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Home My WebLink AboutPermit Building 1993-1-28 (2) RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 . I!lt( - '-V '-'I LOCATION OF PROPOSED WORK: _' lf1...Ct/X',one ASSESSORS MAP' /71/ 3 'J 5 2.. / LOT: BLOCI<" IJ 1-10 (J IT "1/1 ( c"''''c.v( 74 ;~V( OWNER' 'Si-e.Vf7 f\ ADDRESS:' ),,:2.. 7 ::z... E"'-')'<-1<' N."vv CITY' DESCRIBE WORK' NEW V REMODEL ADDITION cf, STAT'" Of/-€. Au: '-,)0.<- d, '.t I . 9 ") /-1'5'0- . I,. J.oB NUMBER 225 Ftfth Street Springfield, Oregon 97477 3'7(0 J)6Ptlt3 ST: A-7 4,7.EJ- s /, TAX LOT' . 42C?-O ';" ,', " SUBDIVISION' i',: PHONF' If ~\ i.f70Z. L 'I:; ". l1 ZIP: Q7(/.0';) , ?,.. ,. COJo1~ +"l-< c-ft p " I:: I'; , DEMOLISH OTHER >. " CONST. CONTRACTOR · CONTRACTOR'S NAME ADDRESS GENERAL: sft'. V( V1 f) I.::t.fl.6 / V] S PLUMBING: fbu., <; 1l.1!1A n1 b I i,,-. ( MECHANICA" ~+-I' (/(il''-''L !J I-/v;:; It I ~: ~~ ~ ELECTRICA' . , - QUAD AREA: 1\{.\\')W ~ . OF BLDGS: OCCY GROUP:..R 't" N\ . OF STORIES: ' E. WATER HEATER: - OFFICE USE - \ \ \ '\ LAND USE: . OF UNITS: I A ) CONSTR. TYPE: \{lV HEAT SOURCE: -0 E:- r::. RANGF' EXPIRES PHONE i.' FLOOD PLAIN: - -, ) ZONING CODE: LUIC-.I . OF BDRMS: --I SECONDARY HEAT: SQUARE FOOTAGE: //4 / :~ , 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 ~ Temporary ElectrIc o Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumblng/Electrlcall Mechanical - Prior to cover. r\7f Footing - After trenches arc ~ excavated. o Masonry - Steol location, bond beams, grouting, ~ Foundation - Afler forms are ~ erected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. o Undertloor Plumbing/Mechanical - Prior to Insulation or decking. o Post and Beam - Prior to floor Insulation or decking. f\:71" Floor Insulallon - Prior to 16,,1 decking. . ~ Sanitary Sewer - Prior to filling ~ trench. _ Qf Storm Sewer - Prior to filling ~ench. ~ Water line - Prior to filling ~ trench. QI Rough Plumbing - Prior to ~ cover. IC7f Rough Mechanical - Prior to ~ cover. ~ Rough Electrical - Prior to cover. ~ Electrical Service - Must be ~approved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. l81' Framing - Prior to cover. ~ Wail/Ceiling Insulation - Prior to ~ cover. .P<l Drywall - Prior to taping. o Wood ,Stove - After I~stallatlcin. o Insert - Alter fireplace approval and Installation of unit. f"iVI Curbcut & Approach - After ~ forms ar~ erected but prior to placement of concrete. IV1 Sidewalk & Driveway - After ~ excavation Is complete. forms and sub.base matorlal In place. o Fence - When completed. ~ Streetrl'ees - When '.,{'requlred . c:::f;I trees are planted. '. 1'v1' Final Plumbing - When all ,.cy plumbing work Is complete. f\:71 Final Electrical - When all ~ electrical work Is complete. K7I Final Mechanical - When all ~ mechanical work Is complete. ,- " ,. ~ Final Building - When all ~requlred Inspections have been approved and building Is completed. o Other ,).. : MOBILE HOME INSPECTIONS , " " I, .... ~ < ~.~ f.' -, f-' ri . t' . " f; ~, [.j I:' c: " If '! .. ',: 1\ l Ij r. " k r; ~ ... ., :','~ ; '';' i.,. \.",', t.' > ..it "~,:_ t.~:., : '_ ' . , o Blo~kln'ii;e;'d Set.Up - When all blocking Is complete. . - . , :. . ;:;';";"."';':1:-,'11;..- D.Plumblng-Connectlons - When home 'has been connected to water'and sewer. . ,"~" :~, "~i-", o Electrlc'al Connection - When blocklng,,'set-up;,and plumbing , Inspeotlons have'beenapproved andthe:home ,15 connected to the serVice 'panel, . 1~ GJ'.I:lnal.:-!..Af,t'lr,al,1 ~aqulred" , ..lnspe9t1Qns'ar~' approved and "."porches:i:'skrrllng;. decks, and ventlng.have been. Installed. Lot faces ~ Lot sq. Itg. ~ Lot coverago ~ Topography ~2.?1l Tolal height j1~;' BUILDING PERMIT sa. FT. /_24 ~rJ ITEM Main < ' Garage Carport Total Value Building Permit Fee State Surcharge Total Fee Lol Type . ',nte'rIOf .', . ' C"rner ~ Panhandle Cui-dc-sac X $/so. FT. <)t;;,'<'> Jd A:J f (A) I P.L. HSE GAR ACC I IN 10 It!) I I s 24 24 I \w I ~ ~ ?