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HomeMy WebLinkAboutPermit Building 1991-5-8 ;' __ \i RESIDENTIAL PERMIT APPLICATION Inspections: 726.3769 Office: 726.3759 .. SPRINGFIELD LOCATION OF PROPOSED WORK: <?/~ j//~?_ '/ ~':l.t'_ C;; AS::;ESSORS MAP: -17-11>2. 2R.3 y,. ?A~~_ LOT: . BLOCt<. :::~~"Y /?9.~7.y~~-S 5..":?!C;-- ;~L&:;~-n"~~~ ,,?~~7") STAT'" -- ~/ 0~'~"A~;:r OWNER: ADDRESS: CITY: DESCRIBE WORK: NEW Y REMODEL " -ADDITION CONTRACTOR'S NAME ~t.vh".~ - ...,~, ~,.] GENERAl' PLUMBING: MECHANICAl' ELECTRICAl' QUAD AREA: 3J\~ \ .t.J.. \ . OF BLDGS' OCCY GROUP: . OF STORIES: WATER HEATER: &/i>. . JOB NUMBER '9/~3'9./ 225 Fifth Street Springfield, Oregon 97477 ~'7.) _ , 'r . ._ . TAX L()T: SUBDIVISION' PHONE: /LI?L///7~ ; . . "9~;;> y~ .:;-~ ZIP' /YY_~8'.;~~~ DEMOLISH OTHER .AJ)DRESS CON ST. CONTRACTOR . PHONE REQUIRED INSPECTIONS o Rough Mechanical - Prior to cover. ~Rough Electri~al,- P.rior to ~ cover. o Electrical Service - Must be approved to obtain permanent electrical power. o Fireplace - Prior to facing materials and framing Insp. ~ Framing - Prior to cover. ~Wall.',r,.;.:::__~ Insulation - Prior to J6.J. cover. o Drywall - Prior to taping. , o Wood Stove - After Installation. o Insert - After fireplace approval and Installation of unit. o Curbcut & Approach - After forms are erected but prior to placement of concrete. .. 0 Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. o Fence - When completed. o Street Trees - \-\lhen "all req-uired trees are plan~ed. ... EXPIRES FLOOD PLAIN' ZONING CODE: ..LQf2..-- . OF BDRMS: SECONDARY H-EAT' SOUARE FOOTAGE: 10'12_ - OFFICE USE .:... I \ It . OF UNITS: \ CONSTR. TYPE: -.J/......f\J LAND USE: HEAT SOURCE: RANGE: 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. o Temporary Electric o Site Inspection - To be made after excavation, but prior to setting forms. o Underslab Plumbing/Electrical/ Mechanical - Prior to cover. """"" "'rooting - After trenches are ~ excavated. o Masonry - Steel location, bond beams, grouting. ~Foundatlon - After forms are ~ ~rected but prior to concrete placement. o Underground Plumbing - Prior to filling trench. o Underfloor Plumbing/Mechanical - Prior to. insulation or decking. l'5?r Post and Beam - Prior .to floor ~insulatjon or decking. 'l'7r Floor Insulation - Prior to ~decking. D Sanitary Sewer - PrIor to fitling trench. o Storm Sewer - Prior to filling trench. D Water Line - Prior to filling trench. o Rough Plumbing - Prior to cover. o Final Plumbing - When all plumbing work is complete. '~Final Electrical - When all ~electrlcal work is complete. D Final Mechanical - When all mechanical work is complete. T':7f' Final Buildin9 - When all ~requlred Inspections have been approved and building is completed. o 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 haye been installed, . I. ~. ;1 "\ Lot faces Lot Type Setbacks S THE PROPOSED WORK IN THE I PL. , , , ACC I HISTORICAL DISTRICT, OR ON Lot sq. Itg. Interior HSE GAR IN I THE HISTORICAL REGISTER? Lot coverage Corner If yes, this application must be signed Is I and approved by the Historical Topography Panhandle Iw -I Coordinator prior to permit issuance. Total height Cul.de-sac IE I AP.PRPVED: BUILDING PERMIT ITEM sa. FT. x $/SO. FT. VALUE Main Garage Carport ~ j/7~ /q,,/~ /~ S~ ~~ Total Val ue /22..1'D kJ3 /2-f,.(p3 , SYSTEMS DEVELOPMENT CHARGE (SDC) JJI./A ,- Building Permit Fee State Surcharge Total Fee (A) (B) PLUMBING PERMIT ITEM FEE Fixtures Residential Bath(s) N' Sanitary Sewer FT. Water FT. FT. Storm Sewer Mobile Home Plumbing Permit State Surcharge Total Charge (C) MECHANICAL PERMIT Furnace Exhaust Hood Vent Fan N' Wood Stove/Insert/Fireplace Unit Dryer Vent Mechanical Permit Issuance State Surcharge Total Permit (D) MISCELLANEOUS PERMITS' Mobile Home State Issuance State Surcharge Sidewalk ft Curbcut ft Demoll tI on State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) -/1.tj. ~3 (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 )he 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: 7.9 -t: 3 Date Paid: ....!/~-'? / Receipt Number: /1!~V'2 ReceK~- ~ p~ReV-iewed tly chl;L -f-&.~e 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 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 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. Slgnatu(/ ~ ::>>;1J:ttJ~A.lH7/ Date r: .,. ? - <9/ VALIDATION: 0 (') RECEIPT NUMB~_ I!c;r ,1 DATE PAID 0 Tcrr AMOUNT RECEI~~': I 1(0,:5. 3fj RECEIVED BY (.....-'.J1.;(x!)t/ ) ~ LY - .- \ r \~ ~ , . . Permit No: en ()~q I' Address: h~ \ ~ ~ '1)\\ 'NlJA to) . .Issued by: ~ \ ffiJ . Date: 6l-Bt-C1 I FOR OFFICE USE ONLY ,. STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . Note: Oregon Law, ORS 701,055(4), requires residential building permit applicants who are not registered with the. Construction Contractors Board to sign the following statement before the building permit can be issued. Licensed Architect and Engineer applicants, exempt from registration under ORS701.010(7), need not submit this statement. This statement will be 'filed with the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or 2B: 1, ~. I own; reside in~ or will reside in the completed structure, 2. A. c=::::J My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and 00 hire a general contractor, I will contract with a contractor who is registered With the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above Information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~ljt A' ----rh(!-Li..l~..4>>-9~ Signatifre of Permit Applicant ...). .f' . 9 I Date CONSTRUCTION CONTRACTORS BOARD 0244J 1/90 . P~(j . ~ COPY TO ISSUING AGENCY PERMIT FILE W . P COPY TO APPLICANT <e.