HomeMy WebLinkAboutPermit Building 1992-10-21
RESIDENTIAL
PERMIT APPLICATION
.
Inspections: 726.3769
Ollice: 726.3759
LOCATION OF PROpp-SED~9f1K: ~
ASSESSORS MAP' II ( ~,J R T oA I
LOT' BLOCK'
OWNER:~IJ~or::r;~' ) l~rr<<1 j
ADDRESS: ~. () ~(; '00 ~ ~j -
jjf. -.-'>II" - -
CITY' V 'i... STATE:
DES~I~OR . ~ 1\ C),{' Cl O~ ~n
NEW\Y./ REMODEL ADDITIO~ DEMOLISH
:(::::ITi'1 Nffip j() ^"",,,
PLUMBING:
MECHANICAL:. I
ELECTRICAL: ~\ \ (\./
OUAD AREA~ ~ R \'J W
. OF BLOCS: ----,;I-A
OCCY GROUP: _,V\
. OF STORIES:
WATER HEATER:
.B NUMBER !1'!iOqEL
225 Fifth Street
Springfield, Oregon 97477
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TAX LOT:
{ ~ ~<V ~
/
SUBDIVISION'
PHONE: \4\n-Lo~~
(~)\Orrn.
11 i'.:b 1 Jl. (L:?
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.
D Fireplace - Prior to facing
materials and framing Insp.
.;gfFramln9 - Prior to cover.
D Wail/Ceiling Insulation - Prior 10
cover.
D Drywall - Prior to taping.
D Wood Stove - After Installation.
D Insert - After fireplace approval
and Installation of unit.
D Curbcut & 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 Street Trees - When, all required
trees are planted.
ZIP:
c{141 1
OTHER
CON ST.
CONTRACTOR .
- OFfiCE ~SE -
LAND USE: \ \ \ \
. OF UNITS' .-I
CONSTR. T~PE: %
HEAT SOURCE:
RANGE:
EXPIRES
PHONE
'*
FLOOD PLAIN'
ZONING CODE: l\)~
. OF BDRMS'
SECONDARY HEAT: -7- -
SQUARE FOOTAGE: _ Lf~_
To request a~irrs.p.ectlon, 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 8.m. will be made the following work day.
D Temporary Electric
D Site Inspecllon ~. e made
alter excavation, ~u\o pr:1br to
setting forms.
D
Undcrslab Plumbing/Electrical/
Mechanical - Prior to cover.
dFooting '- After trenches are
~ ~xcavated.
D
Masonry - Steel location, bond
beams, grouting.
D Foundation - After forms are
erected but prIor to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D
Undcrfloor Plumbing/Mechanical
_ Prior to Insulation or decking.
D Post and Beam - Prior to floor
insulation or decking.
D Floor Insulallon - Prior to
decking.
D
Sanitary Sewer - Prior to filling
trench.
D
Storm Sewer - Prior to fillIng
trench.
D Water Line - Prior to filling
trench.
o Rough Plumbing - Prior to
cover.
D
Final Plumbing - When all
plumbing work Is complete.
D Final ElectrIcal - When all
electrical worK Is complete.
o Final Mechanical - When all
mechanical work Is complete.
~Flnal Building - When all
~~equlred Inspections have been
approved and building is
completed.
DOlher
MOBILE HOME INSPECTIONS
D Blocking Dnd Sel-Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Eleclrlcal Connection - When
blocking, set-up, aneJ plumbing
Inspections have been approved
and the home is conncclod to
the service panel.
D Final - After all required
Inspections are approved anel
porches, skirting, decks, and
venting have been Installed.
Lot faces
Lot Type.
Interior
Lol sq. fig.
Lot coverage
Corner
Topooraphy
Panhandle
Total heighl
Cul.de.sac
BUILDING PERMIT
ITEM SO. FT, X $/SO. FT.
Main
Garage
Carport
~jgt:l.
.S THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, on ON
THE HISTORICAL REGISTER?
If yes. this application mu~;t be signed
and flpproved by the I-lislorlcnl
Coonlinnlor prior 10 pCl ll1i I h;~;uance.
Selbacks
~ HSE GAR ACC
N
~-_._.
W
IE
VALUE
\~. \() r9f\(iL
~.so
/.93
4tJ~3
SYSTEMS DEVELOPMENT CHARGE (SDC)
IV/A
Total Value
Building Permi t Fee
Stnle Surcharge
Tolal Fee
(A)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s)
N'
Sanitary Sewer
FT.
FT,
FT.
Water
Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Venl Fan
N'
Wood SlovellnscrtlFlrcplace Unit
Dryer Vent
Mecllanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
Stale Issuance
State Surcharge
Sidewalk
It
Curbcut
fI
Demolition
Stalu Surchargo
Total Mlscollanooua Permils (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B. C, D, and E Combined)
FEE
40:'73
APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition thai the said
construction shall, In all respects, conform to the Ordinance
adopted by the City 01 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~r:?'ylsions of said ordinances.
Plan Check Fee: 0';J '.fJ0
Date Paid: I) ~ ~\ 'd---
Receipt Number:~ ~
Received y: -C J ,( ~
~~-
Reviewed By
-7/11)/; :L
j'Mtjrc I
Systems Development Charge Is due on all umlcvclopcd
properties within the City limits which arc being improved.
ADDITIONAL COMMENTS
By signature, I state and agree, that Illave carefully examined
the completed applicaUon and do hereby cfJrlify thai all
Information hereon Is true and correct, and I fmlller certify
that any and all work performed shall be done in ilccordnnce
with the Ordlnancus of the City of Springfield. and the Laws
of the State of Oreoon pertaining to the WOIl( described
herein, and lIlal NO OCCUPANCY will be Illnl!c of any
structure without permission of the Building S;llcly Qivi:;lon.
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 lIle approved set of plans will remain
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Dato
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VALIDATION:
RECEIPT NUMBER _6 1:' 't'~
DATE PAID ,If:?- 2/-"'2....
AMOUNT RECEIVED .._~~ ~~
RECEIVED BY ~~.. ..:... ..
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