HomeMy WebLinkAboutPermit Building 1994-9-15
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
LOCATION OF PROPOSED WORK' /35':)' ?k".><l""/
~SSESSORS MAP: / 7~~~~2';;--S"':2
II
LOT'
.::Tc<<"" .r 4v ('Go., \
ADDRESS' 155'~ P/ee;~"V\.+-
~9('i'J~e.\J
DESCRIBE WORK' aJJ;f,,,,^ of
OWNER'
CITY'
BLOCK'
~ 1::,; VlS,OV\.
STAT'"
oIL
I bJ-rtrJ.....
ADDITION X
NEW
REMODEL
CONTRACTOR'S NAME
GENERAl' DIV4i&
PLUMBING: i(
MECHANICAl' If
1 ELECTRICAl' I"
QUAD AREA: A~\\)u)
. OF BLDGS'
OCCY GROUP:
R~
d
. OF STORIES:
WATER HEATER'
aJ.
lM fk:,. ""
.
,,,
99/.z~v
I
DEMOLISH
OTHER
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
TAX LOT'
SUBDIVISION:
7'" ()()
N.(+hJ~-k.
PHONE: 7Jh - ~6&"O
w- 6~ - ~9?"
17'177
ZIP'
,2...t- 4NJ.
ADDRESS
CONST.
CONTRACTOR'
PHONE
- OFFICE USE -
If I I
~AJ
LAND \,JSE:
· OF UNITS:
CONSTR. TYPE:
HEAT SOURCE: 6'/ ~<--/. WL L
RANGF'
EXPIRES
FLOOD PLAIN:
ZONING CODE: lli2--
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE: s;;f;Lq ( f)
To request an Inspection, you must call 726.3769, This Is a 24 hour recording, All Inspections ,equesled before 7:00 a,m, will be
made the same working day, Insp~ctlons requested after 7:00 a.m. will be made the following work day.
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
rit1 Footing - Aller trenches are
l...pJ excavated.
o Masonry - Steel location, bond
.beams, grouting,
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench,
rY1~ PlumbIng/Mechanical
~ - t"'llur to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
fVl Floor Insulation - Prior to
'--('<' decking,
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - PrIor to fIlling
trench.
o Water Line - Prior to filling
trench.
r"Vl Rough Plumbing - Prior to
L...fJ cover.
REQUIRED INSPECTIONS
rv'l Rough Mechanical -.:. Prior to
~ cover.
rVI Rough Electrical - Prior to
~ cover.
rp Electrical Service - Must be
approved to obtain permanent
electrical power.
o FIreplace - Prior to facing
materials and framing Insp.
q Fr8~lng - Prior. to cover" .
rVl Wail/Ceiling Insulation - Prior to
~ cover.
rjJ Drywall - Prior to taping.
o Wood Stove - A.fter Installation.
o Insert - After file place approval
and Installation of unit.
o Curbcut & Approach - Aller
forms are erected but prior to
placemont of concrete.
o Sidewalk & DrIveway - After
excavation Is completc, forms
and sub-base material In place.
o Fence - When completed.
D Street Trees - When all required
trees are planted.
m Final Plumbing - When all
I plumbing wc;>rk Is complet.e.
rV1 Final Electrical - \I\.Qlen all
I electrical work Is complete.'
f'f1 Final Mechanical - When all
I mechanical work Is complete.
Lp Final Building - When all
required Inspections have been
approved and building Is
completed,
OOthar
MOBILE HOME INSPECTIONS
o Blocking and Set,Up - Whe/l all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer,
o Electrical Connection - When
blocking, set.up, and plurvblng
Inspections have been approved
and the home Is connected to
the service panel.
o Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
.---~-......
BUILDING PERMIT
ITEM
sa: FT,
X $/SO. FT, =
Main
Gar<lge
Carport
,II?'
g9,C.
26.26
Total Val ue
Building Permit Fee
State Surcharge
1Q.\~T3."8
Total Fcc
(A)
I-i.
. -- .~, ~L;' ,;J ',"'"
.,' ;, ~. 9"1'1'1f :,\Ii',
. f. .:":.tl:\
Setbacks.
HSE GAR' Acdl
I
I
I
I
P.L
N
Is
W
E
VALUE
"
I~, ~75:76
~,b3C:;,~
,i~.~
q,~
\ ~~. ~.l
SYSTEMS, D~'f..,*,PMENT <}HARGE (S_?~) ~
~1-/~~ (B).J/1.9J.kr.' ,'~
PLUMBING PERMIT
ITEM FEE
3O,CJ:l,.
IS~
w..
,7Sr,'1f' \C').
/~
..x;~ .:'-, ,
Flx~u'es 3-
Residential Bath(s) N'
San! tary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
Stat~. Surcharge
Total Charge
\.~ -\- .~O
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
\
Wood Stovellnsertl Fireplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State'Surcharge
Total Permit
(D)
MISCEllANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcha'ge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
'30~
~,'I&.
:&~. 'iQ..
3.. Q!2.
1\"'1_
~ ~~20
('t
,
~\'1.
_S 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.
APPROVEP'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition 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 of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
?'9'. fG ~
1i? :2 cr, '9'/--
Date Paid:
Receipt Number:~:;'~
elved By: _ ~~1ii _
"'i
~
Systems Development Charge is due on all undeveloped
properlles within the City limits which are being Improved,
ADDITIONAL COMMENTS
-
C]~~ ~ ....:"-k ~ SL\"'tj..,,:.~
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 Sp,'ngfleld, 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 pe,mlsslon 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
:~g:::u:~e ~aJjme; J~rlng construction,
'{'-IS- - q'l
Date
.'
