HomeMy WebLinkAboutPermit Plumbing 1999-3-17
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ADDRESS: ';:50 S 3>bl V'L 0e..l \
CITY: S(n'AC--{/(~J cJ
i'ns+l4 I \ ~ Q.AA)
RESIDENTIAL
PERMIT APpLIcATION
Inspections: 7~6-3.769
Office: 726~37~9 '
ASSESSORS MAP:
LOT'
OWNER'
DESCRIBE WORK:
NEW
REMODEL
CONTRACTOR'S NAME
GENERAL'
.PLUMBING'
Ro1-o gc50-k..v-
MECHANICA' .
ELECTRICAL:
BLOCK:
UJ1
STATE:
(f'"\f2-
JOB NUMBER
,5?6 J C. 0
v-J'~\.e v- ~V\),. LO.-
ADDITION
DEMOLISH
OTHER
225 Fifth Street
Springfield, Oregon 97477
(kH
I
()/.7" '-(
TAX LOT:
SUBDIVISION:
_Ii
PHONE:
rJL/7-3<62:>D
ZIP: ct 7<..(77
ADDRESS
CONST.
CONTRACTOR #
.::,
LfS7 Qlrt.,v ~
EXPIRES
PHONE
1f=( I \ Co 2.
1 Yo, c?
Co~..[71 (
- OFFICE USE -:"
QUAD AREA- LAND USF' FLOOD PLAIN:
# OF BLDGS' # OF UNITS' ZONING CODE:
OCCY GROUP: CONSTR. TYPE: # OF BDRMS:
# OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER:' RANGF' 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. will be made the following work day.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/ ElectrlcalJ
Mechanical - Prior to cover.
D Footing - After trenches are
excavated; .
D Masonry - Steel location, bond
beam~, grouting.
o Foundation - After forms are
erected. but prior to' concrete
placement.
D Underground Plumbing - Prior
to filling trench.
tJ Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - 'Prlor to floor
Insulation or decking. '.
- . " \
D Fioor.lnsulatlon -" Prlo.rto~ 'i
decking. .
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench. '
,e.,., LIne - P,'o, to nlllng'
rench.
o . o. .
j" .'
, .
o ~~~~~ Plum:~.~n~.:- ~rlor. to
REQUIRED INSPECTIONS
D Rough Mechanical -':"P~lor ~o
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.
o Framing - Prl,or to cover.
o Wail/Ceiling Insulation - Prior to
cover.
.D Drywall - Prior to taping.
D Wood Stove - After I~sta"atlon.
o Insert - After fireplace approv~1
't.., 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.
o Street Trees -When all 'requlred
trees are planted.
o Final Plumbing - When all
plumbing wc>r\< Is complete.
o Final Electrical - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is complete.
o 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 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.
o Final -- After all required
Inspections are'approved and
. porches, skirting, decks, and
venting have been Installed.
Lot faces
Lot Type
Interior
Lot sq. Itg. '
Lot coverage
Corner
Panhandle '
Topography
Total height
Cul.de'sac
BUILDING PERMIT;
.t
ITEM
SQ. FT.
X $/SQ. FT..
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fce
(Ai
p.L.
N
S
w
E
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT. ro
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
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
)'
ft
Sidewalk
Curbcut
ft
Demolition
State Surcharge
Total Mlscellaneou~ Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
;.S(P
2S(;#
/.2. fl7f
').- 7. ()U
/r/.75
37. 75
'::'< .; '~...
'\
Setbacks
HSE GAR ACC'
I, IS THEPROPOSED W9R.KtN:THE.
'HISTOI;lICAL DIST~lcr,~OR ON
THE HISTORICAL R'EGISTER?
If yes. this appllcatlor{miJst be srgned
and approved by the .Hlstorlcal
Coordinator prior to permit Issuance.
I
-~-j
APPROVED:
. "' i./
BUILDING VALtJE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition that the said
construction shall, I'll all respects, conform to the Ordinance
adopted by the City. of Springfield. Including tile
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 ~?rdlnances.
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~c~refuIlY examined
the completed application and do hereb~," certify that all
Information hereon Is true and correct, and I further certify
that any and ali work performed shall be doneln accordance
with the Ordinanc~s of the City of Springfield, and the Laws
of the State of Oregon pertaining to tho work described
herein, and that NO OCCUPANCY will be' made of any
structure without permission of the Building 9afety Division.
I further certify that only contractors and employees who
are In compliance with ORS 701:055 will be' use'don this
project.
Signature .
Date ( )
v
..
.....:::::::,.,
--
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RE.CEIVED
RECEIVED BY
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