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Home My WebLink AboutPermit Building 1995-4-18 C6M~ ERCIAL/I N DUSTRIAL. PERMIT APPLICATION 225 Fifth Street, Springfield, Oregon 97477 SPRINGFIELD ~ · JOB NUMBER 9 <:::;""1) ;7'71 INSPECTION LINE: 726-3769 OFFICE: 726.3759 <'.P,r......<. f- <.\d (1. \.I)) TAX LOT: -..C cQ2Q J LOCATION OF PROPOSED WORK'{' \'63(' I '){)3Q fnA.. -:l.., \)\(:IV\e'CIL P0JI<--..Jc..-.J I ASSESSORS MAP: OWNER: \('(0;'" ADDRESS: .:lClll CITY' C/\(-,C,^ <. V'-\.G<.'\ "" e. '-'V C, l....c.""'d(''''- PHONF' -G~5 ,Ion ~59 s:T STATE: ("J ZIP: C, 1'-/0") DESCRIPTION OF WORK:' }.. LN\OO 0!L R a..p..J\.f)' ~ NEW REMODEL ADDITION..I DEMOLISH OTHER VALUE: M;")o " <> ( . NAME ADDRESS PHONE ARCHITECT: t .! CONTRACTOR'\N\~~ 1\ ..l..-ADDRESS GENERAL: '^~\'\.dllF Cl . \ 'ro.llJ\.. PLUMBING: ""~o_\\~~b MECHANICA' . ...."" ELECTRICAL: (.<.<... \\\l \.\(\ YJ..Q~r^,l U'_) CONST. CO NT RACTO R . l~tfO ~ 0\ (01&\ "\1~J)~ PPIRES ~o~ \I\'tI.q~ 10 . 1 -y \ \ .o\~ ~,\f).?fffi . ~- :~'Ff.lV~ 4\o\-~ PLUMBING I I MECHANICAL I NO, FEE CHARGE I I I EEE-I-CHARGEl / Single Fixture I Furnace/burner & vent <100,000 BTUs Relocated Bldg. I I I Furnace/burner & vent I (new fix. addtll > 100.000 BTUs Water Service I I Floor furnace and vent I ft. Sanitary Sewer I I Suspended wall or lIoor ] II. mounted unit healer Storm Sewer I I Appliance Vent I II. separate I I I Stationary evap. I Backflow Device cooler I I I Vent Fan/Single I duct I I I Vent System apart I from AC or htg. I I I I I Mechanical exhaust I I hood and duct I I / I 7'lfr~A'7;O> ~~~ I I ~ I I PermIt Issuance $10,00 j TOTAL PERMIT fl'l/N /5':- I I TOTAL PERMIT ~~. /."i': -I OUAD AREA: I{\n')lt) - OFFICE USE - LAND USE: ....c:<. WC) HANOICAP ACCESS: . OF BLDGS' . OF UNITf" ZONING' FLOOD PLAIN' (l {I ./ OCCY GROUP' . OF STORIES: CONSTR. TYpo. HEAT SOURCF' LIGHTING POWER BUDGET: WATER HEATER: sa. FT. $/SO. FT. VALUE SQ, FTG MAIN SQ. FTG ACCES" SQ. FTG OTHER x x X PLAN CHECK FE<; ? 4. <13 - = RCPP .J'7 /)lJ I TOTAL VALUE OF PROJECT ~ (TO DATE_1/(y9r BY ~ I BUILDING PERMIT I 15% Slale I Surcharoe I MECH~AL I~? I 15% Sl;'~~ I Surcharae :,... ~ I PAVING I 'IY- 9" '::l_ :lI:':;J /.3"1' /U.-- /..;; ,- .7:Y _ V'o!;'" , PLUMBING ~I J"9 /:5":~ .;::>::>~ .~"7 . DEMOLITION I j I I I ffll 5% State Surcharoe I' FENCE VALlI~ $ I SIDEWALK I CURBCUT FT. FT. SUBTOTAL PERM ITS I SYSTEMS DEVELOPMENT o TOTAL PERMIT FEES I EXCLUDING ELECTRICAl 9?'. "7 . REQUIRED INSPECTIONS . i ..... ..._." It is the responsibility of the permit holder to see that all Inspections are made at the proper time. To request an Inspection, call 726.3769 (recorder). state your City designated job number, job address, type of Inspection requested and when you will be ready for Inspection. Requests received before 7:00 a.m. witl be made the same working day, requests made after 7:00 a.m. will be made the following work day. SITE INSPECTION: To be made after excavation, but prior to setup of forms. y ROUGH PLUMBING. ELECTRICAL & MECHANICAL: No work Is to be covered until these Inspections have been made and approved. PAVING: After gravel Is In place but prior to placing asphalt or concrete. / FIREPLACE: Prior to placing facing materials and before framing Inspection. SPECIAL INSPECTIONS: In accordance Section 306 of the State Specialty Code a special Inspector shall be employed by the Owner/ Contractor during construction of rhe following work. A copy of the special testing reports shall be furnished to the Building Division. UNDERSLAB PLUMBING, ELECTRICAL & MECHANICAL: To be made /;~~)~~ed. FOOTINGS & FOUNDATIONS: To be made after trenches are excavated and forms are erected, all steel in place, but prior to placing concrete. ATTIC DRAFT STOPS & CURTAIN WALLS / FRAMING: To be made after the roof, all framing, fire blocking and bracing are In place and all pipes, chimneys and vents are complete and the rough electrical, plumbing and mechanical are approved. STRUCTURAL CONCRETE: In excess of 2500 PS.1. (306 a.1) CONCRETE SLAB: To be made after all Inslab building service equipment, conduit, piping, accessories and other ancillary equipment items are in place but before any concrete Is placed. STRUCTURAL WELDS: Performed on the job. (2722 f) UNDERGROUND: