HomeMy WebLinkAboutPermit Building 1991-4-23
RESIDENTIAL
PERMIT APPLICATION'
Inspections: 726-3769
Office: 726-3759 .'
LOCATION OF PROPOSED WORK:
A~SESSpR,~ Mf'.P:
LOT:
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SPRINGFIELD
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" BLOCK",
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OWNER:t~^\~~.: \c-\ioc )~0 L PHONE: --n~~.\O-C\G\::~J)
ADDRESS:' ~\ :.0.0 ,\..')Q\_ '-_ t ^ ..u- 8-
CITY: '~0~ \~ . \1TATE: l'\JJ\_00\M ZIP:
DESCRIBE WORK:\ . J\. {L-l. ~~, "
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ADDITION
NEW
REMODEL
DEMOLISH
OTHER
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JOB NUMBER q \ ()3 :3
225 Fifth Street
Springfield, Oregon 97477
~
TAX LOT'
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SUBDIVISION:
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'QI4~
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-
CONST,
CONTRACTOR #
.~l)~ .4
CONTRACTOR_NAME 0 _h ~DDRESS
GENERAL~ ~()L(\ U}\\\\ ~sl.
P.LUMBI'~G:-' .. (j.' .' -
MECHANICAL:
.. .. . ~.
ELECTRICAL:
QUAD AREA:
# OF BLDGS'
OCCY GROUP'
# OF STORIES:
WATER HEATER:
"':'OFFICE USE -
LAND USE:
# OF UNITS:
CONSTR, TYPE:
HEAT SOURCF'
RANG E'
EXPIRES PHONE
Bj14!q I
. '
'.'
'." -.. .....
.,0
FLOOD PLAIN'
ZONING CODE'
# OF BDRMS:
SECONDARY HEAT:
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,
o Temporary Electric
D Site lnspection -.- To be ,made ,
after excavation, but prior to
setting forms,
D .Underslab. Plumbing/Electrical/,
Mechanical - Prior to cover,
o Fo'oting - After trenches are
excavated.' , .
D
Masonry -, Steel location, bond
beams, grouting,
D Foundation' - After forms are
. erec,ted but prior to concrete
, placement.
o Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/ Mechanical,
~ Prior to insulation or decking,
o Post a,:,d Beam =-, Prior to floor,
insulation or decking. .
o Floor Insulation - Prior, to
decki ng,
D 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
cover,
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cove~ .
o Rough Electrical,- Priodo.
cover,
o Electrical Service - Must be
approved to obtain permanent
. electrical power,
D Fireplace - Prior to facing
materials and framing Insp.
o Framing - Prior to ~over,
D WalllCeilh1g Insulation -' Prior to
cover,
o Drywall - Prior to taping.
.....t
o Wood Stove ~ After installation.
'-.
D 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
. anq sub-base r.naterial in place.
.
DFenc~ .:.:.. When complet!'ld.
..
, 0 StreetTrees ~"Wh-en 'all req'iJired
trees are planted. :
. .,
o
Final Plumbing - When all
plumbing work is complete,
, ,
o Final Electrical- When all
electrical work is complete, '
, .
o Final Mechanical - When all
mechanical work is complete,
?' Final Building - When all
required Inspections have been
, approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
,'" :
o Blocking and Set-Up - When all
blocking Is complete,
o Plumbing Connections - When
home has been connected to
water and sewer,
D Electrical Connection - When'
blocking, set-up, and plufilblng
inspections have been approved
and the home is connected to
the service panel.
o Final - After all required
. . ,inspecti6ns are approved and
..1:.... ..
porches, skirting, decks, and
venting,have been installed,
Lot faces Lot Type. Setbacks
I I P.L. I I I ACC I
Lot sq, ftg, I Interior HSE GAR
IN I
Lot coverage Corner
Is I
Topography Panhandle
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Total height Cul-de-sac W
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E
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~ THE PROPOSED WORK t THE
'. . . . . !
HISTORICAL DISTRICT; OR ON
, I
THE HISTORICAL REGISTER?
I
, , .
If yes, this application must 'be signed
and approved by the Historical
Coordinator prior to permit i~ssuance.
APPROVED:
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT. = VALUE
i
BUILDING VALUE, PLAN CHECK I
AND BUILDING PERMIT i
This permit'is granted on the express condition th'at the said
, "
construction shall, in all respects, conform to the Ordinance
adopted tly ,the City of Springfield, including the
Development Code, regulating the construction ~nd use of
,
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinartces.
Plan Check Fee: i
!
Main
Garage
Carport
Total Fee
(A)
8a).Cf.J
rS"DO
'.7~
J5.~
Date Paid:
Total Value
Receipt Number'
Building Permit Fee
Received By:
I
State Surcharge.
I J \.
Plans Reviewed By
lpate
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
j
Systems Development Charge is due on all undeveloped
,
properties within the City limits which are beingiimproved.
,
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Vent Fan
NO
,
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By signature, I state and agree, that I have carefullJ examined
the completed application and do _hereby certi'fy that all
I
information hereon is true and correct, and I further certify
, I
that any and all work performed shall be done in accordance
,
with, the Ordinances of the City of Springfield, an~ 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 Safet1y Division,
I further certify that only contractors and emplc!>yees who
i
are in compliance with ORS 701.055 will be used on this
. t I
proJec .
Furnace
Exhaust Hood
Wood Stove/lnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
.
,
,I .
I further agree to ensure that all required inspections are
,
requested at the proper time, that each address i~ readable
from the street, that the' permit card Is located a't the front
I
of the property, and the approved set of plans will remain
I
on the site at all times during construction,
'Y { OWl '
Sl~ l I / 0<7' T7 L)',
Date
(D)
MISCELLANEOUS PERMITS,
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined),
p.'A~
VALIDATION: {qC}/ S f\
RECEIPT NUMBER ./ \. _ ~ ~
DATE PAID < Z'5 '1
AMOUNT RECEIV~ ~. rJ ,~'\ I.~
RECEIVED BY \~()--/
,
,
,
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State Surcharge
Total Miscellaneous Permits (E)