HomeMy WebLinkAboutPermit Application 1997-2-18
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SP'GFOELD
DEVELOPMENT SERVICES DEPAHTMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726.3689
Manufactured Home Placement
Permit Application
City Job Number: 97/ 7,t/2.....
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PJacement Location: ;>:>" ~ v '7"'1 ~ '1 ' v 7
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Assessors Map Number: J 7 · ~ ~ ~ ~ .. 00
Tax Lot Number: t::'/~"'ir:=>
Lot:
Block:
Subdivision:
Partition Number:
Parcel Number:
Has Partition Been Approved?:
--OWNER--
Name: AN6-t;'t... WG"H:..H
Mailing Address: ~~ ~) 1>At ~'1 -4/0 9
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Phone Number: ~ Z. -/WJ(J
City: SI"~c./J State: o-t. Zip: f17cf 78
Installer: S'11nJs ~~
Plumbing: M III ~ ,to",}.",,-
Electrical: t~t n,14J11I1l.
--CONTRACTORS--
CCB#:-OJ '4.orlo1- Exp: z..-"..fi Phone: ~'l7" ') -.., I
CCB#:~Exp: 1-11-~ Phone: ,~~...oS-,..,
CCB#:_IU"'L Exp: J -/7-YB Phone: 7") a.... ~'1
General Contractor:
(if applicable)
Mechanical Contractor:
(if applicable)
CCB#:
Exp:
Phone:
CCB#:
Exp:
Phone:
--LENDING INSTITUTE--
Business Name: ~"t) Co..., )Ge.. ,- .b. -l J; #UA.UUG
Phone Number: ~O. J~~ -/S-f{'l..
Mailing Address:
Attention:
City:
State:
Zip:
--PERMIT INFORMATION--
Value of Home:
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Value of Footing/Foundation:
Sq Footage of Home: <;iq I
Type of Heat: P J A
Heat Pump Installation?: ~ 6
Sq Footage of Garage/Carport: -:::J /'?-
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Application Received By:
Date:
Plan Check Fee:
Receipt Number:
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
, .
LOT:
OWNER:
.
ADDRESS'
CITY:
:>
DESCRIBE WORK'
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SPRINGFIELD
.
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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BLOCK'
TAX LOT:
SUBDIVISION'
-.
. PHONE:
STATE:
ZIP:
NEW
REMODEL
ADDITION
OTHER
CONTRACTOR'S NAME
GENERAl.
,PLUMBING:
MECHANICAL:
ELECTRICAL'
aUAD AREA'
# OF BLDGS:
OCCY GROUP:
/I OF STORIES'
WATER HEATER:
DEMOLISH
ADDRESS.
CONST,
CONTRACTOR /I
EXPIRES 0 PHONE
- OFFICE USE ....
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LAND USE:
FLOOD PLAIN:
ZONING CODE:
,
/I OF UNITS'
CONSTR. TYPE:
/I OF BDRMS:
SECONDARY HEAT:
HEAT SOURCE:
RANGE:
saUARE 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,
o Temporary Electric
, D Site Inspection - To be made
after excavation, but prior to
setting forms.
O Underslab Plumbing/Electrical I
Mechanical - Prior to cover.
o Footing - Atter trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting,
o Foundation - Atter forms are
erected' but- prior to 'concrete
placement.
o Underground Plumbing - Prior
to filling trench.
O Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
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O Floor Insulation - Prior to
decking. '. '.'
O Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to H1llng
trench.
..
o Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover, '
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
o Final Plumbing - When all
.plumbing w9rl< Is complet.e.
D Rough Electrical - Prior to
cover.
D Final Electrical - When all
electrical work Is complete.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Final Mechanical - When all
mechanical work Is complete,
o Fireplace - Prior to facing
materials and framing Insp.
o Final BUilding - When all
required Inspections have been
approved and building Is
completed.
o Framing - Prior to cover.
o Other
o Wall I Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
o Wood Stovo - After Instal~atlon.
o Insert - After fireplace approval
and Installation of unit.
o Blocking and Set-Up - When all
blocking Is complete.
. 0 Curbcut & Approach - After
forms are erected but prior to
placement of concrete,
o Plumbing Connections - When
home has been connected to
water and sewer,
o Sidewalk & Driveway - After
excavation Is complete, forms
and 'sub-base material In place,
o Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home is connected to
the service panel.
o Fence. - When completed.
D,street Trees - WIlen all required
" trees are planted. .
o Final - After all required
. Inspections are approved and
porches, skirting, decks, and
venting have been Installed,'
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L~t ~ype'. . , "
, ..
Lot faces
Lot sq. ftg. Interior I p.L.
IN
Lot coverage Corner
Is
Topography "
Panhandle'
Total height Cul.de'sac W
E
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Setbacks .
HSE GAR ACe'
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~~ THEPROPOSED WORK tN TH;'.
HIST081CAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
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APPROVED'
BUILDING PERro1lT '!'j '& '~
ITEM sa. FT. x $/Sa, FT. = VALUE
BUILDING ~Lt1E,PLAN CHECK
AND BUILDING PERMIT
Garage
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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.
Main
Carport
Plan Check Fee:
Date Paid:
Total Value
Building Permit Fee
Receipt Number:
State Surcharge
Received By:
Total Fee
(A)
Plans Reviewed By
Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT,
Storm Sewer
FT,
FT,
Mobile Home
I/~vr
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1'"3
'5-~
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Plumbing Permit
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State Surcharge
Total Charge
(C)
/6t 2t5>
MECHANICAL PERMIT
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Furnace
Vent Fan
NO
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 Ordinancl:ls 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.
Exhaust Hood
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanica:l Permit
Issuance
State Surcharge
Total Permit
MISCELLANEOUS PERMITS
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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 constructio
Signature ~
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Date' /2-1/ 7/' ')
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(D)
State Surcharge
Sidewalk ft
'~I'- ~
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2~
S.2~
7'/~
Mobile Home
State Issuance
Curbcut
ft
Demolition
State Surcharge
VALIDATION:
2~2-'L-.
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RECEIPT NUMBER
Total Miscellaneous Permits (E)
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DATE PAID
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Comb'lned)
,
AMOUNT RECEIVED
RECEIVED BY