HomeMy WebLinkAboutPermit Plumbing 1995-10-19
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
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ASSESSORS MAP:
LOT'
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BLOCK:
OWNER:
ADDRESS'
CITY:
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DESCRIBE WORK'
NEW --- REMODEL
CONTRACTOR'S NAME
GENERAl'
PLUMBING:
/O/VJ(Jlbe
MECHANICAl'
ELECTRICAL'
QUAD AREA"
. OF BLOGS'
OCCY GROUP:
. OF STORIES'
WATER HEATER:
STATE:
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15//~ S
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT:
SUBDIVISION:
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ADDITION
DEMOLISH
OTHER
PHON'"
747- ~72..?
ZIP: ~7~?_7
ADDRESS
CONST,
CONTRACTOR'
PHONE
- OFFICE USE -
LAND USE:
· OF UNITS:
CONSTR. TYPE'
HEAT SOURCE:
RANGF'
EXPIRES
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 w.orklng day, Inspections r~,Quested after 7:00 a.m. will be made the (ollowlng work day.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D
Underslab Plumbing/ Electrlcel!
Mechanical - Prior to cover.
D Footing - Atter trenches are
excavated.
D Masonry - Sleel location, bond
.beams. grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D
Underground Plumbing - Prior
10 filling trench,
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulatton - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench. .
D Water Line - Prior to filling
trench.
"K7Rough Plumbing - Prior to
~ cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping,
D Wood Stovo - After Installation.
D Insert - After fireplace approvlll
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
and sub.base material in place.
D Fence - When completed.
D Street Trees - When all required
trees are planted.
K7r' Final Plumbing - When all
~Plumblng worl< Is complete.
D Final Electrical - When all
electrical work is complete.
D Final Mechanical - When all
mechanIcal work 15 complete.
D Final Building - When all
required Inspections have been
approved and building is
completed.
DOthor
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - When all
blocking Is complete.
D
Plumbing Connections - When
home has been connected to
waler and sewer.
'.
D Electrical Connection - When
blocking, set.up, and plumbing
inspections have been approved
and the home Is connected to
the servIce panel.
D Final - After.all required
inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot faces
LOI Type.
Interior
Lot sq, ftg,
Lot coverage
Corner
Topography
Total height
Panhandle
Cui-dc-sac
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. THE PROPOSED WORK iN :rHE .
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Se t bac ks
I P,L. HSE GAR ACC
IN
Is
Iw
IE
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT, = VALUE
Main
Garage
Carport
Total Value
Building Permit Fee
Stale Surcharge
TOlal Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT,
,,<
Storm Sewer FT.
Mobile Home
Plumbing Permit
Stale Suroharge /. $'0 + . f 0
Total Charge (C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
'.
FEE
30 .trl?
'2..,~~
~
2"L-o
'<' 2... ~tO
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) .::?" ~O
(A, B, C, D, and E Combined) ,,~ ,
APPROVED:
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
ado pled 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
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved,
ADDITIONAL COMMENTS
By signature, I state and agree, thaI 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 Ordinancos 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
structur~e without permission of the Building Safety Division.
I further certHy 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
<:>n the site ,at .'~I times during construction.
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VALIDATION:
RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVEr>
RECEIVED BY
/07, -.;<;>.
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SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME:\ f'ffin~OO1\\~~
ADDRESS: \t)~~ ~\Jw 0
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Job. No.
q~\\~6
PHONE: rv\F) .lo'71.Cf
STATE: B1Z-ZIP:~
LOCATION OF PROPOSED ~UlrDING SITE:
Street Address: ~ \ ~l\^\JiOIl) l !\r-~ U€....
Plat Name: '\\\/\) Tax Lot Numb~r: \Y\()3~~3\ OlQD 1 ,
1. DEVELOPMENT TYPE; (Check appropriate dwelling(s), SDC calculations and dwelling t
ype definitions are on the back,)
A. Sinale-Familv Detacheti
Single Family home
. NO. OF UNITS \
\ Manufactured home. not in a par~
X $1,000 per unit = $ \ oDD ,
B. Sinnle-F::lrnilv Attached
NO. OF UNITS
X $924 per unit = $
C. Multi-Familv Aoartment
NO. OF UNITS
X $692 per unit = $
D. ,Mpnufactured Home Park
NO. OF UNITS
X $699 per unit =
$
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WILLAMALANE SDC $
./
2. SDC _CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credit approval. See sac Credit Worksheet. $
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
~'~~r~'i2rtmem
City of Springfield
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$,
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Date