HomeMy WebLinkAboutPermit Mechanical 1997-7-11
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
.
LOCATION OF PROPOSED ~ORK' \\ Q}\
ASSESSORS MAP' \. 10~:o ~ 1
LOT'
BLOCK'
OWNER' ~\ \ \ \0.., \\)\}al .
ADDRE~~' \ \O~\ \.C\I I){\~V\,\e
CITY' ~\!\ -
STATE:
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Y
DESCRIBE WORK'
NEW
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ADDITION .
REMODEL
CONTRACTOR'S NAME
GENERA' .
PLUMBIN'"
MECHANICAL: ~\c\ N\~1\
DEMOLISH
OTHER
.
a. ~m~
JOB NUMBER
225 Fifth Street
Springfield. Oregon 97477
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TAX LOT: -L) GOCf )
SUBDIVISION'
ZIP'
~L-
U/HJ1" ~
PHONE: ~ \ . ~ tOI
ADDRESS
CONST.
CONTRACTOR'
EXPIRES '."C PHONE
~\o r\ ~ {\0
UvL'J\
<\'\ ~ l.o
'\ to I. 9 J\ 0 \
O"'\Cl:IrlEAT SOURCE: 'TIlE. 'NOf\\(
N '\ (;.. EXPlf\c1r I .
WATER HEATER: . PEf\~LL --lo'),'" I!; NOT SQUARE FOOTAGE:
T\1IS .. ....cQ T\-I\~ no' " . _ _
unQ\L1:1J J, L _ A' Mf'lf'll'lr.U p"" -
To request an Inspection, you must M10Y2II'3769'JI>II!I. \'5~ recording. All Inspections requested before 7:00 a.m. will be
made the same working day, Inspec~~ttfstllS~ted1hlt1\~:OO a.m. will be made the following work day.
. r>.tl'/ 18oR~\I'I~D INSPECTIONS
rn/ROU9h Mechanical - Prior to
cover.
ELECTRICAl'
QUAD AREA'
. OF BLDGS'
OCCY GROUP:
· OF STORIES:
D Temporary Electric
D SlIe Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlca"
Mechanical - Prior to cover.
o Footing ~ After trenches are
excavated.
o Masonry - Steel location, bond
.beams. groutlng.
o Foundation - After forms Bre
erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
o Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
o Post and Boam - 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.
o Watar LIne - Prior to filling
trench. .
D Rough Plumbing. - Prior to
cover.
- OFFICE USE -
LAND USF'
. OF UNIT~'
CONSTR. TYPE:
l::::r" Rough Electrical - Prior to
. CQver.
o Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materIals and framing Insp.
D Framing - Prior to cover.
D Wall/C'elllng Insulation - Prior to
cover.
D Drywall - Prior to taping.
D Wood Stovo - After Installation.
D Insert - After fireplace approvlll
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sldawalk & DrIveway - After
excavation Is compiete, forms
and sub.base material In place.
o Fence - When completed.
D Streot Trees - Whan all required
trees are planted.
~-<t.qy;
FLOOD PLAIN-
ZONING CODE:
. QF BDRMS'
SECONDARY HEAT:
D Final Plumbing - When all
plumbing wc;>rk Is complet,e.
Q...Flnal Electrical - When all
electrical work Is complete.
,/
[Jd'Flnal Mechanical - When all
mechanical work Is complete.
D Final Building - When all
required Inspections have been
epproved and bulldlng 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.
o 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.
,
Se I bac ks
I PL. HSE GAR Acc'l
I N I
I S I
Iw 1
I E I
Lot facos
, ..
Lot Type
'"..!. ':
.., li-,'_.
-
,
Lot sQ. Itg.
Interior
Lot coverage
Corner
Panhandle ..
Topography
Total height
Cul-de-sac
BUILDING PERMIT;
ITEM SO. FT.
i
"
X $/SO. FT. _
VALUE
Main
Garage
"
Carport
Tolal Value
Building Permit Fee
Slate Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
FEE
Fixtures
Residential Bath(s)
N'
Sanitary S~wer
Water
FT.
FT.
FT.
, .
"C.. :'j"
Storm Sower
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhausl Hood
Venl Fan
N'
Wood StovellnsertlFlreplace Unit
~ ~LJ M{l-
Mechanical Permit
\~W
S.oU
o au
~
Issuance
State Surcharge -t 2>90
Total Permit (0)
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. 0. and E Combined)
a\Q.W
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..
I( IS THE PROPOSED WORK IN THE.
....HISTOI;lICAL DISTRICT, OR ON
THE HISlORtCAL REGISTER?
II yes, this application must be signed
and approved by. the Historical
Coordinator prior to permit Issuance.
APPRovcn.
'. '\ "... "
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the ox press condition that the said
construction shall, In all respects, conform 10 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'
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Dale
Systems Developmenl Charge Is due on all undevelopod
properties within tho City limits which are being Improved.
.ADDITIONAL COMMENTS
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By sIgnature, I stato and agree, that I have carefully examined
the completed application and do hereby certlly 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 perlalnlng to tho work described
herein, and thai NO OCCUPANCY will be made of any
struclure without permission of Ihe Building Safety Division.
I further certify that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
proIec!.
,...
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 pormlt card Is located at the front
of the properly, and Ihe approved set of plans will remain
n the site at all times during construction.
l3_d V.dP
,
Date
\
VALIDATION: \ ~~
RECEIPT NUMBER _ ~~\n V
DATE PAID 'l II. q'i'
1"1
;Jln.~
AMOUNT REC
RECEIVED BY