HomeMy WebLinkAboutPermit Building 1996-3-7
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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LOCATION OF PROPOSED WORK: '=P:'"'=5-S-2.
ASSESSORS MAP' ;5?-.cP2. ~_/<--.
LOT'
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JOB NUMBER~:2/!ii./ '/
225 Fifth Street
'Sprlngfleld, Oregon 97477
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. TAX LOT: t!!:)? /' ~
SUBDIVISION'
BLOCK'
OWNER'
ADDRESS:
CITY'
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STATE'
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DESCRIBE WORK: ~~~~~~ k~v~~~~~J:;~~
NEW REMODE{ , ADDITION'" MOLISH' . E . .
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CONTRACTOR'S NAM~ / ',. ADDRESS'
GENE.fIAL: ~~k c/C:::,? f', .
PLUMBING: ~~~~ -'19.c.( --/ -
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MECHANICAl'
ELECTRICAL: . ~L C5iP' rc: ~ .
CONST .
CONTRACTOR' t'~liES I :___J1l~~ .A~"
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QUAD AREA-
· OF BLDGS:
OCCY GROUP:
· OF STORIES:
WATER HEATER'
- OFFICE USE -
LAND USE:
· OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANG'"
FLOOD PLAIN'
ZONING CODE:_
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
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To.request an Inspection, you must call 726-3769, This Is Ii 24 hour recording. Alllnspecllons requested before 7:00 a.m. wfll be :.
made tha same working day, Inspections requested alter 7:00 a.m. wlfl ba made the following work day. .
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REQUIRED INSPECTIONS
o Temporary Electric
D Site Inspection - To ba made
after excavation, but prior to
setting forms.
o .Underslab Plumbing/ Electrlcal/
Mechanical - Prior to cover.
o Footing - Alter trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting. ..:
o Foundation - Alter forms are ,
erected but prior to concrete .
placement.
o Underground Plumbing - Prior
10 filling trench.
o Underfloor Plumbing/Mechanical
..., Prior to Insulation or decking,
o Post and Beam - Prior to floor
Insulation or deoklng.
o Floor Insulation - Prior to
deckl ng. .
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to fllflng
trench.
o Water Line - Prior to filling
trench. .
lXl Rough Plumbing - Prior to
cover.
~ Rough Mechanical - Prior to
cove~ .
r;7I Rough Electrical - Prior to
LLJ cover.
o Elactrlcal Service - Must be
approved to obtain permanent
electrlcel power.
o Fireplace - Prior to lacing
materials and framing Insp.
ILl Fram~~~. - Prlo! to cov~r.
rn Wail/Ceiling Insulatlon.- Prior 10
cover. . ,
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!XI Drywall - Prior. to lapl~g.
o Wood Stovo - Aftor Installstlon.
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o Insert - After "replace approvel
and Installation of unit.
o Curbcul & Approach - After
. forms are erected but prior to
placemont of concrele.
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o Sidewalk & 'Driveway - After
excavation Is completo, forms
and sUb-bas'e material In place.
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o Fence.. - '~'hen completed.
o Street Trees - ~W~en all required
trees are pJantee. . ,t
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rn Final Plumbing - When all
plumbing wprk Is complet.e.
r--A7l Final Electrical - When all
~ electrical work Is complete.
1-.;11 Final Mechanical - When all
L,CI mechanical work Is complete.
!Xl Final Building - When all
required Inspections have been
approved and building Is
completed.
DOthor
MOBILE HOME INSPECTIONS
o Blocking and Sel.Up - When all
blocking Is complete.
o Plumbing. Connoctlons - When
homo has been connected to
water and sewer.
o Electrical Connection - When
blocking, set.up, and plumbing'
Inspecllons have been approvad
and the home Is connected to
the service panel,
o Final - After all required
Inspections are approved and
porchos, skirting, decks, and
venting have been Installed.
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Lot TYP' ~.IS THE PROPOSED WORK'IN'TH~'.
Lot faces. Setbacks
I P.L. HSE GAR A~CI HISTORICAL DISTRICT, OR ON
Lot sQ. Itg. Interior IN THE HISTORICAL REGISTER7
Lot coverage Corner Is I If yes, this application must be signed
and approved by the Historical
Topography Panhandle Iw Coordinator prior to permit Issuance,
Total height Cul-de.sac IE
APPROVED:
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BUILDING PERMIT
ITEM sa. FT,-
X $/SO, FT. a
VALUE
Main
Garage
Carport
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Total Value
"",,2~ oe-
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'2 .~ ;;'
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Building Permit Fee
State,Surcharge
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Total Fee (A) ~ / .07
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) '7.67.52
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PLUMBING PERMIT
ITEM
FEE
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Fixtures ~
Residential Bath(s) N'
Sanitary S~wer FT.
Water FT.
Storm Sewer FT,
Mobile Home
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Plumbing Permit
State Surcharge
Total Charge
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~::>. '70
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MECHANICAL PERMIT
Furnace
Exhau,st Hood
Vent Fan
N' -2. ~
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
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Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk It
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Curpcut
i Demolition
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Tota! Miscellaneous Permits IE)
, TOTAL AMOUNT DUE (excludlrfg electrical) 0'2"'7.8.8-
lA, B, c. 0. and E Combined)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
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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: ,..34. ? '7
Date Paid:
Receipt Number:
Re~BY:
/M~~'
, ~sli'levlewed By
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Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved,
ADDITIONAL COMMENTS
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 lo ensure that all required Inspections are
requested at the proper tlme,'lhat each address Is readable
from the street, that the permit card Is located at the front
of the property. an~the pproved set of plans will remain
te t,all time ng construction.
tur -
ate
VALIDATION: , (\~ ( ('
RECEIPT NUMBE'r. IN) 0
DATE PAID ,~.,. to
AMOUNT REC~V ; r ~i .
