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Home My WebLink AboutPermit Building 5-7-25 RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: LOT: ~, I"">-... ..." r~ e: c.: /' ~, , BLOCK: z "" 131$ Pr JOB NUMBER 7:"') //72 r L _ _ 225 Fifth Street , Springfield, Oregon 97477 ... '" TAX LOT: ~y~~ eo_~t.ar .' SUBDIVISION: ~ ~~~'" A t.V"Oj, OWNER: ./~~ l' Y7'L~~E' ADDRESS: ~~9G C;; ~,. CITY' ~~Lp DESCRIBE WORK: '" 1:>0 [}\d:Q1\'*'o.Q, l NEW F1EMODE:~ -_~_ ADDITION V- ~/=5, ~FJR:) - STATE: DEMOLISH CONTRACTOR'S NAME,., , b-=iJ~~~. GENERA~#~1-'~ ~~-~A?~ PLUMBING: MECHANICAL: ELECTRICAL: a~/2r;:-~ ~\", '-,. " PHONE: ~-~2,-:> _ ZIP.: ~7y?~ OTHER CON ST. ~~ACTOR , ~W~ ~~. QUAD AREA: 49..ro<;: . II OF BLDGS: \ OCCY GROUP: -R.3-'-' \ II OF STORIES: WATER HEATER,__________,_____ - OFFICE USE _ LAND USE: \\\ \ VA) C('E::.q ~C- EXPIRES PHONE ?y'? --?$Y~ FLOOD PLAIN: ZONING CODE: L{)~ II OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: --dJ05..-_ 1/ OF UNITS: CONSTR. TYPE: , HEAT SOURCE: RANGE: To request an inspection, you must call 726-3769. This Is a 24 hour recording. AI/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 D Tempormy Electric D Site Inspection - To be made after excavlltion, but prior to setting forms, o Underslab Plumbing! Electrical! Mechanical - Prior to Cover. rJ1 Footing - After trenches are Lf-J excavated, o Masonry - Steel location, bond beams, grouting. r\7l Foundation - After forms are L.(::l erected but prior to concrete placement. ,0 Underground Plumbing - Prior to filling trench, D Underfloor Plumbing! Mechanical - Prior to insulation or decl<lng. ~ Post and Bea~ - Prior to floor in su latlon or decl<i ng. f"'\1l Floor Insulation - Prior to t..p=J dec.klng, o Sanitary Sewer - Prior to filling trench. D Storm Sewer - Prior to filling trench. ; . ~ o Water Line - Prior.to'filli'!g trench. D Rough Plumbing:,~ Prior to - , cover. ..,...', . '., D Rough Mechanical - Prior to cover. , I\7'l Rough Electrical - Prior to' '.., Lf>..J cover., \ \ \ f\7f Electrical Service - Must be ~ approved to obtain permanent electrical power. o Fireplace - Prior to facing materIals and framing Insp. ~ Framing - Prior to cover. ~ Wall!Celllng Insulation - Prior to L,C:J cover. ~'DrYWal/ - Prior to taping. o Wood Stovo - After Installation. o Insert :- After fireplace approval and Installation of unit. o Curbqut & Approach - After forms are erected but prior to placement of concrete: o Sidewalk & Driveway - After excavation Is completo, forms and sub-base material In place, o Fence - When completed. o Street Trees - When all, required trees are pi an ted. D' Final Plumbing - When all ,.' plumbing Worl~ Is complete. r ' , i m Final Electrical - When all L~electrlcal work Is complete. o Final Mechanical - When all mechanical work Is complete. , 'r~ Final Building - When all ~ required Inspections have been approved and building Is completed. o Othor MOBILE HOME INSPECTIONS D Blocking and Set.Up - When all blocking Is complete. o Plumbing Connections - When homo has been connected to water and sewer. -' o Electrical Connection - When blocking, set-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. A Lot faces Lot Type --- Interior I P.L. IN Is \W IE Setbacks HSE GAR ACC I I I Lot sq, ftg. Lot coverage Corner Topography Total height ( ~) BUILDING 'PERMIT Panhandle Cul-de-sac ITEM sa. FT. x $/so. FT. VA LU E Main Garage " Carport b~ ~~ --5ii' .~ ~ ,(/ ~z;-- 2,/ Tolal Value ll~~~ S~.~ 1,~\.\ . ,':'1~:q (: Building Permit Fee State Surcharge t.t.103~~J ~ Total Fee (A) SYSTEMS DEVELOPMENT CHARGE (SDC) 45.& {) (B) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) NO Sanitary Sewer FT. FT. FT. Water Storm Sewer Moblie Ho'me Plumbing Permit State Su rcharge Total Charge ~ , (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan NO Wood Stove/Insert/Fireplace Unit, Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit CJ (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It Curbcut ft Demolition State Surcharge Tolal Miscellaneous Permits (E) ~ ,J~S.