HomeMy WebLinkAboutPermit Building 1993-2-16
RESIDENTIAL
PERMIT APPLICATION
.
Inspections: 726-3769
Office: 726,3759
LOCATION OF PROPOSED WORK'
ASSESSORS MAP:
LOT:
SPRINGFIELD
.
J<::4/iH/ A
,,0':::::: 2-d
JOB NUMBER 92 / ~ '7&:'
225 Fifth Street
Springfield, Oregon 97477
BLOCK:
TAX LOT:
SUBDIVISION:
t":)4Jt5 ~
OWNER: ---.4! J/j ,,_ J
ADDRESS:' /4s"/
CITY' ~MI''''''
_~ ,T ,!'
~ jjf/ L-LM'
S .')' T
DESCRIBE WORK: -/!!?J//</.i1it) 7D
NEW
\
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERA' '
PLUMBING'
MECHANICAL:
~\/I/~ ll"'Y
f'Jt1)A Jbe
ELECTRICA' .
QUAD AREA:
:< XJ 'S (I.-
J
~~ i M_
2-
uA:(
. OF BLDGS'
OCCY GROUP:
. OF STORIES'
WATER HEATER:
PHONE:
7#- -19 (;J(L
ZIP: 9"7~'71'
S. r ~~ - 'LL'A/Jb/' ~C,7YLtC/-7.o...]
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
covc~ .
o 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.
~ Framing - Prior to cover.
~WallJCciling Insulation - Prior to
~cover.
~ 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.
STATE:
/'JY
EXPIRES
PHONE
DEMOLISH
OTHER
~
o Sidewalk & Driveway - After
excavation is complete, forms
and sub.base material in place.
o Fence - When completed.
, ,
o Street Trees - Whe~ ail required
trees ;)rc planted.
FLOOD PLAIN'
ZONING CODE: ~~
4-
. OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE: -::2-'72.0..-
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.
ADDRESS
CONST.
. CONTRACTOR'
o Temporary Electric
D
Site Inspection - To be made
after excavatlon, but prior to
selting forms.
o
Underslab Plumbingl Electricall
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o
Masonry - Steel location, bond
beams, groutlng.
o
Foundation - After forms are
erected 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.
o Sanitary Sewer - Prior to filling
trench.
o Storm Sewer - Prior to filling
trench.
o Waler Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
- OFFICE USE -
JI if
I
CONSTR. TYPE: V &
HEAT SOURCE: ~P,A~
.e7 /!l" ~r
LAND USE:
. OF UNITS'
RANGE:
o
Final Plumbing - When all
plumbing work is complet.e.
D
Final Electrical - When all
electrical work is complete.
o Final Mechanical - When all
mechanical work is complete.
'I':/f' Final Building - When all
~equired Inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Sel-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, skirtlng, decks, and
venting have been installed.
Lot faces .
lot Type
lot sq. ltg,
Interior
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de.sac
BUILDING PERMIT
ITEM SQ, FT, X $/SQ, FT,
Main
Garage
"
Carport
.
~ laE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
I PL.
Setb"lcks
I I I
HSE GAR ACC
N
S
Iw
IE
~
VALUE
MP.
.:2,.<)
;
"
, ,r.Jro?,O ,,{101
~25"0
/ c.. !>
31-. I;},
SYSTEMS DEVELOPMENT CHARGE (SDC)
~1Yi.?-e>
Total Value
Building Permit Fee
State Surcharge
Total. Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
-, .'
~
Sanitary Sewer FT.
Water
FT,
Storm Sewer
FT.
Moblie Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stovellnsert/Fireplace 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
-LlU.u A7,iWt5. J
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A. B, C, D. and E Combined)
FEE
.c;Df"D
'~
zS""c:::>
5'2- .5"0
,
.'
APPROVEf"
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shal.l, in all'respects, conform to the Ordinance
adopled by the Cily o( Springfield.' including the
Development Code, regulating the construction and use of
buildings, and may be suspended or -re~oked at any time
u pan violation of any provisions of said ordinances.
Plan.CheCk Fe~: ~ ~..J..L
\ '
Date Paid:
Aecei pt Number.
Recei~
4.. ~~~'
Plans\Aeviewed By ..', .
2-//- J's
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I stale 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 o~ 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 GAS 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
(rom 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 7U~ing construction, ~
Xignatu.~ -" . .G{/.~/~
I~' , -
Date /~;Z-.R,.4 F3
2//3
7/tp.o4
VALIDATION:
RECEIPT NUMBER
75,( L
2-/('..,-5'3
~
DATE PAIr>
AMOUNT RECEiVED
RECEIVED BY