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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-"~/~~ ---- -., ... .-/ ." ASSESSORS MAP: 'I ?~"3....'2(:;; - Y y , , e a~ ,.., , TAX LOT: ./ / ?~ SUBDIVISION: OWNER: .~c:~E'/Y~ _?~~9"""' /2/2- 4-&"",r~H'r//~ :?:P~CI)- 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 # , , ... . .", 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 " State Surcharge /?/~ /?:~ '97 '" :~..,- "r (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 ~,:?~ · ", - 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 ...