HomeMy WebLinkAboutPermit Building 1997-6-25
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION .oF PROPOSED WORK:
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ASSESSORS MAP:
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.oWNER: ~^" fr'Q.<Jd
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ADDRESS:. ~:?-?S- J?1e:u~,...,
CITY: <;;;n"';-,-u".{:).e (J
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DESCRIBE WORK:
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SPRINGFIELD
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JOB NUMBER
~7!)cjc:;~
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225 Fifth Street
Springfield, Oregon 97477
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s-~ 3S- D~r~7 st.
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TAX L.oT:
SUBDIVISION:
,
BLOCK'
PHONI=.
2'(7-'1 t'f ( if
STATE:
0'\
ZIP: c;'7'-f7r
mob,."!€- ,#c.,M <-
DEMOLISH X
NEW
REMODEL
ADDITION
. ,
-
CONTRACTOR'S NAME
GENERA' . Ow N ~ r
PLUMBING' {)....>.J", L: r
MECHANICAL:
ELECTRICAL:
aUAD AREA:
# OF BLDGS'
OCCY GROUP:
,
# OF STORIES:
WATER HEATER'
aTHER
ADDRESS'
CONST.
CONTRACTOR #
EXPIRES ,.... PHONE
.'.
c:::..
- .oFFICE USE -
,-
.' . ....." ....
LAND USE:
FLOOD PLAIN:
ZONING CODE:
# OF UNITS:
CO'N'STR. TYPE:
# OF BDRMS:
(
HEAT SOURCE:
RANGE'
SECONDARY HEAT:
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.
REQUIRED INSPECTIONS
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o Temporary Eiectrlc
I
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumblng/Electrlcal/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
O Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
O Under"oor Plumbing/Mechanical
-,Prior to Insulation or decking.
O Post and Beam - PrlC?r to floor
Insulation or decking.., '.," -'.
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O Floor Insulation - Prior to
. decking. '
D Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
.trench. ,
O Water Line - Prior. to filling
trench. '
O .Rough Plum~lng'- Prior to
cover. ' . ,
'..
. 0 Rough Mechanfcal -.:. Prior to
cover.
"
h Final Plumbing - When all
~plumbing W9rl< Is complet.e.
o Rough Electrical - Prior to
cover.
o Final Electrical - When all
electrical work Is complete.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Final Mechanical - When all
mechanical worl< Is complete.
D Fireplace - Prior to facing
materials and framing Insp.
".
I ')<J Final Building - When ~II .
/ -lrequlred Inspections have been
approved and building Is
completed.
o Framfng - Prior to cover.
~ Other~ CA-;& _
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t,,,
o Wail/Ceiling Insulatlon.- Prior to
cover. .
D Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
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o Wood Stovo - After Installation.
o Insert - After fireplace approvlll
. and Installation of unit.
D Blocking and Set.Up - When all
blocking Is complete.
O Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Plumbing Connoctlons - When
home 'has been connected to
water and sewer,
O Sidewalk & Driveway - After
excavation Is compiete, fqrms
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.
D Fence, - When completed.
O Final - After all required .
Inspections are approved and
porches, skirting, decks, and
venting have been Installed,
" "
D. ,Street Trees - When all, required
trees are planted.
Lot faces
Lot~yP~
Interior
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Lot sq. Itg.
h~L.
IN
Is
Iw
IE
Lot coverage
,',
Corner
Topography
Total height
~.
Panhandle ..
Cui-de-sac
..
BUILDING PER~)lIT:n .'~ .~
ITEM sa, FT. x $/Sa, FT. = VALUE
Main
Garage
"
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s) N'
Sanitary S~wer FT,
Water FT.
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent' Fan
NO
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
"
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk ft
Curbcut ft
Demolition J9J~
. /44-
'. --9D-f- ~ S-f
State Surcharge
L
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
/1-,#
.
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'IS THEPROPOSEO WORK IN THE.
"'HIST08ICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by thE! Historical
Coordinator prior to permit Issuance.
Setbacks .
HSE GAR ACC'
APPROVED' .
" ~~. ',., l~
BUILDIN'G VALOE, 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 revokec;l at any time
upon violation of any provisions of said ordinances. '
Plan Check Fee:
Date Paid:
Receipt Number:
Received By: '
Plans Revlewod By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
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ADDITIONAL COMMENTS
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By signature, I state and agree, that I have carefully examined
the completed application and do hereby certl fy 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
., j,on the site a)111 times during construction.
. Signature ~r/W~
~ (;>..r /97
~
Datf"
VALIDATION:
RECEIPT NUMBER 2eo ..s:;2., I
DATE PAID 0h '" /9 ?
/ /. "4
AMOUNT RECEIVED /9 ,~
RECEIVED BY ~ ~