HomeMy WebLinkAboutPermit Mechanical 1999-1-26
RESIDENTIAL
PERMIT APPLICATION
SPRINGFIELD
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP' 17 () d--
y( 2\ ea Me\ \:Cl.
32- 3 ~
LOT'
BLOCK:
OWNER:
ADDRESS:
CITY'
\')~ -
4l2.\
Sr~
STATE:
Ofl-.
13~ ~ t;L"
('(j ~e \ \: 6.
DESCRIBE WORK:
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NEW
ADDITION
REMODEL
DEMOLISH
OTHER
JOB NUMBER q q D 11 if
.
225 Fi fth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
o lj.CJ7J I
PHON 1=.
ZIP:
"Ill( 7S1
CONTRACTOR'S NAME
GENERAL'
PLUMBING:
ADDRESS
CONST.
CONTRACTOR It
EXPIRES ,~ PHONE
MECHANICAL:
(hA{~ ~t~
H --("do -\~
L( (J () 0 I '-1 ~jO/'- s p (J '? )~ 78
7 V (- {Lfl.{ S-
ELECTRICAL:
, A"(""'E""" " "'..:' 'ivyul,13\\; ~~~,_,irC!~ you'l~o ;\t 2-S'1 '(D
.. ~ ,,, I ,,-,, ....., J L U' - t"'Ir'~'Jnn I It I It V
!O~I?W ~ul~_S '$?Ol-'~t:. ;se ';uI1s,are-sdlftSi1!E USE _
Notlf, ',catloncenter. TIL . ; h QAR 952-001-
, ;;1 Q;^P o~2=D01-001? thro~~sNM ~ttt~5 ~y
0090. You may obtain cop ~one
calling me \';\:llllar. (NO\~i; Notification
--;L:~nr the-9regon 'C0':~~1~) TYPE:
(, ,Center is 1-800-332- .
HEAT SOURCE:
QUAD AREA:
It OF BLDGS:
OCCY GROUP:
It OF STORIES:
WATER HEATER:
"'l~"'l"1"''\-
"~J.) !Il(j!~;~': FLOOD PLAIN:
:i':"'i'c;'r~';.AilJ!:T Zb~~I,rlKf-~~~.: IF THE WORK
fi,' rrHGP{Zi:D.Jj8~~~~I~: PERMIT IS NOT
,,"'-(" ",;:1 IS ABANDONED FOR
'J, 'SECO'NDARY HEAT:
-,/ ;1 ;~:;:~~C)'O.
'SQUARE FOOTAGE:
(;~:".
RANGE: ___
I',,' i'l \
't. I
To request an Inspection, you must caU 726-3769. This Is a 24 hour recording. AU Inspections requested before 7:00 a.m, will be
made the same working day, Inspections requested after 7:00 a.m. wlU be made the foUowlng work day.
REQUIRED INSPECTIONS
o Temporary Electric
o Rough Mechanical - Prior to
cover.
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Rough Electrical - Prior to
cover.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Footing - After trenches are
excavated.
o Fireplace - Prior to facing
materials and framing Insp.
D Masonry - Steel location, bond
beams, grouting.
o Framing - Prior to cover,
D Foundation - After forms are
erected'but prior to concrete
placement.
o Wail/Ceiling Insulation - Prior to
cover,
D Underground Plumbing - Prior
to flUlng trench,
o Drywall - Prior to taping.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Wood Stove - After InstaUatlon.
D Post and Beam - Prior to floor
Insulation or decking,
, ;':' : J\ "
-/"..'1", " .t.
o Floor Insulation <:", Prior to" "
decking.
p.,').
;' D Insert - After fireplace approv2l1
and InstaUatlon of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete,
o Sanitary Sewer - Prior to flUlng
trench.
D Storm Sewer - Prior to H1l1ng
trench.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place,
o Water Line - Prior to filling
trench.
o Fence - When cor,lpleted,
o Rough Plumbing - Prior to
cover.
D Street Trees - When all required
trees are planted.
D Final Plumbing - When all
plumbing W9rl{ Is complete,
: lal Elecl,lcal - When all .
el ctrlcal work Is complete.
Final Mechanical - When all
mechanical work Is complete.
o Final Building - When aU
, required Inspections have been
approved and building is
completed.
D Other
MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete,
o Plumbing Connections - When
home 11as been connected to
water and sewer,
o Electrical Connection - When
blocking, set.up, and plumbing
Inspecllons 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 ,
Lot sq. ftg. Interior I P.L.
IN
Lot coverage Corner
~\' Is
Topography Panhandle
Total height Cul-de-sac W
E
BUILDING PERMIT;
'~f'
"
ITEM
SO. FT.
X $/SO. FT,
Main
Garage
Carport
,'.:\.
Total Value
~uilding Permit Fee
State Surcharge
Total Fee
(A)
\:;,: ~.\~i~ '-:.;
Setbacks
HSE GAR ACC'
VALUE
"
'. .
1 '.,
SV:ST~M~. DEV~hOPIV1ENT CHAR~E (SDC)
. f .: ; . . ; :. ,i i .~. '.' .. . '."
(B) ,,":. ,
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ft
Curbcut
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
,(A, B, C, D, and E Combined)
FEE
1b IS, -
~ {O.
~+ i </j-
$c2b. ~/
I
.~ 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.
"
,
T~-
... .' .
APPROVED:
, " " 'I
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit i~ grantegon the expresscqnditlon that the said
construction shall,'lr; all respeCts, conform to the Ordinance
adopt'ed by, the, crty ,of Sprlngfl,eld, Including the
Development Code, regulatin'gthe cons,tructlon and use of
buildings, and may be suspended or reyoked at any time
upon violation of any provisions of $ald ordinances.
Plan Check Fee:
. I I. .
;'4, .,.
Date' Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
Systems' Development Charge Is.due, 0;'; all undeveloped
t- t. ~ .' . ~ .' ~ ,. ~,
properties wlthlnlhe City limits which are being Improved.
ADDITIONAL COMMj:NTS
, Va. \!A ~ :JIf ,c::;;. '66,~
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 Ordinanctls 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.
I further agree to ensure that all required Inspections are
requested at the proper time, that each address Is readable
from tlie street, that the permit card Is located at the front
of the prope~ty, and the approved set of plans will remain
on, the site at all mes during construction.
Signature
~ Ai\;W. ^'^ 1 ~
o I... 2-' ~1
Date
VALIDATION:
RECEIPT NUMBER 31. (P'b.:?
r-"JIo~9'i
AMOUNT RECEIVED $ J.{g. ~
cKvJ
DATE PAID
RECEIVED BY