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Home My WebLink AboutPermit Building 1993-8-26 RE;.SIDENTIAL ,?PERMIT APPLICATION ;./ .<::.. lf1"speclions: 726-3769 Office: 726-3759 SPRINGFIELD LOCATION OF PROPO,SED ~RK: f- ,/7'1 " ALL F'AI ASSESSORS MAP: l1.l)~ 3) ~ ~ LOT: A V.& BLOCK: 1-1 (!) N L.. i~ f!.Ti/' S ADDRESS: ! 7 Lf A I.-./... ~ N A u /3' CITY: .(" p/Z/y('; F H::.L() OWNER: STATE; "C!Yt2-1E DESCRIBE WORK: OAf - ~/IA.c-I,~,D OTHER NEW X REMODEL CONTRACTOR'S NAME GENERAL: (!)4-I).r~ JZ PLUMBING: MECHANICAl' ELECTRICAL: QUAD AREA:~ :)~1\)_tJ It OF BLDGS: ' . \ ~ \ OCCY GROUP: It OF STORIES: WATER HEATER: (,"'A l2.A tS e ADDITION DEMOLISH JOB NUMBER Q'3/. ( g1 225 Fifth Street Springfield, Oregon 97477 '" TAX LOT: J)?1 W = ") SUBDIVISION: PN 7~7- 17/..s- t'\9lo-- \0/\ \x~5 ZIP: 97477 I I ADDRESS CON ST. CONTRACTOR It PHONE - OFFICE USE - 1\ \, \' It OF UNITS: . 'I CONSTR, TYPE: V N LAND USE: HEAT SOURCE: RANGE: _ EXPIRES FLOOD PLAIN' ZONING CODE: I J)r It OF BDRMS: 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 foilowing work day. o Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. D Underslab Plumbing/ Electrical/ Mechanical - Prior to cover, r><!Footing - After trenches are . "excavated, D Masonry - Steel location, bond beams, grou,ting, . MA!D-c),4..y, , M Foundation -I- After forms are ~ erected but prior to concrete placement. D Underground Plumbing - Prior to filling trench. D Underlloor Plumbing/Mechanical - Prior to insulation or decking. D Post and Beam - Prior to floor' i nsu I ation,.or decki ng, , .' o Floorlnsula,tion - Prior to ,decking; .' . D Sanitary Sewer -'- Prior to filling trench, ", .. ~ Storm Sewer - Prior to filling , . trench. ' D Water Line .- Prior to filling trench. ' , D Rough Plumbing - Prior to cover.., . .' " " " R'EQUIRED INSPECTIONS D Rough Mechanical - Prior to cover, D Rough Electrical - Prior to cover. D Electrical Service - Must be approved to obtain permanent electrical power. D Fireplace - Prior to facing materials and framing Insp. ~ Framing - Prior to cover, D Wall/Ceiling Insula,lion - Prior to cover. ,I' D Drywall - Prior to taping. D Wood Stove -'- AftE;r installation. , D Insert - After firepl~ce approval and installation oPuni!. .. D 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, D Fence - When completed. o Street Trees - When all required , trees are planted. D Final Plumbing - When all "plumbing work is complete, D Final Electrical -'- When all electrical work is complete, D Final Mechanical - When all mechanical work is complete. ""}...../f Final Building - When all ~required inspections have been approved and building is completed, D Other MOBILE HOME INSPECTIONS D Blocking and Set-Up - When all blocking is complete, D 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. D Final - After all required "- inspections are approved and porches, skirting. decks, and venting have been installed. lot faces lot Type lot sq. ftg. Interior lot coverage Corner Topography Total height Panhandle Cul.de.sac BUILDING PERMIT, ITEM sa. FT. X $'/ sa. FT. Main 'l3CYl ~ ;lU Garage Carport Total Value Building Permit Fee State Surcharge Total Fee (A) ';;t~r " t' " :. ". Setbacks .: '.~ ~, , \, -' 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 issuanc'e, I P.l:" HSE GAR ACC IN , ~"' '... '" . .-: S,., W IE VALUE \.:\ }9m " : ,. , . , Q2?O , 4&3 CJ 7, I J SYSTEMS DEVELOPMENT CHARGE (SDC) (B) \)(""1 b PLUMBING PERMIT ITEM Fixtures Residential Bath(s) ~~ewer NO FT. ./ 5' 0 Water FT. Storm Sewer FT, Mobile Home Plumbing Permit State Surcharge 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 (D) MISCELLANEOUS PERMITS , Mobile Home State Issuance State Surcharge Sidewalk It Curbcut It Demolition State Surcharge ...', FEE --Z ~ ()-<) j2f" "2.&.21"" Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) /"2 '2 3~ , - "'~ (A, B, C, 0, and E Combined) APPROVED' BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT . . This permit is granted on the express condition that the said construction shall, 'in all resp'ects, co~'form to the Ordinance adopted by the City of Springfl~ld, including the Development Code, reg'ulating the construction and use of buildings, and may be suspended or revoked at any time upon yiolation qf.,any Rrov,isions of said ordinances, PI~n Check Fee~ JJ;n ~ \~ Date Paid: ~---. Lo . q:s .. Receipt Numbeu ,~" ~~:S') Received By: C=) 1 (.u~ ,-'-I /Y~~ 4R-::i~wed By ...