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Home My WebLink AboutPermit Building 1995-11-22 OWNER: jJM./17'~r Ad;J;:;" &""l/'? ADDRESS: ;;. =3 0 t} ~ CITY: r3?//1j ?J/Blf// dIf DESCRIBE WORK: .A!~ &~/~ RESIDENTIAL PERMIT APPLICATION Inspections: 726-3769 Office: 726-3759 LOCATION OF PROPOSED WORK: )(ASSESSORS MAP: / ? ~ .5 )(lOT- NEW REMODEL ADDITION CONTRACTOR'S NAME 1 - GENERAL: PLUMBING: MECHANICAL: ELECTRICAL: COU-/ A JE:f1O.. " SPRINGFIELD 2~ BLOCK: STATE: ~tfI( ..... JOB NUMBER 9"C;- /~27 ~~ DEMOLISH . OTHER 225 Fifth Street Springfield. Oregon 97477 TAX LOT: eoS-// SUBDIVISION: PHONE: 7~ -(j1?5? ZIP: 97~? ? ADDRESS CONST. CONTRACTOR /I PHONE , EXPIRES: - OFFICE USE - QUAD AREA: LAND USE: _ FLOOD PLAIN: /I OF BLDGS: /I OF UNITS: ZONING CODE: OCCY GROUP: CONSTR. TYPE: /I OF BDRMS: /I OF STORIES: HEAT SOURCE: SECONDARY HEAT: WATER HEATER: RANGE: SQUARE FOOTAGE: To request an Inspection, you must call 726-3769, Ttlls 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 setling forms. D Underslab Plumbing/Electrical! Mechanical - Prior to cover. D Footing - After trenches are excavated. D Masonry - Steel location, bond beams, grouting, D Foundation - After forms are erected bu t prior to concrete placement. . D Underground Plumbing - Prior to filling trench. D Underfloor Plumbing/ Mechanical - Prior to Insulation or decking. D Post ~nd Beam - Prior to floor Insulation ~r decking. o Floor Insulatio~ - Prior to' " decking. . D Sanitary Sewer - Prior to filling trench, DStorm Sewer - Prior to filling trench, D Water Line - Prior to filling trench:, '. D Rough Plumbing - Prior}o cove~ . .' REQUIRED INSPECTIONS D Rough Mechanical - Prior to cO,ver, o Rough Electrical - Prior to cover. D Electrical Service - Must be approved to obtain permanent electrical power. D Fireplace - Prior to facing materials and framing Insp. ~ Framing - Prior to cover. o Wall/Ceiling Insulation - Prior to cover. o Drywall - Prior to taping. o Wood Stovo - After Installation. D Insert - After fireplace approv~1 and Installation of unit. D 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. D Fence - When completed. D Street Trees - When all required trees are planted. o Final Plumbing - When all plumbing worl< Is complete, D Final Electrical - When all electrical work is complete. D Final Mechaolcal - When all mechanical work Is complete. ~ Final Building - When all equired Inspections have been approved and building is completed. D Other MOBilE HOME INSPECTIONS o Blocking and Set-Up - When all blocking Is complete. D Plumbing Connections"":' When home has been connected to water and sewer, D Electrical Connection - When blocking, set-up. and plumbing Inspections have been approved and the home is connected to the service panel. D Final - After all required Inspections are approved and porches, skirting, decks, and venting have been Installed. Lot faces .~ : '1: ; " \~: ~ ~ .- "':''-] >I. ;}' . Lot Typ, Setbacks .1 IHSE , ACC I Interior p.L. GAR IN I I Corner Is I I Panhandle Iw I I Cul-de-sac IE I I . IS THE PROPOSED WORK iN THE. ,uHISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. \ Lot sq, ftg. Lot coverage Topography Total height APPROVED: ..:-. BUILDING PERMIT ITEM SQ, FT. X $/SQ, FT, VALUE BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT ]),-,~,- ";~a.cj /A'/,I( )". This permit is granted on the express condition that the said construction shall, in all, respects, conf<Jrm to the Ordinance adopted by the City of Springfield, bncluding the Development Code, regulating the constrl:Jction and use of buildings, and may be suspended or revoked at any lime upon violation of any provisions of said 9rdinances. Main Garage " Carport. Plan Check Fee: Total Value' ~Z> 15,~ / ;2.. a / ~ 2'2) Date Paid: Building Permit Fee State Surcharge (? r 7-" ~J Receipt Number: Received By: Plans ROV~----'';'''':' Date Total Fee (A) SYSTEMS DEVELOPMENT CHARGE (SDC) (B) Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. PLUMBING PERMIT ITEM ADDITIONAL COMMENTS FEE Fixtures Residential Bath(s) NO ~~-- ~ -#1"'1 ~~6 7(' d<. ~~ qJ-~~ ~ ~) ~,-;:;f -- Sanitary S~wer Water FT. FT, Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan NO By signature, I state and agree, that I have carefully examined the completed application and do hereby certi fy 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 the 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 compliance with ORS 701.055 will be used on this project. Wood Stovellnsert/Flreplace Unit> Dryer Vent Mechanical Permit Issuance State Surcharge (D) '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 the front of the property, and the approved set of plans will remain on the site at all times during construction. Slgna'"e 1J"ltt}111'C~ Date ///,:2;L-/o/~ , I' r Total Permit MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk ft Curbcut ft Demolition State Surcharge VALIDATION: RECEIPT NUMBER J9~&6 J / /2.L/':- J ( ,,/ 2~ /r /') " {~ ' t?/~, Total Miscellaneous Permits (E) DATE PAID TOTAL AMOUNT DUE (excluding electrical) (A, B, C, 0, and E Combined) AMOUNT RECEIVED RECEIVED BY Permit #: q5/~2? , " - :::;2.3 C) J S / ,~~ _,Date: ///.2-L/rr L -#'_11' f Address: Issued by: Statement: Information No~ice, to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential cOnstruction permit appli- cants who are n.ot 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 1 and 2, and either box 3A or 3B: )xf )& U 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. 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 &. 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 Notice to Property.owners about Construction Responsibilities on the reverse side of this form. ~ ~d~tapPlicant) //~/ <1S- (White copy to issuing agency permit file, pink copy to applicant) .~ .r _- '4.' . ... '-"., ........ " '. . Ill1formationfNotice to Property Owners :. Afo>o~~ C~,ll1strQ;H_ctioU'1lReslPonsibi ~ oties . --'. i '\. ~. '" .,:::"'Note: This InformationN~iice.to Property Owners about Construction Responsibilities , , ... t.. . , 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 ,ar:eas 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 aii 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 subje~t to the Oregon Workers' Conipensation Law, and.mtst, obtain workers' compensation insu~ance for yom: ef!1ployees. ..If you fail to obtain workers' compensa~ion 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 at the Department of Consumer and Business Services at 945-7888. ., 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 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsi ble 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 l1ave 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-done, Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure,you have the experti~e 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 perfoimthe required' inspections. .' .... . . ~ ., ..- If you have additional q~estions, write or call the Construction Contractors Board'(PD Box 141~O"Sal~m, OR 97309-5052, 503/378-4621). The"Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1/94