HomeMy WebLinkAboutPermit Mechanical 1995-5-9
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LOCATION OF PROPOSEO ~K' ~\\ '_ ~i"\ l er ~)\OOJ:-
ASSESSORS MAP: \'1~~4l- . TAX LOT:
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.RESIOENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOT'
SPRINGFIELD
BLOCK:
~
5" - ~~'f
JOB NUMBER Cl r:J~(O
225 Fifth Street
Springfleld,Oregon97477
SUBDIVISION:
f)()/1~ ~
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MI~&\
OWNEf+t\'\r '\ l !\\}\J:~ l q\~ Ii PHONE: 14-\ . \q\ t-
ADDRESS' '~R\ l \_~ ru. ,'RjtJ) a..loJLY 1\. .. ._
CITY: ~ f\r'ilt"f1._Q C1 STATE: l\JJl~nY\ _ z'P:~l1-.Jf>
'~\ '-IL (\""'. . . .
DESCRIBE WORKY"~ (j\1 ~ 1 11 ~ ~ (\1\ 0\mN\.\~e\mFJ!\J
NEW REMO(', . A~ITION v--: DEMO\ISH OTHER
CONTRACT"<1'~ './1' .C-.
GENERAL:' ~\.i_,) ~'\\).
. - . ~ . -- -.. -
PLUMBING:
MECHANICAl'
ELECTRICAL:
ADDRESS'
\!.().~ \ B+
CONST,
CONTRACTOR #
\() \ 3\oCJ
EXPIRH~ " PHONE
Ell' ~ ~. 2C{fl
QUAD AREA~ ~~ - OFFICE USE -
LAND USE: I \ I \ FLOOD PLAIN:
# OF BLDGS: _\ # OF UNITS: , , ZONING CODE: lJl> .J
OCCY GROUP' ~~ CONSTR.1YPE: U,J # OF BDRMS:
- F'v
# OF STORIES: l HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE' " SQUARE FOOTAGE: 570'
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To request an Inspection, you must call 726:3769, This Is a 24 hour recording. All inspections requesteej before 7:00':~.(m, will be
made the same working. day, Insl?ections reque~ted after 7:00 a.m. will be made the following work day,
REQUIRED INSPECTIONS
/
.0 Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms,
o Underslab PlumblnglElectrical/
Mechanical - Prior to cover.
lx1 'Footing - After trenches are
. "' excavated. .
o Masonry - Steel location, bond
beams, grouting,
~ '"Foundation - After forms are
~ erected but prior toconcrete
placement.
o Underground Plumbing - Prior
to filling trench,
o Underlloor Plumbing/Mechanical
. - Prior to Insulation or decking.
~ Post and Beam - Prior to floor
,JO.! Insulation or decking,
IV1 Floor Insulation ~ Prior to
~ decking, '
o Sanitary Sewer - Prior to filling
trench, .
:
o Storm Sewer - Prior to filling
trench.
o Water line -- Prior t9 filling
trench. .'
1,..-~ .,
,1.<:+ ~.ough Plumbing - Prior to
" ' ,.. 'cover. .
o Rough Mechanical ~ Prior to
cover,
~ Rough Electrical --:' Prlor'to
~cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials aDd framing, Insp.
~Framlng - Prior to cove~.
rc;;(WalllCelllng Insulation - Prior to
)6{ cover.
~ Drywall ,..... Prior to taPing..
o Wood Stovo - After Installation,
D lrisert - After fIreplace approval
and installation of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material In place.
o Fence --. When completed.
,0 Street Trees":"" When all required
, trees are planted.
o Final Plumbing - When all
plumbing wort< Is complete.
. .
~. Final Electrical - When all
~electrical work is complete.
o Final Mechanical - When all
, mechanical work Is complete.
IXf Final Building - When all
, ~required Inspections have been
approved and building is
completed,
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking is complete.
o PJumbing 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 approved and
porches, st<irting, decl<s, and
venting have been installed.
-~
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~
?? 3.03
SYSTEMS DEVELOPMENT CHARGE (SDC) #5 ~
, (B) 4f.1?1 ~CJ
Lot faces
~
Lot Tn
..........
Interior
Lot sq. ftg.
Lot coverage
Corner
Topography
Total heighct \3/
,:tr )
BUILDING PERMIT
Panhandle
Cul-de-sac
ITEM
SO, FT,
6t"][)
X $/so. FT. =
cw.?-O
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
10.3 3 +t:,,2..o
(A)
Total Fee
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/Insert/Fireplace Unit
Dryer Vent
pqE1Jn ' DJ.l C<T~~j::.
Mechanical Permit
Issuance
State Surcharge , 7S +1.f5
Total Permit (D)
MISCELL.t\NEOUS PERMITS
Mobile ,Home
State Issuance
State Surcharge
Sidewalk
It
Curbcul
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
.' ,:
I P.L.
