HomeMy WebLinkAboutPermit Building 2001-1-22
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
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.
JOB NUMBER
Ot-OOO ~6-0J
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK' I f,O=t
ASSESSORS MAP: --1.7- G ~ j:) -=t-..3-::::2
LOl'
OWNER'
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PHONE:
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ZIP: 0.':f.(.4:l.{ ~ D /l-/!1
CITY:
DESCRIBE WORK'
1<> J1 41/ f\.A\ L
,
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERAl'
PLUMBING' 1<..""+-/Y~""'+""A'
MEOHANIOAI '
ELECTRICA' .
cj". ~~ -( f.l.QA I ,-( "" ^.D
.
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_ TAX LOl:
SUBDIVISION'
BLOCK:
STATE: ' ()~
SP~,.HA
_^L~
DEMOLISH
OTHER
ADDRESS
CON ST.
CONTRACTOR .
EXPIRES .,., PHONE
4 /:!l0-/:+d
- OFFICE USE -
QUAD AREA' LAND USE: FLOOD PLAIN'
· OF BLDGS: . OF UNITS' ZONING CODE:_
OCCY GROUP' CONSTR. TYPE: _ · OF BDRMS:
· OF STORIES: HEAT SOURCE: SECONLlARY HEAT:
WATER HEATER' RANGE: _ SQUARE'. FOOTAGE:_
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. Alllnspecllons requested before 7:00 a.m. wI/I be
made the seme working day. Inspecllons requested after 7:00~.m.(wllI be made, the follOWing work day.
. N..TI :t-:.
. REQUIREDr~~~~~~mA~& EXPIRE IFTHEWORK
O Temporary Eleclrlc 0 Rough MechanlcouIRJ2.prlouto')ERTH'SiJ1:f,!tW!'~J~(TIJj!ng - When 01/
cover. AU I M cu" liUJ plumbing warl< Is complete.
COMMENCED OR IS ABANDONED FOR .
D Rough Elec)'{l~rllljUe:~orlt~RIOD. D Final Eloctrlcal - When all
cover. electrical work Is complete.
D SlIe Inspecllon - To be msdo
after excavation. but prior to
setting forms.
O Underslab Plumblng/Eleolrlcall
Mechanical - Prior to cover.
o Fooling - After trenchea are
excavated. .
D Maaonry - Sleel locallon, bond
, beama, groullng.
O P'ound8Uon - After rorma ar.
erected bul prior to concrete
placement.
o Und''lIround Plumbing - Prior
to filling Irench.'
O Undarlloor Plumbing/Mechanical
-, Prior to 'naulallon or decking.
[j' Posl and Beam - Prior to IIoor
Insulallon or decking.
O Floor Insula n - Prior to
, decking.
nllary Sewer - Prior 10 IIl/lng
Irench.
o Slorm Sewer - Prior to trll/ng
Irench.
o Waler Line - Prior to IIl1lng
Irench.
O Rough Plumbing - Prior to
cover. ' .
,I
O Final Mechanlcsl - When all
mechanical work 1!Ii complete.
o Eleclrfcal Servlco - Must be
approved to obtain permanent
Glectrlcal power.
o Final Building - Wh.n aI/
o Fireplace - Prior to facing -: ;.; ,:.lrequlred Inspections have been
materials snd Iramlng Insp. ','r '\~o~n U\~p'~roved snd building la
" ' ',O,n;" completed.
. "...' JIA!' -I," ,:;at re,.'
O Framing - Prior to,cover. 0"1 Oti ....A20"".OO.,-
,"".1 III I" 'I III IIU J IV r1-0ther
,,"', ,hl;"r 'nl")i~r- ')j tt,~leb u>
o Wail/Ceiling Insul~110n -:;J,~rlor.l!o tale phone
cover. , ", ':;il' ,\Iolificatiof'l
"
o Drywell - Prior to taping.
o Wood Stovc - After I,;stal/otlon.
MOBILE HOME INSPECTIONS
o Inserl - After IIreplace approval
and Inatallatlon of unll.
o Blocking and Set,Up - Wh.n all
blocking Is complete.
o Curbcul & Ar1proach - After
forms are erectod but prior to
placemont of concrete.
o Plumbing Connections - When
home has been connected to
water and sewer:-
o Sidewalk & Driveway - After
excavation Is comp;oto, forms
and'sub.base material In placo.
o Electrical Connecllon - When
blocking, set-up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
o Fence, - When completed.
OSlraet Trees - When aI/ required
trGes ara plan lad.
o Final - After all required
. Inspections are approved and
porch os, skirting, decks, and
venllng hava bean Instal/ed.
J
"
LOI faces
~t ~pe.
Interior
LOI sq. ftg.
Lot cove raga
Topography
Total height
Corner
I'anhandle ):'
Cul.de'sac
I: l'
BUILDING PERJtI!IT ~'".li; '.
ITEM sa. FT. x s/sa. FT, .
Main
Garage
Carport
Tolal Value
Building Permil Fee
Slate Surcharge
TOlal Fee
(A)
,,, '"
~, I'- .:".1
~ I,. ,\ '
:(tt THE PROPOSED~ORK IN THE. '
....HISTOF,i,CAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
S, and approved by the Historical
+ . Coordinator prior to permit Issuance.
~ -1-- -I '.' L.. APPR~VE"" '
BUILDIN'G ~t{1E, ~LAN CHECK
AND BUILDING PERMIT
"
,I'P.L.
1L- _..., ___
VALUE
"
This permit Is grsnted on the express condition that lhe 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
oulldlnga, and may be auapended or revoked al any time
upon violation of any provlalons of aald ordlnancea.
Plan Check Fee'
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
!it
Sanitary S~wer
Water
FT.
FT.
n
Slorm Sewer
Mobile Home
Plumbing Permit
Slate Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnaco
Exhaust I~ood
Ven t Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
'Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
Slate Issuance
Stale Surcharge
Sidewalk ft
Curbcut
fl
Demolition
State Surcharge
Total Miscellaneous Permits (E)
\
TOTAL AMOUNT DUE (excluding electrical)
IA. B, C. 0, snd E Combined)
Systems Development Charge Is due on all undevaloped
properties within the City limits which are being Improved.
ADDITIONAL COMMENTS
FEE
By signature, I state and agree, lhat I have carefully examined
Ihe completed application and do hereby certify ttiat all
Information hereon is true and correct, and I further certify
that any and all work performed shall be done In accordance
with the Ordlnancus of the City of Springfield, and the Laws
of the Stale of Oregon pertaining to tho work described
horeln, and that NO OCCUPANCY will be mad a of any
structure without permission of the Building Safely Division.
I further certify thaI only contractors and employees who
sre In compllanco 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, ~hat each address Is readable
from the atreet, that the pormlt card Is located at the front
of the pr rty, and the approved set 0 ns will remain
,
on the sl e at II times durf const c n.
Signature
Date. ~ Z. z. - C) /
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VAIJDATION:/
REC~n:uMBER L-l d... '8 (;
D~PAII'. (-d'&--O{ \
A OUNT RECEIVED (I ?-'7:f- .50 . _____)
REC VED BY .,;{, UJ,j) ,_-
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