HomeMy WebLinkAboutPermit Mechanical 1995-5-2
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
JOB NUMBER
225 Fifth Streel
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK' 4:0 '-{ 'f
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ASSESSORS MAP:
TAX LOT'
LOT'
BLOCK:
SUBDIVISION'
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OWNER'
ADORES:'"
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CITY'
STATE: '
ZIP:
DESCRIBE WORK: .J.. l'\.S +< \ ~
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NEW
REMODEL
ADDITION
DEMOLISH
OTHER
CONST,
CONTRACTOR'
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
.....MECHANICAI ~ fV\." (~ 1M \ \.J
ADDRESS
EXPIRES
PHONE
7 '-{ 7-7V'(S,
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ELECTRICAL:
- OFFICE USE -
QUAD AREA' LAND USF' FLOOD PLAIN'
· OF BLDGS' · OF UNITS' ZONING CODE:_
OCCY GROUP: CONSTR. TYPE' . OF BDRMS:
· OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE' SQUARE FOOTAGE:
To requ'Jst an Inspection, YOiJ must call. 72C.37GS,-Thl5"i5 a24 hour recording. All Inspections requested before 7:00 a.m. will be
made the same working day. Inspecllons requested after 7:00 a,m, will be made lhe lollowlng work day,
REQUIRED INSPECTIONS
~R~ugh Mechanical -.: Prior to
~over.
D Temporary Electric
D Final Plumbing - When all
plumbing work Is complete,
D Site Inspection - To be made
after excavation, but prior to
setting 'orms.
o Rough Electrical - Prior to
cover.
f"':5<( Final Electrical - VVohen all
~ectrlcal work Is complete. C
D Underalab Plumbing/Electrical/
Mechanical - Prior to cover.
~Flnal MechanIcal - When all
~eChanlcal work Is complete.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fooling - After trenches are
excavated. :
D Final BuildIng - When all
requIred Inspections have been
approved and building Is
completed.
D Fireplace - PrIor to faCing
materials and framing Insp.
D Masonry - Steel location, bond
.beams, grouting.
D Framing - Prior to cover,
i
D Wail/Ceiling InsJlatlon - Prior to
cover.
~Other ~~ La),:"
D Foundallon - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench,
D Drywall - Prior to taping,
MOBILE HOME INSPECTIONS
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking,
D Wood Stove - After I~stallatlon,
D Blocking and Set.Up - Whe/l all
blocking Is complete,
D Post and Beam - Prior to IIoor
Insulation or decking,
D Insert - After lire place approval
and Installation 01 unit.
D Floor Insulation - Prior to
decking.
D Plumbing Connections - When
home has been connected to '
water and sewer.
D Curbcut & Approach - After
forms Bre erected but prior to
placement of concrete.
D Sanitary Sewer - Prior to filling
trench.
D Electrical Connection - When
. blocking. set-up, and plu'1lblng
Inspections have been approved
and the home Is connected to
the servIce panel.
D Sidewalk & Driveway - After
excavation Is completo, forms
and sub-base material In place.
o Storm Sewer - Prior to filling
trench.
D Waler Line - Prior to filling
trench.
D Fence - When completed.
o Ffnal - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
D Rough Plumbing - Prior to
cover.
D Street Troes - When all required
trees arc planted. .
Lot faces
Lot Type.
Interior
LOI sq. flg.
Lot coverage
Corner
Topography
Total ~elght
Panhandle
Cul.de.sac
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BUILDING PERMIT
ITEM sa. FT. x $/SO. FT. = VALUE
t\1aln
Ga,age
Carport
Tolal Value
Building Permi t Fee
State Surcharge
Total 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
Slale Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
,t;..<; / A.l'>l
Mechanical PermIt
,P1 /It) ,
Issuahce
State :surcharge, 7 r r- ,~.j
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 eleclrlcal)
(A, B, C. D, and E Combined)
FEE
c.. 6-0
2....0
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. THEPROPOSED WORK.tN THE - .
HISTOI;IICAL DISTRICT, OR ON
"THE HISTORICAL REGISTER?
" yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.'
Setbacks
HSE GAR ACC
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APPROVEC"
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
adopled by the City .of Springfield, Including the
Development Code, regulating the construction and use 01
buildings, and may be suspended or revoked at any time
upon violation 01 any provisions of said ordinances,
Plan Check Fee'
Date Paid:
Receipt Numbp"
Received By:
Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properlles within lho City limits which are being Improved.
ADDlT)ONAL COMMENTS
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By signature, I stale and agree, that I have carefully examined
the completed application and do hereby certHy 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 thaI NO OCCUPANCY will be made of any
slruclure 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
requ~sted at the proper time, ~hat each address Is readable
from the street, thaI the permit card Is located at the front
of the properly, and the approved set of plans will remain
on the site at all times during construction.
Signature ~ t;l.~ 1\\ ~
Date 5 -( - '4s
VALIDATION:
on~ 00
DATE PAIC' ttf/91/ C("
AMOUNT RECEIVE[k.,.'/ /(jl.p, (IV
RECEIVED BY r tflV'fnJJ
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RECEIPT NUMBER
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