IN
Is
Iw
IE
VALUE~
3&,(J:-."
"
FEE
/
#1/A..J ~
/5pO
-1-0 CO
/ 2-0
~.2.0
_..J
/~.
/"
/
.~~2.
',,-.
".
".;: ;~;- .: ; .: r~:
;.-"
Setbacks .
IS THEPROPOSED WORKtN 'fHE_
'HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance,
HSE GAR
Acel
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APPROVED:
3~
1
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the expre'sS condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfleld,lncludlng the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any projifions of said ordinances.
Plan Check Fee: \~'i. L ~
4.., .q:::; .
Receipt Number: . &~q~
Received y:. ~
Re~~~
Date Paid:
5.4A's-
, .pate
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
~-rtf 1.
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fi'tl? 1/ /AI' !!:1) - -
Sffu}/Pt:f :.e~ P~T ~ ,7=~ 4.h?,
is !::/IlL TCL-6e. LIS6./' . I ~
5/~/AJ4 PUJlr.::v:r.tES ~.A~Y ]7Hfe.
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 alj 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.
VALIDATION:
RECEIPT NUMBER / '7~D'}
~ATE PAID f). C\ .~ ~ '
AMOUNT REC~IVt> II ", ~-)~Q J'FJ!7 -
RECEIVED BY m~ .
.. ....
Permit #:
C\ S(,)'1'bLo
'\~r)fl t ~ leX- 8l:.
'rf\lro ) Date: 6.q lCis
. -
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, exemptfro.m registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
-+
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1. I own, reside in, or will reside in the completed structure.
LJ 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
~ 3A. Mygeneral contractor is \'\l"'>~\L~ ~~ \ (') \ 2L La 0
(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
~ 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 here certify at the above informati is correct and that I have read and do understand the Information
Noti ce to ProperJ own.ers about 0 lruCtio~ ~ponsibmties on lbe reverse si~e of tbis fO':-
~---r !p~. - ')I ..5.- -C;-Cj:i,
f ~ (Jignatureo~tapPlicant). . (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
" .
'-..
. '"' llmormationiNotice'tcfProperty Owners
, ;. ,', . Ab~ut Corist~iu~tioO.,Re~Ronsibilities
.j. ~_.~.~~.......#'-:;::.':-:--,f_.--__,'._~._'. _" -. - u". I _
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Note: This {nformation Notice to Property ,Q,w1J.er?abQut Construction Responsibilitie~\' _,: .-~:', "
. . . "- .# J . ~ .' . . .
wasaeveloped by"ihe 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 pre~~ntII1any ?ro~lems..by bei)Jg aware.of ti!efollo,'1ing re~ponsi~ilities ~n~areas of concern.
{. '
EMPLOVERRESP,.0NSIBllITIES:
. .:
If you hire person~ not ,registyred with the Construction. (:,ontractors Bo.ard.:,to 90.labor in .constructing or assisting in the
construction or inipr9Yt<n;i~nto{ a residential structure, you will, iI\ B1ostjn~tances, be riIied to. be an employer and the people
. L. ", . ~ ' '.
you hire will be employees. As the erpployer, you must comply with the following: ' . . ,-
'. ' - ~ '.~' 4 . - . .. '" ~.. .' . .
Oregon's withholding tax.l~\V: As an 'employer, you must withhold i!lcome taxes from empl?yee ~ages 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 Departmentof Human Resources
at378-3524. '
~ . :_~ - .." ! :
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' compenstltion insur~nce fo.r your employees. If you fail,to obtain workers' compensation insurance, you may
be subject to penalties and will be llable for-all claim costs if one of your employees is injured on the job, For w<;>re infoImation,
call the Workers,' Compensation Division at the Department of Consumer and Business Services 'at 945-7888.
.,') ~ \ \ I ,.'. , ' . ,.' , ..1, .' ,1/ ; ,
. ~ or" _} . .. '..' t I l I ! ~ E ...."0 I .,
. U:S;'Interlial Revenue/Service:-As an employer, yoG'must \vithhoUl feHeral income tax from employees' wages. You will be
. - . . J
liable for.the tax payment even if you didn't actually withhold the tax. For more information, call the Internal. Re.venue 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. . . ' . " I i
Liability ~md prop~rty <Jam age insurance: Contact your insurance agevt to,see.if you have a9~quate, insurance coverage for
accid~nts,and omissiolls.such as falling tools, paint overspray, wat~r daJJ1ag~ from pipe punctures, fire, or wo~k 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 expertiseto act as y'our own general c^ontractor, to coordinate the 'work of rough':in and finish
trades, and to notify building officials at the appropriate ti~es so t~ey can peiforrlllherequired inspections'. '-. "
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If you have additional questions, write or call the Construction Contractors Board (pO Box 14140, Salem,'OR 97-309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, ,in Salem. '. .. //'\
prop-own,pm4
1/94
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