HomeMy WebLinkAboutPermit Mechanical 1998-10-2
.
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
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DESCRIBE Wo.RK' F; J, {JI/'VU
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o.WNER'
CITY:
NEW
REMo.DEL
ADDITlo.N
GENERAl'
PLUMBING'
MECHANICAl'
ELECTRICAl'
SPRINGFIELD
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BLo.CK:
STATF'
01<
Jo.B NUMBER
225 Fifth Street
Springfield, o.regon 97477
TAX Lo.T'
SUBDIVISlo.N:
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PHONE:
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ZIP: 1'1'177
o.THER
ADDRESS
CON ST.
CONTRACTOR'
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REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover.
D Rough Electrical - Prior to
cover.
, D Electrical Service - Must be
approved to obtain permanent
electrical power.
EXPIRES
PHONE
CONTRACTOR'S NAME
/?W IV L f'l-
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ATTENTION:Oregon law requires you to- OFFICE USE -NOT/CE'
QUAD AREAfollow rules adopted by the Orel;l.R~b'Wi!M: TLjIS-PEFl . F.LO,QD PLAIN:
Notification Center. Those rules are set fanh . . M/T SHAll EXPIRE IF THE WORK
. OF BLD~OAn 9!i2 001 9919 through OM'roSJi!lWl>; ~I m,ORIZED UNIfEW\'HrsCODE:
OCCY GRdffillO. You may obtain copies of &Slr-lW& q~PE: C()MMaJcED OR r: OF. BDlrJsRMIT IS NOT
calling the center. (Note: the telephone S I\BI\NUUNED FOR .
· OF STORI ElfuFAbef fer tho Oregon Utility NGliMcftil}l:lRCE: ANY 1 fjn J}A Y PERI~lfl?ONDARY HEAT:
WATER HEATER: Center is 1-800-332-23'WkNGE: _ 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. Inspectlons 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 Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Maaonry - Steel location, bond
beams, grouting. .
D Foundation - After forms are
ereoted but prior .to oonorete
placement.
D Undorground Plumbing - Prior
to filling trench.
D Underlloor Plumbing/Mechanical
- PrIor to In.ufatlon or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insul~t1on - Prior to
decking. .
D Sanitary Sewer - Prior to tilling
trench.
D Storm Sewer - Prior to filling
trench.
D Water Line - Prior to filling
trench.
D Rough Plu~blng .- Prior to
cover.
..;,
D Final Plumbing - When all
plumbing work Is complete.
. .
D Final Electrical - When all
electrical work Is complete.
~al Mechanical - When all
~~chanlcal work Is complete.
D Final Building - When all
required Inspections have been
approved and building Is
completed.
D Framing - PrIor to cover. . {S7 / A S /7, ~
D o.t r /,.~~ P~rJ'
o Wail/Ceiling Insulation - Prior t
cover.
D Fireplace - Prior to facing
materials and framing Insp.
D Drywall - Prior to taping.
D Wood Stovo - After Installation.
D Insert - After fireplace approvaf
and Installation of unit.
D Curbcut & Af,proach - Alter
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 cOfl'lpletcd.
D Street Trees - When all required
trees are planted.
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete. .
D Plumbing 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 service panel.
D Final - After all' required
Inspections are approved and
porchos, skirting, decks, and
venting have been Installed.
Lot faces
,;'
L~t'~ype .
Lot sq. Itg.
Interior
Lot coverage
Corner
Topography
Total height
.,.
Panhandle
Cul-de.sac
.~
BUILDING flERr!lJlT :!j ':~ .'(
ITEM sa. FT. x $/SO. FT.
Main
Garage
Carport
Tolal Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Balh(s)
I
N'
Sanitary S~wer
- ,
FT.
FT.
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan NO
Wood Slove/~lrePlace Unit
Dryer Vent
GA-5 {}{tY
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Stale Surcharge
Sidewalk
It
Curbcut
It
Demolition
Slate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excludIng electrIcal)
(A. B. C, D, and E Combined)
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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,
I P.L.
Setbacks.
HSE I GAR ACC'
~-_..
S
~~-,-
VALUE
"
FEE
If..('D
2.07)
If). {)()
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4r/. 7,
2t.'2A
., APPROVED:
BUilDING "'ALOE, 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,.. Cily of Springfield. Including the
Development COde,- reguiating the constructlon 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 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 Slate of Oregon perlalnlng to the work described
herein, and thaI 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
prolect.
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 ~ all times during ~;n.
Signature hl~ _ 4'1'.L-k-=.
,Date)/JL2-9.7'U: 0
VALIDATION:
RECEIPT NUMBER
03/(" 5 3
10/2-/9 f
2/s 2-d 1/
uJ/wVJAj./
DATE PAID
AMOUNT RECEIVED
RECEIVED BY