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Home My WebLink AboutPermit Building 1991-8-13 "RESIDENTlAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 . SPRINGFIELD LOCATION OF PROPOSED WORK' ;;?L.IS(q ASSE~SqRS MAF", II?J 3z:?/ Z- .M..;nv\ --r.AdrA- ~k)n(')dnAi+- ADDRESS '2-LlS? Cf l/\ .pfl .~ V vi f I~V\ . c,of-tcJ STAT'" ?J?- DESCRIBE W~RK'\. \<Q f),c\ Q f\hO \J . \ dnJ \ i\jCJ\~) ADDITION )( LOT: OWNER' CITY: NEW REMODEL f(j y \; fAf' .BLOCK' DEMOliSH OTHER . 0; 1 V2'Qj JOB NUMBER .225 Fifth Street Springfield, Oregon 97477 TAX LOr. (5 ZLlzYJ SUBDIVISION' PHONE: 7'-11" - 9:777 ZIP: q7477 CONTRACTOR'S NAME GENE~AI. :l2.', chIJ vok CONST. , ADDR~t.- , CONTRAC:rOR # ,EXPIRES S?ffl\OdP.ll\~ ilCdlfojIL,'ilPfC-r-" MTJ5jr7nLln_ \\!1~101 .PLU~BING: MECHANICAl' ELECTRICAl' QUAD AREA \ Q. f\')ll) ~?J -'-~- . OF BLDGS, OCCY GROUP: . OF STORIES: WATER HEATER' - OFFICE USE - LAND USE: \\ \ ~ . OF UNITS: \ CONSTR. TYPE: ~f\) HEAT SOURCE: RANGE: PHONE FLOOD PLAIN' ZONING CODE: ill V . OF BDRMS' SECONDARY HEAT: SQUARE FOOTAGE_1S{ )() 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 l!lspection :- To be made after excavation, but prior to setting forms. D U':1dersl?b Plumbing} Electricall Mechamcal - Prior to cover. ~ Footing - After trenches are ~ excavated. ~Masonry - Steel location, bond ~ beams, grouting. ~ Foundation - After forms are erected but prior to concrete placement. D Underground Plumbing - Prior to filling trench. CJ Underfloor Plumbing/Mechanical - Prior to insulation or decking. ~Post and Beam - Prior to floor I.6J insulation or decking. o Floor Insulation - Prior to decking. o Sanitary Sewer - Prior to filting trench. o Storm Sewer - Prior to filling trench. }". D Water Line - Prior to filling trench. ~ Kough Plum"bing - Prior to ... cover. REQUIRED INSPECTIONS ~Rough Mechanical - Pri~r to ~ ~over. ~OU9h Electrical - Prior to .. cover. o Electrical Service - Must be approved to obtain permanent electrical power. D Fireplace - Prior to facing materials and framing Insp. ~raming - Prior to cover. ~all/Ceiling Insulation"":" Prior to . - cover. ~rYWall - Prior to taping. D Wood Stove .....;.. After inst~lIation. o 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' requi red- trees are planted. 13' Final Plumbing - When all . . - plumbing work is complete. . ~inal Electrical'- Wh'en all electrical work is cOllfplete. ~ 'r-x:r t"inal Mechanical - When all ~echanical work is complete. ~inal Building - When al! ~ ~equired inspections have been approved and building is completed. DOlher 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. D Electrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. D Final - After arl required inspections are approved and porches, skirting, de>cks, and venting have been installed. Lot faces Lot sq. ftg. Lot coverage Topography Total height BUILDING PERMIT ITEM SO. FT. Main Garage Carport ip~di *711 (307\ Total Value Building Permit Fee State Surcharge Total Fee PLUMBING PERMIT ITEM Fixtures Residential Bath(s) NO Sanitary Sewer FT. Water FT. Storm Sewer FT. Mobile Home Plumbing Permit State Surcharge Total Charge MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan Lot TY_ . 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. Interior I P.L IN Is Iw IE Setbacks IHSE'GAR'ACcl I I I I Corner Panhandle Cul-de.sac X $/SO. FT. VALUE hi, !(ilOrPJ ;( fJ't &0 fC(.,f5 ;]03 . ~> SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ..-e- tpi> .;'7{-70 -6rt'~ (A) '-I FEE fLC? &0 (C) 4&. &tJ ,;( ,(JD t.f.;;(, (!)t) Dryer Vent Wood Stove/lnsertl Fireplace Unit NO Mechanical Permit Issuance State Surcharge Total Permit Mobile Home MISCELLANEOUS PERMITS (D) I S. tJO jt'J; &0 i. () 5 ;;U:, ,:;( Ci State Issuance State Sur"charge Sidewalk It Curbcut ft Demolition State Surcharge Total Miscellaneous Permits (E) ,f TOTAL AMOUNT DUE (excluding electrical!-/f3 71. ? 0 (A, B. C, D, and E Combined) APPROVED: 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 City 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 provisions of said ordinances. 1??7,S;:; 7 - 2-"(q i U)'b4Z ~'IA^, u~ Plan Check Fee: Date Paid: Receipt Number. Received By: " - Plans Reviewed By Date Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. ADDITIONAL COMMENTS By signature, I state and agree, that I have carefuify 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 h?rein, 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 on the site at all times during construction. Signature /0A11)J, trj~ Date r!-t~-91 VAliDATION: '? .c!>9 "9 "5 DATE PAI['l /~~ /' AMOUNT RECEIVED -::3 -:Zl.. 7D RECEIVED BY ~/ ~, _->--. '( 'i- ",.,-- ".-- RECEIPT NUMBER , / ---- . . . Permit No: "'9/C:::<:<9 / Address: -:/<-15<''9 //~-",I/b.6' ~ ' Issued by:a.-..- , ~/ ~ Date: %:/;;,,"'5/ STATEMENT: INFORMATION~ NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701,055(4), requires residential building permit applicants who are not registered with. the Construction Contractors Board to sign the following statement before the building permit can be issued, Licensed Architect and Engineer applicants, exempt from registration under ORS 701.010(7), need not submit this'statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or 2B: Q&fir/. -, 1:~ I own, reside in, or will 'reside in the completed structure. 2. A, L.....J My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction CDntractors Board, OR B. i""~ --I will be my own general contractor. If rhire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. /'4.Yf II) fA 1,~j~jJ Signatufe bFPermit APPYtant f/'--/3-9/ Date I CONSTRUCTION CONTRACTORS BOARD 0244J 10/24/89 WHITE COpy TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT <E>,