HomeMy WebLinkAboutPermit Mechanical 1999-12-22
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
ASSESSORS MAP:
LOT:
BLOCK:
OWNER: "V)...,- tl.)t\~1)\(
ADDRESS" Sd,b &/JJ>INA-L LJA.j:.
CITY: ~.PI2.J~'iF"'~L1'> , . ..
STATE: n{?' .
~ t.64S
DESCRIBE WORK: ::I;I.~~u...A.:\, O~
NEW
REMODEL
ADDITION
DEMOLISH
OTHER
t ';'~
CONTRACTOR'S NAM'E
GENERAL:
PLUMBING: ."
MECHANICAL: q16 ~JJ"B::fIMI · ,3,'Jtl11 1ft ~.
ELECTRICAL:
JOBNUMBER ~'qI76~
225 Fifth Street
Springfield, Oregon 97477
.-,.-.--'!
TAX LOT:
() '7/OD
SUBDIVISION:
PHONE:
7~~~~.f~
ZIP:
q~4? f"
ADDRESS.
CON ST.
CONTRACTOR #
EXPIRES ,~ PHONE
1~3L'It,
...#.s:?cf'd:J...
- OFFICE USE -
QUAD AREA: LAND USE:_ FLOOD PLAIN:
# OF BLDGS: # OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: # OF BD~MS:
# 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 w'orklng day, Inspections requested after 7:00 a.m. will be made the following work day.
REQUiRED INSPECTIONS
~R~U9h Mechanical"":' Prior to
cover.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated. .
D Masonry - Steel location, bond
beams, grouting."
r
D Foundation - After forms are
erected but prlor'to concrete
placement.
D Underground Plumbing - Prior
. to filling trench.
D Underlloor Plumbing/ Mechanical
- Prior to Insulation or decking.
D Rough Eiectrical .....,. Prior to
cover. '
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
D Frami':'g - Prior to~ove.r:
D Wail/Ceiling insulation - Pr.lor to
cover. '. . '.
':..~)
D Drywall - Prior to taping.. '.
o Wood Stovo - After Installation.
D Post and Beam - Prior to floor
Insula~lon or, d~fklng., , . \ " t c::J Insert - After fireplace approv.1
" '",' . \' , . , ," I , and Installation of unit.
." . . .-' ':', -.j,...,; : \1 ., \ _. l~i';":. ~.. f ;
O Floor Insulation - Prior to . . . .
decking. ". ;':-'\._ 'r ~. ,II] Curbcllt & Approach - After
'. ., .,.'.."'" . .. 'forms are erected but prior to
D Sanitary Sewer - Prior to filling placement of concrete.
trench. '
D Storm Sewer - Prior to filling
trench. \. o,.. " . ". '
. ,..$.
O Water L1ne'- prlor"to'f!lI!n,g
trench. ,', < .
D Rough Plumbing. - P~lor~,to
cover. ' ',\ .
.~ .,.. ~ '
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
.0 Fence:~ When COi",'pleted.
o iSt~ee~ ,Trees - When all required
trees are planted.
D Final Plumbing - When all
. plumbing w9rl< Is complete.
D Final Electrical ,-- When all
electrical work is complete.
~inal Mechanical - When all
mechanical work Is complete.
o Final Building - When all
required Inspections have been
approved and building is
com~-
D Othe1~ ~
MOBILE HOME INSPECTIONS
o Blocking and ~et.Up - When all
blocking Is cO'mplete.
o Plumbing Connections - When
home has been connected to
water and sewer:
o Electrical Connection - Whe'n
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 _
Lot sq. ftg.
Interior
Lot coverage
Corner
Topography
Total height
';'
Panhandle .
Cui-de-sac
BUILDING PERrillT ;'j
'~
ITEM
sa. FT.
X $/so. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
~ ~. j
~ .~l t ,:,...."! t.''''
,. 1 I
\ '
'. '., :~
" ('
I' P.L.
IN
Is'
w
E
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(8)
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/Insert/Fireplace 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
;C) $6
IO.OV
/.0{/ q5
21,.~
,~ ~"ij ~'~ '
" .~. f1.:j' 'H' I
, ~i" ,.,.~..t.:,'~
Setbacks '
HSE GAR' ACe' I
IS THE PROPO~ED WORK tN THE.
. HISTORICAL DISTRICT, OR ON
THE HisTORIC~L REGISTER?
If yes, this applfcation must be signed
and approved, by the Historical
Coordinator priOr to permit Issuance.
I
APPROV~D'
BUILDIN'G VAL6E, PLAN tHECK
AND BUILDING PERMIT
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
oulldings, and may be suspended ;or revoked at any time
upon violation of any provisions of said ordinances.
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 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.
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 site al a".'lmes du,lng cons~
Slgnalum 'M~.~(I~
Date /~r~-91
VALIDATION: "'
RECEIPT NU~ERl-. 03/~ LJ. '17
DATE PAID / ~I /Jj 17
AMOUNT REC?7VED FlA A ~ L "'. /j,
RECEIVED BY/( . 11~(j