The URL can be used to link to this page

Home My WebLink AboutPermit Building 1993-5-4 ~- t L ~ _~. , ".(~~C ~i f . RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: LOT' SPRINGFIELD . JOB NUMBER 9~t::::!> y~ 225 Fifth Street Springfield, Oregon 97477 L.~~/5 BLOCK' OWNER:Pt!:#.#Er /#~~~~~~~ ADDRESS ~ ;?"7'J'? V ?r. ~ ,.- r-~~e__ ". CiTY' STATE: _~..fif. DESCRiBE WORK: -64-1/~r- ~~~?/~ ~/2> ."...- '" . NEW REMODEL .)" ADDITION CONTRACTOR'S NAM:'o ~N=r'C' GENERAL: PLUMBiNG: '" MECHANICAL: " ELECTRICAl' ,., OUAD AREA:,-c::)R~./ . OF BLDGS: _1 A'?J H OCCY GROUP: . OF STORI ES: WATER HEATER: DEMOLISH OTHER e:Z:>4::> / TAX LOT SUBDIVISION' ""'~E7--~~ -R/-""/ PHONE: -'>YT ~ ZIP: q:?%-- ~ ~r./T~~~. ADDRESS CONST. CONTRACTOR' EXPIRES PHONE REQUIRED INSPECTIONS ~ Rough Mechanical - Prior to cover. lq Rough Electrical - Prior to ~ cover. m Electrical Scrvic~ - :'J!ust be approved to obtain permanent electrical power. o Fireplace - Prior to facIng materIals and framing Insp. ~ Framing - Prior to cover. ~ Wall/Ceiling Insulation - Prior to !,.OJ covel; ~ Drywall - Prior to t<1ping. LJ V,lc~r1 Stove - After installation. L-; If"ser! - Aft~r :j rcpl:'\ce approval -' Llncl jnstall.1Hur. of unit. r-~-' , I '--~ Culi!:u! 3t A:JPp.):\ch - After fDlms ~It: erected but pl:(ll to placei"ent of '=Ol-,cr.::t~::. - OFFICE USE - 1111 . OF UNITS: 1.._ CONSTR. TYPE: -~i1J HEAT SOURCE: 6~ r~ LAND USE: RANGE: . . FLOOD PLAiN: \--..\ \) ~ ~ ZONING CODE: . OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: 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. D Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. D Undcrslab PlumbingJElectricalJ Mechanical - Prior to cover. D Footing - After trenches are excavated. D Masonry - Steel location, bond beams, grouting. ~ Found~t;on - After forms are ~crecteo but prior to concrete placement. D Underground Plumbing - Prior to filling trench. K/( Undcrflo~JMech.mic,,1 J6r.,L - Prior to'tIl'O'U:<:H1.....n or deck-iou. ~ Post and BCitm - Prior to floor IC,J. insulation or decki'\9.c,-101~r Moll. f" , CPo.j1 0.<.)) l':7f floor Insulation - Prior to ~decking. ~ Sanitary Sewer .- pr:,:.r to Iillin(! ~trcr:ch. ~ Storm Sewer - Prior to iilllng ~ trench. l':7f '.J.'ater UniE:' - Prior !(J f!ilinD ~ trench. ~ Rough Pl~mbilir. - PrIor !t) ~C0\'cr. r::::-: 3:de"'Jalk & Griveway - Id :r;r excD.v~:k;r, :s (;l)mplet..~. fl.irrns .:md SUD-!);"'.'.>:' m:lteriai Jr. place. [Ul ., t=cnce - \Ntlcn ~ornpic:cd. i I ~t=-~e! -ii"i]~!S - Vibr;'~l .:.1: :(!-=1uired ! - _: 1 ~:),)s i-"'C, pl;J:~I,::d. - "._h_. _._'_""'_.___~.' ....__..-__....-..-...-.. ~ Final Plumbing - When all ~ plumbIng work is complete. ~ Final Electrical - When all electrical work is complete. ~ Final Mech~l1;cal - VJnen all ~ mechanical work Is complete. f'\:A Final Building - When all ~ required inspections have been approved and building is completed. DOthcr MOBILE HOME INSPECTIONS D Blocking and Set.Up - Wllen",1I blocking is complctp. ""'" r-l Plumbing Connection:::. - When L--.J hQme has been connected to wa~er alld sewer. ri Electrical Conn.:::ction -- 'oNhen -.