HomeMy WebLinkAboutPermit Building 1995-6-28
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Ottice: 726.3759
LOCATION OF PROPOSED WORK: (l f)8
ASSESSORS MAP' \\ \Y~S2~t:L\
JOB NUMBER
225 Fiflh Street
Springfield, Oregon 97477
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TAX ~OT:
SUBDIVISION'
PHONE: r'A4 .lu~'1
BLOCt<.
LOT'
OWNER:~(Uli . \~~~ - -
ADDRESS: ~ \~ \.1{ \.)1<.J
CITY: '-. ~ ~ [\ ~ . STA~E: l~}' Q
DESCRIBE WORK:'-\\OO\~\ITL..0\{\fL}:i nf\
NEW REMODEL ADDITION DEMOLISH
ZIP: Ll~ 1J
L\ \Olot't
CONST.
CONTRACTOR'
ADDRESS
CONTRAC1f~'S NAME '\
GENERAL:~h}~Qi )
EXPIRES
PHONE
PLUMBI~''''' ~
MECHANICAL:';:\. -:=\
ELECTRICAL: H~ or .J
QUAD AREA: ~ ~ f\ 11) - OFFICE U, -
LAND USF' \ \ \ FLOOD PLAIN'
. OF BLDGS' ~~ . OF UNITS: 1.0 ZONING CODE: \I\V
OCCY GROUP: CONSTR. TYPE: . OF BDRMS'
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANG'" SQUARE FOOTAGE:
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All Inspections reques'ed 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.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
o Final Plumbing - When all
plumbing work Is complet,e.
D Temporary Electric
~nal Electrical - Wilen alt
electrical work Is complete.
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Rough Electrical - Prior to
cover.
D Final Mechanical - When all
mechanical work Is complete.
~al Building - Wheo all
required Inspections have been
approved and building Is
completed.
D Underslab Plumbing/Electrical!
Mechanical - Prior to cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
o Footing - After trenches are
excavated.
D FIreplace - Prior to facing
materials and framing Insp.
D Masonry - Steel location, bond
beams, groutl ng.
D Framing - Prior to cover.
DOther
D Foundation - After forms are
erected but prior to concrete
placement.
D Wail/Ceiling Insulallon - Prior to
cover.
D Underground Plumbing - Prior
to filling trench.
D Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking,
D Wood Stovo - After Installation.
D Blocking and Sel.Up - When all
blocking Is complete.
D Post and Boam - Prior to floor
Insulation or decking.
D Insert - After fireplace approval
and Installation of unit.
D Plumbing Connections - When
home has been connected to
water and sewer,
D Floor Insulation - Prior to
decking.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sanitary Sewer - Prior to filling
trench,
D Electrical Connecllon - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
D Sidewalk & Drlvewav - After
excavation Is complete, forms
and sub.base material In place.
D Storm Sewer - Prior to filling
trench.
D Fence - When completed.
D Waler Line - Prior to filling
trench,
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
D Street Trees - When all required
trees are planted.
D Rough Plumbing - Prior to
cover.
,
Lot TY.
Interior
Lot facos
Lot sq. flg.
Lot coverage
Corne r
Topography
Total height
Panhandle
Cul.de-sac
Setbacks
HSE GARIACCI
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IN
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BUILDING PERMIT
ITEM SO. FT. X $/SO. FT. = VALUE
Main
Garage
Carport
Total Value
Bulldlng Permit Fee
Slate Surcharge
Tolal Fee
(A)
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Dvr }. -
.15.UU
1.11.0
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SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT.
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permll
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnserllFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
Stale Surcharge
TOlal Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Slate Surcharge
Sidewalk
fl
Curbcut
fl
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
.--1.kLW
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~ IS THE PROPOSED WORK IN THE.
. "'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
II 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 Ihe express condltloo thai the said
construction shall, In all respects, conform to the Ordinance
adopted by the City 01 Springfield, Including the
Development Code. regulating the construction and use 01
buildings, and may be suspended or revoked at any ufT1ll'"
upon violation of any provisions of said ordlnancer
Plan Check Fee: 'lo.. ~ ~ ~
Date Paid: \ ,V
Receipt Number: \\...~
Recel7 ~
~ Reviewed By Date
Systems Development Charge Is duo on all undeveloped
properties wlthlo 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 eartHy 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, Bod the Laws
of the State 01 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 ensuro that all required Inspections are
requested at the proper lime, that each address Is readable
from the street, that the permit card Is located at the front
of the proper . and the approved set of plans will remain
:~... "'m."C3~
Date
VALIDATION: ~
RECEIPT NUMBER \9:'.,
DATE PAID to 'l6. '
AMOUNT RECEI~Ej .... _ ~ .ro
RECEIVED BY ~ _)
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Permit #:
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Date: (o,zg.q",
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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.
e appropriate blanks and initial boxes 1 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 register 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
Notic~ prope~e\~about ~onstruction Responsibilities on the reverse side :i~I~~
YJ (Signa~rmit applicant) (Date)
(
(White copy to issuing agency permit file,
pink copy to applicant)
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][n1orrmSl~G0i1 i\!liOl~iCi!! ~O lPi'opeiiy Owners
AroiOl~~ COi'ils~li'uc~ioi'il Rlesporasibiliiies
Noti!.: This Information Notice to Property Owners about Construction Responsibilities
was' developed by the Construction Contractors Board in 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 forthis 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 orryissions 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 COTltractors 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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