HomeMy WebLinkAboutPermit Mechanical 1998-6-5
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RESIDENTIAL
PERMIT APPLICATION
Inspeclions: 726.3769
Orrice: 726,3759
LOCATiON OF PROPOSED WORK:
ASSESSORS MAP'
LOT'
OWNER:
ADDRE~~'
CITY:
DESCRIBE WORK:
NEW
REMODEL
CONTRACTOR'S NAME
GENERAl'
PLUMBING'
MECHANICAL: (~mb{);ll: J-IDu)
ELECTRICAL'
OUAD AREA'
. OF BLDGS:
OCCY GROUP'
. OF STORiES:___
WATER HEATER:
.
SPRINCFIELP
" -----'""'--. ",-.,"",
.
JOB NUMBER jJp, n G 7 f '
225 Fifth ~lrcct
Springfield, Oregon 97477
TAX LOT:
SUBDiVISION'
/') ") 7 t"9 0
BLOCK:
f:JerrunlJt
J
STATE:
(')1<
PHONE: _
'1 4b - :;R_d]
ADDITION
DEMOLISH
OTHER
ZiP: !l1tJ 77
11
~l~.
.J:::Jt Ii -
. ""
,
ADDRESS
CONST.
CONTRACTOR'
PHONE
REQUIRED INSPECTIONS
D Rough Mechanical - Prior to
cover,
D Rough Elcclricnl - Prior to
cover. '
o Elcctricnl Servlco - Must be
approved to obtnln pCHnnncnt
electrical power,
D Fireplace - Prior to facing
materials and Imming lnsp,
D Framing - Prlor t~ ~ovcr,
D Wall/C'clling Insulntion - Prior to
cover,
o Drywall - Prior l..o.lJ.ping,..
o Wood Stove - After Install<'lllon,
o Insert - After rlreplace approval
and installation or unit.
D
CurbclIt & Appro<lch - Alter
(orms arc erocted but prior to
plnccmcnl of concrete,
jq5/ DImS-I" c:S'uh D
,
- OFFICE USE -
LAND USE:_
. OF UNITS:
CONSTR, TYPE:
HEAT SOURCE: _____
RANGF.:__
EXPlfiES
C()/fb()
b-'J7.q X'
1;)fo-{)/CD
..LOOD PLAIN:
ZONING CODE:_
1/ OF BORMS:
SECONDMIY HEAT:
SOUARl' FOOTACE:
To request an Inspectlon, you must call 72G-3769, This Is a 24 hour recording, All Inspections requested bclorc 7:00 a,m, will bc
made the same working day, Inspections requeslCd arler 7:00 a,m, will be made the (ollowlng worl< day,
D Temporary Electric
D
Site Inspection - To be made
after excavation. but prior to
setting forms,
'D Underslnb Plumbing/Electrical/
Mochnnlcnl - Prior to cover,
D Footing - After trenches are
excavated,
D
Masonry - Steel location, bond
beams, grouting.
D
Foundation - After forms arc
erectec;1 but prior to concretc
, placement.
o
Underground Plumbing - Prior
to filling trench,
o
Underfloor Plumbing/Mechanical
- Prior to InsulatIon or decl<fng,
D
Post nnd Beam - Prior 10 floor
Insulation or dccl<lng,
D Floor Insulation - Prior to
dcckl ng.
D
Sanitary Sewer - Prior 10 '1IIIng
trench,
D
Storm Sewer":';'" Prior 10 filling
trench.
o
Water Line - 'Prior \0 filling
trench, '
o Rough Plumbing
cover. '\, '
,,.~
- Prior to
D
Sidewalk & DriVCW:I\' - Alter
cxcavation Is complete. forlllS
and sul).base maler!"l In place,
D
Fence - WIlcn completed,
D
~:"root Treos - WIlen all requlrcd
trees are planted, ..
