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Home My WebLink AboutPermit Building 1994-8-16 /~/ "2,7~~ :J~ DESCRIBE WORK- ,k/?~_") NEW REMODEL ~ ADDITION tI~,f!) . .. RESIDENTIAL PERMIT APPLICATION Inspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORt<. /"//Y? ASSESSORS MAP' LOT' . ~ 5 C) ~ ,a{::.. '- f' A?rr 2..2. /~ BLOCK: OWNER: ~ j),J ~ 'I-:f"h1.5r ADDRESS' CITY- CONTRACTOR'S NAME OuJA~ GENERAL: PLUMBING' MECHANICAl' ELECTRICAl' QUAD AREA: . OF BLDGS: OCCY GROUP- . OF STORIES: 5/(, N l/./ WATER HEATER' STAT'" ~ . JOB NUMBER 9~/10 7 A?~/)()?:/ DEMOLISH OTHER 225 Filth Street Springfield, Oregan 97477 _ TAX LOT' 8<"~~ SUBDIVISION' PHONF' ZIP' 774'77 ADDRESS CONST. CONTRACTOR . PHONE REQUIRED INSPECTIONS L~'ROU9h MechanIcal - Prior to . cover. t::71 Rough Electrical - Prior to ~cover. o Electrical Service - Must be approved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. ~Framlng - Prior to cover. 19'T Wail/Ceiling Ins~latlon - Prior to ~ cover. . J2Q"DryWall - Prlar ta taping. o Wood Stovo - After I~stallatlon. o Insert - After fireplace approval and Installatlan 'II unit. o Curbcu! & Approach - After forms are erected but prior to placemont of concrete. o Sidewalk & Driveway - After excavation Is complete, forms and sub.base material In place. o Fence - When completed. o Street Trees - When all required trees are planted. EXPIRES FLOOD PLAIN: ZONING CODE: ---'--1J.Af , . OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: Ta requesl an Inspectlan, yau must call 726-3769. This Is a 24 haur recardlng. All Inspectlans requested be fare 7:00 a.m. will be made the same working day, Inspectlons requested after 7:00 a.m. will be made the following work day. , - OFFICE USE - LAND USE: .1m o Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumbing/Electrical/ Mechanical - Prior to cover. o Footing - Alter trenches are excavated. o Masonry - Steel lacatlan, band beams, groutlng. O Foundation - After forms are erected but prior to concrete placement. o Underground Plumbing - Prior ta filling trench. O Underlloor Plumbing/Mechanical - Prlar ta Insulatlan or decking. o Post and Beam - Prior to floor Insulation or decking. o Floor Insulation - Prlar ta decking. o Sanitary Sewer - Prlar ta filling trench. o Storm Sewer - Prior to filling trench. o Water Line - Prlar ta filling trench. i'I\71 Rough Plumbing - Prior ta ~ cover. · OF UNITS' CONSTR. TYPE: HEAT SOURCE: RANGF' \/ij 1vr Final Plumbing - When .11 ~Iumblng w9rk Is complet,e. 'f;;;:71" Final Electrical - When all ~ electrical work Is complete.' I Final Mechanical - When all . (~echanlcal work Is complete. M Final Building - When all ~eqUlred Inspections have been appraved and building Is completed. o Other MOBILE HOME INSPECTIONS o Blocking and Set-Up - Whe[l all blacking Is camplete. o Plumbing Connections - When home has been connected to water and sewer. o Electrical Connection - When blacking, set-up, and plun;Jblng Inspections have been approved and the home Is connected to the servIce panel. o Final - Alter all required Inspections are approved and porches, skirting, decks, and venting have been Installed. J .\' .~;, Lat ~ype. ... Lot faces Lat sq. Itg. Interior I p.L. IN Lot coverage Corner Is Tapagraphy Panhandle Iw Tatal tlIllght Cul-de-sac IE BUILDING PERMIT ITEM SQ. FT. X $/SQ. FT. = VALUE Main Garage Carport Tatal Value Building Permit Fee State Surcharge "3'P,.~~/IV' (A) Tatar Fee " /::J,A3-Q ::2D,S"O I,q? 'cO~ ,..,..... '''' ---. (B) SYSTEMS DEVELOPMENT CHARGE (SDC) L/~~ PLUMBING PERMIT ITEM Flxl,ures <' Residential Bath(s) N' Sanitary Sewer FT. Water FT. Storm Sewer FT. Mabile Hame Plumbing Permit Stat~. Surcharge Tatal Charge (C) MECHANICAL PERMIT Furnace Exhaust Haad ".