HomeMy WebLinkAboutPermit Building 1995-10-13
RESIDENTIAL
PERMIT APPLICATION
"
Inspections: 726-3769
Office: 726-3759
SPRINGFIELD
, JOB NUMBER q V #/2...
, ' ,
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK: /? J'2, ~F..?~;?"7-E"h-"~/~~
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ASSESSORS MAP: 'I ?~"3....'2(:;; - Y y
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TAX LOT: ./ / ?~
SUBDIVISION:
OWNER: .~c:~E'/Y~ _?~~9"""'
/2/2- 4-&"",r~H'r//~
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DESCRIBE WORK:~~/--;1~C::::_?, ,~~7~~';;;- ~r3' ~~~~ 4~7~(~ '7
REMODEL ADDITION DEMOLISH OTHER l' ~ / --;e::> ~~
LOT:
ADDRESS:
CITY:
NEW
CONTRACTOR'S NAME
GENERAL: ~~~~
PLUMBING:
MECHANICAl'
ELECTRICAl'
BLOCK:
STATE:
~,
or
PHONE:
?sr?-/tC~
ZIP: 97Y/.?
.' ADDRESS
CONST
CONTRACTOR #
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...
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EXPIRES
PHONE
- OFFICE USE ....;.
QUAD AREA: LAND USE: FLOOD PLAIN:
# OF SLOGS: # OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: " ff OF BDRMS:
# OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: 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, 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 Undershib Plumbing/ Electrical!
Mechanical - Prior to cover.
rn Footing - After trenches are
"4-' excavated. ' ,
o Masonry - 'Steel location, bond
beams, grouting, ,
o Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to flll!ng trench, I
o Underlloor Plumbing/Mechanical
, - Prior to insul~tlon or decking.
'0 Post and Beam....;. Prl,or to floor
Insulation or dec~ing. ' i
. 'I
o Floor lri'sulati~n.- Prior to' ../
deckihg, ".;:
I ( t"
o
Sanitary Sewer - Prior to filling
trench,
O Storm Sewer - Prior to filling
trench,
o Water Line' - Prior to filling'
trench. ',.,.
o Rough Plumbing, - Prior to
coveL '
REQUIRED INSPECTIONS
'0 Rough Mechanical - Prior to
cover.
o 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 Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stovo - After Installation.
D Insert - After fireplace approval
and installation of unit.
o Curbcut & Approach - After
, ' forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway -' After,
excavation Is complete, forms
and sub-base material In place,
o Fence - When compl~ted. ",',
D Street Trees - When all required
trees are planted. .
\
D Final Plumbing - When all
, plumbing w()rk Is complete,
D Final Electrical - When all
electrical work is complete,
o Final Mechanical - When all
mechanical work Is complete,
o 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,
D 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 al(,required
inspections are approved and
porches, skirting, decks, and
venting have been Installed,
Lot faces
Lot Typ. ,
Lot sq, ftg,
Interior
Lot coverage Corner
Topography Panhandle
Total height Cul-de-sac
BUILDING PERMIT
ITEM SQ, FT. X $/SQ, FT,
Main
Garage
Carport
"'....
Total Value
": ':, ". ~;,
; .~;
"
Setbacks'
I P.L. HSE GAR ACC I
N
S
W
IE
VALUE
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State Surcharge
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'97 '" :~..,-
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(A) -Lb .:::JC:>
Building Permit Fee
Total Fee
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
NO
Sanitary S~wer
FT,
FT.
Water
Storm Sewer
FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsertlFireplace 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
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· ", - 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.
,A,PPROVED:
BUILDING VALUE, 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 ~ity 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 provis,lons of said ordinances.
Plan Check Fee:
Date Paid:
Receipt Number:
R~Y:
0~~
, v
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
$--/r-9/>
Date
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 workperformed 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,lhe proper time, that each address Is readable
from the street, that the permit card Is located at the front
of the property, t~,d the approved set of plans will remain
;:::2~;;~~ ~
I~ - 1)---
Date
VALIDATION:
/92:? '3
/~,y3~S
AMOUNT RECEIVED -;-16. Zc:::::::>
~~
~ .r
RECEIPT NUMBER
DATE PAID
RECEIVED BY
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