HomeMy WebLinkAboutPermit Building 1991-4-16
-REsiOENTIAL
PERMIT APPLICATION
'.
Inspections: 726.3769
Office: 726.3759
LOT:
-
SPRINGFIELD,
BLOCK.
OWNER: '~, \~' \' \ ~ \\(1.)
ADDRESS. 2\ f\ \ . ~C\. f\
CITY; .....s,f\i\<\\\ ~ 0 Q ,,'
- '\. t'l\
DESCRIBE WORK: C ~C\ " Pl_ f\~
NEW )/J REMODEL ADDITI~' .DEMOLlSH
. OF BLDGS:
. OF STORIES:
WATER HEATER.
.
q \ ()~l
JOB NUMBER
225 Fifth Street
SUBDIVISION:
l \? f'C~ N:ONE ,4. \ . ?-'()lli-
STAT~~', CG\Cl~~ ZIP: q141R
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover. .
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~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.
o
Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
CONST.
CONTRA~O(k\C('M~ 'ARDRESS , CONTRACTOR · EXPIRE~I ' q~~:-_
GENERAL {\~~(\}.. rWJlll1t\)\Q.l~l)(f6),,-\(' ~ (~CH '~
QUAD AREA: n \... G LAND US". \ \ \ FLOOD PLAIN.
\ . OF UNITS: --1. ZONING CODE: Lt\~
OCCY GROUP: ~ CONSTR. TYPE: ~ l\) . OF BDRMS.
\
OTHER
HEAT SOURCE:
RANGE:
SECONDARY HEAT:
SQUARE FOOTAGE:
41~
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.
o Temporary Electric
" ~ Site Inspection - _To be made
~ after excavation, but prior to .
setting forms, ~~rt!!JAC"
o U,:"derslab Plumbing/Electrical I
Mechanical - Prior to cover.
o Footing - After trenches are
excavated. .
D Masonry - Steel rocation, bond
beams, grouting.
~ Foundation - After forms. are
~rected but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
o
Underlloor Plumbing! Mechanical
- Prior to insulation or decking.
o Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation - Prior to
decking.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
o Rough Plumbing - Pr.lor to
cover.
o Sidewalk &-Oriveway - After
excavation Is complete, forms
af)d sub-base material In place.
,0 Fence.- When completed.
. D Str,eet.lrees - When ali 'requlre-d
trees are planted. ..
o
Final Plumbing - When all
plumbing work is complete.
D Final Electrical - When all
electrical work is co~prete.
o Final Mechanical - When all
mechanical work is complete.
~ 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
. inspectlons_ are approved and
, porches, 'skirting, decks, and
venting- have been installed.-
/
Lot Type . Setbacks
I PL. , HSE'GAR'ACCI
Interior I'N I
Corner
Panhandle S I
Cul.de-sac W I
IE I
Lot faces
Lot sq, Itg.
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM SQ, FT. '
X $/SQ, FT.
VALUE
Main
q\o~'
\4.\V
\ ?'Ad\B
, J ,
Garage
Carport
Total Value
Building Permit Fee
./0$ ~
~.2.'
~715q.7!
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT,
FT,
FT,
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Flreplace 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, 0, and E Combined)
-/tl!! 71
~. ~
, I.E PROPOSED WORK IN mE ,""'.
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 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 anr provisions of said ordinances.
Plan Check Fee: ' n'"1.<=\3
Date Paid: 4; 5 -C\ \
Receipt Number' _ },01056
Receive y: M~
~~~
Plan Reviewed By
4-/5-1'/
-, 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, 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 ti me, 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.
Sign~0~- ,_
Date j\ 1-f~/1.J -'1,
, 7 '
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VALIDATION: \I,} ~ ()
RECEIPT NUMBEE ~,-,,\l (j'()
DATE PAID 4- . \ \n .G\
AMOUNT RECEIVE~\ M,{ rt..':)
RECEIVED BY ~l~
'-.../
1
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.
.
Permit No: q J ('2-:2{f) l [)
Address: 4;1 14~~ ycr
Issued brf};Lm_l Date:4Jhq /
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 28:
1 \jl r-/),
2.A.\
/
I own, reside in,or will reside in the cOjJlfletyd structo/e. 1\
My genera,l contractor ,~c: rA \ () 11 If' ,_, -rh ~ rf V[SL.;---
Contractor registration number 4-1r1t~
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 00 hire a Qeneral
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.
{'\~'r (' \^"_}~
I~gnarure of Permit Applicant ! V
J-.; -n -'1 I
Date
CONSTRUCTiON CONTRACTORS BOARD
0244J 1/90
-
~m:' COPY TO ISSUING AGENCY PERMIT FILE
~~K COPY TO APPLICANT
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