HomeMy WebLinkAboutPermit Building 1991-9-12
, ,- R'E~IDENTIAL ' e
PERMIT APPLICATION
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SPRINGFIELD
JOB NUMBER
Inspections: 726-3769
Office: 726-3759 '
LOCATION OF PROPOSED WORI<' ~:\...~,
J\SSESSORS MAP: \'l()8;'o2('(r') "
OWNER:~~~ D \ _[1 ~ (--:; ~ ~
AD~~~St/VU, ' \~~ \t</
CITY: ,~~~.1(\Q ~--' _ ,STATE: J~L\ )
DES~Rr\WORK~ fJA mU l J.. )lH Q , IYI W
NEW'f.-/ REMODEL Q,DDITION DEMOLISH OTHER
I CONS~
CONtRACTOR'S NAME \ J..-.---.J ADDRESS \ _T\'tt\0I C~T~;C.~
GENERAL:~\\\A.)\L~~,~ \\\1' OLJ ~ H
\, \ \
LOT:
PLUMB.ING:
MECHANICAL:~
ELECTRICAL: Q ~ 0 f-?
QUAD ~REA:~ Sl'----"
# OF BLDGS:~
OCCY GROUP: ~ ~
# OF STORIES: \
WATER HEATER' S)
225 Fifth Street
Springfield, Oregon 97477
.,
Crt IDlN:t4-' n 1
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rFfYl
TAX LOT:
BLOCK: '
SUBDIVISION:
PHONE:
(O~t- O~,
ZIP: ~l4--4("),
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EXPIRES
,. '2,q/
PHONE
,47"/~
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I.:
- OFFIC~E -
LAND USE: t \ t:"J()
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FLOOD PLAIN:
ZONING CODE:
-
~
wv
# OF UNITS:
CONSTR. TYPE:
# OF BDRMS'
HEAT SOURCE: .f="'~___
ct:./
SECONDARY HEAT:
SQUARE FOOTAGE:
RANGE:
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 Inspection....,. 1:0 be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
, , Mechanical - Prior to cover,
o Footing - After trenches are _
excavated.
D Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench, '
D ,Underfloor Plumbing/Mechanical
- Prior to insu,lation or decking.
D Post and Beam - Prior to floor
Insulation or decking,
D Floor Insulation - Prior to
decking,
\ \ '
D Sanitary Sewer - Prior to fillinlg
trench,
D Storm Sewer - Prior to filling
trench, ,
"
D Water Line - Prior to filling
trench. ,
o Rough Plumbing - 'Prior to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical -:- Prior to
cove~ . ' ,
D Final Plumbing - When all
, plumbing work is complete.
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.
D Final Mechanical - When all
mechanical work is complete,
D Fireplace - Prior to facing
materials and framing Insp,
o Final Building - When all
requi red ,I nspections have been
approved and building is
completed,
D Framing - Prior to cover.
D Other
D Wall/Ceiling Insulation - Prior to
cover, '
D Drywall - Prior to taping,
MOBILE HOME INSPECTIONS
.
D Wood Stove - After Installation.
.
o Insert - After fireplace approval
and installation of unit.
locking and Set.Up - When all
blocking Is complete,
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
P umbing Connections - When
ome has been connected to
water and sewer,
D Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
.--C\..nal - After all required
UJ~spections are approved and
, porches; skirting, decks, and
'..venting have been 'installed,
,
'0 Fence'....;. When completed.
, D Street Trees....,. When all requ'ired~
, trees are planted. " "
Lot faces'
Lot sq, ftg,
Lot Type _
Interior
I P.l.
IN'
Is
Iw
IE
Setbacks
'HSE'GAR'ACCI
I
I
I,
I
Lot coverage
, Topography
Corner
Total height
Panhandle
_ iCul-de-sac '
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BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT, - VALUE
Main'
Garage
) ) - _I 'I
Carport
Total Value
Building Permit Fee
'StatE:l Surcharge
.
, ,
,
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
NO
Sanitary Sewer
FT.
FT,
Water
Storm Sewer
FT,
l~cV
Mobile Home
Plumbing Permit
\ s .W
:JS
_~.1S
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
IDs,Db
ciD,OO
lC) ,t:R
Mobile Home
.
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Su rcharge
Total Miscellaneous Permits (~)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
IS. PROPOS~D WOR~ IN THe" .
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
i
If yes, this application mus't be signed
and approved by the H,istorical
Coordinator prior to permit issuance,
"
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APPROVED:
~
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on t~e express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted 'by ',the City of Springfield, including the
..., ~"I. t
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:
Date Paid:
Recei pt Number' '
Received By:
Plans Reviewed By
Date
I /
Systems Development Charge is due on all undeveloped
..
properties within the City limits which are being improved,
I
ADDITIONAL COMMENTS
"
By signature, I state and agree, that I have carefully examined
the completed applicq.tion 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 pertai ni ng to the work descri bed
,
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
on the site at all times during construction,
Signature~ VVJr ~
1/-1 ~ j!iJ I ;I
-
Date
VALIDATION: ~ ~f) /1n
RECEIPT NUMB~Q "c:y r::::1.' /':1
DATE PAID Lf- I!L-r-q /; __
AMOUNT RECE~ I~ CO
RECEIVED BY \~J....~ _)
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Issued, by.
CL nl5 '
~~3S~\~\ -#S,
LI)Q) Date: qt, JZql
Permit No:
, Address:
, FOROFFICEUSE ONLY
"
',', 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:
/'
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1., ""fo-- I
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2.A.'" "
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I own, reside in, or will reside in the 'Cofllplited structure,
, My ,genera,l contractor is ~ \\ l u T~ -e ~
Contractor registration number f-\ ~'1 .
I will instruct my general contractor th'at all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. , I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board, If I change my mind and 00 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.
f1/1A~hJ VV)/,~
ature of Permil Appliccjnt /
oaJf/ 2/ q I
CO~'STRUCTION CONTRACTORS BOARD
024~ J 1/90 '
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--vI1HITE-COPY TO ISSUING AGENCY PERMIT FILE
~~ -PINK COPY TO APPLICANT
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