HomeMy WebLinkAboutPermit Building 1992-10-30 (2)
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726-3759
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..,JOB Nl,lMBER
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.' ;225"Flfth' Street
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'. .Sprlngfleld, Oregon 97477
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LOCATION OF PROPOSED WORK'
ASSESSORS MAP: )'7 /) '2.
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11 44- J
BLOCK: S""~
SUBDIVISION:
# f?o
TAX LOT:
LOT:
9'0
OWNER:-!- ~..: ILl ~€lJe~ 'a ~ WtJc /,Q ,'Dt;,.E PHONE: I z. (, -7~ ,e;
ADDRESS: ~lD 0 ~/~1 ~ ~o ~ IS C))c.. lei
CITY: "5 PI< II\J~~ 1,,1 STATF' 't) I(J ZI P: c; ., 1,/.,.,
DESCRIBE WORK: fAlta L./l ~F 13A~ t:> fC" C A- ~f
NEW REMODEL _x ADDITION DEMOLISH
GL,o' S"t-D./J Aq ~ Ir~
OTHER
CONTRACTOR'S NAME
co fA) AJe-n..
ADDRESS
CONST.
CONTRACTOR 1/
EXPI RES
PHONE
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GENERAL:
.\
PLUMBING:
MECHANICAL:
ELECTRICAl.
QUAD ARE~ RSQ....,
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OCCY GROUP: ~
\
'- OFFICE USE -
\150
LAND USE: ~
1/ OF UNITS: A J
CONSTR. TYPI=' V JV
FLOOD PLAIN' . r -,',\
ZONING CODE: JJJ~
1/ OF BDRMS'
1/ OF BLDGS:
1/ OF STORIES:
HEAT SOURCE:
RANGE:
SECONDARY HEAT:
SQUARE FOOTAGE:
WATER HEATER:
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
made the same working day, Inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
o Temporary Electric
o Rough Mechanical - Prior to
cover. '
o Final Plumbing - When all
plumbing work Is complet.e.
D Site Inspection - To be made
. after excavallon, but prior to
setting forms.
. IVI Rough Electrical - Prior to
~ cover.
']::><1 Final Electrical - When all
"",Iectrlcal work Is complete.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Final Mechanical - When all
mechanical work Is complete.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
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o Footing - After trenches are
excavated.
,
~ Final Building - When all
~equlred"lnspectlons have been
approved and building Is
completed.
o Fireplace - Prior to facing
materials and framing Insp.
o Masonry - Steel location, bond
beams, grouting.
~Framlng - ,Prior to cover.
J
o Other
o Foundation - After forms are
erected, but prior to concrete
placement.
o Wail/Ceiling Insulation - Prior to
cover.
o Underground Plumbing - Prior
to filling trench.
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
D Underlloor Plumbing/Mechanical '0 W d S fl' 'I
, _ Prior to InsulatIon or decking. 00 tove - A ter nstallat on.
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,
o Post and Beam - Prior to floor 0
Insulation or decking. Insert - After fireplace approval
and Installation of unit.
o Blocklng:'and Set-Up - When all
blocking Is complete.
o Floor Insulation - Prior to
decking. .
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o Plumbing. Connections - When
home has been connected to
water and s~wer.
o Curbcut & Approach - After
forms ar!') erected but prior to
placement of concrete.
o Sanitary Sewer - Prior to filling
trench.
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0, , "Electrical. Connection -- When
o Sld~walk &',Drlveway - After" , bloqkl.ng;;.f>et-l.Ip, arid plumbing
exqavatlon)s ,complete,'. forms'" .... ,.In.~pe9~lon~;.tiave'''l:leen:'approved
and sub-base material. ~,~, place." '. ':and 'h~'..homels.c.()nnected;t6 ,.
". . ':,.:~.' .' :',:'the servlce:'p~;,el.'" . :,.r:'"
O Ferice'~ Whe~ compl~t~d.' '.:~: ,;>\,,),~.' 'L-:'>;,,}';'<~';::::' '. ,', ",';.',
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. ", " :,:'i" l! . '.:.;..,'. " ,',".' ...... F":'-fFlnalv!''l:! .\ft~r~'alltre'nlllred''''''l'~ '.
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, . .r~e"h .ees -. en,!i ,Irequ r~ ..i;;~;,'" ~~!:~~1MJ?<?,rg,..fil,~!~$~"rt.Qg,"",eqKs'l~nCl~: ' 1"
trees 'arE! R!anted. .. " .' , ,:;.: 'cli' .'. ~":l\-" ,,:ventrng:!nave!;!)een; Ins'talled: . '.
o Storm Sewer - Prior to filling
trench. .
