HomeMy WebLinkAboutPermit Building 1991-7-15
RESIDENTIAL
PERMIT APPLICATION
Inspections 726-3769
Office 726-3759
SPRINGFIELD
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JOB NUMBER
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225 Fifth Street
Springfield, Oregon 97477
LOCATION OF PROPOSED WORK
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ASSESSORS ~MAP
LOT
OWNER
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ADDRESS
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DESCRIBE WORK
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NEW
REMODEL
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BLOCK
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STATE
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OTHER
ADDITION
DEMOLISH
SUBDIVISION
PHONE
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ZIP
CONTRACTOR'S NAME
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CONST
ADDRESS 'jlf 3 ~ ~~It:.'lIlt!';CJCONTRACTOR #
ffr)N!~le(J.. 7 D 973
EXPIRES PHONE
1- ;47- C? ;/..., 'Jif7-J JI;1.0
, PLUMBING
MECHANICAL
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ELECTRICAL
QUAD AREA
# OF BLDGS
OCCY GROUP
# OF STORIES
WATER HEATER
- OFFICE USE -
LAND USE
# OF UNITS
CONSTR TYPE
HEAT SOURCE
RANGE
FLOOD PLAIN
ZONING CODE
# OF BDRMS
SECONDARY HEAT
SQUARE FOOTAG E
To request an Inspectl_on, you must call 726-3769 This IS a 24 hour recording All inspections requested before 700 a m will be
made the same wor~lng day, inspections requested after 700 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
rvJ Footing - After trenches are
l,C::J excavated
D ry1asonry - Steel location, bond
beams, grouting
D Foundation - 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
D
Post and Beam - Prior to floor
Insulation or decking
D Floor Insulation - Prior to
decking
D Sanitary Sewer - Prior to filling
trench
D Storm Sewer - Prior to filling
trench
D Water Line - Prior to filling
trench
D
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
(XJ Framing - Prior to cover
D Wall/Ceiling Insulation - Prior to
cover
IZl Drywall - Prior to taping
D Wood Sto've - After installation
D Insert - After fireplace approval
and IlJstallatlon of unit
I
,
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete
D Sidewalk & Driveway - After
excavation IS complete, forms
and slub-base material In place
D Fe~ce - When completed
D Street Trees - When all required'
trees are planted
D
Final Plumbing - When all
plumbing work IS complete
o Final Electrical - When all
electrical work IS complete
D Final Mechanical - When all
mechanical work IS complete
~ Final Building - When all
reqUired inspections have been
approved and bUilding IS
completed
D Other
MOBILE HOME INSPECTIONS
D Blocking and Set-Up - When all
blocking IS complete
o Plumbing ConnectIons - When
home has been connected to
water and sewer
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home IS connected to
the service panel
o Final - After all reqUired
inspections are approved and
porches, skirting, decks, and
venting have. been Installed
Lot Type , Setbacks THE PROPOSED WORK IN THE
Interior I PL HSE GAR ACC I r(ISTORICAL DISTRICT, OR ON
IN I THE HISTORICAL REGISTER?
Corner Is I If yes, thiS application must be signed
Panhandle and approved by the Historical
\W I Coordinator prior to permit Issuance
Cul-de-sac
IE I APPROVED
Lot faces
Lot sq ftg
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM
SQ FT
X $/SQ FT
VALUE
Main
Garage
Carport
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Total Val ue
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SYSTEMS DEVELOPMENT CHARGE (SDC)
BUilding Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
FEE
Flxtu res
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
NO
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
ft
Curbcut
ft
Demolition
State Su rcharge
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Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical) 2~~S~
(A, B, C, D, and E Combined)
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 prOVIsions of said ordinances
Plan Check Fee
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Date Paid
Receipt Number 2~3
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77/~-:?7
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 Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work descrl bed
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 701055 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 the approved set of plans Will remain
on the site at all times dUring construction
Slgnature~~--
Date
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VALIDATION
RECEIPT NUMBER /t!/6e 7
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DATE PAID -'::>-/5""-7" /
AMOUNT RECEIVED L,S";,c:.;-o
RECEIVED BY ./2~
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