HomeMy WebLinkAboutPermit Plumbing 1991-5-6
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RESIDENTIAL
PERMIT APPLICATION
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SPRINGFIELD
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK: ~8 \ \ 0 ,
ASSESSORS MAP' \1 () ~~\O \ ,.
0WNER:~9~\~(\. ,\\"'''\\''\\y.-
ADDRESS: A~ \ \.9. \::\ Q. D \. (') . \ \\ \~ n 'f> ,f" ~
CITY: ~ \:f- ~ STATE: l ~
DESCRI BE WORK\ ^ ~ ~\ () f{\ Q. . \ 0\ \: ~ ~ \. J.. t\(L)
REMODEL \ ADDITION '
LOT:
NEW
CONTRACTOR'S NAME
BLOCK:
DEMOLISH
OTHER
1-
S\~~
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
l \)5\"U-R.
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TAX LOT:
SUBDIVISION'
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PHONE:
,A\{)-<\~l Q~ ()
ZIP:
q141r
ADDRESS
CON ST.
CONTRACTOR #
PHONE
EXPIRES
GENERAl' .J,_ . ",^"
PLUMBING: ('f\~~Q\J~IS\~0\\:) ~~\m2,~~-n.ruJ;1lVl<A J().~ 141-\CP[)
MECHANICAl' ~~~ \ Q/?lfa.l
ELECTRICAl'
QUAD AREA: c9 ~~ lh)
# OF BLDGS:
~~
OCCY GROUP'
# OF STORIES:
WATER HEATER'
- OFFICE USE -
LAND USE:-U-LI
# OF UNITS:
CONSTR. TYPE:
HEAT ~OURCE:
RANGF'
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.
D Temporary Electric
o
Site Inspection - To be made
after excavation, but prior to
settlng forms.
o
Underslab Plumbing! Electrical I
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
Underfloor Plumbing/Mechanical
- 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.
\~ Water Line - Prior to filling
~ trench.
G Rough Plumbing - P~ior to
cover.
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover. ,
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials al)d framing Insp.
o Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover,
o Drywall - Prior to taping.
o Wood Stove - After Installation.
o Insert - After fireplace approval
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete,
o Sidewalk & Driveway - After
excavation is complete, forms
~nd sub-base material in place.
o Fence - When completed.
o Street Trees - When all required
trees are planted.
o
Final Plumbing - When all
plumbing work is complete.
D Final Electrical - When all
electrical work is complete.
o
Final Mechanical - When all
mechanical work is complete.
o
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.
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the servIce panel.
o
Final - After all required
In.spectlons are approved and
porches, skirting, decks, and
venting have been Installed.
l
Lot Type I , ~
l
Lot faces Setbacks IS THE PROPOSED WORK IN THE
I PL. , , , I HISTORICAL DISTRICT, OR ON
Lot sq. fig. Interior HSE GAR ACC
I THE HISTORICAL REGISTER?
Lot coverage Corner N If yes, this application must be signed
S I and approved by the Historical
Topography Panhandle Iw I Coordinator prior to permit issuance.
Total height Cul.de.sac IE I
APPROVED:
BUILDING PERMIT
ITEM sa. FT. x $/Sa, FT.
Main
Garage
Carport
Total Val us
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT.
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Fu mace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnserl/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fI
Cu rbcut
fI
Demolition
State Surcharge
Total Miscellaneous Permits (E)
/
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
VALUE
BUILDING VALUE, 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 revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee:
Date Paid:
Receipt Number:
Received By:
Plans Reviewed By
Date
ADDITIONAL COMMENTS
FEE
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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 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
on the site at all times during construction.
Slgnaturd ~~~A) (1.1~
Date_,f :rh/9/
VALIDATION:
RECEIPT NUMBER
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DATE PAIr>
\~. fJ5
AMOUNT RECEIVEr>
RECEIVED BY
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Permit No: q \()4-~~
Address: ~?) \lo \:1ilii\oJ
Issued by: Him ~ Date: bj..kicrJ
FOR OFFICE USE 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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I own, reside in, or will reside in the completed struF,i\Jre.
My ~~contractor is c'\n N\S::DO~~ ~ V~ ,
Contractor registration number LD I); () \ R ,
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board,
OR
B. L-.J 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 (to 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 Responsibilitiell on the
reverse side of this form.
ni .JL7-R) (V / ,tA~
siqnature of Permit Ap'Bc'ant
,,5--&- 9/
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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