\l ~ TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) ,S THE PROPOSED WORK IN THE 'HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said constructio'n shall, in all respects, conform 10,tlle Ordinance adopted by. the City of Springfield, including the Development Code, regulating the cODitruction and use of buildings, and may be suspended or revol~ed at any time upon violation of any provisions of said ordinances. Plan Check Fee: ___~. A Date Pald:___7,:~!::'~ Receipt Nurnber:{S3l~_ R.eceiv:.d BY:::> 4~-, 2~evie~ed-B~--"-':~~~---- " ~ll~ Date Systems Development Charge is due on all undeveloped properties within tho City limits ,which are being improved. -, .... .... . ADDITIONAL COMMENTS ---- _ K~ro\'~ - - ~ ~w - "~ T~ ~-- ~ By slgnat,ure, I stale and agree, thaI 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 alj work performed shall be done in accordance, with the Ordinancus 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 struclure without permission of the Building Safety Division, I further certify tllat only contractors and employees who. are In compliance with ORS 701,055 will 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 the front of the property, ilnd the approved set of plans will remain on the site at all limes during construction. s,gnatureh ~~ Date 7-~ 5 -y> VALIDATION: RECEIPT NUMBER /8 y~ DATE PAID ?....2S''''~5 AMOUNT RECEIVED _~.~L./~O? /'A~ " // I .. RECEIVED BY .- ~ '.i.... ') ~,i '~N CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE Name or Company: RON/VAL LANE Location: 5996 G ST Developement Type: A Building Size: 1, STORM DRAINAGE Impervious Sq Ft 205 2, SANITARY SEWER - CITY Number Of PFUs 0 (see Page 2) 3, TRANSPORTATION Number Of Units x Trip Rate Transportation Total 4, SANITARY SEWER - MWMC Number Of PFUs o MWMC CREDIT If Applicable (see Page 2) TOTAL - MWMC SDC SUBTOTAL - (Add Items I, 2, 3 & 4) 5. ADMINISTRATIVE FEES Base Charge (Subtotal Above) X TOTAL SDC Reviewed By: TROY MCALLISTER X X 0.210 43.43 Job No.: 951172 Lot Size: Per Sq Ft Per PFU X Cost Per Trip X X Per PFU + MWMC Admin Fee 18.750 0.50 Date: 07/17/95 Page 1 Sq Ft $43.05 $0.00 $0.00 $0.00 $0.00 $0.00 $43,05 $2.15 $45,20 4' .I Job Number: 951172 FIXTURE UNIT CALCULATION TABLE Page 2 Fixture Type Bathtub Drinking Fountain Floor Drain Interceptors For Grease/Oil/Solids/Etc Inteceptors For Sa~d/Auto Wash/Etc Laundry Tub/Clotheswasher Clotheswasher - 3 Or More Receptor For Refrigerator/Water Station/Etc Receptor for Commercial Sink/Dishwasher/Etc Shower, Single Stall Shower, Gang Sink, Bar, Commercial Urinal, Stall/Wall Wash Basin/Lavatory, Single Water Closet, Public Installation Water Closet, Private Miscellaneous TOTAL FIXTURE UNITS Number of Unit Fixture New Fixture Equivalent Units 0 2 0 0 1 0 0 2 0 0 3 0 0 ,6 0 0 2 0 0 6 0 0 1 0 0 3 0 0 2 0 0 0 0 2 0 0 2 0 0 1 0 0 6 0 0 4 0 0 0 0 CREDIT CALCULATION TABLE: Based on assessed value. If improvements occured after annexation date, credits are calculated separately. (calculations are by $1000) Year Annexed: Credit For Parcel Or Land Only If Applicable: Improvement (if after annexation date) : o X 0.00 - 0.00 o X 0.00 0.00 CREDIT TOTAL = $0,00 (If land value is multiplied by 1 then the parcel/land credit is not accurate.) Permit #: ~ _5"(17-.:2 ~~~ r:: 0~ _Date: '// ' -....... 7'"'~.~~ Address: ?x- l Issued by: 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 1 and 2, and either box 3A or 3B: 4J 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 l.KI 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. ,tf?bPI /~ (Signature of permit applicant) 7-25-1"'?Q (Date) (White copy to issuing agency permit file, pink copy to applicant) - , . \. - Information -Notice to Property Owners About. Construction Responsibilities - y' -:. -'! . ~ . '~ . Note: This Informatio.n NoOce to Property Owners, about Construction Responsibilities _. _ ~'~''''._I>o."N "._..""" . , was developed by the C()nstruction: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 ~ollowing responsibilities and arl?as of concern. : EMPLOYER RESPONSIBILITIES: If you hire persoQs not. registered ',Vith the Const~ction Contractors Board.to do labor in constructin~ or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an empl,oyer and the people you hire will be employees. As the employer, you 'm.ust comply with t?e 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 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 ofHurnan Resour~es at 378-3524. .; '. ~ Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and rrtust obtain workers' compensation insurance for your employees. If you fail to 9l;>tain 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 at the Department of Consumer and Business Services at 945-7888. U,S, InternaJRevenue 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 daJrlage insurance: COI)tact your insurance agent to see if you have adequate insuFance coverage for accid.ents and orpissions such as falling, to()ls, paiIlt overspray, ,wat~r damage fro,m eipe punc?1res, fire, or ,work that must be re~o~, ' . 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 appropnate times so they' can perform the required inspections~. . -- , ILyou'have additional questions, write or call the Construction Contractors,Board (PO Box--f414o",'-Salem\ 'OR97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. ' prop-own. pm4 1/94