HomeMy WebLinkAboutPermit Building 1995-4-24
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RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK'
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ASSESSORS MAP'
LOT'
OWNER:
ADDRESS'
CITY'
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SPRINGFIELD
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STATE:
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JOB NUMBER
225 Fifth Slreet
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
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PHONE:
74(: -~~2....
ZIP' ')' :J?" '/ ?
DESCRIBE WORK: ~A.JWti>r )
NEW REMODEL ~ ADDITION
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DEMOLISH OTHER
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CONTRACTOR'S NAME
GENERAl'
PLUMBING'
/0/} Jj 177/
MECHANICA' .
ELECTRICAl'
QUAD AREA:
. OF BLDGS'
OCCY GROUP'
. OF STORIES:
WATER HEATER'
ADDRESS
CON ST.
CONTRACTOR'
PHONE
- OFFICE USE -
LAND USE:
. OF UNITS'
CONSTR. TYPE:
HEAT SOURCE:
RANG.'
EXPIRES
~~
,~
FLOOD PLAIN:
ZONING CODE:_
. OF BDRMS'
SECONDARY HEAT:
SQUARE FOOTAGE:
To request an Inspection, you must call 72R-3769. Th!s !s 2. 24 heur recordIng. Aii 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.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlca"
MechanIcal - Prior to cover.
'tvrFoollng - After trenches are
~excavated.
o Masonry - Steel location, bond
.beams. grouting,
D<1 I~oundatlon - After forms are
~ erected but prior to concrete
placement.
D Underground PlumbIng - Prior
to filling trench.
D Underfloor PlumbIng/Mechanical
-, PrIor to Insulation or decking.
0" Post and Beam - Prior to floor
Insulation or decking.
o Floor Insulation -- Prlor.to .
decking.
D Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
D Waler Line - Prlo, to filling
trench. '.
o Rough Plumbing - Prior. to
cover.
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
D Electrical Service - Must be
approved to obtain permanent
eleClrlcal power,
D Fireplace - Prior to facing
materials and framing Insp.
D Framing - Prior to cover.
D Wall/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping,
D Wood Stovo - After Installation.
D Insert - After fireplace approvll.l
and InstallatIon of unit.
o CurbCUI & Approach - After
forms are erected but prior to
placement of concrete.
D Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
D Fence - When completed.
D Streot Trees - When all required
trees are planted. "
D Final Plumbing - When all
plumbing wc;>rk is complet.c.
D Final Electrical - When all
electrical work is complete.
D Final Mechanical - When all
mechanical work Is complete.
1"v1' Final Building - When all
~reQUlred Inspections have been
approved and building Is
completed.
DOlhor
MOBILE HOME INSPECTIONS
o Blocking and Set-Up - Wilen all
blocking is complete.
D PJumbing Connections - When
home has been connected to
water and sewer.
D
Electrical Connection - When
blocking, set-up, and plumbing
Inspections have been approved
and the home Is connected to
the serv1ce panel.
D Final - After all required
Inspections are approved and
porches, skIrting, decks, and
venting have been Installed.
Lot ~y. "" ":',., ,;:>;'ii':':..iH--::~r'
Lot faces Setbacks
Lol sq, ltg, Interior I PL. HSE GAR Accl
IN I
Lot coverage Corner
Is I
Topography Panhandle
Iw I
Total height Cul-de.sac
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.,IS THE 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
APPROVEf"
BUILDING PERMIT
ITEM sa. FT,
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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 th~ Clty.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.
X $/SO. FT. VALUE
Main
Garage
"
Carport
.,
-".-
.. Plan Check Fee'
, . ..
Total Value
Date Paid:
Building Permit Fee
Slale Surcharge 17 r -r..fs-
I~~
/.2.<.>
/(~:z...o
Receipt Number'
Total Fee (A)
Recel~~~
Plans Ri1Ylewed By ,
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SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved.
PLUMBING PERMIT
ITEM
ADDITIONAL COMMENTS
FEE
FIxtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Ven I Fan
N'
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and I rurther certlty'
that any and all work performed shall be done in accordan"><c"e
with the Ord;nanc~s of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division,
I further certify that only contractors and empfoyees who
are In compliance with ORS 701.055 will be used on'thls
project.
Wood Stovellnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
Slate Surcharge
Total Permit
(D)
I further agree to ensure that all required Inspections are
requested at the proper time; that each address Is readable
from the street, that the permit card Is located at the front
of the property, and the approved set of plans will remain
on the site at all times during construction,
. ~nature JJ,..f/.J{l, ~ ..g~_
,
Date .11-:24 _ ,..,
MISCELL,~NEOUS PERMITS
Mobile ,Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
It
Demolition
Slate Surcharge
VALIDATION:
RECEIPT NUMBER 1 "7/2.fb
1/2...$""/7-->
,
AMOUNT RECEIVEf' /(,:, 20
RECEIVED BY ~
DATE PAID
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
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