HomeMy WebLinkAboutPermit Building 1991-6-7
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
.
LOCATION OF PROPOrED WORK' .trSf)'AO,
ASSESSORS MAP' \~Ob(ffi \4-
, I \,,' -" BL~CK: 'I
OWNER' .....Jf)'f\ D ~ \{ \~ \- 'f\ , \ \ l~
ADDRE~' RA~ \J....~\Lf\u, t
CITY: ,~\,f\('\n(')'Q. l \tT-~)..", STATE:
DESC\1JWOR~ \.~\ 0 . ~ ''0\ ~
NEW REMODEL ADDITION DEMOLISH
LOT:
.-
q\O~lrD
JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
PHON~'
l\JJ\ o~~ ZIP: q'-rV1a-
C\(\, \\() l\ 9..- ~
OTHER a ~
I
6P1C\Q.. (~~-17/OL.
,C).l .c ~ 1~6X_
---
CONTRACT~~E ~ .. ADDRESS '
GENERAL: } 11:1 Qrt ~ \l'~
PLUMBING: "1f'CrtQ.r\. (\\llli~
CONST.
crTr;tAl
I 010/\ '\ "1
MECHANICAL:
ELECTRICA' .~\ 0_ 0 10 n~
QUAD AREA:A Rsc J
I
OCCY GROUP: ~~ --\- lJ\
\
p~
. OF BLDGS'
. OF STORIES:
WATER HEATER:
lD'3\'~Tl \??fl.'i\ ~L\4-,\~S)
- OFFICE USE -
\ \ 5()
,
LAND USE:
. OF UNITS:
CONSTR, TYPE:
HEAT SOURCE: F G
E-
RANGF'
FLOOD PLAIN'
ZONING CODE: il '\?-
. OF BORMS: ...:'::)
SECONDARY HEAT:
SQUARE FOOTAGE:
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
o Site Inspection - To be made
after ,excavation, but prior to
setting forms.
O Underslab Plumbing/ Electrical/
Mechanical - Prior to cover.
~FOOting - After trenches are
~ excavated. . .
D Masonry -:- Steel location, bond
,. beams, grouting.
o Foundation - Afte-r forms are
erected but prior to. concrete
placement.
D Underground Plumbing - Prior
to filling trench.
o
Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
o
Post and Beam - PrIor to floor
insulation or decking.
o
Floor Insulation - Prior to
decki ng.
IC11)Sanitary Sewer - Prior to filling
L....:::f trench.
dstorm Sewer - Prior to filling
t....::p trench.
If7'Y Water Line - Prior to fi'lling'
Ljt:J trench. .
o
Rough Plumbing - Prior _to
cover. ..,
.... ....... .
REQUIRED INSPECTIONS
o Rough Mechanical - Prior to
cover.
rrB Rough Electrical...,... Prior. to,
'-P cover qCU\ () '\ Q.....,
o Electrical Service - Must be
approved to obtain permanent
electrical power.
o Fireplace - Prior to facing
materials and framing Insp.
~FramqCiA~
o Wall/Ceiling Insulatio~ - Prior to
cover.
o Drywall - Prior to taping.
o Wc:>od Stove - After' installation.
o Insert - After fireplace approval
and installation of unit. '
~urbcut & Approa~h - After t
~ forms are erecteq but prior to
placement of concrete. "
rt:zr::2idewalk & Driveway - After
~ excavation is complete, forms
and sub.base material in place,
-D Fence - When completed.
D Stre~_t Trees -: whi!n all'required.
trees are planted. __
o
Final Plumbing - When all
plumbing work is complete,
rr7} Final Electrical - When all . .
~ electrical qAA~
D Final Mechanical - When all
mechanical ~ork is complete.
r17'J) Final Building - When all
Lp required inspections have been
approved and building is
completed. 9ClA~
o Other
MOBILE HOME INSPECTIONS
~IOCking and Set.Up - When all
"1 blocking is complete.
~IUmbing Connection~ - When
home has been connected to
. water and sewer.
~Iectrical Connection - When
blocking, set.up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
,}'
~inal - After all required .
.; ,'_ i~spections are approved and
porches, skIrting, decks, and
v~nting have been installed,
Lot faces
Lot Type .
~ Interior
Lot sq, Itg.
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
Setb"cks
I P.L.'I HSE GAR I ACC I
I N I
I S I
lw
IE
BUILDING PERMIT
ITEM SQ. FT. X $/SQ, FT - VALUE
Main~ 4-0 \lnn
Garage ~~PA V\.\t 1 ~l~ \4
3?A \D.\() ~
[E2tO
w--
Total Value
Building Permit Fee
C\OI";)~~)
State Surcharge
Total Fee
(A)
Wl DQ1..
R.o.~
4.33
qo.~
SYSTEMS DEVE~OPMENT CHARGE (SDCLC'J
. .', (B) '\ I ()n.~-S?5
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT,
FT.
Water
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StoveJlnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk t-t 5 It
Curbcut ~ ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
~~oo
AS.OU
8~.cO
r:-r 0-)
. ,::S.
-',,~. f)5
'J~.~~
Jl}(\)
ERa3
_.f~. 05
5.~
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.THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER
signed
and approved by t istorical
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 any provisions of said ordinances.
Plan Check Fee'
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL C.OMMENTSA.........\ ~
1....'),,). ~~,\r1..o..... \. )..(ill\', t):1
.. -
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 arid 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 property, and the approved set of plans will remain
on the site at all times during construction.
SignatureUL4 e,1kAAA~
Date G - 7 - "1 /
VALIDATION:
RECEIPT NUMBER 7&3$0
DATE PAIr> L -7-q ~
AMOUNT RECEIVEr> ~L 1"37??2
RECEIVED BY ~~. ..,.--:?~ L"-?