HomeMy WebLinkAboutPermit Building 1994-10-31
OWNER: ~J.I N ~ k.ATfh J!' J /M/r .M#O,e' E d
ADDREr""" k,t/~ I?J Vr/J. )-111.1,...$ l)/I/ v4'
CITY' . <;,OA ; N?~Mrt!,t,? STATE: ~I ~ 6-0#
{
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
ASSESSORS MAP'
LOT'
DESCRIBE WORK'
AAf1
NEW REMODEL
CONTRAcroR'S NAME
GENERAl'
PLUMBING'
MECHANICAl'
ELECTRICAl'
~/r,-':
N/A
QUAD AREA: \\(\\,\0
. OF BLDGS: \
OCCY GROUP: ~{~
\
· OF STORIES:
WATER HEATER'
.
RII/e-I2I1I(.,"S
BLOCK'
$.""AA4I'- '/ .r.?~.,,4o?
ADDITION ~ DEMOLISH OTHER
.
JOB NUMBER ~Y/.'5'5',.
225 Fifth Street
Springfield, Oregon 97477
.0121 (/6'
, TAX LOT:
SUBDIVISION:
.!:!> '"3' 9CS'C:::>
PHONE:
71/1. -6/1?
ZIP: Q7V77
ADDRESS
CONST.
CONTRACTOR'
PHONE
EXPIRES
- OFFICE USE -
LAND USE: \ '- \ \
· OF UNITS: rJ ZONING CODE: II ~\C
CONSTR. TYPE: -11 . OF BDRMS:
HEAT SOURCE: ~G-"'7' -~ c.... SECONDARY HEAT: __ _
RANGE: . SQUARE FOOTAGE: .J3tt ()
FLOOD PLAIN:
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 Ihe same working day. Inspections requested after 7:00 a.m, will be made the following work day,
o Temporary ElectrIc
D Site Inspection - To be mado
after excavation, but prior to
setting forms.
o Underalab Plumblng/Electrlcall
Mechanical - Prior to cover.
rVl Footing - After trenches are
~ excavated. ~
o Masonry - Steel location, bond
beams, grouting.
m Foundation - After forms are
~ erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
O Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
rYl Post and 8eam - Prior to floor
LfJ Insulation or decking,
f'll Floor Insulation - Prior to
r decking,
o Sanitary Sewer - Prior 10 filling
trench.
D Storm Sewer - Prior to fltllng
trench.
o Water Line - Prior to filling
trench,
o Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
rY1 Rough Electrical - Prior to
I cover.
r\71 Electrical Service - Must be
L.N approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
ltJ Fra~tng - Prior to cover.
I
fXl Wall/C'elllng InsJlatlon - Prior to
{ cover.
CP Drywall - Prior to taping.
o Wood Stove - Afler Ins lallation.
o Inaert - 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 wc;>rk Is complet.e.
rifI Final Electrical - V\l.hen all
, electrical work Is complete.c
o Final Mechanical - When all
mechanical work Is complete.
cp Final Building - When all
required Inspections have been
approved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set,Up - Whep all
blocking Is complete.
o PlumbIng Connections - When
home has been connected to .
water and sewer,
o Electrical Connection - When
blocking. sel'up, and plun;lblng
Inspecllons have been approved
and the home Is connected to
the service panel.
o Final - After all required
Inspections are approved and
porches, sklrtfng, decks, and
venting have been Installed.
.'~. ~ .. ,\ -.i":,'v'Volii.f'l.ili
, . ,L~
Lot Type '.'.. \
Setbacks
~ Interior I' HSE GAR ACC' I
I P.L.
Corner I N I
Is I
Panhandle
Iw I
Cul.de.sac
IE I
Lot faces
Lot sq. ftg.
Lot coverage
Topography _
Total height k
, . (4)
BUILDI~G PERMIT
ITEM SO. FT,
,..,.,aln
Galage
Carport
ft'i?D
~2R
Total Val ue
BullCllng Permit Fee
State Surcharge '\- 5~
Total Fee
X $/SO. FT. ~ VALUE
"
~&:::. :;>A /) ~g.y
\1<)S'{
\~~. !iQ...
\f);L.
(A) \'3.8.7Q
SYSTEMS DEVELOPMENT CHARGE (SDC)
~9~. ~~
PLUMBING PERMIT
ITEM
Fixtures
.
Residential Bath(s)
N'
Sanitary Sewer
FT,
, Water FT.
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/ Insert/ Fireplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State'Surcharge
Total Permit
(B)
FEE
(C)
~
(D)
cf..
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk It
Curbcut
It
Demolition
Slate Surcharge
Total MIscellaneous Permits (E)
(b
:l.~~,lS
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C. D, and E Combined)
.IS THE PROPOSED WORK,tN THE _ '
--HISTOI;lICAL 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
construction shall, In all respects, conform to the Ordinance
adopted by the City ,of Springfield, 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,
Plan Check Fee: ~~ S' ",.
'-6- 17 :-cry
Receipt Number: i0lDl '
(0vt~
Date Paid:
R~t~d By:
Pla~~lewed By
~
Systems Development Charge is due on all undeveloped
properties within tho City limits which are being Improved.
ADDITIONAL COMMENTS
~
~ .or..l 'l-lUo>,
~~
""\()-'>.~ ~T\;.:_~
~
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 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.