{OU~tAi7-cfiF Vent Fan NO Wood Stove/Insert/Fireplace Unit Dryer Vent Mechanical Permit Issuahce State'Surcharge Tatal Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It Curbcut It Demalltlan State Surcharge Tatal Mlscellaneaus Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Camblned) FEE '? eJ_~ /.50 co" .. - ':<:2.~O ,? .i.'7d~ ~ -~ ~ --. ,'J':' $.E1]~ ~ 7,.~S -;;'.' ':,. .~", : ~ ,; 'if: ~ ,;. ':;:"}' , . .'Y- :"'~;'~ . . '. ;>., , _S THE PROPOSED WORK IN ;HE o. HISTOI'lICAL DISTRICT, OR ON THE HISTORICAL REGISTER? II yes, this appllcatlan must be signed and appraved by the Hlstarlcal Coordinator prior to permit Issuance. Setbacks . HSE GAR ACC. APPROVEf" BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit Is granted an the express canditlan that the said construction shall, 'In all respects, conform to the Ordinance adapted by the City. 'II Springfield, Including the Develapment Cade, regulating the canstructlan and use 'II buildings, and may be suspended ar revaked at any time upon violation of any provisions of said ordinances. Plan Check Fee' /3,H Date Paid: Receipt Number: Received By: /~ Plans 'Reviewed By ~~.r/f~ -'/oaljl' / . Systems Develapment Charge,ls due an all undevelaped praperties within the City limits which are being Impraved. ADDITIONAL COMMENTS / AlT5e /~ I< / (7'.-#70;;,) A~t7:dd DI' )Lv. ,/ By signature, I state and agree, that I have carefully examined the campleted apptlcatlan and da 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 Ordinancus 01 the City 'If Springfield, end the Laws 'If the State 'II Oregan pertaining ta the wark described herein, and that NO OCCUPANCY will be made 'If any structure without permission of the Building Safety Division, I further certify that only contractors and employees who are In campllance 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 fram the street, that the permit card Is lacated at the rrant of the property. and the approved set of plans will remain an the site at ~Imes ~ur?J1n ca tructian. .K Slgnatu~L... J. ,.. (' Sig ----.,.. , _ . Date'PI fa -a 4" J VALIDATION: RECEIPT NUMBER DATE PAIf' AMOUNT RECEIVEn RECEIVED BY /~33~ ~ -/G -5'~ , o 7tIP @ /~ . . . Permit#: 9f//07 Address: ~~~ P!t.F=7t..~,,6d'"J"" . . ./ Issued by: Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement 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 appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~ ~ D 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. 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 ~ 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 ~ PrJperty O~~t Construction Responsibilities on the reverse side of this form. ~Y"/VVI~ ft/VI~ P//?,-t:{4 ~ I (Signaiure of permit applicant) '(Date) (White copy to issuing agency permit file, pink copy to applicant) . . .. '. '- "- rrl11ioi'mal~ioB'lNo~ica io Pmpaiiry Ownars . Aroo!J~ COU1sii'!.Dc~ioi1 fRaslPlolnsDlbliii~ias ........ . .. - -- "'........, ~. - . ...." ,-... Note: This lnformation Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5): 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 RIESPONSIBILlTIES: 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 Dept. 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 Employment Division at the Department of Human Resources at 378-3524. / 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 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 information, call the Internal Revenue Service at 1 -800-829-1040. 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 inspectians. " 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 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 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 1/94