HomeMy WebLinkAboutPermit Building 2000-1-7
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP'
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SPRINGFIELD
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JOB NUMBER 00 -t>CJt).; '3, -01
225 Fifth Street
Springfield. Oregon 97477
TAX LOT:
SUBDIVISION:
/;) I"'> 7/'r?")
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1132 ~.I'.>"'1;
?~<) /2
BLOCK:
OWNER: ~f=:\l r-: ~ It...\ Q ,rib d , - ~Ji.rv\ Lc\Q{'<,(jfY\ PHONF-it..f,/- t+s,r;:; V
ADDRESS: - I c:rs., L I1YV\ I'rv\ ,I ~\ (l
CITY: S-..or I V\ (15:;, 0 \ rl STAT~- 0-( ZIP: 0, '14-/l
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DESCRIBE WORK' \ V"I S,A L\ C-J\s' \,01'\ \{--;-"IC..
NEW REMOOEL -.,/ AOOITION OEMOLISH
~ p.;r>, R / 'G,.... ~ Q..r
OTHER /' ,
CONTRACTOR'S NAME
GENERAL'
,PLUMBING-
MECHANICAL'
/'}/.1 ~1lJ?:l.
ELECTRICA' .
QUAD AREA:
. OF BLDGS'
OCCY GROUP:
. OF STORIES:
WATER HEATER:
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumbing/Electrical/
Mechanical - Prior to cover.
D Footing - After trenches afe
excavated.
D Masonry - Steel location, bond
.beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
o Undorground 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
decking,
D Sanitary Sewer - PrIor to filling
trench.
D s.!o!!.1l1Sewer - Prior to filling
trench:-
....~
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r., rT1 ,.,.,
D Water:.tlne - Prior to filling
...-.....,;; n
t!.~n.2.h.. <<
~";"'$V1 S;'!
Rough'l'PJUmblng - Prior to
'o";er.4~li::
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ADDRESS
CONST.
CONTRACTOR'
.0
- OFFICE USE -
LAND USE:
. OF UNITS:
CONSTR_ TYPE:
HEAT SOURCE:
RANGE: _
REQUIRED INSPECTIONS
~~ugh MechanIcal - PrIor to
)C{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.
D Framing - Prior to cover.
D Wail/Ceiling Insulation - Prior to
cover.
D Drywall - Prior to taping.
o Wood Stovo - After Installallon.
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 compiele. forms
and sub-base material in place.
o Fence - When completed.
D Street Trees.- When all required
trees Bre planted.
EXPIRES
PHONE
FLOOD PLAIN-
- - se.:- 2:QNI~if()'i~'lF._WOR":.
NV ~ ~C:Qt-Mi S\i~\..I.. \::)\.~ ._--=~i:\Sf'I(j,
\\1'''' '" LlNOE:~~M~~
i-lf,,;U()R\IE.~OOR \~~HEAT:
CnMNlE.NC ?E.R\0lIDARE FOOTAGE:
'1:\ ,Q,(\O~'{
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To request an Inspection, you must call 726-3769. This Is a 24 hour recording. Alllnspecttons 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.
rs;;:;j'Flnal Plumbing - When all
~ plumbing w9rk Is complet.e.
D FInal Electrical - When all
electrical work is complete.
~ Final Mechanical - When all
~echanlcal work Is complete.
D Final Building - When all
. required Inspections have been
approved and building Is
completed.
~ Other ,,::; A'5
~ -dA-<
WJ/=
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MOBILE HOME INSPECTIONS
D Blocking and Set.Up - When all
blocking Is complete.
D Plumb1ng 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
venttng have been Installed.
.,..;../
.::' ~,;" '..' 'I ::..::'~I>.~-ifC~~)'
L~t~ype '. ~.
Lot faces ,,'
Lot sq. ftg. ......,.- Interior
Lot coverage Corner
\'
Topography Panhandle'
Total height Cul-de-sac.
. "
,.
\ IS THE PROPOSED WORK IN THE.
....HISTOI;1ICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit Issuance.
'." Setbacks.
I 'P.L HSE GAR ACC'
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BUILDiNG PER~IT;~.';;!ut
ITEM sa, FT, x $/sa. FT. = VALUE
Main
Garage
Carport
"
Total Value
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
"PLUMBING PERMIT
ITEM FEE
Fixtures
Residential Bath(s) N'
Sanitary S,ewer FT.
Water FT.
Storm Sewer FT.
Mobile Home
Plumbing Permit
State Surcharge
/
Total Charge (C)
!' MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan N'
Wood StovellnserllFlreplace Unit
Dryer Vent
Mechanical Perml t
-'.
Issuance: "''". J. f-, ,
.~
,--
State Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
fl'
Oemolltlon
'\".
State Surcharge
Total Miscellaneous Permits (E)
\ " TOTAL AMOUNT DUE (excluding electrical)
~ ','::':' (A.,~ C. 0, and E Combined) . ,
\
APPROVED:
"'1 ,~, 'J 'I.
BUILDIN'G \fALtlE, 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 01 Springfield. Including the
Development Code, regulating the construction and use of
ouildings, 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
Date
Systems Development Charge is due on al/ undeveloped
properties within the City-'lImlts which are being Improved.
ADDITIONAL COMMENTS
By signature. I stale 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 dons In accordance
with the Ordlnancos 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.
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 Inspoctlons 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 wilt remain
on the site at all times during construction.
Slgn.,ur./d L ~z~--t:<>----
Date /- 7 - CJO
VALIDATION:
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RECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
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