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HomeMy WebLinkAboutPermit Mechanical 1993-8-3 RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726-3759 LOCATION OF PROPOSED WORK: ASSESSORS MAP: LOT' OWNER' fl}1l;-/-,~ t A/O/la.. ADDRESS:' Lf.3 8 S- A) ,j-Ie,.. CITy'fJ/r'1~ rh'.e"(,/ SPRINGFIELD BLOCK: fre.e//1Cf"'i Sf- STATE: fYl- DESCRIBE WORK: Ai)l;' 0 } NEW REMODEL ~ C)'AJ /;,,~ f . c1(f;-1f;"/:'~ IdLIv- L~ v . '" " ADDITION CONTRACTOR'S NAME GENERAL: JOt.. h.. Loq~ v ,PLUMBING: MECHANICAL~/V\/ ~Q ELECTRICAL: DEMOLISH OTHER JOB NUMBER , q~JJLfI 225 Fifth Street Springfield, Oregon 97477 TAX LOT' OObOI SUBDIVISION: PHONF' 7'c<(f; -?YOb ZIP: ell Cf7?- S-? p{;; (;;/- 9d~ w~ 4.;?, v ~ ,JlotAP CONST. ADDRESS ..!.. CONTRACTO~ # ':<9'f3r ~~~(j UI/ (11 (G-ct~) REQUIRED 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. D Framing - Prior to cover. D Wall/Ceiling Insulation - Prior to cover, D Drywall - Prior to taping. D Wood Stove - After i~sta"ation. ' D Insert - After fireplace approval and Installation of unit. D Curbcut & Approach - After forms are erected but prior to placement of concrete. D Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. , D Storm Sewer - Prior to filling trench. ' , ~ y\Q.W WaWV \-'V- ~ater Line - Prior to filling , D trench. " :J,q/)(~ G: ~,p-P., Fence - When completed. D Street Trees - When allrequlfed' trees are planted. ' , EXPIRES PHONE :J Cf.F '::/..:rr t:? '0 6L1 a::::- 11/1 I ' . ,&j 0"l... - OFFICE USE - QUAD AREA: LAND USE: FLOOD PLAIN: # OF BLDGS: # OF UNITS: ZONING CODE: OCCY GROUP: CONSTR. TYPE' # OF BD'RMS: # OF STORIES: HEAT SOURCI=' SECONDARY HEAT: WATER HEATER: RANGE' 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. wl;1 be made the following work day. D Temporary Electric D Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumbing/Electrical/ Mechanical - Prior to cover. , 0 Footing - After trenches are excavated. o Masonry - Steel location, bond beams, grouting. , D Foundation - 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 insulation or decking. ' " o Floor Insulation - Prior to decking. o Sanitary Sewer - Prior to filling trench. o Rough Plumbing - Prior to cover. ~nal Plumbing - When all plumbIng work is complete., D Final Electrical -When all electrical work is complete. ~nal Mechanical - When all mechanical work is complete. o Final Building - When all required Inspections have been , approved and building is completed. ~Other 'qCt~' ~ 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. D Final - After all required ' .' inspections are 'a'pproved and ,:' , porches', sklrtin'g, decks, and venting have ,been, Installed., ' Lot faces Lot Type Lot ~q:ftg.>;:', Lot coverage Interior Corner "-"', . Topography", : Total height Panhandle ClIl-de-sac BUILDING PERMIT ITEM sa. FT. X. $/SO. FT. " '. Main ~arage Carport \ "\' Total Value Building Permit, Fee , t \ . ~ State Surcharge \.... ~ (A) Total Fee L, I: .", h \ ,.., THE PROPOSED WORK IN THE , HISTORICAL DISTRICT, OR ON.,~,/,t:~t" :':'~i ~J:, : THE HISTORICAL REGISTER? . '''.-: : ~~; 1~:; ) . _.., '_..~,'f.' ~' .' If yes, this application must be signed" -j' ;, ~ ; and approved by the ',Historlcall',:ft~ ::'''j~ . . . _" ~.,y '..,.'1 . " Coordinator prior to permiUssuance:' i', F:1':'~ ~ 1 . " ,~I: ~ r, '. p.L:.. Setbacks HSE GAR ACC N Is \W ~ VALUE ) ) SYSTEMS DEVELOPMENT CHARGE (SeC) (B) PLUMBING PERMIT ITEM Fixtures Residential Bath(s) NO Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan NO Wood StovellnsertlFlreplace Unit Dryer Vent 01 tic c., L~:JL (j Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS Mobile Home State Issuance State Surcharge Sidewalk It It Curbcul Demolition' State Surcharge FEE I }~.OO I I;' I 'i./~ ) S.) s:- J c::; .00 10,00 ':J,~ ~S,)S- Total Miscellaneous Permits ,(E) TOTAL AMOUNT DUE (excluding electrical) .!:::LI, c;:::,~ (A, B, C, D, and E Combined) :;..., " . ' ~ '-\ APPROVED: " ~'~. BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT , 'Thispermiris, granted on the'express condition th~t the said construction shall, in all respects, conform to tile Ordinance adopted by the City of "'Springfield,', i,:,cludlng 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: Date Paid: Receipt Number:' Received By: , ., t. Plans Reviewed By Date' Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS , I' By signature, I state and agree, that I have carefully examined the com pi eted application and do hereby certi fy 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 Ordlnanc~s 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 cont~actors and employees,who are In compliance with ORS 701.055 will be used on'thls project. I further agree to ensure that all r13quired 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, and the approved set of plans will remain on the site, a~ a'jJres furi;1~struction. Slgnature-< If/ ~/('l~ ;;yl.?J9~ Date VALIDATION: RECEIPT NUMBER '1:\ q Ji").. 91:~J0~ AMOUNT RECEIVED :PI' /-.J I ,S () GB DATE PAID RECEIVED BY ... .," ... Permit No: q~J)LlI LJ~~s A.si,^)~ Q~ Date: 8h.)C)~ Address: Issued by: 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. _/ I 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.,J~t~f~'n't~actoris ~~ f,o~ Contractor registration number 7 bLf:D~ 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 to Property Owners about Construction Responsibilities on the reverse S~'de this form. ~ ~/~ "i?Jr:.ln /jiii hire oyFefmit Applicant Date' I . 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: . rhis .Information Notice to Property Owners About Construction Responsibilities ,- was developed by the Construction, Contractors Board in accordance with ORS 701.Qq5(5), . " "passed by_the 198.9.0regon_ Legis'latur-e. ~ ~. . , , If you' ah3 actin~g'as your own' contractor 'to d:>nstr~ct a new home or make a s~bstantialimprove;"erit to an existing structur~, you can' prevent many problems by being aware of the following responsibilities and areas of con'cern. " ',; " . '. ' , ,.. , . . EMPLOYER RESPONSIBILITIES:' If you hire persons not registered with the Co~struction Contractors Board to do lapor in co_nst~ucting or assisting in the construct,ion or improvement of a residential structura,' you wHI, in most,instances,"be ruled to be an "employer" and t~e geople,You hire will'be "employees". f\s t~E! ~!TIploy~r,' yo'u must,comply with the following: ~ ~ ' . ~ " . .' ..1 ...". . _ Oregon's Withl:lofding Tax Law: As an employer, yqu must withhoid income tax~s from employee wages at the time employees are paid. .You will be liable for, the .iax.:payments even if you don't actually withhold the , . ." . . ~ tax from your employees, For more information, call the Oregon Department of Revenue a~ 378-3390. ' Unemployment Insurance Tax: As an employer, you are required to pay'a tax for unemployment insurance purposes on the wages of all ~r.nplqy~es. For more ,information, call the Oregon Employm,ent 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 cosls if one of your employees is injured on the job. For more information, ca~1 the Workers' Compen~ation Division DIF at 373-7434. .U.S. Internal Revenue Service: ~ an employer, you must withhgl,d federal incoIT:le. tax from employees' wages. You will D'e liable for thE;! tax paYfTlsnt 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: . , . ~'t Code Compliance: As the permit holder for this profect, you arecresponsible for resolving any failure to meet code requirements that may be brought.to your attention through' inspections. liability and Property Damage hlsurance: Contact your insurance agent t6 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 Super.vise Employees: Make sure you have suf.ticieAt time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general ,contractor, to cpordinate 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 . .1. Salem, OR '97310~0151 . Phone 503-378-4621 0244J 10/24/89"- ..' . 't,',' ,. :..... '.:.'