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Home My WebLink AboutPermit Building 1994-3-31 I~;I RESIDENTIAL PERMIT APPLICATION' Inspections: 726-3769 Office: 726-3759 , , LOCATION OF PROPOSED WORK: LOT: CITY: DESCRIBE WORK: NEW REMODEL CONTRACTOR'S NAME GENERAL: 2- c..,. ~'S7-;' PLUMBING: MECHANICAL: ELECTRICAL: ~p~ L , ' - I,. ' QuAD AREA: _S 'R~\AD # OF BLDGS' ~ j' OCCY GROUP: '~~ # O~ STOHIES:' ~ WATER HEATER: '. ~"'- JOB NUMBER Oj~ O~~~ 225 Fifth Street Springfield, oregon 97477 S'F(20JC1.~IEL-b, I DvL q~-f,1/7 , I TAX LOT: .JI-~ Qy ZOO SUBDIVISION:3 PflAbf)ITflJ;'; /t1C!:e-,..;ue; p1I1 hJorf- PHONE: 1-41- Cf?JOI/- BLOCK' STATF' ~, ZIP: 11-41 =r' J -~!h4-m 1(;1.( !Z+.r7 , fdtr 17' I ' t ~~\-rl crr..J .-; l --- S l(i~ . ,. V DEMOLISH OTHER, REQUIRED INSPECTIONS ~ Rough Mechanfcal -:-.Prior to J./""'ol'.cover. , D Site Inspection - To be made , "r'......{..Rough Electrical ~ pri'or to ' after excavation, but prior to ' ~ cover. setting forms, ADDITION, CON ST. ADDRESS . CONTRACTOR # 17fC1 IlZVi IJ~ /Zb. 1+ 40'55'1 .--r"......--'...-,.-' , 0';;'" OFFICE USE _ t \ \ \ , CONSTR, TYPE: \IA) LAND USE: #OF UNITS: HEAT SOURCE:, RANG,F' D Electrical Service - Must be approved to obtain permanent electrical power, ' ' D Fireplace - Prior to facing materials and framing Insp, M'Framiilg -- Prior to cover, 1'Y1"WaIl/Ceiling Insulation - Prior to ~cover. ' . , ~DrYWall - Prior to~a~in,g.: o Wood Stove -- After j~stalIatlon, ' D Insert - After fireplace approval , and InstalIation of unit, ! O. Curbcut & Approach 0- After ' forms are erected but pri'or to placement of concrete, o Sidewalk & Driveway - After " excavatiof'l is complete, forms and sub-base material in place, o Fence':':'" When completed. ' D Str.eet Trees - When all required trees are planted, ' " " EXP,'RES I ( 4 1/'7.q~ PHONE fe.?1-3~ FLOOD PLAIN: ZON'ING CODE: -.L.f) f2-- # OF BDRMS: SECONDARY HEAT: SQUARE FOOTAGE: ,-9LcQ ASSESSORS MAp: #1, OWNER: (Oft/v NoR:R.1s ADDRESS: at c; /tu..kfJ AtE, SP/.)r NGF(EL[) -:<,L, () S7~ ~Q p, To request an inspection, you must calI 726-3769. This Is a 24 hour recording, AII Inspections requested before 7:00 a,m, will be made the same working day, Inspections requested after 7:00 a,m. wllI be made the following work day, o Temporary Electric o Underslab Plumbingl Electrical! ' Mechanical - Prior to cover. ~ Footing - After trenches are ~ excavated, o Masonry ..,... Steel location, bond bear:ns, grouti ng, I"v1Foundation - After forms are ~ erected but',prior to concrete placement. o Underground Plumbing - Prior to fi/ling trench, i:7f Und~rfloorosrumbing)Mechanical ~ ...,..,Prior to InsUlatiorior decking, 0(71" Post and Beam ,- Prior to floor ~. insulation or decking. MFloor Insulation ~ Prior to ',. decking. D Sanitary Sewer - Prior to fi/ling trench. 'M"Storm Sewer - Prior to filling ~trench, o Water Line - Prior to filling trench, " ,N'"RoUgh Plumbing'--:- Prio:r ,to / ..cover", \< ~ ~ Final Plumbing - When all plumbing work Is complete, rvr Final Electrical -,When all ~electrical work is complete, ~ Final Mechanical - When all ~ mechanical work is complete, ~Final Building - When all ~ required inspections have been approved and building is completed. o Other, MOBILE HOME INSPECTIONS ,0 Blocking and Set-Up '-- When all blocking is complete. o Plumbing Connections - When home has been c,onnected 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, ski rti ng, decks, and venting have been installed, Lot faces Lot sq. ftg, Lot coverage Topography / Total height \ n f\ ~C?) BUILDING PERMIT SQ, FT. r)J[j ~~O ITEM Main Garage Carport Total Val ue Building Permit Fee State Surcharge Total Fee L~t }Ype -.6' Interior Corner Panhandle Cul-de-sac X $/SQ, FT. S~:;;l (A) ,~ I P,L. IN Is Iw IE Setbacks IHSEIGARIACC\ I I I I VALUE c- I '). I" Ol ,~"'"f......,l ::lO/d:?;'J.. /~,~a 733 153,9-.'