HomeMy WebLinkAboutPermit Plumbing 1992-3-2
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RES1DENTIAL
PE~MIT APPLICATION
IIl~JlCcliOIl~: 72G-3769
Ollico: 726-3759
ASSESSORS MAP:
LOT:
OWNER:
ADDRESS:
CITY:
DESCRIBE WORK:
NEW
REMODEL
CONTRACTOR'S NAME
GENERAL: _
.
SPRINGFIELD
..
Q';103./9
BLOCK'
of),.
ADDITION
Sr.vvu 1"' ^-^--"-;$
DEMOLISH OTH&,.!
JOB NUMBER
225 Filth Stmet
Sprinoliclrl, Oregon ~7j177
TAX LOT
) :}t-,O()
c...o I
SUBDIVISION:
PHONE:
jLI). J ~J)?
ZIP:
Ci7'flj
~/..-""'"
ADDRESS
CONST_
CONTRACTOR'
PHONE
EXPIRES
PLUMBING:
"dvl>t. " Yl
-----P.a. Bo)< -'""fex.)}.,} (P 7
_~~, ~ W)"'O'-L.__ .~3.o ._.
L/SLt -- 030?-,
- -
MECHANICAL
ELEcrnICAL:
QUAD AREA: .
II OF BLOCS: _
OCCY GROUP:
. OF STORIES:
WATER HEATER'
- OFFICE USE -
LAND USE:
. OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANGF'
,) )
_ .:n '1?-
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
rn3elc the same working day. Inspections requested after 7:00 a.m. will be made the following work day.
o Temporary Electric
o
Slto Inspection - To be made
after excavation, but prior to
setting forms.
D
Undcrslab Plumbing/Electrical/
Mechanical - Prior to cover.
I 1 Footing - Afler trenches are
excavated.
o
Masomy - Steel location, bond
bCl.\lllS, urouling.
o
Foundation - After forms are
crecte(l IJtil prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
o
Underlloor Plumbing/ Mechanical
- Prior to insulation or decking.
o
Post and Beam - Prior to floor
insulation or decking.
o Floor Insulation - Prlor to
decking.
o
Sanitary Sewer - Prior to filling
trench.
o
Storm Scwcr - Prior 10 filling
trench.
O Watcr 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 Wall/Ceiling Insulation - Prior to
cover.
o Drywall - Pr.ior to taping.
o Wood Stove - After installation.
o Insert - Aft~r fireplace approval
and installatIon ot unit.
o Curbcut & Approach - Alter
forms are erected but prior to
placement of COncrete.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material in place.
D Fence - When completed.
o Stroet Treos - When all required
trees are planted.
fV'f Final Plumbing - When all'
AJ plumbing work is complete.
D Final Electrical - Wtlen all
electrical work is complete.
o Final Mechanical - When all
mechanical work is complete.
o Final Building - Wilen all
required inspections have bcen
approved and building is
completed.
DOthcr
MOBILE HOME INSPECTIONS
o Blocking and Sel-Up - When all
blocking is complete.
o Plumbing Conncctions - When
home tlas been connected to
water and sewer.
o Electrical Conncction - When
blocking, set.up, and plumbIng
inspections have been approvc(j
and the home is connected 10
Ihe service panel.
D Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been installed.
Lot faces
Lot Type.
Lot sq_ Itg_
Interior
Lot coverage
Corner
Topography
Panllandlc
Total IlCight Cul-de.sac
BUILDING PERMIT
ITEM SO_ FT X $/SO_ FT.
Main
Garage
Carport
Tolal Value
Building Permil Fcc
State Surcharge
Tolal Fcc
(A)
PL
N
Sctb"lckS
HSE GAR Accl
I
." THE PROPOSED WORK IN THE \
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER? I
If yes, this application musl be signed
and approved by the Historlcal
Coordinator prior to pennil issuancc.
..L-___
Y:i-_~-
LL- _~ _ APPROVED-
BUILDING VALUE, PLAN CHECK
VALUE AND BUILDING PERMIT
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Rcsidential Bath(s) NO
Sanitary SCWCI
FT. ':;0'--
FT
Water
Slorlll Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovc/lnsertlFircplacc Unit
Dryer Vent
"
Mechanical Perlnit
Issuance
Stale Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demoli lion
State Surcharge
FEE
_.25,00
:::)c,_ no
I_d'S
;)f-,.,::l ,
Total Miscellaneous Permits (E)
TOTAL AMOUNT Du'E (cxclvding e,ectrica?;;;lio- ')~
(A, B. C, 0, and E Combined)
This permit is gran led on the express condition Ihat tile said
construction shall, in alllcspccts, conform 10 the Ordinance
adopted by the City of Springfield, including 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 Fcc:
Date Paid:
Receipt Number.
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties wllhin Ihe Cily limits which are being improved.
ADDITIONAL COMMENTS
By signature, I stale and agree, that I have carefully examined
the completed application and do hereby cerlify that all
Information hereon is true and correct, and I further certify
that any and all worl( performed shall be donc in accordance
with the Ordinances of the City of Springfield, and the Laws
of the Slate of Orenon pcrlninlng to Ihe work desctibed
herein, :tne.! tllal NO OCCUPANCY will lllJ made 01 ,my
stlucture wilhout pClln;s~;ion of the 8uildinU Safely Divi!.ion.
I further certify th~t only contractors and employees who
arc in compliance with OAS 701.055 will be used on tills
projecl.
I further agree to ensure that all required inspections arc
requested at the propcr time, that each address is readable
from the street, that Ihe permit card Is located al Ihe front
of the property, and the approved set of plans will remain
:~g~;j *n~s dur?7Z;_on
Oat; 3 - 2 - C; 1--
VALIDATION,
RECEIPT NUMBER
DATE PAin
AMOUNT RECEIVED
RECEIVED BY
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Issued by:
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Date: 3)-) h ",\
Permit No:
Address:
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 \"..-1 I own, reside in, or will reside in the completed':structure.
"
2. I
I understand that I must register as'a construction contractor if the structure is sold
or offered for sale before or upon' completion.
'y ~ I My general contractor is Q /'I /) ~ ~'J '\/'1 _ ~ ,r-, /
" I __- - -
3_ A.I
Contractor registration number I.:: Q ?;.ni
.'
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.I
I, 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
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
vhv. ~l) ~
'Sig'mHure of Permit Applicant
(,
'3/, Jro"
Date -
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFO.ATION NOTICE TO PROPERTY &ERS
ABOUT CONSTRUCTION RESPONSIBILITIES
\
1
NafE: 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 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 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 SI. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89