HomeMy WebLinkAboutPermit Building 1993-2-2
OWNER:___DctC<il~ nCA 'ItL\ $:
ADDRESS: ~_.-=.L() O~_k_U~- _ \5Jj./{L___ -
CITY: ~ p f-A,. () ~ - STATE:.....
DESCRIBE WORK: ~C\ \ \ '3 d t'\~\' ('O \ GG.4 F~[ '\ CI. c: F
RESIDENTIAL
PERMIT APPLICATION
.
Inspections: 726.3769
Office: 726,3759
1.01':_
NEW
REMODEL
ADDITION
CONTRACTOR'S NAME
GENERA' .
SPRINGFIELD
BLOCI<'
DEMOLISH
OTHER
.
-~
JOB NUMBER q 3fYl ~1- ';,1
225 Fifth Strcet
Sprlngflcld. Orcgon 97477
"
~ ~
~~
TAX LOT:
SUBDIVISION:
mlC?)
PHON'"
ZIP:
q 7 ~CL,7
ADDRESS
CONST.
CONTRACTOR #
EXPIRES
PHONE
PLUMBING:
MECHANICAL:~~ ~.Jb_tl ~ -1.l~_'-fJ1.LE
ELECTRICAl'
QUAO AREA:._ ___
It or- BLOCS: __' ._________.
OCCY GnOup: _ ____
N OF STOrlIES:_
WATER HEATER: ,__
sic ...~T
- OFFICE USE -
LAND LISE: ________
1/ OF UNITS: _..______
CONSTR. TYPE: ___
HEAT SOURCE:__
RANGF'
.s.pfd . ~7\C7'R
..1>1>- ) ~-'q0
IY7-7<{O:fS
I <./ u/r; 1
,
FLOOD PLAIN:
ZONING CODE:_
# OF BDRMS:
SECONDARY HEAT:
SQUARE FOOTAGE:
T()-r(;qu~st an InspiJctlon, you mU81cnll 726.3769. Thl::;Js C_2t..RhoL:r.rCCD!fHl1g. Alllnspccllons requested bf"!ff)rp. 7~OO a.m. Will h~
made the same working clay. inspections requested after 7:00 a.m. will be made the following work day.
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms. "
o
Underslab Plumblngl Electricall
Mechanical - Prior to cover.
D
Footing - After trenches are
excavated.
D
Mnsonry - Steel location, bond
beams, grouting.
D Foundation - ABur forms arc
erected but prIor to concrete
placement.
D
Underground Plumbing - Prior
to filliug trench.
D
Underlloor Plumblng/Mechnnlcal
_ Prior to Insulation or decking.
D
Post and Bcom - Prior to floor
Insulation or decking.
u
D Floor Insulallon - Prior to
decking.
D
Sanitary Sewer - Priol to filling ;
trench.
D
Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
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.
D Frnmlng - Prior to cover.
D Wail/Ceiling Insulation - PrIor to
Gover.
D Drywall - Prior to taping.
D Wood Stove - After Installation.
D Insert - After fireplace approval
and Installation of unit.
o
Curbcut & Approach - After
forms arc erected but prior to
placement of concrotn.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Fence - When completed.
D Street Trees - When all requIred
trees are planted.
o
Final Plumbing - When all
plumbing work Is complel.e.
D Final Electrical - When all
electrical work Is complete.
o Final Mechanical - When all
mechanical work Is completo.
o Final Building - When all
required Inspections have been
approved and building Is
completed.
DOther
MOBILE HOME INSPECTIONS
D Blocking and Sel.Up - Whcn all
~locklng Is complete.
,
,
D 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 rCQulred
Inspections are approved and
porches, skirting, decks, and
venting have been installed.
""-
:\
1'1
I:;
~--
Lot faces
Lot Type
'e
Lot sQ. ftg.
Interior
Lot coverage
Corner
,
"
I:
Panhandle
Topography
Total height
Cul.dc.sac
BUILDING PERMIT
ITEM SO. FT. X $/SQ, FT.
MaIn
Garage
Carpol't
Total Value
Building Permit Fcc
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B),
PLUMBING PERMIT
ITEM
Fixtures
ResldenUal Bath(s)
N'
San 1 tary Sewer
FT.
Water
FT.
Storm Sewer
FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stale Surcharge
Sidewalk
It
Curbcut
fl
DemolitIon
State Surcharge
Setbacks
I PL. HSE GAR I ACC
I N I
Is
l..16E 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.
L~J_I
Y'!.-___
APPROVED:
VALUE
FEE
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrICal)~h. f 1')
(A, B, C, D, and E Combined)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted 011 the express condition tl1al the said
construction ~;hall, in all respects, conform 10 the Oldinancc
adopted by the City of Sprinofield, including tlle
Dovelopment Code. re{lulating U1C construction and WiC of
blJlldln~l:;, and IlIaY btJ suspended or revolwll :11 any limo
upon violation of any plOvi:.ions of said ordinances.
Plan Check Fcc: _.______
Dale Paid:
Receipt Number:
Rcccivml By:
Plans Reviewed By
Dale
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 cmefully eX!lmined
the completed application and do hereby certify Ihat all
Information hereon is true and correct, and I further certify
that any and all work performed shall be done in accordance
with the OrdinanCtl5 of the City of Springfield, and ttle Laws
of the Stale of Oreoon pertaining to Ihe worl~ described
IlCrcin, and Ihal NO OCCUPANCY will 'be made of any
slructure wittlOut permission of the Building Safety Division.
I further certify that only contractors and employecs who
are in compliance with ORS 701.055 will be usccl on this
projcct.
I further agree 10 ensure Ihat all required inspections arc
requested at the proper time, that each addres~ is readable
from the slreet, thai the permit card Is located 'at the front
of tile properly, and the approved set of plans will IClllain
on the site at :JI~ ti~lOS during construction.
Signature ~~ 1v~
2-2--1.{ k~
Datp
VALIDATION: 4&
RECEIPT NUMBER- "d
DATE PAID ry' l . ':::)
AMOUNT REC!f!!1. 6t:::) . r)~
RECEIVED r€..2l.!)D )
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