<: SYSTEMS DEVELOPMENT CH~GAiSBDC) (8) L1:::J PLUMBING PERMIT ITEM Fixtu res Residential Bath(s) NO Sanitary Sewer Water Storm Sewer Mobile Home Plumbing Permit State Su rcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan 4- . FT. FT. FT. (C) Dryer Vent Wood Stove/Insert/Fireplace Unit NO / Mechanical Permit Issuance State Su rcharge Total Permit Mobile Home MISCELLANEOUS PERMITS (D) State Issuance State Surcharge Sidewalk ft Curbcut ft Demolition State Su rcharge Total Miscellaneous Permits (E) FEE ~.&O 2CHJ ...... 42~O , /:1?/AI... / G". t5"O I tJ,6>O .7j- 25 ,75"" TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) 22-1, Si (, IS 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, AP~ROVED' 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. qs.~~ ~ J-Ji '1 &..f Receipt Number: II ~ Sf ~~o Plans Reviewed By, Plan Check Fee: Date Paid: 3/~0'f' Systems Development Charge is due on all undeveloped properties within the Ci.ty limits whic,hare being improved. ADDITIONAL COMMENTS /f//!/d .z, ~ E(77'~7. ~/7 /~ ,(~ 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 pertai ni ng to the work descri bed herein, and that NO OCCUPANCY will be r;';ade 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, an~~roved set of plans will remain., ><~g:::~~~, . :,)(O~ ?f{J71 f Date VALIDATION: RECEIPT NUMBER IA0~ DATE PAID ~-'?J-?9' AMOUNT RECEIVED ~~2_S3 RECEIVED BY //~_... .// ~ I. " · Permit No: ~7" O'2'2E":< Address: 2/9 AC'~~y~ ,. , , - Issued bY-r-"- 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 applicant~, 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. V ,., 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. 3. A.I I My general contractor is 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 I I 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 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 understand the Information Notice Property Owners about Construction Responsibilities on the reverse ~ this fo ,/ ~ IZ- . {-t,)e-Jfi~ SigJ of Per it Applicant CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 ' D'3,,?J(,9t? Date WHITE COpy TO ISSUING AGENCY PERMIT F:IJ ~ PINK COPY TO APPLICANT ' JIll .- "~ A\ j~ INFORMATION NOTIC.E TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This;ln"fbrmatiQn Notice to Property Owners About Construction Responsibilities was developed by !he Construction Contractors Boar.d in accordance with ORS 701:055(5), pass'ed by the 1989 Oregon Legislature, '. " '. . If you are acting as your Qw"nconUa'ctor 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 struct,ure; you will, in most ,insta!,\ces, 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 LaltFi ~f FI') ,i?--?YJloyer, you must withhold ~ncorne t~?fes from employee wages at the time employees are paid. Ydu 'v~ijl J~:~iable for the tax payment~.,t~ .:(;;~;;;},-)Li don't actually withhold the tax from your employees. For more information, call the Ore,gon 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 infor:mation, call the Ore,gon Employmen~ 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 tax 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, y6u- 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 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 S1. NE, Suite 300 Salem, OR97310-0151 Phone 503-378-4621 ~ 02~ 10/24/89