- blocl<ing, S{+up, and pll.Jmbing inspecti,,:,ns have been approved :"!nd the hQf!1p' is connected to tile ~e,v~r.e panel. o Finnl - After al! required -' inspections are approveri and f)(:;Chl)s', skirting. decks, fl'1d vFi,:lna have ccerl installed. , Lot faces ...:rt- Lot sq, Itg. ~ Lot coverage l.ZiJ, Topography ~Z?a Total height ~:, Lot Type _ Interior ~ Corner Panhandle Cul-dc.sac BUILDING PERMIT ITEM SO. FT. X $/SO. FT. Main Garage . . . ;IS.,l HE PROPOSED WORK IN THE . ftHISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior.to permit issuance. Setback~ ~ HSE IGAR. ACC N I S I I W I ~- ---1-'-- VALUE Carport ~7-??~ /.:<YY~A~./O '"'>'f//.~~~ .::21. ~,S'O 10.78 '22 ~ZZ3 SYSTEMS DEVELOPMENT CHARGE (SDC) (B) \ )G f) Total Value Building Permit Fee Slate Surcharge Total Fee (A) PLUMBING PERMIT ITEM Fixtures Residential Bath(s) N' :z. Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' .~ Wood Stove/lnsertlFireplace Unit Dryer Vent ~~ Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It Curbcut It Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) FEE /thO. 00 !J!;~ 1-0~ tP.oo 4.50 ~.o-o _3,tTO _ zoo ~4,50 ~i) ,00 /P 3.5. 73 !/6D...E../ ,\PPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Thjs perr.1!! is g~antcd on the express condition that tile said construction shall, in all rc.spccts, conform to the Ordinance adopted by the City 01 ~pringfield, 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, Pian Check Fee: -/-?b-~.P.. tI-b43 Date Paid: Receipt Number: zrt::>:z.s- Received By: /7 ~ ...~ ~ L:r . ~~~ ~~CWCd Sf n~ Systems Development Charge is due on all undeveloped properties within the City limits which arc being improved. '~~t~0ir) _~C:;I~MI.lY.llttft.lWl ~ ._~(,ljK.Cll1fA')~4Y ..co~'i 5E31JVc- AUtt>tb'f / IVS7k/.l.t'il Oy 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 certify that any and all work performed shall be done in accordance with the Ordinances of (he 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 cOfTlpliancc with ORS 701.055 will be used on this project. I further agrec to ensure that all required inspections are rcquested at the proper lime, that each address is readable lrom 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 times during construction. ~lgnatur~~A dJ~ , , 5-1./- 93. Oat" VALIDATION: RECEIPT NUMBER B'5ib 6 s-;.<;/-9 :::;? AMOUNT RECEIVEI' fz/ 3P_c:::r--/ RECEIVED BY 4~ .. DATE PAiD . . . Permit No: 9'?07"?,t;; Address: 9 79 //~7 &A?'~ Issued by,d4~""~C Date: 5-5'.~ r~..-q. 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 V /, 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 I My general contractor i" 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.I 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. ~d~ #~.,. J Sigrfature of Permit APPli~ 5=- '1- f.J Date CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT . . " , INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: lhis Information Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701,055(5), passed by the 1989 Oregon Legislature. If you are acting as your own'1:ontractor 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. 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 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: 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 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 9731()'()151 Phone 503-378-4621 0244J 10/24189