HomeMy WebLinkAboutPermit Mechanical 1999-8-4
''-' . )'';: ',,~.,;,
RESIDENTIAL
PERMIT APPLICATION
,r"'--
:l"
"--
Inspections: 726.3769
,Office: 726.3759 :' ' '
"'.' '
/ ' 'LOCATIONOF PROPOSED WORK~ -:5.Ll1\
ASSESSpRS MAP: / t tJ 2. 6 '2... ~,2
OWNER:~'\ nn ) (--hOf\h
'ADDRESS' . ~~4A C'c:)..L)('.A r1 0 ~.
CITY: O.Prf-V\o~1~)Cl~) STATE:iL~~
, , "" {~ IIe-J- (A U~,.....
DESCRIBE WORK: "-..:: (ll 'fAm,/J
LOT:
NEW
ADDITION
REMODEL
BLOCK:
DEMOLISH
OTHER
- , . ;. '6j/IC) )2-
JOB NUMBER
SUBDIVISION: '
PHONE: _J fl-L,f> -1&(/)--#
ZIP:
~
CONTRA~~AME \ t" .~.. . kAI\9RESS, I _ " 'gg~~<fTOR # .' EXPIRES '::'l 'PHONE'" .
GENERA 1'C,.t4Vfrl~Ll:.Al~)(1'rre.,-JC 473lJi:J. 1Le/-2fDL
PLUMBING: , ''v ' ,
MECHANICAl'
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.
o Temporary Electric
o Site Inspection- - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated,
D Masonry - Steel location, bond
, beams, grouting. ,
""-'"
,
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing -:- Prior
to filling trench. ,
o UnderlloorP/umblng/Mechanlcal'
- Prior to Insulatlo~ or decking. '
"-7.;J;-:::';;'::- - ~ '-:' - - . "
J ' D Post and Beam ~ Prior to floor
Insulation or decking,
D Floor Insulation -' Prior.to
decking,
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. ,_ " .J"
l, ~J ~.J~' I ,".
" '
O Water Line - Prior to.fiIling'.'.
trench. ! t .,
" ".-'
o Rough Plumbing, -:7 Pr-tor to
cover, '\ \
I ~ 10' >, ..
, ,
REQUIRED INSPECTIONS
, '. '
, 0 Rough Mechanical -.:. Prior to
cover.
'0 Rough Electrical -,. Prior to
cover,
'0 Electrical Service - Must be
" ' approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior t'o cover:
.', ""'~ t !::~r'.. I
0, Wall/Ceili'"!9 Insulatlo.n',:-:- fr~or to
cover, " ':
;z'\ ~'."
,D Drywall- Prior tot~PIF~"'t_
'- '., ""'.
o Wood Stove - After Installation.
o Insert - After fireplace approvlll
'. and Installation of unit.
D Curbcut 8. Approach - After
, forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
., excavation is complete, forms
and'sub-base material in place,
.. ; 0 Fence ,'"","- Whe,n conlpleted,
D'street Trees - When all required
trees are planted,
D Final Plumbing - When all
, plumbing worl< Is complete.
Inal Mechanical - When all.
mechanical work is complete.
D Final BUilding - When all
required Inspections have been
approved and building is
completed, ',"" \.
\; ,;;;'\:', \
.
D Other
MOBILE HOME INSPECTIONS
" :__' . ""oA:.,...:"v>_ ~'!::.~....._,..,. ~. . .. ..,
D 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.
D Final-- After all required
inspections are approved and
porches, skirting, decks, and
venting have been Installed.'
"'--,,/
Lot faces
Lot sq, ftg.
Lot coverage
Topography
Total height
Lot Type
Interior
Corner
Panhandle "
Cul-de-sac
.~;..~ f?~ .:;~::';
'j;
Setbacks
, . \
. \:---"IS 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,.
I P.L. HSE GAR Acc'l
IN
Is
W
E
BUILDING PER!tt1IT ,."j
ITEM SQ, FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(1
't
VALUE
"
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
Sanitary S~wer
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
X $/SQ, FT.
(A)
N'
FT.
FT.
FT.
(C)
Wood Stovellnsert/Flreplace Unit
NO
JJ;;)nt;J~
~ /
Mechanical Permit
Issuance
State Surcharge
Total Permit
Mobile Home
MISCELLANEOUS PERMITS
(D)
State Issuance
State Surcharge
Sidewalk
ft
ft
Curbcut
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
/6: ()()
/O,dO
/In
2~ . ,.) ()
---J
__.J
APPROVED: . '
"': ' '!
BUILDING VALtJE, PLAN CHECK
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 Springf.ield, 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.
Plan Check Fee:
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on ail undeveloped
properties within the City limits which are being improved,
ADDITIONAL COMMENTS
E-e?7tt1J /JPt-'-"/ ~,,//d
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 wiii remain
on the site at all tim"es durin,lo/'C". truct~
/J ../,,/ led //1
Signature /, ~ d/t,f'/
;
Date
VALIDATION:
RECEIPT NUMBER' () J!:7' 7
DATE PAID ~lfl r 7'
AMOUNT RECEIVEDI7 r lA. ') D
RECEIVED BY ~I!U~