HomeMy WebLinkAboutPermit Plumbing 1992-7-9
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RESIDENTIAL
PERMIT APPLICATION
Inspection~J: 726,3769
OUice: 726-3759
LOCATION OF: PROPOSED wonK:
ASSESSORS MAP:
/ 7!'J2-:
LOT:
"
SPRINGFIELD
BLOCK:
OWNER'
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A<IL~
ADDRESS:
CITY:
DESCRIBE WORK:
NEW.______ REMODEL
CONTFlACrOrl'S NAME
GENEIlAL __
PLUMBING:
----C)t<.)A2~.---. __,
MECHANICAL:
ELECTRICAL:
STATE:
dK
JOEl NUMBER -9/ CJL 6;L___..__
225 Fifth Street
Springfield, Oregon 9747'1
TAX LOT
~ l' f!;(70
SUBDIVISION:
PHON E:
ZIP:
J'Y747~
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L$,A!.J~
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REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cove~ '
o Rmlgh Electrical - Prior to
cove~
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o
Fireplace - Prior to facing
materials and framing Insp,
ADDITION
DEMOLISH
OTHER
ADDRESS
CONST.
CONTRACTOR II
PHONE
[J
Framing - Prior to cove~ ,
EXPIRES
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN:
II OF BLDGS: II OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: II OF BDRMS:
II OF STORIES: HEAT SOURCE: 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 l)e
maeje the same working day, inspections requesteej after 7:00 a,m, will be made the following work day,
o Tempor;try Electric
D
Site Inspection - To be maele
after excavation, l)Llt prior to
setting forms,
o
Underslab Plumbing/ Electrical!
Mechanical ""'"7' Prior to Cove~
o
Footing - After trenches are
excava ted,
o
Masonry - Steel location, bone!
beams, grouting,
D
Foundation - After forms are
erectec! I)ut prior to concrete
placement.
o
Ii>
Underground Plumbing - Prior
to filling trench,
o
Underfloor Plumbing/Mechanical
- Prior to insulation or clecking,
o
Post and Beam - Prior to floor
insulation or clecking,
o Floor Insulation - Prior to
decking,
D
Sanitary Sewer - Prior to filling
trench,
o
Storm Sewer - Prior to filling
trench,
o
Water Line - Prior to filling.
trench,
" ,
'F::7r Rough Plumbing - Prior to
~cover, .
o Wall/C'eiling Insulation - Prior to
cove~ '
o Drywall - Prior to taping,
o Wood Stove - After installation,
o Insert - After fireplace approval
and installation of unit.
o Curbcul & Approach - After
fo'rms are erected but prior to
placement of concrete,
1:==1 Sidewalk & Driveway - After
excavation is complete, forms
ami sub-base material in place,
o Fence - Wilen completed,
o
Street Trees - When all required
trees are planted,
'~Final Plumbing' - When all
~mbing worle is complete,
o
Final Electrical - Wilen all
electrical worl{ is complete,
o
Final Mechanical - Wilen all
mecllanical work is complete,
o Final Building - When all
required inspections llave been
approved and building is
completed,
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking is complete,
o Plumbing Connections - Wilen
home has been connected to
water and sewe~
D
Electrical Connection - Wilen
blocking; set-up, ane! plumbing
inspections 11.1Ve been approved
'and the hOllle is connected to
the service panel.
o
Final - After all requireej
inspections are approved and
porches, skirting, decks, and
venting have been installee!.
Lot faces
Lot Type;
Interior
Lot sq, ftg,
Lot coverage
Corner
Topography
Panhandle
Total height
Cul.de.sac
BUILDING PERMIT
ITEM
SQ, FT.
X $/SQ, FT,
Main
Garage
Carpal' I
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
'.
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,
Setbacks
I P.L HSE GAR ACC
N
S
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VALUE
.I
SYSTEMS DEVELOPMENT CHARGE (SDC)
(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 Stove/lnsert/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
Slate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
/?'1/A) I
/5 o;P
, ?S"
/ S:7S
) C::. 7 S
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APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted OQ~tlle express condition thaI the said
.construction shall, in all resriects, conform to tile Ordinance
adopted by the, Cjty 0':" Springfield, including the
Development Code, regul'3ling 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:
Plans Reviewed By
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 thaI all
information hereon is true and correct, and I flJrther 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 worl~ 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 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 at all ~es dU~ construction, ____
~natuce ('~. ~.
Date r? - cr - 7..2- "
VALIDATION:
5~7S-
DATE PAID 7/9.4-2-
-{ "( / 7S
AMOUNT RECEIVED _!L, ' ~ .
RECEIVED BY ~?- ~J.-4
RECEIPT NUMBER
,
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Permit No:
CJI()/~J
~3fU; /tf~
$~ Date:
~u: /
FOR OFFICE USE ONLY
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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
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 -::><-k I own, reside in, or will reside in the completed structure.
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2. I -::><-.J
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I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
J
3. A.~ 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 J:::><~"<i I will be my own general contractor.
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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 side of this form.
~~~.
Signature of Permit Applicant
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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INFOh.tlATION NOTICE TO PROPERTY c.., ./NERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: ' This)nform<;ttion Notic~ to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701~b55(5),
passed, by !he.,,1989 Oreg()n Legislature.
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.) If you-are, acting as your"own' contractor to construct' a new home or make a substantial 'improvement to an
existing structure, you can preven~ 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" an'd the people yo,u hir~ will be "employees". As the-empioy~r, you must complywith the following:
Oregon's Withholding Tax Law: As an employer, you mU,st 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 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 information, call the Oregon Employ~ment 'E>ivision DHR
at 378-3224.
":\Iorkers' Compensation Insurance: As an employer" you are,sl,lbject to the Oregoo Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. If you fajl 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 D_ivision DIF at 373-7434.
U.S. Internal Revenue Service: As an employer, you must withh,old federal income tax from employees' wages.
You will be liable for'thetax 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 CONCER,N:
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,-,ode Compliance: As the,pe~mit holder for this project, you C;lre responsible for resolving any failure to meet
~ode requirements that may be brougt:lt to your attention throl!gh inspections.
Liability and Property Damage Insurance: Contact your insurance agentto 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.
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Time to Supervise' Employees: Make sure you have sufficient time to supervise your employees. '
Expertise: Make sure YOl:l have the expertise to act as your own ge!leral contractor, to coordinate the work
of rough-in and ,finish, t(ade~,\. and to notify building officials at the ~j::>propriate t!mes so they can perform
the required'-inspections., ", - -. / h" ",'
If you have additional questions, write to:
Construction Contractors Board
700 SU!TImer S1. NE, Suite 300
Salem; OR 97310-0151
Phone 503-378-4621
0244J 10/24/89