Plumbing, electrical, gas, sanitary sewer, storm sewer, water and . d ral nage II nes. To be made prior to covering or filling trenches. INSULATION & VAPOR BARRIER: To be made after all Insulation and required vapor barriers are In place but before any lath or gypsum board Interior wall covering Is applied. HIGH STRENGTH BOLTING: During all bolt Installation and tightening operations. (306 a.6) SPRAYED ON FIREPROOFING: U.B.c. Standards 43.8. UNDERFLOOR: Plumbing, electrical, mechanical. To be made prior to installation of floor Insulation, decking or floor sheathing. FIRE & SEPARATION WALL: Located and constructed according to plans. SPECIAL GRADING, EXCAVATION AND FILLING: During earthwork. (306 a.11 & Chapter 29) y LATH AND/OR GYPSUM BOARD: To be made after all lathing and gypsum board, Interior and exterior, Is In place but before any plastering Is applied or before gypsum board Joints and fasteners are taped and finished. GLU.LAM BEAMS: Inspection Certificate by an approved agency, furnished to the Clty's Building Division before beams are placed. (2501 U.S.G. STDS. 25.10,11). POST & BEAM: To be made prior to Installation of floor insulation, decking or floor sheathing. FLOOR INSULATION & VAPOR BARRIERS: To be made prior to Installation of decking or floor sheathing. STRUCTURAL MASONRY: (306 a.7) MASONRY: Steel location. bond beams grouting or verticals In accordance with UBC 2415. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete and form work and sub-base materia! In pl.ace. ROOF SHEATHING AND NAILING: Prior to Installing any roof covering. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. "In addition to the inspec. tions specified, the Building Official may make or require other inspections of any construction work to ensure compliance with the Building, City or Development Code. x FINAL PLUMBING SITE PLAN REVIEW BOARD: Must be requested 2 days in advance of the date you wish Inspection. All project conditions such as landscaping, parking lot striping, etc. must be completed before requesting this Inspection. V FINAL BUILDING: Requested after the final plumbing, electrical, mechanical and Fire Department inspections are made and approved. No occupancy of the premises can be made until a Certificate of Occupancy has been Issued by the Building Division and posted on the premises. x FINAL ELECTRICAL y FINAL MECHANICAL FINAL FIRE DEPARTMENT ADDITIONAL COMMENTS: ...-? PLANS REVIEWED BY /' ~~ - I By slgnature,l state and agree, that I have carefully examined the completed application and do hereby certify that all Information herein 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. .: ~-~ r -- DATE ~-2~-~ I further agree to ensure that all required Inspections are requested at the proper time, that project 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 ~Imes dur~n construction. I at re OJ) m~ G Date 10 dCJ ~C{~ ( , ~ALlDATIO : AMOUNT RECEIVED: \~ I ':l \ RECEIPT N' \\CA... \ \ /J . -.: DATE PAID: .J::..7 Y .~ '"J RECEIVED BY: 8 '\,b~ ..,...,. I 'r' . Permit#: Gq D~ Address: ,\ ~% \ ~\rJ:\Q())( \ . ISSUedby:~\[)J~ Date: \o.?fl ~ 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. . 23A. .1 ~~:~::~;::t:o:~~:~:~.s~:~_: _ :~n.s_..:;: ~trocoo, if ilio ,"",re i, ';d: Of:red ~"bSale q1 My general contractor is \,^-'--.1.\m~.L/ u. -d- J...l- il ame) Contractor regis. # I will instruct my general contractor that 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 to Prop, rty Owners about Construction Responsibilities on the reverse side of this form. /) -<<\ frb-41 D W'" (Signature of permit applicant) I/J -:20 .t:(~ (Date) (White copy to issuing agency permit file, pink copy to applicant) . . 'f ,.-... I -:rr'lT'iioli'mal~ioi1 No~iclS io t:l>Ii'OplSrty OWI11IISIi'S Aroou~ CO~s~li'l.Ac~ioD1 ~eslOol11lsibi~i~oes i.. Note: This Information 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 irnprovement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPlOVER RESPONSIBlliTiIES: 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: ,I 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 yollr attention through inspections. Liability and p. ~"~':J 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 emptoyees: 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