HomeMy WebLinkAboutPermit Building 1995-6-12 (2)
OWNER: ~\'1~CJ y+, '- \ n \ ~'" f.-..>.-
ADDRESSkAd()~ '\.J:"f\\\ CJ(\. / '- \n~()T (.'
CITY' >l \\2\\ ~ \\~~ ~ ~ Q\ ST~TE \\J \ ~ k\\JY"\
DESCRIBE WOR~sk\).r\ \/_~.' f\f\ ~~\N.0f\QSL~
I " _-"
NEW REMODEL, -'ADDITION V DEMOLISH OTHER
lU~~
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOT:
CONTRACT9:'\.S NAME,- J '_
GENERA" ~~~
PLU~BING'~\\!V
, MECHANICA~)"\\~)
ELECTRICAl . ~~Q V
QUAD AREA: .:) (l.,S('./
. OF BLDGS: _'
g0
I
OCCY GROUP:
. OF STORIES'
WATER HEATER:
..
SPRINGFIELD ",
.
v---
C\~CicN-
BLOCK'
JOB NUMBER
TAX LOT'
SUBDIVISION'
O\l\O ')
~HO~E: ~\ . \ Sll as
ZIP:
Ul1lP>
ADDRESS
CON ST.
CONTRACTOR'
PHONE
- OFFICE USE -
LAND USE:
\I \ I'
I
\IN
EXPIRES
FLOOD PLAIN:
ZONING CODE:-Wtl-
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
1J;1JJf.t.
N OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANGF-
To request an Inspection,You must call 726.3769. Ttlls is a 24 hour recording. Alllnspecttons requested before 7:00 a.m. will be
made tho same working day, Inspections requested after 7:00 a.m. will be made the followIng work day.
o Temporary Electric
D Slto Inspection - To be mado
after excavation, but prior to
setting forms.
o Underslnb Plumbing/Electricall
Mechanical - Prior to cover.
rV1' Fo'otlng - After trenches are
~excavated. ... '
o Masonry - Steel locatio,:" bond
beams, grouting.
~ Foundation - After forms are
~ erected but prior to concrete
placement.
"
o Underground Plumbi'ng - Prior
to filling trench. .,'
"f'.:7f Underlloo~echanlcal
~ - Prior to Itf::>UldllOri or decking.
'lv1 Post and Beam' - Prior to floor
~Insulatlon or decking.
'f;7f Floor Insulation - Prior to
~decklng.
o Sanitary Sewer - Prior to (1IlIng
trench.
o Storm Sewer - Prior to filling
trench. -
o Water Line - Prior to filling
trench.
,
"
~ough Plumbing - Prior to
~cover,
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
~oU9h Electrical - Prior to
~over.
D Electrical Service - Must be
approved to oblaln permanent
electrical power.
o Fireplace - prior to facing
materials and framing Insp.
~ramlng - Prior to cover.
Wf Wall/Ceiling Insulation - PrIor to
~ cover.
~ Drywall - Prior to taping.
o Wood Stove - After Installation.
D Insert - After fireplace approval
and Installation of unIt.
o
Curbcut & Approach - After
(orms are erected bllt prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
o Fence - When completed.
D Street Treos - When all required
trees are planted.
tx:f Final Plumbing - When all
( .../umblng w9rk Is complet.e.
-
1X1 ....Inal Electrical - When all
~electrlcal work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
1\7'1 Final Building - When all
~ required Inspections have been
approved and building Is
completed.
DOlhor
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blockIng Is complete.
o Plumbing Connections - When
home has been connected 10
water and sewer.
o Electrical Connection - When
blocking, sel-up. and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Final - After all required
inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lol Type~ I P.L.
Interior
V Corner IN
Is
Panhandle
Iw'
Cul.de.sac
'I E
Lot faces
. Lot sq. ftg.
Lot coverage
Topography 'l
Total height ~'? I
(Q)
BUILDING PERMIT
SQ. FT.
,~~
ITEM
<:::.:;'il\5i\
. THE PR~POSED WORK IN THE.
'''HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this appllcallon must be signed
and approved by the. Historical
CoordInator prIor to permit .Issuance.
Setbacks
HSE GAR ACC
x ~\s;: 2-D ~ Jftffi~
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge ti::>,73 -I- +.o{-
Total Fee (A)
.
