HomeMy WebLinkAboutPermit Plumbing 1991-10-14
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SPRINGFIELD
RESIDENTIAL
PERMIT APPLICATION
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JOB NUMBER
Inspections: 726.3769
Office: 726.3759
225 Fifth Street
Springfield, Oregon 97477
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LOCATION OF PROPOSED WORK:
ASSESSORS MAP'
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SUBDIVISION'
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OWNER:
ADDRES""
STATF'
ZIP:
CITY'
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DEMOLISH
DESCRIBE WORK'
ADDITION
OTHER
REMODEL
NEW
CON ST.
CONTRACTOR #
ADDRESS
EXPIRES
CONTRACTOR'S NAME
PHONE
GENERAL'
PLUMBING-
OlJ/V..I/'/
MECHANICAl'
ELECTRICAl'
- OFFICE USE -
OUAD AREA: LAND USE: FLOOD PLAIN:
# OF BLDGS: # OF UNITS' ZONING CODE:
OCCY GROUP: CONST~R. TYPE: # OF BDRMS'
" HEAT SOURCE:
# OF STORIES: SECONDARY HEAT'
WATER HEATER' RANGE: SQUARE FOOTAGE:
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.
REQUIRED INSPECTIONS
@Final Plumbing - When all
plumbing work Is complete.
D Rough Mechanical - Prior to
cover.
D Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
D Rough Electrical - Prior to
cover.
D Final Electrical - When all
electrical work is comple~e.
o Final Mechanical - When all
mechanical work is complete.
o
Underslab PlumbingJ Electricall
Mechanical - Prior to cover.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
o
Footing - After trenches are
excavated.
D Final Building - When all
required inspections have been
approved and building is
completed.
D Fireplace - Prior to facing
materials and framing Insp.
D
Masonry - Steel location, bond
beams, grouting.
o Framing - Prior to cover.
o Other
o
Foundation '- After forms are
erected but prior to concrete
placement.
D Wall/Ceiling Insulation - Prior to
cover.
o Underground Plumbing - Prior
to filling trench.
o Drywall - Prior to taping.
MOBILE HOME INSPECTIONS
o
Underfloor Plumbing/Mechanical
-:-: Prior to InsulatIon or decking.
D Wood Stove - After installation.
o Blocking and Set-Up - When all
blocking Is complete.
o
Post and Beam - PrIor to floor
Insulation or decking.
o Insert - After fireplace approval
and installation of unit.
D Plumbing Connections - When
home has been connected to
water and sewer.
o Floor Insulation - Prior to
decking.
~Sanitary Sewer - Prior to filling
liS] trench.
D Curbcut & Approach - After -
forms are erected but prior to
placement of concrete.
o Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
'the service panel.
D Sidewalk & Driveway - After
excavation is complete, forms
and sub-base material in place,
o Storm Sewer - Prior to filling
trench.
o Fence - When completed.
D Water Line - Prior to filling
trench.
D Final - After all required
inspectlons~are approved and
. porches, sklrting,-decks"and .-
venting haye been Installed. .
o Rough Plumbing - Prior to
cover.
D Street Trees ~ When all requfred
trees are planted.
Lot faces
Lot Type.
Interior
Lot sq. Itg.
Lot coverage
Corner
Topography
Total height
Panhandle
Cul-de-sac
BUILDING PERMIT
ITEM sa. FT. x $/SO. FT.
Main
Garage
Carport
Total Val ue
Building Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT. t:1o'
Water FT.
Storm Sewer FT.
Mobile Home
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Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(0)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
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. 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 permit issuance.
Setbacks
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APPROVED'
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:
Date Paid:
Receipt Number'
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ADDITIONAL COMMENTS
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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 alt 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 wilt remain
on the site at all tl es dUr~g construction.
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Signature ~,--....I"': J.I\./
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Date
VALIDATION:
RECEIPT NUMBER
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DATE PAID
AMOUNT RECEIVEP
RECEIVED BY
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Address:
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Date: . /I'-f;c, I
Permit No:
. Issued by:
. FOR OFFICE USE ONLY
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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 ORS 701.010(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:
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1. L2CJ
I own, reside in, or will reside in the completed structure,
.2. A. L...J My genera.1 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 co 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.
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'---Si~ure of Permi~ Applicant
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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--t-; WHITE COPY TO ISSUING AGENCY PERMIT FILE
LlJl,,,,,- F!lNK COPY TO APPLICANT
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