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
ont::u:~te~~
~ 1tJ3/Fr --
VALIDATION: I rJ YJ nrf
RECEIPT NU~"R . ~ I ~
DATE PAID J ( h. ~,I Cf(
AMOUNT RE~D/~~S
RECEIVED BQ.LL1)_ )
. ATTACHMENT 81
.OB NO, 9oj!'/s93
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
. WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NA~E OR COMPANY:
~~ ))'~ ~4~
~/~ j)~
LOCATION: ~ ~1
DEVELOP~1ENT TYPE' ~ f." f /7~..' J
BUILDING SIZE: 20.x .2/,5- (cAi/E5) lOT Sj7F
SQ. Ft.
1, STnRM nRATNAGF
IMPERVIOUS SQ. FT,
4~o
X $0,209 PER SQ, FT,
$ l?9'. ~ 7
2, SANTTARY SFWFR.rlTY
NO. OF PFU' S .
(See Reverse)
X C'~ 7' "E" DFU
. _"":"....... _0 r r<. ,
sN:4
/
3. ~:-,':l.,'~ :.:-:;.T ~ T i ;::.J
:;0 OF UNiTS X TRIP FATE X COST PER TRIP
v
^
X ,436,19
$
~
/
x
>: 5436. 19
s
>: ~-4~:6. 19
s
SUBTOTAL (ADD Im',s 1. 2, & 3) $ F f, ? 7
t 5~1~1T~;Y S~W~P-MWMC
I!O, OF PFU'S x 517,19 PER PFU.;- no MvJl1C ADIJ,IN.FEE
(Use PFU Total From Item 2 Above)
$
SUBTOTAL (ADD ITEMS 1.2,3 & 4)
.~ ~
I'
$ ?r, F"
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
TOTAl .MWMr snr
5. AnMTNTSTATTVF FFFS
BASE CHARGE (SUBrOTAL ABOVE) X ,05
---0# I
7~ #~~. 'Date:
/ rH~rlv Hornig, .E.
,/ \g>C"Coordinato
$ of. f!'1
/0 - 'zJ' '1-/
IQIAI snr
$ "l~,3C.
B2 ' SDC .
I .
=IXTURE UNIT CALCULA ... TABLE: Number of New Fixture.unit Equivalent = Fixture Units
NOTE: For remodels, calculate only the IiEI additional fixtures)
NUMBER OF
NEW FIXTURES
'IXTURE TYPE
3athtub"""..",.""",..""."",,""""""""',.,"""""""'" .
Jrinking Fountain"",," """ ,..' ,""," ,..'" ",',' """",."."
,=Ioor Drain,.""""""".""""""""","",..,..,"""""""'"
Interceptors For Grease/OiI/Solids/Etc.................
Interceptors For SandlAuto Wash/Etc..................
Laundry Tub/Clotheswasher"..",.."....."..,.,..,.,""'"
Clotheswasher. 3 Or More....................................,
Mobile Home Park Trap (1 Per Trailer).................,
Receptor For Relrigerator/Water Station/Etc.......,
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall......................,..................,.......
Shower, Gang,.."....,.,....""""",.,.,",..,",..,',."."..".,'
Sink: Bar, Commercial, Residential Kitchen........................
Urinal, Stall/Wall., :.."..,..,..,......,....,.... .....,..,.........."..
Wash Basin/Lavatory, Single...,........,....,..,.............
Toilet, Public Installation..........,............,......,.........
Toilet, Private,.......,.............................,.........,..,...
Miscellaneous: ,TANI ~P'.s ,$.INK
TOT AL FIXTURE UNITS
UNIT
EOUIVALENT
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
.2.
=
FIXTURE
UNITS
CREDIT CALCULATION TABLE: Based on assessed value, If improvements occurred after annexation date in table,
c8\cula.te credits separates.
'1
i
i
i
,
Year
Annexed
1979 or before
1980
",961
1982
1983
1984
1985
Rate per $1,000
Assessed Value
$3.46
3,38
3,32
3,21
3,06
2,92
2,73
Credit for Parcel or Land Only If Applicable
Improvement lif after annexation date)
-
Year
Annexed
1985
1986
1987
1988
1989
1990
1991
1993
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
=r
Ii
Rate per $ 1 ,000
Assessed Value
=
=
CREDIT TOTAL = $
$2.46
2,14
1.77
1.37
0,97
0,61
0.44
0,15
J
.
Permit #:
~~
~lMl1\l~ \X
) Date: \ D,(~~
Address:
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 he app.vp.;ate blanks and initial boxes I and 2, and either box 3A or 3B:
I own, reside in, or will reside in the completed structure,
2, I understand that I must fegister 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
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 Propert~ers about onstruction Responsibilities on the reverse side of this form.
" ~ ~ - /cJJI?Y
/ \; t/ (Signature of perrnft applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
][111~Oi"i11i81~60U'i ~O~iiCe ~O I?~o~ei"fry OwneR'S
A\blm.ll~ iCOnS~i'lBiC~U~n lAesLO:OlliJs6\blm~ies
Note: This Information Notice to Property Owners about Construction Responsibilities
was developed by the'Construction Contractors Board ill 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,
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 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 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 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.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 or call the Construction Contractors Board (PO Box 14I40,SaIem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem,
prop-own.pm4
1/94