& /21/9.J f Daril Systems Development Charge is due on all undeveloped properties within the City limits which are being Improved. ADDITIONAL COMMENTS \ m{)-q (\~\)\lirr~JJUL~ L6J \::4.r)~ hrynJlVr~Lb ~)\!)\ nSf. clJlC1,nnO.t: (!f1J/111i ~ (\ ~ 0 [iJ l ,t1Q) iQ;t(\ _16 C1J- L "fl('i i1\ ,SJrJ LJfiCtL.l_C&J 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 a9cordance 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 re~dablE3 ' from the street, that the permit card Is located at the front of the property, and the approved set ' I~maln ~on the sit all. es du~on ,< _ I Ignature __ I I V-z. Date ~ - 2J; - 9 ~ , VALIDATION: RECEIPT NUMBER /~~ 6 7 DATE pAID ' "if:: -~...~ 33 AMOUNT RECEIVED I ~~ :?c!!!> RECEIVED BY ~ ~ i /./ ; " . " ..- Permit No: 9~ ~€? Address: //~ ~6'~v-c-.. - ." , - Issued bv~4~ Date: B72~.!?~ ?~' - 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 GRS 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 , x 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. l My general contractor is 3. A.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 X 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 to Propert t Construction Responsibilities on the reverse ide of this form. ..j) ~ 'l-z(; % Date L CONSTRUCTION CONTRACTORS BOARD 0244J 8/91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES '\" '" NOTE: <T:hi5'lnfpfrn.~i9n Notice to, Property Owners About Construction Respon~ibilities was developed by the Construction Contractors Board in accordance with ORS 701'.055(5), '0, . ,p81ssed','by the '19..89"Ora~io,n Legislature. ' '" "':,' " ' ' . " .. ~. . . :"""..': '~"".- ~ .'~,. .:' -:~......-- ~ . . . -'~ .-..' I(you are ac'ting as yoi.Jr-<>wn"contraGto! to construct a new home or make a substantial improvement to an existing structure, you can p~event many problems by being aware of the following responsibilities and areas of concern. ' ' . ' ' >, .-"'\ EMPLOYER RESPONSIBILITIES: If you hire persons nof registered with the Construction Contr,actors, Board to do labor in construeting or assisting in the construction or improvement of a residential"structure, youwHl, in most ,instances, be'ru1ed to be an "employer" and the p~ople you hire will be "employees". ~s ,tI1e,emplbyer, you'l11ust comply '^',itt:l the following: Oregon's Withho,lding.Tax Law: As an.empk>yer, you mU'st W!thhpld income tax~s from emp!oyee wages at the time employees ar? paid. Yo~ will:be,iiable f,or t~e tax payments even if you'don't actually withhold the tax from your employees, For more information, call the Oregon Departm~nt pf 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 empJQyees. For more information, call. the Oregon EmploymelJLDivision DHR at 378-3224. "', . Workers' Compensation Insurance: As an employer, you are sobject 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 bei.1iable for all claim costs if one of your employees is injured on the job. For more information, call.th~ Workers'. qompensation Division DIF at 373-7434. U,S, Internal Rev~n~e Seryice: As an employer, YOIJ mlJst withhold federal inc~I'!",e tax from employees' wages. You will be liable for the tax payment ev~n ~fyou didn't.actually withhold the'tax. For more information, call the Internal Revenue Service at 221-3960. . ,,' , OT~IER RESPONSIBIUTDES AND AREAS OF CONG,I;.RN: Code Compliance: As the permit holder for this project, you are responsibleJor resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: ContactVourinsurance agent to 'see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint oversp-ray,' water damage from pipe punc- tures, fire, or work that must be re-done. Time'to Supervise Employees: Make sure you have swJficient time to supervise your .employees. . ....... -':5/' Expertise: MC!ke sure you have the expertise to act a~ ,your,olivn general.ppntractor, to coordinate the work of rough-in an~ :firiish t~C!Q~,~,' C!:nd to notify b~!ld,in,Q offIdals", flt -theappr9priat.e. ti~~~:.so the~. can perform the required inspections. "'" ,,~'<-<.,-:-' ':/ '.'~~_,/-', If you have additional questions. write to: Construction Contractors Board 700 Summer S1. NEt ,Suite ,~QO Salem, OR 97310-0151' Phone 503-378-4621 .. . . ':: - 0244J' '10/24/89; '. : If ~ ....;' ~. \ '\ \ (,-< "'.. t