RECEIVED BY ~ ~
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Permit #: U\ \cC:B.3-
Address: % ~'5~ ~hn. QQc\q q~ [)~
Issued by: lJ\ lDlA. ') Date: :3. 'J-C( ~
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.
B" I.
D 2.
I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
n/3A. My general contractor is\'(\\)\P. ~~[)(\S-tr(X:-\iD\. aL1-1-~
V - , (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
D 3B. 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 Prop~rty ~ about Construction Responsibilities on the reverse side of this form.
\iD~f2p LW _ 3-7-71:..
~ (Signature of permit applicant) (Date)
(White copy to issuing agency permitfile,
pink copy to applicant)
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Notl': This !nf,.mnatioll Nu!ice 10 Pmperty OWllers about Canslrltction Responsibilities
, "u< ,jJ,'clop"',' l1.1t/," CrJ//slmct!un COil tractors Board in ucmrdaTlce with VRS 701.055(5).
If you ar" acting a' yoU,r o"'n ClH,lrador to construct" new home or makc a substantial improwment to an existing structure,
you Cill1 prevent lDJJ,l' lImbic,," by heing aware of the rl1llowin~ re'pl>n,ibilities and areas of concern.
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If)'Ce "i:e person' no', regi,te'cd ',;ih the Construction Contractors Roard tf' do labor in constructing or assisting in the
constructiop. or !mprn1c'1Jcnt c" ,I r,,',dent;1] ,trllc!l1i,', YOll Will, in most instances, be rulcd to be an employer and the pcople
you hire will be emplo)'ees, A, the employer, you must comply with the following:
G~~g:r:'s '," :~~::."':;::~_;-gu:m :(".'.-.: A~ ;;n cmplo) ~i", yo;..1 ml'~t withhold income taxe~ from LmpJoy~e wages at the time cm!'Jo)'e~"i
,lr~ ;.cit" Yl1Cl ,,:11 D" I'abie fe: :he t.'X payments e'en ir)ou don't actually Withhold the tax from your employees. For [,lOre
information, call the Oregon iJcpt. of R~venue a, 945-8091.
~~~~:"':""~: '~/--:2-.i :-:s~'1::;.c~ >~.~ A~ ;.,;.n cr.~nl:1~\'-'. you ~r.: r~~ulred to ).1;1)' U tJ\ for unemployment in\UiJ.TIC~ pur1)(I"'(', l" ih~
\\'dE":~ of [11' ...rr,~I~))\:L'{~ FUi- '1:;", ~ ir::-orrH~Ltir t~, ~.'a'1 the Orego!l Em~lJC) n'.:nt ni\'i~jon at the Department of H:J!1'1:11l ~l'..;nu'ce~
at 37R-:'l5;>4" I,
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\.To-~\:: .:,' l'C-.::'~:.::-:-'_~~iUi:::- ~.:: - ~:1C'Z': A.... m~ -.;f':111:uyer. ) ilL! 1.r~ subjcrt to tl"te Or~go;1 \Vorkers' Compensation Ll\\. Jrd mu'\t
oh' ~'ill '''1 ..!\...:~r:" co;nl_-...~ll~dti~::' lH,Ufi.L1CC f~lr ) llL'- empl11}i::t'o;;. If) ou rall to l)bta.in \\orl,ers' compensation in\uranc..:. ) dll !TIa)'
he 'U"Yd '(1 penalt;", al1d ",;11 h' liat,le ,-nr all d,im co't, if one of youl employee, i, injured on the job. For more information,
.::dl tl1..' \\'or:..c;-s' Cor,lpen~~L1'i,l Dj\, j,ildl ut th: DepJ.rtr11O:T1t ofCon!.umer and Bu~iness Ser\'kes at 945-i8RH.
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~3. ':".~d-c::': ~c,tc,,~ ~~::-c:.\: '\,.m ecnpll1ycC,YO:l nlu,t withh":d'J~i,df;T<l] incomc ta< from employees' wages. You will he
Iiabk for the tax p~ymJ'r.t even ,f yo~ didn't actt..tlly "ithhold the tax, Fa! more information, call the Internal Revenue Service
at ] -800.829-1040,
C'.'::,,:~ '1>::~:zG\\:R;3;U':r:i<:S t\~) t7\~q:f.f.\S C~~ CO~C~:~N:
Co::eC;;'1:)':t.:~2: A, the perrelt holclc(forthi, proj~ct, YOll arerespon,ible for resolving any f~ilure to meet code requirements
that may he brought lO your alt~ntion through inspection:,.
LiaGi!'~y flnG prc,..~rty damfll'~ inst;n:n~e: Contact your insumnce agent to see if you have adequate in,urance coverage for
accidents and omi"ions such a' falling tools, paint over;pmy, water damage from pipe punctures, fire, or work that must be
r~-done ,
Time to supervise employe2s: Make sure you have sufficient time to supervise your employees.
!Expertise: Make sure you haw the expertise to aetas YOllrown general contractor, to coordinate the work ofrollgh-in and finish
trades, and to notify b~lilding orlicials 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 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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