HomeMy WebLinkAboutPermit Building 1995-5-1
LOCATION OF PROPOSED WORK: 533.':)
~SSESSORS MAP' J 7~"2 -~"'3-a:::::::>
x('LOT: BLOCK:
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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SPRINGFIELD
. 9~:>~'7'
JOB NUMB~R ~9 9 7 -
225 Fifth Street
Springfield, Oregon 97477
. fj'7'1 7 ?
.s f'~ce 50 Sprlt'l6j.(l:./) O/"7r-J-
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SUBDIVISION:
~WNER' D",tJI,J----
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ADDRESS: ..!:J 335
~ITY: S fL' 'V1i (Ii .,
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PHONE: 7't1f - ,;205i(
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- ZIP: ,/7r7 F
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STATE: ~nv,.o, .
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On/I (8W'~~)
DESCRIBE WORK:
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ADDITIONJ
/ .5~<<HtU7l
I
, DEMOLISH
.OTHER
NEW
REMODEL
CONTRACTOR'S NAME
Ou.;~~~-
GENERAL"
'"
PLUMBING:
MECHANICAl'
ELECTRICAL:.
or
ADDRESS
CONST,
CONTRACTOR /I
,
EXPIRES
PHONE
- OFFICE USE -
aUAD AREA: LAND USE' FLOOD PLAIN:
/I OF BLDGS' /I OF UNITS' ZONING CODE:
OCCY GROUP: CONSTR. TYPE: /I OF BDRMS:
/I OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGF' SaUARE FOOTAGE:
To request an Inspection, you must call 726.3769. This Is a 24 hour recording, Alllnspecllons 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 Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/ Electrlcall
Mechanical - Prior to cover.
ri71 Footing - After trenches are
I..,.CJ excavated. .
D 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 Underfloor Plumblng/Mechanlcal
- Prior to Insulation or decking.
.
o Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation.... Prior to
decking.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench. '
D Water Line - Prior to filling
trench.
D Rough Plumbing - Prior to
cover.
REQUIRED INSPECTIONS
D 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,
D Efectrlcal Service - Must be
approved to obtain permanent
electrical power.
D Final Mechanical - When all
mechanical work Is complete,
D Fireplace - Prior to facing
materials and framing Insp.
IZI Final Building - When all
, required Inspections have been
approved and building Is
completed,
D Framing -, Prior to cover.
o Other
D Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping,
MOBILE HOME INSPECTIONS
. .
D Wood Stove - After Installation,
D Insert - After fireplace approval
and Installation of unit.
o Blocking and Set.Up - When all
blocking Is complete, '
o 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.
D Fence. - When completed.
o Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
o Street Trees - When all required
trees are planted. .
Lot faces
, Lot ~y.
_ Interior
- Lot sq, ftg,
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de-sac
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. .IS THEPROPOSED WORK tNTHE_
HIST081CAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
Setbacks .
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HSE GAR ACC'
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IN
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BUILDING PERMIT
ITEM sa, FT, x $/sa, FT, = VALUE
r~':7- 2.6
6'~.~
;$- 1-~
~~~
Main
"
Garage
Carport
"2 !iJ1rS
/ytf
/~ It?
I~/o
~
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
,
. ,
,
,
;Z')1""E~
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SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary Sewer FT,
Water FT,
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
.MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELL.~NEOUS PERMITS
Mobile Home
.
State Issuance
State Surcharge
Sidewalk
ft
ft
Curbcut
Demolition
State Surcharge
~/PP ~~A~/Y 7'C$
, -,-
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
FEE
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1
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APPROVED:
-
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the expre'SS 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.
Plan Check Fee: '.
~2_.F57
Date Paid:
Receipt Number:
'j
Re~ j A. . ~/?.<:1
"'P;~~lewedBt ., ~ Date
S~tems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
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ADDITIONAL COMMENTS
By signature, I state and agree, that' 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.
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 per card Is located at the front
of the property, n the a ro"ed ~et~f I will remain
on the site at II tl eS,d rln~ con u I
Signature " t"UIot!~/
Datef!)av I /11:;-' /
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VALIDATION:
RECEIPT NUMBER
DATE PAID
JrJ/9~
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/l~;::'
AMOUNT RECEIVED
RECEIVED BY
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