"
D Finnl Plumbing - When DII
plumbing w~::HI< is complet.c,
\ ',.
~ Fi'Hll Elccl~cill - Vtll1cn all,
~JeC(riCar work is complCle,
( .
KA'Final Mcchnnical - Whcn all
r-mcchanical worl< .15 completc,
D Fin.1I Ouilding - When all
required InspcctJons have been
approved and building is
compleled,
"
o Other
, ,
MOBILE HOME INSPECTIONS
D Blocking llnd SCI-Up - WIlen all
blocl<lnU is complete, .
D
Plumbing Conncctions - When
home 1105 been connected to
waler anti sewer,
o Electricnl Conncction - Whcn
blocldnu. sel-up. iJnd plumbing'
, Inspections h:wc been iJpproved
and tllC tlQlnC is connected 10
the service panet.
D Finn! - After all required
Inspections are approved and
porches, sldrting, cJccl<s, and
venting have been Installed,
Lot faces
Lot sq, ftg:
LOI Type
.
Interior'
.
Lot coverage
Corner
Topography
Total helgill
Panhandle
Cul-(Jc-:;ac
BUILDING PERMIT
ITEM
sa, FT,
X $/SO, FT,
Main
Garage
Carport
Total Value
Building Permi I Fee
State Surcharge
Tolal Fee
(AI
:~;,.!'., .~J':~(~"~~~f;';!'~':"
~ '.' .ol:i.I.Oi;"
Setbacl(5
I P,L. 'HSE' GAR I ACC I
IN
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 permll issuance,
W
----- -- ----
APPROVED:
.L___~__
VALUE
"
(B)
SYSTEMS DEVELOPMENT CHARGE (SDC)
PLUMBING PERMIT
ITEM
Flxlures
Residential Bath(s)
N'
Sanl tory S~wcr
Water
FT,
FT.
Slorm Sewer
FT,
Mobile Home
Plumbing Permit
Stotc Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vcnt Fan
N'
Wood Stove/lnscrt/Fircplacc'Unlt
Dryer Vent
Mecl1anlcal PermIt
Issuance
Slale Surcharge 17 r r- ,.of;-
Total Permll (D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
Slate Surcharge
Sidewalk
it
Curbcut
II
Demolition
\>Iale Surcharge
Total Miscellaneous Permi Is (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D. and E Cornblned)
FEE
15"t:rO
.10<9-0
):;:~
.2.6-.:2- ()
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 of Springlieid, including Ihe
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any tlmo
upon violation of any provisions of said ordinances,
Plan Check Fee'
Datc Paid:
Rcceipt Number'
Reccived By:
Plans Rcvi(W.,cd-.By-------
Date
Syslcms Developmcnt Charge Is due on all undoveloped
propcrtles wlthin lhe Clly limits which are being Improved,
ADDITIONAL COMMENTS
\
(
By signature, I state and agree, that I hqve carefully examined
tho completed application and do hereby certlry that all
Informatlon hereon Is true and correct, and I further certify
that any and all work performed shall be done' in accordanco
with the Ordinancus of ttw CHy of SpringfIeld, and the Laws
of lhc Stale of Oregon pertaining 10 the work descrIbed
hcr~in. and that NO OCCUPANCY will be Inade of any
structure without pcm~ission of tho Building Safely Division,
I further certify Hlat only contractors and employees who I
are In cornpllance'wilh ORS 701,055 will be usod on this,
project.
.
I further agree to ensure that all required Inspections aro
requested at the proper lime, that each address Is readable
from tile slreet, that 1I":e permll card is located at the rronl
or the propert , thc. approved set of plans will remain
on the site al I mes during construction,
Signatur
Date
(pO~
1o-5-q1 t
VALIDATION:
<n /'7";-
DATE PAir> ,:;,/ J /5".4
AMOUN'T RECEIVED ~5~.
RECEIVED BY Af . /'VL--l
RECEIPT NUMBER