"
/-::J4. '5b
. - ,
ID,77
/4-5.::z.7
SYSTEMS DEVELOPMENT CHARGE (SDC) tj;
(B) ,*/9~
PLUMBING PERMIT
ITEM
Fixtures
~
Resldenllal Bath(s)
N'
Sanitary Sewer
FT.
FT.
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge ;Z p-o -1-/,2.0
TOlal Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Dryer Vent
Wood Stovellnserl/ Fireplace Unit
Mechanical permV
Issuance /
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge'
Sidewalk
Curbcul
Demolition
Slate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
40.-
<. 2..0
43.. 2..0
/'
/
/
/
/
267-17
,-
APp,ROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the Clly of Springfield, including the
Oevelopment Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of an~slons~f saId ordinances.
Plan Check Fee ,-l;' l ."t~
Date Paid: _~' La.q <:;
Recclved B __ /
-~
PI n Rcvlewed By
~/i~\
Dife
Systems Development Charge Is duc on all undeveloped
properties within the Cil(limlts which are being improved.
ADDITIONAL COMMENTS
"PAm 'L
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and I further certffy
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 descrlbed
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Dlvlslor"!.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project.
I further agree to ensuro that all required Inspectlons are
requested at the proper time, that each address Is readable
from the street, that the permIt card Is located at the front
of the pro d tho approved set of plans wIll remain
~the Ite at all mes dur~ ~~:IO: r ,
Slgnatu ~ ( '..~
Date ~- 2-- QS
VALIDATION:
RECEIPT NUMBER /7~
DATE PAin .c: -/2 ,""3~
AMOUNT RECEIVED -3;./, 7 SO
~ -~ 'e_
RECEIVED BY
- /'
,
.
.B NO. '1Z>o"42. .
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: 'R.o1>:>f:.R:T :s- un I ~+-\
LOCATION: \?f>J:; 1J,.,t-,lDvA <Err.
I ","0"2-0c,,4:Z..- 0\"\00
DEVELOPMENT TYPE: Loe.... b.-nr:., -r lbl.l.
BUILDING SIZE: 'b)l4-t?&w-uD"-~ f:;Ayf"h)
1. STORM DRAINAGE
LOT SIZE
SQ. Ft.
IMPERVIOUS SQ. FT.
~u,{)
X $0.209 PER SQ. FT. C-l'::;' '2A)
2. SANITARY SEWER-CITY
NO. OF PFU'S
(See Reverse)
f..JA.
X $43.26 PER PFU
C0
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
X $436.19
X $436. 19
X $436.19
G- )
'- ..--"
$
X
s
4. SANITARY SEWER-MWMC
NO. OF PFU'S x $17.19 PER PFU + $10 MWMC ADM FEE S
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAL-MWMC SDC
$
r-;
--- ---
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ I ~ -Z4
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE)
\~ 13.LJ..
\I Ki P Burdi ck
SDC Coordinator
X .05
Date: S/t9 Iqr:;,
, ,
G ?I(.~
'-- ../
TOTAL SDC
$ 1"1 ~
. .
Pennit #: q"J~ Y2
- - .
Address: /2C;:;;;;- z:hA7L>~ S-
ISSUedbY:;.~~~!!' Date:-t?-/2.9 S--
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:
rn
D
I. 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.
D
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
[E] 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
N"~ t;1 o-;,n ab .........00 O"""",lb","" 00 tho ~..~ "do of lb" r.=
O<XA/"I _ &-'-/2-95
(Signatu~ (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
-~
.... - --.'
...... ... ~... . ~
HnformationNotice to Property Owners
, ~bout- Construction Responsibilities
_0 \..~..... '. _. . . h
~,
-::- _. t>/ote:, This Informatioll.N.o.!icel~ Property 9wr~re ab'!ut 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.
EIIIlPLOYER RESPONSIBILITIES:
If you hire persons not registered with the, Construction Contractors Board t? do labor in <;onstructil)g or assisting in the
construction or improvement of a residential structure, you will" in most inst~nces, be ruled to be an employer and the people
you hire will be employees. As the employer, you must c.omply with the follo,,:i~g: '
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 joIl. For more information,
c.all the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U,S.lnternal 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 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 punctures, fire, or work that must be
re-dom;.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the'expertise to acfas 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
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