-C1 I l APPROVEn. BUILDING VALUE. PLAN CHECK AND BUILDING PERMIT Selb~cks VALUE .~ 'YY~~ 7'7'7~70 <f"3a3~O ?</':: ~ c_ c .Dt /~.,!O ~ SYSTEMS DEVELOPMENT CHARGE (SDC) tk . ~ ~W (B) "'1'2.1,,"0;>- PLUMBING PERMIT ITEM Fixtures Residential Bath(s) NO Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permll State Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan / (C) Dryer Vent Wood Slove/lnsertlFlreplace Unit N' Mechanical Permit Issuance State Surcharge Total Permit /J'J I ifJ . (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk '7--~ It Curbcut 21b It Demolition State Surcharge Total Miscellaneous Permits (E) FEE .-!l-I~ 4.SW 96 ?'v 4/",0 .~ 8" /56-C /0&0 .7r 26.7.!" J 2. 3<<> i'4,2a ~'7,~o /6~/,~(P TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) l ._HE PROPOSED WORI< IN l'iiE ' I~TORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? .-.... ~' .!':, 1tI If yes, this application must be signed and approved by the Hlslorlcal Coordlnator prior to permit lssuance. This permlt is granted on the express conditlon that Ole saId construction shall, In all respects. conform to the Ordinance adopted by the Cily 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 Fee: _I (~/~ . ~I Dale Paid: _ICJ - 2/.:. - '72- Recelpl Number:___~_~2~_ Received By: __4_~~- ~~C_ jti~6-b- 'Y"o'Xe" Systems Development Charge i5 due on all undevoloped properlles within the Clty limits which are being Improved. ADDITIONAL COMMENTS /-nT fIal; ~tlib;;d.~j T t:P.y,.ef A-?;n. \ ~~ I Il ') 4-( ')( ') - -, - \ cA rUl QJ{ Dn To ) j ., 1- PArH Lw/ r~-lqA v.JAld.<. By signature, I stale and <Jgree, that I have carefully examined the completed appllcation and do hereby certify that all Information hereon Is true and correct, and I further certify that any and all work pedorrnod shall be done In accordance with the Ordinances of the City of Springfield, and 'he Laws of the State of Oregon pertaining to the work descrlllod herein, and that NO OCCUPANCY will be made of any structure without permission of the Building Safety Division. I further certi ly that only contractors and employees who are In compliance wlth GAS 701.055 wlll 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 from the street, that the permit card Is located at tho front of the property, and the approved set of plans will remain on the site at all times during construction. ~nature ~ -'1J .ikt.L-:-- Date~(?..q, 1'1< , VALlDATION:1 RECEIPT NtMfJEI1 Z:; 70 DATE PAID 1. -2:. ~h,< , ~ AMOUNT RECE'VED __L~L. 2(j:;> RECEIVED BY ....;~ . . . . . Permit No: 92/4)'0 , , Issued by: '2,C:Y{n ~//~ 5""'T ~ Date: /~Z~-(3 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...J;.><::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. 3. A.I I My general contractor ip, Contractor registration number 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 ...L><"_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. J#;:;,,,,,, 1; ~ ~ Signature of Permit Aprllicant I /2.. C{ /O(!J Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COpy TO APPLICANT INFORrl-ION NOTICE TO PROPERTY O\IERS ABOUT CONSTRUCTION RESPONSIBILITIES . . .... NOTE: This Information Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), pa'ssed by the 198,9 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. 'lIforkers' 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: ~ode 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, a(ld 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. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89