HomeMy WebLinkAboutPermit Building 1994-4-22
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
/),SSESSORSM'AP:
/Z/
LGS II E-
ADDRESS: .~ I 0 ~ ""BuN ~\E-
CITY' S{JI?, /'JC.....'H S-ilj
Pft- II U
LOT:
OWNER:
H-
DESCRIBE WORK:
NEW ~ REMODEL
1
CONTRACTOR'S NAME
GENERAL: SL ~r=--
PLUMBING:
MECHANICAL:
ELECTRICAL:
SPRINGFIELD
--llo/(
'P--, ') N I\.J , E-
LA- ~ tf-
JOB NUMBER
".7 7/ ~6'-::::>
BLOCK'
Bt2DW'~
LIT-tV ~
STATE: _/1fJll_
r~cPS'?~
ADDITION
DEMOLISH
OTHER
225 Fifth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION: ;y/?:~CE ~~
, PHONE:
7~b '"',<7ar
ZIP' 9' '/v77
ADD'r,SS
~I uY; I16VNN\(~; ll\J
CONST.
CONTRACTOR #
PHONE
EXPIRES
- OFFICE USE -
QUAD AREA: LAND USE: FLOOD PLAIN:
# OF BLDGS: # OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: # OF BDRMS:
# OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER' RANGE: SQUARE FOOTAG E:
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! Electrical!
Mechanical - Prior to cover.
D Footing - After trenchEJs are
excavated.
D
Masonry - Steel location, bond
beams" grouting.
12I Foundation - After forms are
, erected but, prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D
Underfloor Plumbing! Mechanical
- Prior to insulation or decking.
D
Post and Beam - Prior to floor
insulation or decking.
.......
D Floor Insulation - Prior to
decki ng,
D Sanitary Sewer - Prior to filling
trench.
, D Storm Sewer - Prior to filling
trench. -..--,:
\ '~~, \ '
~~t" . ;-_.._ \
D Water Line :- ~rior to filling
trench. .' ,
D Rough Plumbing - Prior to
cover. .
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.
o Wood Stove - After i~stallatlon.
D Insert - After fireplace approval
" and Installation of unit.
o Curbcut & ,Approach - After
',' forms are erected but prior to'
placement of concrete.
D S'ideJ.,alk & Driveway - After
, excavation is complete, forms
, and sub-base material in place.
D Fence ~ When completed. '
o Street Trees - When 'ann3qLiired
trees are planted.' ,
D Final Plumbing - When all
plumbing work is complete.
D Final Electrical -When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work is complete.
D Final Building - When all
required inspections have been
approved and building is
completed.
D Other
?l-
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blocking is complete.
o Plumbing Connections- When
home has been connected to
water and sewer.
o Elect~ical ConnectIon - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the servlce,panel.
o Final - After all required
inspections: areapprovEJd and
" porches, skirtin'g, decks, and
venting have been installed.
i
i
Lot coverage
-Lot Type Setbacks
Interior I P.L. HSE GAR Accl
Corner N I
Panhandle S I
Iw
Cul-de-sac
IE
\.. (HE 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.
Lot faces
-'.
Lot sq: ftg.
Topography
Total height
APPROVED:
aUllDING PERMIT, ;
ITEM sa. FT. x $1 sa. FT.
VALUE
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Main
This permit Is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of 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.
~?S-
Plan Check Fee:
Garage
Carport
Building Permit Fee
ft~~
1.:..4): ~
.?~
-p5~
SYSTEMS DEVELOPMENT CHARGE (SDC)
Date Paid:
Total Value
Receipt Number'
Received By:
State Surcharge
Total Fee
(A)
Plans Reviewed By
Date
(B)
, Systems Development Charge is dUEl on all undeveloped
properties within the City limits which are being improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
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
Vent Fan
NO
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 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.
Exhaust Hood
Wood Stove/lnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
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 sit: a~dUring construction.
,/,./' .- -,- /. //-...~
SlgnaturEJ-'" ~
Date f~2-h~
'/ / I
MI$CELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
VALIDATION:
1~9"~
c/~::?--99""
AMOUNT RECEIVED'25:'!!!5>c::>
/7~,.,
'-'f
..
DATE PAID
RECEIPT NUMBER
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
2~SZ:>
RECEIVED BY