---/~~ ~q7'7
./(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
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~i1l1o~maJ~DOI1'O i\lOl~ice to I?l1'opel1'iy Ownel1's
AlOoll~ COI1'ilS~I1'IUICiiOil Respoi1lsDlOiii~Des
......, ."
Nore: This Informa/ion No/ice IO.Prop'erry Owners about Constructioll Respollsibilities
was developed by the COllstructioll Contractors Board in accordallce with ORS 701.055(5).
If you are acting IL~ your own contractor to construct a new home or make a substantial improvement to lID 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
infonnation, call the Oregon Ocpt. of Revenue at 945-8091.
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurancc purposes on the
wages of all employees. For more infonnation, call the Oregon Employment Department at 378-3524.
Worker's 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 infornlation,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
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 infonnation, call the Internal Revenue Scrvice
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the pennit 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 punctures, fire. or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise our employees.
Expertise: Make sure you bave 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 al'l',vl',;ate times so they can perfonn the required inspections,
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309.5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem
prop~own.pm4
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SP.Q01