HomeMy WebLinkAboutPermit Building 1991-8-26
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RESIDENTIAL
PERMIT APPLICATION
Inspections:,726.3769
Office: 726.3759
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SPRINGFIELD
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OWNER:
ADDRESS: 15" '?()
CITY: SP/=LD.
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DESCRIBE WORK:
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NEW
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ADDITION
REMODEL
CONTRACTO~ NAME
GENERA" \\!,I.. t.,"~\.~
PLUMBING: {\)..1 Jt\ (tV
MECHANICAJ'C)..Q)f\Q \f'")
ELECTRICAl K"'~ f'\f1 0 J2 /
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QUAD AREA:
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. OF BLDGS"
oqCY GROUP:
. OF STORIES'
WATER HEATER:
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C{ \,C67~h) ,
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
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SUBDIVISION"
PHONE:i(j6 - <(/6''1
STATE: f)l?E.
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REQUIRED INSPECTIONS
@ROU9h Mecha':lical - Prior to
cove~ "
NROU9h Electr!cal - Prior to
. cover.
~Iectrical Service - Must be
\ approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
~Framing - Prior to cover.
~Wall/ceiling Insulation - Prior to
cover.
~DryWall - Prior to taping,
o Wood Stove - After Inst~"atlon:
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 s.ub.base material In place.
D 'Fence .;.:., Whe~ completed.
@,l&J S reel'T~ees ~ When all required'
ees are planted.
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ZIP"
971(1'['[/
DEMOLISH
OTHER
CONST,
ADDRESS CONTRACTOR'
EXPIRES
PHONE
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FLOOD PLAIN"
ZONING CODE:
. OF BDRMS:
~~
- OFFICE USE -
LAND USE: \ \. \ \
". OF UNiTS: \
CON";TR, TYPE: V f\J
HEAT SOURCE:f'lJ,\~
RANGE: -i:. ./ -' -
SECONDARY HEAT"
SQUARE FOOTAGE: aI\~..,
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.
~TempOrary Electric
D Site Inspection ~ To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
I~ I""ooting - After trenches are
~ excavated.
o Masonry - Steel location, bond
beams, grouting.
\
~Foundation - After forms are
J2SJ.. ~rected but prior to concrete
placement.
~ Underground Plumbing - Prior
J6J to filling trench.
~U nderfloo~'P I u mblnqn." echanlcal
.~ - Prior to Insulation or decking.
~Post and Beam - Prior "to floor
~insulation or decking.
~Ioor Insulation - Prior to
decking.
,~ Sanitary Sewer - Prior to filling
~ trench.
~iorm Sewer - Prior to filling
trench.
~ater Line - Prior to filling
~ trench.
f":;?( Rough Plumbing -:-. Prior to
~cover.
~nal Plumbing - When all
plumbing work is complete.
. - ~inal Electrical - When all
electrical work is complete"
~al Mechanical - When all
~ ~~chanical work Is complete.
~I Building - When all
~~~~~ired inspections have been
approved and building is
completed.
DOlher
L
MOBILE HOME INSPECTIONS
D 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.
D Final - After all required .
. inspections are approved and
. ~,~ "porches,"skirting, decks, and
venting .have been installed,
Lot faces .J Lot Type .
J'I~f &0 ./
Lot sq. ftg. _ Interior
Lot coverage .006 Corner
Topography -( Panhandle
Total height '2L2 Cul-de-sac
ITEM
Main
Garage
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
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. _THE PROPOSED WORK IN THE
""l"I'iSTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
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Setbacks
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I cH Jf.BS
1~3.cv
17,15
.36 0 J!i
SYSTEMS DEVELOPMENT CHARG~;i4C)
(B)
BUILDING PERMIT
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440BJQ
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N' ;;(
Sanitary Sewer FT.
Water FT.
Storm Sewer FT,
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
v
Wood Stovellnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Surcharge
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FEE
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~.OO
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4,1; ()
9.&0
3.fJO
I 6 ,t;? c)
10, (f}O
1.1'?
~7&3
/10;;0
Total Miscellaneous Permits (E) .
TOTAL AMOUNT DUE (excluding electriCal)rJ;...:;;;: ..;. , 'f:j;,-
(A. B, C, D, and E Combined) ~<5.9'~
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APPROVED:
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, in all re.spects, 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 an1\prc\Vir<\nS%Bi ordinances.
Plan Check Fee: rl~rt-
Date Paid: fl-!:). J=) .
Receipt NumbeN VJB'8fJ7
Received By: )
J/~~
Plans Reviewed By
53..6./51
7 'i~te
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
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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 pro?perty. and the approved set of plans will remain
on the sit at all times dU'N const~ctton.
Slgnaturf' l.~~. V~
Dat~ ~-~c..-<; \
VALIDATION:
RECEIPT NUMBER -:2 / /.c>~
.:if? - -::;>&" -?;/'
DATE PAIl"
AMOUNT RECEIVED ~C"<. ~~
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RECEIVED BY
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Permit No: <;1 /LJ?S 7_:;:;-
Address: t.-//;/,c /~2/.g:-R
Issued bY'~"""'-""" -P' - Date: ,R--?t:::.-'7/
t,/ .
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:
1. ~ I own, reside in, or,will reside in the completed structure.
2. A. L....J My general contractor is,
Contractor registration number
\
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 Clo 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.
,
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Signature o'f Permit Applicant
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Dale
CONSTRUCTION CONTRACTORS BOARD
0244J 10/24/89
WHITE COPY TO ISSUING AGENCY PERMIT'FILE
PINK COPY TO APPLICANT
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