HomeMy WebLinkAboutPermit Building 1994-8-16
RESIDENTIAL
PERMIT APPLICATION,
Ins pectlons:' 726-3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
'><~SSESSORS MAP: .
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LOT: \ '5' i \ (0..' ~ \~.
BLOCK: ' "2. 3";
OWNER'~e.K.t~L'~'-o~.s\V5 SA~b" '.
ADDRESS/ ',--i: \."L: ~",-\-e f'~,c.o...\ 9,\~&"
S~FD
CITY:
, STATE:. ("'\ ~
NEW
,<).'
DESCRIBE WORK:G1li CD. CA(2., c..oJ\ \Ie. rs;"c...:J
, <....I
-to +-~:~ ro~~
, DEMOLISH OTHER
u\ ~ '~\r rbo..M
REMODEL
GENERA' .
PLUMBING:
ADDITION
,4'.
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
ZIP:
,\,
CONST.
CONTRACTOR #
t
-
MECHANICAL:
ELECTRICA~' r~ A-l aVS'\ uS
, I
CONTRACTOR'S NAME . '. ' " ADDRESS.
F~~ A'W)'i~\ IJ~S;AN~,
~t:.D~~ ~LdYS.\us.. ~~t\",
I t
S-A~ ~-"1
, 'f
- OFFICE USE -
LAND USE: '\ \ \ )
QUAD AREA: r'\? QJ\..)u....)
_\
OCCY GROUP:'f\ ~
,-
it OF BLDGS:
# OF' STORIES:
WATER HEATER:
# OF UNITS:
CONSTR. TYPE:
vrV
EXPIRES
PHONE
FLOOD PLAIN:
tONING CODE:
# OF BDRMS:
SECONDARY HEAT:
LJ:),JL/
SQUARE FOOTAGE:
To request an Inspection. you must call 726-3769.. This Is a24 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,
REQUIRED INSPECTIONS
D Temporary Electric
D Site Inspection -.:. To be made
after excavation. but prior to
setting forms.
D Underslab Plumbing/Electrical/
Me'chanlcal - Prior to cover.
rt1 Footing - Aft~rtrenches are
'"\ excavated.
D Masonry - Steel location. bond
. beams, grouting. .,
, rvl Foundation ~ After forms are
~' erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
rn Post and Beam - Prior to floor
T Insulation or decking.
m Floor Insulation - Prior to
~ decking.
D Sanitary Sewer - Prior to filling
trench.
m Storm Sewer - Prl9r to filling
L...p.J trench.
D Water Line - Prior to filling
trench.
'D Rough Plumbing - Prior to
cover. '
HEAT, SOURCE:
RANGI='
D Rough Mechanical - Prior to
cover.
D Rough Eh!ctrlcal ....,. Prior to
cover. ..
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
,materials and framing Insp.
[lJ Framlng~ Prior to cover.
r\71 Wail/Ceiling Insulation - Prior to
L..N cover. , ,
f.$I Drywall '~ Prl;or to ta~:',ng.
D Wood Stove - After I~stallatlon.
D Insert - After fireplace approvlll
and Installation of unit. '
D Curbcut & Ap'proach - After
forms are erected but prior to
. placement of concrete. '
I
, D Sidewalk & Driveway - After
excavation Is complete, forms
, and 'sub-base material In place,
D Fence. - When ~omPleted.
o ;Street Trees - When all required
trees are planted.
D Final Plumbing - When all
plumbing work Is complete,
D Final Electrical - When all
electrical work Is complete.
D Final Mechanical - When all
mechanical work Is complete,
rvl Final Building - When all
~ required Inspections have been
approved and building is
~~tt~ ~ON}
~~I'c. "d/t~ A<fHftr
-
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.
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 Type',' ,
Lot Sq, ftg.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de'sac
f ~; X,:.:f ":" ;
I':P.L
"'1' ,
, '.. .
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'Is
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I'E
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT. VALUE
Main. .,
. ,
"
Garage
Carport ,-. ~
I
~I/~ ~/.)C:;L ?~ I e/ /6'??,~
. .. ./r
Total Value
Building Permit Fee
State Surcharge
?~ AV~.w,
(A)
Total Fee
~_,o
14~; '.
j,Cr. -.Q
O:l. 43
, "
SYSTEMS DEVELOPMENT CHARGE (SDC)
. (B) P
PLUMBING PERMIT
ITEM FEE
Fixtures 2 ::2..0 ,crt}
Residential Bath(s) NO
Sanitary Sewer FT.
Water FT,
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge ~~<<.J.. /.~
. (p1U
Total Charge (C) '?J~(J
- ,"
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan NO
Wood Stove/ln.sertl Fireplace Unit
Dryer Vent ~htJ.
, / ~<) 6-0
Mechanical Permit
'Issuance /0, (TO .
State Surcharge '7S'
1~ ~I'-GI, '1-'
, ...'
Total Permit (D) ? t:. ~gp
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk It
Curbcut It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) 4J,;J.~
(A, B, C, D, and E Combined)
. '.\ ':}{j!2~t~:
Setbacks '
is THEPROPOSED WORK tNTHE _,'
HISTORICAL DISTRICT, OR ON
THE HISTORICAL. REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
HSE GAR ACC'
APPROVED:
BVILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the,express co!:,ditlon that the said
construction shall, In all respects, conform to the Ordinance
adopted by the 9i.ty .oJ. $prlng~ie!d.,' including the
Developmeht 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' -S-0.....4:r
7-2/-51-
/4CJ2r
, ~?I:-,_
iA{J~ "
Date Paid:, '
Receipt Number:
ReCeIV~Y: '
~
Plans Revie.yed B'y
€5/f~ h~
/ Da{e '
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
-b'VhIf?~AZE e~~~- ,A1~~/r-
/S' /f/(.;(pC/ /.A" ~
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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
Xg=~:"ng Ons""cllon
Date
VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
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