HomeMy WebLinkAboutPermit Building 1994-8-19
RESIDENTIAL
PERMIT APPLICATION
Inspections: '726.3769
orflce: 726.3759
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LOCATION OF PROPOSED WORK'
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ASSESSORS MAP'
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OWNER:
ADDRESS:
CITY'
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JOB NUMBER q Y' /:< '7:2..
225 Fifth Slreel
Springfield, Oregon 97477
. TAX LOT"
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SUBDIVISION:
PHONF'
?Y7- 7/93
ZIP'
9'/ '( 7 7 ~rf'<i 1?
DESCRIBE WORK' 1?e->orC)"t.&o(. .c,"~pl4-c.~,lcJ,i..,.e'r R ~,,/4 <-, ^ ()( ~ ." W<l,.1/ "" +' 100"'.. rLt-.......,.U w...JI .
NEW REMODEL ADDITION DEMOLISH OTHER
CONTRACTOR'S NAME
OWpJpR--
GENERA' .
PLUMBINC"
MECHANICAl -
ELECTRICAl'
ADDRESS
CONST.
CONTRACTOR'
PHONE
EXPIRES
- OFFICE USE -
QUAD AREA' LAND USE: FLOOD PLAIN:
. OF BLDGS: . OF UNITS: ZONING CODE:
OCCY GROUP: CONSTR. TYPE: . OF BDRMS'
. OF STORIES: HEAT SOURCE: SECONDARY HEAT:
WATER HEATER: RANGE: SQUARE FOOTAGE:
To request an Inspection, you must call 726-3769. This Is a 24 hour recording. Alllnspecllons requesled before 7:00 a.m. will be
made the same working day, Inspecllons requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
o Temporary Electric
o SUe Inspection - To be made
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated.
o Masonry - Steel location, bond
,beams, grout! ng.
lRJ Foundation - After forms are
erected. but prior to.concrete
placement. .
o 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
deckl ng.
o Sanitary Sewer - Prior to filling
trench.
D Storm Sewer - Prior to filling
trench.
o Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
o Rough Mechanical": Prior to
cover.
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.
[Z] Framing - Prior to cover.
o Wail/Ceiling Insulation - Prior to
cover.
o Drywall - Prior to taping.
o Wood Stove - After Installation.
o Insert - After fireplace approv41
and Inslallatlon of unit.
o Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub-base material In place.
o Fence - When completed.
D Street Trees - When all required
trees are planted.
o Final Plumbing - When all
plumbing w9rk Is complet,e.
o Final Electrical - \^.U1en all
electrical work Is complete. ~
o Final Mechanical - When all
mechanical work Is complete.
IXI Final Building - When all
required Inspections have been
approved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set.Up - When all
blocking Is complete. '
o Plumbing Connecttons - When
home has been connected to .
water and sewer.
o ElectrIcal Connecllon - When
blocking, set.up, and pluflJblng
Inspections have been approved
and the home Is connected to
the service panel.
D Final - After all required
Inspections are approved and
porches, skirting, decks, and
venting have been Installed.
Lot faces
L~t ~ype .
Lot Sq.;flg.
Interior
.-
Lot coverage
Corner
Topography
Total l\elght
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM sa. FT.
X $/SO. FT, =
Main
Garage
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fcc
(A)
(B)
PLUMBING PERMIT
ITEM
Flxl,ures
Residential Bath(s) N'
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
Stat~. Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuahce
State'Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
fl
Curbcut
fl
Demolition
Slate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT OUE (excluding electrical)
(A, B, C, 0, and E Combined)
,\,,~:'f ':'. ';;"!!;:~i':~'.'.j ~i"I.~it:!~~~i.;~?::-.
Setbacks.
HSE GAR' Acc'l
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1
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IN
Is
W
E
VALUE
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FEE
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'l<< THEPROPOSED WORK tN THE_
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this appllcallon must be signed
and approved by the Historical
. Coordinator prior to permit issuance.
APPRov"n.
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SYSTEMS DEVELOPMENT CHARGE (SDC)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condlllon thaI the said
construcllon shall, In all respects, conform to the Ordinance
adopted by the City ,of Springfield, Including the
Development Code, regulallng the construcllon and use of
buildings, and may be suspended or revoked at any lime
upon violation of any P~~~o~f ~nances.
Plan Check Fee: ---f!1't/p j?/" .
Date Paid:
I
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 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 and all work performed shall be done in accordance
with the Ordlnanc~s of the Clly 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 thai 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. slle at al~s ~ construction.
Signature ~ y~
-/
Oat.. 'fiE: - 19-~
VALIDATION:
/ C/~ /"
9'/9,5'Y
AMOUNT RECEIVED /h. ?c:::>
R~CEIVED BY -4~-----'
RECEIPT NUMBER
DATE PAIr>