HomeMy WebLinkAboutPermit Building 1993-10-28
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK'
;< ASSESSORS MAP' /7 f) '3
LOT'
OWNER: ~4Nlc
ADDRESS'.~ 2 t, '{
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CITY'
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SPRINGFIELD
BLOCK:
.
JOB NUMBER
9 ?oj 5"o~
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225 Fifth Street
Springfield, Oregon 97477
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TAX lO'~: ~:3.. I 4-
SUBDIVISION'
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STAT~'
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ZIP: 1'7 <(77
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DESCRIBE WORK: (' f'\AlVe.r.f~) 0-..}
REMODEL K ADDITION
NEW
CONTRACTOR'S NAME
OTHER
DEMOLISH
ADDRESS
CON ST.
CONTRACTOR' I
EXPIRES
PHONE
PLUMBING:
MECHANICAL'
L f......., ~
ULU/l/C.K
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It
GENERAL:
ELECTRICAl.
QUAD AREAJlR\'\ '\ Q)
:~;yB~:::p ~
\
. OF STORIES:
WATER HEATER:
- OFFICE USE -
LAND USE 1. \.\ "\
. OF UNITS'
\IV
1
FLOOD PLAIN: .
ZONING CODE: WJ~
. 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.
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumbing/Electrical!
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
o
Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Undertloor Plumbing/Mechanical
_ Prior to Insulation or decking.
r:;:::;;r Post and Beam - Prior to floor
~ Insulation or decking.
o Floor Insulation - Prior to
decking.
o SanitMY Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trencl).
o Water Line - Prior to filling
trench.
..c-::::r Rough Plumbing - Prior to
~ cover.
CONSTR. TYPE:
HEAT SOURCE:
RANGF'
REQUIRED INSPECTIONS
~ Rough Mechanical - Prior to
~ cover.
~ Rough Electrical - Prior \0
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
~ Framing - Prior to cover.
. \.
o Wail/Ceiling Insulation """7 Prior to
cover.
~ Drywall - Prior to taping.
o W.)od Stove - After installation.
o Insert - After fireplace approval
,and installatlon of unit,
o Curbcut & Approach - Alter
fo~ms are erected but prior \0
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 reauired
tr-ges are planted.
~ Final Plumbing - When all
~ plumbing work is complete.
fVf Final Electrical - When all
~ electrical work is complete.
~ Final Mechanical - When all
~ mechanical work Is complete.
l"V1 Final Building - When all
~ required inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking is complete.
o Plumbing Connections - When
home 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.
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Lot (aces
Lot Type
Lot sq. ftg.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cui-dc-sac
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
Main
Garage
Carport
('I1I}II~<il.) /S;
(4MNiG ;0 Qnc.~
2'- '1.,ID
Total Value
BuIlding Permit Fee
State Surcharge
Total Fee
(A)
PLUMBING PERMIT
ITEM
Fixtures
2
Residential Bath(s)
N'
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbln,9 Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
/
Wood Stovellnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
Stale Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ft
Curbcut
ft
Demolition
State Surcharge
~~ /()ilfln~'V FtS'e
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding eleclrical)
(A, B, C, D. and E Combined)
9THE PROPOSED WORK IN ni:
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
-.
I PL.
IN
Is
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Setbacks
I I I I
HSE GAR ACC
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VALUE
_~4)
FEE
20~
,/0-0
2/. a.o
flIlU .
_/5. q-O
It) ~
7.r
2,<):' ?.J
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APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on lhe 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: _32- "3
.,
5L2 S'b
? .'S!.
S3~_Q3
SYSTEMS DEVELOPMENT CHARGE (SDC)~
(B) # '-It./- 'Y..
/6/ -/ -5'.J
Receipt Number: /c9c154.
Received: ..f~
~~ I>>UL
Plan' Reviewed By
Date Paid:
IO;;'~/,J
Systems Development Charge is due 'on all undeveloped
properties wilhin the City limits which are being improved.
ADDITIONAL COMMENTS
~~~Lrf-c;f) L.///t':-I7'Z, LYn4,
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AtEi[Y./f '" r;. .
By signature, I state and agreo, that I have carefully examined
the completed application and do hereby certify that all
information hereon is true and correct, and t 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 Stale of Oregon pertainIng to the work descrlbed
herein, and lhat NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further cerlily that only contractors and employees who
are in compliance with GRS 701.055 will be used on this
project.
