HomeMy WebLinkAboutPermit Mechanical 1995-6-12
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
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ASSESSORS MAP:
LOT'
SPRINGFIELD
56"0
(!J'2
CAS CA dE
2... <...
BLOCK:
OWNER'
ADDRESS:
CITY:
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DESCRIBE WORK:
j I\J S"T A- LLA f-I~ON
NEW~'
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAL:
PLUMBING:
MECHANICAL:
ELECTRICAL:
Hf3r1<1/ELf C1- P~ttE ~,
, /
6WA. ') m
DEMOLISH
OTHER
JOB NUMBER
950/3flA
, ,
2,25 Fifth Street
Spi-ingfield, Oregon 97477
TAX LOT:
SUBDIVISION'
o~~&O
. ' PHONE:
7C),.l,... ~7(3
ZIP:
9 7l(...7~
~
/ " ,
ADDRESS
CONST.
CONTRACTOR #
EXPIRES
PHONE
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 I Ceiling Insulation - Prior to
. cover. "
, .
D Drywall - Prior to taping.
D Wood Stove - After i~stallation.
\
D Insert - After fireplace approval
and Installation of unit.
D Curbcut & 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.
D Fence':":" When completed.
o Street Trees - When all 'required;'
trees are planted. , . '
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. ,
~ OFFICE USE -
QUAD AREA: LAND LlSr=. FLOOD PLAIN:
# OF BLDGS: # OF UNIT~' ZONING CODF'
OCCY GROUP: CONSTR. TYPE: # OF BDRMS:
# OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGr=. SQUARE FOOTAG E:
To request an inspection, you must call 726-3769. l:hls 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
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbingl Electricall
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting, ,
o Foundation - After fo"rms are
, erected,but, prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underfloor PlumbingJ Mechanical
-Prior to insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking. .
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench. '
o Water Line - I:'rior to filling
trench.
D Rough Plumbing - Prior to
cover.
D Final Plumbing - When all
plumbing work Is complete.
D Final Electrical-When all
electrical work Is complete.
... :,', . .
... f'X(Final Mechanical - When all
~echanical work is complete.
D Final Building - When all
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 has been connected to '
water and sewer. .
D Elect~ical 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 '
. inspectlonsarea'pproved and
porches', sklrtln'g, decks, and
venting .have been, installed:
Lot faces
Lot Type
Interior I P.L.
IN
Corner
Is
Panhandle
Iw
Cul-de-sac
IE'
X $/SQ. FT. VALUE
, '
,
Lot.sq. ftg.
Lot coverage
Topography
Total height
! '....
BUILDING PERMIT
ITEM SQ. FT.
Main "
Garage
Carport '. '. '
....
I,. .
Total Value'
Building Permit Fee
State Surcharge
Total Fee
(A)
'SYSTEM_S DEVELOPMENT CHARGE (S.o,q> "
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
? tr()
Vent Fan
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
~r~~~(~)
{p6-0
/ S/N7
I D ~o
,
;.J.. 'Q
~~<>
Mechanical Permit
Issuance
State Surcharge ,75>..,.. ,.,0-
Total Permit (D)
MISCELLANEOUS PERMITS
Mobile Home
State ,Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
DemollHon
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
? 1- .~
Setbacks
HSE GAR
;'
(,_ " 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.
ACC I
i
I
I
I
APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express.condition that the said
construc'tlori shall,'ih allnispec,ts, confor~ to the Ordinance
adopted by, the City of Springfield, including the
Development Code, regu'lating the construction and use of
buildings, and may be sus'pended or revoked at any time
upon violation.of any'provlsion's of saicf'O"rdinar.lces,
Plan Chec.k Fee:
. ; ...' 't ~
Date Paid:
".
Receipt Number'
ReceIved By:
Plans Reviewed By
Date
. ~ . . .- - . . ..
. ,Systems'Development, ~harge Is: du~ ,on ,'all undeveloped
prope.rt'ies within the City limits ~hich'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 app~oved set of plans will remain
on the site a II times dU~. . structlo~. A?
O~ (:?7~~
G'-(~7~
Signature
Date
VALIDATION:
RECEIPT NUMBER
DATE PAID
/70 '7-0
~//Y5:)-
7k ,20
?~
AMOUNT .RECEIVED
RECEIVED BY