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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