HomeMy WebLinkAboutPermit Building 1992-11-23
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726-3759
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SPRINGFIELD
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Cl.2/2 'J /
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JOB NUMBER
225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED ~RK' :21'10
ASSESSORS MAP: \() ():) Q'll n
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TAX LOT' rrl
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LOT'
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ADDRESS' .;21")0 L..O. u.. (" C>.-
CITY" "'h,~"'o...-f'(e..Id
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OWNER'
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DESCRIBE WORK:
13Y 30
NEW
..
REMODEL
ADDITION
L..u ( d--o.
BLOCK'
Sr;. r, +h..s-Y f
<:,,+........ 0+ t:i:
L"2..--Y
STAT~' (r-. re.. .
SUBDIVISION'
PHONE: --2% - S.:::,-I:S-
ZIP: <1 7 4-7 7
G~nr,,~ '*""
DEMOLISH OTHER
CONST. '7' 9.~?
CONTRACTOR' ,-/1::,""5 IEXPIRES)--(7-' -1>HONE
('IZ../--e,-,-,~,,\ '# 7 3.. 7;).~-4C)::)d
IO-('e , <:r(7 '-(7 7
C!.-ct'r f) C"lf+
CONTRACTOR'S NAME ADDRESS
GENERAl,kn tit' -../-t.- It. ~cctt 3J.s","
PLUMBING: ~\?'l' """~-FI' e-tcf
MECHANICAl'
ELECTRICA' '
- OFFICE USE -
QUAD AREA" LAND US~' 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. All 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 Plumbing/Electrical I
Mechanical - Prior to cover.
~ Footing - After trenches are
~excavated.
D Masonry - Steel location, bond
.beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
deckl ng,
D Sanitary Sewer - Prior to filling
trench.
D Storm Sower - Prior to filling
trench. .
D 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.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
~ Framing - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover. .
D Drywall - Prior to taping.
D Wood Stove - After I~stallatlon.
D Insert - After Oreplace approvlll
and InstallaVon 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.
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.
~Inal Building - When all
required Inspections have been
approved and building Is
completed.
DOther
MOBILE HOME INSPECTIONS
D 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
porches, skirting, decks, and
venting have been Installed.
, ." ~
..
Lot faces Lot Ty.
Lot sq, Itg. Interior
Lot coverage Corner
Topography Panhandle
Total height Cul.dc-sac
, . ~ . . -. df~~,~',~.'
(..;~~:"t';~l';~ ~fVI,}~~~~~.t'H. f '.~ .'!
, .'\'\1', ',. '.... "'Tloi".l,' .
Setbacks '''. IS THE PROPOSED WORK IN THE
HSE GAR' ACC I HISTORICAL DISTRICT: OR or'!
I THE HISTORICAL REGISTER?
If yes, this application must be signed
I and approved by the Historical
I Coordinator prior to permit Issuance.
I
I P.L.
IN:
S
W
IE
BUILDING PERMIT
ITEM sa. FT. x $/SO. FT. ~ VALUE
Main
Garage
Carport
, .
Total Val ue
Building Per~lt Fee
State SU,rcharge
Total Fee
(A)
"
/~9S~
7, 1. 60
;
/.S.r
_~2. -Ff" .
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B) ~M.
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) NO
Sanitary 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 StovellnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
Slate Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
FEE
:? 2.. f"r
APPROVED'
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 the City 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 pro~isions of said ordinances.
Plan Check Fee'
~
Date Paid:
Receipt Numbc"
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties wlthln the City limits which are being I~proved.
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 Ordlnanct!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.
J 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 propert and the approve:nSs~~1 plans will remaIn
on the site II Ii -"s dU?, c4 ~lion.
Signature '_ _ ->,_,"~':L:2 !t--~
//- .;j 3 - '1~
Date
VALiDATION:
RECEIPT NUMBER
~S~@
1/-2..1-'92-
~~..ST
~~
DATE PAl",
AMOUNT RECEIVED _
RECEIVED BY