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Home My WebLink AboutPermit Building 1992-6-5 (2) =lnh) L,' r#YA"c.d/6L ~r; VP7_A ," - ... RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Ollice: 726.3759 LOCMION Or- PROPOSED WORK: ASSESSORS MAP' /7 tJ .3 2.-7 LOT' " OWNER' ADDRESS: CITY' DESCRIBE WORK: ~//;r )A/Ail)) , ~ - NEW REMODEL ADDITION CONTRACTOR'S NAME GENERAL -J. j)J, J?t~ P1.UMBING: MECHANICA' . E1.ECTRICAL: QUAD AREA:~~ . OF Il1.DGS: - 1r:::2- OCCY GROUP: ~ J \ . OF STORIES: WATER HEATER: . .... I JOB NUMBER 92067S \ SPRINGFIELD ~A"///~ ) BLOCK' . ~ /1R 225 Filth Street Springlleld, Oregon 97477 TAX LOT: CJ2./0() ( I I I STAT'" 1--:7Ivn/~ ~ ~ I DEMOLISH OTHER SUBDIVISION' PHONE: 7~7- '7i!:>/~S- ZIP: 97.;f'77 .1 CON ST. ADDRESS . CONTRACTOR' ~M /",7 ~ //) ('~.r - OFFICE USE - \ \:\ \ LAND USE: . OF UNITS: "- \ CONSTR. TYPE: .JLN HEAT SOURCE: E~ EXPIRES PHONE /?_ -2?-'7.z. 9.?7-;};Z2~ FLOOD PLAIN: I_\"\{?~_ ZONING CODE: -UJJL...I . OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE:c;QJ~ 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 ronde the same working day, Inspections requested after 7:00 a.m. will be made the following work day. . 0 Temporary Eleclrlc K"7'1" Site Inspection - To be made .L6J..after excavation, but I?~ior to setting forllls. t:.>'(~Tz::;.. FDN. f FIA:Jl( SpulCTtlRB o Undcrslab PlumblngJElectrlcalJ Mechanical - Prior to cover. rv( Footing - After trenches are ~cxcavalecl. o Masonry - ~teel location, bond beams, grouting. l'V'f Foundation - After forms are ~ erected bul prIor 10 concrete placement. o Underground Plumbing - Prior 10 filling Irench. o Underlleer PlumblngJMechanlcal _ Prior to Insulation or decking. lV'f Posl and Beam - Prior 10 floor ~Insulation or decking. lVf Floo~ Insulation - Prior to ~decklng. o Sanitary Sewer - Prior to filling trench, o Slorm Sewer - PrIor to filling Irench. O Water Line - Prior 10 filling tmnch. '.-, o Rough Plumbing -- Prior 10 cover. RANGE: REQUIRED INSPECTIONS i -:-:-;' Rough Mechanical - Prior to e-. -'.,cover. '1\:71 Rough Electrical - Prior 10 J6.<. cover. o Electrical Service - Must be approved to obtain permanent electrIcal power. o Fireplace - Prior to facing materials and framing Insp. .s.. Framing - Prior ~o cover. 15<1 Wail/Ceiling Insulation - Prior to -.-over. ;gr Drywall - Prior to taping. o Wood Stove - After InstallatIon. o Insert - After fireplace approval and Installation of unit. o Curbcut & Approach - After forms are erected but prior to placement 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. ," o Final Plumbing - When all plumbing work Is complet.e. ~ Final Electrical - When all ~ electrical work Is complele. I~ Final Mechanical - When all ~'~mechanlcal work Is complete. lVf Final Building - When all ~eQulred Inspections have been approved and building is completed. DOlher MOBILE HOME INSPECTIONS o Blocking anll Set.Up - When all blocking Is complete. o Plumbing Connections - When home has been connected 10 water and sewer. D Electrical Connection - When blocking, sel-up, and plumbing Inspections have been approved and the home Is connected to the servIce panel. o Final - Aller all required Inspections are approved and porches, sklrtlfJg, decks, nnd venting have been Installed. .. Lot faces Lot Typel Lot sQ. Itg. Interior I PL. IN Lot coverage Corner Is Topography Panhandle Iw Tolal height Cul.de.sac IE BUILDING PERMIT ITEM sa. fT. X $/sa. FT. VALUE Main Garage Carport 1b c:, '71. ere 5,,4 I SOo li;)fJ9. ,r> -/../.0 ,So 5$'5 1/ 0.0~ SYSTEMS DEVELOPMENT CHARGE (SDC) If, (B) (f'-f7 ~ ~, 2./9 :::U?~5 :S9.7<O ""Ch,o,/,;;;f Total Value Building Permit Fee State Surcharge Total Fee (A) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(sl N' Sanitary Sewer FT. Waler FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace y Exhaust Hood Vent Fan N' Wood Stove/lnsert/Flreplace Unit Dryer Vent Mechanical perml\ ,P'ItItJ , Issuance '" \ State Surcharge \. Total Permit , (D) MISCELLANEOUS PERMITS Mobile Home State Issuance Stato Surcharge Sldowalk It Curbcut It Demolition Slate Surcharge Total Miscellaneous Perr;nlts (E) / TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) /t;; 5,Z't ~ .