HomeMy WebLinkAboutPermit Plumbing 1993-10-28 (2)
RESidENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK: 77?
ASSESSORS MAP' ! "7 CJ ~ '2- "2-
pt?ltJ(j l,u;;r ~n pCW -
LOT' BLOCK'
TAX LOT:
3 to/..J'.
SUBDIVISION'
.
SPRINGFIELD
OWNER:
ADDRESS:
CITY:
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JOB NUMBER
130P/fbL
225 Fifth Streel
Springfield. Oregon 97477
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2.9cn'3 f
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PHONE:
:?4. '( - .)~92-
ZIP'
CJ'74rJ /
DESCRIBE WORK:
-Aj;b/,()~ ';)!1tkJ/# 77) ~6 /../.&}Ah? a!l':.V1'J17T
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
MECHANICA' .
ELECTRICAl'
~~J~
DEMOliSH
OTHER
ADDRESS
CON ST.
CONTRACTOR"
PHONE
REQUIRED INSPECTIONS
o Rough Mechanical - Prior 10
cover.
D Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o
Fireplace - Prior to facing
materials and framing Insp.
EXPIRES
- OFFICE USE -
QUAD AREA: LAND USf' FLOOD PLAIN'
. OF BLDGS: . OF UNITS: ZONING CODE:_
OCCY GROUP' CONSTR. TYPE: . OF BDRMS:
. OF STORI ES' HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: SQUARE FOOTAGE:
To request an inspection, you must carl 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 Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumbing I Electricall
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.
o Water Line - Prior to filling
trench.
F':7( Rough Plumbing - Prior to
~ cover.
o
Framing - Prior to cover.
o Wall/Ceiling Insulation - Prior to
cover.
I
\0 Drywall - Prior to taping.
D Wood Stove - After installation.
o Insert - After fireplace approval
and installation of unit.
o
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place.
o Fence - When completed.
D Street Trees - When all required
trees are planted. .
'fX?f Final Plumbing - When all
~lumbing work Is complet.e.
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
Inspections are approved and
porches, skirting, decks, and
venting have been installed.
.
Lot faces
Lot Type
Lot sq. ilg.
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cui-dc-sac
BUILDING PERMIT
ITEM SQ. FT. X $/SQ. FT.
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
Setbacks
. HSE . GAR I ACC I
I
I
[.
J
I P.L.
IN
Is
~
~.
VALUE
) .
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
I
Resldentiai Bath(s)
..I'
N'
SanltarY'~ewer
Water
FT.
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit.
State Surcharge
,
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertlFireplace 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
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B. C, D, and E Combined)
FEE
-/(1.00
//).00
So
LO.6"O
/ IJ."'- 0
_HE PROPOSED WORK IN TN-!<'
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
""-.
APPROVED:
,
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition Olat the said
construction shaH, 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
Systems Development Charge Is due 'on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
By signature, 1 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 t11at NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify tll~t only contractors and employees who
are In compliance with QRS 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.
;<;ignaturn
Datn
I r SAc. 7
/ /J ?~"7 S~// /')7(12
/ () - /~ 9. -';":] '/ ti.
AMOUNT RECEIVED //"J 82 / ~~?? (
-- ~-
RECEIVED BY ~
VALIDATION:
RECEIPT NUMBER
DATE PAID
'-'~~
./ -
.
.
JOB NO.
ATTACHMENT Bl
CITY OF SPRINGFIELD S~STEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: JAvnP< :K -!,A RUE
LOCATION: '7 '72 AI, r:..L:rvi;..-e...l ~ l:o,
DEVELOPMENT TYPE:
BUILDING SIZE:
1. STORM DRAINAGE
IMPERVIOUS SQ. FT.
LOT SIZE
SQ. F t.
X $0.203 PER SQ. FT. S
2. SANITARY SEWER-CITY A)j) S/7'&Wb<.. . yD (S~~
NO. OF PFU'S '2-- X $42.08 PER PFU ~ c?:,4/~
(See Reverse)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X $424.31
X $424.31
X $424.31
5
X
X
4. SANITARY SEWER-MWMC
NO. OF PFU'S x $15.125 PER PFU + $10 MWMC ADM FEE 5
(Use PFU Total From Item 2 Above)
5
5
. .J."'
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
s
:~ .
T(lTAL-MWMC SDC $
. - . . ~:. : ; '.;, :,
SUBTOTAL (ADD ITEMS 1,2,3 & 4) S
._~ -- ..... . - _.'
....,' ; './ l . I., ':;'"J i....~
._ __.:5._. ADMINISTRATIVE FEES -- ,.' .' - .- - - -
BASE CHARGE (SUBTOTACABOVE) X .05
~~L~~ ./I!t/f~
. ~ Kip Burdick . .'
SDC Coordinator
. $
4...1-1
TOTAL SDC S
~9l,~'7
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