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o Water Line - Prior to filling
, trenc~. " '
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o Roug~ Plumbing - Prior to
cover.
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Total ~~19ht", -'- .~~:~~.~,~.sac:, I E"~ : . . '.' ,1
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~ rHE PliOPOSED WORK IN THE " ....
. HIST().~ICAL.'QI?1~',19t" p'Rio~. ,..~~:
THE HIST08ICAI:"REGISTER?':::
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If yes:ltr.jS, ~'p.pllq.?tlon'..~u~~'be signed , .
and " ~ppro.Ye~r 'by'the' ,Historical
Coordinator prior to permit Issuance.
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APPROVED:
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.. iB.UILpING'VALY,E:::PLAN CHECK
. '"AND,BUILDING PERMIT
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'This per'mlt Is granted on the express condition that the said
construction shall, In all respects, conform to 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.
2 5' .~ 3
10 -/2.-7"2.:.
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Received By: ~
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Plans-Reviewed By
Plan Check Fee:
BU iLo'ING"RE'R'Mli :",
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ITEM ,'SQ:IFf.,' X'
VALUE
Main
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Garage
Carport
/;?J~S E-:PeJtt ~t~~ ~t:)rJ f-O
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Date Paid:
Total Value
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Receipt Number:
3S .'SD
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. SYSJEM.~DE~7~~~~,~~;~,r: ~.~A~~.~' (SDC);<tg
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PLUMBING PERMIT
Building Permit Fee
Total Fee
. (A)
/O/~~L
/ Day!
State Surcharge
'Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
ITEM
FEE
Residential Bath(s)
NO
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A?6<,? ~b.
~T. A~~r
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Fixtures
Sanitary Sewer
FT.
FT.
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State SiJrcharge
Total Charge
(C)
1
MECHANICAL PERMIT
Furnace
Mechanical Permit
By signature, I state and agree, that I have carerully 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 perrormed 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 thi'lt NO OCCUPANCY will be made of any
structure without permission of the Building Sarety Division.
I further certHy that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project.
Exhaust Hood
Vent Fan
NO
Wood Stove/lnserllFlreplace Unit
Dryer Vent
Issuance
State Surcharge
Total Permit
(D)
I further agree to ensure that all required Inspections are
requested at the proper time, that each address Is readable
from the stree't, that the permit ca'rd Is located at the front.
of the property, and the approved set of plans will remain
on the site at all limes during construction.
Signature -'."t/.~
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MISCELLANEOUS PERMITS
.
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Date
,//.J_/2- -??/'
Curbcut
ft
Demolition
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VALIDATION: I /)~
RECEIPT NUM~n '" \..9 ()~
DATE PAID I u'3f ) . q:..J... _ ,A
IJ'~ R ()
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AMOUNT RE
State Surcharge
. ,
Total Miscellaneous Permits' . (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined) . '.~"""':" ':.:
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· RECEIVED
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Permit No: 0 d ~ ~
Address: . ~ t:::)\ _Q \oJ) '~~ ~l} =J:t:D
Issued bY~_) Date: J-h ~2f)q~').J
FOR OFFICE USE ONLY
ST A TEM ENT:
. '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:
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1. I. / I A' 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.
3. A.I . I My generalcontractor is
, '
Contractor registration number
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I will instruct my general contractor that' all subcontractors who work on the struc-
ture must be 'registered with the Construction Contractors Board.
OR /J
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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.
~1)9
~nature of Permit Applicant ~
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CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
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WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COpy TO APPLICANT
INFOR.ON NOTICE TO PROPERTY O.ERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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NOTE: Thi~ Iflformati9n Notice to Property Owners About Construction Responsibiliti~s .
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Qregon Legislature.
If you are- acting as your own contracto( 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~ 'youwill, in most instances, be ruled to be an
"employer" and the people you hire will be "employees". As the employer, you ~ust comply with the following:
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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 infor:rylation, call the Oregon Employment Division DHR
at 378-3224.
Workers' Compensation Insurance: As an employer; you aresubject'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 incom.e tax from employees' wages.
You will be liable for the tax payment even if youqidn'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 YOLl 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 Empioyees: 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 finis~, 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. N~, Suite 300
Salem, 'OR 97310-015f '
Phone 503-378-4621
0244J 10/24/89
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