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVEf'I
RECEIVED BY _
/4 72.3
1'/i.f"/5'4
':>s.6-~. ~L. .
~~
~-
--~:.:.:..,.;
. NO. '1?/2"iJ"-P-
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: J1I'J?~ f ~
LOCATION: 1~"5' J? ~
OEVELOPMENT TYPE' ~..M A / ~ r I ~ ;.. d .k/
/
.
ATTACHMENT Bl
,
BUILOING SIZE:
1. STORM nRA,INAGE
IMPERVIOUS SQ. FT. #6 },.})/) IL..
2, SANTTARY SFWFR-rTTY
NO. OF PFU'S ' ;<
(See Reverse)
3, TRANSPORTATION,
LOT SI71='
SQ. Ft.
X $0.209 PER SQ, FT.
$
ri
I
X $43.26 PER PFU
'0~"2.0
NO OF UNITS X TRIP RATE X COST PER TRIP
X /'
A
/ X
X $436.19
X $436.19
X $436.19
td
/
$
$
~
SUBTOTAL (ADD ITEMS 1. 2. & 3) $ 3 0.2. ~ 2
4. SANITARY SFWFR-MWMC
NO. OF PFU'S ; x $17.19 PER PFU + $10 MWMC ADMIN.FEE
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
'. TOTAl -M\JMr. snr;
$ /70,3J ./
SUBTOTAL (ADD ITEMS 1.2.3 & 4)
$ Rn'ldf)$ L
$ If}
I
$ 3C,2.'ii 2.
5. AnMTNTSTATTVF FFFS
B~f CHARGE (SU~ ABOVE) X .05
~d~' Date, ,,-.-,.<'
~ ~Coordinator
/5'. / ?
G~)
I'"
1
IOIAI snr
'3/ t. 9c"
(D~
B2.S0C .
FIXTURE UNIT CALCUL.liiilON TABLE: Number of New Fixt. X Unit Equivalent = Fixture Units
(NOTE: For remodels, calculate only .Nfl additional fixtures)
NUMBER OF UNIT FIXTURE
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub..,....,.,....,...""....,.",...."",.,....,."...."",...,..,... .
Drinking Fountain..,......,...."...,.,.,..."....."".".......,....
Floor Drain. ..........,....;,....,......,.. ....., .,...,..... .""... ....,..
Interceptors For Grease/Oil/Solids/Etc..ou............
Interceptors For Sand/Auto Wash/Etc..................
Laundry Tub/Clotheswasher......,......,...""...........".
Clotheswasher - 3 Or More.....................................
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Refrigerator!Water Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single Stall..;....................,....,.,........,.........
Shower, Gang.......................,...,.............."..........,...
Sink: Bar, Commercial, Residential Kitchen........................
Urinal, Stall!Wall..:.......................,............................
Wash Basin/Lavatory, Single......,....,....,...........,..,..
Toilet, Public Installation........... .,.,.......,. ................
Toilet, Private..,..............................................,..,..
Miscellaneous: ,TAl'll TCR'.s $.INk
CREDIT CALCULATION TABLE:
calculate credits separates.
'i
I
2
1
2
3
6
2
6
6
1
3
2
lIHead
2
2
1
6
4
~
z.
I
4-
-;z
Based on assessed value. If improvements occurred after annexation date in table,
Year
Annexed
Rate per $ 1 ,000
Assessed Value
1979 or before
1980'
1981"
1982
1983
.1984
1985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
Credit for Parcel' or Land Onl,)' If Applicable
Improvement (if after annexation datel
>
. . ,-
/
TOTAL FIXTURE UNITS
=
Year
Annexed
1985
1986
1987
1988
1989
1990
1991
1993
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Valuel
=
=
CREDIT TOTAL = $
Rate per $ 1 ,000
Assessed Value
$2.46
2.14
1.77
1.37
0,97
0.61
0.44
0.15
j
.
Issued by:
.
Cf4; 2. ~4-
/3 ~5" P.t~/b:1rT
etJ~ Date: 1~~1
Permit #:
Address:
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.
Fill in the app,vp,;ate blanks and initial boxes I and 2, and either box 3A or 3B:
I6C I, I own, reside in, or will reside in the completed structure,
n 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
PI
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 Property Owners about Construction Responsibilities on the reverse side of this form.
jJ 1,.1 -
CJ I' (Signature of permit applicant)
;;<.
7'-IS- - f~
(Date)
(White copy to issuing agency permit file,
pink copy to applicant)
.
.
p "" .... ' . ~ . \. "_. r't,
TI~~cwMBl~nOli'l NCii~ice ~(Q) Pli'opsrlty Owm:!li's
, i:..,:': .. .A~IQ)l!t ~i1'iS~~~C~DOi1'i IF&espoll1lsiromfties
~
Note, This Information Notice to Property Owners about Construction Responsibilities
Was developed by the:Construction Contractors Board in accordance with ORS 701.055(5),
1.
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,
Work.ers' 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, InternallRevenue 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 for this 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 omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
fe-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 cail the Construction Contractors Board (pO Box 14140, Salem, OR 97309-5052,
503/378-4621), !he Board is located at 700 Summer St NE Suite 300, in Salem.
prop-own.pm4
1/94