~. Setbacks HSE GAR .S THE PROPOSED WORK IN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must bc signed and approved by the Historical Coordinator prior to pennil issuance. ACC I I I .[ . I I APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit Is granted on the express condition IIlat the said construction shall,ln all respects, conform to the Ordinance adopted by the Cily of Springfield. including tllC Development Code, regulating the construction and use 01 buildings, and may be suspended or revoked at any lime upon violation of any provisions of said ordinances. '''7/.63 Plan Check Fee' / / Date Pald:C:; k/S' L Receipl Number:_4S-7 S- Received y: ~~ A /'>>-<..- :, ~/sA2..- 7' c'Ze~ Plan PReviewed By Systems Development Charge Is due on all unclevcloped properties within the City limits which are being improved. ADDITIONAL COMMENTS JP /f17f" / ( By signature, I state and agree, that I have carefully examined the completed application and do hereby certHy thai all Information hereon 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 worl( 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 wllQ are In compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections arc requested at the proper time, that each address is readable from the street, that the permit card Is located at the fronl of the property, and the approved set of plans will remain \ ithe SIU" times dullng ciyruCtlOn;(1 ' ~natup;/;)4 c-1f ( O/tuu/~ / DatA t,/:5/97- . , VALIDATION: RBCEIPT NUMBER -:Ie; j(o I~/ 6. /e)2_ ( '( - :z9 //'~~,. ,~~~ DATE PAID AMOUNT RECEIVE["I RECEIVED BY .... " \.. . I Issued by' 92CJ&7~ '7 7S' ~~"'6J ~ Date: ~02- ,I I Permit No: 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. ~ I I own, reside in, or will reside in the completed structure. /' ...... 2. i. =:-:::-..!.. 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 My general contractor is_LM S Lu'5~ .... Contractor registration number J /J S"~ s: 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.' 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 rever~ :~~:~s~, ~m/J/J /J\ /J /'f/'n "-A", UK~// jD'^tke~ {,? X idnature -of Permit Applkani . t1 /7' CONSTRUCTION CONTRAC1ORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT .... INFOFt'ATION NOTICE TO PROPERTY C..NERS ABOUT CONSTRUCTION RESPONSIBILITIES ..I. ~ I I NOTE:, ',This Information Notice to Property Owners About Construction Responsibilities was de~eloped by the Construction Contractors Board in accordance with ORS 701.055(5), passed:bY't~e 1989'Oregon Legislature. . '- - , , . '\ ..' . \ . 'n 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. . . ~ - '.yorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensatipn insurancE( for your employees. If you fail to obtain workers' compensation insurance, you.may-be sObjectto penalties and will be liable for all clairT) 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 I;ode requirements that maybe 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 overs pray, 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, 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 SI. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 0244J 10/24/89 -- . I JOB riO. Cfz.-Of.eJ_2 CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NN1E OR C01.1PANY: :;fo#1-l L. CJ..tL.t~c..l-tILL LOCATION: "'f7S FAIR-VIeW I7b":a.:>'2-7?:>/ - 02/00 DEVELOP~lENT TYPE: !-P2. - A.t> I? l--nc,,1 LOT SIZf SQ o' Ft. BUILDING SIZE: 1. STORM DRAINAGE IMPERVIOUS SQ. FT. 2<1-2. X SO.186 PER SQ. FT. b t.f 5 oJ (See Reverse For Runoff Coefficients If Actual Imperv. Area Is Unknown) 2. SANITARY SEWER-CITY NO. OF PFU'S X $38.55 PER PFU Is - (See Reverse To Determine Total PFU'S) 3. TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X $388.61 Is X X $388.61 S ~ X X S388.61 S; - (See Attachment C To Determine .Trip Rates) 45~ SUBTOTAL '(ADD ITEMS 1,2, & 3) S 4. ADMINISTRATIVE FEES 'BASE. CHARGE (SU~TOTAl ABOVE) X ;05 Is 7... '2-..z TOTAL-CiTY SDCS; 47 ~ 5. SANITARY SEWER-MWMC NO. OF PFU'S x S13.25 PER PFU + S!OMWHC ADMIN. FEE S - (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) ~~L~ ,- () Kip Burdick SDC Coordinator S TOTAL -MI-IMC SDC Is -4- TOT At SDC S 47 2." ~ /; /'1'2- ( I