I further agree to ensure that all required inspections are
requested atlhe proper time, that each address is readable
from tho street, that the permit card is located at the front
of the property. and the approved set of plans will remain
on the sito at all lmes during constructlon.
~ignalU e <C h...... .-e:_
/'
Dale /,4-:28""7":>
VALIDATiON:
RECEIPT NUMBER /~?..o
/~.g...~~
2/J-i. 'i'1
DATE PAID
AMOUNT RECEIVED
RECEIVED BY .~
-.~
-- - -
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Permit No: 9~ / 5o~
Address: '22~4 A'~/..D~(~
Issued by:
Date:
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. ,.r-=:-:::::--'., I own, reside in, or will reside in the completed structure.
2., I ~ 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 1 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::>< 11 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 notifythe 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" ~ C2~ J<,,-
Signature of Peffi1it Applicant
/6~'i?"-'11
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
. WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
~
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
..
NOfE: _'. This Inforr':1ation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
pass,!a by ttie 191;19 Oregon Legislature.
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 Conslruction 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 l1ire 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 lax 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 arid 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 St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89
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.OB NO. q7lSo~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: H:.A/IJ I< tC06 €:.E.!:>
LOCATION: 2-2-,,';
DEVELOPMENT TYPE:
BUILDING SIZE:
1?ose t$1-C SSDM ~.
LA?fZ. - ReM()PE::.L
170'7'1--(.,1/ - ?1ZILl-
(ADf)~ 5mJ~)
.LOT SiZE
.SQ. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT. ~ X $0.203 PER SQ. FT. C0
2. SANITARY SEWER-CITY
NO. OF PFU'S I X $42.08 PER PFU. (4~ o~)
(See Reverse)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
-- -- r-- -- ~
X X $424.31 J
"- .-/
X X $424.31 $ --
X X $424.31 $
4. SANITARY SEWER-MWMC
NO. OF PFU'S x $15.125 PER PFU + $10 MWMC ADM FEE $
(Use PFU Total From Item 2 Above)
-
MWMC CREDIT IF APPLICABLE (SEE REVERSE) $
TOTAL-MWMC SDC ~
SUBTOTAL (ADD ITEMS 1,2,3 & 4) $ <+ 2- 0..;.
5. ADMINISTRATIVE FEES
C:0
TOTAL SDC $ Lf~ I~
BASE CHARGE (SUBTOTAL ABOVE) X .05
~,4~.L""--- ID/~J<13
u Kip Burdick I I
SDC Coordinator
FIXTURE UNIT ,CALGU LA ,eN TABLE: Numb~r of New Fixtures X. Equivalent ~ Fixture Units (N?TE: c
For remodels. calculate only the NET additional fooures) -.
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
J
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
Bathtub.... ....................-............ -........... -....................
Drinking Fountain........................... -. -............ --.........
Roor Drain............................. -. -................................
Interceptors For Grease/Oil/Sollds/Etc.................
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub /Ootheswasher................. ......... .........
Ootheswa~her - 3 Or More....................................,
MoMe Hdnie Park Trap (1 Per Trailer)....~.............
Receptor FiJr Refrigerator fWater Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc...
Shower, Single.Stall.................................................
Shower, Gang...........................................................
Sink, Bar, COmmercial.............................................
Urinal, StallfWall.......................................................
Wash Basin/Lavatory, Single..................................
Water Oose!. Public Installation.............................
Water Ooset, Private...............................................
Miscellaneous:
Year
Annexed
1979 or before
1980
1981
1982
1983
1984
'1985
TOTAL FIXTURE UNITS
I
,
Based on assessed value. If improvements occurred after annexation date in table,
Rate per $1,000
Assessed Value
Year
Annexed
CREDIT CALCULATION TABLE:
calculate credits separates.
r
$3.21
3.13
3.0B
2.96
2.82
2.68
2.51
1986
19B7
1988
1989
1990
1991
1992
Rate per $1.000
Assessed Value
S 2.24
1.93
1.57
1.18
0.79
0.44
0.28
X $
(Rate X Assessed Value)
X $ ~
(Rate X Assessed Value)
CREDIT TOTAL = $
Credit for Parcel or Land Only If Applicable
Improvement (If after annexation date)
RUNOFF COEFFICIENTS FOR.STORM DRAINAGE
Residential........................................:.;............. 0.4
CommerciaL................................................... 0.9
IndustriaL........................................................ 0.45
GovernmentaL................................................ 0.5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT